The prevention and treatment of exercise-induced muscle damage

Effect of milk-based carbohydrate-protein supplement timing on the attenuation of exercise-induced muscle damage

Exercise-induced muscle damage (EIMD) leads to decrements in muscle performance and increases in intramuscular enzymes measured in the plasma, and to delayed onset of muscle soreness (DOMS), partly due to the activation of degradative pathways. It has been shown that milk-based carbohydrate-protein (CHO-P) can limit changes in markers of EIMD, possibly by attenuating protein degradation and (or) increasing protein synthesis. However, the timing of supplementation has received limited attention, and this may alter the response. This study examined the effects of acute milk-based CHO-P supplementation timing on the attenuation of EIMD. Four independent matched groups of 8 healthy males consumed milk-based CHO-P before (PRE), immediately after (POST), or 24 h after (TWENTY-FOUR) muscle-damaging exercise. Active DOMS, isokinetic muscle performance, reactive strength index (RSI), and creatine kinase (CK) were assessed immediately before and 24, 48, and 72 h after EIMD. POST and TWENTY-FOUR demonstrated a benefit in limiting changes in active DOMS, peak torque, and RSI over 48 h, compared with PRE. PRE showed a possible benefit in reducing increases in CK over 48 h and limiting changes in other variables over 72 h. Consuming milk-based CHO-P after muscle-damaging exercise is more beneficial in attenuating decreases in muscle performance and increases in active DOMS at 48 h than ingestion prior to exercise.

Analgesics and anti-inflammatory medications in sports: use and abuse

Both acute and overuse musculoskeletal injuries are common in adolescent athletes. Pharmacologic agents including nonsteroidal anti-inflammatory drugs, acetaminophen, and topical over-the-counter agents have been shown to be effective in controlling pain, but data regarding their efficacy in expediting healing and time to recovery continue to be debated. Studies indicate that adolescents consume analgesic agents on their own and may be unaware of their potential toxicities. Data also indicate that adolescent athletes use medications in hopes of alleviating pain and allowing continuation of sports without adequate time for healing. This article reviews the mechanisms, toxicity, drug interactions, efficacy, and abuse potential of commonly used analgesic and anti-inflammatory drugs.

Efficacy of tart cherry juice in reducing muscle pain during running: a randomized controlled trial

Background

Long distance running causes acute muscle damage resulting in inflammation and decreased force production. Endurance athletes use NSAIDs during competition to prevent or reduce pain, which carries the risk of adverse effects. Tart cherries, rich in antioxidant and anti-inflammatory properties, may have a protective effect to reduce muscle damage and pain during strenuous exercise. This study aimed to assess the effects of tart cherry juice as compared to a placebo cherry drink on pain among runners in a long distance relay race.

Methods

The design was a randomized, double blind, placebo controlled trial. Fifty-four healthy runners (36 male, 18 female; 35.8 ± 9.6 yrs) ran an average of 26.3 ± 2.5 km over a 24 hour period. Participants ingested 355 mL bottles of tart cherry juice or placebo cherry drink twice daily for 7 days prior to the event and on the day of the race. Participants assessed level of pain on a standard 100 mm Visual Analog Scale (VAS) at baseline, before the race, and after the race.

Results

While both groups reported increased pain after the race, the cherry juice group reported a significantly smaller increase in pain (12 ± 18 mm) compared to the placebo group (37 ± 20 mm) (p < .001). Participants in the cherry juice group were more willing to use the drink in the future (p < 0.001) and reported higher satisfaction with the pain reduction they attributed to the drink (p < 0.001).

Conclusions

Ingesting tart cherry juice for 7 days prior to and during a strenuous running event can minimize post-run muscle pain.

Energy and macronutrient requirements for physical fitness in exercising subjects

Optimal nutritional intakes are critical for health- and skill-related physical fitness. This review details the effect of energy restriction and supplementation on physical fitness, discusses the optimal chronic macronutrient intakes for physical fitness in exercising subjects and finally overviews the impact of short-term intakes of carbohydrate and protein, before, during and after exercise, on physical fitness of athletes. The present standings highlight that it is essential that health care givers personalize nutritional advice to meet the specific needs of exercising individuals while applying the described recommendations. It reminds the difficulty of providing straight nutritional recommendations for physical fitness on the basis of evidence-based medicine.

The effects of theaflavin-enriched black tea extract on muscle soreness, oxidative stress, inflammation, and endocrine responses to acute anaerobic interval training: a randomized, double-blind, crossover study

Background

Muscle soreness and decreased performance often follow a bout of high-intensity exercise. By reducing these effects, an athlete can train more frequently and increase long-term performance. The purpose of this study is to examine whether a high-potency, black tea extract (BTE) alters the delayed onset muscle soreness (DOMS), oxidative stress, inflammation, and cortisol (CORT) responses to high-intensity anaerobic exercise.

Methods

College-age males (N = 18) with 1+ yrs of weight training experience completed a double-blind, placebo-controlled, crossover study. Subjects consumed the BTE (1,760 mg BTE·d^-1) or placebo (PLA) for 9 days. Each subject completed two testing sessions (T1 & T2), which occurred on day 7 of the intervention. T1 & T2 consisted of a 30 s Wingate Test plus eight 10 s intervals. Blood samples were obtained before, 0, 30 & 60 min following the interval sessions and were used to analyze the total to oxidized glutathione ratio (GSH:GSSG), 8-isoprostane (8-iso), CORT, and interleukin 6 (IL-6) secretion. DOMS was recorded at 24 & 48 h post-test using a visual analog scale while BTE or PLA continued to be administered. Significance was set at P < 0.05.

Results

Compared to PLA, BTE produced significantly higher average peak power (P = 0.013) and higher average mean power (P = 0.067) across nine WAnT intervals. BTE produced significantly lower DOMS compared to PLA at 24 h post test (P < 0.001) and 48 h post test (P < 0.001). Compared to PLA, BTE had a slightly higher GSH:GSSG ratio at baseline which became significantly higher at 30 and 60 min post test (P < 0.002). AUC analysis revealed BTE to elicit significantly lower GSSG secretion (P = 0.009), significantly higher GSH:GSSG ratio (P = 0.001), and lower CORT secretion (P = 0.078) than PLA. AUC analysis did not reveal a significant difference in total IL-6 response (P = 0.145) between conditions.

Conclusions

Consumption of theaflavin-enriched black tea extract led to improved recovery and a reduction in oxidative stress and DOMS responses to acute anaerobic intervals. An improved rate of recovery can benefit all individuals engaging in high intensity, anaerobic exercise as it facilitates increased frequency of exercise.

Efeito da massagem clássica na percepção subjetiva de dor, edema, amplitude articular e força máxima após dor muscular tardia induzida pelo exercício

O treino de força com cargas elevadas tem induzido indivíduos a apresentarem sintomas de dano muscular que incluem a dor muscular tardia. Na tentativa de diminuir sintomas e desconforto da DOMS, estratégias têm sido utilizadas, entre elas, a massagem. O objetivo do presente estudo foi verificar os efeitos da massagem clássica na percepção subjetiva de dor (DOMS), circunferência do braço (CIR), amplitude de movimento (ADM) e força máxima (1RM) após protocolo para indução de DOMS. Para isso, 18 adultos jovens saudáveis do gênero masculino foram divididos em três grupos (G1 = massagem; G2 = protocolo; G3 = protocolo + massagem) equalizados pelo teste de uma força máxima de flexão de cotovelo no banco Scott. O protocolo de indução de DOMS consistiu de 30 ações excêntricas musculares supramáximas (seis séries de cinco repetições a 110% de 1RM). A massagem foi realizada no grupo G3 imediatamente após o protocolo durante seis minutos. As variáveis dependentes (DOMS, CIR, ADM) foram avaliadas 24, 48, 72 e 96 horas após o protocolo, enquanto a força máxima, apenas após 48 e 96 horas. Os resultados indicaram aumento na DOMS e diminuição na ADM e 1RM, similar aos de outros estudos que utilizaram protocolos semelhantes. No entanto, não houve diferenças entre os grupos G2 e G3 em nenhuma das variáveis analisadas. Pode-se concluir que com esse design experimental o protocolo utilizado foi eficaz para provocar as alterações nas variáveis analisadas e a massagem não causou nenhum benefício na recuperação das funções musculares nem na percepção subjetiva de dor.

Influence of acetaminophen on performance during time trial cycling

To establish whether acetaminophen improves performance of self-paced exercise through the reduction of perceived pain, 13 trained male cyclists performed a self-paced 10-mile (16.1 km) cycle time trial (TT) following the ingestion of either acetaminophen (ACT) or a placebo (PLA), administered in randomized double-blind design. TT were completed in a significantly faster time ( t12 = 2.55, P < 0.05) under the ACT condition (26 min 15 s ± 1 min 36 s vs. 26 min 45 s ± 2 min 2 s). Power output (PO) was higher during the middle section of the TT in the ACT condition, resulting in a higher mean PO ( P < 0.05) (265 ± 12 vs. 255 ± 15 W). Blood lactate concentration (B[La]) and heart rate (HR) were higher in the ACT condition (B[La] = 6.1 ± 2.9 mmol/l; HR = 87 ± 7%max) than in the PLA condition (B[La] = 5.1 ± 2.6 mmol/l; HR = 84 ± 9%max) ( P < 0.05). No significant difference in rating of perceived exertion (ACT = 15.5 ± 0.2; PLA = 15.7 ± 0.2) or perceived pain (ACT = 5.6 ± 0.2; PLA = 5.5 ± 0.2) ( P > 0.05) was observed. Using acetaminophen, participants cycled at a higher mean PO, with an increased HR and B[La], but without changes in perceived pain or exertion. Consequently, completion time was significantly faster. These findings support the notion that exercise is regulated by pain perception, and increased pain tolerance can improve exercise capacity.

Increased iNOS, MMP-2, and HSP-72 in skeletal muscle following high-intensity exercise training

Skeletal muscle adapts to exercise by an upregulation of cellular defenses, such as inducible nitric oxide synthase (iNOS) and matrix metalloproteinase type 2 (MMP-2) and heat shock protein type-72 (HSP-72). The aims of the study were to examine iNOS, MMP-2, and HSP-72 mRNA and protein expression after high-intensity exercise training and to examine whether the expression levels are fiber type dependent. Young Wistar rats were assigned to either 2 or 4 weeks of a high-intensity (32 m/min) running exercise for 40 minutes 5 day per week. A non-running group served as a control. Western blotting and reverse transcriptase-polymerase chain reaction of muscle mRNA and protein levels were assessed in the medial gastrocnemius, quadriceps, soleus, crural, and sternal head of diaphragm muscles. High-intensity exercise training for 4 weeks but not for 2 weeks resulted in a significant increase in both RNA and protein levels of iNOS, MMP-2, and HSP-72 in all muscles examined except the sternal head of diaphragm. High-intensity exercise training is required to promote the expression of iNOS, MMP-2, and HSP-72 in hind limb muscles regardless their muscle fiber type, whereas in the diaphragm the changes are fiber-type dependent.

Effect of local cold-pack application on systemic anabolic and inflammatory response to sprint-interval training: a prospective comparative trial

We evaluated the effect of cold ice-pack application following a brief sprint-interval training on the balance between anabolic mediators [growth hormone (GH), insulin-like growth factor-I (IGF-I), testosterone], catabolic markers (cortisol, IGFBP-1), and circulating pro [Interlukin-6 (IL-6) and IL-1β]- and anti-inflammatory cytokines [IL-1 receptor antagonist (IL-1ra)]. Twelve males, elite junior handball players performed 4 × 250 m treadmill run, at 80% of each individual’s maximal speed, followed by a rest period with and without local cold-pack application. Pre, immediately post, and 60-min post-exercise blood samples were drawn. Exercise was associated with a significant increase in IL-6, GH, IGFBP-3, and testosterone levels. Local cold-pack application was associated with significant decreases in IL-1β, IL-1ra, IGF-I, and IGFBP-3 and a greater increase of IGFBP-1 during recovery. Local ice therapy immediately following sprint-interval training was associated with greater decreases in both pro- and anti-inflammatory cytokines and anabolic hormones supporting some clinical evidence for possible negative effects on athletic performance.

Systemic indices of skeletal muscle damage and recovery of muscle function after exercise: effect of combined carbohydrate–protein ingestion

Previous studies indicate that exercise-induced muscle damage may be attenuated when protein is included in a carbohydrate recovery supplement. This study was designed to examine systemic indices of muscle damage, inflammation, and recovery of muscle function, following strenuous exercise, with ingestion of either carbohydrate alone or a carbohydrate–protein mixture. Seventeen highly trained volunteers participated in 2 trials in a randomized order, separated by approximately 9 weeks. Each trial involved 90 min of intermittent shuttle-running, either with ingestion of a 9% sucrose solution during and for 4 h after (1.2 g·kg–1 body mass·h–1) or with the same solution plus 3% whey protein isolate (0.4 g·kg–1 body mass·h–1). Blood was sampled throughout and 24 h after each trial to determinate the systemic indices of muscle damage and inflammation. An isokinetic dynamometer was used to establish reliable baseline measurements of peak isometric torque for knee and hip flexors and extensors, which were then followed-up at 4-, 24-, 48-, and 168-h postexercise. The exercise protocol resulted in significantly elevated variables indicative of muscle damage and inflammation, while peak isometric torque was immediately reduced by 10%–20% relative to baseline, across all muscle groups tested. However, none of these responses varied in magnitude or time-course between the treatments, or between participants’ first and second trials. The addition of whey protein isolate to a dietary carbohydrate supplement ingested during and for 4 h following strenuous exercise did not attenuate systemic indices of muscle damage or inflammation, nor did it restore muscle function more rapidly than when the carbohydrate fraction was ingested alone.

The influence of cold water immersions on adaptation following a single bout of damaging exercise

The aim of this investigation was to elucidate the effects of cold water immersions (CWIs) following damaging exercise on the repeated bout effect (RBE). Sixteen males performed two bouts of drop jump exercise separated by 14-21 days. Participants were equally, but randomly assigned to either a CWI (12-min CWI at 15 degrees C) or control group (12-min seated rest). Treatments were given immediately after the first exercise bout, 24, 48 and 72 h post-exercise. No interventions were given following the second bout. Maximum voluntary contraction (MIVC), soreness (DOMS), creatine kinase (CK), thigh girth and range of motion (ROM) were recorded before and for 96 h following the initial and repeated bouts of damaging exercise. All variables, except ROM, showed a significant time effect (P < 0.01) indicating the presence of muscle damage following the initial bout; there were no differences between the CWI and control groups after the initial bout. Following the repeated bout of exercise there was a significant attenuation in the reduction of MIVC (P = 0.002) and a reduction in DOMS (P < 0.001), which is indicative of the RBE. There were no significant differences between groups following the repeated bout of damaging exercise. These data show that CWI had no effect following damaging exercise and did not inhibit the RBE. Despite CWI being used routinely, its efficacy remains unclear and there is a need to elucidate the benefits of this intervention on recovery and adaptation to provide practitioners with evidence based practice.