|Year : 2017 | Volume
| Issue : 2 | Page : 65-69
Effect of recovery modalities on blood lactate clearance
Lalita Sharma, M Ejaz Hussain, Shalini Verma
Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia (Central University), New Delhi, India
|Date of Web Publication||6-Jun-2017|
Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia (Central University), New Delhi - 110 025
Recovery is an important tool for achieving an appropriate balance between training and competition stresses in maximizing the performance of athletes. Recovery modalities are being widely used as integral parts of the training programs of athletes to help in attaining this balance. This review examines the available evidence on efficacy of various modalities in enhancing recovery in athletic population with regard to their ability to improve the rate of blood lactate removal following high-intensity exercise. Modalities reviewed include massage therapy, contrast water therapy, active recovery, whole-body vibration therapy, pneumatic compression therapy, compression garments, and neuromuscular electrostimulation therapy.
Keywords: Fatigue, high-intensity exercise, performance
|How to cite this article:|
Sharma L, Hussain M E, Verma S. Effect of recovery modalities on blood lactate clearance. Saudi J Sports Med 2017;17:65-9
|How to cite this URL:|
Sharma L, Hussain M E, Verma S. Effect of recovery modalities on blood lactate clearance. Saudi J Sports Med [serial online] 2017 [cited 2017 Aug 20];17:65-9. Available from: http://www.sjosm.org/text.asp?2017/17/2/65/207577
| Introduction|| |
Proper and informed recovery is becoming an important aspect of preparation for elite athletes. Athletes' performance impairment may result from stressful components of training and competition. This impairment may be transitory or long lasting. Short-term impairment occurs due to metabolic disturbances following high-intensity exercise  that may lead to disturbance in the contractile process  and affect subsequent performance. Longer lasting impairment may be related to exercise-induced muscle injury and delayed onset muscle soreness. Correlation between the appearance of fatigue and accumulation of lactic acid has been found in many studies., Optimal performance is regained earlier with fast lactic acid elimination in athletes., As a result, many studies have examined the effects of various recovery protocols on blood lactate clearance following maximal exercise and it is important to know the effectiveness of and the rationale underlying each modality. The main purpose of this review article is to examine the evidence of the efficacy of currently used modalities on lactate recovery in athletes, post high- intensity exercise, also discussing in brief, relevant aspects of fatigue and recovery and mechanism of action of various modalities. Conclusions are drawn and recommendations for future researches are presented.
| High-Intensity Exercise and Blood Lactate|| |
The identification of lactic acid as a product of muscle activity was discovered early in the 20th century. The concept that this metabolite is a major player in fatigue was then evolved through their student, AV Hill., With the advent of the muscle biopsy technique and then nuclear magnetic resonance spectroscopy in the 1960s and 1970s, detailed studies appeared on the buildup of lactate and H + (i.e., acidosis) in working muscle. Further, it has been shown that short-term high-intensity exercise produces high levels of arterial lactate with values of up to 25 mmol·l -1 in highly motivated individuals , and it is considered one of the most important factors in fatigue.
High-intensity exercise is associated with a high rate of glycolysis, which challenges metabolic stability through accumulation of [H +] and consequent pH reduction. Evidence from numerous experimental approaches  suggested that an elevated muscle [H +] could depress muscle function by (i) reducing the transition of the cross-bridge from low- to high-force state, (ii) inhibiting maximal shortening velocity, (iii) inhibiting myofibrillar ATPase, (iv) inhibiting glycolytic rate, (v) reducing cross-bridge activation by competitively inhibiting Ca 2+ binding to troponin C, and (vi) reducing Ca 2+ reuptake by inhibiting the sarcoplasmic ATPase (leading to subsequent reduction of Ca 2+ release). Another hypothesis proposed increased glycerophosphate shuttle, which is more prevalent in Type 2 muscle fibers and activated only in high-intensity exercise, delivers FADH2 to Complex III of the electron transport chain, resulting in a lower P/O compared with the delivery of NADH + H + to Complex I.
Bieuzen et al. described the main mechanism for lactate removal as an increased blood flow to the muscles, thereby facilitating (i) lactate oxidation within the muscle itself; (ii) an increase in lactate elimination from the muscle; (iii) lactate transportation to other tissues (liver, heart, muscles) where it can be oxidized or used as a substrate for glucose resynthesis; or (iv) a combination of these 3 factors. Faster return to baseline during recovery causes the inhibition of calcium release by the sarcoplasmic reticulum and the interference with calcium–troponin binding, which contributes to the reduced contractile force.
| Recovery Modalities|| |
Active recovery is a recovery method, wherein athletes participate in an active movement, often cardiovascular, in an effort to increase blood flow and has been shown in previous studies to be the most effective form of recovery. Numerous studies have found improved lactate removal and/or performance with active rather than with passive rest in different types of exercise.,,, Swimmers subjected to active recuperation exercises may have better athletic performance and lower blood lactate values than those subjected to passive recuperation. Valenzuela et al. compared the effects of recovering with easy climbing (CR) or walking (WR) on markers of fatigue and climbing performance. Peak La-values were lower for CR than for WR. Therefore, the quantity and type of muscle mass activated may influence the increment in blood flow to different parts, facilitating metabolites clearance, and consequently improving performance.
Passive recovery refers to an athlete doing nothing out of the ordinary after a game or training, i.e., often seated inactivity. Passive recovery is used for the intrinsic return of the body to homeostasis., Several studies have found passive rest to enhance blood lactate recovery ,, although less effective when compared to active recovery.,, Hinzpeter et al. found higher blood lactate values in those subjected to passive rather than active recuperation. Similarly, Yoon and Kim  investigating the effects of 10-min rest on performance and fatigue-related factors after submaximal exercise, found lower levels of lactate, ammonia, and free radicals, following active recovery than passive rest.
Massage has gained popularity among athletes as a training recovery modality. This may be because it feels good, has no known side effects, and is not prohibited by any sport governing body. The potential benefits of massage on recovery include increased blood circulation and venous return, greater lactate clearance, decreased pain sensation, and general well-being., Despite these advantages, studies have failed to show any effect of massage on improving lactate clearance and blood flow., Hinds et al. proposed that massage increases skin blood flow without an increase in arterial blood flow, and therefore, could be potentially counterproductive diverting the blood flow away from recovering muscle. Pinar et al. concluded that as a method of postexercise recovery intervention massage did not represent a performance enhancement modality superior to passive rest only. Delextrat et al. also reported nonsignificant effect of a 30-min lower limb massage performed immediately after an official match on vertical jump and repeated sprint performance in men and women.
Whole-body vibration therapy
Whole-body vibration (WBV) methods are based on the mechanical massage effects of low frequency vibration, which could accelerate the recovery process by stimulating the muscle receptors to ease muscular tension thereby increasing blood flow.,, Therefore, it has been suggested that passive application of vibration may be beneficial to recovery and tissue healing, help overcome fatigue, decrease recovery time, and improve athletic performance., Despite these speculated physiological effects, there is a little evidence of its efficacy. Cheng et al. compared 10 min of low frequency (20 Hz, 0.4 mm) and high frequency (36 Hz, 0.4 mm) WBV to no vibration and observed no significant differences in blood lactate 30 or 60 min postexercise. Marin et al. reported no improvements in recovery or blood lactate removal after high-intensity exercise following low-frequency (20 Hz) WBV application for an interval of 15 min. More recently, Manimmanakorn et al. concluded that although WBV during recovery increased muscle oxygenation, it had little effect in improving subsequent performance compared with a normal active recovery.
Contrast water therapy
Contrast therapy has become one of the more popular methods of athletic recovery. Large increase in extraintravascular fluid movement and an increase in cardiac output and blood flow might enhance the ability to transport and metabolize waste products., Previous studies examining the efficacy of contrast water therapy revealed that although it produced significant improvements in recovery when compared to passive rest,, contrast bath was as good as to other recovery modalities., Bastos et al. showed that active recovery and cold water immersion offer benefits regarding the removal of blood lactate following high-intensity exercise. Ozrudi et al. also investigated the effects of contrast temperature water therapy on blood lactic acid clearance of university male students and found significantly reduced concentration of blood lactic acid after exhausting performance.
Neuromuscular electrical stimulation therapy
Neuromuscular electrical stimulation (NMES) is a technique that delivers electrical impulses through an external device that is connected to surface electrodes, which are placed on the skin in proximity of the skeletal muscle motor point to elicit visible muscle contractions. The physiological effects of electromyostimulation vary depending on the current characteristics (frequency, pulse width, voltage, etc.) used. NMES primarily increases muscle blood flow facilitating metabolite removal or causes stimulation of afferent fibers providing an analgesic effect. This, in turn, reduces muscle soreness and restores neuromuscular properties thereby helping restore sports performance. Studies exploring the efficacy of NMES have been equivocal. While some have observed that NMES can hasten blood lactate clearance faster than passive rest during an acute recovery phase (20–30 min) in various athletic populations,,,, others, in contrast, showed that using NMES during 30-min recovery from supramaximal exercise did not accelerate blood lactate removal ,, in comparison to passive resting. A review done by Malone et al. found strong evidence (Level 1) that NMES is effective for lowering postexercise blood lactate compared to passive recovery. These discrepancies in findings may be, to an extent, explained by the protocols, equipment, and location of the stimulation used to maximize its effectiveness.
Compression garments have become popular as an attempt to improve sport performance , including volleyball, basketball, and track and field, all of which rely on muscle power. It has been shown that the external pressure applied by compression sleeves (CS) increases blood flow. This change in blood flow leads to an improvement in venous return providing quicker lactate clearance leading to increased performance, especially during high-intensity intermittent exercise. Furthermore, wearing compression garments may allow training at a higher physiological intensity, which results in completion of a greater training volume. However, some studies have reported a lack of significant effect. Dascombe et al. demonstrated no improvement on oxygenation measures or performance using upper body compression garments. Furthermore, Martorelli et al., examining the effects on neuromuscular and metabolic responses during power training, demonstrated no positive peak power and mean power performance effects in young trained men when wearing upper body graduated CS during power exercise.
Pneumatic compression therapy
In athletic populations, intermittent pneumatic compression (IPC) has been used to enhance localized muscle recovery and performance higher than that of the passively recovery., Reason for the IPC's success in decreasing blood lactate more than passive might be attributed to its ability to mimic the muscle venous pump. Zelikovski et al. found 45% improvement in exercise performance following an exhaustive exercise bout after 20-min application of modified intermittent sequential pneumatic device. A recent study by Martin et al. showed positive acute effects of peristaltic pneumatic compression on repeated anaerobic exercise performance and blood lactate clearance and concluded that application of IPC during recovery may be a viable alternative when “inactive” recovery is desirable.
| Conclusion|| |
Most studies examining the efficacy of recovery modalities have focused on postexercise lactate removal or performance of individuals following a high-intensity exercise bout. The applicability of passive recovery and massage as recovery modalities in athletes is questionable with regard to recovery between training sessions because evidence as to the positive effect of these recovery modalities is lacking. Active recovery, compression therapy, and NMES therapy appear to be advantageous. The possible efficacy of both WBV and contrast water therapy needs more investigation for clarification as these recovery modalities continue to gain wide acceptance among elite athletes and sports bodies are investing time and money in making them more accessible, further research and better consideration of the evidence of their efficacy appear warranted.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Bieuzen F, Borne R, Toussaint JF, Hausswirth C. Positive effect of specific low-frequency electrical stimulation during short-term recovery on subsequent high-intensity exercise. Appl Physiol Nutr Metab 2014;39:202-10.
Barnett A. Using recovery modalities between training sessions in elite athletes: Does it help? Sports Med 2006;36:781-96.
Westerblad H, Allen DG, Lännergren J. Muscle fatigue: Lactic acid or inorganic phosphate the major cause? News Physiol Sci 2002;17:17-21.
Maffiuletti NA. Physiological and methodological considerations for the use of neuromuscular electrical stimulation. Eur J Appl Physiol 2010;110:223-34.
Allen DG, Lamb GD, Westerblad H. Skeletal muscle fatigue: Cellular mechanisms. Physiol Rev 2008;88:287-332.
Cheung K, Hume P, Maxwell L. Delayed onset muscle soreness: Treatment strategies and performance factors. Sports Med 2003;33:145-64.
Fabiato A, Fabiato F. Effects of pH on the myofilaments and the sarcoplasmic reticulum of skinned cells from cardiace and skeletal muscles. J Physiol 1978;276:233-55.
Monedero J, Donne B. Effect of recovery interventions on lactate removal and subsequent performance. Int J Sports Med 2000;21:593-7.
Bangsbo J, Madsen K, Kiens B, Richter EA. Effect of muscle acidity on muscle metabolism and fatigue during intense exercise in man. J Physiol 1996;495(Pt 2):587-96.
Fletcher WM. Lactic acid in amphibian muscle. J Physiol 1907;35:247-309.
Hill AV, Kupalov P. Anaerobic and aerobic activity in isolated muscle. Proc R Soc Lond B 1929;105:313-22.
Hill AV, Lupton H. Muscular exercise, lactic acid, and the supply and utilization of oxygen. Q J Med 1923;16:135-71.
Sahlin K. Muscle fatigue and lactic acid accumulation. Acta Physiol Scand Suppl 1986;556:83-91.
McLoughlin P, McCaffrey N, Moynihan JB. Gentle exercise with a previously inactive muscle group hastens the decline of blood lactate concentration after strenuous exercise. Eur J Appl Physiol Occup Physiol 1991;62:274-8.
Rowell LB, Saltin B, Kiens B, Christensen NJ. Is peak quadriceps blood flow in humans even higher during exercise with hypoxemia? Am J Physiol 1986;251(5 Pt 2):H1038-44.
Gladden LB. Lactate metabolism: A new paradigm for the third millennium. J Physiol 2004;558(Pt 1):5-30.
Fitts RH. Mechanism of muscular fatigue. Principles of Exercise Biochemistry. Poortmans JR, 3rd
ed, Karger, Basel; 2003. p. 279-300.
Fitts RH. Cellular mechanisms of muscle fatigue. Physiol Rev 1994;74:49-94.
Neric FB, Beam WC, Brown LE, Wiersma LD. Comparison of swim recovery and muscle stimulation on lactate removal after sprint swimming. J Strength Cond Res 2009;23:2560-7.
Grassi B, Rossiter HB, Zoladz JA. Skeletal muscle fatigue and decreased efficiency: Two sides of the same coin? Exerc Sport Sci Rev 2015;43:75-83.
Coffey V, Leveritt M, Gill N. Effect of recovery modality on 4-hour repeated treadmill running performance and changes in physiological variables. J Sci Med Sport 2004;7:1-10.
Warren CD, Brown LE, Landers MR, Stahura KA. Effect of three different between-inning recovery methods on baseball pitching performance. J Strength Cond Res 2011;25:683-8.
Heyman E, de Geus B, Mertens I, Meeusen R. Effects of four recovery methods on repeated maximal rock climbing performance. Med Sci Sports Exerc 2009;41:1303-10.
Menzies P, Menzies C, McIntyre L, Paterson P, Wilson J, Kemi OJ. Blood lactate clearance during active recovery after an intense running bout depends on the intensity of the active recovery. J Sports Sci 2010;28:975-82.
Arazi H, Mosavi SS, Basir SS, Karam MG. The effects of different recovery conditions on blood lactate concentration and physiological variables after high intensity exercise in handball players. Sport Sci 2012;5:13-7.
White GE, Wells GD. The effect of on-hill active recovery performed between runs on blood lactate concentration and fatigue in alpine ski racers. J Strength Cond Res 2015;29:800-6.
Hinzpeter J, Zamorano A, Cuzmar D, Lopez M, Burboa J. Effect of active versus passive recovery on performance during intrameet swimming competition. Sports Health 2014;6:119-21.
Valenzuela PL, de la Villa P, Ferragut C. Effect of two types of active recovery on fatigue and climbing performance. J Sports Sci Med 2015;14:769-75.
Lattier G, Millet GY, Martin A, Martin V. Fatigue and recovery after high-intensity exercise. Part II: Recovery interventions. Int J Sports Med 2004;25:509-15.
Dupont G, Blondel N, Berthoin S. Performance for short intermittent runs: Active recovery vs. passive recovery. Eur J Appl Physiol 2003;89:548-54.
Dupont G, Moalla W, Guinhouya C, Ahmaidi S, Berthoin S. Passive versus active recovery during high-intensity intermittent exercises. Med Sci Sports Exerc 2004;36:302-8.
Pinar S, Kaya F, Bicer B, Erzeybek MS, Cotuk HB. Different recovery methods and muscle performance after exhausting exercise: Comparison of the effects of electrical muscle stimulation and massage. Biol Sport 2012;29:269-75.
Malone JK, Blake C, Caulfield BM. Neuromuscular electrical stimulation during recovery from exercise: A systematic review. J Strength Cond Res 2014;28:2478-506.
Cochrane DJ, Teo C. The effect of neuromuscular electrical stimulation (Firefly TM device) on blood lactate clearance and anaerobic performance. Edorium J Sports Med 2015;1:1-6.
Gupta S, Goswami A, Sadhukhan AK, Mathur DN. Comparative study of lactate removal in short term massage of extremities, active recovery and a passive recovery period after supramaximal exercise sessions. Int J Sports Med 1996;17:106-10.
Taoutaou Z, Granier P, Mercier B, Mercier J, Ahmaidi S, Prefaut C. Lactate kinetics during passive and partially active recovery in endurance and sprint athletes. Eur J Appl Physiol Occup Physiol 1996;73:465-70.
Spencer M, Bishop D, Dawson B, Goodman C, Duffield R. Metabolism and performance in repeated cycle sprints: Active versus passive recovery. Med Sci Sports Exerc 2006;38:1492-9.
Yoon YB, Kim SH. Effect of rest method on fatigue related factors and performance after submaximal exercise. Indian J Sci Technol 2015;8 Suppl 1:384-90.
Hausswirth C, Meur LY. Physiological and nutritional aspects of post-exercise recovery. Sports Med 2011;41:861-82.
Bakar Y, Coknaz H, Karli Ü, Semsek Ö, Serin E, Pala ÖO. Effect of manual lymph drainage on removal of blood lactate after submaximal exercise. J Phys Ther Sci 2015;27:3387-91.
Martin NA, Zoeller RF, Robertson RJ, Lephart SM. The comparative effects of sports massage, active recovery, and rest in promoting blood lactate clearance after supramaximal leg exercise. J Athl Train 1998;33:30-5.
Shoemaker JK, Tiidus PM, Mader R. Failure of manual massage to alter limb blood flow: Measures by Doppler ultrasound. Med Sci Sports Exerc 1997;29:610-4.
Hinds T, McEwan I, Perkes J, Dawson E, Ball D, George K. Effects of massage on limb and skin blood flow after quadriceps exercise. Med Sci Sports Exerc 2004;36:1308-13.
Delextrat A, Calleja-González J, Hippocrate A, Clarke ND. Effects of sports massage and intermittent cold-water immersion on recovery from matches by basketball players. J Sports Sci 2013;31:11-9.
Lohman EB 3rd
, Petrofsky JS, Maloney-Hinds C, Betts-Schwab H, Thorpe D. The effect of whole body vibration on lower extremity skin blood flow in normal subjects. Med Sci Monit 2007;13:CR71-6.
Maloney-Hinds C, Petrofsky JS, Zimmerman G. The effect of 30 Hz vs 50 Hz passive vibration and duration of vibration on skin blood flow in the arm. Med Sci Monit 2008;14:CR112-6.
Lythgo N, Eser P, de Groot P, Galea M. Whole-body vibration dosage alters leg blood flow. Clin Physiol Funct Imaging 2009;29:53-9.
Cheng CF, Hsu WC, Lee CL, Chung PK. Effects of the different frequencies of whole-body vibration during the recovery phase after exhaustive exercise. J Sports Med Phys Fitness 2010;50:407-15.
Marin PJ, Zarzuela R, Zarzosa F, Herrero AJ, Garatachea N, Rhea MR. Whole-body vibration as a method of recovery for soccer players. Eur J Sport Sci 2012;12:2-8.
Manimmanakorn N, Ross JJ, Manimmanakorn A, Lucas SJ, Hamlin MJ. Effect of whole-body vibration therapy on performance recovery. Int J Sports Physiol Perform 2015;10:388-95.
Wilcock IM, Cronin JB, Hing WA. Physiological response to water immersion: A method for sport recovery? Sports Med 2006;36:747-65.
Wilcock IM. The Effect of Water Immersion, Active Recovery and Passive Recovery on Repeated Bouts of Explosive Exercise and Blood Plasma Fraction [Master's thesis]. Auckland, New Zealand: Health and Environmental Sciences, Auckland University of Technology; 2005.
Vaile JM, Gill ND, Blazevich AJ. The effect of contrast water therapy on symptoms of delayed onset muscle soreness. J Strength Cond Res 2007;21:697-702.
Vaile J, Halson S, Gill N, Dawson B. Effect of cold water immersion on repeat cycling performance and thermoregulation in the heat. J Sports Sci 2008;26:431-40.
Buchheit M, Bishop D, Haydar B, Nakamura FY, Ahmaidi S. Physiological responses to shuttle repeated-sprint running. Int J Sports Med 2010;31:402-9.
Halse RE, Wallman KE, Guelfi KJ. Postexercise water immersion increases short-term food intake in trained men. Med Sci Sports Exerc 2011;43:632-8.
Bastos FN, Vanderlei LC, Nakamura FY, Bertollo M, Godoy MF, Hoshi RA, et al.
Effects of cold water immersion and active recovery on post-exercise heart rate variability. Int J Sports Med 2012;33:873-9.
Ozrudi MF, Aliabadi SR, Firozmandi A. The effect of contrast temperature water therapy on blood lactic acid clearance of male students of Mazandaran university of science and technology after exhausting activity. Int J Appl Exerc Physiol 2015;4:51-8.
Seyri KM, Maffiuletti NA. Effect of electromyostimulation training on muscle strength and sports performance. Strength Cond J 2011;33:70-5.
Taylor T, West DJ, Howatson G, Jones C, Bracken RM, Love TD, et al.
The impact of neuromuscular electrical stimulation on recovery after intensive, muscle damaging, maximal speed training in professional team sports players. J Sci Med Sport 2015;18:328-32.
Seo B, Kim D, Choi D, Kwon C, Shin H. The effect of electrical stimulation on blood lactate after anaerobic muscle fatigue induced in Taekwondo athletes. J Phys Ther Sci 2011;23:271-5.
Cortis C, Tessitore A, D'Artibale E, Meeusen R, Capranica L. Effects of post-exercise recovery interventions on physiological, psychological, and performance parameters. Int J Sports Med 2010;31:327-35.
Ali A, Creasy RH, Edge JA. The effect of graduated compression stockings on running performance. J Strength Cond Res 2011;25:1385-92.
Kemmler W, von Stengel S, Köckritz C, Mayhew J, Wassermann A, Zapf J. Effect of compression stockings on running performance in men runners. J Strength Cond Res 2009;23:101-5.
Kraemer WJ, Bush JA, Bauer JA, McBride NT, Paxton NJ, Clemson A, et al
. Influence of compression garments on vertical jump performance in NCAA division I volleybal players. J Strength Cond Res 1996;10:180-3.
Bochmann RP, Seibel W, Haase E, Hietschold V, Rödel H, Deussen A. External compression increases forearm perfusion. J Appl Physiol 2005;99:2337-44.
Born DP, Sperlich B, Holmberg HC. Bringing light into the dark: Effects of compression clothing on performance and recovery. Int J Sports Physiol Perform 2013;8:4-18.
Faulkner JA, Gleadon D, McLaren J, Jakeman JR. Effect of lower-limb compression clothing on 400-m sprint performance. J Strength Cond Res 2013;27:669-76.
Dascombe B, Laursen P, Nosaka K, Polglaze T. No effect of upper body compression garments in elite flat-water kayakers. Eur J Sport Sci 2013;13:341-9.
Martorelli SS, Martorelli AS, Pereira MC, Rocha-Junior VA, Tan JG, Alvarenga JG, et al.
Graduated compression sleeves: Effects on metabolic removal and neuromuscular performance. J Strength Cond Res 2015;29:1273-8.
Wiener A, Mizrahi J, Verbitsky O. Enhancement of tibialis anterior recovery by intermittent sequential pneumatic compression of the legs. Basic Appl Myol 2001;11:87-90.
Hanson E, Stetter K, Li R, Thomas A. An intermittent pneumatic compression device reduces blood lactate concentrations more effectively than passive recovery after Wingate testing. J Athl Enhanc 2013;4:18-25.
Comerota AJ. Intermittent pneumatic compression: Physiologic and clinical basis to improve management of venous leg ulcers. J Vasc Surg 2011;53:1121-9.
Zelikovski A, Kaye CL, Fink G, Spitzer SA, Shapiro Y. The effects of the modified intermittent sequential pneumatic device (MISPD) on exercise performance following an exhaustive exercise bout. Br J Sports Med 1993;27:255-9.
Martin JS, Friedenreich ZD, Borges AR, Roberts MD. Acute effects of peristaltic pneumatic compression on repeated anaerobic exercise performance and blood lactate clearance. J Strength Cond Res 2015;29:2900-6.