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Enhanced recovery following physical activity and exercise-induced muscle damage (EIMD) has become a priority for athletes. Consequently, a number of post-exercise recovery strategies are used, often without scientific evidence of their benefits. Within this framework, the purpose of this study was to test the efficacy of whole body cryotherapy (WBC), far infrared (FIR) or passive (PAS) modalities in hastening muscular recovery within the 48 hours after a simulated trail running race. In 3 non-adjoining weeks, 9 well-trained runners performed 3 repetitions of a simulated trail run on a motorized treadmill, designed to induce muscle damage. Immediately (post), post 24 h, and post 48 h after exercise, all participants tested three different recovery modalities (WBC, FIR, PAS) in a random order over the three separate weeks. Markers of muscle damage (maximal isometric muscle strength, plasma creatine kinase [CK] activity and perceived sensations [i.e. pain, tiredness, well-being]) were recorded before, immediately after (post), post 1 h, post 24 h, and post 48 h after exercise. In all testing sessions, the simulated 48 min trail run induced a similar, significant amount of muscle damage. Maximal muscle strength and perceived sensations were recovered after the first WBC session (post 1 h), while recovery took 24 h with FIR, and was not attained through the PAS recovery modality. No differences in plasma CK activity were recorded between conditions. Three WBC sessions performed within the 48 hours after a damaging running exercise accelerate recovery from EIMD to a greater extent than FIR or PAS modalities.
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Effects of Whole-Body Cryotherapy vs. Far-Infrared vs.
Passive Modalities on Recovery from Exercise-Induced
Muscle Damage in Highly-Trained Runners
Christophe Hausswirth
1
*, Julien Louis
1,2
, Franc¸ois Bieuzen
1
, Herve
´Pournot
1,2
, Jean Fournier
1
, Jean-
Robert Filliard
3
, Jeanick Brisswalter
2
1Research Department, National Institute of Sport, Expertise and Performance (INSEP), Paris, France, 2Laboratory of Human Motricity, Education and Health, University of
Nice Sophia-Antipolis, Nice, France, 3Medical Department, National Institute of Sport, Expertise and Performance (INSEP), Paris, France
Abstract
Enhanced recovery following physical activity and exercise-induced muscle damage (EIMD) has become a priority for
athletes. Consequently, a number of post-exercise recovery strategies are used, often without scientific evidence of their
benefits. Within this framework, the purpose of this study was to test the efficacy of whole body cryotherapy (WBC), far
infrared (FIR) or passive (PAS) modalities in hastening muscular recovery within the 48 hours after a simulated trail running
race. In 3 non-adjoining weeks, 9 well-trained runners performed 3 repetitions of a simulated trail run on a motorized
treadmill, designed to induce muscle damage. Immediately (post), post 24 h, and post 48 h after exercise, all participants
tested three different recovery modalities (WBC, FIR, PAS) in a random order over the three separate weeks. Markers of
muscle damage (maximal isometric muscle strength, plasma creatine kinase [CK] activity and perceived sensations [i.e. pain,
tiredness, well-being]) were recorded before, immediately after (post), post 1 h, post 24 h, and post 48 h after exercise. In all
testing sessions, the simulated 48 min trail run induced a similar, significant amount of muscle damage. Maximal muscle
strength and perceived sensations were recovered after the first WBC session (post 1 h), while recovery took 24 h with FIR,
and was not attained through the PAS recovery modality. No differences in plasma CK activity were recorded between
conditions. Three WBC sessions performed within the 48 hours after a damaging running exercise accelerate recovery from
EIMD to a greater extent than FIR or PAS modalities.
Citation: Hausswirth C, Louis J, Bieuzen F, Pournot H, Fournier J, et al. (2011) Effects of Whole-Body Cryotherapy vs. Far-Infrared vs. Passive Modalities on
Recovery from Exercise-Induced Muscle Damage in Highly-Trained Runners. PLoS ONE 6(12): e27749. doi:10.1371/journal.pone.0027749
Editor: Alejandro Lucia, Universidad Europea de Madrid, Spain
Received July 22, 2011; Accepted October 24, 2011; Published December 7, 2011
Copyright: ß2011 Hausswirth et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Funding: The authors have no support or funding to report.
Competing Interests: The authors have declared that no competing interests exist.
* E-mail: christophe.hausswirth@insep.fr
Introduction
Endurance events such as long distance running, cycling or
triathlon competitions require extensive physical and psychological
involvement of the athlete during both the training and the
competition in order to achieve success. Well-trained runners
complete training sessions practically every day or two, and so
acute recovery becomes a vital factor in supporting supplementary
training loads or competitions [1,2]. Especially after a running
session, where a large proportion of eccentric work is performed,
muscular recovery becomes pertinent. It is well documented that
eccentric contractions, which involve force generation in a
lengthening muscle, procure severe structural damage in muscles,
affecting their contractile properties [3].Within days after exercise,
these structural alterations are classically accompanied by
physiological and subjective perceptions of muscle damage that
delay recovery. The release of muscular enzymes (e.g. creatine
kinase, CK) into the plasma and sensations of pain or discomfort
(i.e. delayed-onset-muscle-soreness, DOMS) typically occur after
eccentric loading of the skeletal muscle and are classically used to
study the extent of muscle damage [4,5,6]. In addition, the ensuing
decline in maximal force generating capacity constitutes a relevant
indicator of exercise-induced muscle damage (EIMD) [7].
A variety of authorized strategies are proposed to alleviate the
deleterious effects of EIMD and enhance recovery such as
nutritional supplementation [7], post-exercise massages [8],
compressive garments [5], water immersion [9], whole-body
cryotherapy (WBC) [10] or body expositions to the warmth [11].
Therapies based on temperature diminution through cold water
immersion (4uCto16uC) or local application of cooling
apparatus (i.e. ice-vests, cold towels or ice packs) are some of
the most recent strategies for promoting recovery from
endurance efforts [12,13]. Whatever the technique used, the
main beneficial effect of cold during recovery is the cold-related
vasoconstriction that may limit vessels’ permeability and thus
inflammatory processes, reducing muscle pain [14]. Based upon
this framework, in addition to the different cold methods
currently available, the use of WBC to alleviate pain and
inflammatory symptoms has recently been suggested [15]. WBC
consists of exposure to very cold air that is maintained at
2110uCto2140uC in a special temperature-controlled
cryochamber, generally for 3 to 4 minutes [16]. Despite the
increasing popularity of WBC in sports, very few studies have
tried to verify its efficacy on recovery. Recently, Banfi et al. [17]
have recorded beneficial effects of a one week course of daily
sessions of WBC on recovery from EIMD in professional rugby
PLoS ONE | www.plosone.org 1 December 2011 | Volume 6 | Issue 12 | e27749
players. Results indicate a significant reduction in muscular
enzymes (creatine kinase [CK] and lactate dehydrogenase
[LDH]) and pro-inflammatory cytokines into the plasma,
associated with an increase in anti-inflammatory cytokines.
Additionally, Pournot et al. [18] recently reported that a single
exposure to WBC significantly alleviated inflammation after a
strenuous exercise run mainly composed of eccentric contrac-
tions. According to these results, WBC could hasten muscular
recovery after exercise by reducing inflammatory processes,
vascular permeability and subsequent edema development [15].
In an attempt to better understand the effects of WBC on human
physiology, additional studies have been recently conducted with
healthy men. The main results indicate a number of physiolog-
ical changes occurring after body exposures to cold. These
changes principally concern hematologic values [19], immuno-
logical and inflammatory responses [20,21], and antioxidant/
prooxidant balance [20,22]. As an example, Lubkowska et al.
[20,21] have reported an increase in body’s immunity, associated
with a decrease in total oxidative status and inflammatory
response after repeated WBC sessions (10 to 20 sessions). Klimek
et al. [23] have also shown an improvement in anaerobic
capacity after 10 WBC sessions, principally explained by
metabolic changes (i.e. increased activity of anaerobic glycolitic
enzymes) and a better tolerance to pain, highlighted by an
increase in blood lactate concentration. Practically, it seems that
a sufficient number of WBC sessions (at least 10 sessions) are
necessary to stimulate an immunological response, while
antioxidant and anti-inflammatory effects would be obtained
from the first session. Such reactions could be particularly
beneficial during the recovery period following exercise, and
reinforce the significance of WBC in a sporting context.
Other recovery modalities such as far-infrared (FIR) therapy
are also used to relieve pain in patients with muscular disorders
and more recently have been considered as an efficient recovery
strategy in sport [24,25]. FIR therapy generally consists of a
30 min body exposition to FIR in a specially built apparatus. FIR
are not visible by the human eye but are experienced by the
warmth it produce. Potential positive effects of FIR during
recovery are mainly based on the increase of peripheral flow due
to the warmth-related vasodilatation, which could enhance the
evacuation of edema, limiting inflammation and perceived pain,
and enhancing muscle repair [26]. Moreover, by penetrating into
the skin, the FIR energy could break agglomerates of water
molecules in smaller groupings, which could reduce edema and
facilitate the release of metabolic wastes [26]. However, similarly
to WBC, the effect of FIR on recovery is mainly based on
observations and habitual utilization. To date, the only verified
effect of FIR is a reduction of perceived muscle pain and
tiredness, induced by an increase in endorphin production
[25,27].
In order to determine the most appropriate recovery strategy for
running-induced muscle damage, this study compared three
different recovery modalities (WBC, FIR and passive [PAS]
recovery) on symptoms of EIMD following a strenuous simulated
trail running race performed by highly-trained endurance runners.
Materials and Methods
Ethical standards
These experiments were conducted according to the Helsinki
Declaration (1964: revised in 2001) and the protocol was approved
by the local Ethics committee (Ile-de-France, XI, France. Ref.
200978). All subjects gave their written informed consent before
the initiation of the experiment.
Subjects
Nine well-trained runners participated in the study (see Table 1
for characteristics), all with similar training levels and statures. The
criteria used for selection of runners were a minimal performance
of 38 min on a 10 km running race, and a minimum of 4 training
sessions per week over the last year before the experiment.
Selected runners regularly engaged in long distance running events
(e.g. marathon, trails) and presented no contraindications to WBC
or FIR therapy, such as claustrophobia and cold/warmth
hypersensitivity. All subjects were volunteers and were informed
about the study protocol, the risks of tests and investigations, and
their rights according to the Declaration of Helsinki. Participants
gave their written informed consent and the study was approved
by the local Ethics Committee (I
ˆle-de-France XI, France; Ref.
200978) before its initiation.
Experimental design
This study was conducted in order to analyze the effect of three
different recovery modalities on EIMD following a simulated trail
running race. In three non-adjoining weeks, the nine runners
performed three identical repetitions of a simulated trail run on a
motorized treadmill, designed to induce muscle damage. Within
the first hour (post), 24 h (post 24 h), and 48 h (post 48 h), after
each strenuous running exercise, all participants tested one of the
three recovery modalities (WBC, FIR, PAS) presented in a
random order. Classical indicators of EIMD such as, plasma CK
activity, isometric maximal voluntary torque, and perceived
sensations of pain, tiredness and well-being (typically grouped
under the term DOMS), were assessed immediately before (pre)
and after (post) each simulated running trail, and after each of the
three recovery sessions (post 1 h, post 24 h, post 48 h). All
participants performed three identical running trails and used all
the three recovery modalities over the experiment. Between trials,
a minimum of three weeks of low intensity training was ensured, in
order to allow a complete muscular recovery. However, in order to
limit and control the development of additional EIMD, subjects
were asked not to train for the three days preceding and
succeeding the data recording.
One week before the experiment, subjects were familiarized
with the test scheme and location and preliminary testing was
Table 1. Characteristics of runners.
Variables (units) Subjects (n = 9)
Age (years) 31.866.5
Height (m) 1.7960.06
Weight (kg) 70.666.5
Training in running (sessions.week
21
) 4.861.3
VO
2
max (ml.min
21
.kg
21
) 62.063.9
MAS (km.h
21
) 18.761.1
V VT1 (km.h
21
) 14.260.7
V VT2 (km.h
21
) 16.761.2
10 km personal best (hour:min:sec) 00:34:48600:02:35
Semi-marathon personal best (hour:min:sec) 01:17:12600:06:12
Marathon personal best (hour:min:sec) 02:45:38600:15:58
Data are means 6SD.
Legend Table 1: VO
2
max (ml.min
21
.kg.
21
), maximal oxygen consumption; MAS,
maximal aerobic speed; V VT1 velocity at 1
st
ventilatory threshold; V VT2,
velocity at 2
nd
ventilatory threshold.
doi:10.1371/journal.pone.0027749.t001
Effects of Recovery Modes after a Running Trail
PLoS ONE | www.plosone.org 2 December 2011 | Volume 6 | Issue 12 | e27749
performed. From this week onwards until the end of the
experimentation period, the training loads of all subjects were
controlled by asking them to train with a heart rate monitor, and
they did not use other recovery strategies like stretching,
nutritional supplementation, electro stimulation, or cold water
immersion. Moreover, in order to control the influence of other
recovery modalities, nutritional recommendations were sent to
runners during all the experiment and they were asked to respect
identical menus during the three days preceding and succeeding
the running sessions.
Preliminary testing
Maximal oxygen uptake (VO
2max
) was determined on a
motorized treadmill (H/P/CosmosHSaturn, Traunstein, Ger-
many). The test consisted of a 6 min warm-up at 12 km.h
21
and
an incremental period in which the running speed was increased
by 1 km.h
21
every 2 min until volitional exhaustion. Oxygen
uptake (VO
2
), minute ventilation (VE), and respiratory exchange
ratio (RER) were continuously recorded with a breath by breath
gas exchange analyzer (Quark CPET, Cosmed, Roma, Italy).
Heart rate (HR) was recorded using a chest belt (Cosmed wireless
HR monitor, Roma, Italy). The criteria used for the determination
of VO
2max
were threefold: a plateau in VO
2
despite an increase in
power output, a RER above 1.1, and a heart rate (HR) above 90%
of the predicted maximal HR [28].VO
2max
was determined as the
average of the four highest VO
2
values recorded (mean VO
2
max:
62.063.9 ml.min
21
.kg
21
). The first and the second ventilatory
thresholds (VT1 and VT2) were determined as described by
Wasserman et al. [29].The maximal aerobic speed (MAS) was the
highest running velocity completed for 2 min (mean MAS:
18.761.1 km.h
21
). After this preliminary running exercise,
subjects were familiarized with the ergometer used to evaluate
lower limb muscle strength and with the recovery apparatus.
Simulated trail running race
Once a month within a three months’ period, subjects
completed a simulated trail running race with a large amount of
downhill sections (total downhill time: 15 min), well-known to
induce muscle damage [30,31,32], on the same treadmill used for
preliminary testing. The trail run was designed to replicate as
completely as possible the race constraints encountered in a trail
run. The race lasted 48 min and was divided in 5 blocks. The first
block included 6 min on the flat (0% gradient), followed by 3 min
uphill (+10% gradient) and 3 min downhill (215% gradient).
Velocity was continuously adjusted as a function of gradient in
order to obtain a variety of intensities and elicit a similar metabolic
demand to trail races in the field (Fig. 1). Therefore, velocity at 0%
gradient was between VT1 and VT2 (mean Vflat: 15.56
0.9 km.h
21
), while velocity at +10% gradient corresponded to
,80% (mean Vuphill: 11.160.9 km.h
21
) of the maximal aerobic
velocity at this gradient [33], and velocity at 215% corresponded
to velocity at VT1 (mean Vdownhill: 14.260.7 km.h
21
). Blocks 2–
5 consisted of 3 min at 0u, followed by 3 min uphill and 3 min
downhill at the gradients and velocities previously described.
Recovery interventions (WBC vs. FIR vs. PAS)
Subjects were randomly assigned to one recuperation modality
(WBC, FIR or PAS) to be used after the simulated trail running
race (post), post 24 h and post 48 h when EIMD are typically
reported to be the most important [32,34]. All subjects used each
of the recovery modalities in the course of the experiment. WBC
sessions were administered under medical supervision, in a
specially built, temperature-controlled unit (Zimmer Elektromedi-
zin, Germany), which consists of three rooms (210, 260 and
2110uC). The temperature of all rooms remained constant
throughout the experiment. During each WBC session, subjects
traversed the warmer rooms and remained in the therapy room for
3 min. In the familiarization session, exposure was reduced to
1 min. Subjects were instructed to dry eventual sweat, wear a
bathing suit, surgical mask, earband, triple layer gloves, dry socks
and sabots. During the 3 min, subjects avoided tension by slightly
moving their arms and legs by walking. After the WBC session,
subjects spent 10 min seated comfortably in a temperate room
(24uC) wearing a bath robe, and were allowed to dress themselves
as warmly as they wished to avoid a subjective sensation of cold.
The second recovery modality was a 30 min exposure to far-
infrared radiation (Inovo, IRL technology, Montpellier, France).
Subjects lay in a supine position on the table of the apparatus,
clothed only in a bathing suit and thus exposing the whole body,
except for the head, to FIR (4–14 mm, 45uC).
Finally, the last recovery modality was a passive recovery
(control modality) during which subjects were seated comfortably
in an armchair for 30 min, located in the same temperate room
previously presented.
Data recording
Indicators of exercise-induced muscle damage. Indicators
of EIMD included maximal muscle force, muscle enzyme creatine
kinase (CK) activity in the plasma, and perceived sensations of
muscle pain, tiredness and well-being, which have been commonly
used as indirect markers of muscle damage in previous studies
[5,32,35].All markers were measured in pre, post, post 1 h, post
24 h and post 48 h conditions.
Muscle torque assessment. Knee extensors’ isometric
maximal voluntary torque was assessed at a 70uknee angle with
an isokinetic ergometer (Con-Trex Multi-Joint System,
Du¨bendorf, Switzerland).After a brief warm-up which consisted
of 5 min low intensity running and submaximal isometric
contractions, subjects were placed in a seated position in the
ergometer chair with their hips and thigh strapped to the seat.
Subjects were instructed to extend their knee ‘‘as fast and as hard
as possible’’ [36] and each maximal contraction was sustained for
5 s. Three isometric maximal voluntary contractions (MVC) of the
knee extensor muscles were performed with rest periods of 60 s in
Figure 1. Schematic representation of the simulated running trail. Flat, 0% gradient section; Up, +10% gradient section; Down, 215%
gradient section.
doi:10.1371/journal.pone.0027749.g001
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PLoS ONE | www.plosone.org 3 December 2011 | Volume 6 | Issue 12 | e27749
between. Maximal MVC performance was defined as the highest
peak torque value of the three maximal attempts.
Plasma creatine kinase activity. Each time, blood samples
were collected before MVC had been performed, in order to avoid a
potential influence of this maximal exercise on CK level into the
plasma. Plasma CK activity was determined from a 5 ml sample of
whole blood collected into vacutainer tubes via antecubital
venipuncture. Once the blood sample was taken, tubes were
mixed by turning and placed on ice for 30 s before centrifugation
(10 min, 3000 rev.min
21
,4uC). The obtained plasma sample was
then stored in multiple aliquots (Ependorf type, 500 ml per samples)
at 280uC until analysis. As a marker of sarcolemma disruption,
plasma CK activity was measured spectrophotometrically by using
commercially available reagents (Roche/Hitachi, Meylan, France).
Perceived sensations. The effects of recovery interventions
on EIMD were also recorded through the assessment of the
perceived sensations of subjects. The Mindeval system (www.
mindeval.com) was used to collect the data (Mindeval GydleInc.
Que´bec, CANADA). This system is comprised of a web interface
with a database and a stand-alone application. In Pre, Post, Post
1 h, Post 24 h, and Post 48 h conditions, participants entered their
personal key and answered three areas of questions related to 1)
pain, 2) tiredness, and 3) well being. For example, to answer the
question ‘‘how sore are you?’’ subjects use the computer mouse to
move the indicator between the two ends ‘‘no pain’’ and
‘‘maximum pain’’. The software records the location of the
indicator with a number ranging between 0 (no pain) and 100
(maximum pain). The collected data was stored on a secured
server. Before the initiation of the study, subjects were accustomed
to the software, and the questions relative to their subjective
sensations were thoroughly explained to be sure that all subjects
understood the same meaning.
Statistical analysis
All data were expressed as mean 6standard deviation (SD). A
two-way analysis of variance (recovery modality6period) for
repeated measures was performed to analyze the effects of the
running trail (Pre vs. Post, Post 1 h, Post 24 h, Post 48 h) and
recovery intervention (Post vs. Post 1 h, Post 24 h, Post 48 h) with
MVC, plasma CK activity, and perceived sensations as dependent
variables. The LSD Fischer post-hoc test was used to determine
the between-means differences if the analysis of variance revealed
a significant main effect for period or interaction of recovery
modality6period. For all statistical analyses, a p,0.05 value was
accepted as the level of significance.
Results
No significant differences between running sessions were
observed in absolute terms at baseline for maximal voluntary
torque, plasma CK activity, and perceived sensations.
Maximal voluntary contractions
Results indicated a significant MVC decline immediately after
the trail run whatever the groups, without differences between
them (mean post MVC decline for all subjects and sessions:
29.6%, p,0.05). MVC capacity was recovered after the first
WBC session (post 1 h), while it was recovered later with FIR (post
24 h), and did not recover in the PAS condition (Fig. 2).
Plasma creatine kinase activity
In all subjects, CK activity significantly increased after the
simulated trail running race (post: +51.7%, p,0.05). No effect of
recovery modalities on CK activity was recorded in all testing
periods (post 1 h, post 24 h, and post 48 h). The peak of CK
activity following exercise occurred 24 h post-exercise (post 24 h)
without significant differences between recovery conditions
(Table 2).
Perceived sensations
Psychological parameters were influenced both by the strenuous
running exercise and recovery modality during the following 48 h
(Table 2). In all subjects, the perceived pain and tiredness
significantly increased immediately after exercise (Post) and
Figure 2. Recovery of knee extensor’s maximal voluntary contraction (MVC, % of post), assessed after each of the three recovery
sessions (post 1 h, post 24 h, post 48 h). {significantly different from post condition (p,0.05), {significantly different from post 1 h condition
(p,0.05).
doi:10.1371/journal.pone.0027749.g002
Effects of Recovery Modes after a Running Trail
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remained elevated post 1 h, post 24 h, and post 48 h. Pain and
tiredness were reduced after the first WBC session (post 1 h),
whereas FIR only reduced pain at a later point in time (post 48 h).
Neither pain nor perceived tiredness was modified by passive
recovery during the 48 h after exercise. In FIR and PAS
conditions, well-being was altered after the running trail and
remained lower than pre-exercise values in all testing periods
excepted in post 48 h in the FIR condition. Well-being was,
however, higher than post exercise values at post 24 h in the WBC
condition and post 48 h in the FIR condition.
Discussion
This study was designed to compare the effects of different
recovery strategies following a damaging simulated trail run,
performed by highly-trained endurance runners. As expected, this
running exercise induced significant muscle damage, manifested
through a reduction in maximal torque generating capacity, an
increase in plasma CK activity, and an increase in pain and
tiredness sensations. The main results are that MVC and
perceived sensations were recovered after the first WBC session
(post 1 h) while recovery took 24 hours in the FIR recovery
modality and was not achieved with the PAS modality. However,
no beneficial effect of recovery modality was observed on plasma
CK activity.
A decrease in maximal torque generating capacity is widely
accepted as a marker of muscle damage following a strenuous
exercise. This decline is magnified when exercise involves eccentric
contractions [30,37]. In the present study, the mean MVC
decrease for all subjects over the three running trails was 29.6,
28.2, 22, and 20.8% respectively post, post1 h, post 24 h, and
post 48 h after the simulated running race. This MVC decline is
less accentuated than in previous field studies on longer races
(marathon or trail running races), where 216 to 237% MVC
declines were recorded [7,38,39]. Moreover, it could be supposed
that simulated running races on treadmill are classically less
damaging for muscles than real running races where the courses
are often more difficult, with bigger variations in level, unstable
surfaces, and variations in atmospheric conditions. Increases in
pain, tiredness, and plasma CK activity (mean peak in post 24 h:
+247%) confirm the success of the present protocol in generating
muscle damage, but still in lower proportions than longer
overground running protocols [38,40].
The most beneficial effects of recovery sessions organized within
the first 48 hours after the simulated trail running race were
recorded with the WBC modality. MVC was recovered after the
first WBC session (post 1 h), while recovery took 24 h with FIR,
and was not attained through PAS recovery. On contrary, Costello
et al. [41] reported no beneficial effect of 2 WBC sessions on the
recovery of maximal muscle strength after repeated eccentric
contractions of knee extensors. However, in the study of Costello
et al. [41], participants were not highly-trained runners as in our
study, and therefore were not accustomed to eccentric contrac-
tions, which may explain this absence of positive effect of WBC.
Additionally, multiple studies on the effects of cold therapy
through ice or water immersion on maximal force recovery
present contradictory results depending on the activity and its
intensities [9,13,14,42,43]. However, the majority of studies
suggest that short-term whole body immersion is beneficial to
restoring force-generating capacity and repeating endurance
performance when performed immediately after exercise
[13,44].The main hypothesis suggested to explain this effect is
related to the fall in core temperature during the cold exposition
inducing, via a vasoconstriction mechanism, a decrease in vessels
Table 2. Indicators of exercise-induced muscle damage (EIMD), assessed before (pre) and after (post) the simulated running trail,
and after the three recovery sessions (post 1 h, post 24 h, post 48 h).
Variables (units) Pre Post Post 1 h Post 24 h Post 48 h
CK (% of pre)
FIR 0.060.0 40.5618.4* 44.2620.9* 192.36179.3*{{107.56121.1*$
WBC 0.060.0 58.2618.9* 73.9633.4* 318.96224.7*{{195.36141.6*$
PAS 0.060.0 56.4625.1* 63.7626.5* 231.86132.1*{{137.6699.8*$
Pain (/100)
FIR 1.663.2 61.9619.0* 58.3618.4* 49.3629.1* 45.2629.1*{
WBC 0.260.7 60.6620.7* 31.7623.8*{33.3626.1*{39.0624.0*{
PAS 0.160.3 55.7618.2* 44.3623.7* 53.9625.5* 58.9619.0*
Tiredness (/100)
FIR 8.369.8 75.3611.2* 67.8621.3* 65.8620.0* 61.8615.9*
WBC 5.269.8 77.9613.3* 44.6626.3*{35.9619.4*{46.6624.0*{
PAS 8.7612.3 65.4626.6* 52.2627.0* 49.2621.4* 60.7626.7*
Well-being (/100)
FIR 86.8616.9 56.6631.9* 67.9628.2* 66.9627.6* 72.4619.2{
WBC 77.7625.2 65.4626.6 74.9626.7 87.160.0{81.2620.4{
PAS 93.969.0 58.4626.8* 69.8625.3* 65.4621.1* 68.7628.1*
Data are means 6SD.
Legend Table 2: CK, plasmatic creatine kinase activity; FIR, far infrared; WBC, whole body cryotherapy; PAS, passive.
*significantly different from pre condition (p,0.05);
{
significantly different from post condition (p,0.05);
{
significantly different from post 1 h condition (p,0.05);
$
significantly different from post 24 h condition (p,0.05).
doi:10.1371/journal.pone.0027749.t002
Effects of Recovery Modes after a Running Trail
PLoS ONE | www.plosone.org 5 December 2011 | Volume 6 | Issue 12 | e27749
permeability to immune cells, and thus reducing the edema and
inflammatory process and/or pain [14]. However, long-term cold
immersion could be detrimental for recovery by inducing an
increase in TNF-a(i.e. a proinflammatory cytokine), lymphocytes
and monocytes [45,46]. According to these authors, this
immunostimulating effect of cold could be related to an enhanced
noradrenalin response to the cold [46]. In another side, published
data suggest that repeated short-term expositions to WBC have
beneficial effects by reducing inflammatory processes, and having
a mobilization effect on the immunological system. First, Banfi
et al. [17] have reported no effect of 3 min WBC on
immunological parameters in rugby players after 5 days of
WBC, but a decrease in pro- inflammatory cytokines associated
with an increase in anti-inflammatory cytokines. More recently,
Lubkowska et al. [20,21] have reported a significant increase in
while blood cell count after numerous (10 to 20 sessions) WBC
expositions in healthy men, systematically accompanied with an
increase in anti-inflammatory cytokines. A significant anti-
inflammatory effect was also reported by Pournot el al. [18] after
a single WBC session performed after an exhaustive run in well-
trained runners. Both the anti-inflammatory and pro-inflamma-
tory cytokines were positively modified after the WBC session,
mainly explained by a vasoconstriction mechanism at muscular
level. According to Miller et al. [22], 10 WBC sessions could also
significantly stimulate the antioxidant protection by increasing the
amount of enzymatic and non-enzymatic antioxidant species.
Changes in while blood cell count, in pro- and anti-inflammatory
cytokines, and changes in both the total oxidative and antiox-
idative status, after WBC exposures confirm the significance of
WBC to improve body’s defenses and thus post-exercise recovery.
Moreover, a cold-related reduction in nervous activity, combined
with an increased endorphin concentration could have an
analgesic effect, reducing the perception of fatigue and pain
[34,47], and allowing subjects to develop more force. The
perception of pain or tiredness is determined by both physiological
and psychological influences, and thus constitutes a relevant
indicator of muscle recovery to support physiological findings [48].
Similar to MVC capacity, the present study recorded beneficial
effects of WBC on psychological recovery within days after
exercise. Pain and tiredness sensations subsequent to the simulated
trail running race were reduced after the first WBC session, while
pain sensation only was lowered later (post 48 h) by using FIR,
and no effect of PAS recovery was recorded. Beneficial effects of
the WBC and FIR recovery modalities on well-being were also
recorded post 24 h with WBC and post 48 h with FIR. All
previous studies on cold exposure methods (i.e. ice application,
cold water immersion) have indicated minimal or no effect of cold
on recovery of psychological feelings after exercise [4]. Moreover,
in the recent study of Costello et al. [41] muscle soreness sensations
were not lowered after 2 WBC. As previously mentioned, it can be
hypothesized that muscle damage could be higher in the study of
Costello et al. [41] when compared with ours, mainly related to
the fact that participants were not accustomed to eccentric
contractions. Indeed, numerous studies have shown that the
amount of EIMD can be dramatically different according to the
training status, and that only one previous exposure to eccentric
contractions provides a protective effect for muscle structures
[49,50]. Within this frame, our results seem to confirm a previous
study conducted in the medical domain, in which WBC induced a
reduction of depressive symptoms by enhancing well-being, sleep
and relaxation [51,52]. The results indicate that sufficiently low
temperatures and a whole body exposure to cold seem to be
beneficial in enhancing the sensation of recovery.
In contrast to previous studies, the WBC session did not
influence plasma CK activity within the first 48 hours after
exercise [15,53,54]. Indeed, in our study, no differences in
absolute plasma CK concentrations were recorded before and
after exercise between recovery modalities in all testing sessions.
One hypothesis to explain the lack of effect of recovery modalities
on CK concentrations could be the number of WBC recovery
sessions performed after exercise. Banfi et al. [53] reported a
significant 240% reduction in CK level after five days of daily
WBC sessions in rugby players, and Wozniak et al. [54] reported a
234% decline in CK concentration after 10 WBC sessions
performed by 21 kayakers before each training session. The
repeated cold-related stimulations of noradrenalin could partly
explain the decrease in CK concentration after WBC sessions,
associated with a decline in prostaglandin PGE2 (i.e. an
inflammatory mediator and vasodilator) which could reduce
vascular permeability [53]. In contrast, our results show that 3
WBC sessions doesn’t limit the increase in plasma CK activity
generally related to structural damage of the muscle fibers.
According to these results, it seems that repeated expositions (a
minimum of 5 to 10 sessions) to WBC are required to stimulate
recovery from muscle fiber damage by reducing muscle membrane
breakdown or increased cell permeability induced by physical
exercise.
In conclusion, this study was designed to compare the effects of
three different recovery modalities (WBC vs. FIR vs. FIR) during
the acute recovery period (post 48 h) following a damaging
simulated trail run. WBC (3 min at 2110uC) was the best recovery
modality to hasten recovery from EIMD by limiting the torque loss
and subjective sensations of pain, classically recorded after
repeated eccentric contractions.
Acknowledgments
The authors would like to thank the athletes who took part in this
experiment, and the medical department of INSEP for the use of the WBC
and the availability of the nurses for the blood collection.
Author Contributions
Conceived and designed the experiments: CH JL HP FB JF JRF JB.
Performed the experiments: CH JL HP FB JF JRF JB. Analyzed the data:
CH JL HP FB JF JRF JB. Contributed reagents/materials/analysis tools:
CH JL HP FB JF JRF JB. Wrote the paper: CH JL HP FB JF JRF JB.
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Effects of Recovery Modes after a Running Trail
PLoS ONE | www.plosone.org 7 December 2011 | Volume 6 | Issue 12 | e27749
... Hausswirth et al 14 reported that a 30-minute FIR lamp therapy applied to the whole body immediately, 1 and 2 days after a 48minute simulated trail run increased the recovery of knee extensor (KE) strength at 1 day postrunning. In a review paper, Leung 15 has stated that FIR has therapeutic effects to delay muscle fatigue, reduce chronic muscle and joint pain, increase microcirculation, and enhance metabolism. ...
... on muscle damage and performance parameters relating to soccer, but they did not find significant effects of the FIR therapy on muscle damage and performance parameters. 11,12 Hausswirth et al 14 showed that a 30-minute FIR lamp therapy applied to the whole body immediately, 1 and 2 days after a 48-minute simulated trail run performed by trained runners improved the recovery of KE MVC torque by 9%; although, no effects on DOMS and plasma CK activity were observed. This was why we used a FIR lamp therapy in the present study, but it should be noted that the FIR lamp therapy used in the present study was different from that in the study by Hausswirth et al 14 in terms of the device and application of the therapy (ie, whole body vs local muscles). ...
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Purpose: The authors investigated whether far-infrared radiation (FIR) lamp therapy would reduce muscle damage and enhance recovery from multiple soccer-match-related running activities. Methods: Twenty-four elite female soccer players (20-24 y) were assigned into a FIR or a sham treatment group (n = 12/group). They performed a daily 90-minute Loughborough Intermittent Shuttle Test (LIST) for 6 consecutive days. Maximal voluntary contraction torque of the knee extensors (KEs) and flexors, muscle soreness, plasma creatine kinase activity, countermovement jump, and several other performance measures (eg, 30-m dash, Yo-Yo Intermittent Recovery Test Level 1) were taken before the first LIST, 1 hour after each LIST, and 24, 48, 72, 96, and 120 hours after the last LIST. All participants received a 30-minute FIR or sham treatment on KEs and knee flexors, respectively, at 2 hour after each LIST and 25, 49, 73, and 97 hours after the last LIST. Results: All measures changed significantly (P < .05) at 1 hour after the first LIST without difference (P > .05) between groups. Maximal voluntary contraction torque (eg, the largest decrease of KE for FIR: 13% [4%], sham: 25% [5%]), countermovement jump height (4% [3%] vs 14% [4%]), and other performance measures (eg, Yo-Yo Intermittent Recovery Test: 11% [5%] vs 26% [5%]) decreased less, and peak muscle soreness (eg, KE: 26 [9] vs 51 [18] mm) and plasma creatine kinase activity (172 [32] vs 1289 [610] IU/L) were smaller for the FIR than for the sham group (P < .05), and they returned to the baseline earlier (P < .05) for the FIR group. Conclusions: These results suggest that the FIR therapy provided potent effects on reducing accumulated muscle damage and enhancing recovery.
... The potential positive effects of FIR therapy are mainly based on the increase of the peripheral flow due to vasodilatation under the influence of heat, which could improve drainage of the edema, limit the inflammation and perceived pain, and thus improve muscle repair (Lin et al., 2007). Furthermore, by penetrating the skin, the FIR energy could break down the clusters of water molecules, which could reduce the edema and facilitate the release of metabolic wastes (Lin et al., 2007), all the while providing a feeling of already proven well-being (Hausswirth et al., 2011). Moreover, negative air ionisationsuch as in the case of Polish salt cavescould have complementary effects with far infrared energy to increase immune function (Zajac et al., 2014). ...
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Background Adipose-derived mesenchymal stem cells (ADSCs), as seed cells for tendon tissue engineering, are promising for tendon repair and regeneration. But for ADSCs, diverse oxygen tensions have different stimulatory effects. To explore this issue, we investigated the tenogenic differentiation capability of ADSCs under hypoxia condition (5% O2) and the possible signaling pathways correspondingly. The effects of different oxygen tensions on proliferation, migration, and tenogenic differentiation potential of ADSCs were investigated. Methods P4 ADSCs were divided into a hypoxic group and a normoxic group. The hypoxic group was incubated under a reduced O2 pressure (5% O2, 5% CO2, balanced N2). The normoxic group was cultured in 21% O2. Two groups were compared: HIF-1α inhibitor (2-MeOE2) in normoxic culturing conditions and hypoxic culturing conditions. Hypoxia-inducible factor-1α (HIF-1α) and VEGF were measured using RT-qPCR. Specific HIF-1α inhibitor 2-methoxyestradiol (2-MeOE2) was applied to investigate whether HIF-1α involved in ADSCs tenogenesis under hypoxia. Results Hypoxia significantly reduced proliferation and migration of ADSCs. Continuous treatment of ADSCs at 5% O2 resulted in a remarkable decrease in HIF-1α expression in comparison with 20% O2. Additionally, ADSCs of hypoxia preconditioning exhibited higher mRNA expression levels of the related key tenogenic makers and VEGF than normoxia via RT-qPCR measurement (p ˂ 0.05). Furthermore, the effects of hypoxia on tenogenic differentiation of ADSCs were inhibited by 2-MeOE2. Hypoxia can also stimulate VEGF production in ADSCs. Conclusions Our findings demonstrate that hypoxia preconditioning attenuates the proliferation and migration ability of ADSCs, but has positive impact on tenogenic differentiation through HIF-1α signaling pathway.
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Athletes experience minor fatigue and acute reductions in performance as a consequence of the normal training process. When the balance between training stress and recovery is disproportionate, it is thought that overreaching and possibly overtraining may develop. However, the majority of research that has been conducted in this area has investigated overreached and not overtrained athletes. Overreaching occurs as a result of intensified training and is often considered a normal outcome for elite athletes due to the relatively short time needed for recovery (approximately 2 weeks) and the possibility of a supercompensatory effect. As the time needed to recover from the overtraining syndrome is considered to be much longer (months to years), it may not be appropriate to compare the two states. It is presently not possible to discern acute fatigue and decreased performance experienced from isolated training sessions, from the states of overreaching and overtraining. This is partially the result of a lack of diagnostic tools, variability of results of research studies, a lack of well controlled studies and individual responses to training. The general lack of research in the area in combination with very few well controlled investigations means that it is very difficult to gain insight into the incidence, markers and possible causes of overtraining. There is currently no evidence aside from anecdotal information to suggest that overreaching precedes overtraining and that symptoms of overtraining are more severe than overreaching. It is indeed possible that the two states show different defining characteristics and the overtraining continuum may be an oversimplification. Critical analysis of relevant research suggests that overreaching and overtraining investigations should be interpreted with caution before recommendations for markers of overreaching and overtraining can be proposed. Systematically controlled and monitored studies are needed to determine if overtraining is distinguishable from overreaching, what the best indicators of these states are and the underlying mechanisms that cause fatigue and performance decrements. The available scientific and anecdotal evidence supports the existence of the overtraining syndrome; however, more research is required to state with certainty that the syndrome exists.
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The blood pressure responses to an acute and long-term (three months) whole-body cryotherapy (WBC) were measured in men and women. Acute cold exposure (−10°C, −60°C, −110°C) increased both systolic and diastolic blood pressures temporarily. Neither significant gender differences nor adaptation in blood pressures were found during WBC. The variation of individual responses to the acute and long-term WBC was wide.
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The aim of this investigation was to elucidate the effects of cold water immersions (CWIs) following damaging exercise on the repeated bout effect (RBE). Sixteen males performed two bouts of drop jump exercise separated by 14-21 days. Participants were equally, but randomly assigned to either a CWI (12-min CWI at 15 degrees C) or control group (12-min seated rest). Treatments were given immediately after the first exercise bout, 24, 48 and 72 h post-exercise. No interventions were given following the second bout. Maximum voluntary contraction (MIVC), soreness (DOMS), creatine kinase (CK), thigh girth and range of motion (ROM) were recorded before and for 96 h following the initial and repeated bouts of damaging exercise. All variables, except ROM, showed a significant time effect (P < 0.01) indicating the presence of muscle damage following the initial bout; there were no differences between the CWI and control groups after the initial bout. Following the repeated bout of exercise there was a significant attenuation in the reduction of MIVC (P = 0.002) and a reduction in DOMS (P < 0.001), which is indicative of the RBE. There were no significant differences between groups following the repeated bout of damaging exercise. These data show that CWI had no effect following damaging exercise and did not inhibit the RBE. Despite CWI being used routinely, its efficacy remains unclear and there is a need to elucidate the benefits of this intervention on recovery and adaptation to provide practitioners with evidence based practice.
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Whole-body cryotherapy (WBC) covers a wide range of therapeutic applications and consists of briefly exposing the body to extremely cold air. In sports medicine, WBC is used to improve recovery from muscle injury; however, empirical studies on its application to this area are lacking. To fill this gap, we compared changes in immunological parameters (C3, IgA, IgM, IgG, C-reactive protein, PGE2), cytokines (IL-2, IL-8, IL-10), adhesion molecules (sICAM-1), and muscle enzymes (creatine kinase [CK], lactate dehydrogenase [LAD]) before and after WBC in 10 top-level Italian National team rugby players. The subjects underwent five sessions on alternate days once daily for 1 week. During the study period, the training workload was the same as that of the previous weeks. Compared to baseline values, immunological parameters remained unchanged, while CK and LAD levels significantly decreased after treatment. No alterations in immunological function were observed but there is a decrease in pro-inflammatory cytokine/chemokine and an increase in anti-inflammatory cytokine.As measured by changes in serum CK and LAD concentrations, and cytokines pathway, short-term cold air exposure was found to improve recovery from exercise-induced muscle injury and/or damage associated with intense physical training.