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Recovery from exercise can be an important factor in performance during repeated bouts of exercise. In a tournament situation, where athletes may compete numerous times over a few days, enhancing recovery may provide a competitive advantage. One method that is gaining popularity as a means to enhance post-game or post-training recovery is immersion in water. Much of the literature on the ability of water immersion as a means to improve athletic recovery appears to be based on anecdotal information, with limited research on actual performance change. Water immersion may cause physiological changes within the body that could improve recovery from exercise. These physiological changes include intracellular-intravascular fluid shifts, reduction of muscle oedema and increased cardiac output (without increasing energy expenditure), which increases blood flow and possible nutrient and waste transportation through the body. Also, there may be a psychological benefit to athletes with a reduced cessation of fatigue during immersion. Water temperature alters the physiological response to immersion and cool to thermoneutral temperatures may provide the best range for recovery. Further performance-orientated research is required to determine whether water immersion is beneficial to athletes.
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Sports Med 2006; 36 (9): 747-765
2006 Adis Data Information BV. All rights reserved.
Physiological Response to
Water Immersion
A Method for Sport Recovery?
Ian M. Wilcock,
John B. Cronin
and Wayne A. Hing
1 Institute of Sport and Recreation Research New Zealand, Division of Sport and Recreation,
Faculty of Health and Environmental Sciences, Auckland University of Technology,
Auckland, New Zealand
2 School of Physiotherapy, Faculty of Health and Environmental Sciences, Auckland University
of Technology, Auckland, New Zealand
Abstract ....................................................................................747
1. Water Immersion as a Recovery Strategy ...................................................748
1.1 Cryotherapy ........................................................................748
1.2 Thermotherapy ......................................................................749
1.3 Contrast Therapy ....................................................................749
1.4 Water Immersion per se ..............................................................749
2. Hydrostatic Pressure ......................................................................750
2.1 Water Pressure.......................................................................750
2.2 Weightlessness and Perceived Fatigue .................................................751
2.3 Fluid Shifts ...........................................................................752
2.4 Exercise-Induced Muscle Oedema ....................................................753
2.5 Cardiac Response ...................................................................754
2.6 Peripheral Resistance and Blood Flow ..................................................756
2.7 Summary of Findings .................................................................757
3. Temperature ............................................................................757
3.1 Cold Temperature Effects.............................................................757
3.2 Hot Water Temperatures ..............................................................758
3.3 Contrasting Temperature .............................................................760
4. Conclusions and Recommendations .......................................................761
Recovery from exercise can be an important factor in performance during
repeated bouts of exercise. In a tournament situation, where athletes may compete
numerous times over a few days, enhancing recovery may provide a competitive
advantage. One method that is gaining popularity as a means to enhance
post-game or post-training recovery is immersion in water. Much of the literature
on the ability of water immersion as a means to improve athletic recovery appears
748 Wilcock et al.
to be based on anecdotal information, with limited research on actual performance
change. Water immersion may cause physiological changes within the body that
could improve recovery from exercise. These physiological changes include
intracellular-intravascular fluid shifts, reduction of muscle oedema and increased
cardiac output (without increasing energy expenditure), which increases blood
flow and possible nutrient and waste transportation through the body. Also, there
may be a psychological benefit to athletes with a reduced cessation of fatigue
during immersion. Water temperature alters the physiological response to immer-
sion and cool to thermoneutral temperatures may provide the best range for
recovery. Further performance-orientated research is required to determine
whether water immersion is beneficial to athletes.
Water immersion has been used in some cultures 1. Water Immersion as a
Recovery Strategy
for centuries as a means of health restoration.
Recently, water immersion has gained popularity as
There are four different methods of using water
a means to improve recovery from exercise, al-
immersion in recovery: (i) cryotherapy; (ii) ther-
though much of its use is based on anecdotal infor-
motherapy; (iii) contrast therapy; and (iv) water
For example, Netball New Zealand
immersion per se. Cryotherapy, thermotherapy and
ommends that during the course of tournament-type
water immersion per se are immersion in water at a
events, players should perform 5 minutes of water
constant temperature, whereas contrast therapy is
immersion (contrast therapy) after games to aide
immersion in alternating extremes of temperature.
recovery and performance. There is some basis for
the use of water immersion (non-exercising) to en-
1.1 Cryotherapy
hance recovery from exercise as it can produce
beneficial physiological changes within the body.
Cryotherapy is immersion in cold water. No spe-
These physiological changes have been attributed
cific water temperature range has been determined
principally to effects of hydrostatic pressure and
for cryotherapy. Low and Reed
state that the sen-
temperature. Exercise in water is also used as a
sation of cold pain begins at 15°C, and some re-
recovery session by some sport teams. However, the
search has used temperatures of 15°C for the study
focus of this article is the physiological response of
of cold-water immersion compared with thermoneu-
the body during non-exercise immersion. This arti- tral water
and in performance studies.
cle will briefly describe the water immersion recov- fore, for the purpose of this article, cryotherapy was
ery strategies used in the laboratory and in the field. considered to be immersion in water of 15°C. In
Thereafter, the effect that hydrostatic pressure may the field, cryotherapy normally consists of putting
have on the body in thermoneutral water, and the bags of ice in a container (such as a plastic drum)
effect that cold and hot water temperature has on the full of water in which an athlete stands to immerse
body, will be examined. This information may assist their legs. In performance research, the duration of
athletes, trainers, physiotherapists and coaches in immersion time varies from 15 to 20 minutes.
determining whether to adopt water immersion as a However, in the field, immersion time may be as
recovery strategy or assist in developing water im- little as 30 seconds as a result of the ability of an
mersion recovery protocols. individual athlete to withstand cold discomfort. For
2006 Adis Data Information BV. All rights reserved. Sports Med 2006; 36 (9)
Physiological Response to Water Immersion 749
a large number of athletes, or team sports, this 1.3 Contrast Therapy
method can be impractical because of the time re-
Contrast therapy is a post-exercise recovery
quired to treat all of the athletes.
method that has recently gained popularity.
trast therapy necessitates alternating temperature
1.2 Thermotherapy
immersion, from a hot to cold bath and vice versa.
Protocols vary (see table I) but generally consist of
Thermotherapy refers to immersion in water that
30–300 seconds of one temperature extreme, imme-
diately followed by 30–300 seconds of the contrast-
raises the core body temperature. This increase in
ing temperature. This is repeated a number of times
core temperature occurs in water with a temperature
and lasts for 4–30 minutes. Vascular ‘pumping’
Facilities that provide a heated pool
caused by the variation in temperature has been
are required to perform thermotherapy. Anecdotally,
proposed as the mechanism that could improve re-
there are numerous teams that are based in facilities
Whether such a contention is supported
that provide heated baths/spas and who perform
by the literature will be discussed in section 3.3.
thermotherapy after training. However, compared
with thermoneutral immersion, little research has
1.4 Water Immersion per se
been conducted on the physiological or performance
effect of hot water immersion. An immersion dura-
Water immersion per se is both the easiest
tion of 10–20 minutes has been suggested by
method of application in the field and, compared
Brukner and Khan
to aide athletic recovery and
with the other water immersion modes, widely
rehabilitation, although this time period does not
researched (physiologically). No resources are re-
appear to be based on research and is unsubstantiat-
quired to heat or cool the water, only a container,
ed. bath or pool in which to immerse athletes. The
Table I. Examples of contrast therapy protocols
Study Temperature (°C) Application time Repeats Order
cold hot
Coffey et al.
10 42 1 min cold: 2 min hot 5 Start cold, end hot
Cote et al.
10–15 39–41 1 min cold: 3 min hot 4 Start hot, end hot
Hamlin and Magson
8–10 38 1 min cold: 1 min hot 3 Start cold, end hot
Hamlin and Sheen
8–10 38 1 min cold: 1 min hot 3 Start cold, end hot
Higgins and Kaminski
15 40 10 min hot, then 5 Start hot, end cold
1 min cold: 4 min hot
Kuligowski et al.
13 39 3 min hot: 1 min cold 6 Start hot, end cold
15 38 3.5 min hot: 30 sec cold 3 Start hot, end cold
Vaile et al.
8–10 40–42 1 min cold: 2 min hot 5 Start cold, end hot
10–15 NA 3 min hot: 1 min cold 5 ×/h Start hot, end cold
Brukner and Khan
15 40 4 min hot: 1 min cold 3–7 Start hot, end cold
13–18 38–43 4 min hot: 1 min cold 15–20 min
10–18 38–44 10 min hot, then 30 min total Start hot, end hot
1 min cold: 4 min hot
Zuluaga et al.
NA 45 3 min hot: 1 min cold NA Start cold, end cold
NA = data not available.
2006 Adis Data Information BV. All rights reserved. Sports Med 2006; 36 (9)
750 Wilcock et al.
temperature widely used in this mode ranges from 2.1 Water Pressure
cool to thermoneutral, which for this review is con-
Air exerts pressure equally on all sides of the
sidered to range from 16 to 35°C. Research into the
body. At sea level, the pressure exerted around the
physiological effect of water immersion generally
body equates to approximately 1013Pa. Water is
has concentrated on the use of thermoneutral immer-
>800 times denser than air; consequently, at an
sion and has ranged in immersion time from 5
equal depth, water will create a greater pressure than
minutes to 6 hours. This article only considered the
Due to this greater density, water produces
effect of immersion over a maximum of 30 minutes
the same pressure at a depth of only 10m as the
to replicate a time similar to post-exercise recovery
entire atmosphere of air at sea level.
sessions. Unlike cryotherapy, thermotherapy or con-
When immersed in water, hydrostatic pressure
acts on the body in relation to the depth of immer-
trast therapy, the main effect of water immersion per
sion. The amount of pressure that acts on a body is
se comes from the effect of hydrostatic pressure and
equal to:
perhaps to a lesser degree buoyancy, rather than
P = P
+ g ρ h
temperature. The few studies into water immersion
where P = water pressure; P
= atmospheric pres-
as a performance recovery method have concen-
sure (standard sea level 1013 hPa); g = gravity (9.81
trated on cryotherapy, thermotherapy and contrast
); ρ = water density (1000 kg/m
) and h =
therapy, combining both temperature and hydrostat-
height of the water (m).
ic pressure effects.
To gain greater un-
Water pressure does not correlate to the total
derstanding of water immersion, the effects of hy-
weight of the water in a vessel, only to the depth. If
drostatic pressure and temperature would be best
the wall of a container is solid then the walls of the
studied in isolation and provide the focus for the
container exert a pressure on the water equal to the
remainder of this article.
pressure of the water at that depth. This means that
water pressure is a force per unit area and is trans-
mitted equally throughout the water at a given level.
2. Hydrostatic Pressure
On a body immersed in water, the pressure varies
relative to depth. A body part such as a foot im-
When a body is immersed, water exerts a com-
mersed at a depth of 1m would have 981Pa extra
pressive force on the body called hydrostatic pres-
pressure acting on it, whereas at hip level (0.1m),
sure. This pressure can cause the displacement of
only an extra 98.1Pa. To relate this external pressure
fluids within a person from the extremities towards
to blood pressure measurement, for every 1cm depth
the central cavity. This displacement of fluid may
of immersion, the pressure increases by 0.74mm Hg.
increase the translocation of substrates from the
The proportional change in pressure with depth
muscles, increase cardiac output, reduce peripheral
causes an upward squeezing action on the body,
resistance and increase the ability of the body to
which at 1m depth (74mm Hg) is almost equal to
transport substrates. Additionally, the antigravity
normal diastolic blood pressure (80mm Hg).
effect caused by buoyancy may reduce perception of
The human body is mostly water with the addi-
fatigue and aide energy conservation. The following
tion of some oil (fats) and proteins. Because water is
sections (sections 2.1–2.7) will explore the physio-
essentially non-compressible, it occupies the same
logical effects of hydrostatic pressure during
volume regardless of pressure.
When external
thermoneutral immersion.
pressure on the body increases, gas and fluid sub-
2006 Adis Data Information BV. All rights reserved. Sports Med 2006; 36 (9)
Physiological Response to Water Immersion 751
stances are displaced to lower pressure areas.
Therefore, a person standing in water experiences
compression on the body acting inwards and
upwards. During hip-level immersion, this ‘squeez-
ing’ causes the displacement of fluid from the lower
extremities of a person into the thoracic region.
During head-out immersion, hydrostatic pressure on
the central cavity reduces the residual air volume of
the lungs increasing the displacement of fluids into
the thorax.
It is the movement of these fluids that
may enhance the ability of an athlete to recover from
2.2 Weightlessness and Perceived Fatigue
• ρ •
Fig. 1. Water upthrust. g = gravity; h = height; ρ = water density;
= atmospheric pressure
standard sea level 1013 hPa
One significant consequence of water pressure
system, allowing for a greater relaxation of gravita-
being proportional to the immersion depth is that the
tional muscles and conservation of energy. Such
body will weigh less when immersed in a liquid i.e.
greater relaxation would appear to reduce perceived
it is easier to lift a rock in water than it is on dry land.
fatigue. A number of studies (see table II) have
This is because water exerts a net upward force on
observed lower perception of fatigue after exercise
the body immersed in it. This upward force helps to
during and after water immersion. While two au-
support all or part of the weight of the body im-
did not observe any significant difference
mersed in it. The upward force exerted by a fluid on
in perceived fatigue, both did observe a moderate
any object placed in it is called buoyancy or hydro-
effect of lower sense of fatigue with water immer-
static upthrust.
sion compared with other recovery modes (Cohen’s
The force created by upthrust is calculated as:
effect size = 0.50–0.89).
F = h ρ g A
The decrease in the perception of fatigue may
taking the calculation further, F = V ρ g
also be due to reduced neuromuscular responses
F = m/g
during water immersion.
During water immer-
where h = height; ρ = water density; g = gravity; A =
sion, electromyographic activity produced during
base area; V = immersed volume; and m = mass.
maximal contractions have been observed to reduce
Hence there is a net upward pressure, giving rise
by 11–35%.
In their 2002 study, P
onen and
to an upward force equal to upward pressure times
also observed a 13% decrease in maximal
horizontal base area (as shown in figure 1). In other
voluntary contraction force during immersion. Im-
words, any body partly or wholly immersed in a
mersion may modify the peripheral processes asso-
liquid, experiences an upthrust that is equal to the
ciated with contraction and change central and/or
weight of the liquid displaced (Archimedes Princi-
neural command contractions,
or trigger inhibito-
ple). The greater the body density, the less buoyancy
ry mechanisms. The reduced perception of fatigue
a person has, which is why people with higher fat
may come then not only from a reduction in the
mass (less density) are more buoyant than those who
neuromuscular activation required to maintain pos-
are lean. The effect of buoyancy is a reduction in the
gravitational forces that act on the musculoskeletal ture but also due to an overall reduction in neural
2006 Adis Data Information BV. All rights reserved. Sports Med 2006; 36 (9)
752 Wilcock et al.
transmissions. However, more research is required
on whether water immersion does reduce neural
efficiency, whether such reductions are due to
weightlessness or hydrostatic pressure
and if
there are any post-immersion effects.
2.3 Fluid Shifts
Under normal conditions, the body is comprised
of 50–60% fluid, which is located either in the
intracellular, interstitial (between cells) or intravas-
cular (blood plasma) space (see figure 2). Typical
intracellular, interstitial and plasma volumes are
35–40%, 11–15% and 4–5%, respectively, of body-
Fluid within these compartments acts as a
vehicle for the transport and exchange of materials,
such as metabolic wastes and nutrients, between the
body and the external environment.
Movement of fluid and materials between the
intravascular and extravascular space occur in the
vascular capillaries. Fluid and substance movement
across the capillaries occur via three processes: (i)
diffusion; (ii) vesicular transport; and (iii) filtration-
reabsorption. Diffusion is the movement of fluid/
substances from a high concentration to a low con-
centration, whereas vesicular transport is active
transport (requiring adenosine triphosphate) of sub-
stances across the vascular membrane. Diffusion
occurs along all of the capillary membrane and
accounts for the largest exchange of fluids and sub-
stances, whereas vesicular transport and filtration
account for a small portion of fluid movement.
Filtration-reabsorption is the net movement of fluid
due to the capillary-interstitial pressure gradient.
Filtration is the net movement of fluid into the
interstitial space at arteriolar ends of the capillaries,
which is then reabsorbed at the venular ends of the
capillaries. Approximately 2–4L of this fluid per
day is not reabsorbed by the capillaries through
filtration-reabsorption, but moves through the lym-
phatic vessels and drains into the subclavian
Disruption in the balance of filtration-reab-
2006 Adis Data Information BV. All rights reserved. Sports Med 2006; 36 (9)
Table II. Water immersion and perception of fatigue
Study Scale Exercise Recovery Measurement timing Main findings
Coffey et al.
20-point RPE Maximal sprints 15 min contrast therapy, 4, 8, 12, 16, 20 min post- No significant difference between
recovery scale active or passive sprint. Pre- and post-second recoveries
set of sprints
Kuligowski et al.
12cm graphic pain DOMS-inducing arm curl 24 min warm water, cold 0, 24, 48, 72, 96h post- pain perception with cold water
scale water, contrast therapy or exercise and contrast therapy
Nakamura et al.
5-point fatigue scale 10 min of submaximal 10 min in 30°C or 38°C Not specified fatigue for 30°C bathing
cycling water bath, or control
10-point CR scale Repeated Wingate test 12 min contrast therapy, 3 and 7 min during recovery fatigue at all times with contrast
active or passive Post-recovery therapy
Post second exercise bout
Vaile et al.
10cm VAS score DOMS-inducing leg press 15 min contrast therapy (i) 0 Both groups had increased pain. No
or control (ii) 24h significant difference
(iii) 48h
(iv) 72h
Viitasalo et al.
10cm VAS score Strength, plyometric and 20 min warm water Over 2 days post-training DOMS during immersion week
sprint training over 3d immersion or control
CR = Borg category ratio scale; DOMS = delayed onset of muscle soreness; RPE = rating of perceived exertion; VAS = visual analogue scale; = decreased.
Physiological Response to Water Immersion 753
Venous end
of the
end of the
and vesicular
and vesicular
. 2. Schematic dia
ram showin
the intracellular-intravascular movement of fluid.
sorption, through effects such as physical trauma, blood and haematocrit densities (
1.5% and
lymph blockage or changes in pressure gradients,
respectively). While plasma dilution occurred in
can cause an abnormal increase in interstitial fluid in
these studies, the intravascular fluid shift was also
localised areas, a condition called oedema, swelling,
accompanied by a plasma protein shift of albumin.
or inflammation.
Stocks et al.
suggested that the increase in the
It is well documented that water immersion
extracellular fluid volume ultimately comes at the
causes a rise in central blood volume, which in-
expense of intracellular fluid, although further in-
creases with the depth of immersion.
vestigation and verification of this hypothesis is
increase in central blood volume is due to two
required. Such fluid shifts would increase the intra-
effects: haemodilution (increased diffusion and re-
cellular-intravascular osmotic gradients and some
absorption) and blood displacement. During immer-
intracellular constituents, such as metabolic wastes,
sion at hip level, haemodilution occurs as a result of
may leave the cells and interstitial space to maintain
negative transcapillary pressure in the legs. This
an osmotic balance.
It is possible then that
pressure gradient causes a fluid shift from the inter-
immersion may cause improvements in the translo-
stitial to intravascular space in the legs.
cation of substrates, which may help to increase the
With immersion above hip level, additional in-
ability of an athlete to recover, as reduced transpor-
creases in central blood expansion results as blood
tation time could increase clearance of waste sub-
from the abdomen, which acts as a blood reservoir,
is displaced.
Norsk et al.
studied changes in
plasma concentration during head-out immersion
2.4 Exercise-Induced Muscle Oedema
and observed significant decreases in haematocrit
and haemoglobin concentration with an associated
Apart from assisting the possible removal of sub-
6.5 ± 1.9% (mean ± standard error [SE]) increase in
stances, the gradient between internal tissue hydro-
plasma volume. Hinghofer-Szalkay et al.
static pressure and capillary filtration pressure may
served similar results when using plasma densitom-
also improve the reabsorption of interstitial fluids,
etry to measure transvascular fluid shifts during
reducing oedema.
An increase in the pressure
immersion to the neck. After 30 minutes of ther-
gradient between the interstitial compartment of the
moneutral immersion, the six men in the study had
legs and the intravascular space caused by hydro-
plasma volume increases of 11 ± 3%, with decreased
2006 Adis Data Information BV. All rights reserved. Sports Med 2006; 36 (9)
754 Wilcock et al.
static pressure should reduce oedema in a similar reduction in muscular inflammation may improve
contractile function as well as lowering the levels of
fashion to compression stockings.
inflammatory cells and muscle enzymes circulating
Exercise causes a shift of plasma from the blood
in the blood.
Reducing oedema may, therefore,
into the muscles, with this fluid movement being
decrease secondary damage to tissue, which in turn
relative to the intensity of the exercise.
may increase the ability of an athlete to recover from
mode of exercise does not appear to be a factor but
muscle damaging exercise.
rather the respondent increase in mean arterial pres-
Researchers have observed that cycling at
2.5 Cardiac Response
intensities of 30–120% of maximal oxygen uptake
decreased blood plasma by 5–17% as fluid shifted
The predominant effect of water immersion and
However, during resistance
the associated increase in central blood volume ex-
training, plasma decreases of 8–14% have been ob-
pansion is an increase in cardiac pre-load. Central
served in relation to an intensity range of 40–70%
blood volume expansion increases atrial pre-load
one repetition maximum (1RM).
The decrease in
and stroke volume. Increasing the depth of immer-
plasma volume observed by Knowlton et al.
sion causes greater stroke volume increases. Com-
ing the resistance training correlated highly with an
pared with non-immersion, at the level of the hips
increasing mean arterial pressure (r =
0.98). How-
stroke volume has been reported to increase by
ever, fluid shifts from the vascular space reflected
this increases to 38–67% at the level
movement into active but not inactive muscle during
of the xiphoid process
and 28–95% during
Using magnetic resonance imaging,
head-out immersion.
The effect size be-
pre- and post-resistance exercise (six sets of 10RM
tween each level of immersion from these studies
squats) Ploutz-Synder et al.
observed an increase
ranged from moderate to very large (0.75–3.95).
in the cross-sectional area of the vasti and adductor
When immersed in thermoneutral water to the
muscle groups coinciding with a 22% decrease in
level of the hips, heart rate has a tendency to de-
plasma volume (measured by Evans blue dye). The
crease by approximately 4–6%.
coefficient of determination between the plasma
depth of immersion to the xiphoid process has de-
decrease and volume increase in the adductor and
creased heart rates by 11–18% compared with non-
vasti muscle groups was strong (r
= 0.75, p =
However, rather than a
0.0157). Muscles that were less active during squats
linear decrease in heart rate with increasing immer-
(rectus femoris and the hamstring muscle groups)
sion depth, the decrease in heart rate during head-out
had smaller non-significant increases in their cross-
immersion (3–15%)
is less than that
sectional area.
observed during immersion to the xiphoid process.
Oedema in response to exercise or muscle dam-
Individual heart rate response to immersion var-
age may increase both the transport route and com-
ies and decreases in heart rates have been non-
pression of localised capillaries, reducing oxygen
significant in some studies.
While non-sig-
delivery to localised cells. With excessive muscle
nificant, a negative effect on heart rate was still
oedema, such an increase in transportation time can
apparent in the immersed subjects of these studies
cause an increase in cellular damage or death.
(see table III). The explanation for heart rate vari-
A positively increased pressure gradient can reduce
ance may be due to conflicting physiological feed-
cellular infiltration by leukocytes and monocytes
back systems. Increasing mean arterial pressure
decreasing further tissue degeneration.
Such causes arterial baroreceptors to bring about a reflex
2006 Adis Data Information BV. All rights reserved. Sports Med 2006; 36 (9)
Physiological Response to Water Immersion 755
Table III. Cardiac response of thermoneutral immersion compared with non-immersion (p < 0.05 unless otherwise stated)
Study Immersion Change in Change in Change in cardiac
duration (min) stroke volume (%) heart rate (%) output (%)
Hip level immersion
Farhi and Linnarsson
3.9 14.0
ollgen et al.
5.7 29.2
Xiphoid process immersion
Farhi and Linnarsson
10.5 48.0
ollgen et al.
11.4 48.1
Bonde-Petersen et al.
15 38.7
14.5 NS 19.1
Gabrielsen et al.
10 50.8
10.6 32.6
Gabrielsen et al.
Watenpaugh et al.
Weston et al.
15 50.0
11.0 31.5
Head-out immersion
Arborelius et al.
10 28.3
3.3 NS 28.9
Farhi and Linnarsson
6.6 66.0
ollgen et al.
11.4 59.1
Gabrielsen et al.
Johansen et al.
6.9 NS
Park et al.
30 54.7
1.4 53.2
Shiraishi et al.
30 62.1
8.6 52.4
Sramek et al.
Yun et al.
[68] a
20 52.5
1.7 NS 49.4
Yun et al.
[68] b
20 56.4
6.3 NS 48.7
Yun et al.
[68] c
20 95.3
2.3 NS 101.7
a Subjects = breath-hold divers (mean age 55y).
b Subjects = housewives (mean age 55y).
c Subjects = housewives (mean age 22y).
NS = non-significant.
to slow the heart, most likely to prevent abnormally Regardless of an individual’s heart rate response,
the increase in stroke volume ultimately causes an
high blood pressure levels. Opposing this sympa-
increase in cardiac output. Observed cardiac outputs
thetic response, an increased atrial stretch caused by
(see table III) vary but have been reported to be
the greater central blood volume (most notably
approximately 14–29% at hip level,
19–48% at
when the water level rises above the hips) stimulates
the height of the xiphoid process
atrial stretch receptors and increases heart rate
29–66% at head-out immersion.
Yun et
through a neural reflex called the Bainbridge re-
observed larger increases in cardiac output
Individual physiological variables (such as
(102%) during head-out thermoneutral immersion,
heart size) would then determine the dominant re-
but was the only study in which the subjects were
flex. Generally speaking, however, the mean heart
both female and Korean. Subjects used in immer-
rate of subjects appears to decrease during short-
sion research have for the most part been male and
term thermoneutral immersion. European.
2006 Adis Data Information BV. All rights reserved. Sports Med 2006; 36 (9)
756 Wilcock et al.
2.6 Peripheral Resistance and Blood Flow resistance would seem to occur during head-out
immersion only.
While studies of immer-
Accompanying the increased cardiac output dur-
sion at a depth under chin level have shown a
ing immersion is a decrease in peripheral resistance
decrease in peripheral resistance and increased
implying that peripheral vasodilation oc-
blood flow (with small to very large effect sizes;
Total peripheral resistance (TPR)
0.59 to
2.62) the findings of these studies com-
has been measured indirectly using the following
pared with non-immersion have been non-signifi-
TPR = (MAP – CVP)/
With the increase in cardiac output, some reduc-
TPR = (MAP – right atrial pressure)/
tion in peripheral resistance and vasodilation, in-
creased blood flow may result throughout the body.
where MAP = mean arterial pressure, CVP = central
During erect head-out immersion, dogs have re-
venous pressure and
Q = cardiac output.
sponded with large increases (>50%) in blood flow
Decreases in peripheral resistance of 27–51%
have been reported
during head-out water
through the liver, intestinal tract, pancreas, spleen,
immersion. Immersions at lower depths do not seem
renal cortex and skeletal muscle.
If the responses
to reduce peripheral resistance. Gabrielsen et al.
displayed by dogs can be extrapolated to humans,
determined intramuscular blood flow using a count-
greater organ and muscle blood flow may allow
ing signal between two cadmium-telluride detectors
improved removal of metabolites and an increased
to measure the washout of injected
ability to replenish energy stores. However, such
(k). From the determined blood flow, peripheral
extrapolation may not be possible. Blyden et al.
resistance was determine as TRP = MAP/k. Muscu-
observed that the clearance of lidocaine (lignocaine)
lar vascular resistance did not change significantly
in humans was unaltered by immersion to the neck,
with immersion to the xiphoid process but decreased
indicating no change in splanchnic blood flow. Ep-
by approximately 15% with immersion to the neck.
stein et al.,
using the clearance of p-aminohip-
Similarly, Gabrielsen et al.
observed that during
puric acid and inulin to determine changes in renal
immersion to the xiphoid process, blood flow did
plasma flow and glomerular filtration rate, sup-
not significantly increase but increased by 49 ± 16%
ported the findings of Blyden et al.
With greater
(mean ± SE) during head-out immersion. Bonde-
cardiac output, lower peripheral resistance and vaso-
Petersen et al.
and Weston et al.
also observed
dilation (at head-out immersion at least), it could be
no significant decrease in total peripheral resistance
logically assumed that an increase in blood flow
during immersion to the xiphoid process.
through the muscles and perhaps the organs would
A direct method of measuring venous tone during
occur. Results from Epstein et al.
and Blyden et
immersion is occlusion plethysmography. Echt et
imply that renal blood flow is unaffected,
used this method to determine venous elastici-
although their research only analysed the clearance
ty during a 3-hour immersion to the neck of subjects.
of certain chemicals not actual blood flows. Other
In the first 15 minutes of immersion, the venous
metabolites, notably blood lactate, have an in-
volume elasticity coefficient reduced from 16.6 to
creased clearance rate when subjects have been par-
13.5mm Hg/mL/100g tissue, a decrease of 19%.
tially immersed in water,
indicating that
Venous tone slowly reduced a further 30% by the
blood flow through the muscle beds increase.
third hour of immersion and persisted for 1 hour
Whether blood flow increases to organs other than
post-immersion. However, reduction in peripheral
2006 Adis Data Information BV. All rights reserved. Sports Med 2006; 36 (9)
Physiological Response to Water Immersion 757
the kidneys is unknown and requires further investi- 3. Temperature
The previous sections have considered the physi-
ological response that thermoneutral immersion in
2.7 Summary of Findings
water can have on a person. This article has concen-
trated on the immersion of subjects in thermoneutral
Hydrostatic pressure during water immersion
water because of the abundance of research in this
aids the return of fluid from the muscles into the
area. Colder, warmer or a variation in water temper-
If plasma volume increases due to a fluid
ature may alter these physiological responses, pro-
shift from the interstitial space, the translocation of
viding either additional benefits or detriment to any
metabolic waste may be improved due to blood
possible recovery enhancement.
dilution and improved diffusion gradients.
tionally, the increase in blood volume increases
3.1 Cold Temperature Effects
stroke volume and cardiac output, increasing blood
flow through the body. Improved diffusion gradients
Thermoneutrality is considered to occur in a
and increased blood flow through the body could
small range (35°C) in which subjects can maintain
increase the ability of an athlete to metabolise waste
their core temperature for at least 1 hour.
products and enhance recovery from exercise by
cold temperatures at which an individual cannot
reducing transport time of substrates.
The in-
maintain core temperature for an hour ranges from
creased clearance of blood lactate in subjects that
30 to 34°C depending on cutaneous fat.
have been immersed in water following exer-
core temperatures can be maintained during head-
would support such a theory. Sports
out immersion at temperatures as low as 18°C for up
that cause a large depletion in muscle energy stores
to 30 minutes.
or cause large increases in metabolites (high-intensi-
Cooler temperatures do have some effect on the
physiological responses of the body. As water tem-
ty anaerobic power-endurance or endurance sports)
perature decreases, heart rate reduces,
may therefore benefit from water immersion, espe-
decreases cardiac output.
Additionally, arterial
cially in tournament situations where an athlete may
blood pressure and peripheral resistance also in-
compete a number of times within a few days.
The increase in peripheral resistance is
Hydrostatic pressure may also aide the reduction
due to blood being redirected from the periphery to
exercise-induced muscle oedema. Excessive muscle
maintain core temperature.
Oxygen consump-
oedema may cause capillary constriction and in-
tion and metabolism also increase to maintain core
crease substrate transportation time leading to
greater cellular damage or death. Reduction of oede-
Reduced permeability of cellular, lymphatic and
ma may therefore improve nutrient delivery and
capillary vessels due to localised vasoconstriction
speed recovery from exercise that has induced mus-
reduces fluid diffusion into the interstitial
cle damage. Where fluid shifts could improve athlet-
This reduced fluid diffusion can assist in
ic recovery physiologically, buoyancy may provide
reducing acute inflammation from muscle dam-
a psychological enhancement to recovery as some
This in turn can reduce pain, swelling and the
studies have observed a lower perception of fatigue
loss of force generation that is also associated with
in immersed subjects.
Hence, cold is often used in the
2006 Adis Data Information BV. All rights reserved. Sports Med 2006; 36 (9)
758 Wilcock et al.
treatment of inflammation to improve the rehabilita- ally, sudden severe cold immersion of a large por-
tion process.
tion of the body can produce hyperventilation,
which may cause ventilation to increase up to five
One metabolite that is used as a marker of muscle
times the resting rate.
The decrease in arterial
damage is the level of creatine kinase in the
carbon dioxide caused by hyperventilation may lead
Exercise-induced injury is thought to in-
to blood acidosis and impaired consciousness, even
crease the permeability of cells increasing the diffu-
in fit young people.
Additionally, sudden cold
sion of myoproteins such as creatine kinase into the
immersion can cause tachycardia and acute periph-
extracellular space.
Cold water immersion
eral vasoconstriction producing sudden loss of con-
decreases the level of creatine kinase in the blood
sciousness, convulsions, ventricular ectopy, cardiac
after exercise-induced muscle damage.
arrest and death.
creatine levels are attributed to a decrease in cellu-
While rare, some people also have cold hypersen-
lar, lymphatic and capillary permeability caused by
sitivity and can be at risk if body parts are suddenly
vasoconstriction induced by the cooler tempera-
immersed in cold water. Conditions consist of aller-
However, caution is warranted when ap-
gic and possible anaphylactic reactions, Raynaulds
plying the presence of creatine kinase in the blood as
phenomenon, and paroxysmal cold haemoglobin-
an indication of muscle damage. Levels of creatine
Allergic reactions can consist of rashes
kinase in the blood reflect not only creatine kinase
and wheals, which may advance into anaphylaxis.
release rate but also the removal rate. Exercise-
The signs and symptoms of fully developed anaphy-
induced haemoconcentration or haemodilution and
laxis include hypotension, syncope and vascular col-
alterations of tissue clearance due to blood-flow or
lapse and can lead to death.
Raynaulds phe-
function will affect creatine concentration in the
nomenon is peripheral vasoconstriction that leads to
blood. Creatine kinase may not then accurately indi-
numbness, tingling and burning pain,
while par-
cate muscle damage or fatigue.
oxysmal cold haemoglobinuria is a rare and poten-
Neural components are also affected by the cold.
tially life-threatening affliction that causes the re-
Cooling of tissue decreases the rate of transmission
lease of haemoglobin from red blood cell into the
along neurons by decreasing the production of ace-
urinary system causing acute transient anaemia.
and possibly stimulates superficial in-
While cold hypersensitivity is rare, care should
hibitory cells that regulate the impulse of pain per-
be taken when using cold immersion on athletes.
ception to the CNS.
Reduction of nerve impulse
Very cold water temperatures may be best only in a
transmission by cold has two effects: (i) reduced
localised manner to treat acute injuries and reduce
level of pain perception (analgesia); and (ii) reduc-
inflammation, rather than being used as a recovery
tion in muscle spasm.
While reduction in pain
may be of benefit, a reduced neural transmission
may decrease muscular contractile speed
force-generating ability of an athlete post-applica-
3.2 Hot Water Temperatures
Performance may then be initially inhib-
ited if exercise is performed shortly after cold im-
Considering the use of thermotherapies such as
hot baths in physiotherapy, there is a lack of re-
There are risks to athletes whom may be im- search-based literature on the effect that superficial
mersed in cold water, dependent on the temperature heat application has on a person. Apart from basic
extreme and amount of the body immersed. Gener- physiological responses, much of the literature
2006 Adis Data Information BV. All rights reserved. Sports Med 2006; 36 (9)
Physiological Response to Water Immersion 759
comes from texts that cite other texts or is based on studies that have analysed the effect of the superfi-
anecdotal information.
cial application of heat, flexibility was not enhanced
unless accompanied with stretching.
A report
Superficial application of heat increases subcuta-
by Bigos et al.
on back pain and thermal applica-
neous and cutaneous tissue temperature while tissue
tions concluded that not enough data existed to
temperature at depths >2cm remains unchanged.
recommend the use of heat in pain reduction. More
An increase in superficial tissue temperature causes
recent research
has observed that pain may be
an increase in the cutaneous blood flow, over short
reduced if heat is applied continuously (8 hours/day)
durations, due to peripheral vasodilation.
over a long term (2–5 days). However, research is
rate also increases in response to hot water immer-
This increase in heart rate may reduce lacking in the short-term application of heat and
stroke volume due to lack of cardiac filling time, but
possible effects on pain.
overall cardiac output increases compared with
There are contraindications to immersion in hot
thermoneutral immersion.
water. The most obvious is the possibility of burns
The increase in cardiac output and a lower pe-
due to high water temperatures. At 45–50°C protein
ripheral resistance allows an increase in subcutane-
denaturation occurs and immersion water tempera-
ous and cutaneous blood flow.
An increase in
tures should be below this range.
Superficial heat
subcutaneous and cutaneous blood flow increases
application also causes an inflammatory response
the permeability of cellular, lymphatic and capillary
and swelling,
which may prolong recovery
Increased permeability increases metab-
Cote et al.
observed increased oedema
olism, nutrient delivery and waste removal from the
in 30 patients with first- and second-degree ankle
cells that can increase healing.
However, for
sprains when 20 minutes of hot water immersion
short-duration superficial application, these changes
was applied each day over 3 days. Volumetric in-
are not likely to occur within the muscle, but rather
crease in ankle size was 25% with hot water immer-
within the skin.
Additionally, Bonde-Petersen
sion of the foot compared with 3% in patients re-
et al.
observed that while subcutaneous and cuta-
ceiving cold water immersion. The effect size of this
neous blood flow increased, blood flow through the
difference was large (1.95). If heat increases oedema
muscle may decrease compared with thermoneutral
in sprains, it can be speculated that in may also
immersion. Lower water temperatures may then
increase muscle inflammation.
have greater benefits in substrate transportation
within a muscle. However, the effect size Bonde- Hot water immersion of a large portion of the
Petersen et al.
observed in blood flow difference
body can produce a potentially dangerous strain on
between thermoneutral and hot water immersion
the cardiovascular system causing ectopic beats,
was small (0.29).
hypotension, heat syncope, excessive tachycardia
and even death.
Heat syncope is fainting and
Superficial heat may also increase neural trans-
giddiness due to the collapse of vasomotor control
proprioception and improve reaction
and a decrease in blood pressure owing to rapid
Other proposed benefits of thermotherapy
Care is warranted with athletes who
include increased muscle elasticity, joint extensi-
have acute injuries, oedema, vascular disease,
bility, analgesia and reduction of muscle
wounds or infections as these can be exacerbated
While a large amount of anec-
with heat application and increase potential
dotal support is available, little research-based evi-
dence has been found to support these claims. Of
2006 Adis Data Information BV. All rights reserved. Sports Med 2006; 36 (9)
760 Wilcock et al.
3.3 Contrasting Temperature during contrast therapy, it would seem unlikely to
cause a great effect at such a slow frequency.
Another point to consider with vaso-pumping is
Contrast therapy has been considered to enhance
that intramuscular temperature has not been ob-
athletic recovery through:
served to change with alternating contrasts, only
stimulating area-specific blood flow;
subcutaneous temperature.
A study by Higgins
increasing blood lactate removal;
and Kaminski
observed that at a 4cm depth, intra-
reducing inflammation and oedema;
muscular temperature also did not fluctuate with
stimulating circulation;
repeated 1-minute immersions into cold water (after
relieving stiffness and pain;
4 minutes of warm whirlpool therapy), but gradually
increasing range of motion;
increased by 0.85 ± 0.60°C over 31 minutes. If
reducing delayed onset of muscle soreness.
temperature does not change at deep tissue levels
One reason behind such possible benefits to re-
with alternating immersion, any vaso-pumping
covery is that contrast therapy may mimic one of the
would then be likely to occur at a subcutaneous level
mechanisms attributed active recovery without the
only. To aide recovery and intramuscular waste
same energy demands.
Recovery using ac-
removal by vaso-pumping, temperature changes
tive low-intensity exercise is considered to enhance
would surely be required at a deeper tissue level.
recovery compared with passive modalities.
Additional to the unlikely vaso-pumping within
One theory for increased recovery is alternating
deep tissue, the sudden immersion into an icy bath
muscular contractions acting in a pumping/squeez-
from heat may not cause vasoconstriction. During
ing action. Low-intensity repetitive mechanical
high body temperatures, as may occur after intense
‘squeezing’ by the muscles during contraction-re-
athletic exertion and hot water immersion, the sud-
laxation may increase the translocation and removal
den immersion into cold may cause cutaneous vaso-
of metabolites, such as lactate, and reduce intracel-
dilation rather than vasoconstriction in a shock re-
lular fluid volume.
Much of the research and
literature regarding contrast therapy perpetrate the
To date, no research was found that had observed
theory of contrast therapy causing a similar action
or measured any form of alternating vasodilation-
with vaso-pumping. Alternating vasoconstriction
constriction caused by contrast therapy. If vaso-
and vasodilation is thought to act in a comparable
pumping does not occur, another explanation for
way to muscle pumping, increasing blood flow and
elevated blood lactate removal during contrast ther-
metabolite removal, enhancing recovery.
apy must exist. One area that is little discussed in
However, vaso-pumping would seem unlikely to
contrast therapy literature that may explain in-
occur at a level that could act effectively in this
creased removal of wastes from the body is simply
the hydrostatic pressure caused by immersion in
During contrast therapy, each alternation of tem-
perature generally lasts for 30–120 seconds and is
repeated 2–5 times. Vaso-pumping would then oc-
Similar to heat application, contrast therapy may
cur at a slow rate and only with 2–5 ‘pumps’ over a
be harmful to athletes by causing inflammation.
period of around 2–10 minutes (at a low frequency
Compared with cold water immersion, Cote et al.
such as 0.03–0.008Hz). Under active recovery, such
observed a 26.5% increase in oedema using contrast
as light-running, muscular pumping would occur at
therapy on patients with first- and second-degree
a rate of around 2Hz. If vaso-pumping does occur
ankle sprains. The effect size of this difference was
2006 Adis Data Information BV. All rights reserved. Sports Med 2006; 36 (9)
Physiological Response to Water Immersion 761
large (2.05). However, Vaile et al.
observed that fatigue, which may be due to reduced neuromuscu-
15 minutes of contrast therapy after muscle damag-
lar signal magnitudes and energy conservation.
ing eccentric leg presses reduced thigh volume oe-
Decreasing water temperature may reduce some
dema significantly over 72 hours compared with
of the physiological responses associated with hy-
passive recovery. Mean (± standard deviation) thigh
drostatic changes. The body responds to cold by
measurements increased by 2.3 ± 0.8% with passive
reducing heart rate and cardiac output, and inducing
recovery compared with 0.6 ± 0.6% in the contrast
vasoconstriction. This response reduces peripheral
therapy group. The reason for the benefit observed
blood flow and conserves body core temperatures.
in the study of Vaile et al.
may be due to the large
Additionally, central metabolism increases to main-
portion of the body that was immersed (immersion
tain the core temperature, which increases the pro-
to the gluteal fold), rather than the effect of tempera-
duction of waste products and erodes energy stores.
ture. A greater physiological response would have
However, cold also assists the reduction of oedema
occurred due to the higher hydrostatic pressures
by increasing vasoconstriction and lowering periph-
compared with the study of Cote et al.
where only
eral metabolism, which may reduce secondary cellu-
the foot was immersed. Alternatively, in the study of
lar death due to muscular damage. The analgesic
Cote et al.,
subjects had acute injuries rather than
effect of cold is likely due to reduced neural trans-
induced muscle damage, which may account for the
mission magnitude and speed. Heat and contrast
possible effect difference of the contrast therapy.
therapy provide lesser possible benefits to the recov-
More research is required before any conclusion can
ery process by increasing oedema and increasing the
be drawn on whether contrast therapy is harmful or
energy requirement due to an increased metabolic
beneficial to oedema. Other contraindications of
rate. Immersion in cool to thermoneutral water may
contrast therapy are likely to include those of both
provide the best option for recovery unless muscle
the hot and cold temperatures.
Care is war-
sprains or strains have occurred, in which case cold
ranted when using extremes of temperature in con-
water immersion may provide greater benefit. Ex-
trast immersion.
tremes of water temperature have contraindications
and cool to thermoneutral immersion may provide
4. Conclusions and Recommendations
both a safer and more beneficial immersion temper-
ature range.
Hydrostatic pressure from water immersion
Physiologically speaking, hydrostatic pressure
causes an inward and upward displacement of body
would seem the mechanism that could benefit exer-
fluid. This action reduces oedema, increases ex-
cise recovery. Ultimately, the aim of the recovery
tracellular fluid transfer into the vascular system and
process is to enhance future performance. To date, a
increases cardiac output. Greater cardiac output in-
small amount of research has been conducted into
creases blood flow through the body and in response
the use of water immersion as an exercise recovery
to increased arterial pressure vasodilation may oc-
The varied methodology and
cur. Increased blood flow through the body may
observations of these studies provide an unclear
assist in the metabolism of waste products that accu-
picture of whether water immersions could provide
mulate during exercise by reducing transport time.
a benefit to exercise recovery. Numerous factors
Additionally, reductions in oedema due to fluid
such as duration, water temperature, immersion
shifts may assist short-term in maintaining muscle
depth, exercise type and intensity, and timing be-
function and assist muscular repair. Weightlessness
when immersed in water decreases the perception of tween exercise and recovery sessions require study.
2006 Adis Data Information BV. All rights reserved. Sports Med 2006; 36 (9)
762 Wilcock et al.
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... The VO 2 max was measured to confirm cardiopulmonary function indicating the ability to sustain long-term exercise. Likewise, indicating the ability to exercise, the degrees of recovery of muscle strength, muscular endurance, and muscle fatigue caused by exercise were investigated [12][13][14][15][16][17]. ...
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Background: After high-intensity exercises, the body's core temperature increases, affecting the body's metabolism, increasing thermal stress and muscle fatigue. The most popular technique to maximize post-workout recovery is cryotherapy. However, the cooling effect may vary depending on the body part being cooled since body tissues do not process the same perfusion. Objective: This study investigates the effects of hand cooling on human body functional recovery and exercise ability improvement by comparing normal rest and rest with hand cooling gloves after high-intensity exercise. Methods: Thirty healthy subjects participated in this study wherein they exercised and used normal rest for one session and hand cooling rest for the next. Blood lactate concentration, heart rate recovery rate, VO2 max measurement, and the degree of recovery of muscle strength, muscular endurance, and muscle fatigue were investigated in both groups to determine the efficacy of hand cooling gloves for postexercise recovery. Results: When hands were cooled after exercise, blood lactate concentration and body temperature significantly decreased, and cardiopulmonary function, muscle strength, and muscular endurance significantly recovered. Conclusion: Using hand cooling gloves after exercise could attenuate core temperature elevation and improve postexercise recovery. It could also effectively improve athletic performance without using large-scale facilities.
... It seems that the use of post-cooling in the form of PBC as a method of regeneration immediately after the football match is a procedure with great potential. The mechanisms that can accelerate regeneration and return to cellular homeostasis after PBC can be considered: inducing a redirection of blood flow from the periphery to the core and thereby improving venous return and cardiac efficiency [81,82], reduction of nerve conduction velocity leading to acute analgesic effect, and reduction of acute inflammation from muscle damage [83]. ...
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Infrared thermography has been widely used to visualize skin temperature in human science. One of the important areas of its application is the analysis of changes in body surface temperature as a result of the use of physical medicine treatments in post-exercise regeneration in sports. The aim of this study was to evaluate the cutaneous temperature response in selected body areas and the range of chosen markers of skeletal muscle damage to partial body cryostimulation (PBC) as a method of post-match regeneration. Fourteen football players underwent PBC after a match. Thermographic analyses of anterior and posterior surfaces of the body were performed before and immediately after the treatment. Before, directly after, and 24, 48, and 72 h after the match serum creatine kinase (CK), lactate dehydrogenase (LDH), and aspartate aminotransferase (AST) were evaluated. After PBC, a significant (p ≤ 0.001) decrease in skin temperature (Tsk) in all analyzed areas occurred. The greatest drop was observed in the areas of the thighs (∆ = 9.96–11.02 °C); the smallest temperature drop occurred in the areas of the upper and lower part of the back (∆ = 6.18−6.70 °C) and in the area of the chest (∆ = 6.80 °C). The most significant positive relationships between the magnitude of change in Tsk of the anterior and posterior surfaces of the thighs, body fat, and systolic and diastolic blood pressure have been shown. There were no significant differences between temperatures in selected areas in relation to the sides of the body, both before and after PBC. The range of temperature changes confirms the stimulating effect of PBC. The course of changes in the concentration of CK and AST indicates a potentially beneficial effect of PBC on the course of post-workout regeneration, without side effects. Maintaining a constant body temperature during PBC comes at the expense of thermoregulatory mechanisms leading to a lower body surface temperature.
... The water environment is associated with a decreased risk of falling and body pain during exercise, and it induces physiological responses that are different from those promoted by the land environment. Thus, middle-and old-aged individuals prefer aquatic exercise 12) . Moreover, this type of exercise is relatively safe, and aquatic properties complement the effects of exercise. ...
Previous studies have shown that normal and complex land walking (e.g. dual-task and obstacle walk) have a positive effect on the prefrontal cortex (PFC) and executive function. However, little is known about the benefits of aquatic walking. The underwater environment is a complex environment with water flow and resistance. Such an environment may induce different brain responses than the land environment. These responses can possibly affect brain function. Therefore, we hypothesized that aquatic walking enhances PFC and executive function more than land walking. Seven participants (age: 57.6 ± 7.0 years, body mass index: 22.9 ± 4.6 kg m−2) performed walking for 10 mins at a self-selected comfortable speed in both conditions. Then, the color-word Stroop task (CWST) was administered at pre- and post-exercises. The left prefrontal hemoglobin activity was monitored via functional near-infrared spectroscopy during the CWST and walking trial. Stroop interference performance, which reflects executive function, was calculated using reaction time and hemoglobin activity during the CWST. Compared to land walking, aquatic walking enhanced cortical activations and reaction time in the Stroop interference. In addition, aquatic walking was more likely to enhance cortical function than land walking. Hence, aquatic walking can induce higher cortical activation relative to land walking at a similar intensity, and it promotes executive function in healthy middle- and old-aged individuals.
Endurance athletes strive to maintain peak performance by alternating between periods of intensive training and periods of rest and recovery, which can be difficult given the nature of the requirements for endurance sports. When there is an inadequate balance of activity and rest and recovery, the likelihood of injury increases dramatically. Recent evidence suggests that endurance athletes, who are already at an increased risk for physical injury, may also be more susceptible to psychological issues and/or mental health disorders. Therefore, it is important to take an individualized and holistic approach to the treatment of each athlete to minimize the risk of injury or to assist in recovery. In this chapter, the authors discuss various preventive and recovery modalities used in their orthopedic practice that encompass the diverse and multidimensional needs of endurance athletes.KeywordsEndurance athleteInjuryRecoveryPreventionTreatmentOrthopaedicsHolistic
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Bu çalışmanın amacı, kadın güreşçilere müsabaka sonrası uygulanan pasif dinlenme (PD), aktif dinlenme (AD) ve myofasyal gevşeme (MG) egzersizlerinin toparlanma üzerine etkisinin araştırılmasıdır. Çalışmaya yaş ortalaması 18.80 ± 2.616 yıl; antrenman yaşı ortalaması 5.40 ± 2.951 yıl; vücut ağırlığı ortalaması 60.30 ± 5.229 kg ve boy uzunluğu ortalaması 166.50 ± 5.759 cm olan 10 kadın güreşçi katılmıştır. Sporculara müsabaka sonrasında pasif dinlenme, aktif dinlenme ve myofasyal gevşeme egzersizlerinden oluşan 3 farklı toparlanma yöntemi uygulanmıştır. Uygulanan toparlanma protokollerinin her birinde sporculara FILA kurallarına uygun 3’er müsabaka yaptırılmış ve sporcuların müsabaka öncesinde, müsabaka sonrasında ve toparlanma protokolünün sonrasında toplamda 9 kez olmak üzere laktat düzeyleri, vücut sıcaklığı, sistolik-diastolik kan basıncı, oksijen saturasyonu değerleri ve kalp atım hızları belirlenmiştir. Çalışmanın istatistiksel analizlerinde SPSS 24 paket programı kullanılmıştır. Toparlanma yönteminin etkisine ilişkin grup içi analizleri Repeated Measures testi ile, gruplar arası analizleri ise, Multivariate ANOVA (MANOVA) testi ile yapılmış ve anlamlılık düzeyi p<0,05 olarak alınmıştır. Sonuç olarak, kadın güreşçilere müsabaka sonrası uygulanan myofasyal gevşeme egzersizlerinin toparlanma üzerine olumlu etkisinin olduğu tespit edilmiştir.
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The purpose of this study was to measure the changes in oxidized (GSSG) and reduced (GSH) glutathione, glutathione reductase (GR) and glutathione peroxidase (GPX) after repeated-sprint activity (RSA) and subsequent cold water immersion (CWI). Twenty trained athletes with maximal oxygen uptake (VO2max) 52.9±2.9, age 21.9±2.2 yrs, height 174.2±5.4 cm, and weight 68±4.4 kg was assigned to take part in this study. After performing repeated-sprint activity, 10 participants immersed in cold water (14°c) and 10 participants passively sat on a chair at room temperature. Blood sampling was performed before and after RSA, after CWI or passive rest and after 24 h. The blood variables assessed through ELISA method. The results showed that antioxidant levels did not return to baseline levels and CWI had no effect on these factors, compared to GPX and GR returned to baseline levels after 24 h …
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ATP repletion following exhaustive exercise is approximated to be 90-95% complete in 3 minutes, and is crucial in the performance of short duration, high intensity work. Few studies appear to have used this 3-minute interval in the investigation of recovery modes, blood lactate accumulation and power output. Thus, our aim was to investigate changes in peak power (PP), average power (AP) and blood lactate during repeated bouts of high intensity, short duration cycling, comprising active and passive recovery modes lasting 3 minutes. Seven male cyclists (age 21.8±3.3 yrs, mass 73.0±3.8kgs, height 177.3±3.4cm) performed both an active (3 min at 80rpm & 1kg resistance) and a passive recovery (no work between bouts) protocol. Following a warm-up, subjects performed six 15-second maximal sprints against a fixed workload of 5.5kg. Mean PP across the six trials was 775±11.2Watts (W) and 772±33.4W for active and passive protocols respectively; whereas mean AP was 671±26.4W and 664±10.0W, respectively. Neither was significantly different. There was a significant difference within trials for both peak power and average power (p<0.05), with both values decreasing over time. However, the decrease was significantly smaller for both PP and AP values during the active recovery protocol (p<0.05). In the current study, variation in power output cannot be explained by lactate values, as values did not differ between the active and passive protocol (p=0.37). Lactate values did differ significantly between trials within protocols (p<0.05). The results of this study suggest that an active recovery of 3 minutes between high intensity, short duration exercise bouts significantly increases PP and AP compared to a passive recovery, irrespective of changes in blood lactate levels.
The wide array of superficial heat and cold modalities offers physicians many options for treating sports-related injuries. Appropriate application of heat and cold therapies can reduce the impact of an injury by relieving pain, reducing swelling, and encouraging rehabilitation.
Cheap, simple, safe, and effective, ice therapy after soft-tissue injury can cut weeks off of recovery time-but almost nobody uses it.
Familiarize yourself with the acute care environment with this essential guide to physical therapy practice in an acute care setting. Acute Care Handbook for Physical Therapists, 4th Edition helps you understand and interpret hospital protocol, safety, medical-surgical 'lingo', and the many aspects of patient are from the emergency department to the intensive care unit to the general ward. This restructured new edition streamlines the text into four parts- Introduction, Systems, Diagnoses, and Interventions to make the book even easier to use as a quick reference. Intervention algorithms, updated illustrations, and language consistent with the ICF model all help you digest new information and become familiar with new terminology. This comprehensive resource is just what you need to better manage the specific needs of your patients in the complex acute care environment.
Context It has been suggested that contrast-bath therapy alters sensation and enables patients to return to exercise more quickly. Objective To determine whether contrast-bath therapy alters sensation of pressure in the ankle. Design A 2 × 4 × 4 factorial design with repeated measures on 2 factors. Independent variables included gender, time (preapplication and 1, 6, and 11 min postapplication), and treatment (control, cold bath, hot bath, and contrast bath). Setting Laboratory. Participants 12 men and 12 women, college track athletes actively engaged in preseason workouts 5-6 days/wk. Interventions Sensation of pressure was tested preapplication and 1, 6, and 11 min postapplication. Each treatment lasted 20 min. Main Outcome Measure Sensation of pressure at baseline and 1, 6, and 11 min postapplication over the anterior talofibular ligament of the right ankle. Results There was no difference between genders. Sensation of pressure was greater for the heat condition than the other 3 conditions at 1 and 6 min postapplication. During the heating condition, sensation of pressure was greater at 1 and 6 min postapplication than during preapplication. During the contrast condition, sensation of pressure was less at 6 min postapplication than during preapplication. Conclusion Contrast- and cold-bath therapy (at 13 °C) do not affect numbness.
In this investigation on the relationships between maximal running velocity, muscle fiber characteristics, force production, and force relaxation, 25 male sprinters (100 m in 10.4-11.8 s) were studied. Maximal running velocity over 30 m, average stride rate, and average stride length were analyzed from video film. Needle biopsy samples were taken from the m. vastus lateralis for the calculation of the distribution and relative area of the fast twitch (FT) and slow twitch (ST) fibers. Force production in various performances was measured on a force platform and on a dynamometer, on which also the relaxation period was recorded. Forward speed strength was studied by means of standing multijumps. The results showed that maximal running velocity correlated positively and significantly with the percentage of fast twitch fibers (p<0.01), stride rate (p<0.001), upward speed strength (p<0.001), forward speed strength (p<0.05), and maximal isometric force (p<0.001). The percentage of fast twitch fibers correlated positively and significantly with stride rate (p<0.001), upward speed strength (p<0.05), and maximal isometric force (p<0.05), and negatively with muscle endurance (p<0.01). Muscle endurance also correlated negatively with the fiber area ratio (type II:type Ig p<0.001). It was concluded that muscle fiber distribution and stride rate strongly affect maximal running velocity and that, of the various tests used, the drop jump may prove useful in testing the speed strength component of sprinters.
Findings and recommendations on the assessment and treatment of adults with acute low back problems-activity limitations due to symptoms in the low back and/or back-related leg symptoms of less than 3 months' duration-are presented in this clinical practice guideline. The following are the principal conclusions of this guideline: The initial assessment of patients with acute low back problems focuses on the detection of "red flags" (indicators of potentially serious spinal pathology or other nonspinal pathology).In the absence of red flags, imaging studies and further testing of patients are not usually helpful during the first 4 weeks of low back symptoms.Relief of discomfort can be accomplished most safely with nonprescription medication and/or spinal manipulation.While some activity modification may be necessary during the acute phase, bed rest >4 days is not helpful and may further debilitate the patient.Low-stress aerobic activities can be safely started in the first 2 weeks of symptoms to help avoid debilitation; exercises to condition trunk muscles are commonly delayed at least 2 weeks.Patients recovering from acute low back problems are encouraged to return to work or their normal daily activities as soon as possible.If low back symptoms persist, further evaluation may be indicated.Patients with sciatica may recover more slowly, but further evaluation can also be safely delayed.Within the first 3 months of low back symptoms, only patients with evidence of serious spinal pathology or severe, debilitating symptoms of sciatica, and physiologic evidence of specific nerve root compromise corroborated on imaging studies can be expected to benefit from surgery.With or without surgery, 80 percent of patients with sciatica recover eventually. Nonphysical factors (such as psychological or socioeconomic problems) may be addressed in the context of discussing reasonable expectations for recovery.
Hot bathing has been associated with sudden death and so the present study investigated its effects on autonomic activity and hemodynamics in the elderly patient and the healthy young by analyzing heart rate variability (HRV), Subjects were 9 elderly men (mean age, 75 years) and 9 young men (mean age, 27 years), who were immersed up to shoulder level while in a sitting position for 10 min with the bath temperature at 40 degreesC. Blood pressure (BP) and heart rate (HR) were monitored. BP in the young decreased during bathing (p<0.01), whereas in the elderly BP had a maximum value just at the start of immersion (p<0.05) with a slight decline at 4 min after the start of immersion. Although HR in the young increased (p<0.01), in the elderly there was an abrupt increase in HR just at the start of immersion (p<0.05), followed by a decrease in HR. With regard to HRV, the high-frequency (HF) component in the young men was suppressed during immersion (p<0.01), but was unaffected in the elderly. The LF (low frequency)/HF ratio in the elderly decreased at 4 min (p<0.05). In conclusion, hypotensive syncope may cause sudden death by drowning during hot bathing, and is a consequence of the decrease in sympathetic tone that develops approximately 4 min after immersion.