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Vol. 61 - No. ?? THE JOURNAL OF SPORTS MEDICINE AND PHYSICAL FITNESS 1
11341-JSM_N
The Journal of Sports Medicine and Physical
Fitness
Mese 2021
Vol. 61 - No. ??
REVIEW
SECTION
Evidence-based post exercise recovery
in combat sports: a narrative review
Isaac LÓPEZ-LAVAL 1 *, Juan MIELGO-AYUSO 2, Nicolás TERRADOS 3, Julio CALLEJA-GONZÁLEZ 4
1Department of Physiatry and Nursing, Faculty of Health and Sport Science, University of Zaragoza, Huesca, Spain; 2Department of
Biochemistry and Physiology, School of Physical Therapy, University of Valladolid, Soria, Spain; 3Regional Unit of Sports Medicine,
Aviles and Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Spain; 4Department of Physical Education and Sport,
Faculty of Education and Sport, University of Basque Country (UPV/EHU), Vitoria, Spain
*Corresponding author: Isaac López-Laval, Department of Physiatry and Nursing, Faculty of Health and Sport Science (FCSD), University of Zaragoza,
Huesca, Spain. E-mail: isaac@unizar.es
ABSTRACT
BACKGROUND: Some methods such as ergo nutritional aids, cooling or massage among others could improve recovery in combat sports (CS).
The effects, doses, duration, and timing of these methods remains unknown. Nowadays, there is no clear consensus regarding the recovery strate-
gies and it is necessary to understand the type of fatigue induced in CS and its underlying mechanisms. The main aim of this article is to review
the update literature related to recovery strategies in CS.
METHODS: A literature search was conducted following preferred reporting items for review statement on the topic of: “combat sports,” “re-
covery,” “nutrition,” “fatigue,” “ergogenic aids,” “weight cutting” and “hydration.”
RESULTS: The initial search of the literature detected 369 articles about CS. Later, 307 were excluded after being determined unrelated to re-
covery or after failure to fulll the inclusion criteria. Of the 80 included articles, 19 satised the nal inclusion criteria.
CONCLUSIONS: To optimize CS performance, adequate recovery is required during training and competition processes. Traditional ergo nu-
tritional supplementation of carbohydrates and proteins combined. Besides, the consumption of evidence supported supplementation (green tea,
beetroot gels, creatine or alkaline water) improve recovery processes. Further methods of recovery including physical (cold water immersion,
massage or photobiomodulation) and physiological (types of active recovery, sleep and rest) therapies have also been shown useful. This narra-
tive review elucidates the important role of recovery techniques in CS.
(Cite this article as: López-Laval I, Mielgo-Ayuso J, Terrados N, Calleja-González J. Evidence-based post exercise recovery in combat sports: a nar-
rative review. J Sports Med Phys Fitness 2021;61:000-000. DOI: 10.23736/S0022-4707.20.11341-0)
Key words: Recovery of function; Dietary supplements; Martial arts; Athletes.
Journal of Sports Medicine and Physical Fitness 2021 mese;(0):000–000
DOI: 10.23736/S0022-4707.20.11341-0
LÓPEZ-LAVAL
POST EXERCISE RECOVERY IN COMBAT SPORTS
© 2020 EDIZIONI MINERVA MEDICA
Online version at http://www.minervamedica.it
Combat sports (CS) are old traditional sports activities
that have been solidly established worldwide.1 Among
them, boxing, mixed martial arts (MMA) wrestling, judo,
taekwondo, kickboxing (Kbox) karate and Jiu-jitsu (JJ)
are considered the most popular CS encompassing a wide
variety of disciplines.2 With the same goal, disabling the
opponent or scoring more points always within the same
weight category,3 all disciplines are characterized by a
great number of very high intensity movements and short
breaks that are insufcient for a complete recovery during
the different rounds that compose a ght.4 Without car-
rying out an analysis of the ratio action/recovery, all CS
disciplines need the development of the anaerobic endur-
ance capacity as the primary metabolic source (explosive
strength endurance).5 In addition, previous research has
highlighted the importance of the enough aerobic capac-
ity to relate the training and competition requirements.6
Therefore, the varied and demanding needs of CS will lead
to different degrees of muscle damage and fatigue within
the context of competition.7 This is the main reason why
CS present multifactorial fatigue regardless of the disci-
pline.8
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to offer guidelines for coaches, team staff and strength and
conditioning coaches to improve athlete’s performance.
Materials and methods
Information sources
A computer-based scientic literature search was complet-
ed from inception to April 30, 2020, using the following
information sources: Medline (PubMed), Web of Science
(WOS), the Cochrane Collaboration Database, Cochrane
Library, Evidence Database (PEDro), Evidence Based
Medicine (EBM) Search review, National Guidelines, EM-
BASE, Scopus and Google Scholar system. The keywords
used in the search were: “combat sports,” “recovery,” “nu-
trition” “fatigue,” “ergogenic aids,” “weight cutting” and
“hydration.” The specic search strategy was performed
following the Boolean equation: (“antioxidants”[all
elds] OR “antioxidants”[all elds]) AND (“caffeine”[all
elds] OR “caffeine”[all elds]) AND (“creatine mono-
hydrate supplementation”[all elds] OR “creatine
supplementation”[all elds]) AND (“hydration”[all
elds] OR “beta hydroxy beta methylbutyrate
supplementation”[all elds] OR (beta-Hydroxy[all elds]
AND methylbutyrate[all elds] AND supplementation[all
elds])) AND (“muscle recovery”[all elds] OR (“com-
bat sports”[MeSH terms] OR “combat sports”[all elds])
OR (“ghters”[MeSH terms] OR “ghters”[all elds]) OR
“sport performance”[all elds] OR “weight cutting”[all
elds]). Through this equation, relevant articles of this eld
were obtained applying the snowball strategy. Furthermore,
this narrative review was conducted in accordance with the
preferred reporting items for review statement guidelines.39
Study inclusion criteria
All titles and abstracts from the search were cross-ref-
erenced to identify duplicates and any potential missing
studies. The titles and abstracts were screened for a sub-
sequent full-text review. The search for published stud-
ies was independently performed by two authors and
disagreements about all outcomes were resolved through
discussion. The criteria for allocations in the articles were
satised. Manuscript’s full text was obtained to ascertain
if the publication satised the inclusion criteria. In addi-
tion, the reference sections of the selected articles were
searched to identify other relevant articles. Finally, for the
current review, only studies focusing on the effect of ergo-
nutritional (nutritional supplements, hydration and weigh
loss), physiological (post training recovery, rest and sleep),
Recovery in sports science is a hot topic. During the last
10 years the number of scientic studies regarding recov-
ery has increased signicantly.9 In sports, the importance
of optimizing the recovery-stress state is critical. Effective
recovery from intense training loads often faced by elite
athletes can often determine sporting success or failure.10
In order to the recovery process to be more efcient, two
important issues should be considered to achieve optimal
performance during the competition day; the competition
schedule11 and the strategy employed for rapid weight loss
the day before the ght.12 In this context, boxing, Kbox,
MMA or JJ athletes compete in single bout events (twice
per year) with complete recovery time between ghts.
However, Judo, Karate or Taekwondo, athletes compete in
a multiple bout tournament with an insufcient post ght
recovery.13 Accordingly, the specic metabolic require-
ments within the discipline or the competition schedule are
important aspects to be taken in account.7 The control of the
glycolytic system to assure adequate acid-based balance
and the phosphocreatine resynthesis during the ght14 are
fundamental in this strategy.15 Also, it should be highlight-
ed that ghters commonly aim to compete in lower weight
divisions than their day-to-day weight, something that is
achieved via chronic and acute manipulations of body
mass. Although these manipulations may impair health and
absolute performance, their strategic use can improve com-
petitive success and recovery.16 Because of this, nighttime
eating, particularly before bed, has received considerable
attention. Limiting and/or avoiding food before nighttime
sleep has been proposed both as a weight loss strategy and
approach to improve health and body composition.17 Fur-
thermore, an adequate weight cutting strategy (hydration
and nutrition) promotes recovery and has shown no physi-
cal performance decits in CS competitions.18
In this sense, several methods have been proposed as
recovery strategies used by CS practitioners. Antioxi-
dants,19-21 creatine (Cr),22, 23 alkaline water (Aw),24-26 com-
bined recovery techniques,27-29 sleep and rest,30-32 water
immersion,33-35 massage36 and weight cutting strategies37, 38
can be highlighted among the most used tools. However,
although some of these methods could improve the recov-
ery in CS, there is some controversy regarding the effects,
doses, duration, and timing. To the bets of the authors´
knowledge, there is no clear consensus related to the re-
covery methods that could be more effective to maintain or
increase performance, reduce injury range and improve the
metabolic recovery processes in CS. Therefore, the main
aim of this narrative review was to discern the potential
effects of different recovery methods used in CS in order
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physical (water therapy, stretching and massage), and psy-
chological methods for recovery in CS were included.
Study exclusion criteria
Other sports were not considered, and duplicated articles
were deleted. Moreover, abstracts, non-peer reviewed pa-
pers and book chapters were excluded. Furthermore, to ef-
fectively quantify the quality of scientic evidence, each
recovery strategy was referenced attending to a level of
recommendation (no, low, medium, or high) and timing of
application (after, during or post training or competition).
These ratings appear after each sub-category.
Results
The initial search of the literature detected 369 articles
about CS; nevertheless, 307 were excluded after being
determined unrelated to recovery in CS or failure to ful-
ll the inclusion criteria, or both (Figure 1). Of the 80 in-
cluded articles, 19 satised the inclusion criteria. In rela-
tionship with the results and recovery methods, Table I19-26 Figure 1.—Flow chart of study selection.
Table I.—Nutri-ergogenicrecoverymethodsincombatsportswithbenets.
Reference
number, authors
and year Modality and sample size Dose and timing Outcomes Results
Lin et al.,19
2014
Taekwondo; taekwondo athletes.
13 males;20.5±1.2 years, 9
females; 19.9±1.5 years
28 mg/kg green tea (Cf 6 mg/kg
and catechins 22 mg/kg). After
training
Oxidative stress and antibacterial
capacity
Antioxidant activity ↑
Antibacterial capacity ↑
de Oliveira et
al.,20 2018
Jiu-jitsu: Jiu-jitsu athletes. 12
males 29±9 years
100 g beetroot-based nutritional
gel. 120 min before exercise, 8
days
Time until fatigue, muscle O2
saturation, blood volume and
plasma nitrate and lactate post
exercise
Muscle O2 saturation
during recovery ↑
Force decline in response
to exercise ↓
de Oliveira et
al.,21 2020
No specied; combat sport
athletes. 14 males 29.9±8.5
years
100 g beetroot-based nutritional
gel. 120 min after exercise
Maximal voluntary contraction,
exercise time until fatigue,
muscle O2 saturation and blood
volume
Strength recovery in
combat sport athletes ↑
Oöpik et al.,22
2002
Wrestler; Wrestler athletes. 5
males 20.6±0.9 years
320 g of glucose plus 30 g of Cr
monohydrate, oral administration.
7 hrs. post-training
Submaximal and maximal
intensity work and body mass
loss after recovery
Regain of physical
performance in
maximal intensity
efforts ↑
Van Cutsem et
al.,23 2020
No specied; combat sport
athletes. 14 males 24±3 years
20 g of Cr supplementation. After
practice, 7 days
Dynamic handgrip and mental
fatigue
Physical performance ↑
Prolonged cognitive
performance ↑
Chycki et al.,24
2018
No specied; combat sport
athletes. 16 males 22.3±0.5
years
840 mg/dm3 of Sb. After exercise,
3 weeks
Metabolic acidosis and enhances
anaerobic performance
Hydration ↑
Acid base balanced ↑
Performance ↑
Timpmann et
al.,25 2012
Wrestler; Wrestler athletes. 5
males 22.5±3.9 years
600 mg/kg-1 of Sb. 16 hrs.
postexercise
Rehydration (urine gravity and
plasma volume) and rapid body
mass loss
Blood buffering capacity
↑
Stimulated body mass
regains ↑
Gough et al.,26
2019
Box; Boxing athletes.7 males
27.1±5.1 years
300 mg/kg-1 of Sb 10 min. after
exercise
Acid base balance and punch
performance
Acid base balance ↑
Recovery ↑
Cf: caffeine; Cr: creatine; Sb: sodium bicarbonate; hrs: hours: min: minutes.
Records identied through
database searching
(N.=369):
PubMed (N.=90)
Web of Science (N.=83)
Scopus (N.=93)
SportDicous (N.=103)
Studies included
in qualitative synthesis
(N.=19)
Nutri nutritional methods (N.=8)
Physiological methods (N.=6)
Physical methods (N.=5)
Records screened
(N.=80)
Records after duplicates removed
(N.=307)
Records excluded
(N.=63)
IdenticationIncluded Eligibility Screening
Additional records identied
through other sources
(N.=18)
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and performance staff commonly apply numerous recov-
ery methods. Recovery methods are commonly applied
pre-, during or postght; thus, within this review they have
been classied as such.11
Ergo nutritional supplementation
With the intention of optimizing performance, ergo nu-
tritional supplementation (ENS) is a common practice
shows the ergo nutritional supplementation effects, Table
II27-32 shows the physiological methods and nally, Table
III26, 33, 40 the physical methods.
Discussion
In order to increase performance, to minimize the risk of
injury and to enhance the recovery process, CS ghters
Table II.—PhysiologicalrecoverymethodsinCombatSportswithbenets.
Reference number,
authors and year Modality and sample size Dose and timing Outcomes Results
Franchini et al.,27
2003
Judo; Judo athletes. 17
males 21.6 ±3.9 years
AR vs. PR. 15 min at 70% of the anaerobic threshold
velocity after judo simulated combat
LA and performance Lactate removal ↑
Performance =
Ouergui et al.,28
2014
Kickboxing; Kbox
athletes. 18 males
18.5±1.8 years
AR vs. PR. 10 min. at 50% of maximal aerobic speed
after kickboxing simulated combat
LA and performance Acid base balance ↑
Performance =
Ghorbani et al.,29
2015
Wrestler: Wrestlers
athletes. 8 males 23.2±1
year
Different recovery intensities; individual ventilatory
threshold, lactate threshold, fatmax and passive
recovery, after wrestling combat
LA Fatmax intensity for
lactate removal ↑
Soussi et al.,30
2013
Judo; Judo athletes. 12
males 18.6 ±2.4 years
Partial sleep deprivation effect Judo performance
competition
Performa competition
post sleep deprivation
↓
Ben Cheikh et
al.,31 2017
Karate; Karate athletes.
12 males 16.9 ±0.8
years
One-night sleep deprivation effect Selective attention and
isometric force
Selective attention ↓
Maximal isometric
strength ↓
Daaloul et al.,32
2019
Karate; Karate athletes.
13 males 23±2 years
Nap effect. The nap lasted 30 min at 1:00 PM Alertness, cognitive and
physical outcomes
Cognitive outcomes ↑
Fatigue ↓
Kbox: Kickboxing; AR: active recovery; PR: passive recovery; LA: blood lactate; min: minutes.
Table III.—Physicalrecoverymethodsincombatsportswithbenets.
Reference
number, authors
and year Modality Dose and timing Outcomes Results
Tabben et al.,33
2018
Mix Martial Art;
MMA athletes. 12
males 26.5±5.0
years
Cold water immersion: 10ºC for 15
min in a seated position. After 3x5
min MMA rounds separated by 1
min of passive rest
Short sprint performance,
blood samples and perceptual
measures (well-being, fatigue,
recovery and muscle soreness)
Sprint performance ↑
Perceived measures after 24 hrs. ↓
Blood samples values =
Lindsay et al.,34
2017
Mix Martial Art:
MMA athletes. 15
males 28.3±5.7
years
Cold water immersion: 10ºC for 15
min in a seated position. After 3x5
min MMA rounds separated by 1
min of passive rest
Markers of muscle damage,
inammation stress and
perceptual measures
DOMS ↓
Inammation stress ↓
Perceived measures ↓
Fonseca et al.,35
2016
Jiu-Jitsu; JJ. athletes.
8 males 24.0±3.6
years
Cold water immersion: 6º-5ºC for 19
min. After Jiu jitsu training: 40 min
calisthenics, technical training and
combat simulation
Serum level, perceived muscle
soreness, recovery and muscle
power.
Serum levels ↓
DOMS perception ↓
Muscle power recovery ↑
Zebrowska et
al.,36 2019
Mix Martial Art:
MMA athletes. 8
males 27.5±6.5
years
Massage; Physical methods of
lymphatic drainage. Post muscle
test
Maximal strength, muscle tissue
tension, pain threshold, LA
concentration and creatine
kinase activity
Postexercise LA concentration ↓
Postexercise muscle tension ↓
Muscle regeneration ↑
Maximal strength after massage ↑
de Araujo et
al.,40 2017
Jiu-Jitsu; JJ. athletes.
10 males 16.2±3.8
years
Photobiomodulation therapy.
Between 2 sets of simulated
combats. 15 min resting between
bounds.
Maximal isometric handgrip
strength, LA concentration
Maximal isometric handgrip ↑
Strength recovery between ght ↑
MMA: Mix Martial Art; JJ: Jiu-Jitsu; DOMS: onset muscle soreness; LA: blood lactate.
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ated by some authors regarding the negative effects of ex-
cessive antioxidant dosages,54 there is low evidence about
the effect of antioxidant supplementation.55 We consider
that more research in this area is necessary.
The timing observed was before training and competi-
tion and the level of recommendation was low.
Caffeine
The enhancing effect of caffeine (Cf) has been well docu-
mented in the scientic literature56 and is considered as
the ENS with more pronounced performance-enhancing
effects on velocity.57 The Cf is a modulator of the central
nervous system,58 increases alertness, improves vigilance,
attention and reaction time.59 At the neuromuscular level,
Cf increases the recruitment of motor units and therefore
muscle energy during the sporting actions,60 Increments
in agility and decision-making have also been observed
after Cf ingestion. All these consequences derived from
the use of Cf supplementation have a direct relationship
with the performance-enhancing effect.2 To the author´s
knowledge, all the scientic literature that relates Cf and
CS aims to assess the incidence on performance,2, 61-64 but
the effects on recovery remain unknown. In a recent non-
specic review about CS, Loureiro et al.,65 reported con-
icting data regarding the effects of caffeine on muscle
glycogen recovery. In 2019 Grgic et al.66 also observed,
in a non-specic CS review, that ingestion prior to resis-
tance training may reduce the occurrence of delayed onset
muscle soreness (DOMS).67
The timing observed was before training and competi-
tion and the level of recommendation was low.
Creatine
Creatine (Cr) is a nitrogenous organic compound found in
muscle as a part of phosphocreatine (PCr) and serves as
a source to restore adenosine triphosphate (ATP).68 As an
ENS it is one of the most commonly used69 supplements
to increase resting phosphocreatine levels in muscles and
free Cr, with the goal of postponing fatigue.70 The evi-
dence regarding Cr supplementation for recovery in CS
is scarce and to our knowledge only two published studies
have addressed the recovery process in CS. Oöpik et al.22
observed that Cr supplementation during recovery periods
after fast mass reductions does not accelerate the restora-
tion of body mass but helps in the maintenance of physical
performance in maximal intensity efforts in well trained
wrestlers. Further, another study reported that 7 days of Cr
supplementation (20 g per day) improved strength endur-
ance and prolonged cognitive performance. However, did
among many athletes and many sport disciplines.41 The
contribution of energy metabolism and type of effort are
the keys for choosing the right recovery method.42-44 De-
spite the variety of disciplines that compose CS and the
different studies that have analyzed the effect of ENS on
performance enhancement, to our knowledge, there are no
reviews related to the current status of the different ENS
as a recovery tool.
Antioxidants
The antioxidant effect has been well documented on the
athletic performance world.45 In a greater or lesser de-
gree, the free radical system is activated as a consequence
of hemoglobin and myoglobin oxidation.46 In CS disci-
plines, energy expenditure is different when the diverse
disciplines are compared to each other, from the aerobic
metabolism which predominates in karate,47 through an-
aerobic power in wrestling,48 to the high level of both in
MMA49 or Boxing.50 Similarly, oxidative stress differs
among disciplines.46 For example, Gomes-Santos et al.,51
in a recent study, considered that metabolic and mechani-
cal stress imposed by combat actions generated inam-
mation and oxidative stress after combat. This oxidative
stress occurs when the athletes do not possess adequate
capacity to protect against free radicals.52 For this reason,
some ghters consume supplements with antioxidants to
reduce the presence of free radicals.
Given that oxidative stress increases in CS disciplines,46
three studies have attempted to verify whether supplemen-
tation of antioxidants could reduce the oxidative stress
after practice. In this sense, Lin et al.19 investigated the
short-term effect of green tea consumption in taekwondo
athletes following intensive training and showed that this
infusion signicantly enhances oxidative activity. With an-
other natural antioxidant (beetroot gel), Oliveira et al.21
observed that gel supplementation could be an appropriate
nutritional strategy to improve muscle O2 saturation post
exercise and prevent force decline in response to exercise
in a group of JJ athletes.20 Finally, it should be highlighted
that a recent study by the same authors concluded that a
single dose of beetroot gel supplementation could be con-
sidered as a good nutritional strategy to improve strength
recovery in CS athletes.
In conclusion, dietary antioxidants (green tea and beet-
root gel) may counteract oxidative stress by reducing the
production of free radicals and reactive oxygen species
and could improve strength recovery after training.53 De-
spite the scarce scientic bibliography related to antioxi-
dant supplementation and CS and the controversy gener-
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Nonetheless, it is advisable for athletes to replace water
with energy containing beverages as a better option to in-
crease CHO intake.
In the only descriptive nutritional and performance pro-
le study with Cs athletes (JJ), values of 54±7% of CHO
were considered low intake, 19±4% of protein was con-
sidered high intake and 27±6% of lipids were considered
an adequate intake. In conclusion, the authors determined
that this macronutrient distribution was poor and negative-
ly affected performance in the ghts.82
In summary, due to the lack of studies in Cs, it recom-
mends the following basic guidelines from nutritional
strategies to promote post exercise recovery. It determined
that CHO should be ingested with hydrolyzed whey pro-
teins at a 3-4/1 ratio, with 1g/kg of CHO for optimal recov-
ery post exercise.75 A minimum of 8-10 g CHO/kg73 and
between 1.4 g/kg to 2.0 g/kg PR per day is necessary for
a proper long-term recovery.77 In this kind of disciplines
where the ghters must qualify for competition by weigh-
ing at a designated weight category before competition,
more research that would describe more accurately energy
CHO and PR contribution is necessary.
The timings observed were before, during and after
training and competition and the level of recommendation
was high.
β-Alanine
Carnosine is a multifactorial dipeptide composed by
β-Alanine (β-A) and L-histidine with many roles. Among
them, the measurement of the enzymes synthesis83 should
be highlighted. β-A supplementation rises the intramuscu-
lar carnosine concentrations, generating a calcium regula-
tor and intramuscular buffer effect.84 These processes are
fundamental to attenuate the metabolic acidosis85, 86 that
occurs in CS and that is responsible of the fatigue through-
out the competition and training processes. A recent sys-
tematic review and meta-analysis conrmed the efcacy
of β-A supplementation to improve high-intensity exercise
performance, particularly those that last between 1 and 4
min and a borderline efcacy in exercise lasting over 240
s and less than 60 s duration87 was demonstrated. One year
later, in another non-specic CS review, Brisola et al.88
determined the possibility that discrepancies in outcomes
may be related to the specicities of each sport discipline.
In CS, only two studies have been found in relation
to β-A.89, 90 In 2012 Donovan et al. tried to test the hy-
pothesis that β-A supplementation improves punch power
and frequency in a group of sixteen boxers. The results
concluded with improvements in punching performance
not cancel the impairments in mental fatigue.23 Although
Cr is a widely used ergogenic aid these results warrant fur-
ther investigation, even though, from a physiological point
of view, the potential role of Cr as a recovery supplement
in CS is clear.
The timing observed was before training and competi-
tion and the level of recommendation was high.
Carbohydrates and proteins
To optimally prepare for training and competition, the
athlete needs to obtain appropriate energy sources.71 It is
well known that carbohydrates (CHO) are the main en-
ergy contribution to ensure that muscle glycogen stores
are adequately replenished.72 In addition to CHO, proteins
(PR) are also required to maintain high levels of training
and to perform ideally during competition.71 An optimal
dietary PR intake provides a foundational aspect for pro-
moting recovery.73, 74 The role of PR on recovery includes
the positive effect on muscle protein synthesis, lean tissue
gains, increases in strength75 and reductions in the signs
and symptoms of exercise induced muscle damage.76
The CS athletes are advised to emphasize adequate CHO
intake before a competitive bout.71 Consequently, 8-10 g
CHO/kg body mass per day are normally suggested for Cs
athletes.73 Following the recommendations of the “Inter-
national Society of Sports Nutrition” in relation with the
daily PR intake for CS, a range between 1.4 g/kg to 2.0 g/
kg per day is required.77 A recent study has suggested that
protein intakes exceeding 2.0 g/kg per day may provide
an even greater enhancement of strength performance.78
Beelen et al.75 determined as a general recovery guideline
the consumption of CHO with small amounts of protein
and leucine within 30 min of the exercise bout (0.3 g/kg of
CHO, 0.2 g/kg of protein and 0.01 g/kg of leucine) in order
to resynthesize muscle glycogen stores.
An interesting study in wrestling athletes described the
effect of 1.2 g/kg CHO, 1 g/kg HCO + 0.1 g/kg arginine
(ARG) + 0.1 g/kg amino acids (BCAA) and water (pla-
cebo trial). In this study, there were no differences among
the CHO, CHO+ARG+BCAA and trials, and the peak
and average power was similar in all the 3 ghts.79 These
results indicate that the supplementation of CHO with or
without BCAA and ARG during the ght period had no
effect on performance in wrestlers. In addition, BCAA
and ARG did not provide additional insulinemic effects.80
Besides, Pettersson et al.81 suggested CHO mouth rinses
(0.4 g/kg = approximately 25 mL of dextrose solution) in
a boxing ght simulation 10 seconds before each round.
This method did not show an increase in performance.
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has been used as a potential recovery mechanism in other
sport disciplines; rowers,102 sprinters,103 cyclists,24 basket-
ball players104, 105 or soccer players106 among others. In
particular, in CS, Gough et al.26 reported increases in acid-
base balance during postexercise recovery in a group of
professional boxers. The athletes had improvement in the
subsequent bouts of exercise after they had ingested 300
mg/kg-1 body mass of sodium bicarbonate (Sb). Further,
another similar study in a group of 16 well trained CS ath-
letes reported that ingesting Aw for three weeks improves
acid base balance and anaerobic exercise performance
assessed by two double 30 s Wingate tests.24 Moreover,
Timpmann et al.25 researched the effects of 600 g/kg-1 Sb
after 16h recovery periods. The results indicated increases
in blood buffering capacity and plasma volume and stimu-
lation of body mass recovery during 16 h recovery periods
after fast body mass losses in trained wrestlers.
Nonetheless, it should be noted that the only study that
compared active recovery methodology and Aw regard-
ing the removal of blood lactate concentration after a judo
match simulation and specic judo tness test suggested
that levels of blood lactate acid were signicantly lower
when athletes used active recovery versus Aw.107 In sum-
mary, if glycolytic metabolism decreases at the end of the
rounds in CS, it seems to be necessary to apply strategies
to inhibit key enzymes of the glycolytic pathway impli-
cated in muscular fatigue.108
The timings observed were the ones after, during and
before training and competition and the level of recom-
mendation was low.
Physiological recovery methods
Weight cutting recovery strategies
Weight cutting is a key role in CS given that athletes com-
pete in predetermined weight categories.15 Fast weight
losses and a good recovery strategy for a rapid weight
gains could lead to perform enhancement through size
and strength advantages over the lighter opponent.109 In
this sense, Reale et al.110 determined in a group of Judo
athletes a relationship among good recovery, weight gain
and victory. However, contrary results were found in stud-
ies with boxers and wrestlers.37 Scientic literature sug-
gests that weight-in, combat time and experience in the
weight cutting cycle are the key factors to plan a good
recovery strategy with no negative effects in terms of per-
formance.27 Regarding physical performance, it appears
clear that severe weight cuts (~5% body mass in under 24
h) will impair repeated efforts.38 Among methods used to
and suggested potential positive results for other combat
related sports.90 Also, in this strategy to improve perfor-
mance, Andrade-Kratz et al.89 analyzed twenty-three high-
ly trained judo athletes who received either β-A (6.4 g per
day) or placebo (dextrose, same dosage) for 4 weeks and
determined an enhancement in performance. Despite the
evidence to support the enhancement in performance with
the use of β-A as an ENS,89, 90 there is no specic evidence
to support that β-A has a recovery effect in these types of
efforts. Future research is needed to identify this possible
aspect.
The timing observed was before training and competi-
tion and the level of recommendation was low.
β-hydroxy-β-methylbutyrate
β-hydroxy-β-methylbutyric acid (HMB) is a metabolite of
leucine and 2-ketoisocaproic acid which has been used ex-
tensively as an ENS for athletes.91 Generally, its suggested
uses in the literature are related to increases in muscle
strength, muscle hypertrophy, reduction in fat mass and
enhancement of recovery.92-95 Despite these effects, a re-
cent meta-analysis found no effect of HMB supplemen-
tation on strength and body composition in trained and
competitive athletes.96 In contrast, Hung et al.97 analyzed
the effects of HMB during energy restriction periods in
judo athletes and found an increase in muscle mass and
reductions in body fat. Short-term supplementation of
HMB during energy restriction periods may help to reduce
body fat but has no effect on lean body mass or exercise
performance. Also, another study with forty-two CS ath-
letes that supplemented HMB for 12 weeks found advanta-
geous changes in body composition and increases in aero-
bic and anaerobic capacity. Despite the scarce literature
in the world of Cs and contrary to the conclusion of some
studies,96 HMB can enhance performance and help reduce
body fat in high-level CS athletes.
The timing observed was before training and competi-
tion and the level of recommendation was high.
Alkaline water
Alkaline water (Aw) is a widely used ENS that has been
reported to minimize intracellular H+ accumulation in-
creasing glycolytic metabolism and enhancing perfor-
mance during short-term high-intensity actions that are
typical of CS.98 Besides, it is an effective alternative in
preventing the effects of postexercise induced metabolic
acidosis.99 Whilst the effects of pre-exercise Aw have been
well-researched,98, 100, 101 the effects of postexercise recov-
ery have received minimal attention. This kind of strategy
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carefully supervised by specialized professionals to reduce
health risks and improve performance.13 If the time for re-
covery is limited, athletes should prioritize CHO and uid
ingestion to enhance subsequent athletic performance.123
Currently, there is insufcient evidence to determine the
use of a unique and correct hydration and nutritional re-
covery protocol.15
Active recovery
It is a common practice to compare methods that are usu-
ally used and have scientic support. Regardless of the
method of choice, the recovery response will be related
to the CS athlete physical capacity.124 Active recovery
(AR) or passive recovery (RP) are common practices in
the sports community.9 In this sense, Ouergui et al.28 mon-
itored fatigue 3, 5 and 10 min after a kickboxing ght.
The Eighteen Kbox athletes were randomly assigned to
complete AR (10 min at 50% of maximal aerobic speed)
or PR. Better recovery was observed in the AR group no
improvement in performance was described. Also, in a
group of 17 male judo athletes of different competitive
levels, the effects of AR and PR after a judo ght were
analyzed regarding the lactate removal. Similarly, AR was
a better option compared with PR. An important aspect
in this study was that the ability to maintain performance
was related to the athletes’ level.125 Ghorbani et al.29 de-
termined that fatmax intensity is the most effective method
for removal of lactate in CS athletes. In relationship with
the recovery during intra-combat situation, only one study
tried to determine which is the best body position during
combat breaks (sitting or standing). This study did not pro-
vide evidence for different physiological impacts of body
positions during breaks in simulated boxing ghts but con-
cluded by afrming that the body position might affect the
perception of effort.126
Based on the evidence in this type of sports, when im-
plementing recovery interventions during or post competi-
tions it is important to consider AR as a relevant method.
However, in relationship with recovery during competi-
tion, more research is needed.
The timings observed was after the training and compe-
tition and the level of recommendation was high.
Sleep and rest
Sleep is considered as a part of the recovery process
from training and has a large impact on the athletic per-
formance.127, 128 In particular, in the world of CS, a study
with karate athletes has previously concluded that one
night sleep deprivation negatively affected post combat
produce fast weight loss,111 water restriction and dietary
restriction are the main ones.112 A bad periodization of the
recovery strategy could be detrimental, but not only re-
garding performance, also about health.113
In particular, the time available for recovery follow-
ing weigh-in before competition will determine what de-
gree of acute body mass loss could be implemented and
reversed.114 To our knowledge, there are no guidelines
regarding how much liquid it must drink to avoid dehy-
dration in CS. However, it is accepted by sport profession-
als that a substantial uid decit during physical activity
may produce some loss in performance.115, 116 In the CS
eld, dehydration has been showed to uctuate in rela-
tion to performance.117-119 Different investigations have
demonstrated that 3% body mass loss during rapid weight
cutting procedures translated into signicant declines in
neuromuscular performance for both brief and sustained
contractions in competitive boxers.119 In a recent review,
it was determined that athletes are able to exploit the rules
to compete up to three weight categories higher than at
the ofcial weigh-in.15 This condition of dehydration was
observed in 69% of medal winners in a National Cham-
pionship,118 data that indicate that most boxers competed
with performance restrictions. Hypohydration is highly
prevalent in CS at weigh-in and is not fully reversed in the
weigh-in to competition. In this sense, Peterson et al.120
researched the effects of water intake and timing of of-
cial weigh-in and their relationship with hydration status
in a group of 63 CS athletes. The results indicated that the
prevalence of hypohydration was 89% in the morning of
the competition day and serious hypohydration was also
prevalent (urine specic gravity >1.030). It was also in-
dicated that a higher water intake in the evening before
competition was not associated with a more favorable hy-
dration.
In relation with the nutritional restrictions, the main
issue is the increased risk of overreaching/overtraining
leading up to competition if this method is not properly
planned.121 Despite the scarce literature about nutritional
restriction protocols in Cs,122 Brito et al.,112 reported in
a study with 580 Cs athletes that the rapid weight losses
were accompanied by CHO restrictions 24 h before weigh-
in. Regarding the best strategy to organize a good recovery
nutritional plan after weight cutting, Reale et al.114 deter-
mined a CHO intake of 5-10 g/kg/day to replenish the lost
glycogen and improve the recovery of body mass.
In summary, it is important to note that many athletes
consider the weight cutting process as an essential part of
the preparation for a competition.38 This period should be
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trointestinal temperature were measured. The CS athletes
who are subjected to impact induced stress may benet
from immediate CWI as a simple recovery intervention
that reduces delayed DOMS as well as macrophage and
hypothalamic pituitary axis activation whilst does not
impair functional performance. Similar ndings were
reported in a JJ athlete using CWI (6.0±0.5 °C) for 19
minutes. According to this study, the use of CWI could
be benecial because it reduces circulating lactate dehy-
drogenase levels, results in less perceived muscle sore-
ness and helps muscle power recovery at 24 hours postre-
covery.35
To the author´s knowledge there is a lack of CS litera-
ture about no effect or negative effect of CWI on CS. But
it must be indicated that in a recent and non-specic sys-
tematic review of this sports there was no evidence that
CWI produced any objective recovery during a 96-hour
recovery period. This idea should be considered when 4
days pauses between ghts are included.134 In conclusion,
CWI can be implemented after training or competition
for CS athletes but more research in these modalities is
needed.
The timings observed was after the training and compe-
tition and the level of recommendation was high.
Massage
Post exercise massage is one of the most frequently ap-
plied interventions to enhance performance. However, the
last meta-analysis concluded that the effects of massage
on recovery are rather small and partly unclear.135 To the
best of our knowledge, only one article36 analyzed the ef-
fects of massage or different types of massage on CS ath-
letes. It demonstrated that the muscle fatigue test showed
reduced maximal strength (Fmax) in all participants, but in
the groups receiving manual lymphatic drainage (MDL),
lymphatic drainage by deep oscillation, and body ow
therapy, signicantly higher Fmax was observed at recovery
when compared with postexercise values. The application
of MDL reduced the postexercise blood lactate concentra-
tions and postexercise muscle tension. More research is
needed regarding this topic.
The timings observed was after the training and compe-
tition and the level of recommendation was medium.
Stretching
Static stretching (SS) is one of the most debated topics in
the sport science literature.136 Nonetheless, most of the
conclusions regarding the use of SS have considered sig-
nicant reductions in muscular performance137 and no con-
recovery.31 Selective attention and maximal isometric
strength, two key skills in CS, were especially affected.
Souissi et al.30 also concluded that sleep deprivation has a
negative performance effect, especially when competition
is scheduled in the afternoon. Related to sleep efciency
there were no signicant associations with the physical
performance of a group of taekwondo athletes throughout
a training macrocycle, but an individual analysis showed
that some participants had worse performance with worse
sleep efciency.129 Following the conclusion of Daaloul et
al.32 in relation to karate athletes, a 30 min nap is an effec-
tive strategy to overcome the cognitive and physical dete-
riorations caused either by sleep loss or by fatigue induced
by exhaustive training.
In summary, CS athletes should have adequate post
competition sleep patterns and adjust training demands to
accommodate the altered physical and cognitive state after
sleep deprivation.130
The timings observed was after the training and compe-
tition and the level of recommendation was high.
Physical recovery methods
Cold-water immersion
Cold-water immersion (CWI) is one of the most popular
tools aimed at enhancing recovery following training and
competition.131 It has been suggested that physiological al-
terations associated with post exercise CWI may serve to
improve subsequent training load and quality and diminish
the effects of soft tissue injury via attenuation of edema,
inammation, pain, and hematoma formation.10
Nowadays, optimal levels of immersion, duration of
practices, temperature, position and methodology of ex-
position (continuous or intermittent)132 have strong sci-
entic evidence to support the optimization of protocols
for performance benets.133 The articles that have ana-
lyzed the effects of CWI in the eld of CS show posi-
tive effects on recovery.33-35 A recent study in 2018 by
Tabben et al.,33 reported that CWI improves 10-m sprint
performance as well as perceived wellness 24-h after a
simulated MMA competition (3×5-min MMA rounds
separated by 1-min of passive rest). Moreover, Lindsay
et al.34 analyzed 15 Semiprofessional MMA competitors
randomly assigned to cold-water immersion (15 min at
10 °C) or passive recovery protocol (ambient air) com-
pleted immediately after a training session. Markers of
muscle damage, inammation, oxidative stress, hypotha-
lamic-pituitary axis, saliva cortisol, ratings of perceived
soreness and fatigue, counter movement jump, and gas-
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posite to these conclusions, da Rosa et al.,150 suggested
no effect of PBT applied before exercise to reduce lower
limb and muscle damage fatigue in sixteen judo athletes
after a stretch-shortening cycle protocol. These results are
contradictory and opposed to other studies in which an
enhancement in recovery after different kinds of practices
was observed.149 The scientic literature in the CS is very
limited and more research is needed.
The timings observed was after the training and compe-
tition and the level of recommendation was low.
Psychological recovery methods
Psychological techniques
It is not surprising that in recent years the importance of
psychological skills training (PST) has increased consid-
erably and has been used to maximize the recovery pro-
cess and enhance performance.151 These psychosocial
skills include imagery, relaxation techniques, goal setting,
self-talk and motivation.152 It has been demonstrated that
psychological aspects are related to the recovery process
in CS athletes.151 The relevance of such psychological as-
pects of CS athletes in certain phases of the competitive
period must be established on future research. Weight cut-
ting and subsequent recovery before the start of the main
competitive period has been shown to produce substantial
changes to the mood state, although these changes seem
to be independent to the body mass oscillations.153 An-
drato et al.,154 indicated that the athletes presented a high
average level of anxiety before the competition and this
could inuence performance. The scientic literature in
the mental area of CS is scarce and inconclusive. Based
on this afrmation, CS athletes should have the ability to
identify when and how they need to apply PST to maxi-
mize performance. More research is needed regarding this
topic.
The timings observed were the ones after, during and
before training and competition and the level of recom-
mendation was low.
From a practical point of view, it must be considered
that research around recovery is a relatively new area for
sport scientists. Many of the current recommendations
are only general guidelines and disagreement may exist
regarding their application. Despite this, the current manu-
script attempts to provide useful information for real ap-
plications in the CS eld. Future research should explore
important key points such as the potential effects of the
combination of different recovery methods and their ef-
fects in the CS eld.
clusion has been found regarding the relationship between
stretching and recovery.138 In a recent review, Barbosa et
al., reported that caution is needed when prescribing SS to
improve performance or to prevent injuries due to nega-
tive effect on the eccentric torque of exor joints.139 De-
spite this possible negative effect on muscle effectiveness,
there is evidence that the SS is good recovery strategy post
competition by reducing viscoelastic proprieties of muscle
and decrease stiffness.140 While SS is commonly used un-
der the guise of improving post competition recovery, evi-
dence of its use in Cs is very scarce.141-143
The timings observed was after the training and compe-
tition and the level of recommendation was low.
Hyperbaric oxygen therapy
Hyperbaric oxygen therapy (HOT) is a mode of therapy
that involves working at pressures three to four times
higher than the atmospheric pressure while inhaling pure
oxygen (100%) through a face mask inside a hyperbaric
chamber.144 The HOT promotes rapid recovery of soft tis-
sue, nevertheless, scarce evidence has been published on
its benets.145 To date, numerous professional team sports
(hockey, football, basketball and soccer), usually use the
HOT therapy for numerous sports related injuries.145, 146 To
our knowledge, in Cs eld only one previous study evalu-
ated the effects of HOT for post training recovery in JJ
athletes by measuring hormone concentrations (cortisol/
testosterone), damage markers (creatine kinase) and lac-
tate. The main conclusions determined that HOT did not
inuence the recovery hormonal status, damage markers
or lactate in JJ athletes after sessions of 1 hour and 30 min-
utes.147 There is no evidence to support the usage of HOT
as a recovery therapy in Cs athletes.
The timings observed was after the training and compe-
tition and the level of recommendation was low.
Photobiomodulation therapy
Photobiomodulation therapy (PBT) has emerged as an
effective non-invasive strategy applied before different
types of exercise in which it is combined with low-level
laser therapy and light-emitting diode therapy.148 Nowa-
days, growing evidence supports the use of PBT for per-
formance enhancement and reduction in muscular fatigue
signals.149 One study analyzed the effects on maximal
isometric handgrip strength and blood lactate concentra-
tions after two sets of simulated ghts.40 The ndings sug-
gested that PBT is associated with better strength recovery
between ghts compared to other recovery methods. Op-
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in real-life mixed martial arts competition. Int J Sport Nutr Exerc Metab
2018;27:1–8.
14. Messonnier L, Kristensen M, Juel C, Denis C. Importance of pH regu-
lation and lactate/H+ transport capacity for work production during supra-
maximal exercise in humans. J Appl Physiol (1985) 2007;102:1936–44.
15. Matthews JJ, Stanhope EN, Godwin MS, Holmes ME, Artioli GG.
The magnitude of rapid weight loss and rapid weight gain in combat sport
athletes preparing for competition: a systematic review. Int J Sport Nutr
Exerc Metab 2019;29:441–52.
16. Reale R, Slater G, Burke LM. Acute-weight-loss strategies for com-
bat sports and applications to Olympic success. Int J Sports Physiol Per-
form 2017;12:142–51.
17. Kinsey AW, Ormsbee MJ. The health impact of nighttime eating: old
and new perspectives. Nutrients 2015;7:2648–62.
18. Artioli GG, Iglesias RT, Franchini E, Gualano B, Kashiwagura DB,
Solis MY, et al. Rapid weight loss followed by recovery time does not af-
fect judo-related performance. J Sports Sci 2010;28:21–32.
19. Lin SP, Li CY, Suzuki K, Chang CK, Chou KM, Fang SH. Green tea
consumption after intense taekwondo training enhances salivary defense
factors and antibacterial capacity. PLoS One 2014;9:e87580.
20. de Oliveira GV, Nascimento LA, Volino-Souza M, Mesquita JS, Al-
vares TS. Beetroot-based gel supplementation improves handgrip strength
and forearm muscle O2 saturation but not exercise tolerance and blood
volume in jiu-jitsu athletes. Appl Physiol Nutr Metab 2018;43:920–7.
21. de Oliveira GV, do Nascimento LA, Volino-Souza M, do Couto Vel-
lozo O, Alvares TS. A single oral dose of beetroot-based gel does not im-
prove muscle oxygenation parameters, but speeds up handgrip isomet-
ric strength recovery in recreational combat sports athletes. Biol Sport
2020;37:93–9.
22. Oöpik V, Pääsuke M, Timpmann S, Medijainen L, Ereline J, Gapejeva
J. Effects of creatine supplementation during recovery from rapid body
mass reduction on metabolism and muscle performance capacity in well-
trained wrestlers. J Sports Med Phys Fitness 2002;42:330–9.
23. VAN Cutsem J, Roelands B, Pluym B, Tassignon B, Verschueren JO,
DE Pauw K, et al. Can creatine combat the mental fatigue-associated de-
crease in visuomotor skills? Med Sci Sports Exerc 2020;52:120–30.
24. Chycki J, Kurylas A, Maszczyk A, Golas A, Zajac A. Alkaline water
improves exercise-induced metabolic acidosis and enhances anaerobic ex-
ercise performance in combat sport athletes. PLoS One 2018;13:e0205708.
25. Timpmann S, Burk A, Medijainen L, Tamm M, Kreegipuu K, Vähi
M, et al. Dietary sodium citrate supplementation enhances rehydration
and recovery from rapid body mass loss in trained wrestlers. Appl Physiol
Nutr Metab 2012;37:1028–37.
26. Gough LA, Rimmer S, Sparks SA, McNaughton LR, Higgins MF.
Post-exercise supplementation of sodium bicarbonate improves acid base
balance recovery and subsequent high-intensity boxing specic perfor-
mance. Front Nutr 2019;6:155–62.
27. Franchini E, Brito CJ, Artioli GG. Weight loss in combat sports: phys-
iological, psychological and performance effects. J Int Soc Sports Nutr
2012;9:52–61.
28. Ouergui I, Hammouda O, Chtourou H, Gmada N, Franchini E. Effects
of recovery type after a kickboxing match on blood lactate and perfor-
mance in anaerobic tests. Asian J Sports Med 2014;5:99–107.
29. Ghorbani S, Mohebbi H, Safarimosavi S, Ghasemikaram M. The ef-
fect of different recovery methods on blood lactate removal in wrestlers. J
Sports Med Phys Fitness 2015;55:273–9.
30. Souissi N, Chtourou H, Aloui A, Hammouda O, Dogui M, Chaouachi
A, et al. Effects of time-of-day and partial sleep deprivation on short-
term maximal performances of judo competitors. J Strength Cond Res
2013;27:2473–80.
31. Ben Cheikh R, Latiri I, Dogui M, Ben Saad H. Effects of one-night
sleep deprivation on selective attention and isometric force in adolescent
karate athletes. J Sports Med Phys Fitness 2017;57:752–9.
32. Daaloul H, Souissi N, Davenne D. Effects of napping on alertness,
Conclusions
To optimize CS performance, adequate recovery is re-
quired after ghts. Nevertheless, literature pertaining to
these types of disciplines is limited. Traditional ENS of
consuming CHO and PR combined with the consumption
of supplementation with scientic evidence (i.e., green tea,
beetroot gel, creatine or alkaline water) increases recovery
processes. Other methods of recovery including physical
(water immersion, massage or photobiomodulation) and
physiological (types of recovery, sleep and rest) therapies
have also been shown to be benecial for recovering. In
summary, to the best of our knowledge, the scientic lit-
erature regarding Cs and recovery is scarce and often con-
tradictory.
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Conictsofinterest.—The authors certify that there is no conict of interest with any nancial organization regarding the material discussed in the manuscript.
Authors’ contributions.—All authors conceived the research idea and the framework of this study. All authors have read and approved the nal manuscript.
History.—Article rst published online: October 22, 2020. - Manuscript accepted: October 13, 2020. - Manuscript revised: September 8, 2020. - Manuscript
received: June 7, 2020.
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