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Perrey S, Quaresima V, Ferrari M. Muscle Oximetry in Sports Science: An Updated Systematic Review. Sports Med 2024; 54:975-996. [PMID: 38345731 PMCID: PMC11052892 DOI: 10.1007/s40279-023-01987-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2023] [Indexed: 04/28/2024]
Abstract
BACKGROUND In the last 5 years since our last systematic review, a significant number of articles have been published on the technical aspects of muscle near-infrared spectroscopy (NIRS), the interpretation of the signals and the benefits of using the NIRS technique to measure the physiological status of muscles and to determine the workload of working muscles. OBJECTIVES Considering the consistent number of studies on the application of muscle oximetry in sports science published over the last 5 years, the objectives of this updated systematic review were to highlight the applications of muscle oximetry in the assessment of skeletal muscle oxidative performance in sports activities and to emphasize how this technology has been applied to exercise and training over the last 5 years. In addition, some recent instrumental developments will be briefly summarized. METHODS Preferred Reporting Items for Systematic Reviews guidelines were followed in a systematic fashion to search, appraise and synthesize existing literature on this topic. Electronic databases such as Scopus, MEDLINE/PubMed and SPORTDiscus were searched from March 2017 up to March 2023. Potential inclusions were screened against eligibility criteria relating to recreationally trained to elite athletes, with or without training programmes, who must have assessed physiological variables monitored by commercial oximeters or NIRS instrumentation. RESULTS Of the identified records, 191 studies regrouping 3435 participants, met the eligibility criteria. This systematic review highlighted a number of key findings in 37 domains of sport activities. Overall, NIRS information can be used as a meaningful marker of skeletal muscle oxidative capacity and can become one of the primary monitoring tools in practice in conjunction with, or in comparison with, heart rate or mechanical power indices in diverse exercise contexts and across different types of training and interventions. CONCLUSIONS Although the feasibility and success of the use of muscle oximetry in sports science is well documented, there is still a need for further instrumental development to overcome current instrumental limitations. Longitudinal studies are urgently needed to strengthen the benefits of using muscle oximetry in sports science.
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Affiliation(s)
- Stephane Perrey
- EuroMov Digital Health in Motion, University of Montpellier, IMT Mines Ales, Montpellier, France
| | - Valentina Quaresima
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy.
| | - Marco Ferrari
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
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DiFrancisco-Donoghue J, Rothstein A, Jung MK, Zwibel H, Werner WG. Upper body compression wear improves muscle oxygenation following intense video game training: a randomized cross-over study among competitive gamers. BMC Sports Sci Med Rehabil 2023; 15:108. [PMID: 37697389 PMCID: PMC10496220 DOI: 10.1186/s13102-023-00720-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 08/29/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Esport players require a high number of action moves per minute to play, with substantial contractions of the wrist extensor muscles. Players frequently suffer from acute fatigue. The purpose of this study was to examine the use of below the elbow compression sleeves on Sm02 during intense aim training. Secondly, to examine players' performance and perception with and without compression. METHODS This study was conducted at the New York Institute of Technology and enrolled fifteen collegiate esport players, 2 women and 13 men (age 21.2 ± 2.2). All subjects signed written consent. Participants performed 3 high intensity bouts of an aim trainer followed by a 15-minute rest before doing another 3 bouts of high intensity training conducting the other arm of the study. The compression wear order was randomized. The primary outcome included Sm02 of the extensor carpi radialis longus using near-infrared spectrometry. Secondary outcomes included Kills Per Second (KPS), Score, Total Time to Kill (TTK), accuracy, and perceived performance. RESULTS Following 15 min of recovery, there was a significant rise in Sm02 while wearing the compression sleeve compared to no compression sleeve (p = 0.004). No change in Sm02 was seen while gaming. In trials 1 and 2, wearing the compression sleeve resulted in a significant increase in KPS and score when compared to not wearing it (p = 0.002,0.006). Although TTK and accuracy did not alter, 46.7% of participants believed the compression sleeve aided their performance. CONCLUSIONS This study provides support that wearing below the elbow upper body compression sleeves while performing high intensity gaming may reduce fatigue, improve muscle recovery and gaming performance. TRIAL REGISTRATION Clinicaltrials.gov identifier NCT05037071. Registered 08/09/2021. URL: Arm Compression on Muscle Oxygen Saturation - Full Text View - ClinicalTrials.gov.
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Affiliation(s)
- Joanne DiFrancisco-Donoghue
- Department of Osteopathic Medicine, New York Institute of Technology/Academic Health Care Center, College of Osteopathic Medicine (NYITCOM), Northern Blvd, PO Box 8000, Old Westbury, NY, 11568, USA.
| | - Alexander Rothstein
- Department of Interdisciplinary Health Sciences, New York Institute of Technology (NYIT), Old Westbury, NY, USA
| | | | - Hallie Zwibel
- Department of Family Medicine, NYITCOM, Old Westbury, NY, USA
| | - William G Werner
- School of Health Professions, Department of Physical Therapy, New York Institute of Technology (NYIT), Old Westbury, NY, USA
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Do Sports Compression Garments Alter Measures of Peripheral Blood Flow? A Systematic Review with Meta-Analysis. Sports Med 2023; 53:481-501. [PMID: 36622554 DOI: 10.1007/s40279-022-01774-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND One of the proposed mechanisms underlying the benefits of sports compression garments may be alterations in peripheral blood flow. OBJECTIVE We aimed to determine if sports compression garments alter measures of peripheral blood flow at rest, as well as during, immediately after and in recovery from a physiological challenge (i.e. exercise or an orthostatic challenge). METHODS We conducted a systematic literature search of databases including Scopus, SPORTDiscus and PubMed/MEDLINE. The criteria for inclusion of studies were: (1) original papers in English and a peer-reviewed journal; (2) assessed effect of compression garments on a measure of peripheral blood flow at rest and/or before, during or after a physiological challenge; (3) participants were healthy and without cardiovascular or metabolic disorders; and (4) a study population including athletes and physically active or healthy participants. The PEDro scale was used to assess the methodological quality of the included studies. A random-effects meta-analysis model was used. Changes in blood flow were quantified by standardised mean difference (SMD) [± 95% confidence interval (CI)]. RESULTS Of the 899 articles identified, 22 studies were included for the meta-analysis. The results indicated sports compression garments improve overall peripheral blood flow (SMD = 0.32, 95% CI 0.13, 0.51, p = 0.001), venous blood flow (SMD = 0.37, 95% CI 0.14, 0.60, p = 0.002) and arterial blood flow (SMD = 0.30, 95% CI 0.01, 0.59, p = 0.04). At rest, sports compression garments did not improve peripheral blood flow (SMD = 0.18, 95% CI - 0.02, 0.39, p = 0.08). However, subgroup analyses revealed sports compression garments enhance venous (SMD = 0.31 95% CI 0.02, 0.60, p = 0.03), but not arterial (SMD = 0.12, 95% CI - 0.16, 0.40, p = 0.16), blood flow. During a physiological challenge, peripheral blood flow was improved (SMD = 0.44, 95% CI 0.19, 0.69, p = 0.0007), with subgroup analyses revealing sports compression garments enhance venous (SMD = 0.48, 95% CI 0.11, 0.85, p = 0.01) and arterial blood flow (SMD = 0.44, 95% CI 0.03, 0.86, p = 0.04). At immediately after a physiological challenge, there were no changes in peripheral blood flow (SMD = - 0.04, 95% CI - 0.43, 0.34, p = 0.82) or subgroup analyses of venous (SMD = - 0.41, 95% CI - 1.32, 0.47, p = 0.35) and arterial (SMD = 0.12, 95% CI - 0.26, 0.51, p = 0.53) blood flow. In recovery, sports compression garments did not improve peripheral blood flow (SMD = 0.25, 95% CI - 0.45, 0.95, p = 0.49). The subgroup analyses showed enhanced venous (SMD = 0.67, 95% CI 0.17, 1.17, p = 0.009), but not arterial blood flow (SMD = 0.02, 95% CI - 1.06, 1.09, p = 0.98). CONCLUSIONS Use of sports compression garments enhances venous blood flow at rest, during and in recovery from, but not immediately after, a physiological challenge. Compression-induced changes in arterial blood flow were only evident during a physiological challenge.
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Adding heat stress to repeated-sprint training in hypoxia does not enhance performance improvements in canoe/kayak athletes. Eur J Appl Physiol 2023; 123:339-349. [PMID: 36278988 DOI: 10.1007/s00421-022-05054-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 09/12/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE The present study investigated the effects of adding heat stress to repeated-sprint training in hypoxia on performance and physiological adaptations in well-trained athletes. METHODS Sixteen canoe/kayak sprinters conducted 2 weeks of repeated-sprint training consisting of three sets of 5 × 10 s sprints with 20 s active recovery periods under conditions of either normobaric hypoxia (RSH, FiO2: 14.5%, ambient temperature: 18 ℃, n = 8) or combined heat and normobaric hypoxia (RSHH, FiO2: 14.5%, ambient temperature: 38 ℃, n = 8). Before and after training, the 10 × 10 s repeated-sprint ability (RSA) test and 500 m time trial were performed on a canoe/kayak ergometer. RESULTS Peak and average power outputs during the RSA test were significantly improved after training in both RSH (peak power: + 21.5 ± 4.6%, P < 0.001; average power: + 12.5 ± 1.9%, P < 0.001) and RSHH groups (peak power: + 18.8 ± 6.6%, P = 0.005; average power: + 10.9 ± 6.8%, P = 0.030). Indirect variables of skeletal muscle oxygen extraction (deoxygenated hemoglobin) and blood perfusion (total hemoglobin) during the RSA test were significantly increased after training in the RSH group (P = 0.041 and P = 0.034, respectively) but not in the RSHH group. In addition, finish time during the 500 m time trial was significantly shortened after the training only in the RSH group (RSH: - 3.9 ± 0.8%, P = 0.005; RSHH: - 3.1 ± 1.4%, P = 0.078). CONCLUSION Adding heat stress to RSH does not enhance performance improvement and may partially mask muscle tissue adaptation.
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O'Riordan SF, Bishop DJ, Halson SL, Broatch JR. Compression-induced improvements in post-exercise recovery are associated with enhanced blood flow, and are not due to the placebo effect. Sci Rep 2022; 12:16762. [PMID: 36202885 PMCID: PMC9537593 DOI: 10.1038/s41598-022-21029-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 09/21/2022] [Indexed: 11/24/2022] Open
Abstract
The aim of this study was to investigate the physiological effects of compression tights on blood flow following exercise and to assess if the placebo effect is responsible for any acute performance or psychological benefits. Twenty-two resistance-trained participants completed a lower-body resistance exercise session followed by a 4 h recovery period. Participants were assigned a post-exercise recovery intervention of either compression tights applied for 4 h (COMP), placebo tablet consumed every hour for 4 h (PLA) or control (CON). Physiological (markers of venous return, muscle blood flow, blood metabolites, thigh girth), performance (countermovement jump, isometric mid-thigh pull), and psychological measures (perceived muscle soreness, total quality of recovery) were collected pre-exercise, immediately post-exercise, at 30 (markers of venous return and muscle blood flow) and 60 min (blood metabolites, thigh girth and psychological measures) intervals during 4 h of recovery, and at 4 h, 24 h and 48 h post-exercise. No significant (P > 0.05) differences were observed between interventions. However, effect size analysis revealed COMP enhanced markers of venous return, muscle blood flow, recovery of performance measures, psychological measures and reduced thigh girth compared to PLA and CON. There were no group differences in blood metabolites. These findings suggest compression tights worn after resistance exercise enhance blood flow and indices of exercise recovery, and that these benefits were not due to a placebo effect.
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Affiliation(s)
- Shane F O'Riordan
- Institute for Health and Sport (iHeS), Victoria University, PO Box 14428, Melbourne, VIC, 8001, Australia. .,Department of Physiology, Australian Institute of Sport, Canberra, Australia.
| | - David J Bishop
- Institute for Health and Sport (iHeS), Victoria University, PO Box 14428, Melbourne, VIC, 8001, Australia
| | - Shona L Halson
- School of Behavioural and Health Sciences, Australian Catholic University, Brisbane, Australia
| | - James R Broatch
- Institute for Health and Sport (iHeS), Victoria University, PO Box 14428, Melbourne, VIC, 8001, Australia
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Imai A, Yamaguchi K, Goto K. Comparison of systemic and peripheral responses during high-intensity interval exercise under voluntary hypoventilation vs. hypoxic conditions. Phys Act Nutr 2022; 26:8-16. [PMID: 35982624 PMCID: PMC9395251 DOI: 10.20463/pan.2022.0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 06/02/2022] [Indexed: 11/22/2022] Open
Abstract
[Purpose] This study aimed to determine the systemic and peripheral responses to high-intensity interval exercise (HIIE) with voluntary hypoventilation at low lung volume (VHL) or HIIE under hypoxic conditions. [Methods] Ten male participants completed a single session of HIIE (three sets of 6 × 8-s high-intensity pedaling at 170% of maximal oxygen uptake [VO2max]) under three different conditions: normoxia with normal breathing (NOR: 23 °C, 20.9% of fraction of inspired oxygen [FiO2]), hypoxia with normal breathing (HYP: 23 °C, 14.5% FiO2), and normoxia with VHL (VHL: 23 °C, 20.9% FiO2). A randomized crossover design was used. Power output, arterial oxygen saturation (SpO2), heart rate, and muscle oxygenation were monitored during the exercise and the 16-s recovery. Muscle blood flow (mBF) of the vastus lateralis was also evaluated. [Results] SpO2 during the exercise and the 16-s recovery in the VHL group was significantly lower than in that of the NOR group. However, this parameter in the VHL group was significantly higher than that of the HYP group (NOR: 94.9 ± 0.4%, HYP: 82.8 ± 1.2%, VHL: 90.4 ± 0.5%; p < 0.001). Muscle oxygen saturation was significantly lower in the HYP group than those in the VHL and NOR groups (NOR: 79.6 ± 17.4%, HYP: 65.5 ± 7.7%, VHL: 74.4 ± 7.8%; p = 0.024). No significant difference in this parameter was observed between the VHL and NOR groups (p > 0.05). Additionally, the exercise-induced increase in mBF did not differ significantly among three groups (p > 0.05). [Conclusion] HIIE-induced SpO2 decrease was smaller under hypoxic conditions than during VHL. Moreover, mBF was not enhanced by the addition of VHL during HIIE.
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Limmer M, de Marées M, Roth R. Effects of Forearm Compression Sleeves on Muscle Hemodynamics and Muscular Strength and Endurance Parameters in Sports Climbing: A Randomized, Controlled Crossover Trial. Front Physiol 2022; 13:888860. [PMID: 35726278 PMCID: PMC9206081 DOI: 10.3389/fphys.2022.888860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 05/10/2022] [Indexed: 11/22/2022] Open
Abstract
Purpose: Wearing compression garments is a commonly used intervention in sports to improve performance and facilitate recovery. Some evidence supports the use of forearm compression to improve muscle tissue oxygenation and enhance sports climbing performance. However, evidence is lacking for an effect of compression garments on hand grip strength and specific sports climbing performance. The purpose of this study was to evaluate the immediate effects of forearm compression sleeves on muscular strength and endurance of finger flexor muscles in sports climbers. Materials and Methods: This randomized crossover study included 24 sports climbers who performed one familiarization trial and three subsequent test trials while wearing compression forearm sleeves (COMP), non-compressive placebo forearm sleeves (PLAC), or no forearm sleeves (CON). Test trials consisted of three performance measurements (intermittent hand grip strength and endurance measurements, finger hang, and lap climbing) at intervals of at least 48 h in a randomized order. Muscle oxygenation during hand grip and finger hang measurements was assessed by near-infrared spectroscopy. The maximum blood lactate level, rate of perceived exertion, and forearm muscle pain were also determined directly after the lap climbing trials. Results: COMP resulted in higher changes in oxy[heme] and tissue oxygen saturation (StO2) during the deoxygenation (oxy[heme]: COMP –10.7 ± 5.4, PLAC –6.7 ± 4.3, CON –6.9 ± 5.0 [μmol]; p = 0.014, ηp2 = 0.263; StO2: COMP –4.0 ± 2.2, PLAC –3.0 ± 1.4, CON –2.8 ± 1.8 [%]; p = 0.049, ηp2 = 0.194) and reoxygenation (oxy [heme]: COMP 10.2 ± 5.3, PLAC 6.0 ± 4.1, CON 6.3 ± 4.9 [μmol]; p = 0.011, ηp2 = 0.274; StO2: COMP 3.5 ± 1.9, PLAC 2.4 ± 1.2, CON 2.3 ± 1.9 [%]; p = 0.028, ηp2 = 0.225) phases of hand grip measurements, whereas total [heme] concentrations were not affected. No differences were detected between the conditions for the parameters of peak force and fatigue index in the hand grip, time to failure and hemodynamics in the finger hang, or performance-related parameters in the lap climbing measurements (p ≤ 0.05). Conclusions: Forearm compression sleeves did not enhance hand grip strength and endurance, sports climbing performance parameters, physiological responses, or perceptual measures. However, they did result in slightly more pronounced changes of oxy [heme] and StO2 in the deoxygenation and reoxygenation phases during the hand grip strength and endurance measurements.
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Affiliation(s)
- Mirjam Limmer
- Institute of Outdoor Sports and Environmental Science, German Sports University Cologne, Cologne, Germany
- *Correspondence: Mirjam Limmer, , orcid.org/0000-0002-8032-6152
| | - Markus de Marées
- Department of Sports Medicine and Sports Nutrition, Faculty of Sport Science, Ruhr-University Bochum, Bochum, Germany
| | - Ralf Roth
- Institute of Outdoor Sports and Environmental Science, German Sports University Cologne, Cologne, Germany
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Ienaga K, Yamaguchi K, Ota N, Goto K. Augmented muscle deoxygenation during repeated sprint exercise with post-exercise blood flow restriction. Physiol Rep 2022; 10:e15294. [PMID: 35586958 PMCID: PMC9117971 DOI: 10.14814/phy2.15294] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 01/19/2022] [Accepted: 01/20/2022] [Indexed: 06/15/2023] Open
Abstract
Blood flow restriction (BFR) during low-intensity exercise has been known to be a potent procedure to alter metabolic and oxygen environments in working muscles. Moreover, the use of BFR during inter-set rest periods of repeated sprint exercise has been recently suggested to be a potent procedure for improving training adaptations. The present study was designed to determine the effect of repeated sprint exercise with post-exercise BFR (BFR during rest periods between sprints) on muscle oxygenation in working muscles. Eleven healthy males performed two different conditions on different days: either repeated sprint exercise with BFR during rest periods between sets (BFR condition) or without BFR (CON condition). A repeated sprint exercise consisted of three sets of 3 × 6-s maximal sprints (pedaling) with 24s rest periods between sprints and 5 min rest periods between sets. In BFR condition, two min of BFR (100-120 mmHg) for both legs was conducted between sets. During the exercise, power output and arterial oxygen saturation (SpO2 ) were evaluated. Muscle oxygenation for the vastus lateralis muscle, exercise-induced changes in muscle blood flow, and muscle oxygen consumption were measured. During BFR between sets, BFR condition presented significantly higher deoxygenated hemoglobin + myoglobin (p < 0.01) and lower tissue saturation index (p < 0.01) than those in CON condition. However, exercise-induced blood lactate elevation and reduction of blood pH did not differ significantly between the conditions. Furthermore, power output throughout nine sprints did not differ significantly between the two conditions. In conclusion, repeated sprint exercise with post-exercise BFR augmented muscle deoxygenation and local hypoxia, without interfering power output.
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Affiliation(s)
- Koki Ienaga
- Graduate School of Sport and Health ScienceRitsumeikan UniversityKusatsuShigaJapan
| | - Keiichi Yamaguchi
- Graduate School of Sport and Health ScienceRitsumeikan UniversityKusatsuShigaJapan
| | - Naoki Ota
- Graduate School of Sport and Health ScienceRitsumeikan UniversityKusatsuShigaJapan
| | - Kazushige Goto
- Graduate School of Sport and Health ScienceRitsumeikan UniversityKusatsuShigaJapan
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Putting the Squeeze on Compression Garments: Current Evidence and Recommendations for Future Research: A Systematic Scoping Review. Sports Med 2021; 52:1141-1160. [PMID: 34870801 PMCID: PMC9023423 DOI: 10.1007/s40279-021-01604-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2021] [Indexed: 11/30/2022]
Abstract
Background Compression garments are regularly worn during exercise to improve physical performance, mitigate fatigue responses, and enhance recovery. However, evidence for their efficacy is varied and the methodological approaches and outcome measures used within the scientific literature are diverse. Objectives The aim of this scoping review is to provide a comprehensive overview of the effects of compression garments on commonly assessed outcome measures in response to exercise, including: performance, biomechanical, neuromuscular, cardiovascular, cardiorespiratory, muscle damage, thermoregulatory, and perceptual responses. Methods A systematic search of electronic databases (PubMed, SPORTDiscus, Web of Science and CINAHL Complete) was performed from the earliest record to 27 December, 2020. Results In total, 183 studies were identified for qualitative analysis with the following breakdown: performance and muscle function outcomes: 115 studies (63%), biomechanical and neuromuscular: 59 (32%), blood and saliva markers: 85 (46%), cardiovascular: 76 (42%), cardiorespiratory: 39 (21%), thermoregulatory: 19 (10%) and perceptual: 98 (54%). Approximately 85% (n = 156) of studies were published between 2010 and 2020. Conclusions Evidence is equivocal as to whether garments improve physical performance, with little evidence supporting improvements in kinetic or kinematic outcomes. Compression likely reduces muscle oscillatory properties and has a positive effect on sensorimotor systems. Findings suggest potential increases in arterial blood flow; however, it is unlikely that compression garments meaningfully change metabolic responses, blood pressure, heart rate, and cardiorespiratory measures. Compression garments increase localised skin temperature and may reduce perceptions of muscle soreness and pain following exercise; however, rating of perceived exertion during exercise is likely unchanged. It is unlikely that compression garments negatively influence exercise-related outcomes. Future research should assess wearer belief in compression garments, report pressure ranges at multiple sites as well as garment material, and finally examine individual responses and varying compression coverage areas. Supplementary Information The online version contains supplementary material available at 10.1007/s40279-021-01604-9.
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O'Riordan SF, McGregor R, Halson SL, Bishop DJ, Broatch JR. Sports compression garments improve resting markers of venous return and muscle blood flow in male basketball players. JOURNAL OF SPORT AND HEALTH SCIENCE 2021:S2095-2546(21)00092-2. [PMID: 34314879 PMCID: PMC10362518 DOI: 10.1016/j.jshs.2021.07.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 05/10/2021] [Accepted: 06/21/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND The benefits associated with sports compression garments are thought to be closely related to enhanced blood flow. However, findings are equivocal, possibly due to heterogeneity in the techniques used for measuring blood flow, the garment types used, and the pressures applied. This study combined Doppler ultrasound and near-infrared spectroscopy technologies to provide the first comprehensive assessment of the effects of 3 sports compression garment types on markers of venous return and muscle blood flow at rest. METHODS Resting lower-limb blood flow measures (markers of venous return, muscle blood flow, and muscle oxygenation) of 22 elite, junior, male basketball players (age = 17.2 ± 0.9 years, mean ± SD) were assessed in 4 separate conditions: no compression (CON), compression tights (TIGHTS), compression shorts (SHORTS), and compression socks (SOCKS). Markers of venous return (cross-sectional area, time-averaged mean and peak blood flow velocity, and venous blood flow) were measured via Doppler ultrasound at the popliteal and common femoral veins. Muscle blood flow and muscle oxygenation were measured in the gastrocnemius medialis and vastus lateralis using near-infrared spectroscopy. RESULTS Popliteal markers of venous return were higher in TIGHTS compared to CON (p < 0.01) and SHORTS (p < 0.01), with SOCKS values higher compared with CON (p < 0.05). Common femoral vein markers of venous return were higher for all conditions compared to CON (p < 0.05), with TIGHTS values also higher compared to SOCKS (p < 0.05). Gastrocnemius medialis blood flow was higher for TIGHTS compared to CON (p = 0.000), SOCKS (p = 0.012), and SHORTS (p = 0.000), with SOCKS higher compared to SHORTS (p = 0.046). Vastus lateralis blood flow was higher for TIGHTS compared to CON (p = 0.028) and SOCKS (p = 0.019), with SHORTS also higher compared to CON (p = 0.012) and SOCKS (p = 0.005). Gastrocnemius medialis oxygenation was higher for TIGHTS compared to CON (p = 0.003), SOCKS (p = 0.033), and SHORTS (p = 0.003), with SOCKS higher compared to CON (p = 0.044) and SHORTS (p = 0.032). Vastus lateralis oxygenation was higher for TIGHTS compared to CON (p = 0.020) and SOCKS (p = 0.006). CONCLUSION Markers of venous return, muscle blood flow, and muscle oxygenation are increased with sports compression garments. TIGHTS are most effective, potentially because of the larger body area compressed.
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Affiliation(s)
- Shane F O'Riordan
- Institute for Health and Sport (iHeS), Victoria University, Footscray, VIC 3011, Australia; Department of Physiology, Australian Institute of Sport, Bruce, ACT 2617, Australia.
| | - Rod McGregor
- Faculty of Health, University of Canberra, Bruce, ACT 2617, Australia
| | - Shona L Halson
- School of Behavioural and Health Sciences, Australian Catholic University, Banyo, QLD 4014, Australia
| | - David J Bishop
- Institute for Health and Sport (iHeS), Victoria University, Footscray, VIC 3011, Australia
| | - James R Broatch
- Institute for Health and Sport (iHeS), Victoria University, Footscray, VIC 3011, Australia; Department of Physiology, Australian Institute of Sport, Bruce, ACT 2617, Australia
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11
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Broatch JR, O'Riordan SF, Keske MA, Betik AC, Bishop DJ, Halson SL, Parker L. Reduced post-exercise muscle microvascular perfusion with compression is offset by increased muscle oxygen extraction: Assessment by contrast-enhanced ultrasound. FASEB J 2021; 35:e21499. [PMID: 33811697 DOI: 10.1096/fj.202002205rr] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 02/16/2021] [Accepted: 02/17/2021] [Indexed: 11/11/2022]
Abstract
The microvasculature is important for both health and exercise tolerance in a range of populations. However, methodological limitations have meant changes in microvascular blood flow are rarely assessed in humans during interventions designed to affect skeletal muscle blood flow such as the wearing of compression garments. The aim of this study is, for the first time, to use contrast-enhanced ultrasound to directly measure the effects of compression on muscle microvascular blood flow alongside measures of femoral artery blood flow and muscle oxygenation following intense exercise in healthy adults. It was hypothesized that both muscle microvascular and femoral artery blood flows would be augmented with compression garments as compared with a control condition. Ten recreationally active participants completed two repeated-sprint exercise sessions, with and without lower-limb compression tights. Muscle microvascular blood flow, femoral arterial blood flow (2D and Doppler ultrasound), muscle oxygenation (near-infrared spectroscopy), cycling performance, and venous blood samples were measured/taken throughout exercise and the 1-hour post-exercise recovery period. Compared with control, compression reduced muscle microvascular blood volume and attenuated the exercise-induced increase in microvascular velocity and flow immediately after exercise and 1 hour post-exercise. Compression increased femoral artery diameter and augmented the exercise-induced increase in femoral arterial blood flow during exercise. Markers of blood oxygen extraction in muscle were increased with compression during and after exercise. Compression had no effect on blood lactate, glucose, or exercise performance. We provide new evidence that lower-limb compression attenuates the exercise-induced increase in skeletal muscle microvascular blood flow following exercise, despite a divergent increase in femoral artery blood flow. Decreased muscle microvascular perfusion is offset by increased muscle oxygen extraction, a potential mechanism allowing for the maintenance of exercise performance.
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Affiliation(s)
- James R Broatch
- Institute for Health and Sport (IHES), Victoria University, Melbourne, VIC, Australia.,Australia Institute of Sport, Canberra, ACT, Australia
| | - Shane F O'Riordan
- Institute for Health and Sport (IHES), Victoria University, Melbourne, VIC, Australia.,Australia Institute of Sport, Canberra, ACT, Australia
| | - Michelle A Keske
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - Andrew C Betik
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - David J Bishop
- Institute for Health and Sport (IHES), Victoria University, Melbourne, VIC, Australia
| | - Shona L Halson
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC, Australia
| | - Lewan Parker
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
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12
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Commentaries on Viewpoint: Fragile bones of elite cyclists: to treat or not to treat? J Appl Physiol (1985) 2021; 131:29-33. [PMID: 34181462 DOI: 10.1152/japplphysiol.00335.2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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13
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Yamaguchi K, Sumi D, Hayashi N, Ota N, Ienaga K, Goto K. Effects of combined hot and hypoxic conditions on muscle blood flow and muscle oxygenation during repeated cycling sprints. Eur J Appl Physiol 2021; 121:2869-2878. [PMID: 34195866 DOI: 10.1007/s00421-021-04738-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 06/08/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE The purpose of the present study was to determine muscle blood flow and muscle oxygenation during repeated-sprint exercise under combined hot and hypoxic conditions. METHODS In a single-blind, cross-over research design, 11 active males performed three sets of 5 × 6-s maximal sprints with 30-s active recovery on a cycling ergometer under control (CON; 23 °C, 50% rH, 20.9% FiO2), normobaric hypoxic (HYP; 23 °C, 50% rH, 14.5% FiO2), or hot + normobaric hypoxic (HH; 35 °C, 50% rH, 14.5% FiO2) conditions. The vastus lateralis muscle blood flow after each set and muscle oxygenation during each sprint were evaluated using near-infrared spectroscopy methods. RESULTS Despite similar repeated-sprint performance among the three conditions (peak and mean power outputs, percent decrement score), HH was associated with significantly higher muscle blood flow compared with CON after the first set (CON: 0.61 ± 0.10 mL/min/100 g; HYP: 0.81 ± 0.13 mL/min/100 g; HH: 0.99 ± 0.16 mL/min/100 g; P < 0.05). The tissue saturation index was significantly lower in HYP than in CON during the latter phase of the exercise (P < 0.05), but it did not differ between HH and CON. CONCLUSION These findings suggest that a combination of normobaric hypoxia and heat stress partially facilitated the exercise-induced increase in local blood flow, but it did not enhance tissue desaturation.
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Affiliation(s)
- Keiichi Yamaguchi
- Graduate School of Sport and Health Science, Ritsumeikan University, 1-1-1, Nojihigashi, Kusatsu, Shiga, 525-8577, Japan
| | - Daichi Sumi
- Research Center for Urban Health and Sports, Osaka City University, Osaka, Japan
| | - Nanako Hayashi
- Graduate School of Sport and Health Science, Ritsumeikan University, 1-1-1, Nojihigashi, Kusatsu, Shiga, 525-8577, Japan
| | - Naoki Ota
- Graduate School of Sport and Health Science, Ritsumeikan University, 1-1-1, Nojihigashi, Kusatsu, Shiga, 525-8577, Japan
| | - Koki Ienaga
- Graduate School of Sport and Health Science, Ritsumeikan University, 1-1-1, Nojihigashi, Kusatsu, Shiga, 525-8577, Japan
| | - Kazushige Goto
- Graduate School of Sport and Health Science, Ritsumeikan University, 1-1-1, Nojihigashi, Kusatsu, Shiga, 525-8577, Japan.
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14
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Customised pressure profiles of made-to-measure sports compression garments. SPORTS ENGINEERING 2021. [DOI: 10.1007/s12283-021-00350-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AbstractThe purpose of this study was to make made-to-measure compression garments that elicit pressures within and below clinical standards. The study also examined whether pressures and gradients can be replicated within and between participants’ legs, and between separate compression garment conditions. Ten males volunteered to participate. Based on three-dimensional scans of the participants’ lower body, three different made-to-measure garments were manufactured: control, symmetrical and asymmetrical. Garment pressures were assessed from the malleolus to the gluteal fold using a pressure monitoring device. A root mean squared difference analysis was used to calculate the in vivo linear graduation parameters. Linear regression showed that peak pressure at the ankle in the left and right leg were: control garment, 13.5 ± 2.3 and 12.9 ± 2.6; asymmetrical garment, 12.7 ± 2.5 and 26.3 ± 3.4; symmetrical garment, 27.7 ± 2.2 and 27.5 ± 1.6 (all mmHg, mean ± standard deviation). Pressure reduction from the ankle to the gluteal fold in the left and right leg were: control, 8.9 ± 3.5 and 7.4 ± 3.0; asymmetrical, 7.8 ± 3.9 and 21.9 ± 3.2; symmetrical, 25.0 ± 4.1 and 22.3 ± 3.6 (all mmHg, mean ± standard deviation). Made-to-measure compression garments can be made to elicit pressures within and below clinical standards, and to elicit equivalent pressures and gradients in different participants.
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15
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Enhanced Cycling Time-Trial Performance During Multiday Exercise With Higher-Pressure Compression Garment Wear. Int J Sports Physiol Perform 2020; 16:287-295. [PMID: 32871554 DOI: 10.1123/ijspp.2019-0716] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 03/23/2020] [Accepted: 04/03/2020] [Indexed: 11/18/2022]
Abstract
PURPOSE Compression garments are widely used as a tool to accelerate recovery from intense exercise and have also gained traction as a performance aid, particularly during periods of limited recovery. This study tested the hypothesis that increased pressure levels applied via high-pressure compression garments would enhance "multiday" exercise performance. METHODS A single-blind crossover design, incorporating 3 experimental conditions-loose-fitting gym attire (CON), low-compression (LC), and high-compression (HC) garments-was adopted. A total of 10 trained male cyclists reported to the laboratory on 6 occasions, collated into 3 blocks of 2 consecutive visits. Each "block" consisted of 3 parts, an initial high-intensity protocol, a 24-hour period of controlled rest while wearing the applied condition/garment (CON, LC, and HC), and a subsequent 8-km cycling time trial, while wearing the respective garment. Subjective discomfort questionnaires and blood pressure were assessed prior to each exercise bout. Power output, oxygen consumption, and heart rate were continuously measured throughout exercise, with plasma lactate, creatine kinase, and myoglobin concentrations assessed at baseline and the end of exercise, as well as 30 and 60 minutes postexercise. RESULTS Time-trial performance was significantly improved during HC compared with both CON and LC (HC = 277 [83], CON = 266 [89], and LC = 265 [77] W; P < .05). In addition, plasma lactate was significantly lower at 30 and 60 minutes postexercise on day 1 in HC compared with CON. No significant differences were observed for oxygen consumption, heart rate, creatine kinase, or subjective markers of discomfort. CONCLUSION The pressure levels exerted via lower-limb compression garments influence their effectiveness for cycling performance, particularly in the face of limited recovery.
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Leicht AS, Ahmadian M, Nakamura FY. Influence of lower body compression garments on cardiovascular autonomic responses prior to, during and following submaximal cycling exercise. Eur J Appl Physiol 2020; 120:1601-1607. [PMID: 32424726 DOI: 10.1007/s00421-020-04391-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 05/06/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE The aim of the current study was to examine the impact of lower body compression garments (CG) on cardiac autonomic control of heart rate (HR) prior to, during and following submaximal exercise. METHODS Thirty (15 males, 15 females) healthy, active adults undertook consecutive 10-min stages of supine rest, moderate-intensity upright cycling and supine recovery while wearing either normal clothing (CONTROL) or normal clothing plus CG tights in a randomised order. Heart rate (HR) and rating of perceived exertion (RPE) were assessed every minute while cardiovascular autonomic responses were assessed during the final 5 min of each stage via HR variability (HRV). The change in HR at 1-min (HRR1) and 2-min (HRR2) post-exercise and the time constant of HR recovery (HRtau) were assessed as indices of cardiac autonomic reactivation. Differences between variables were assessed via repeated measures ANOVA and corrected pairwise comparisons. RESULTS Compared to rest, exercise resulted in a reduction of HRV that was similar for CONTROL and CG. A main effect for condition was identified for one non-linear, long-term HRV variable only with a significantly lower value (61.4 ± 47.8 vs. 67.1 ± 50.2 ms, p < 0.05) for CG compared to CONTROL. Cardiac autonomic reactivation (HRR1, 42.0 ± 16.8 vs. 45.5 ± 13.4 bpm; HRR2, 58.9 ± 10.5 vs. 58.9 ± 8.2 bpm; HRtau, 63.4 ± 22.3 vs. 65.1 ± 23.0 s, p > 0.05) was comparable for CONTROL and CG. CONCLUSION Lower body CG failed to alter most cardiac autonomic responses during rest, moderate-intensity exercise or recovery. Mechanisms for potential ergogenic benefits of CG remain to be characterised.
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Affiliation(s)
- Anthony S Leicht
- Sport and Exercise Science, James Cook University, Townsville, QLD, 4811, Australia.
| | - Mehdi Ahmadian
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada
| | - Fabio Y Nakamura
- Associate Graduate Program in Physical Education UPE/UFPB, João Pessoa, PB, Brazil
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17
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The effects of compression stockings on the energetics and biomechanics during walking. Eur J Appl Physiol 2019; 119:2701-2710. [DOI: 10.1007/s00421-019-04245-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 10/17/2019] [Indexed: 10/25/2022]
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18
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Yang K, Isaia B, Brown LJE, Beeby S. E-Textiles for Healthy Ageing. SENSORS (BASEL, SWITZERLAND) 2019; 19:E4463. [PMID: 31618875 PMCID: PMC6832571 DOI: 10.3390/s19204463] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 10/04/2019] [Accepted: 10/08/2019] [Indexed: 12/13/2022]
Abstract
The ageing population has grown quickly in the last half century with increased longevity and declining birth rate. This presents challenges to health services and the wider society. This review paper considers different aspects (e.g., physical, mental, and social well-being) of healthy ageing and how health devices can help people to monitor health conditions, treat diseases and promote social interactions. Existing technologies for addressing non-physical (e.g., Alzheimer's, loneliness) and physical (e.g., stroke, bedsores, and fall) related challenges are presented together with the drivers and constraints of using e-textiles for these applications. E-textiles provide a platform that enables unobtrusive and ubiquitous deployment of sensors and actuators for healthy ageing applications. However, constraints remain on battery, integration, data accuracy, manufacturing, durability, ethics/privacy issues, and regulations. These challenges can only effectively be met by interdisciplinary teams sharing expertise and methods, and involving end users and other key stakeholders at an early stage in the research.
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Affiliation(s)
- Kai Yang
- Electronics and Computer Science, University of Southampton, Southampton SO17 1BJ, UK.
| | - Beckie Isaia
- Electronics and Computer Science, University of Southampton, Southampton SO17 1BJ, UK.
| | - Laura J E Brown
- School of Health Sciences, University of Manchester, Manchester M13 9PL, UK.
| | - Steve Beeby
- Electronics and Computer Science, University of Southampton, Southampton SO17 1BJ, UK.
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Ballmann C, Hotchkiss H, Marshall M, Rogers R. The Effect of Wearing a Lower Body Compression Garment on Anaerobic Exercise Performance in Division I NCAA Basketball Players. Sports (Basel) 2019; 7:sports7060144. [PMID: 31200478 PMCID: PMC6628409 DOI: 10.3390/sports7060144] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 05/30/2019] [Accepted: 06/11/2019] [Indexed: 11/16/2022] Open
Abstract
Lower body compression (LBC) has been shown as an effective recovery tool from basketball but it is unknown how it affects performance. The purpose of this study was to examine the effects of wearing a LBC garment on anaerobic exercise performance in collegiate basketball players. Healthy Division I collegiate basketball players (n = 12) were recruited for this study. In a crossover, counterbalanced study design, subjects volunteered to participate in two separate visits each with a different condition: wearing a LBC garment or non-compressive control (CON) garment. During each visit, subjects completed 2 × 30 second Wingate Anaerobic Tests (WAnTs) separated by a 5-min active recovery period. Each visit was separated by a 72 h washout period. Results revealed that over the 2 × 30 second WAnTs, mean power output (p = 0.028; d= 0.35), anaerobic capacity (p = 0.018; d = 0.45), and total work (p = 0.027; d = 0.36) were higher when wearing the LBC versus CON garment. However, peak power output (p = 0.319; d = 0.09), anaerobic power (p = 0.263; d = 0.23), and fatigue index (p = 0.749; d = 0.05) were not statistically different. Rating of perceived exertion (RPE) was significantly lower (p = 0.032; d = 0.72) with LBC compared to CON. Results indicate that LBC may increase anaerobic exercise performance in collegiate basketball players.
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Affiliation(s)
| | - Hunter Hotchkiss
- Department of Kinesiology, Samford University, Birmingham, AL 35229, USA.
| | - Mallory Marshall
- Department of Kinesiology, Samford University, Birmingham, AL 35229, USA.
| | - Rebecca Rogers
- Department of Kinesiology, Samford University, Birmingham, AL 35229, USA.
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20
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Siebert T, Eb M, Ryan DS, Wakeling JM, Stutzig N. Impact of Multidirectional Transverse Calf Muscle Loading on Calf Muscle Force in Young Adults. Front Physiol 2018; 9:1148. [PMID: 30174622 PMCID: PMC6107699 DOI: 10.3389/fphys.2018.01148] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 07/31/2018] [Indexed: 11/13/2022] Open
Abstract
It has been demonstrated that unidirectional transversal muscle loading induced by a plunger influences muscle shape and reduces muscle force. The interaction between muscle and transversal forces may depend on specific neuromuscular properties that change during a lifetime. Compression garments, applying forces from all directions in the transverse plane, are widely used in sports for example to improve performance. Differences in the loading direction (unidirectional vs. multidirectional) may have an impact on force generating capacity of muscle and, thus, on muscle performance. The aim of this study was to examine the effect of multidirectional transversal loads, using a sling looped around the calf, on the isometric force during plantarflexions. Young male adults (25.7 ± 1.5 years, n = 15) were placed in a prone position in a calf press apparatus. The posterior tibial nerve was stimulated to obtain the maximal double-twitch force of the calf muscles with (59.4 and 108.4 N) and without multidirectional transverse load. Compared to the unloaded condition, the rate of force development (RFD) was reduced by 5.0 ± 8.1% (p = 0.048) and 6.9 ± 10.7% (p = 0.008) for the 59.4 and 108.4 N load, respectively. No significant reduction (3.2 ± 4.8%, p = 0.141) in maximum muscle force (Fm ) was found for the lower load (59.4 N), but application of the higher load (108.4 N) resulted in a significant reduction of Fm by 4.8 ± 7.0% (p = 0.008). Mean pressures induced in this study (14.3 and 26.3 mm Hg corresponding to the 59.4 and 108.4 N loads, respectively) are within the pressure range reported for compression garments. Taking the results of the present study into account, a reduction in maximum muscle force would be expected for compression garments with pressures ≥26.3 mm Hg. However, it should be noted that the loading condition (sling vs. compression garment) differs and that compression garments may influence other mechanisms contributing to force generation. For example, wearing compression garments may enhance sport performance by enhanced proprioception and reduced muscle oscillation. Thus, superposition of several effects should be considered when analyzing the impact of compression garments on more complex sport performance.
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Affiliation(s)
- Tobias Siebert
- Department of Motion and Exercise Science, University of Stuttgart, Stuttgart, Germany
| | - Manuel Eb
- Department of Motion and Exercise Science, University of Stuttgart, Stuttgart, Germany
| | - David S. Ryan
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Vancouver, BC, Canada
| | - James M. Wakeling
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Vancouver, BC, Canada
| | - Norman Stutzig
- Department of Motion and Exercise Science, University of Stuttgart, Stuttgart, Germany
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