Métodos de recuperação pós-exercício: uma revisão sistemática

L-Arginine Supplementation Did Not Impact the Rapid Recovery of Cardiovascular and Autonomic Function Following Exercise in Physically Active Healthy Males: A Triple-Blind Randomised Placebo-Controlled Crossover Trial

BACKGROUND AND AIMS

Post-exercise recovery strategies include massage, low-intensity active exercise, thermal contrast, hydration, and nutritional and herbal approaches. These strategies aim to accelerate recovery, enhance performance, and optimise the physical training process. L-arginine (L-ARG) is the physiological precursor of nitric oxide (NO), a crucial mediator of vasodilation and the inhibition of platelet aggregation. A previous study reported that L-ARG supplementation could significantly reduce the systolic blood pressure (SBP) and diastolic blood pressure (DBP). This study aimed to investigate the effects of L-ARG on autonomic and cardiovascular recovery immediately following submaximal exercise.

METHODS AND RESULTS

Thirty-two healthy individuals were subjected to two experimental protocols. The first protocol included 60 min of rest, a treadmill warm-up, and load increments until reaching 80% of their maximum HR. Before this protocol, the subjects consumed 3 g of starch (placebo protocol). The second protocol was identical, but the subjects consumed 3 g of L-ARG. Heart rate recovery (HRR), heart rate variability (HRV), and blood pressure (BP) responses were assessed. No significant differences in HRR were found (p = 0.944) regarding the root mean square of successive differences in the RR interval (RMSSD30) of HRV (p = 0.562) or in the BP responses (mean arterial pressure (MAP), p = 0.687; pulse pressure (PP), p = 0.929) between the protocols.

CONCLUSIONS

L-ARG supplementation did not significantly alter immediate post-exercise autonomic recovery in healthy males.

What Parameters Influence the Effect of Cold-Water Immersion on Muscle Soreness? An Updated Systematic Review and Meta-Analysis

OBJECTIVE

Our objective was to determine the efficacy of cold-water immersion (CWI) on the management of muscle soreness to identify the impact of immersion time, water temperature, CWI protocol, and type of exercise on this outcome.

DESIGN

Intervention systematic review and meta-analysis.

SETTING

MEDLINE/PubMed, Embase, Central, and SPORTDiscus databases were searched from their earliest record to July 30, 2020. Only randomized controlled trials that assessed muscle soreness comparing CWI and control were included. Studies were pooled in different subgroups regarding the used protocol: water temperature (severe or moderate cold), immersion time (short, medium, or longer time), CWI protocol (intermittent or continuous application), and type of exercise (endurance or resistance exercise). Data were pooled in a meta-analysis and described as weighted mean difference (95% confidence interval, P < 0.05).

PARTICIPANTS

Athletes and nonathletes.

INTERVENTIONS

Cold-water immersion and control condition.

MAIN OUTCOME MEASURES

Muscle soreness.

RESULTS

Forty-four studies were included. For immediate effects, CWI was superior to control regardless of water temperature and protocol, and for short and medium immersion times and endurance exercises. For delayed effects, CWI was superior to control in all subgroups except longer immersions time.

CONCLUSIONS

This study suggests that CWI is better than control for the management of muscle soreness and water temperature and CWI protocol do not influence this result, but only short and medium immersions times presented positive effects. Aiming immediate effects, the best results suggest CWI application only after endurance exercises, while delayed effect CWI was superior both after endurance and resistance exercises.

Effectiveness of the contrast technique as recovery after effort according to professional athletes

Abstract Introduction: Alterations caused in the metabolism of those who practice physical exercise regularly generate health benefits, however, in athletes, these alterations can cause muscle damage, so post-recovery recovery methods are extremely important for their physiological maintenance. Objective: To analyze the effectiveness of the contrast therapy technique with post-exercise recovery according to professional athletes. Methods: A questionnaire was applied that addressed the technical scientific knowledge of professional athletes over 18 years of age, of both sexes, about post-exerciseffort recovery techniques (PERT), personal information, and ethical issues, on an online platform. Descriptive statistical analysis was performed, with values presented in percentages and an association through the Chi-Square test on the knowledge of PERT and other independent variables. Results: In total, 63 athletes, 15 women and 48 men, answered the online questionnaire, 71.4% were between 18 and 30 years old, including swimmers, footballers, and athletics practitioners, and 85.7% had more than three years' experience in the sport and 57.1% competed at an international level. Considering the main PERTs, 92.1% were aware, 58.7% knew more than four, 96.8% frequently used at least one PERT, and 65.1% had used it for more than three years. Knowledge of PERTs is associated with age (p = 0.001), education (p = 0.001), practice time (p = 0.001), hours of daily training (0.001), and competitive level (p = 0.03). With respect to the use of the contrast technique, 36.5% of the respondents had already used it, and 34.9% found it effective. Conclusion: The athletes who used the contrast technique reported a good perception of recovery.

Phototherapy on Management of Creatine Kinase Activity in General Versus Localized Exercise: A Systematic Review and Meta-Analysis

OBJECTIVE

The main focus of this systematic review was to determine the efficacy of phototherapy in the management of creatine kinase (CK) activity after exercise and furthermore to identify for which exercise model protocol phototherapy provides the best results.

DESIGN

Meta-analysis comparing phototherapy with a control condition.

SETTING

The MEDLINE, EMBASE, SPORTDiscus, PEDro, and CENTRAL databases were searched from their earliest records to October 03, 2016. Data were pooled in a meta-analysis and described as standardized mean difference (SMD) with 95% confidence intervals (CIs) using a random effects model.

PARTICIPANTS

Healthy subjects (no restrictions were applied, eg, age, sex, and exercise level).

INTERVENTION

Phototherapy (low-level laser therapy and/or light-emitting diode therapy) before or after exercise and a placebo or control condition.

MAIN OUTCOME MEASURES

Creatine kinase activity (no restriction to any analysis, eg, serum, plasma, or capillary blood).

RESULTS

Fourteen studies were included for review. The results revealed that phototherapy has a more positive effect than control condition in management of CK activity [SMD = 0.77, 95% CI (0.32 to 1.22); P = 0.0007; I = 72%]. In exploratory analysis, the results showed that phototherapy was effective only in the exercise protocol with localized exercise with large effect size [localized exercise: SMD = 0.89, 95% CI (0.26 to 1.51); P = 0.0002; I = 76%; general exercise: SMD = 0.61, 95% CI (-0.05 to 1.26); P = 0.07; I = 67%].

CONCLUSIONS

The available evidence suggest that phototherapy has beneficial effects on the management of CK activity and demonstrate a possible relationship based on damage caused by exercise, providing a greater effect in studies that used localized exercise.

Postpartum perineal pain: may the vaginal treatment with CO2 laser play a key-role in this challenging issue?

PURPOSE

Pregnancy and childbirth, despite being physiological events, represent a very delicate period in a woman's life, because they expose to important vulvo-perineal traumas. The pelvic pain that follows each delivery, whether spontaneous or surgical (caesarean section), does not end in the first days after birth but, depending on the studies, becomes persistent in a very variable percentage of cases. Therefore, in the present pilot study, we aimed, for the first time in literature, to assess the efficacy of CO₂ laser in women affected by perineal postpartum symptoms.

MATERIALS AND METHODS

Between February 2013 and June 2018, all women with late postpartum pelvic pain referred to the Department of Obstetrics and Gynecology of San Marino Hospital, were recruited and treated using the CO₂ laser for three applications every 4-6 weeks.

RESULTS

Between February 2013 and June 2018, according to the inclusion and exclusion criteria, 32 women with late postpartum pelvic pain were recruited in our protocol study. Mean age of patients was 34.1 years. At latest follow-up, our data demonstrated an improvement in symptoms (dyspareunia, pain at introitus, vaginal dryness, itching and vaginal burning) with a mean reduction of this symptom of 70% from baseline.

CONCLUSIONS

This study has shown the effectiveness of CO₂ laser treatment in postpartum perineal pain. Nevertheless, our results should be considered promising but preliminary. In fact, they need to be tested in larger cohort of patients to confirm its application in clinical practice and to evaluate the long-term duration of this treatment.

Can Water Temperature and Immersion Time Influence the Effect of Cold Water Immersion on Muscle Soreness? A Systematic Review and Meta-Analysis

Background

Cold water immersion (CWI) is a technique commonly used in post-exercise recovery. However, the procedures involved in the technique may vary, particularly in terms of water temperature and immersion time, and the most effective approach remains unclear.

Objectives

The objective of this systematic review was to determine the efficacy of CWI in muscle soreness management compared with passive recovery. We also aimed to identify which water temperature and immersion time provides the best results.

Methods

The MEDLINE, EMBASE, SPORTDiscus, PEDro [Physiotherapy Evidence Database], and CENTRAL (Cochrane Central Register of Controlled Trials) databases were searched up to January 2015. Only randomized controlled trials that compared CWI to passive recovery were included in this review. Data were pooled in a meta-analysis and described as weighted mean differences (MDs) with 95 % confidence intervals (CIs).

Results

Nine studies were included for review and meta-analysis. The results of the meta-analysis revealed that CWI has a more positive effect than passive recovery in terms of immediate (MD = 0.290, 95 % CI 0.037, 0.543; p = 0.025) and delayed effects (MD = 0.315, 95 % CI 0.048, 0.581; p = 0.021). Water temperature of between 10 and 15 °C demonstrated the best results for immediate (MD = 0.273, 95 % CI 0.107, 0.440; p = 0.001) and delayed effects (MD = 0.317, 95 % CI 0.102, 0.532; p = 0.004). In terms of immersion time, immersion of between 10 and 15 min had the best results for immediate (MD = 0.227, 95 % 0.139, 0.314; p < 0.001) and delayed effects (MD = 0.317, 95 % 0.102, 0.532, p = 0.004).

Conclusions

The available evidence suggests that CWI can be slightly better than passive recovery in the management of muscle soreness. The results also demonstrated the presence of a dose–response relationship, indicating that CWI with a water temperature of between 11 and 15 °C and an immersion time of 11–15 min can provide the best results.

Electronic supplementary material

The online version of this article (doi:10.1007/s40279-015-0431-7) contains supplementary material, which is available to authorized users.

The effects of cold water immersion with different dosages (duration and temperature variations) on heart rate variability post-exercise recovery: A randomized controlled trial

OBJECTIVES

The aim of the present study was to investigate the effects of cold water immersion during post-exercise recovery, with different durations and temperatures, on heart rate variability indices.

DESIGN

Hundred participants performed a protocol of jumps and a Wingate test, and immediately afterwards were immersed in cold water, according to the characteristics of each group (CG: control; G1: 5' at 9±1°C; G2: 5' at 14±1°C; G3: 15' at 9±1°C; G4: 15' at 14±1°C).

METHODS

Analyses were performed at baseline, during the CWI recuperative technique (TRec) and 20, 30, 40, 50 and 60min post-exercise. The average HRV indices of all RR-intervals in each analysis period (MeanRR), standard deviation of normal RR-intervals (SDNN), square root of the mean of the sum of the squares of differences between adjacent RR-intervals (RMSSD), spectral components of very low frequency (VLF), low frequency (LF) and high frequency (HF), scatter of points perpendicular to the line of identity of the Poincaré Plot (SD1) and scatter points along the line of identity (SD2) were assessed.

RESULTS

Mean RR, VLF and LF presented an anticipated return to baseline values at all the intervention groups, but the same was observed for SDNN and SD2 only in the immersion for 15min at 14°C group (G4). In addition, G4 presented higher values when compared to CG.

CONCLUSIONS

These findings demonstrate that if the purpose of the recovery process is restoration of cardiac autonomic modulation, the technique is recommended, specifically for 15min at 14°C.

Effect of cryotherapy on the ankle temperature in athletes: ice pack and cold water immersion

Introduction Cryotherapy is often used for rehabilitation of injured athletes. Objective To compare the effectiveness of ice pack (IP) and cold water immersion (CWI) on lowering the ankle skin surface temperature in athletes. Materials and methods Thirteen athletes (seven women and six men), age 19.53 (± 2.9) years. IP and CWI were applied on the anterior talofibular ligament (ATFL) of the dominant leg for 30 minutes. The skin surface temperature was measured with an infrared digital thermometer prior to the application and during cryotherapy (10, 15, 20, 25 and 30 minutes) and up to two hours of rewarming. During rewarming, the athletes remained at rest and the temperature was measured every 1 minute until 10 minutes, every 5 minutes for up to an hour and every 15 minutes until 2 hours. Results The two types of cold application were effective in lowering the skin surface temperature after the 30-minute procedure. Significant differences were observed among the following temperatures: pre-application (IP = 29.8 ± 2.4 °C and CWI = 27.5 ± 3 °C – P < 0.05); after 30 minutes (IP = 5 ± 2.4 °C and CWI = 7.8 ± 3 °C – P < 0.01). For rewarming, after 25 minutes (IP = 20.8 ± 3.3 °C and CWI = 18.2 ± 2.7 °C – P < 0.04); after 45 minutes (IP = 24.5 ± 2.3 °C and IP = 22.1 ± 3.5 °C – P < 0.05); after 75 minutes (IP = 26.4 ± 2.2 °C and CWI = 24 ± 2.7 °C – P < 0.02). Conclusion After the 30-minute application, both IP and CWI produced the appropriate temperature; however the application of CWI produced the lowest temperature during rewarming.

Recovery after aerobic exercise is manipulated by tempo change in a rhythmic sound pattern, as indicated by autonomic reaction on heart functioning

Physical prowess is associated with rapid recovery from exhaustion. Here we examined whether recovery from aerobic exercise could be manipulated with a rhythmic sound pattern that either decreased or increased in tempo. Six men and six women exercised repeatedly for six minutes on a cycle ergometer at 60 percent of their individual maximal oxygen consumption, and then relaxed for six minutes while listening to one of two sound pattern conditions, which seemed to infinitely either decrease or increase in tempo, during which heart and breathing activity was measured. Participants exhibited more high-frequent heart rate variability when listening to decreasing tempo than when listening to increasing tempo, accompanied by a non-significant trend towards lower heart rate. The results show that neuropsychological entrainment to a sound pattern may directly affect the autonomic nervous system, which in turn may facilitate physiological recovery after exercise. Applications using rhythmic entrainment to aid physical recovery are discussed.

Efeito de diferentes métodos de recuperação sobre a remoção de lactato e desempenho anaeróbio de futebolistas

INTRODUÇÃO: O futebol é caracterizado como uma modalidade com intensidades elevadas, realizado de forma intermitente e com sequências aleatórias de fases de esforço e recuperação, dessa forma estratégias que possam de alguma forma minimizar a fadiga muscular, pode fornecer uma importante vantagem competitiva. OBJETIVO: O presente estudo teve como objetivo comparar diferentes tipos de métodos de recuperação sobre remoção de lactato (La-) sanguíneo e desempenho anaeróbio de futebolistas. MÉTODOS: A amostra foi composta por 23 atletas de futebol entre 16 e 17 anos do sexo masculino, divididos em três grupos: recuperação ativa (RA), passiva (RP) e com gelo (RG). Para a avaliação da capacidade aeróbia foi utilizada a velocidade crítica e para a indução da hiperlactacidemia e desempenho anaeróbio foi utilizando o teste de RAST, aplicado antes (T1) e após (T2) os intervalos de recuperação. As dosagens de La- sanguíneo ocorreram nos minutos dois, quatro, seis, oito e 10 durante a recuperação. A análise de variância ANOVA one-way foi utilizada para a comparação entre as variáveis de caracterização dos grupos. A ANOVA two-way foi realizada para a comparação entre os valores pico e mínimo de La- sanguíneo e o desempenho anaeróbio no T1 e T2 para as três condições de recuperação. RESULTADOS: Não foi verificada diferença significante entre T1 e T2 para a potência máxima e média em nenhum dos grupos estudados (p > 0,05). Foi verificada maior remoção do La- sanguíneo para a RA (47,62%), quando comparada a RG (16,9%; p = 0,001) e a RP (18,20%; p = 0,02). CONCLUSÃO: Pode-se concluir que a RA, RP e RG são eficazes para manutenção do desempenho anaeróbio de jogadores de futebol sub-17. A recuperação ativa se demonstrou mais eficiente para a remoção do La- sanguíneo quando comparada a RP e RG.