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Maximizing PotentialMaximizing Potential
““The Science of Recovery”The Science of Recovery”
March 25, 2011
Doug Stacey, MSc, BHScPTSport Physiotherapist - Diploma
““HigherHigher
FasterFaster
Stronger”Stronger”
COST??COST??
– Fatigue?Fatigue?
– Injury?Injury?
– Over-training?Over-training?
Training ResponseTraining Response
Arja L.T. et al, 2001
Training ResponseTraining Response
Arja L.T. et al, 2001
FatigueFatigue
““A failure to maintain the required or A failure to maintain the required or expected force and power output; expected force and power output; or a reduction in the capacity to or a reduction in the capacity to generate force and power.”generate force and power.”
Central/Peripheral - Central/Peripheral - Metabolic FatigueMetabolic Fatigue
Decreased Energy Supply/ProductionDecreased Energy Supply/Production– GlycogenGlycogen– ATP & PCrATP & PCr
Accumulation of MetabolitesAccumulation of Metabolites– Lactate and pH - H+, PiLactate and pH - H+, Pi– AmmoniaAmmonia– Electrolytes – KElectrolytes – K++, Na, Na+, +, CaCa++
– HeatHeat– Magnesium ions (MgMagnesium ions (Mg2+2+))– Adenosine diphosphate (ADP)Adenosine diphosphate (ADP)– Reactive Oxygen SpeciesReactive Oxygen Species
Peripheral versus Central FatiguePeripheral versus Central Fatigue
CentralCentral-Reduction in recruitment/ -Reduction in recruitment/
activation of neurotransmittersactivation of neurotransmitters-CNS-CNS-motor neuron-motor neuron-muscle fiber surface -muscle fiber surface membranemembrane
PeripheralPeripheral-Reduction in muscle contraction-Reduction in muscle contraction
-Ca-Ca++++ binding to binding to troponintroponin-crossbridges – -crossbridges – actin actin
and and myosinmyosin-SR Ca-SR Ca++++ pump pump
Central/Peripheral - Central/Peripheral - Metabolic FatigueMetabolic Fatigue
Hargreaves, (2005)
““Fatigue”Fatigue” - the Numbers…. - the Numbers….
>60% of long distance >60% of long distance runners during their runners during their career career Urhausen, (2002)Urhausen, (2002)
> 50% of professional > 50% of professional soccer players during a 5 soccer players during a 5 month season month season Urhausen, (2002)Urhausen, (2002)
Expected incidence of 7-Expected incidence of 7-20% of elite athletes at 20% of elite athletes at any one time any one time Hooper, (1995)Hooper, (1995)
““Recovery”Recovery”
High usage with athletesHigh usage with athletes
LITTLE scientific validationLITTLE scientific validation
RecoveryRecovery
1.1. Low-Moderate Low-Moderate Intensity ExerciseIntensity Exercise
2.2. StretchingStretching
3.3. Nutrition and Nutrition and HydrationHydration
4.4. Therapeutic Therapeutic ModalitiesModalities
5.5. RestRest
1.1. Low-Moderate Low-Moderate
Intensity ExerciseIntensity Exercise
Low-Moderate Intensity ExerciseLow-Moderate Intensity Exercise
10-20 minutes @ 40-10-20 minutes @ 40-60% VO2max, Sub 60% VO2max, Sub AeT, or AeTAeT, or AeT
~50% reduction in La after ~50% reduction in La after
only 10 minonly 10 min Belcastro and Bonen, Belcastro and Bonen,
(1975)(1975)
Glycolytic Systemglucose / glycogen
pyruvate
NAD
NADH
(mitochondria)
NADH
NAD
H+ + e-
O2
lactate
LDH
acetyl CoAPDH
Low-Moderate Intensity ExerciseLow-Moderate Intensity Exercise
What’s the problem with increased lactate?
“ Lactic Acid ” H+ + Lactate –
muscle pH
“Metabolic inhibition”
( enzyme activity)
“Contractile inhibition”
( X-bridge cycling )
Low-Moderate Intensity ExerciseLow-Moderate Intensity Exercise
Metabolic FatigueMetabolic FatigueAccumulation of Metabolites – AcidosisAccumulation of Metabolites – Acidosis
HH++ and Pi and Pi– Inhibit the rate of force developmentInhibit the rate of force development– Inhibit velocity or cross-bridge cycle ratesInhibit velocity or cross-bridge cycle rates
BUTBUT……– Force production still evident despite high levels of Force production still evident despite high levels of
HH++ and Pi and Pi– Full recovery of La within 1 hr regardless of Full recovery of La within 1 hr regardless of
intervention – still performance deficitsintervention – still performance deficits– Acidosis may have a protective effectAcidosis may have a protective effect
Low-Moderate Intensity ExerciseLow-Moderate Intensity Exercise
Active RecoveryActive Recovery
10-20 minutes @ 40-60% VO2max10-20 minutes @ 40-60% VO2maxIncreased blood flowIncreased blood flow
– Resynthesizes high-energy phosphatesResynthesizes high-energy phosphates– Replenishes oxygen in the blood and muscleReplenishes oxygen in the blood and muscle– Restores body fluid homeostasisRestores body fluid homeostasis– Limits the harmful effects of immunosuppression Limits the harmful effects of immunosuppression
Dupont et al., (2004)Dupont et al., (2004)
Wigernaes et al., (2001)Wigernaes et al., (2001)Wigernaes et al., (2000)Wigernaes et al., (2000)Bangsbo et al., (1996)Bangsbo et al., (1996)
Take home points…Take home points…
2. Stretching2. Stretching
StretchingStretching
Widespread acceptanceWidespread acceptanceImproves flexibilityImproves flexibility
Reduces injury riskReduces injury risk
Improves performanceImproves performance
“Flexibility is the extent to which a muscle can be lengthened by a given amount of
force”
Limited scientific evidenceLimited scientific evidence
StretchingStretching
TechniquesTechniquesActiveActive
Static – hold 15-60 sStatic – hold 15-60 sIsometric – exert against fixed resistanceIsometric – exert against fixed resistanceBallistic – rapid muscle lengthening – bouncingBallistic – rapid muscle lengthening – bouncing
PassivePassiveAssisted – externally applied pressure – 15-60 sAssisted – externally applied pressure – 15-60 sProprioceptive Neuromuscular facilitation (PNF) Proprioceptive Neuromuscular facilitation (PNF) – contract/relax - ~5s– contract/relax - ~5s
StretchingStretching
FlexibilityFlexibility
Roberts and Wilson (1999)Roberts and Wilson (1999)15-30 s better than <15s or >30s15-30 s better than <15s or >30s
Laroche and Connolly (2006)Laroche and Connolly (2006)30s of static as effective as 30s 30s of static as effective as 30s ballisticballistic
Shrier (2004)Shrier (2004)Single stretching session good for Single stretching session good for ~90min~90minRegular stretching (3-5d/week) good Regular stretching (3-5d/week) good for many weeksfor many weeks
StretchingStretching
Injury PreventionInjury Prevention
Pope et al. (1998, 2000)Pope et al. (1998, 2000)Male army recruitsMale army recruits1284 – stretching group – 1284 – stretching group – 181181 injuriesinjuries1346 – control group – 1346 – control group – 200200 injuriesinjuries
** ** aerobic fitness a stronger aerobic fitness a stronger predictor of injury riskpredictor of injury risk
Thacker et al. (2004)Thacker et al. (2004)Review of 361 articles (6 Review of 361 articles (6 qualified)qualified)NO convincing evidenceNO convincing evidence for for pre-exercise stretchingpre-exercise stretching
StretchingStretching
PerformancePerformance
Hayes and Walker (2007)Hayes and Walker (2007)Pre-exercise stretching has Pre-exercise stretching has NO NO impactimpact on running economy on running economy
Shrier (2004)Shrier (2004)NO benefitNO benefit of acute stretching on of acute stretching on isometric force production, isometric force production, isokinetic torque, or jumping heightisokinetic torque, or jumping heightRegular stretching improves Regular stretching improves strength, jump height and running strength, jump height and running speedspeed
Fowles et al. (2000) and Kokkonen Fowles et al. (2000) and Kokkonen et al. (1998)et al. (1998)
Strength reduced up to 1 hourStrength reduced up to 1 hour after after acute bout of stretchingacute bout of stretchingAlters visco-elastic behavior of Alters visco-elastic behavior of muscle and tendonmuscle and tendon
StretchingStretching
Take Home Points…Take Home Points…
Regular stretchingRegular stretching – post – post activity improves flexibility activity improves flexibility and performanceand performance
Pre-exercise stretching has Pre-exercise stretching has little effectlittle effect on Performance on Performance or Injury Preventionor Injury Prevention
3. Nutrition and Hydration3. Nutrition and Hydration
Nutrition and HydrationNutrition and Hydration
NutritionNutrition
HydrationHydration
Main Food Energy Sources in Exercise Metabolism
• glucose
• glycogen
• fatty acids
• triglycerides
• amino acids
95-100% of total energy production
Carbohydrates(CHO)
Lipids(Fats)
Protein
“fuel mix” depends on exercise intensity
NutritionNutrition
NutritionNutrition
Short Term RecoveryShort Term RecoveryRestore carbohydrate Restore carbohydrate storesstores
Long Term RecoveryLong Term RecoveryOptimize protein Optimize protein synthesissynthesis
StrategiesStrategies - - (sport, type of exercise, intensity, (sport, type of exercise, intensity, duration, time)duration, time)
Short TermShort Term - Glycogen Resynthesis - Glycogen Resynthesis
Begins immediately post-exerciseBegins immediately post-exerciseRapid during first 5-6 h of recoverRapid during first 5-6 h of recover
Goforth et al. (2003)Goforth et al. (2003)
1 - 1.5 g CHO/kg1 - 1.5 g CHO/kg body weight – every 2 hours body weight – every 2 hours until next mealuntil next meal
OR…OR…Greater recovery with Greater recovery with 1.2 g/kg/30min1.2 g/kg/30min over 5 hr over 5 hr period period
Especially with limited time between eventsEspecially with limited time between events
van Loon et al., (2000)van Loon et al., (2000)
NutritionNutrition
Short TermShort Term
Recovery of endurance running capacity 4 hr after the first run (70% VO2 for 90min) Fallowfield et al., (1995)
Time
NutritionNutrition
Long TermLong Term
Glycogen Resynthesis – Glycogen Resynthesis – Endurance PerformanceEndurance Performance
Recovery of endurance running capacity 22 hr after the first run (70% VO2 for 90min) Fallowfield et al., (1993)
Time
Glycogen Resynthesis – Glycogen Resynthesis – High-Intensity Performance High-Intensity Performance
Recovery of intermittent high-intensity performance (15-min shuttle run) 22 hr after the first bout. Nicholas et al., (1997)
# shuttle runs/15 min
NutritionNutrition
Long-Term - ProteinLong-Term - Protein
Daily RequirementsDaily Requirements
Dietary Reference Intake (DRI) – 0.8 g protein/kg/dDietary Reference Intake (DRI) – 0.8 g protein/kg/d - persons - persons >18yrs of age – irrespective of activity status>18yrs of age – irrespective of activity statusEndurance athletes-Endurance athletes- recovery with recovery with 1.2 -1.4 g/kg/d1.2 -1.4 g/kg/dResistance athletesResistance athletes – recovery with – recovery with 1.6 – 1.7 g/kg/d1.6 – 1.7 g/kg/d
(ACSM, ADA, DC)(ACSM, ADA, DC)
Protein ResynthesisProtein Resynthesis
Begins immediately post-exercise – last up to 24 hrsBegins immediately post-exercise – last up to 24 hrsRapid during first 5-6 h of recover with as little as 6g protein/hr until Rapid during first 5-6 h of recover with as little as 6g protein/hr until next mealnext mealNo further effect on performance or glycogen resynthesis No further effect on performance or glycogen resynthesis
Philips, (2004)Philips, (2004)
NutritionNutrition
Protein ResynthesisProtein Resynthesis
Net protein balance (synthesis minus breakdown) under the same condi-tions. AA, amino acid; RE, resistance exercise. Phillips, (2004)
NutritionNutrition
Protein and CHOProtein and CHO
Post-Exercise – a high-carbohydrate diet Post-Exercise – a high-carbohydrate diet ((10g/kg/d10g/kg/d) is essential for glycogen resynthesis) is essential for glycogen resynthesisShort-term – Greater recovery with Short-term – Greater recovery with 1.2 1.2 g/kg/30ming/kg/30min over 5 hr period over 5 hr periodBetter glycogen recovery = better performance Better glycogen recovery = better performance in both ST and LT activitiesin both ST and LT activities
NutritionNutrition
Take home points…Take home points…
Protein is essential for muscle anabolism post Protein is essential for muscle anabolism post exercise – as little as exercise – as little as 6g6g will boost synthesis will boost synthesisProtein with CHO in recovery phase effective for Protein with CHO in recovery phase effective for glycogen re-synthesisglycogen re-synthesis
RecoveryRecoveryKarp et al., Karp et al., Chocolate milk as a post-exercise recovery aid. Int. J. Sport Nutr. Exerc.Int. J. Sport Nutr. Exerc. Metabol.,16:78-91. 2006. Metabol.,16:78-91. 2006.
The results of this study suggest that chocolate milk is an effective recovery aid between two exhausting exercise bouts.
NutritionNutrition
HydrationHydration
DehydrationDehydrationImpaired heat Impaired heat dissipationdissipation
Increased core Increased core temperaturetemperature
Increased Increased cardiovascular straincardiovascular strain
Impaired motor functionImpaired motor function
HydrationHydration
Exercise corresponding to an average intensity of 75% VO2max – 90 min soccer game
Players may lose sweat up to 2 liters/hour
Increases with -heat, humidity, altitude
330C, 40% humidity = fluid loss of 3.1 % body mass
>1% body mass will impair performance
Reilly and Ekblom, (2005)
Hydration Recommendations: Hydration Recommendations: Institute of Medicine (IOM) – 2004Institute of Medicine (IOM) – 2004
HydrationHydration
SedentarySedentaryMales – Males – 3.7 L/day3.7 L/day (16 cups of fluid) (16 cups of fluid)
Females – Females – 2.7 L/day2.7 L/day (12 cups of fluid) (12 cups of fluid)
Active/AthletesActive/AthletesMales/Females – Males/Females – 5-10 L/day5-10 L/day
Based on training conditionsBased on training conditions
Kenny, (2006)
Hydration Recommendations: Hydration Recommendations: Institute of Medicine (IOM) – 2004Institute of Medicine (IOM) – 2004
HydrationHydration
SodiumSodiumRDA – RDA – 3.8 g/day3.8 g/day (upper level 5.8 g/day for athletes) (upper level 5.8 g/day for athletes)
Average American consumes 8-12 g table salt/dayAverage American consumes 8-12 g table salt/day
PotassiumPotassiumRDA - RDA - 4.7 g/day4.7 g/day
Sweat concentration rarely exceeds 10 mmol/LSweat concentration rarely exceeds 10 mmol/L
Kenny, (2006)
How to Rehydrate?How to Rehydrate?After the game/practice, drink After the game/practice, drink
2 cups of fluid for every 2 cups of fluid for every pound body weight lostpound body weight lost
Replace fluids lost due to Replace fluids lost due to sweating by drinking:sweating by drinking:
water, juices, sport drinkswater, juices, sport drinks
Or eating:Or eating:watery foods such as watery foods such as
soups, fruits, vegetablessoups, fruits, vegetables
HydrationHydration
Take home points…Take home points…
HydrationHydration
SedentarySedentary
Daily Daily AllowanceAllowance
SedentarySedentary
Upper LimitUpper Limit
Active/AthleteActive/Athlete
Daily Daily AllowanceAllowance
Active/AthleteActive/Athlete
Upper LimitUpper Limit
WaterWater
3.7 L/day3.7 L/day
(male)(male)
2.7 L/day2.7 L/day
(female)(female)
NoneNone
3.7 L/day3.7 L/day
(male)(male)
2.7 L/day2.7 L/day
(female)(female)
NoneNone
SodiumSodium 1.5 g/day1.5 g/day
(3.8 g/day salt)(3.8 g/day salt)
2.3 g/day2.3 g/day
(5.8 g/day salt)(5.8 g/day salt)
>1.5 g/day>1.5 g/day
(>10 g/day salt)(>10 g/day salt)
NoneNone
PotassiumPotassium 4.7 g/day4.7 g/day NoneNone 4.7 g/day4.7 g/day NoneNone
IOM Guidelines, (2004)
4. Therapeutic modalities4. Therapeutic modalities
Therapeutic modalitiesTherapeutic modalities
A.A. HydrotherapyHydrotherapy
B.B. MassageMassage
A. HydrotherapyA. Hydrotherapy
CryotherapyCryotherapy
Contrast therapyContrast therapy
Thermo-therapyThermo-therapy
CryotherapyCryotherapy
Immersion in water that lowers the core body Immersion in water that lowers the core body temperaturetemperatureWater with a temperature <15Water with a temperature <1500 C for a duration of ~15-20 C for a duration of ~15-20 minmin
Decreased heart rate and cardiac outputDecreased heart rate and cardiac outputIncreased Oxygen consumption and metabolismIncreased Oxygen consumption and metabolismLocalized vasoconstriction Localized vasoconstriction reduced cellular, lymphatic and reduced cellular, lymphatic and capillary permeabilitycapillary permeabilityReduced inflammationReduced inflammationReduced pain and swelling Reduced pain and swelling
Wilcock et al., (2006)
HydrotherapyHydrotherapy
REST, LIGHT EXERCISE OR CRYOTHERAPY: REST, LIGHT EXERCISE OR CRYOTHERAPY: WHAT IS THE MOST EFFECTIVE WAY TO WHAT IS THE MOST EFFECTIVE WAY TO
RECOVER BETWEEN REPEATED BOUTS OF RECOVER BETWEEN REPEATED BOUTS OF INTENSE EXERCISE?INTENSE EXERCISE?
Doug StaceyDoug Stacey, BHScPT, BHScPT
Sport Physiotherapist – DiplomaSport Physiotherapist – Diploma
B.W. TimmonsB.W. Timmons†††† and M.J. Gibala and M.J. Gibala††. . ††Exercise Metabolism Research Group, Dept. of Exercise Metabolism Research Group, Dept. of Kinesiology, Kinesiology, ††††Children’s Exercise and Nutrition Children’s Exercise and Nutrition Center, McMaster University, Hamilton, ON Center, McMaster University, Hamilton, ON
HydrotherapyHydrotherapy
MethodsMethods
Pre Week 1 Week 2 Week 3
Testing &Familiarization
Training – 3 boutsRandom intervention
Training – 3 boutsRandom intervention
Training – 3 boutsRandom intervention
Recovery Intervention – 20 min
Rest, Active, Cryo
Familiarization
VO2peak
Bout1 50KJ
Bout 3 50KJ
Bout 2 50KJ
Rest
Blood Sample and Questionnaires
Lactate, IL-6, CBC – RPE, VAS, Preparedness
lactate lactate
HydrotherapyHydrotherapy
50 kJ Time Trial Performance
0
50
100
150
1 2 3
Bouts
Tim
e (s
ec) Cold tub
Active
Passive
* p .≤ .05 vs bout 1 (main effect).≤ .05 vs bout 1 (main effect)
* *
HydrotherapyHydrotherapy
Blood Lactate
0.00
1.00
2.00
3.00
4.00
5.00
Time
Blo
od L
acta
te m
mol
/L
Cold tub
Active
Passive
Rest Post 1hrBout 2Bout 1 Bout 3
**
* p .≤ .05 vs Rest(main effect); ** .≤ .05 vs Rest(main effect); ** p .≤ .05 vs Passive, Cold.≤ .05 vs Passive, Cold
* * *
HydrotherapyHydrotherapy
IL-6
0.00
2.00
4.00
6.00
Time
IL-6
(pg/
ml) Cold Tub
Active
Passive
Bout 2Rest Post 1hr
* p .≤ .05 vs Rest, Bout 2 (main effect).≤ .05 vs Rest, Bout 2 (main effect)
*
HydrotherapyHydrotherapy
Lymphocytes
0.00
2.00
4.00
6.00
Time
lym
phoc
yte
cells
10
9/L
Cold Tub
Active
Passive
Post 1hrRest Bout 2
* p .≤ .05 vs Rest (main effect); **.≤ .05 vs Rest (main effect); **p .≤ .05 vs Active, Passive.≤ .05 vs Active, Passive
**
*
*
HydrotherapyHydrotherapy
ConclusionsConclusions
The type of recovery intervention did not affect The type of recovery intervention did not affect the decline in exercise performance during the decline in exercise performance during repeated bouts of intense cycling,repeated bouts of intense cycling,
Blood lactate was slightly reduced after ACTIVE,Blood lactate was slightly reduced after ACTIVE,
CRYO caused greater perturbations in blood CRYO caused greater perturbations in blood immune markers and created the perception that immune markers and created the perception that subjects were better prepared for subsequent subjects were better prepared for subsequent exercise. exercise.
HydrotherapyHydrotherapy
Cryotherapy ResearchCryotherapy Research
BenefitBenefit
PerformancePerformancePournot et al., (2010)Pournot et al., (2010)Vaile et al., (2008)Vaile et al., (2008)Vaile et al., (2007)Vaile et al., (2007)Lane KN., (2004)Lane KN., (2004)Fowles et al. (2003)Fowles et al. (2003)Verducci, (2000, 1997)Verducci, (2000, 1997)
DOMSDOMSVaile et al., (2008)Vaile et al., (2008)Bailey et al., (2007)Bailey et al., (2007)
RPERPEMaw et al., (1993)Maw et al., (1993)Nelson et al., (1991)Nelson et al., (1991)
HydrotherapyHydrotherapy
Cryotherapy ResearchCryotherapy Research
NO BenefitNO Benefit
PerformancePerformanceCrowe et al., (2007)Crowe et al., (2007)
Yamane et al., (2006)Yamane et al., (2006)
Schniepp et al., (2002)Schniepp et al., (2002)
DOMSDOMSSellwood et al., (2007)Sellwood et al., (2007)
RPERPENo available dataNo available data
HydrotherapyHydrotherapy
HydrotherapyHydrotherapy
Cryotherapy SummaryCryotherapy Summary
Performance benefits are questionablePerformance benefits are questionable
Seems effective in reducing pain Seems effective in reducing pain associated with DOMSassociated with DOMS
Effective at reducing RPEEffective at reducing RPE
Alternating temperature immersion, from a hot to Alternating temperature immersion, from a hot to cold bath and vice-versacold bath and vice-versaProtocols vary – 30-300 sec of one extreme Protocols vary – 30-300 sec of one extreme temperature, immediately followed by 30-300 sec temperature, immediately followed by 30-300 sec of the contrasting temperature – for 4-30 minof the contrasting temperature – for 4-30 min
Stimulates specific area blood flowStimulates specific area blood flowIncreases blood lactate removalIncreases blood lactate removalReduces inflammation and edemaReduces inflammation and edemaStimulates general circulationStimulates general circulationRelieves stiffness and painRelieves stiffness and painIncreases ROMIncreases ROMReduces DOMSReduces DOMS
Wilcock et al., (2006)
Contrast therapyContrast therapy
HydrotherapyHydrotherapy
Contrast therapyContrast therapy
– ““Vascular Exercise”Vascular Exercise”
Vaso-dilationVaso-dilation
Vaso-constrictionVaso-constriction
HydrotherapyHydrotherapy
Testing the Water: Are the Effects of Testing the Water: Are the Effects of Hydrotherapy More Psychological Than Hydrotherapy More Psychological Than
Physiological?Physiological?
Doug StaceyDoug Stacey, , Sport PT – dip. Sport PT – dip.
K.K. Martin-GinisMartin-Ginis22, M. Poling, M. Poling11, and M.J. Gibala, and M.J. Gibala11. 1. Exercise Metabolism . 1. Exercise Metabolism
Research Group and 2. Health Psychology Laboratory, Dept. of Kinesiology, Research Group and 2. Health Psychology Laboratory, Dept. of Kinesiology, McMaster Univ., Hamilton, ON. McMaster Univ., Hamilton, ON.
HydrotherapyHydrotherapy
Methods:
Pre Training Training Post Training
Familiarization trials
VO2max
Wingate
Challenge ride
VO2max
Wingate
Challenge ride
5 5 64 4
Numbers represent the # of Wingate tests / training session
Hydrotherapy N=6 Vs. Control N=6
HydrotherapyHydrotherapy
TreatmentTreatment
ControlControl – 20 min rest20 min rest
HydrotherapyHydrotherapy– Contrast bath – 20 minContrast bath – 20 min– 2 min cold (102 min cold (1000C)C)– 3 min hot (403 min hot (4000C)C)
HydrotherapyHydrotherapy
Results – AnaerobicResults – Anaerobic Power Power (sig.≤ .05)(sig.≤ .05)
prepost
Control
Treatment
0
200
400
600
800
1000
1200
1400
Wat
ts
Wingate Peak Power
Control 1219.833333 1343.166667
Treatment 1214.833333 1309.5
pre post
Results – PerformanceResults – Performance ( sig. ≤ .05) ( sig. ≤ .05)
prepost
Control
Treatment
0
200
400
600
800
1000
1200
Sec
250KJ Time Trial
Control 1130 1088
Treatment 1002 945
pre post
HydrotherapyHydrotherapy
ConclusionsConclusions
– 5 days of HIT increased peak anaerobic power and 5 days of HIT increased peak anaerobic power and performance during a time trialperformance during a time trial
– The use of Hydrotherapy did not further enhance The use of Hydrotherapy did not further enhance physiological performancephysiological performance
– Hydrotherapy created the perception that subjects Hydrotherapy created the perception that subjects were better prepared for exercisewere better prepared for exercise
HydrotherapyHydrotherapy
Contrast Therapy ResearchContrast Therapy Research
PerformancePerformance
BenefitBenefitPournot et al., (2010)Pournot et al., (2010)
No BenefitNo BenefitVaile et al., (2008)Vaile et al., (2008)Vaile et al., (2007)Vaile et al., (2007)Gill et al., (2006)Gill et al., (2006)Coffey et al., (2004)Coffey et al., (2004)
HydrotherapyHydrotherapy
Contrast therapyContrast therapy
Vascular Exercise?Vascular Exercise?
For physiological For physiological effects to occur, must effects to occur, must produce fluctuations in produce fluctuations in muscle temperaturemuscle temperature
Myrer et al. Myrer et al. 19941994
HydrotherapyHydrotherapy
Contrast Therapy SummaryContrast Therapy Summary
HydrotherapyHydrotherapy
No performance benefitsNo performance benefits
Perception of recovery greater in Contrast Perception of recovery greater in Contrast groupsgroups
ThermotherapyThermotherapy
Immersion in water that raises the core body Immersion in water that raises the core body temperaturetemperatureWater with a temperature >36Water with a temperature >3600 for a duration of for a duration of ~10-20 min~10-20 min
Increased cutaneous and subcutaneous tissue temperatureIncreased cutaneous and subcutaneous tissue temperaturePeripheral vasodilationPeripheral vasodilation inc. cutaneous blood flow inc. cutaneous blood flowIncreased heart rateIncreased heart rateIncreased permeability of cellular, lymphatic and capillary Increased permeability of cellular, lymphatic and capillary vesselsvesselsIncreased nutrient delivery and waste removalIncreased nutrient delivery and waste removalIncreased muscle elasticity, joint extensibilityIncreased muscle elasticity, joint extensibilityReduced pain and muscle spasm Reduced pain and muscle spasm
Wilcock et al., (2006)
HydrotherapyHydrotherapy
Thermotherapy ResearchThermotherapy Research
PerformancePerformance
BenefitBenefitNo available dataNo available data
No BenefitNo BenefitVaile et al., (2007)Vaile et al., (2007)
Vaile et al., (2008)Vaile et al., (2008)
HydrotherapyHydrotherapy
Hydrotherapy Benefits????Hydrotherapy Benefits????
Hydrostatic PressureHydrostatic PressureInward and upward Inward and upward displacement of body fluidsdisplacement of body fluids
Reduces edemaReduces edema
Increases extracellular fluid transfer into the vascular systemIncreases extracellular fluid transfer into the vascular system
Increases cardiac output (Increases cardiac output (greater blood flowgreater blood flow))
BuoyancyBuoyancyDecreases Decreases perception of fatigueperception of fatigue
Aides in Aides in energy conservationenergy conservation
Wilcock et al., (2006) Wilcock et al., (2006)
HydrotherapyHydrotherapy
Take Home Points….Take Home Points….
Most limited benefits associated only with Most limited benefits associated only with cryotherapy – DOMS, Performancecryotherapy – DOMS, Performance
HydrotherapyHydrotherapy
No recovery benefits associated with No recovery benefits associated with thermotherapy (limited research)thermotherapy (limited research)
Cryo and Contrast improve RPE Cryo and Contrast improve RPE associated with exerciseassociated with exercise
B. MassageB. Massage
Chinese writing - 2500 B.C.Chinese writing - 2500 B.C.Describes the use of massage for a Describes the use of massage for a variety of medical purposesvariety of medical purposes
Sports MassageSports MassageBenefits – post-exercise:Benefits – post-exercise:
Increases circulation and nutrition to Increases circulation and nutrition to recovering tissuesrecovering tissuesIncreases removal of blood LaIncreases removal of blood LaDecreases pain and swelling (including Decreases pain and swelling (including DOMS)DOMS)Improves subsequent performanceImproves subsequent performanceReduces excessive muscle toneReduces excessive muscle toneIncreases muscle flexibilityIncreases muscle flexibilityDeactivates symptomatic trigger pointsDeactivates symptomatic trigger pointsEnhances tissue healingEnhances tissue healing
Weerapong et al.,(2005)Weerapong et al.,(2005)
MassageMassage
Sport MassageSport Massage
““Defined as a collection of Defined as a collection of massage techniques performed massage techniques performed on athletes or active individuals on athletes or active individuals for the purpose of aiding for the purpose of aiding recovery or treating pathology.”recovery or treating pathology.”
Bandy et al., (2008)Bandy et al., (2008)
Includes:Includes:EffleurageEffleuragePetrissagePetrissageDeep transverse friction massageDeep transverse friction massage
Massage - ResearchMassage - Research
Blood FlowBlood Flow
BenefitBenefitNo available dataNo available data
No BenefitNo BenefitWiltshire et al., (2010)Wiltshire et al., (2010)
Hinds et al., (2004)Hinds et al., (2004)
Tiidus and Shoemaker, (1995)Tiidus and Shoemaker, (1995)
Doppler US studies – no increase in Doppler US studies – no increase in muscle blood flow during or post muscle blood flow during or post sport massagesport massage
Massage - ResearchMassage - Research
Lactate ClearanceLactate Clearance
BenefitBenefitNo available dataNo available data
No BenefitNo BenefitWiltshire et al., (2010)Wiltshire et al., (2010)Ogai et al., (2008)Ogai et al., (2008)Robertson et al., (2004)Robertson et al., (2004)Monedero et al., (2000)Monedero et al., (2000)Martin et al., (1998)Martin et al., (1998)Gupta et al., (1996)Gupta et al., (1996)Dolgener et al., (1993)Dolgener et al., (1993)Bale et al., (1991)Bale et al., (1991)
Combination of massage techniques from Combination of massage techniques from 10-20 min post exercise10-20 min post exerciseMassage failed to reduce blood lactate Massage failed to reduce blood lactate levels significantly greater than passive restlevels significantly greater than passive rest
Massage - ResearchMassage - Research
D.O.M.S.D.O.M.S.
BenefitBenefitZainuddin et al., (2005)Zainuddin et al., (2005)Hilbert et al., (2003)Hilbert et al., (2003)Farr et al., (2002)Farr et al., (2002)Tiidus et al., (1995)Tiidus et al., (1995)Rodenburg et al., (1994)Rodenburg et al., (1994)Smith et al., (1994)Smith et al., (1994)
No BenefitNo BenefitHart et al., (2005)Hart et al., (2005)Hasson et al., (1992)Hasson et al., (1992)Wenos et al., (1990)Wenos et al., (1990)
NO significant improvement in strength NO significant improvement in strength force or torque for any studiesforce or torque for any studies
Massage - ResearchMassage - Research
Performance (post muscle fatigue)Performance (post muscle fatigue)
BenefitBenefitOgai et al., (2008)Ogai et al., (2008)Monedero et al., (2000)Monedero et al., (2000)Rinder et al., (1995)Rinder et al., (1995)Ask et al., (1987)Ask et al., (1987)
No BenefitNo BenefitFletcher, IM. (2010)Fletcher, IM. (2010)Zainuddin et al., (2005)Zainuddin et al., (2005)Young et al., (2005)Young et al., (2005)Robertson et al., (2004)Robertson et al., (2004)Hemming et al., (2000)Hemming et al., (2000)Newman et al., (1996)Newman et al., (1996)Tiidus and Shoemaker, (1995)Tiidus and Shoemaker, (1995)Carafelli et al., (1990)Carafelli et al., (1990)
Variable methodology and massage Variable methodology and massage techniques – questionable conclusionstechniques – questionable conclusionsBenefits more with low intensity activity than Benefits more with low intensity activity than maximal effortsmaximal effortsInconclusive as to true benefit for recovery Inconclusive as to true benefit for recovery from muscle fatiguefrom muscle fatigue
Massage - ResearchMassage - Research
PsychologicalPsychological
BenefitBenefitOgai et al., (2008)Ogai et al., (2008)Hemming et al., (2000)Hemming et al., (2000)Tyurin, (1986)Tyurin, (1986)
No BenefitNo BenefitDrews et al., (1990)Drews et al., (1990)
Most benefits to mood states are found Most benefits to mood states are found in studies with non-athletic populationsin studies with non-athletic populationsIn athletic populations all benefits are In athletic populations all benefits are associated with ratings of perceived associated with ratings of perceived exertion (RPE) exertion (RPE)
Massage - ResearchMassage - Research
Take Home Points….Take Home Points….
NO effect on blood flowNO effect on blood flow or blood La or blood La removalremoval
Variable Variable improvements in painimprovements in pain related to DOMS, although NO related to DOMS, although NO significant improvement in strength significant improvement in strength force or torqueforce or torque
Improvements in recovery of Improvements in recovery of muscle fatigue are more associated muscle fatigue are more associated with with low intensitylow intensity versus high versus high intensity exerciseintensity exercise
Increased ratings of perceived Increased ratings of perceived exertion and exertion and perception of recoveryperception of recovery
5. Rest5. Rest
RestRest
Research in Aviation, Research in Aviation, Transportation and MilitaryTransportation and Military
SleepSleepActive physiological stateActive physiological state
Critical metabolic, Critical metabolic, immunological and immunological and cognitive/memory processes cognitive/memory processes occuroccur
Samuels, (2008)
Sleep Deprivation studiesSleep Deprivation studies
Negative effect on:Negative effect on:–Glucose metabolismGlucose metabolism Spriegel, (1999)Spriegel, (1999)
–Neuroendocrine and immune functionNeuroendocrine and immune function Basta, ( 2007)Basta, ( 2007)
–AppetiteAppetite Spriegel, (1999)Spriegel, (1999)
–Fat depositionFat deposition Spriegel, (1999)Spriegel, (1999)
–Neural plasticityNeural plasticity VanDongen, (2004)VanDongen, (2004)
–Cognitive performanceCognitive performance VanDongen, (2004)VanDongen, (2004)
RestRest
Take home points….Take home points….
RestRest
Sleep time – Sleep time – 7-10 hrs7-10 hrsCausal relationship exists between sleep, memory Causal relationship exists between sleep, memory and performance and performance Walker and Stickgold, (2005)Walker and Stickgold, (2005)
Sleep quality – Sleep quality – undisturbed or restorativeundisturbed or restorativeArousal and awakening during sleep are associated Arousal and awakening during sleep are associated with a sympathoadrenal response that negatively with a sympathoadrenal response that negatively affects sleep quality affects sleep quality impair performance impair performance
Vgontzas, (2004)Vgontzas, (2004)
Sleep Timing – Sleep Timing – circadian phase (REM)circadian phase (REM)Circadian phase directly affects sleep length and Circadian phase directly affects sleep length and quality – timing important quality – timing important Samuels, (2008)Samuels, (2008)
Current interventions are still based largely on clinical experience and Current interventions are still based largely on clinical experience and evidence derived from research in other fields (removed from elite evidence derived from research in other fields (removed from elite athletes)athletes)
““It is ironic that despite the It is ironic that despite the wonders of modern wonders of modern medicine, medicine, RESTREST and and NUTRITIONNUTRITION may be the may be the most potent healing most potent healing agents.”agents.”
Smith, MSSE, 1999Smith, MSSE, 1999
““Art vs. Science”Art vs. Science”
Research IssuesResearch IssuesPoor study designPoor study design
RandomizationRandomizationControlsControls
Small Sample SizeSmall Sample SizeType 2 errorType 2 errorStatistical significanceStatistical significanceAppropriate subjects – Appropriate subjects – high level athleteshigh level athletes
Optimal Regime?Optimal Regime?Underlying Underlying Mechanisms?Mechanisms?Outcome measures?Outcome measures?Sport Specific?Sport Specific?
““Experience”Experience”
““Your mind is like Your mind is like a parachute… a parachute…
..it only works ..it only works when it is open”when it is open”
Thank - YouThank - You
Questions??Questions??
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