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2024, Retos, 59, 54-63
© Copyright: Federación Española de Asociaciones de Docentes de Educación Física (FEADEF) ISSN: Edición impresa: 1579-1726. Edición Web: 1988-2041 (https://recyt.fecyt.es/index.php/retos/index)
-54- Retos, número 59, 2024 (octubre)
Eccentric-induced delayed-onset muscle soreness impairs cardiac autonomic activity in adolescent
athletes: a pre-experimental study
El dolor muscular de aparición tardía inducido por contracción excéntrica afecta negativamente la
actividad autonómica cardíaca en adolescentes atletas: un estudio pre-experimental
*Matías Mabe-Castro, *Diego Mabe-Castro, *Matias Castillo-Aguilar, **Manuel Vera Carrasco, ***, ****Pablo Valdés-Badilla,
*****,******Eduardo Guzman-Muñoz, *Sergio Cares Barrientos, *******Oscar Niño Mendez, *Cristian Núñez-Espinosa.
*Universidad de Magallanes (Chile), **Instituto Nacional de Deportes (Chile), ***Universidad Católica del Maule (Chile),
****Universidad Viña del Mar (Chile), *****Universidad Santo Tomás (Chile), ******Universidad Autónoma de Chile (Chile),
*******Universidad de Cundinamarca (Colombia)
Abstract. Objective: To investigate the impact of eccentric-induced delayed-onset muscle soreness (DOMS) on cardiac autonomic
activity in adolescent athletes. Methods: A pre-experimental one-group pre-test/post-test design was carried out on fifteen competitive
adolescent athletes, and the effect of DOMS on cardiac autonomic activity was assessed while controlling for body composition and
anxious state/trait factors. An eccentric exercise protocol was applied to the elbow’s flexor muscles to induce DOMS. Then, heart
rate variability was compared before and two days after DOMS induction under resting and resisted movement conditions of the painful
limb, using a t-test for paired samples. The body composition and the State-Trait Anxiety Inventory (STAI) were also measured.
Results: The analysis revealed a significant effect of DOMS on autonomic response in time domain measures of root mean square of
successive differences (RMSSD) (MD = -5.58, 95%CI[-9.36, -1.8], t(14) = -3.2, p = 0.007) and standard deviation of normal-to-
normal intervals (SDNN) (MD = -9.43, 95%CI[-15.47, -3.39], t(13) = -3.4, p = 0.005), as well as on sympathetic nervous system
(SNS) autonomic indices (MD = 0.68, 95%CI[0.07, 1.29], t(14) = 2.4, p = 0.031) and Stress index (SI) (MD = 2.72, 95%CI[0.67,
4.77], t(14) = 2.8, p = 0.013) under exercise conditions. Conclusions: DOMS changes cardiac autonomic activity compared to control
conditions during mechanically evoked pain but not at rest. This study highlights the importance of considering the presence of DOMS
when HRV is used in adolescent athletes for training, clinical, or research purposes.
Keywords: Sports, Acute pain, Autonomic nervous system, Mechanical hyperalgesia, Muscle damage
Resumen. Objetivo: Investigar el impacto del dolor muscular de aparición tardía inducido por ejercicios excéntricos (DOMS, por sus
siglas en inglés) sobre la actividad autonómica cardíaca en atletas adolescentes. Métodos: Se llevó a cabo un diseño preexperimental de
un solo grupo con preprueba y postprueba en quince atletas adolescentes competitivos, y se evaluó el efecto de DOMS en la actividad
autonómica cardíaca, controlando por composición corporal y los factores de ansiedad estado/rasgo. Se aplicó un protocolo de ejercicio
excéntrico a los músculos flexores del codo para inducir DOMS. Luego, se comparó la variabilidad de la frecuencia cardíaca antes y
dos días después de la inducción de DOMS, tanto en condiciones de reposo como durante movimientos resistidos del miembro con
dolor, utilizando la prueba t para muestras pareadas. Además, se midió la composición corporal y el Inventario de Ansiedad Estado-
Rasgo (STAI, por sus siglas en inglés). Resultados: El análisis reveló un efecto significativo de DOMS en la respuesta autonómica
cardíaca en el dominio de tiempo en raíz cuadrada de las diferencias sucesivas (RMSSD) (MD = -5.58, IC del 95%[-9.36, -1.8], t(14)
= -3.2, p = 0.007) y desviación estándar de los intervalos normales a normales (SDNN) (MD = -9.43, IC del 95%[-15.47, -3.39],
t(13) = -3.4, p = 0.005), así como en los índices autonómicos del sistema nervioso simpático (SNS, por sus siglas en inglés) (MD =
0.68, IC del 95%[0.07, 1.29], t(14) = 2.4, p = 0.031) e Índice de Estrés (SI) (MD = 2.72, IC del 95%[0.67, 4.77], t(14) = 2.8, p =
0.013) en condiciones de ejercicio. Conclusiones: El DOMS modifica la actividad autonómica cardíaca en comparación con condiciones
de control durante el dolor evocado mecánicamente, pero no en reposo. Este estudio destaca la importancia de considerar la presencia
de DOMS cuando se utiliza la VFC en atletas adolescentes para fines de entrenamiento, clínicos o de investigación.
Palabras clave: Deportes, Dolor agudo, Sistema nervioso autónomo, Hiperalgesia mecánica, Daño muscular
Fecha recepción: 22-04-24. Fecha de aceptación: 03-07-24
Cristian Núñez-Espinosa
cristian.nunez@umag.cl
Introduction
Delayed-onset Muscle Soreness (DOMS) is a common
phenomenon, generally considered a benign and self-limit-
ing condition, experienced by both recreational and elite
athletes after strenuous physical activities that involve mus-
cle overload and is characterized by muscle soreness and
weakness, which increases substantially with movement,
due to mechanical hyperalgesia(Mizumura & Taguchi,
2024; Nahon et al., 2021). DOMS onset usually occurs 6
to 12 hours after physical activity, with its greatest intensity
experienced between 48 to 72 hours later. Typically, re-
peated eccentric contractions (i.e., a muscle action pro-
duced during muscle lengthening, where the external force
overcomes the internal force exerted by the muscle) have
been associated with the apparition of DOMS, as they have
been observed to cause greater damage to muscle tissue
(Domínguez-Gavia et al., 2022; Douglas et al., 2017;
Manetti et al., 2019; Newham et al., 1983; Tenberg et al.,
2022). Therefore, previous studies have employed this mo-
dality to induce DOMS in various research scenarios (Hody
et al., 2019; Nguyen et al., 2009; Nosaka et al., 2002; Ochi
et al., 2020; Tenberg et al., 2022; Yoshida et al., 2022).
Numerous theories have been proposed to explain the
etiology of DOMS. The mechanism for its development has
been proposed to be the ultrastructural damage of muscle
cells and mechanical receptors, leading to further protein
degradation, apoptosis, and local inflammatory response
(Hotfiel et al., 2018; Newham et al., 1983). However, un-
like research on other types of pain, the effects of DOMS
2024, Retos, 59, 54-63
© Copyright: Federación Española de Asociaciones de Docentes de Educación Física (FEADEF) ISSN: Edición impresa: 1579-1726. Edición Web: 1988-2041 (https://recyt.fecyt.es/index.php/retos/index)
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outside the musculoskeletal system have not been exten-
sively explored (Forte et al., 2022).
Regarding the autonomic nervous system (ANS), pain
has been studied as a stressor agent, which can be either
personal (i.e., inherent to the individual; for instance,
chronic pain) or external (i.e., induced by a controlled ex-
ternal nociceptive source; for instance, heat o electrically
induced pain). Research shows that personal and external
pain can change cardiac autonomic activity, as measured
typically by heart rate variability (HRV)(Bandeira et al.,
2021; Forte et al., 2022).
In athletes, the ANS assumes a pivotal role, serving as a
crucial regulator to address the heightened metabolic de-
mands of skeletal muscle during exercise (Freeman et al.,
2006; Uzawa et al., 2023). This system balances sympa-
thetic and parasympathetic activity, ensuring optimal phys-
iological responses to physical exertion and permitting per-
formance (Freeman et al., 2006). The sympathetic branch
of the ANS becomes increasingly active, mobilizing re-
sources and enhancing cardiovascular capacity to deliver ox-
ygen and nutrients to working muscles (Hargreaves &
Spriet, 2020; Mongin et al., 2022). Meanwhile, the para-
sympathetic branch moderates this heightened state, pro-
moting recovery and restoring homeostasis once the exer-
cise stimulus has ceased (Peçanha et al., 2017).
HRV is a non-invasive tool used to assess the autonomic
regulation of the heart by analyzing variations in the time
intervals between consecutive heartbeats (Malik, 1996). It
provides valuable insights into the balance between sympa-
thetic and parasympathetic nervous system activity, with
higher HRV indicating greater autonomic flexibility and
adaptability (Kubota et al., 2017; Zhao et al., 2024). How-
ever, it is not only influenced by external factors (Tiwari et
al., 2021): body composition and anxiety state and trait,
which are relevant variables in sports performance, can also
influence HRV. Therefore, it is important to control their
mediating effects (Martinho et al., 2023).
Furthermore, HRV has been used in the athlete popula-
tion because it is a marker of fatigue, recovery, training sta-
tus, and acute physical adaptation to exercise (Manresa‐
Rocamora et al., 2021). HRV has been widely utilized in
sports science as a reliable marker for controlling training
load, allowing coaches and athletes to monitor training in-
tensity and recovery status (Tibana et al., 2019). Therefore,
training programs can be optimized to prevent overtrain-
ing, an adverse effect diminishing performance, physiologi-
cal adaptations, and outcome improvements. However, if
DOMS produces changes in HRV, its presence could lead
to misinterpreting HRV data, providing incorrect conclu-
sions about an athlete's physiological state, which poten-
tially results in suboptimal training adjustments and nega-
tively affecting performance outcomes. Thus, a compre-
hensive understanding of DOMS effect on HRV becomes
important for coaches and athletes.
However, the specific effects of DOMS on cardiac auto-
nomic activity, particularly in adolescent athletes, remain
poorly understood. In contrast to other forms of controlled
induced pain, DOMS presents with tissue damage and in-
flammatory response, which could produce a different au-
tonomic response than that observed previously(Kox et al.,
2011; Newham et al., 1983). A protocol that includes the
analysis of HRV both at rest and during mechanical pain re-
production could be employed to understand whether the
autonomic changes are caused by pain or by other charac-
teristics inherent to DOMS.
We hypothesize that DOMS will increase sympathetic
but decrease parasympathetic activity during painful exer-
cise but not at rest. Furthermore, body composition and
anxiety state may modulate this effect. Therefore, the pre-
sent study aims to investigate the impact of eccentric-in-
duced DOMS on cardiac autonomic activity in adolescent
athletes, using HRV as a sensitive measure of autonomic
regulation.
Materials and methods
Experimental design
A pre-experimental one-group pre-test/post-test de-
sign was conducted. The data-collection protocol included
four stages: in the first, the one maximum repetition in non-
dominant elbow flexion was evaluated; in the second, body
composition, anxious state/trait, and the first two measures
of heart rate variability were obtained; in the third, a pro-
tocol to induce delayed-onset muscle soreness was applied;
finally, anxious state and the last two measures of heart rate
variability were evaluated. All stages were carried out be-
tween 18:00 to 19:00 hrs.
Participants
Athletes training in the Weights Room of the Regional
Training Center of Punta Arenas, Chile, aged 16 ± 0.85
years, were selected by accidental non-probabilistic sam-
pling.
The inclusion criteria were as follows: a) at least two
years of experience in the practice of their sport; b) partic-
ipation in at least one regional, national, or international
tournament during the last two years; c) participation in at
least three training sessions per week; and d) between 14
and 17 years of age in 2022. Exclusion criteria were: a) di-
agnosis of heart disease; b) consumption of analgesic and/or
beta-blocker drugs; c) injury not compatible with the ex-
perimental protocol; d) consumption of tobacco, alcohol,
coffee, and/or psychostimulant drugs since 72 h before the
first measurement; e) presence of pain of any type during
first and second HRV assessment and pain other than
DOMS during third and fourth HRV assessment; and f)
pregnancy. After selection, 15 adolescent athletes were re-
cruited (male, n=12; female, n=3), practicing three sports:
swimming (n=1), handball (n=10) and judo (n=4).
All participants and their legal representatives voluntar-
ily signed the assent and informed consent before partici-
pating. The study was approved by the Research Ethics
Committee of the University of Magallanes (N° 015/CEC-
UMAG/2022) and conducted following the World Medical
2024, Retos, 59, 54-63
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Association and Helsinki Declaration concerning the ethical
principles of human experimentation. Furthermore, the
participants were instructed to sleep at least 7 hours the
night before evaluations and avoid non-pharmacological
stimulant consumption.
Instruments
Body composition
Body weight (kg), total fat mass (%), total free fat mass
(kg), bone composition (kg), and water (%) were measured
by bioimpedance with the Tanita BC-558 Iron-man Seg-
mental Body Composition Monitor (Tanita Ironman, Ar-
lington Heights, IL 60005 USA). Height (cm) was obtained
by stadiometer CHARDER® HM230M hand-held measur-
ing rod (Charder Electronics Co., Ltd. No.103, Guozhong
Rd., Taiwan, R.O.C.).
Anxiety State and Trait
The 70-item State-Trait Anxiety Inventory (STAI) ad-
aptation, Spanish version, was used, which contrasts two
facets of anxiety: those related to the person (trait) and
those related to external triggers in an environment close
to the subject (state) (Burgos Fonseca et al., 2013).
DOMS intensity
Athletes self-reported their perception of intensity
through the Numeric Rating Scale (NRS). It corresponds to
the most used numeric scale in which the participants rate
the pain from 0 to 10, with 0 being the absence of pain and
10 being the worst pain intensity. The NRS is an interna-
tionally validated scale, and its clinical and research use has
been reported as the most preferred by professionals
(Atisook et al., 2021).
Cardiovascular parameters
HRV was recorded with Polar Team2 equipment (Po-
lar®, Finland). In the time domain, the parameters evalu-
ated were the standard deviation of normal RR intervals
(SDNN), which is understood as a marker of the total
power of HRV, reflecting sympathetic and parasympathetic
activity on the myocardium (BERNTSON et al., 1997a;
Buchheit & Gindre, 2006); and the square root of root mean
squared differences of successive RR intervals (RMSSD),
which reflects parasympathetic activity on cardiac contrac-
tion (Buchheit et al., 2010).
In the frequency domain, three components were eval-
uated: the high-frequency (HF) power band at 0.15 to 0.40
Hz (Akselrod et al., 1981) and the low-frequency (LF)
power band at 0.04 to 0.15 Hz, which is considered a
marker of parasympathetic and sympathetic activity over
the heart (Goldstein et al., 2011). The very low frequency
(VLF) band is between 0.0033 and 0.04 Hz (Fisher et al.,
2014; Mccraty & Shaffer, 2015).
In addition, the parasympathetic nervous system index
(PNS), sympathetic nervous system index (SNS), and Stress
Index (SI) were calculated. The PNS reflects the total vagal
stimulation and is calculated from the time average of the
R-R intervals, RMSSD, and the index derived from Poinca-
ré's graph corresponding to the width of the ellipse (SD1)
in normalized units (related to RMSSD) and indicates the
standard deviations above or below the averages obtained in
the normal population (Tulppo et al., 1996). The SNS in-
dex, reflecting the total sympathetic stimulation, is calcu-
lated from the time-averaged R-R intervals, the Baevsky SI
(a value positively correlated with cardiovascular system
stress and cardiac sympathetic activity), and the Poincaré
graph-derived index of ellipse length (SD2) in normalized
units (related to SDNN) (Tulppo et al., 1996). The SI indi-
cates the degree of load on the autonomic nervous system;
it is normalized using the square root of the Baevsky SI
(BERNTSON et al., 1997b; Rajendra Acharya et al., 2006).
The data obtained on HRV were digitized and analyzed
using Kubios HRV® software.
Artifacts and ectopic heartbeats, which did not exceed
3% of the recorded data, were excluded (“Heart Rate Var-
iability: Standards of Measurement, Physiological Interpre-
tation, and Clinical Use. Task Force of the European Soci-
ety of Cardiology and the North American Society of Pacing
and Electrophysiology.,” 1996).
Procedure
Measurements were conducted in the Regional Training
Centre of the Punta Arenas Fiscal Gymnasium (National
Sports Institute) in a quiet room illuminated by cold-spec-
trum lighting between 18:00 and 20:00 hours. Tempera-
ture and relative humidity were not controlled. The partic-
ipants were instructed to sleep adequately for at least 7
hours from the night before the assessments start until the
protocol's end. Additionally, they were asked to refrain
from eating 1 hour before each session, avoid strenuous
physical activity, and consume sufficient water. The assess-
ment protocol consisted of measuring HRV on four occa-
sions: two before the induction of delayed-onset muscle
soreness, at rest and during a protocol consisting of isotonic
bicep curls, and two after induction, at rest and during the
execution of the same bicep curls. The study was performed
in four stages, detailed below:
Stage 1: The subjects' one repetition maximum (1RM)
was recorded in elbow flexion exercise of the non-domi-
nant arm with a kettlebell in a supine grip (bicep curl). This
joint is little used in comparison to others in everyday life.
The 1RM measurement was performed according to an
adaptation of Lavender and Nosaka's protocol. For the
warm-up and the measurement, the subjects were seated,
with the trunk tilted anteriorly and the forearm of the non-
dominant arm in supination, resting on the ipsilateral thigh.
The warm-up consisted of a three-minute self-regulated
continuous elbow flexion and extension. Then, for the
1RM measurement, they were given a progressively heavier
Russian weight with an increase of 5 lbs and asked to per-
form a full elbow flexion. Each repetition was separated by
2 minutes of rest. The test ended if the subject could not lift
the same weight with the correct technique in 3 consecutive
2024, Retos, 59, 54-63
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attempts. The 1RM was considered the last weight effec-
tively lifted. At the end of the session, the subjects were
instructed to have optimal rest during the week, especially
before starting the subsequent stages. In addition, they were
asked to consume sufficient water, avoid consuming drugs
(e.g., coffee, alcohol, tobacco), and limit strenuous physi-
cal activity.
Stage 2: 7 days after Stage 1, the subject's body compo-
sition was measured by bio-impedance analysis. Then, they
were instructed to answer the STAI autonomously but with
the assistance of the evaluators to attend questions. Finally,
baseline measures of HRV were measured as follows: (i)
subjects were placed seated in a quiet and calm environment
for 6 minutes, keeping feet, hands, and back supported
(HRV 1); (ii) immediately afterward, subjects were asked
to perform a 3-minutes series of elbow flexions controlled
by an online metronome at six bpm (every 10 seconds), the
concentric and eccentric phases were performed in 1 sec-
ond each, verified by the evaluators with a digital stopwatch
(HRV2). The technique used for the exercise was the same
as that for obtaining the RM with 50% of this weight.
Stage 3: Induction of DOMS: 24 hours after the previ-
ous stage, the subjects participated in a standardized and in-
dividualized protocol in intensity. For this, the protocol
proposed by Lavender and Nosaka was adopted (Lavender
& Nosaka, 2008).
A protocol of eccentric muscle actions was used to elicit
DOMS in the elbow’s flexor muscles. Athletes were posi-
tioned seated in a chair, with the performing elbow on the
ipsilateral thigh. They performed non-dominant eccentric
bicep curls with a Russian dumbbell at 90% of 1RM, using
the dominant hand to aid the concentric phase. Six sets of 5
repetitions were performed, with 2 minutes rest between
each set. The athlete started with a flexion of approximately
120° and extended the elbow in a controlled and uniform
manner for 5 seconds until reaching maximum elbow ex-
tension. Two evaluators monitored correct execution. The
protocol was terminated early if the athlete could not con-
trol elbow extension for 5 seconds twice in a row in two
consecutive sets. The subject was verbally motivated to de-
liver their maximum effort when a failure occurred. Full
elbow mobility was checked before the protocol.
The elbow flexor muscles have been extensively used to
elicit muscle pain (Agten et al., 2017; Lavender & Nosaka,
2008; Nguyen et al., 2009; Nosaka et al., 2002; Stennett et
al., 2021; Yoshida et al., 2022).
Stage 4: 48 hours after DOMS induction, subjects com-
pleted the Anxious State questionnaire from the STAI.
Then, the Stage 2 protocol was repeated, obtaining meas-
urements at rest (HRV3) and during the 3-minute bicep
curls with DOMS (HRV4). Finally, the NRS was used to
quantify pain intensity during bicep curls.
A visual summary of the protocol can be seen in Figure
1.
Figure 1. Protocol Flowchart.
Statistical analysis
The mean and standard deviation were used to describe
the numerical variables (M ± SD), and for categorical vari-
ables, relative (%) and absolute (n) frequency were used.
The variables' normality was evaluated using parametric sta-
tistics with the Shapiro-Wilk test and graphical exploration
of the data.
To analyze the effect of DOMS on cardiac autonomic
regulation, an analysis of covariance (ANCOVA) was used
to determine within-subjects differences in HRV indices,
controlling for the residual effect of age and sex differences.
This allowed the evaluation of the variation in HRV indices
between DOMS and basal conditions during exercise and at
rest to establish if the observed effect was attributable to the
residual impact of the exercise performed in the basal pe-
riod and the exercise performed in DOMS conditions.
To assess whether body composition or anxious state
exerted a significant influence on HRV indices in response
to DOMS, it was performed 10,000 bootstrap resampling-
based simulations of a linear model with least-squares opti-
mization, using as dependent variable the observed differ-
ence between the experimental condition concerning basal
(∆: DOMS - Control), as a measure of autonomic response
in response to DOMS during exercise, and as independent
variable the body composition or anxious state variables se-
quentially. Estimating the p-values of the linear model's
simulations were obtained from the transformation of the
maximum likelihood of the effect, expressed as follows:
2 𝑥 (1 − 𝑚𝑎𝑥(𝑝𝑑, 1 − 𝑝𝑑)), where pd represents the
probability of direction.
To describe the relationship between body composition
and anxious state parameters, Pearson's correlation coeffi-
cient was used to characterize their relationship with the
main effects.
For statistical significance, it was considered a probabil-
ity of committing a type I error (𝛼) of less than 5% (i.e., p
< 0.05). All analyses were performed with the statistical
programming language R in version 4.2.2 (R Core Team,
2021)
Results
The characteristics of the sample can be seen in Table 1.
Autonomic response to DOMS
DOMS mean intensity and standard deviation assessed
by NRS were 5.1±2.1, which shows that the induction pro-
tocol was sufficient to cause moderate muscle pain while
isotonic bicep curls were performed. When assessing auto-
nomic response to DOMS, a significant effect was observed
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for RMSSD in the time domains, as well as for the auto-
nomic indices SNS and SI under exercise conditions (see Ta-
ble 2) but not at rest (see Table 3).
Table 1.
Sociodemographic, sports, and body composition characteristics of the study sample.
Descriptive statistics
Characteristic
Mean
SD
N
%
Age (years)
16.00
0.85
–
–
Years of sports practice
4.27
2.34
–
–
Sport
Handball
–
–
10
67%
Judo
–
–
4
27%
Swimming
–
–
1
6.7%
Gender
Female
–
–
3
20%
Male
–
–
12
80%
Body composi-
tion
Weight (kg)
69
9
–
–
Height (cm)
172
10
–
–
Body fat
Total
16
8
–
–
LUL 1
14
7
–
–
RUL 2
12.8
6.9
–
–
RLL 3
17
10
–
–
LLL 4
16
10
–
–
Torso
15.5
6.9
–
–
Muscle mass
Total
55
9
–
–
LUL 1
3.19
0.73
–
–
RUL 2
3.23
0.71
–
–
RLL 3
9.51
1.54
–
–
LLL 4
9.61
1.51
–
–
Torso
29.3
4.4
–
–
Body water (%)
61.3
4.6
–
–
Bone mass
2.88
0.44
–
–
1 LUL = Left upper limb.
2 RUL = Right upper limb.
3 RLL = Right lower limb.
4 LLL = Left lower limb.
Table 2.
Comparisons of paired exercise condition HRV measurements (HRV 4 - 2) se parated by domain
evaluated.
IC95%
Statistic 3
Domain
Parameter
η2p
Low
High
F
df
p-value
Time
RMSSD
0.402
0
0.698
6.722
1, 10
0.027
SDNN
0.101
0
0.481
1.12
1, 10
0.315
Mean R-R interval
0.153
0
0.530
1.801
1, 10
0.209
Frequency
HF
0.117
0
0.498
1.328
1, 10
0.276
LF
0.229
0
0.589
2.969
1, 10
0.116
LF/HF
0.030
0
0.383
0.305
1, 10
0.593
VLF
0.004
0
0.267
0.042
1, 10
0.843
Autonomic
Activity
indices
SNS
0.442
0.015
0.720
7.922
1, 10
0.018
PNS
0.210
0
0.575
2.653
1, 10
0.575
Stress
0.541
0.078
0.773
11.809
1, 10
0.006
Table 3.
Comparisons of paired resting condition HRV measurements (HRV 3 - 1) separated by domain
evaluated.
IC95%
Statistic 3
Domain
Parameter
η2p
Low
High
F
df
p-value
Time
RMSSD
0.000
0
0.105
0.003
1, 10
0.955
SDNN
0.010
0
0.321
0.102
1, 10
0.756
Mean R-R interval
0.043
0
0.409
0.455
1, 10
0.515
Frequency
HF
0.001
0
0.172
0.008
1, 10
0.930
LF
0.033
0
0.390
0.343
1, 10
0.571
LF/HF
0.001
0
0.158
0.007
1, 10
0.936
VLF
0.000
0
0.000
0.000
1, 10
0.992
Autonomic
activity
indices
SNS
0.004
0
0.265
0.036
1, 10
0.854
PNS
0.002
0
0.215
0.016
1, 10
0.903
Stress
0.021
0
0.361
0.212
1, 10
0.655
1 η2p = Partial Eta squared from ANCOVA.
2 IC95% = 95% Confidence interval .
3 Test statistics from ANCOVA, including sex and age as covariates.
Effect of anxiety and body composition on HRV
Of the estimated effects, the anxious state seemed to
moderate the effect of DOMS on the SI proportionally to
the increase of this (β = 0.12, 95%CI [-0.02, 0.20]). De-
spite the above, this effect was not statistically significant (p
= 0.07).
Concerning body composition, it was observed that
body fat seemed to affect the VLF response in DOMS con-
ditions. In contrast, fat assessed by body segments seemed
to suggest a moderating effect that increases the VLF re-
sponse in exercise conditions versus DOMS compared to
the control condition (RUL, β = 3. 76, 95%CI[0, 10.64],
p = 0.05; RLL, β = 2.37, 95%CI[0.13, 6.34], p = 0.033;
LLL, β = 2.38, 95%CI[0.08, 6.71], p = 0.04).
No moderating effect of the other anxious state or body
composition variables assessed on the DOMS response on
HRV parameters was observed.
Body composition and anxiety
The significant correlations between body composition
and anxious state parameters can be seen in Figure 3.
Figure 3. Correlogram of the relationship between the variables of body compo-
sition and anxious state. Note: The color of the lines represents the correlation
between the variables with a significance level of less than 5% (i.e., p < 0.05).
MM: Muscle mass. LLL: left lower limb. RLL: Right lower limb. LUL: left up-
per limb. RUL: Right upper limb
Discussion
This study aimed to investigate the effects of DOMS on
cardiac autonomic activity in adolescent athletes while con-
trolling the impact of body composition and anxiety state
and trait. To our knowledge, this is the first study to inves-
tigate the effect of DOMS on cardiac autonomic modulation
through assessment of HRV in rest and exercise conditions
in this population. Previous research has studied the effect
of various types of pain on cardiac autonomic activity, find-
ing HRV analysis to be a reliable method and reporting sig-
nificant changes in sympathetic and parasympathetic auto-
nomic activity in response to different types of induced
pain(Forte et al., 2022; Koenig et al., 2014). Although
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these findings have been mostly reported in healthy adults
and not adolescents, the observations were hypothesized to
be similar.
During the execution of standardized isotonic bicep
curls, the analysis of HRV showed higher sympathetic activ-
ity parameters when comparing DOMS to the control con-
dition, as evidenced by decreased RMSSD and SDNN, in-
creased SNS index, and SI. These results suggest that me-
chanical hyperalgesia associated with DOMS could be the
primary cause of the observed changes in autonomic func-
tion. Earlier research has shown that nociceptive inputs
could activate sympathetic pathways, contributing to the
prevalence of sympathetic activity instead of vagal
tone(Forte et al., 2022). However, other variables, such as
pain intensity and subjective pain experience, may also
modulate autonomic response to pain, highlighting the need
for further research in this area(Hohenschurz-Schmidt et
al., 2020; Kocsel et al., 2023).
On the other hand, the results obtained at rest did not
show evidence of significant changes in the markers of car-
diac autonomic activity in this sample of adolescent athletes.
This could suggest that the effects of DOMS are primarily
attributable to pain rather than other characteristics, such as
muscle damage or inflammation. However, it is important
to note that the induction of DOMS was performed on a
small and unilateral muscle group (elbow flexors), being
hypothesized that this may limit its effect on global auto-
nomic activity. Thus, while our findings do not evidence
significant changes, we cannot rule out the possibility that
muscle damage and local inflammation induced by DOMS
may have some effect on cardiac autonomic activity. A pre-
vious study reported the impact of acute inflammation on
HRV, but DOMS-associated inflammation has not been ex-
plored (Kox et al., 2011). Further investigation is necessary
to explore the effects of DOMS on broader muscle groups
for a more precise understanding of the effects of muscle
damage and inflammation on cardiac autonomic activity.
Concerning the relationship between morphological
and physiological measures, positive correlations were ob-
served between total body fat percentage and the anxious
state score obtained by the athletes before and after DOMS
induction. This agrees with the results reported by Mar-
tínez-Rodríguez et al. in young soccer players, where they
found higher anxiety scores in athletes with higher body fat
percentages in a sample of similar ages to our adolescent
athletes (Martínez-Rodríguez et al. 2022). Since body fat
percentage is a relevant parameter for athlete performance,
those with higher body fat percentages might feel more
pressure regarding their performance in the measurements
or their ability to respond to the demands of the protocol,
which may explain why anxious state scores were higher in
those with higher body fat percentages (Esco et al., 2018).
Nevertheless, this pre-experimental study is not exempt
from limitations. First, these results are not generalizable to
other populations of adolescent athletes due to the small
sample size and the non-probabilistic accidental sampling.
Secondly, the protocol was executed in the regional train-
ing center in calm and quiet conditions; however, other fac-
tors, such as relative humidity and temperature, were not
controlled. Finally, this study did not consider a control
group without DOMS induction, which would have al-
lowed us to consider the aforementioned confounding fac-
tors in the analysis but requires a much larger sample size to
avoid the effects of measuring as dependent on personal cir-
cumstances as HRV.
Future research should consider more homogeneous
and representative samples of athletes and include a control
group, ideally separated by type of sport and years of prac-
tice. In addition, the protocols should be carried out in a
controlled laboratory setting to avoid the influence of other
factors outside the study and to consider longitudinal de-
signs to measure the evolution of the effect. Moreover, ad-
ditional research is necessary to ascertain the significance of
the spread of DOMS and the muscle damage and inflamma-
tion it causes. It is also relevant to investigate how practic-
ing various types of exercise affects cardiac autonomic ac-
tivity in the presence of DOMS. This can be achieved
through sport-specific protocols.
Implications in sports practice
The present study provides valuable insights into the au-
tonomic response to DOMS in adolescent athletes. The
finding of increased sympathetic activity in response to ex-
ercise-induced DOMS suggests that athletes may experi-
ence altered autonomic control during the recovery phase
of their training (Michael et al., 2017). These findings have
potential implications for adolescent athletes' training and
load control strategies. Coaches and trainers should con-
sider incorporating measures to monitor and regulate auto-
nomic activity in athletes during the recovery phase after
intense or new exercise. However, caution should be exer-
cised when extrapolating these findings to different proto-
cols since exercise intensity could mediate autonomic re-
sponse (Kaufmann et al., 2023; Michael et al., 2017).
Overall, these results highlight the importance of consider-
ing DOMS when using HRV as an instrument during ath-
letes’ recovery.
Finally, this study's findings provide additional back-
ground information to the current understanding of the re-
lationship between DOMS, exercise, and cardiac auto-
nomic activity. However, further investigation using the
previously mentioned recommendations is relevant to
providing a more comprehensive understanding of this
complex interaction and its potential implications for ath-
letic health and performance.
Conclusions
These findings suggest that the autonomic nervous sys-
tem responds to DOMS when it is reproduced by muscle
contraction in adolescent athletes, showing a greater prev-
alence of sympathetic activity compared with the condition
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without DOMS. This study highlights the importance of
considering the presence of DOMS when HRV is used in
adolescent athletes for training, clinical, or research pur-
poses. It also opens the door to investigate further the pos-
sible moderation effect of HRV in DOMS and specific
sports performance.
Acknowledgment
This study was possible thanks to the support of Paula
Sanhueza Rodríguez and Fernando Atencio Cifuentes from
Magallanes University Medical School, who worked on
data collection. The authors would like to thank the Na-
tional Institute of Sports in the Magallanes and Chilean
Antarctica Region for providing access to their facilities at
the Punta Arenas Fiscal Gymnasium to conduct this study.
We thank the institutions the authors are affiliated
with: Centro Asistencial Docente y de Investigación, Uni-
versidad de Magallanes (CADI-UMAG), Punta Arenas,
Chile (MM-C, DM-C, CN-E); Escuela de Medicina, Uni-
versidad de Magallanes, Punta Arenas, Chile (MM-C);
Departamento de Kinesiologia, Universidad de Magal-
lanes, Punta Arenas, Chile (DM-C, MC-A, SCB); Depart-
ment of Physical Activity Sciences, Universidad Católica
del Maule, Talca, Chile (PV-B); Education School, Uni-
versidad Viña del Mar, Viña del Mar, Chile (PV-B); Kine-
siology School, Universidad Santo Tomás, Chile (EG-M);
Kinesiology School, Universidad Autónoma de Chile,
Chile (EG-M); Faculty of Sports Sciences and Physical Ed-
ucation, Universidad de Cundinamarca, Colombia
(ONM).
Data availability statement
The original contributions presented in the study are
included in the article. Further inquiries can be directed
to the corresponding author.
Disclosure of interest
The authors report that there are no competing inter-
ests to declare.
Funding details
This work was funded with resources from the Na-
tional Fund for the Promotion of Sports of Chile, code
2200120010 (Instituto Nacional de Deporte de Chile,
IND).
Author contributions
All the authors have intellectually contributed to the
development of the study, assume responsibility for its
content, and agree with the definitive version of the arti-
cle.
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Datos de los/as autores/as y traductor/a:
Matías Mabe-Castro
mmabe@umag.cl
Autor/a
Diego Mabe-Castro
mmabe@umag.cl
Autor/a
Matias Castillo-Aguilar
matias.castillo@umag.cl
Autor/a
Manuel Vera Carrasco
manuel.veracarr@gmail.com
Autor/a
Pablo Valdés-Badilla
valdesbadilla@gmail.com
Autor/a
Eduardo Guzman-Muñoz
eguzmanm@santotomas.cl
Autor/a
Sergio Cares Barrientos
sergio.cares@umag.cl
Autor/a
Oscar Niño Mendez
oscarnio@gmail.com
Autor/a
Cristian Núñez-Espinosa
cristian.nunez@umag.cl
Autor/a – Traductor/a
