ArticlePDF Available

Comparison of Swim Recovery and Muscle Stimulation on Lactate Removal After Sprint Swimming

Authors:

Abstract

Competitive swimming requires multiple bouts of high-intensity exercise, leading to elevated blood lactate. Active exercise recovery has been shown to lower lactate faster than passive resting recovery but may not always be practical. An alternative treatment, electrical muscle stimulation, may have benefits similar to active recovery in lowering blood lactate but to date is unstudied. Therefore, this study compared submaximal swimming and electrical muscle stimulation in reducing blood lactate after sprint swimming. Thirty competitive swimmers (19 men and 11 women) participated in the study. Each subject completed 3 testing sessions consisting of a warm-up swim, a 200-yard maximal frontcrawl sprint, and 1 of 3 20-minute recovery treatments administered in random order. The recovery treatments consisted of a passive resting recovery, a submaximal swimming recovery, or electrical muscle stimulation. Blood lactate was tested at baseline, after the 200-yard sprint, and after 10 and 20 minutes of recovery. A significant interaction (p < 0.05) between recovery treatment and recovery time was observed. Blood lactate levels for the swimming recovery were significantly lower at 10 minutes (3.50 +/- 1.57 mmol.L-1) and 20 minutes (1.60 +/- 0.57 mmol.L-1) of recovery than either of the other 2 treatments. Electrical muscle stimulation led to a lower mean blood lactate (3.12 +/- 1.41 mmol.L-1) after 20 minutes of recovery compared with passive rest (4.11 +/- 1.35 mmol.L-1). Submaximal swimming proved to be most effective at lowering blood lactate, but electrical muscle stimulation also reduced blood lactate 20 minutes postexercise significantly better than resting passive recovery. Electrical muscle stimulation shows promise as an alternate recovery treatment for the purpose of lowering blood lactate.
PubMed:
U.S. National Library of Medicine
National Institutes of Health
Articles about H-Wave
lJ Strength Cond Res. 2009 Dec;23(9):2560-7.
Comparison of swim recovery and muscle stimulation on lactate removal after sprint
swimming.
Neric FB, Beam WC, Brown LE, Wiersma LD.
Exercise Physiology Laboratory, Department of Kinesiology, California State University, Fullerton, Fullerton, California, USA.
Competitive swimming requires multiple bouts of high-intensity exercise, leading to elevated blood lactate. Active
exercise recovery has been shown to lower lactate faster than passive resting recovery but may not always be practical. An
alternative treatment, electrical muscle stimulation, may have benefits similar to active recovery in lowering blood lactate
but to date is unstudied. Therefore, this study compared submaximal swimming and electrical muscle stimulation in
reducing blood lactate after sprint swimming. Thirty competitive swimmers (19 men and 11 women) participated in the
study. Each subject completed 3 testing sessions consisting of a warm-up swim, a 200-yard maximal frontcrawl sprint,
and 1 of 3 20-minute recovery treatments administered in random order. The recovery treatments consisted of a passive
resting recovery, a submaximal swimming recovery, or electrical muscle stimulation. Blood lactate was tested at baseline,
after the 200-yard sprint, and after 10 and 20 minutes of recovery. A significant interaction (p < 0.05) between recovery
treatment and recovery time was observed. Blood lactate levels for the swimming recovery were significantly lower at 10
minutes (3.50 +/- 1.57 mmol.L-1) and 20 minutes (1.60 +/- 0.57 mmol.L-1) of recovery than either of the other 2
treatments. Electrical muscle stimulation led to a lower mean blood lactate (3.12 +/- 1.41 mmol.L-1) after 20 minutes of
recovery compared with passive rest (4.11 +/- 1.35 mmol.L-1). Submaximal swimming proved to be most effective at
lowering blood lactate, but electrical muscle stimulation also reduced blood lactate 20 minutes postexercise significantly
better than resting passive recovery. Electrical muscle stimulation shows promise as an alternate recovery treatment for
the purpose of lowering blood lactate.
PMID: 19910818 [PubMed - in process]
BMC Musculoskelet Disord. 2009 Oct 29;10:132.
Repetitive H-Wave device stimulation and program induces significant increases in the
range of motion of post operative rotator cuff reconstruction in a double-blinded
randomized placebo controlled human study.
Blum K, Chen AL, Chen TJ, Waite RL, Downs BW, Braverman ER, Kerner MM, Savarimuthu SM, DiNubile N.
Department of Physiology & Pharmacology, Wake Forest University School of Medicine, Winston -Salem, North Carolina, USA.
drd2gene@aol.com
BACKGROUND: Albeit other prospective randomized controlled clinical trials on H-Wave Device Stimulation (HWDS),
this is the first randomized double-blind Placebo controlled prospective study that assessed the effects of HWDS on range
of motion and strength testing in patients who underwent rotator cuff reconstruction. METHODS: Twenty-two patients
were randomly assigned into one of two groups: 1) H-Wave device stimulation (HWDS); 2) Sham-Placebo Device
(PLACEBO). All groups received the same postoperative dressing and the same device treatment instructions. Group I
was given HWDS which they were to utilize for one hour twice a day for 90 days postoperatively. Group II was given the
same instructions with a Placebo device (PLACEBO). Range of motion was assessed by using one-way ANOVA with a
Duncan Multiple Range Test for differences between the groups preoperatively, 45 days postoperatively, and 90 days
postoperatively by using an active/passive scale for five basic ranges of motions: Forward Elevation, External Rotation
(arm at side), External Rotation (arm at 90 degrees abduction), Internal Rotation (arm at side), and Internal Rotation (arm
at 90 degrees abduction). The study also evaluated postoperative changes in strength by using the Medical Research
Council (MRC) grade assessed strength testing. RESULTS: Patients who received HWDS compared to PLACEBO
demonstrated, on average, significantly improved range of motion. Results confirm a significant difference for external
rotation at 45 and 90 days postoperatively; active range at 45 days postoperatively (p = 0.007), active at 90 days
postoperatively (p = 0.007). Internal rotation also demonstrated significant improvement compared to PLACEBO at 45
and 90 days postoperatively; active range at 45 days postoperatively (p = 0.007), and active range at 90 days
postoperatively (p = 0.006). There was no significant difference between the two groups for strength testing.
CONCLUSION: HWDS compared to PLACEBO induces a significant increase in range of motion in positive
management of rotator cuff reconstruction, supporting other previous research on HWDS and improvement in function.
Interpretation of this preliminary investigation while suggestive of significant increases in Range of Motion of Post -
Operative Rotator Cuff Reconstruction, warrants further confirmation in a larger double-blinded sham controlled
randomized study.
PMID: 19874593 [PubMed - in process]
J Orthop Res. 2009 Sep;27(9):1248-51.
H-Wave induces arteriolar vasodilation in rat striated muscle via nitric oxide-mediated
mechanisms.
Smith TL, Blum K, Callahan MF, DiNubile NA, Chen TJ, Waite RL.
Department of Orthopedic Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157-1070, USA.
tsmith@wfubmc.edu
H-Wave electrical device stimulation (HWDS) is used clinically to expedite recovery from soft tissue injuries. We
hypothesized that HWDS induces arteriolar dilation, a mechanism involved in the healing process. Acute effects of
HWDS on striated muscle arteriolar diameters were studied. Arteriolar diameters were measured in the cremaster muscle
of 57 male anesthetized rats using intravital microscopy before and after HWDS or sham stimulation (SS) at 1 or 2 Hz for
periods of 30-60 min. In a separate cohort, the role of nitric oxide (NO) in the response to HWDS was assessed by
blocking NO synthase using topical L-NAME at 10(-5) M. Maximal arteriolar responses to stimulation were compared to
prestimulation diameters. HWDS both at 1 and 2 Hz resulted in significant arteriolar vasodilation (p < 0.05). The
arterioles in SS animals demonstrated no changes in diameter. Similarly, microvascular diameters did not change with
HWDS following blockade of NO production. Because of Poiseuille's Law, the significant arteriolar dilation induced by
HWDS would translate into increases in blood flow of 26-62%. In addition, lack of arteriolar dilation following HWDS
with blockade of NO production suggests that NO plays a role in the microvascular response to HWDS. These studies
suggest that arteriolar vasodilation accompanying HWDS may result in increased perfusion, contributing to the observed
therapeutic effects of HWDS. (c) 2009 Orthopaedic Research Society.
PMID: 19204915 [PubMed - indexed for MEDLINE]
Phys Sportsmed. 2008 Dec;36(1):103-14.
The H-Wave((R)) Device Induces NODependent Augmented Microcirculation and
Angiogenesis, Providing Both Analgesia and Tissue Healing in Sports Injuries.
Blum K, Ho CK, Chen AL, Fulton M, Fulton B, Westcott WL, Reinl G, Braverman ER, Dinubile N, Chen TJ.
Department of Physiology and Pharmacology, Wake Forest University School of Medicine, Winston Salem, NC, 27157, USA. drd2gene@aol.com.
The hypothesis that the H-Wave(R) device (Electronic Waveform Lab, Inc., Huntington Beach, CA), a small-diameter
fiber stimulator, is a paradigm shift of electrotherapeutic treatment of pain associated with human neuropathies and sports
injuries is based on a number of its properties. The primary effect of H-Wave(R) device stimulation (HWDS) is the
stimulation of "red-slow-twitch" skeletal muscle fibers. The authors propose, based on the unique waveform, that the H-
Wave(R) device specifically and directly stimulates the small smooth muscle fibers within the lymphatic vessels
ultimately leading to fluid shifts and reduced edema. In unpublished rat studies, it has been observed that HWDS induces
protein clearance. The H-Wave(R) device was designed to stimulate an ultra low frequency (1-2 Hz), low tension,
nontetanizing, and nonfatiguing contraction, which closely mimics voluntary or natural muscle contractions. The H-
Wave(R) device can stimulate small fibers due in part to its exponentially decaying waveform and constant current
generator activity. The main advantage of these technologies over currently applied electrical stimulators (eg,
transcutaneous electrical nerve stimulator [TENS], interferential [IF], neuromuscular electrical stimulation [NMES], high-
volt galvanic, etc.) is that H-Wave\'s(R) small fiber contraction does not trigger an activation of the motor nerves of the
large white muscle fibers or the sensory delta and C pain nerve fibers, thus eliminating the negative and painful effects of
tetanizing fatigue, which reduces transcapillary fluid shifts. Another function of the H-Wave(R) device is an anesthetic
effect on pain conditions, unlike a TENS unit which in the short term activates a hypersensory overload effect (gate
theory) to stop pain signals from reaching the thalamic region of the brain. When the H-Wave(R) device is used at high
frequency (60 Hz), it acts intrinsically on the nerve to deactivate the sodium pump within the nerve fiber, leading to a
long-lasting anesthetic/analgesic effect due to an accumulative postsynaptic depression. Moreover, HWDS produces a
nitric oxide (NO)-dependent enhancement of microcirculation and angiogenesis in rats. Thus, the authors hypothesize that
because of these innate properties of the H-Wave(R) device, it may provide a paradigm shift for the treatment of both
short- and long-term inflammatory conditions associated with pain due to sports injuries. A recent meta-analysis found a
moderate-to-strong effect of the H-Wave(R) device in providing pain relief, reducing the requirement for pain medication,
and increasing functionality. The most robust effect was observed for improved functionality, suggesting that the H-
Wave(R) device may facilitate a quicker return to the field. Keywords: H-Wave(R) device; sportsmedicine, nitric oxide-
dependent blood flow; analgesia; angiogenesis.
PMID: 20048478 [PubMed - in process]
Adv Ther. 2008 Jul;25(7):644-57.
The H-Wave device is an effective and safe non-pharmacological analgesic for chronic
pain: a meta-analysis.
Blum K, Chen AL, Chen TJ, Prihoda TJ, Schoolfield J, DiNubile N, Waite RL, Arcuri V, Kerner M, Braverman ER, Rhoades P, Tung H.
Department of Physiology and Pharmacology, Wake Forest University, School of Medicine, Winston-Salem, North Carolina 27157, USA.
drd2gene@aol.com
INTRODUCTION: This meta-analysis was conducted to systematically review the efficacy and safety of the H-Wave
(Electronic Waveform Lab, Inc, Huntington Beach, CA, USA) device and programme as a non-pharmacological analgesic
treatment in chronic soft tissue inflammation and neuropathic pain. METHODS: Five studies related to pain relief,
reduction in pain medication and increased functionality obtained with the H-Wave device were included in the analysis.
Data were analysed using the random effects model, including adjustment to evaluate variability, size of study and bias in
effect size. A total of 6535 participants were included in the meta-analysis; there were 8065 participants' outcomes
measured due to multiple measurements per participant. RESULTS: The H-Wave device decreased pain ratings across
various chronic soft tissue inflammation and neuropathic pain conditions. The mean weighted effect size was 0.59, and
the estimated effect size variance was 0.00003 (95% confidence intervals [CI]: 0.580, 0.600). The H-Wave device also
decreased the intake of pain medication in patients with various chronic soft tissue inflammation and neuropathic pain
conditions. The mean weighted effect size was 0.56, and the estimated effect size variance was 0.000013 (95% CI: 0.553,
0.567). Patient functionality was also improved with use of the H-Wave device. The mean weighted effect size was 0.70,
and the estimated effect size variance was 0.00002 (95% CI: 0.691, 0.709). A chi-square test for homogeneous effect sizes
found highly significant (P<0.00001) variability, indicating a robust significant effect size for increased functionality
relative to both pain relief and reduction in pain medication. There was little to no evidence of any adverse effects
associated with the use of the H-Wave device. CONCLUSION: The findings indicate a moderate to strong effect of the H-
Wave device in providing pain relief, reducing the requirement for pain medication and increasing functionality. The most
robust effect was observed for improved functionality, suggesting that the H-Wave device may facilitate a quicker return
to work and other related daily activities.
PMID: 18636234 [PubMed - indexed for MEDLINE]
Adv Ther. 2006 Sep-Oct;23(5):739-49.
The H-Wave small muscle fiber stimulator, a nonpharmacologic alternative for the
treatment of chronic soft-tissue injury and neuropathic pain: an extended population
observational study.
Blum K, Chen TJ, Martinez-Pons M, Dinubile NA, Waite RL, Schoolfield J, Blum SH, Mengucci J, Downs BW, Meshkin B.
Department of Physiology and Pharmacology, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157, USA.
In a previous study, the H-Wave small-muscle fiber stimulator significantly reduced chronic pain and restored physical
function among patients with pain in the lower and upper extremities and spine. In this extended population observational
study, a cross-sectional,computer-administered 10-item survey was administered to 6774 patients (3367 men [49.7%],
3406 women [50.3%], and 1 sex not reported [<1%]; mean+/-SD age, 45.28+/-10.08 y; range, 18-65 y) with chronic soft-
tissue injury or neuropathic pain to assess their therapeutic response. The mean+/-SE duration of self-administered H-
Wave treatment before the survey was completed was 87.35+/-1.39 d. Sixty-five percent of study participants reported a
reduced or eliminated need for pain medication; 79% reported improved functional capacity or activity; and 78% reported
25% or greater reduction of pain. This cross-sectional evaluation represents the largest outcome study on the benefits of
the H-Wave device in patients with chronic soft-tissue injury or neuropathic pain. The results suggest that this
nonpharmacologic approach may provide an important alternative to standard pharmacologic treatment.
PMID: 17142209 [PubMed - indexed for MEDLINE]
Adv Ther. 2006 May-Jun;23(3):446-55.
H-Wave, a nonpharmacologic alternative for the treatment of patients with chronic soft
tissue inflammation and neuropathic pain: a preliminary statistical outcome study.
Blum K, DiNubile NA, Tekten T, Chen TJ, Waite RL, Schoolfield J, Martinez-Pons M, Callahan MF, Smith TL, Mengucci J, Blum SH, Meshkin B.
Department of Physiology and Pharmacology, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA.
The burden of chronic soft tissue inflammation and neuropathic pain on individuals and society is substantial. This study
was conducted to evaluate the H-wave device--an innovative form of treatment for chronic pain and inflammation--in
patients with persistent pain associated with injuries or conditions affecting the upper or lower extremities or the back.
Patients with at least moderate pain despite conventional therapy were included in a systematic survey after they had been
given 2 to 6 wk of treatment with the H-wave device. Measures of improvement involved the proportion of patients with
diminished medication requirements, improved function, or pain relief greater than 25%. More than 60% of patients with
pain in the lower extremities, upper extremities, or back experienced pain relief exceeding 25%. The proportion of
patients whose function improved and who were able to perform a new activity was consistently greater than 50% across
the 3 anatomic subgroups. More than 40% of patients in each group were able to reduce or completely eliminate the use of
pain medications. These benefits of treatment were independent of the type of pain therapy administered previously. In
each anatomic subgroup, the proportion of patients who reported improvement on more than 1 of the 3 endpoints was
significantly higher than the expected response to placebo therapy (P<.001). Results suggest that the H-wave device
provided important benefits to patients with chronic soft tissue inflammation and neuropathic pain.
PMID: 16912027 [PubMed - indexed for MEDLINE]
Diabetes Technol Ther. 1999 Spring;1(1):77-80.
Transcutaneous electrostimulation: emerging treatment for diabetic neuropathic pain.
Alvaro M, Kumar D, Julka IS.
California College of Podiatric Medicine, San Francisco, California, USA.
Diabetes Technol Ther. 1999 Spring;1(1):81-3.
Three independent studies utilizing transcutaneous electrical nerve stimulation to relieve diabetic peripheral neuropathic
pain were reviewed. The proprietary equipment, an H-wave machine, administered all electrotherapy. The first two
studies assessed the efficacy of electrotherapy alone and electrotherapy with amitriptyline. The treated electrotherapy
group reported an overall greater reduction of symptoms, 52% with 2-3 weeks of active treatment. Amitriptyline alone
produced a 26% reduction of pain after 4 weeks. The addition of active electrotherapy to amitriptyline produced a 66%
reduction of pain. The final study looked at patients who have utilized electrotherapy for over one year. A reported 44%
improvement of symptoms was attained with continuous electrotherapy treatment. The data also suggested that a
maintenance treatment protocol for long-term pain relief would have to be developed.
PMID: 11475308 [PubMed - indexed for MEDLINE]
Diabetes Care. 1998 Aug;21(8):1322-5.
Diabetic peripheral neuropathy. Effectiveness of electrotherapy and amitriptyline for
symptomatic relief.
Kumar D, Alvaro MS, Julka IS, Marshall HJ.
Department of Medicine, Los Angeles County University of Southern California Medical Center 90033, USA.
OBJECTIVE: To evaluate the efficacy of combining electrotherapy with amitriptyline for the management of chronic
painful peripheral neuropathy in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS: Patients (n = 26)
with peripheral neuropathy were treated with amitriptyline. After 4 weeks, those patients (n = 23) who failed to respond to
amitriptyline or who only had partial relief were randomized between a sham treatment group (control) or an
electrotherapy group. Transcutaneous electrotherapy was given for 12 weeks by a portable unit (H-wave machine) that
generated a biphasic exponentially decaying waveform (pulse width 4 ms, 25-35 V, > or = 2 Hz). The degree of pain and
discomfort was graded on a scale of 0-5. An analog scale was used to record the overall change in symptoms. RESULTS:
Amitriptyline produced some degree of symptomatic relief in 15 (60%) of the 26 patients by the 4th week; pain scores
decreased from 3.8 +/- 0.1 to 2.9 +/- 0.2 (P < 0.1) and the overall reduction in pain was 26 +/- 5% on an analog scale. In
the amitriptyline plus sham treatment group (n = 9), pain scores declined from 2.8 +/- 0.3 to 1.9 +/- 0.5 (P < 0.03) and the
overall reduction in pain was 55 +/- 12%, suggesting a procedure-related placebo effect. In the group receiving combined
electrotherapy and amitriptyline (n = 14), symptomatic improvement occurred in 12 (85%) patients. Five (36%) of the
patients in this group became asymptomatic. Pain scores declined from 3.2 +/- 0.2 to 1.4 +/- 0.4 (P < 0.01) and the overall
reduction in pain was 66 +/- 10%. The degree of reduction in pain scores and the incremental relief (above the
amitriptyline effect) were significantly greater (P < 0.03) with electrotherapy as compared with sham treatment. The
outcomes indicate a substantial beneficial effect of electrotherapy over and above any placebo influence.
CONCLUSIONS: Our clinical observations suggest that transcutaneous electrotherapy is effective in reducing the pain
associated with peripheral neuropathy. This form of therapy may be a useful adjunctive modality when it is combined
with a pharmacological agent, such as amitriptyline, to augment symptomatic relief.
PMID: 9702441 [PubMed - indexed for MEDLINE]
J Foot Ankle Surg. 1998 May-Jun;37(3):191-4.
Beneficial effects of electrical stimulation on neuropathic symptoms in diabetes patients.
Julka IS, Alvaro M, Kumar D.
Department of Medicine, Los Angeles County University of Southern California Medical Center, University of Southern California School of
Medicine 90033, USA.
Transcutaneous electrical nerve stimulation is utilized for relieving pain in the diabetes peripheral neuropathy. Previous
studies were short-term and did not document sustained beneficial effects. In this study, the authors evaluated long-term
effectiveness of electrotherapy administered by proprietary equipment, an H-wave machine. A detailed questionnaire
concerning patients' symptoms prior to and following electrotherapy was mailed to the users of H-wave machine. The
responses of 34 individuals who had diabetes mellitus were analyzed (age 74.1 +/- 1.6 SEM years, body mass index 28.5
+/- 0.8 kg/m2, duration of diabetes 15.8 +/- 2.0 years and duration of neuropathic symptoms 8.0 +/- 1.8 years). Telephone
interviews were conducted with 20 additional diabetes patients selected randomly from the persons who did not return the
questionnaire. Forty-one (76%) patients reported a 44.0 +/- 4.0% subjective improvement in their neuropathic pain. The
overall improvement in pain was also significant on an analog scale of 10 (p < .01), and correlated well with the percent
amelioration data (r2 = .65). These data suggest an effectiveness of electrotherapy in managing neuropathic pain as an
adjunct to the analgesics. It appears to provide continued benefit as the responders have used this nonpharmacological
treatment modality for an average period of 1.7 +/- 0.3 years.
PMID: 9638542 [PubMed - indexed for MEDLINE]
Diabetes Care. 1997 Nov;20(11):1702-5.
Diabetic peripheral neuropathy: amelioration of pain with transcutaneous
electrostimulation.
Kumar D, Marshall HJ.
Department of Medicine, Los Angeles County University of Southern California Medical Center 90033, USA.
OBJECTIVE: To evaluate the efficacy of transcutaneous electrotherapy for chronic painful peripheral neuropathy in
patients with type 2 diabetes. RESEARCH DESIGN AND METHODS: Thirty-one patients with symptoms and signs of
peripheral neuropathy were randomized to the electrotherapy or sham treatment (control) group. The electrostimulation
was given by a portable unit (H-Wave machine) than generated a biphasic, exponentially decaying waveform (pulse width
4 ms, 25-35 V, > or = 2 Hz). Patients treated each of their lower extremities for 30 min daily for 4 weeks at home. Nine
patients from the sham-treatment group participated for a second period, during which all of them received the active
electrotherapy. Patient's degree of pain and discomfort was graded on a scale of 0 to 5. RESULTS: In the sham-treated
group (n = 13), the neuropathic symptoms improved in five (38%) patients, and the pain score declined from 2.92 +/- 0.13
to 2.38 +/- 0.26 (P < 0.04), suggesting a procedure-related placebo effect. In the electrotherapy group (n = 18),
symptomatic improvement was seen in 15 (83%) cases, 3 of which were completely asymptomatic; the pain score
declined from 3.17 +/- 0.12 to 1.44 +/- 0.25 (P < 0.01) and the posttreatment pain scores were considerably lower (P <
0.03), indicating a substantial treatment effect over and above any placebo influence. Patients in the electrotherapy group
reported greater reduction in symptoms (52 +/- 7% vs. 27 +/- 10% in control subjects, P < 0.05) on an analog scale.
Moreover, the electrotherapy decreased pain scores (from 3.0 +/- 0.62 to 1.56 +/- 0.32, P < 0.02) in nine patients who had
received sham treatment earlier. CONCLUSIONS: A form of transcutaneous electrotherapy ameliorated the pain and
discomfort associated with peripheral neuropathy. This novel modality offers a potential non-pharmacological treatment
option.
PMID: 9353612 [PubMed - indexed for MEDLINE]
Submitted for Publication
Cases Journal (accepted … publication date pending)
Healing enhancement of chronic venous stasis ulcers utilizing h-wave® device therapy: a
case series
Kenneth Blum1, 4, 6, 7,9*, Amanda LH Chen 2, Thomas JH Chen 3, B William Downs 4, Eric R Braverman 5, 6 , Mallory Kerner 6, Stella
Savarimuthu,6Anish Bajaj,6 Margaret Madigan 7, Seth H Blum 7, Gary Reinl 8, John Giordano,9 Nicholas DiNubile 10
Addresses:
1Department of Psychiatry, University of Florida College of Medicine, Gainesville, Fl. USA, ,2Engineering & Management of Advanced
Technology, Chang Jung University, Taiwan, Republic of China, 3 Department of Occupation Health and Safety, Chang Jung University, Taiwan,
Republic of China, 4 Department of Nutrigenomics, LifeGen, Inc. La Jolla, CA, USA, 5 Department of Neurosurgery, Weill Cornel School of
Medicine, New York, NY, USA, 6 Department of Clinical Research, Path Research Foundation, New York, NY USA, 7 Department of Personalized
Medicine, Synaptamine, Inc. San Antonio, Texas, USA, 8Nautilus, Inc. Vancouver, WA, USA, 9Department of Holistic Medicine, G&G Holistic
Addiction Treatment Center (Pain Track) North Miami Beach, Florida, USA, 10Department of Orthopedic Surgery, Hospital of the University of
Pennsylvania, Philadelphia, PA, USA
KB*: Drd2gene@aol.com
Abstract
Approximately 15% (more than 2 million individuals, based on these estimates) of all people with diabetes will develop a
lower-extremity ulcer during the course of the disease. Ultimately, between 14% and 20% of patients with lower-
extremity diabetic ulcers will require amputation of the affected limb. Analysis of the 1995 Medicare claims revealed that
lower-extremity ulcer care accounted for $1.45 billion in Medicare costs. Therapies that promote rapid and complete
healing and reduce the need for expensive surgical procedures would impact these costs substantially. One such example
is the electrotherapeutic modality utilizing the H-Wave® device therapy and program.
It has been recently shown in acute animal experiments that the H-Wave device stimulation induces a nitric oxide-
dependent increase in microcirculation of the rat Cremaster skeletal muscle. Moreover, chronic H-Wave device
stimulation of rat hind limbs not only increases blood flow but induces measured angiogenesis. Coupling these findings
strongly suggests that H-Wave device stimulation promotes rapid and complete healing without need of expensive
surgical procedures.
Hospital Practice (in final review)
H-Wave Device® Augments Healing by Inducing Cellular Mechanisms Responsible For
Increased Blood Flow and Loading of Injured Tissue: A hypothesis Having implications
for Clinical Practice.
Kenneth Bluma,b.f,g,I,n, Thomas JH Chenb, Gary Reinlc, Amanda LH Chend, Nicholas DiNubilee, Margaret Madiganf, B. William Downsg, Abdalla
Bowirrath, Anish BajajI Siohban Morsej, John Giordanok, Wayne Westcottl, Leonard Smithm, Mallory Kerner,n Uma Damlen and Eric R.
Braverman,n,m.
aDepartment of Psychiatry, University of Florida, College of Medicine & McKnight Brain Institute , Gainesville, Florida, USA. b Department of
Health and Occupational Safety ,Chang Jung Christian University, Taiwan, Republic of China cNautilus Inc., Vancouver, WA d Department of
Advanced Engineering , Chang Jung Christian University, Taiwan, Republic of China e Department of Orthopedic Surgery, Hospital of the University
of Pennsylvania, Philadelphia, Pennsylvania . f Department of Molecular Nutrition, Synaptamine, Inc. San Diego, California. g Department of
Nutrigenomics and Personalized Medicine, LifeGen, Inc, San Diego, California h Clinical Neuroscience and Population Genetics, Ziv Government
Medical Center, Safed, Israel, I Department of Executive Health, Path Research Foundation NY, New York, New York. j Department of Holistic
Rehabilitation, National Institute of holistic Studies, North Miami Beach, Florida jk Department of Holistic Medicine and Pain Track, , G & G
Holistic Addiction Treatment Center, North Miami Beach, Florida ll Department of Exercise Science, Quincy College, Quincy, Massachusetts m
Department of Surgery, University of Miami School of Medicine, Miami, Florida., nDepartment of Neurological Surgery, Weil Cornel College of
Medicine, New York, New York., oPath Research Foundation NY, New York, Ne w Yo rk
S U M M A R Y
The hypothesis is that the H-Wave ® device (Electronic Waveform Lab, Inc., Huntington Beach, CA) a small diameter
fiber stimulator, is a paradigm shift in electrotherapeutic treatment used to augment tissue healing associated with human
neuropathies and injuries. Its effect is based on known cellular mechanisms, which increase blood flow and loading of
injured loci. The primary effect of H-Wave ® device stimulation (HWDS) is the stimulation of “red slow-twitch” skeletal
muscle fibers. We are proposing that HWDS directly stimulates the smooth muscle fibers within the lymphatic vessels.
This leads to reduced edema, the induction of nitrous oxide (NO)-dependent augmented microcirculation and
angiogenesis. It is further hypothesized that these cellular mechanisms coupled with the unique ability of HWDS to load
healing injured muscle tissue by inducing small muscle contraction will lead to accelerated healing. Since unlike others
(TENS, IF, NMES etc) the device does not trigger an activation of the motor nerves of large white muscle fibers or the
sensory delta and C pain nerve fibers. Thus, the negative and painful effects of tetanizing fatigue, which reduces trans-
capillary fluid shifts are eliminated and healing is accelerated. Accordingly clinical scientists correctly suggest that
patients with musculoskeletal injuries and those who have recently undergone surgery should be treated with controlled
physical activity that loads their healing tissues. Once a decision to introduce activity that loads the healing tissue is made,
techniques that help calm irritated muscles and nerves and/or around the healing tissue like: lymphatic massage,
accupressure, trigger point release, muscle activation (i.e. ankle pumps, non-tetanizing powered muscle stimulation) will
assist in this process. The H-Wave ® device was designed using a unique waveform, to stimulate an ultra low frequency
(1-2Hz), low tension, non-tetanizing and non-fatiguing contraction, which closely mimics voluntary muscle contractions.
In support of the beneficial outcome of HWDS a recent meta-analysis found a moderateto-strong-positive effect of the
H-Wave ® device in providing pain relief, reducing requirement for pain medication, and increasing functionality. The
most robust effect observed was for improved functionality, suggesting that HWDS may facilitate a quicker return to work
and thus warrants further intense investigation. In agreement with Buckwalter and Grodzinsky [1] and others, the
promotion of healing of bone, fibrous tissue and muscle should include consideration of the effects of loading on tissue
repair and remodeling. Utilizing controlled intensity the HWDS approach provides the basis for early induction of loading
potentially even before the repair process occurs. In this hypothesis we intend to show the relevance of loading derived
from HWDS (repetitive muscle contractions) coupled with increased blood flow (increased perfusion due to NO and
angiogenesis) as an important electrotherapeutic approach to treat musculoskeletal disorders, tissue and sports injuries,
neuropathies and for enhancement of overall performance.
Hypothesis
H-wave® electrical device stimulation (HWDS) is used clinically to expedite recovery from soft tissue injuries. The
process of healing tissues involves many factors predominantly: (a) Loading of bone, fibrous tissue and muscle; (b) Nitric
–oxide dependent increase in blood flow (c) increased formation of new blood vessels or angiogenesis and (d) increase in
protein clearance at injured loci. While loading in by itself may promote healing through these known elements and the
loading of injured tissue seems parsimonious (when the injury reaches stability), we hypothesize that since HWDS
accomplishes all of these required healing elements, it may become a frontline approach to promote soft tissue healing.
Support of this hypothesis, albeit the need for more intensive research, is derived from both animal and human studies
delineated in this hypothesis article. It is further hypothesized that genotyping for certain genetic antecedents for pain and
tissue healing may significantly increase positive outcomes (e. g. mu-opioid receptor, dopamine D2 receptor, TNF-alpha,
interluekens and eNOs) of the utilization of the HWDS [see schematic figure 1].
©2010 Hospital Practice. All rights reserved
... 11 As blood lactate accumulates within muscles, there is a decrease in pH. 12 This low pH within the muscle can impair motor control during pitching, thereby increasing the risk of injury. 12 Given this information, recovery following vigorous physical activity such as pitching in a competition is of utmost importance. ...
... 11 As blood lactate accumulates within muscles, there is a decrease in pH. 12 This low pH within the muscle can impair motor control during pitching, thereby increasing the risk of injury. 12 Given this information, recovery following vigorous physical activity such as pitching in a competition is of utmost importance. Recovery becomes a more significant concern when working with highlevel baseball leagues, where there may be fewer rest days and instances in which pitchers may compete more than once in 24 hours. ...
... Previous research on determining the best method for lactate removal in pitchers has focused primarily on comparing passive rest to physical activity. 11,12 Within the study, the researchers assessed the effect of electrical stimulation performed on the anterior and posterior deltoid muscle on lactate removal when compared to active or passive recovery. 11 These studies showed mixed results, but all previously reviewed studies have shown that increasing blood flow may assist with restoring normal pH levels, mitigating some of the deleterious effects of muscle fatigue. ...
... Fatigue has also been viewed as either central fatigue, where the central nervous system (CNS) stops the muscle from exerting extraordinary effort to protect the muscle from injury, or peripheral fatigue, where the muscles homeostasis has been disturbed due to physical muscle damage and biochemical changes [10]. In swimming the level of BLa can be as high as 12.6 mmol/L -1 [11], [12] and the main problem with lactate increase and the subsequent accumulation is the prevention of muscle contraction [13]. The increase of BLa leads to the increase in hydrogen ions which as a result increases the level of Adenosine diphosphate (ADP) and impairs the function of the muscle by creating a sodiumpotassium-ATPase (Na-K-ATPase) imbalance [12]. ...
... In swimming the level of BLa can be as high as 12.6 mmol/L -1 [11], [12] and the main problem with lactate increase and the subsequent accumulation is the prevention of muscle contraction [13]. The increase of BLa leads to the increase in hydrogen ions which as a result increases the level of Adenosine diphosphate (ADP) and impairs the function of the muscle by creating a sodiumpotassium-ATPase (Na-K-ATPase) imbalance [12]. Apart from this direct impact to performance, the increase in lactate and hydrogen ions inhibit the rate-limiting enzymes phosphofructokinase (PFK) and lactate dehydrogenase of glycolysis [12], thus affecting the subsequent high intensity exercise (sprint) bout. ...
... The increase of BLa leads to the increase in hydrogen ions which as a result increases the level of Adenosine diphosphate (ADP) and impairs the function of the muscle by creating a sodiumpotassium-ATPase (Na-K-ATPase) imbalance [12]. Apart from this direct impact to performance, the increase in lactate and hydrogen ions inhibit the rate-limiting enzymes phosphofructokinase (PFK) and lactate dehydrogenase of glycolysis [12], thus affecting the subsequent high intensity exercise (sprint) bout. However, it is debatable whether lactate alone can be attributed to the onset of fatigue [14], but it is used widely as an indicator of fatigue. ...
Article
Full-text available
This study recognizes the effectiveness of cold-water immersion recovery post short-term exhaustive exercise. The purpose of this study was to understand if 16-20 °C of cold-water immersion would be beneficial in a tropical environment to achieve an optimal recovery in sprint swim performance in comparison to 10-15 °C of water immersion. Two 100 m-sprint swim performance times were measured along with blood lactate (BLa), heart rate (HR) and rate of perceived exertion (RPE) in a 25 m swimming pool with full body head out horizontal water immersions of 10-15 °C, 16-20 °C and 29-32 °C (pool temperature) for 10 minutes followed by 5 minutes of seated passive rest outside; in between the two swim performances. Ten well-trained adult swimmers (5 male and 5 female) within the top twenty in the Sri Lankan nationals swimming championships in 100m Butterfly and Freestyle in the years 2020 & 2021 volunteered for this study. One-way ANOVA analysis (p < 0.05) suggested performance time, BLa and HR had no significant differences between the three conditions after the second sprint, however RPE was significantly different with p = 0.034 between 10-15 °C and 16-20 °C immersion conditions. The study suggested that the recovery post the two cold-water immersion conditions were similar in terms of performance and physiological factors however the 16-20 °C temperature had a better “feel good” factor post sprint 2. Further study is recommended as there was participant bias with the swimmers not reaching optimal levels in sprint 1. Therefore, they might have been possibly fully recovered before sprint 2 invalidating the physiological effect of recovery.
... Fatigue has also been viewed as either central fatigue, where the central nervous system (CNS) stops the muscle from exerting extraordinary effort to protect the muscle from injury, or peripheral, where the muscles homeostasis has been disturbed due to physical muscle damage and biochemical changes [10]. In swimming the level of BLa can be as high as 12.6mmol/L-1 [11], [12] and the main problem with lactate increase and the subsequent accumulation is the prevention of muscle contraction [13]. The increase of Bla leads to the increase in hydrogen ions which as a result increase the level of Adenosine diphosphate (ADP) and impairs the function of the muscle by creating a sodium-potassium-ATPase (Na-K-ATPase) imbalance [12]. ...
... In swimming the level of BLa can be as high as 12.6mmol/L-1 [11], [12] and the main problem with lactate increase and the subsequent accumulation is the prevention of muscle contraction [13]. The increase of Bla leads to the increase in hydrogen ions which as a result increase the level of Adenosine diphosphate (ADP) and impairs the function of the muscle by creating a sodium-potassium-ATPase (Na-K-ATPase) imbalance [12]. Apart from this direct impact to performance, the increase in lactate and hydrogen ions inhibit the rate-limiting enzymes phosphofructokinase (PFK) and lactate dehydrogenase of glycolysis [12], thus affecting the subsequent high intensity exercise (sprint) bout. ...
... The increase of Bla leads to the increase in hydrogen ions which as a result increase the level of Adenosine diphosphate (ADP) and impairs the function of the muscle by creating a sodium-potassium-ATPase (Na-K-ATPase) imbalance [12]. Apart from this direct impact to performance, the increase in lactate and hydrogen ions inhibit the rate-limiting enzymes phosphofructokinase (PFK) and lactate dehydrogenase of glycolysis [12], thus affecting the subsequent high intensity exercise (sprint) bout. However, it is debatable whether lactate alone can be attributed to the onset of fatigue [14], but it is used widely as an indicator of fatigue. ...
Experiment Findings
Full-text available
Objectives: This study recognized the effectiveness of cold-water immersion recovery post short-term exhaustive exercise. The purpose of this study was to understand if 16-20°C of cold-water immersion would be beneficial in a tropical environment to achieve an optimal recovery in sprint swim performance in comparison to 10-15°C of water immersion. Method: Two 100m-sprint swim performance times were measured along with blood lactate (Bla), heart rate (HR) and rate of perceived exertion (RPE) in a 25m swimming pool with full body head out horizontal water immersions of 10-15°C, 16-20°C and 29-32°C (pool temperature) for 10 minutes followed by 5 minutes of minutes of seated passive rest outside; in between the two swim performances. Twelve well-trained adult swimmers (5 male and 5 female) within the top twenty in the Sri Lankan nationals swimming championships in 100m Butterfly and Freestyle in the years 2020 & 2021 volunteered for this study. Results: One-way ANOVA analysis (p<0.05) suggested performance time, Bla and HR had no significant differences between the 3 conditions after the second sprint, however RPE was significantly different with p=0.034 between 10-15°C and 16-20°C immersion conditions. Conclusion: The study suggested that the recovery post the two cold-water immersion conditions were similar in terms of performance and physiological factors however the 16-20°C temperature had a better "feel good" factor post sprint 2. Further study is recommended as there was participant bias with the swimmers not reaching optimal levels in sprint 1. Therefore, they might have been possibly fully recovered before sprint 2 invalidating the physiological effect of recovery.
... In addition to being used as a strength stimulus, NMES has been used as a recovery modality. [12][13][14][15] Low-frequency electrostimulation (2)(3)(4)(5) has been shown to increase lactate clearance subsequent to swimming sprints 13 and decrease creatine kinase concentration (muscle damage biomarker) 3 days after an eccentric exercise-induced muscle damage protocol was performed. 14 However, the low-frequency electrostimulation procedures do not seem to influence voluntary torque production after muscle fatigue 15 delayed onset muscle soreness. ...
... In addition to being used as a strength stimulus, NMES has been used as a recovery modality. [12][13][14][15] Low-frequency electrostimulation (2)(3)(4)(5) has been shown to increase lactate clearance subsequent to swimming sprints 13 and decrease creatine kinase concentration (muscle damage biomarker) 3 days after an eccentric exercise-induced muscle damage protocol was performed. 14 However, the low-frequency electrostimulation procedures do not seem to influence voluntary torque production after muscle fatigue 15 delayed onset muscle soreness. ...
... 14 It has been suggested that the increased lactate clearance following exercise and decreased creatine kinase concentration within the blood after eccentric exerciseinduced muscle damage is because of a reactive hyperemia response subsequent to the NMES procedure. 13,14 In agreement with this reactive hyperemia hypothesis, McNeil et al, 16 using NIRS techniques, demonstrate that NMES contractions result in a higher microvascular blood volume (increased THb response) 1 minute postexercise compared with voluntary contractions. However, it is currently unknown how the THb response reacts postexercise for longer recovery durations (after 1 min of passive recovery) and how the THb response may be affected by different NMES waveforms. ...
Article
Context: When emphasizing muscular strength during postoperative rehabilitation it is recommended to use a neuromuscular electrical stimulation (NMES) waveform that elicits the greatest muscle force and local metabolic demand that is also well tolerated. The present investigation examined the effects that 3 different clinically used NMES waveforms had on the electrically elicited force (EEF), local metabolic demand (exercising muscle oxygen saturation [SmO2]), and the subsequent reactive hyperemia response (recovery total hemoglobin concentration [THb]) of the knee extensors. Design: Single session repeated-measures design. Methods: EEF, local metabolic demand, and reactive hyperemia responses were measured during and subsequent to 3 NMES waveforms: Russian burst modulated alternating current (RUS), biphasic pulsed current (VMS™), and burst modulated biphasic pulsed current (VMS-Burst™). Exercising SmO2 and recovery THb were assessed noninvasively using a near-infrared spectroscopy sensor placed on the vastus lateralis. Participants completed one set of 10 repetitions of each NMES waveform and were provided with 5 minutes of passive, interset recovery. Two-way, repeated-measures analysis of variance examined if NMES waveform or repetition significantly affected (P < .05) EEF or exercising SmO2. Two-way, repeated-measures analysis of variance examined if NMES waveform or recovery time affected recovery THb. Results: VMS™ and VMS-Burst™ yielded higher EEF (F = 11.839, P < .001) and greater local metabolic stress (lower exercising SmO2, F = 13.654, P < .001) compared with RUS. Greater rate of EEF decline throughout the NMES set was observed during RUS (%Δ = -50 [6] %Rep1) compared with VMS-Burst™ (%Δ = -30 [7] %Rep1) and VMS™ (%Δ = -32 [7] %Rep1). VMS™ elicited a higher reactive hyperemia response (higher recovery THb) compared with RUS (F = 3.427, P = .048). Conclusions: The present findings support the use of VMS™ or VMS-Burst™ compared with RUS when promoting muscular strength. In addition, the use of VMS™ might provide a greater blood volume to the target muscle subsequent to NMES contractions compared with RUS.
... To assess varus torque at the medial elbow (Nm) and arm speed (degrees/s), a wearable inertial measurement unit (DriveLine PULSE, DriveLine, Kent, WA) was placed two finger widths below the medial humeral epicondyle of the participant's throwing arm [16]. The inertial measurement unit was housed in either a neoprene sleeve or a fabric strap depending on the participant's preference. ...
... Considering that the largest correlation with normalized varus torque was found with increased mass, it is possible that musculoskeletal and cardiovascular fitness may play a role increased shoulder and elbow injury incidence in pitchers. Previous studies have indicated that increased fatigue and blood lactate levels have the potential to decrease musculoskeletal control during physical activity [16,17]. Decreased fitness may be related to decreased ankle dorsiflexion, thereby providing a causative link to increased risk of elbow and shoulder injuries in pitchers. ...
... Surely, it would be expected to design dedicated recovery protocols for sprinters and for middle-distance swimmers, given that the shorter the event is, the longer a swimmer should cool down (Riewald, 2015). This is because the intensity of the swimming bout determines how high blood lactate concentration will rise (Neric et al., 2009). For these reasons, sprinters can produce higher lactate concentrations than endurance athletes do, needing more time to clear lactate from their bodies (Issurin, 2010). ...
Article
The purpose of this study was to elucidate whether a specific approach regarding active swimming recovery could better promote psycho-physiological recovery right after competing in a high-level swimming race. To achieve this, we recruited 50 national level youth swimmers, randomly and equally assigning them to two groups, named “experimental” and “coach prescribed”. Each group performed a specific post-competition recovery protocol, consisting of different swimming paces, rest times, self-management of the exercises. We gathered data about blood lactate (BL), heart rate (HR), and rate of perceived exertion (RPE) at two different moments, the first moment right after the swimming competition (named post-competition phase), the second moment right after swimming the respective recovery protocol assigned (named post-recovery phase). A mixed MANOVA with Tukey HSD post-hoc analysis revealed no significant differences between the experimental and coach-prescribed groups in BL, HR, and RPE at the post-competition phase. At the post-recovery phase, however, the experimental group presented lower BL levels than the coach-prescribed group (2.40 ± 1.18 vs. 4.29 ± 2.07 mmol/L, p < 0.05). Finally, we found no interaction of swimming race ranking on recovery capacities. We conclude that for immediate improvement of BL in a wide range of high-level swimmers, an efficient recovery protocol should consist of several paces, high volumes, fixed and short rest times, whereas the widely popular self-managed, lower intensity approach does not seem as equally effective. Our study advances the development of novel recommendations for optimizing immediate fatigue management in competitive swimming.
... Thus, it is unclear whether extended blood lactate accumulation by VOLES results from augmented blood lactate production or delayed blood lactate removal in the present study. Interestingly, previous studies that focused on the effect of VOLES on blood lactate removal as an alternative recovery treatment reported that VOLES had a similar effect (Akinci et al. 2020) or was much more effective for lactate removal than passive recovery (Neric et al. 2009).Thus, although the VOLES phase differs between previous studies (post-sprint) and the present study (pre-sprint), we speculate that VOLES augmented blood lactate production rather than impaired lactate removal. ...
Article
Full-text available
Purpose Concentration- and time-dependent effect of lactate on physiological adaptation (i.e., glycolytic adaptation and mitochondrial biogenesis) have been reported. Subtetanic neuromuscular electrical stimulation (NMES) with voluntary exercise (VOLES) can increase blood lactate accumulation. However, whether this is also true that VOLES can enhance the blood lactate accumulation during sprint exercise is unknown. Thus, we investigated whether VOLES before the Wingate test can enhance blood lactate accumulation without compromising Wingate exercise performance. Methods Fifteen healthy young males (mean [SD], age: 23 [4] years, body mass index: 22.0 [2.1] kg/m²) volunteered. After resting measurement, participants performed a 3-min intervention: VOLES (NMES with free-weight cycling) or voluntary cycling alone, which matched exercise intensity with VOLES (VOL, 43.6 [8.0] watt). Then, they performed the Wingate test with 30 min free-weight cycling recovery. The blood lactate concentration ([La]b) was assessed at the end of resting and intervention, and recovery at 1, 3, 5, 10, 20, and 30 min. Results [La]b during intervention was higher with VOLES than VOL (P = 0.011). The increase in [La]b after the Wingate test was maintained for longer with VOLES than VOL at 10- and 20-min recovery (P = 0.014 and 0.023, respectively). Based on the Wingate test, peak power, mean power, and the rate of decline were not significantly different between VOLES and VOL (P = 0.184, 0.201, and 0.483, respectively). Conclusion The combination of subtetanic NMES with voluntary exercise before the Wingate test has the potential to enhance blood lactate accumulation. Importantly, this combined approach does not compromise Wingate exercise performance compared to voluntary exercise alone.
... The decrease in blood lactate offers the possibility of a faster recovery in order to get involved in new efforts be they training or competitive This fall is achieved faster by active equating than by passive recovery (Ahmaidi et al.,1996;Dodd et al., 1984;Monedero & Donne, 2000), with no significant differences between jogging and running but significant from passive recovery (Arazi et al., 2012). This is what Neric et al. (2009) mentions, passive recovery had the weakest efficiency in eliminating lactate, 20 minutes after exertion, the most effective being submaximal swimming followed by electrical stimulation of the muscles. In the exercise physiology lab at the University of Virginia, Greenwood et.al., (2008), they found that 15 minutes of active recovery conducted at 50% of VO2max, or a combined 7.5-minute massage program and 7.5 minutes of active recovery conducted at 50% of VO2max, decreased blood lactate compared to passive recovery. ...
Article
Full-text available
Handball is a dynamic game and requires from the subjects an intense physical effort and a great psychic commitment. The handball training process has to solve a whole series of performance skills that are found in the handball game, in this respect in order to achieve both the offensive actions with accuracy and speed and to block the actions of the opposing team. The sooner handball players recover after training or matches, the more work can be done, and the increased levels of training translate into more efficient games. Swimming in general is associated with performance sports but also as a means of recreation and improvement of the quality of life, the horizontal position favouring this. In this regard we have investigated the efficiency of swimming in eliminating lactate from the blood, and increasing the quality of sleep after intense efforts, in the sense of optimizing sports efficiency. The study carried out on twenty amateur athletes handball players, aged between 19 and 25 years, being divided into two equal groups. The experiment group (Group 1), after intense effort, performed an active recovery with specific elements of swimming for 20 minutes at an intensity of 55-60% relative to the maximum heart rate, and the control group (Group 2) during this time achieved a passive recovery. The results of the study have shown that specific elements of swimming, after intense efforts, cause significant changes in the elimination of lactate from the blood and provide a quieter sleep for amateur athlete’s handball players members of the experiment group.
Article
Full-text available
Purpose: Achieving top performance requires recovery to be at its best. Lactic acid is one of the main byproducts of anaerobic activity, and its buildup has a detrimental impact on the player's performance. In this case, the optimum strategy for lactate clearance is active recovery. Furthermore, swimmers benefit most from self-paced active recuperation. But now the issue was: Should swimmers favour self-paced land recovery or water recovery? This study has been undertaken to comprehend the analysis of Blood Lactate Responses on Land and Water Active Recovery after Maximum Sprint Swimming. Methods: Ten male competitive swimmers at the national level from the Rewa District in Madhya Pradesh (Age: 23.6 ± 3.2 years; Height: 1.74 ± .05 m; Weight: 68.30 ± 8.76 kg; BMI: 22.68 ± 2.90 k g/m²) were selected as subjects. Subjects performed a 200-meter individual medley with their best effort and then underwent a 20-minute active recovery. Subjects were separated evenly into two groups for post-workout recovery: recovery on land (LR) and recovery in water (WR), and measurements of blood lactate, heart rate, and respiratory rate were recorded. Results: Descriptive statistics and a 2-way mixed ANOVA at the level of significance of 0.05 were used to analyze the data. The findings indicated that the 200m IM can elevate heart and breathing rates to peak values. The data revealed that the land recovery (7.88 + 0.70852) and water recovery (3.74 + 0.80187) significantly removed lactate after 20 minutes of self-paced active recovery. This study revealed a significant difference between pre-warm-up lactate reading and post-200m IM (p = 0.000) and post-200m IM and post 20 min active recovery (p = 0.000). Further, comparing lactate clearance rates in land recovery and water recovery, it was found that water recovery clears lactate significantly higher (P = 0.014).
Article
Introduction: The aim of this study was to examine differences between a control warm-up and an Electric Muscle Stimulation (EMS)-induced warm-up in off-road cyclists when examining anaerobic performance measures from a repeated Wingate test (WAnT). Methods: Twelve trained off-road cyclists completed a randomized crossover study (age: 31 ± 10 years, height: 176.79 ± 6.09 cm, body mass: 74.57 ± 4.77 kg). Participants completed two randomized, separate testing sessions involving a control warm-up and an EMS warm-up before undergoing the repeated WAnT, which was used to collect anaerobic performance and physiolo- gical measures during both sessions. High-frequency EMS was applied to the knee extensor muscles for 4 min after a standardized warm-up during the EMS session. Results: Analysis revealed that there were no significant differences between mean power output, peak power output, and percentage decrement between the two sessions. The EMS session resulted in significantly lower average HR values and significantly lower differences in pre-to-post-test blood lactate values when compared to the control session. Discussion: According to the results of this study, an acute application of EMS is not a useful tool for off-road cyclists to improve power output or maintain anaerobic capacity. Hence, its use before competition is questionable.
Article
Full-text available
The ability of additional muscles to perform after certain other muscles of the body had been exercised to exhaustion was studied in three male subjects. Exhaustive exercise was performed in two series: series L-A, a bout of leg exercise preceded a bout of arm exercise; series A-L, arm preceded leg (6-min recovery between bouts). Biopsies were taken during the course of each experiment from both the deltoideus and vastus lateralis muscles for determination of ATP, creatine phosphate, lactate, and pyruvate. Exhaustive exercise led to marked elevations in lactate and decreases in ATP and CP in exercised muscle and marked increases in blood lactate concentration. Similar changes, especially in lactate, were observed during and after the first exercise bout in nonexercised muscle. When arm or leg exercise was performed as the second bout, decreases in performance time were observed as compared to performance as the initial bout. It is suggested that the performance potential of muscle is decreased because of internal changes elicited by elevated blood lactate and/or blood H+ concentrations brought about by other muscle groups previously exercised to exhaustion.
Article
Full-text available
Lactate metabolism was studied in six normal males using a primed continuous infusion of lactate tracer during continuous graded supine cycle ergometer exercise. Subjects exercised at 49, 98, 147, and 196 W for 6 min at each work load. Blood was sampled from the brachial artery, the iliac vein, and the brachial vein. Arteriovenous differences were determined for chemical lactate concentration and L-[1-14C]-lactate. Tracer-measured lactate extraction was determined from the decrease in lactate radioactivity per volume of blood perfusing the tissue bed. Net lactate release was determined from the change in lactate concentration across the tissue bed. Total lactate release was taken as the sum of tracer-measured lactate extraction and net (chemical) release. At rest the arms and legs showed tracer-measured lactate extraction, as determined from the isotope extraction, despite net chemical release. Exercise elicited an increase in both net lactate release and tracer-measured lactate extraction by the legs. For the legs the total lactate release (net lactate release + tracer-measured lactate extraction) was roughly equal to twice the net lactate release under all conditions. The tracer-measured lactate extraction by the exercising legs was positively correlated to arterial lactate concentration (r = 0.81, P less than 0.001) at the lower two power outputs. The arms showed net lactate extraction during exercise, which was correlated to the arterial concentration (r = 0.86). The results demonstrate that exercising skeletal muscle extracts a significant amount of lactate during net lactate release and that the working skeletal muscle appears to be a major site of blood lactate removal during exercise.
Article
The aim of this study was to determine the effect of exercise mode on the blood lactate removal during recovery of high-intensity exercise. Nine male individuals performed the following tests in order to determine the blood lactate removal: Running - 2×200 m, the subjects ran at their maximum capacity, and rested 2 min between each bout. Swimming - 2×50 m, the subjects swam at their maximum capacity, and rested 2 min between each bout. Each test was realized on different days with three recovery modes: passive (sitting down), swimming, or running. Recovery exercise intensity was corresponding to the aerobic threshold. All recovery activities lasted 30 min. The two forms of active recovery were initiated 2 min after the end of high-intensity exercise and lasted 15 min, and were followed by 13 min of seated rest. After 1,7,12,17, and 30 min of the end of high-intensity exercise, blood samples (25 μl) were collected in order to determine the blood lactate concentration. By linear regression, between the logarithm of lactate concentration and its respective time of recovery, the half-time of blood lactate removal (t1/2) was determined. Time of high-intensity exercise and the lactate concentration obtained in the 1st min of recovery were not different between running and swimming. Passive recovery (PR) following running (R-PR=25.5±4.3 min) showed a t1/2 significantly higher than PR after swimming (S-PR=18.6±4.3 min). The t1/2 of the sequences running-running (R-R=13.0 min), running-swimming (R-S=12.9±3.8 min), swimming-swimming (S-S=13.2±2.8 min), and swimming-running (S-R=8.1±1.3 min) were significantly lower than the t1/2 of the R-PR and S-PR. There was no difference between the t1/2 of the sequences R-R, R-S, and S-S. On the other hand, the sequence S-R showed a t1/2 significantly lower than the sequences S-S and R-R. It was concluded that the two forms of active recovery determine an increase in the blood lactate removal, regardless of the mode of high-intensity exercise performed previously. Active recovery performed by the muscle groups that were not previously fatigued, can improve the blood lactate removal.
Article
Electrical therapy is a popular therapeutic modality for the management and rehabilitation of athletic injuries. Electrical stimulation is commonly used to elicit muscle contraction, reduce edema, and control pain. However, electrical therapy can also be a tremendous challenge for clinicians. The purpose of this paper is to present current and accurate information that will serve as a guide in the use of electrical therapy for the effective management of athletic injuries. With an understanding of the basic current types provided by various electrical stimulators and the modifications of the currents that an available, electrical therapy becomes an invaluable tool for injury management and rehabilitation.
Article
13 male subjects were studied and placed in 3 groups. Each group exercised one leg with sprint (S), or endurance (E) training and the other leg oppositely or not at all (NT). Oxygen uptake (Vo 2 ), heart rate and blood lactate were measured for each leg separately and for both legs together during submaximal and maximal bicycle work before and after 4 weeks of training with 4–5 sessions per week. Muscle samples were obtained from the quadriceps muscle and assayed for succinate dehydrogenase (SDH) activity, and stained for myofibrillar AT Pase. In addition eight of the subjects performed after the training two‐legged exercise at 70% Vo 2 max for one hour. The measurements included muscle glycogen and lactate concentrations of the two legs as well as the blood flow and the a‐v difference for O 2 , glucose and lactate. The improvement in Vo 2 max, the lowered heart rate and blood lactate response at submaximal work levels were only found when exercising with a trained leg (E or S). Part of the variables studied were markedly more changed with E as compared with S‐training. Although muscle fibre composition did not change a pronounced muscle adaptation took place with the training with enhancement of the SDH activity of the S and E legs while the NT‐leg did not change. Blood flow and oxygen uptake were similar in NT and S–E legs while femoral vein oxygen content was slightly lower in the trained as compared to the NT‐leg. Glycogen utilization was lowest in the trained leg with similar glucose uptake in all legs regardless of training status. Moreover, lactate was only continuously released from the NT‐leg. It is concluded that training induces marked local adaptations which not only affects the metabolic response to exercise but also are of importance eliciting an improved cardiovascular function.
Article
The effects of differing recovery patterns following maximal exercise on blood lactate disappearance and subsequent performance were examined. Nine subjects completed four randomly assigned experimental sessions. Each session consisted of a 5-min maximal effort performance test conducted on a Monark bicycle ergometer (T1) followed by 20 min of recovery and a second 5-min maximal effort performance test (T2). Blood lactate levels were measured during min 5, 10, 15, and 20 of recovery. Recovery patterns consisted of passive recovery (PR), active recovery below anaerobic threshold (AR less than AT), active recovery above anaerobic threshold (AR greater than AT), and active recovery above anaerobic threshold while breathing 100% oxygen (AR greater than AT + O2). Blood lactate levels prior to T2 were significantly different across treatments (P less than 0.05). Comparison among treatments and between T1 and T2 revealed no significant differences in work output. It was concluded that while lactate disappearance following severe exercise can be affected by varying the recovery pattern, elevated levels of blood lactate exert no demonstrable effect on maximal effort performance of 5-min duration.
Article
After exercise the lactate (La) removal from blood occurs significantly faster during moderate exercise than at rest. However, under both conditions there are considerable inter-individual differences in La removal. These differences in man may depend on the slow-twitch (ST) fiber content of muscle (X1), the La concentration in blood (X2), and the intensity of the recovery exercise (X3). Therefore, multiple regression models were obtained to describe La removal rates with these variables. In 10 women La concentrations were increased via a 6 min bicycle ergometer ride (87% VO2max) and blood La concentrations were measured every 5 min during 20 min resting and active recovery periods (29--49% VO2max). For resting recovery only the initial La concentration after the 6 min exercise provided a significant description for La removal in 8 subjects (P = 0.03). However, for the active recovery a highly significant description for La removal was obtained: La removal rate (mM/1 . min) = 0.773 x 10-2X1 + 0.321 x 10-1X2 - 0.120 x 10-1X3 + 0.202 (R = 0.91; P = 0.01). The statistical independence (P greater than 0.010) of each of these variables in the model suggests that each is contributing uniquely to the total removal rate of La observed during an active recovery period. The relationship between La removal and %ST fibers may be related to the metabolic and anatomical features of these fibers, the La concentration probably reflects the significance of the mass action effect of La, and the intensity of exercise reflects the role of the muscle's metabolic rate. The present results illustrate that the removal of blood lactate is influenced by the interactive effects of the intensity of the recovery exercise, blood lactate concentration and the ST fiber content of muscle.
Article
The purpose of this study was to compare lactic acid removal rates during three modes of recovery from a standardized exercise bout. Each subject (N = 6) completed a 1 mile run (92.2 +/- 3.7% Vo2max). Thereafter, lactic acid removal rates were compared in the runners at each of three different modes of recovery: a) rest; b) a self-selected, continuous jogging pace (free-jogging); and c) completely uncontrolled recovery (free-intermittent) normally practiced by athletes. Venous blood samples were taken immediately after the mile run and every 5 min thereafter for 20 min. Data were expressed relative to the initial post-exercise blood sample (100%). Lactic acid removal was significantly faster during the free-jogging recovery than during the free-intermittent and the resting recoveries (P less than 0.001). Removal rates during the free-intermittent recovery were significantly faster than during the resting recovery (P less than 0.001). The results indicated that nearly optimal lactic acid removal rates were attained during the free-jogging recovery.
Article
The supply of energy is of fundamental importance for the ability to sustain exercise. The maximal duration of exercise is negatively related to the relative intensity both during dynamic and static exercise. Since exercise intensity is linearly related to the rate of energy utilisation this suggests that energetic deficiency plays a major role in the aetiology of muscle fatigue. Characteristic metabolic changes in the muscle are generally observed at fatigue--the pattern being different after short term exercise (lactate accumulation and phosphocreatine depletion) from after prolonged exercise at moderate intensity (glycogen depletion). A common metabolic denominator at fatigue during these and many other conditions is a reduced capacity to generate ATP and is expressed by an increased catabolism of the adenine nucleotide pool in the muscle fibre. Transient increases in ADP are suggested to occur during energetic deficiency and may be the cause of fatigue. Experimental evidence from human studies demonstrate that near maximal power output can be attained during acidotic conditions. Decreases in muscle pH is therefore unlikely to affect the contractile machinery by a direct effect. However, acidosis may interfere with the energy supply possibly by reducing the glycolytic rate, and could by this mechanism be related to muscle fatigue.
Article
Swimming is an endurance-intensive sport resulting in accumulation of lactate. Repeat performances are often necessary in championship events. Lactate produced during a maximal effort requires time to metabolize to a base level. If this does not occur, performance in a repeat effort may be impaired. Thus, techniques to enhance lactate clearance are of potential benefit to the athlete. We have demonstrated previously that swimming at 65% of maximum velocity significantly improved lactate clearance over passive resting. This study tested the effect of various swimming velocities on lactate clearance. Following a maximal swim, blood lactate clearance was tracked during a 15 minute cool down swim. Velocities of 55%, 65%, and 75% of maximum were tested. The results confirmed that cool down swimming will return lactate values to near resting levels in the test interval. However, statistical superiority of any of the test velocities was not demonstrated. The intensity of the swim should be below the lactate accumulation level. The 65% of maximum velocity was felt by all swimmers to be most comfortable and is a good target velocity for the athlete to reference.