|
 
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| REVIEW ARTICLE |
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| Year : 2017 | Volume
: 17
| Issue : 2 | Page : 65-69 |
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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 |
Correspondence Address:
Shalini Verma
Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia (Central University), New Delhi - 110 025
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/1319-6308.207577
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 |
| Introduction | |  |
Proper and informed recovery is becoming an important aspect of preparation for elite athletes.[1] Athletes' performance impairment may result from stressful components of training and competition.[2] This impairment may be transitory or long lasting. Short-term impairment occurs due to metabolic disturbances following high-intensity exercise [3] that may lead to disturbance in the contractile process [4] and affect subsequent performance.[5] Longer lasting impairment may be related to exercise-induced muscle injury and delayed onset muscle soreness.[6] Correlation between the appearance of fatigue and accumulation of lactic acid has been found in many studies.[5],[7] Optimal performance is regained earlier with fast lactic acid elimination in athletes.[8],[9] 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.[10] The concept that this metabolite is a major player in fatigue was then evolved through their student, AV Hill.[11],[12] 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.[13] 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 [14],[15] and it is considered one of the most important factors in fatigue.[16]
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 [17] 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,[18] (ii) inhibiting maximal shortening velocity, (iii) inhibiting myofibrillar ATPase, (iv) inhibiting glycolytic rate,[19] (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.[20]
Bieuzen et al.[1] described the main mechanism for lactate removal as an increased blood flow to the muscles, thereby facilitating (i) lactate oxidation within the muscle itself;[21] (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.[19] 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.[5]
| Recovery Modalities | | |
Active recovery
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.[22] Numerous studies have found improved lactate removal and/or performance with active rather than with passive rest in different types of exercise.[23],[24],[25],[26] Swimmers subjected to active recuperation exercises may have better athletic performance and lower blood lactate values than those subjected to passive recuperation.[27] Valenzuela et al.[28] 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
Passive recovery refers to an athlete doing nothing out of the ordinary after a game or training, i.e., often seated inactivity.[29] Passive recovery is used for the intrinsic return of the body to homeostasis.[30],[31] Several studies have found passive rest to enhance blood lactate recovery [32],[33],[34] although less effective when compared to active recovery.[35],[36],[37] Hinzpeter et al.[27] found higher blood lactate values in those subjected to passive rather than active recuperation. Similarly, Yoon and Kim [38] 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 therapy
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.[39],[40] Despite these advantages, studies have failed to show any effect of massage on improving lactate clearance and blood flow.[41],[42] Hinds et al.[43] 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.[32] 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.[44] 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.[45],[46],[47] 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.[45],[46] Despite these speculated physiological effects, there is a little evidence of its efficacy. Cheng et al.[48] 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.[49] 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.[50] 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.[51] 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.[51],[52] Previous studies examining the efficacy of contrast water therapy revealed that although it produced significant improvements in recovery when compared to passive rest,[53],[54] contrast bath was as good as to other recovery modalities.[55],[56] Bastos et al.[57] showed that active recovery and cold water immersion offer benefits regarding the removal of blood lactate following high-intensity exercise. Ozrudi et al.[58] 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.[59] 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,[1],[60],[61],[62] others, in contrast, showed that using NMES during 30-min recovery from supramaximal exercise did not accelerate blood lactate removal [32],[33],[34] in comparison to passive resting. A review done by Malone et al.[33] 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
Compression garments have become popular as an attempt to improve sport performance [63],[64] including volleyball, basketball, and track and field, all of which rely on muscle power.[65] It has been shown that the external pressure applied by compression sleeves (CS) increases blood flow.[66] 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.[67] Furthermore, wearing compression garments may allow training at a higher physiological intensity, which results in completion of a greater training volume.[68] However, some studies have reported a lack of significant effect. Dascombe et al.[69] demonstrated no improvement on oxygenation measures or performance using upper body compression garments. Furthermore, Martorelli et al.,[70] 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.[71],[72] 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.[73] Zelikovski et al.[74] 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.[75] 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.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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