Effects of different levels of compression during sub-maximal and high-intensity exercise on erythrocyte deformability

Effects of Wearing Compression Stockings on Exercise Performance and Associated Indicators: A Systematic Review

This systematic review investigated the effects of wearing below-knee compression stockings (CS) on exercise performance (or sports activity) and associated physiological and perceived indicators. We searched articles on PubMed using the following terms: "graduated compression stockings"; "compression stockings"; "graduated compression socks"; "compression socks" combined with "performance", "athletes", "exercise", "exercise performance", "fatigue", "sports" and "recovery", resulting in 1067 papers. After checking for inclusion criteria (e.g., original studies, healthy subjects, performance analysis), 21 studies were selected and analyzed. We conclude that wearing CS during exercise improved performance in a small number of studies. However, wearing CS could benefit muscle function indicators and perceived muscle soreness during the recovery period. Future research should investigate the chronic effect of CS on Sports Medicine and athletic performance.

Acute Low-Dose Hyperoxia during a Single Bout of High-Intensity Interval Exercise Does Not Affect Red Blood Cell Deformability and Muscle Oxygenation in Trained Men-A Randomized Crossover Study

Recent technological developments provide easy access to use an artificial oxygen supply (hyperoxia) during exercise training. The aim of this study was to assess the efficacy of a commercially available oxygen compressor inducing low-dose hyperoxia, on limiting factors of endurance performance. Thirteen active men (age 24 ± 3 years) performed a high-intensity interval exercise (HIIE) session (5 × 3 min at 80% of W_max, separated by 2 min at 40% W_max) on a cycle ergometer, both in hyperoxia (4 L∙min⁻¹, 94% O₂, HYP) or ambient conditions (21% O₂, NORM) in randomized order. The primary outcome was defined as red blood cell deformability (RBC-D), while our secondary interest included changes in muscle oxygenation. RBC-D was expressed by the ratio of shear stress at half-maximal deformation (SS¹/₂) and maximal deformability (EI_max) and muscle oxygenation of the rectus femoris muscle was assessed by near-infrared spectroscopy. No statistically significant changes occurred in SS¹/₂ and EI_max in either condition. The ratio of SS¹/₂ to EI_max statistically decreased in NORM (p < 0.01; Δ: −0.10; 95%CI: −0.22, 0.02) but not HYP (p > 0.05; Δ: −0.16; 95%CI: −0.23, −0.08). Muscle oxygenation remained unchanged. This study showed that low-dose hyperoxia during HIIE using a commercially available device with a flow rate of only 4 L·min⁻¹ may not be sufficient to induce acute ergogenic effects compared to normoxic conditions.

Investigation of the Impact of Below-Knee Compression Garments on Markers of Exercise-Induced Muscle Damage and Performance in Endurance Runners: A Prospective Randomized Controlled Trial

BACKGROUND

Compression garment utilization is very popular among runners despite a lack of consensus in the literature regarding a beneficial impact. The aim of the study was to investigate the impact of training and competing with compression garments on exercise-induced muscle damage and performance in ultramarathon runners.

HYPOTHESIS

Compression garments will reduce the severity of exercise-induced muscle damage and improve performance in long-distance runners compared with control conditions.

STUDY DESIGN

Prospective, randomized controlled trial.

LEVEL OF EVIDENCE

Level 1.

METHODS

The study was conducted in healthy, uninjured endurance runners (n = 41) participating in a 56-km ultramarathon. The experimental group (n = 20; 14 males, 6 females) trained for 6 weeks and participated in the race wearing below-knee compression garments while the control group (n = 21; 15 males, 6 females) did not. Participants were tested on 4 occasions for various markers of exercise-induced muscle damage and running performance.

RESULTS

Ankle circumference measurements increased significantly less ( P = 0.01, Cohen d = 0.9) in the experimental group from immediately after until 2 days post-race compared with the control group. No further statistically significant changes were detected over time in midcalf circumferences, muscle architecture, or race performance. Selected pain ratings were statistically significant and worse in the experimental group.

CONCLUSION

There are limited indications of a beneficial impact of compression garments with improvements in ankle circumference measurements. No ergogenic impact was detected.

CLINICAL RELEVANCE

There is limited evidence to support the continued utilization of commercially available below-knee compression garments during running for the purpose of muscle recovery or as a performance aid.

Acute L-Arginine supplementation does not affect red blood cell aggregation and deformability during high intensity interval exercise in healthy men

BACKGROUND

L-Arginine, the precursor of NO might be involved in improving the cardiovascular disorders via regulation of functional properties of erythrocytes.

OBJECTIVE

This study investigated the effects of L-Arginine supplementation on responses of red blood cell (RBC) properties to high intensity interval exercise (HIIE).

METHODS

Ten overweight healthy men participated voluntarily in the study and performed two HIIE trials with and without L-Arginine in two separate weeks. The HIIE protocol included 12 intervals of 3-min encompassed 1-min running at 100% of vVO2max and 2-min active recovery at 40% of vVO2max. Three blood samples were taken before and after supplementation, and immediately after exercise; and were used to measure red blood cell properties.

RESULTS

The HIIE protocol increased hematocrit, hemoglobin and lactate significantly (P < 0.05), but had no significant effect on RBC aggregation, RBC deformability, and fibrinogen concentration. When data were compared for two trials no significant differences between the responses of RBC properties to two HIIE protocols were detected (P > 0.05), whereas the increases in lactate concentration following HIIE was significantly lower in L-Arginine than placebo trial (P < 0.05).

CONCLUSIONS

It is concluded that L-Arginine consumption prior to HIIE does not lead to any improvement in RBC properties during HIIE in overweight healthy men.

Association of Lower Limb Compression Garments During High-Intensity Exercise with Performance and Physiological Responses: A Systematic Review and Meta-analysis

BACKGROUND

Although compression garments are used to improve sports performance, methodological approaches and the direction of evidence regarding garments for use in high-intensity exercise settings are diverse.

OBJECTIVES

Our primary aim was to summarize the association between lower-limb compression garments (LLCGs) and changes in sports performance during high-intensity exercise. We also aimed to summarize evidence about the following physiological parameters related to sports performance: vertical jump height (VJ), maximal oxygen uptake (VO₂max), submaximal oxygen uptake (VO₂submax), blood lactate concentrations ([La]), and ratings of perceived exertion (RPE, 6-20 Borg scale).

METHODS

We searched electronic databases (PubMed, EMBASE, Cochrane Library, and ClinicalTrials.gov) and reference lists for previous reviews. Eligible studies included randomized controlled trials with athletes or physically active subjects (≥ 18 years) using any type of LLCG during high-intensity exercise. The results were described as weighted mean difference (WMD) with a 95% confidence interval (95% CI).

RESULTS

The 23 included studies showed low statistical heterogeneity for the pooled outcomes. We found that LLCGs yielded similar running performance to controls (50-400 m: WMD 0.06 s [95% CI - 1.99 to 2.11]; 800-3000 m: WMD 6.10 s [95% CI - 7.23 to 19.43]; > 5000 m: WMD 1.01 s [95% CI - 84.80 to 86.82]). Likewise, we found no evidence that LLCGs were superior in secondary outcomes (VJ: WMD 2.25 cm [95% CI - 2.51 to 7.02]; VO₂max: WMD 0.24 mL.kg^-1.min^-1 [95% CI - 1.48 to 1.95]; VO₂submax: WMD - 0.26 mL.kg^-1.min^-1 [95% CI - 2.66 to 2.14]; [La]: WMD 0.19 mmol/L [95% CI - 0.22 to 0.60]; RPE: WMD - 0.20 points [95% CI - 0.48 to 0.08]).

CONCLUSIONS

LLCGs were not associated with improved performance in VJ, VO₂max, VO₂submax, [La], or RPE during high-intensity exercise. Such evidence should be taken into account when considering using LLCGs to enhance running performance.

Deformability of different red blood cell populations and viscosity of differently trained young men in response to intensive and moderate running

BACKGROUND

Red blood cell (RBC) deformability and blood viscosity are essential to ensure optimal microcirculation and may contribute to athletic performance.

OBJECTIVE

To investigate the acute responses of density fractionated young, middle old and old RBC, RBC viscosity (RBCV), plasma viscosity (PV) and hematological changes to two running modes (intensive and moderate).

METHODS

27 young and healthy men of different training status participated in this study and were grouped into three groups in accordance to their VO2peak and conducted an intensive and moderate running test, respectively (crossover design). Pre and Post exercise, RBC were fractionated via percoll density gradient centrifugation. RBC deformability of the entire RBC population and the fractionated RBC was determined. Viscosity, hematocrit and mean cellular volume were determined.

RESULTS

Baseline results reveal that high trained subjects possess more young RBC and show increased deformability of un-fractioned RBC and middle aged RBC. Baseline PV, RBCV, hematocrit and mean cellular volume did not differ between groups. Applied running modes did not change RBC deformability of any sub-fractions. Viscosity only increased after intensive running. Hematological changes were observed after both exercises.

CONCLUSIONS

Acute effects of exercise on RBC are marginal, but chronic differences can be observed in RBC function.

Impact of training volume and intensity on RBC-NOS/NO pathway and endurance capacity

BACKGROUND

Acute exercise increases red blood cell-nitric oxide synthase (RBC-NOS) activation and RBC deformability but the effect of regular training remains unclear.

OBJECTIVE

To detect the chronic effect of enduring moderate and high intensity training on the RBC-NOS/NO pathway and to detect a relation between RBC deformability and endurance capacity.

METHODS

38 healthy male subjects were randomly assigned to one of three training groups: High Volume Training (HVT; 120-140 beats per minute (bpm)), High Intensity Training (HIT; 160-180 bpm) and Moderate Intensity Training (MIT; 140-160 bpm). Blood parameters, maximum oxygen capacity (VO2 max), RBC deformability, RBC nitrite level and RBC-NOS activation were measured after venous blood sampling at rest pre (T0) and after six weeks of training (T1).

RESULTS

RBC-NOS activation, RBC nitrite concentration and RBC deformability were significantly increased at T1 in the HIT group. Parameters were unaltered in MIT and HVT. Maximum oxygen uptake was only significantly increased in the HIT group and regression analysis revealed positive regression between VO2 max and RBC deformability.

CONCLUSIONS

High intensity training was the only training programme that sustainably affected RBC-NOS dependent NO production and performance capacity. HIT therefore represents a time efficient training program resulting in improved RBC function potentially improving physical condition.

Is There Evidence that Runners can Benefit from Wearing Compression Clothing?

BACKGROUND

Runners at various levels of performance and specializing in different events (from 800 m to marathons) wear compression socks, sleeves, shorts, and/or tights in attempt to improve their performance and facilitate recovery. Recently, a number of publications reporting contradictory results with regard to the influence of compression garments in this context have appeared.

OBJECTIVES

To assess original research on the effects of compression clothing (socks, calf sleeves, shorts, and tights) on running performance and recovery.

METHOD

A computerized research of the electronic databases PubMed, MEDLINE, SPORTDiscus, and Web of Science was performed in September of 2015, and the relevant articles published in peer-reviewed journals were thus identified rated using the Physiotherapy Evidence Database (PEDro) Scale. Studies examining effects on physiological, psychological, and/or biomechanical parameters during or after running were included, and means and measures of variability for the outcome employed to calculate Hedges'g effect size and associated 95 % confidence intervals for comparison of experimental (compression) and control (non-compression) trials.

RESULTS

Compression garments exerted no statistically significant mean effects on running performance (times for a (half) marathon, 15-km trail running, 5- and 10-km runs, and 400-m sprint), maximal and submaximal oxygen uptake, blood lactate concentrations, blood gas kinetics, cardiac parameters (including heart rate, cardiac output, cardiac index, and stroke volume), body and perceived temperature, or the performance of strength-related tasks after running. Small positive effect sizes were calculated for the time to exhaustion (in incremental or step tests), running economy (including biomechanical variables), clearance of blood lactate, perceived exertion, maximal voluntary isometric contraction and peak leg muscle power immediately after running, and markers of muscle damage and inflammation. The body core temperature was moderately affected by compression, while the effect size values for post-exercise leg soreness and the delay in onset of muscle fatigue indicated large positive effects.

CONCLUSION

Our present findings suggest that by wearing compression clothing, runners may improve variables related to endurance performance (i.e., time to exhaustion) slightly, due to improvements in running economy, biomechanical variables, perception, and muscle temperature. They should also benefit from reduced muscle pain, damage, and inflammation.

Compression therapy in sport

Sportkompressionsstrümpfe werden zuneh-mend während und auch außerhalb des Sports eingesetzt. Während sich medizinische Kompressionsstrümpfe bei phlebologischen und lymphologischen Erkrankungen längst bewährt haben, ist der Nutzen von Sport-kompressionsstrümpfen für den Sportler nicht zufrieden stellend geklärt. Viele Studien, die sich mit möglichen Auswirkungen der Sportkompressionsstrümpfe auf den Athleten beschäftigen, berücksichtigen die Produkteigenschaften nur unzureichend. Im Gegensatz zu medizinischen Kompressionsstrümpfen besteht hier keine einheitliche Norm. Ferner sind die Studien in der detaillierten Thematik zum Teil nicht vergleichbar. Mal ging es um Ganzkörperkompression, mal nur um die Unterschenkel. Mal lag die Intensität im Regenerationsbereich, mal an der Belastungsgrenze. Zudem erscheint eine Differenzierung des Outcome zwischen untrainiertem Sportler und Leistungssportlern sinnvoll. Es werden zusätzlich mehr verlässliche Messverfahren benötigt, um die bisher dünne Datenlage zu verbessern. Bis dahin ist in vielerlei Hinsicht kein abschließendes Urteil zu dieser Thematik möglich.

Wearing lower-body compression garment with medium pressure impaired exercise-induced performance decrement during prolonged running

Objective

To investigate the effect of wearing a lower body compression garment (CG) exerting different pressure levels during prolonged running on exercise-induced muscle damage and the inflammatory response.

Methods

Eight male participants completed three exercise trials in a random order. The exercise consisted of 120 min of uphill running at 60% of VO₂max. The exercise trials included 1) wearing a lower-body CG with 30 mmHg pressure [HIGH]; 2) wearing a lower-body CG with 15 mmHg pressure [MED]; and 3) wearing a lower-body garment with < 5 mmHg pressure [CON]. Heart rate (HR), and rate of perceived exertion for respiration and legs were monitored continuously during exercise. Time-course change in jump height was evaluated before and immediately after exercise. Blood samples were collected to determine blood glucose, lactate, serum creatine kinase, myoglobin, free fatty acids, glycerol, cortisol, and plasma interleukin-6 (IL-6) concentrations before exercise, 60 min of the 120 min exercise period, immediately after exercise, and 60 min after exercise.

Results

Jump height was significantly higher immediately after the exercise in the MED trial compared with that in the HIGH trial (P = 0.04). Mean HR during the 120 min exercise was significantly lower in the MED trial (162 ± 4 bpm) than that in the CON trial (170 ± 4 bpm, P = 0.01). Plasma IL-6 concentrations increased significantly with exercise in all trials, but the area under the curve during exercise was significantly lower in the MED trial (397 ± 58 pg/ml·120 min) compared with that in the CON trial (670 ± 86 pg/ml·120 min, P = 0.04).

Conclusion

Wearing a lower body CG exerting medium pressure (approximately 15 mmHg) significantly attenuated decrease in jump performance than that with wearing a lower body CG exerting high pressure (approximately 30 mmHg). Furthermore, exercise-induced increases in HR and the inflammatory response were significantly smaller with CG exerted 15mmHg than that with garment exerted < 5 mmHg.

Calf Compression Sleeves Change Biomechanics but Not Performance and Physiological Responses in Trail Running

Introduction: The aim of this study was to determine whether calf compression sleeves (CS) affects physiological and biomechanical parameters, exercise performance, and perceived sensations of muscle fatigue, pain and soreness during prolonged (~2 h 30 min) outdoor trail running.

Methods: Fourteen healthy trained males took part in a randomized, cross-over study consisting in two identical 24-km trail running sessions (each including one bout of running at constant rate on moderately flat terrain, and one period of all-out running on hilly terrain) wearing either degressive CS (23 ± 2 mmHg) or control sleeves (CON, <4 mmHg). Running time, heart rate and muscle oxygenation of the medial gastrocnemius muscle (measured using portable near-infrared spectroscopy) were monitored continuously. Muscle functional capabilities (power, stiffness) were determined using 20 s of maximal hopping before and after both sessions. Running biomechanics (kinematics, vertical and leg stiffness) were determined at 12 km·h⁻¹ at the beginning, during, and at the end of both sessions. Exercise-induced Achilles tendon pain and delayed onset calf muscles soreness (DOMS) were assessed using visual analog scales.

Results: Muscle oxygenation increased significantly in CS compared to CON at baseline and immediately after exercise (p < 0.05), without any difference in deoxygenation kinetics during the run, and without any significant change in run times. Wearing CS was associated with (i) higher aerial time and leg stiffness in running at constant rate, (ii) with lower ground contact time, higher leg stiffness, and higher vertical stiffness in all-out running, and (iii) with lower ground contact time in hopping. Significant DOMS were induced in both CS and CON (>6 on a 10-cm scale) with no difference between conditions. However, Achilles tendon pain was significantly lower after the trial in CS than CON (p < 0.05).

Discussion: Calf compression did not modify muscle oxygenation during ~2 h 30 of trail running but significantly changed running biomechanics and lower limb muscle functional capabilities toward a more dynamic behavior compared to control session. However, wearing compression sleeves did not affect performance and exercise-induced DOMS, while it minimized Achilles tendon pain immediately after running.

Comparison of hemorheological changes in patients after acute coronary events, intervention and ambulatory rehabilitation

During the past decades, our group have investigated the hemorheological parameters (HPs) of more than 1,000 patients with various forms of ischemic heart disease (IHD). Our data indicate that HPs are altered in patients with IHD and the extent of the alterations is in good correlation with the clinical severity of the disease. Our findings have also proven that HPs play a critical role in the pathogenesis of myocardial ischemia.The lack of regular exercise is an important cardiovascular risk factor. Regular physical activity - as part of the cardiovascular rehabilitation training program (CRP) - is recommended for the treatment of IHD and the prevention of first or further cardiovascular events. To estimate the beneficial hemorheological effects of CRP, compared to patients after a coronary event or intervention and not participating in CRP, the data of four of our prospective studies (three non-CRP and one CRP-participating) were evaluated.Hematocrit (Hct), plasma and whole blood viscosity (WBV), Hct/WBV ratio significantly (p < 0.05) increased in the non-CRP groups during the 6-12 months follow-up, while in the CRP group they significantly decreased (p < 0.05). Red blood cell aggregation decreased in a much greater manner in the CRP group.Our results indicate that CRP has beneficial hemorheological effects and is able to reverse the deterioration of HPs after coronary events or intervention.

Increases in core temperature counterbalance effects of haemoconcentration on blood viscosity during prolonged exercise in the heat

NEW FINDINGS

What is the central question of this study? The purpose of the present study was to determine the effects of exercise-induced haemoconcentration and hyperthermia on blood viscosity. What is the main finding and its importance? Exercise-induced haemoconcentration, increased plasma viscosity and increased blood aggregation, all of which increased blood viscosity, were counterbalanced by increased red blood cell (RBC) deformability (e.g. RBC membrane shear elastic modulus and elongation index) caused by the hyperthermia. Thus, blood viscosity remained unchanged following prolonged moderate-intensity exercise in the heat. Previous studies have reported that blood viscosity is significantly increased following exercise. However, these studies measured both pre- and postexercise blood viscosity at 37 °C even though core and blood temperatures would be expected to have increased during the exercise. Consequently, the effect of exercise-induced hyperthermia on mitigating change in blood viscosity may have been missed. The purpose of this study was to isolate the effects of exercise-induced haemoconcentration and hyperthermia and to determine their combined effects on blood viscosity. Nine subjects performed 2 h of moderate-intensity exercise in the heat (37 °C, 40% relative humidity), which resulted in significant increases from pre-exercise values for rectal temperature (from 37.11 ± 0.35 to 38.76 ± 0.13 °C), haemoconcentration (haematocrit increased from 43.6 ± 3.6 to 45.6 ± 3.5%) and dehydration (change in body weight = -3.6 ± 0.7%). Exercise-induced haemoconcentration significantly (P < 0.05) increased blood viscosity by 9% (from 3.97 to 4.33 cP at 300 s(-1)), whereas exercise-induced hyperthermia significantly decreased blood viscosity by 7% (from 3.97 to 3.69 cP at 300 s(-1)). When both factors were considered together, there was no overall change in blood viscosity (from 3.97 to 4.03 cP at 300 s(-1)). The effects of exercise-induced haemoconcentration, increased plasma viscosity and increased red blood cell aggregation, all of which increased blood viscosity, were counterbalanced by increased red blood cell deformability (e.g. red blood cell membrane shear elastic modulus and elongation index) caused by the hyperthermia. Thus, blood viscosity remained unchanged following prolonged moderate-intensity exercise in the heat.

Exercise-induced blood lactate increase does not change red blood cell deformability in cyclists

BACKGROUND

The effect of exercise-induced lactate production on red blood cell deformability and other blood rheological changes is controversial, given heavy-exercise induces biochemical processes (e.g., oxidative stress) known to perturb haemorheology. The aim of the present study was to examine the haemorheological response to a short-duration cycling protocol designed to increase blood lactate concentration, but of duration insufficient to induce significant oxidative stress.

METHODS

Male cyclists and triathletes (n = 6; 27±7 yr; body mass index: 23.7±3.0 kg/m²; peak oxygen uptake 4.02±0.51 L/min) performed unloaded (0 W), moderate-intensity, and heavy-intensity cycling. Blood was sampled at rest and during the final minute of each cycling bout. Blood chemistry, blood viscosity, red blood cell aggregation and red blood cell deformability were measured.

RESULTS

Blood lactate concentration increased significantly during heavy-intensity cycling, when compared with all other conditions. Methaemoglobin fraction did not change during any exercise bout when compared with rest. Blood viscosity at native haematocrit increased during heavy-intensity cycling at higher-shear rates when compared with rest, unloaded and moderate-intensity cycling. Heavy-intensity exercise increased the amplitude of red blood cell aggregation in native haematocrit samples when compared with all other conditions. Red blood cell deformability was not changed by exercise.

CONCLUSION

Acute exercise perturbs haemorheology in an intensity dose-response fashion; however, many of the haemorheological effects appear to be secondary to haemoconcentration, rather than increased lactate concentration.