Effect of hydrotherapy on recovery of muscle-damage

and exercise-induced fatigue.

Joanna Vaile
BSpExSc (Hons)

School of Sports Science, Exercise and Health

The University of Western Australia

This thesis is presented in fulfillment of requirements for the degree of

Doctor of Philosophy

2008

Publications Arising From This Thesis

Vaile, J., Halson, S., Gill. N., Dawson, B. (2008). Effect of cold water
immersion on repeat cycling performance and thermoregulation in the
heat. Journal of Sport Sciences. March; 26(5): 431-440.

Vaile, J., Halson, S., Gill. N., Dawson, B. (2008). Effect of hydrotherapy
on the recovery from fatigue. International Journal of Sports Medicine.
29: 539-544.

Vaile, J., Halson, S., Gill. N., Dawson, B. (2007). Effect of hydrotherapy
on the signs and symptoms of delayed onset muscle soreness.
European Journal of Applied Physiology.

Published online ahead of

print, DOI 10.1007/s00421-007-0605-6, (In Press).

Peer Reviewed Conference Proceedings

Vaile, J., Halson, S., Gill. N., Dawson, B. (2007). Effect of hydrotherapy
on the signs and symptoms of delayed onset muscle soreness.
European College of Sports Science. Jyvaskyla, Finland.

Vaile, J., Halson, S., Gill. N., Dawson, B. (2007). Effect of hydrotherapy
on the recovery of exercise-induced fatigue and performance. Australian
Conference of Science and Medicine in Sport. Adelaide, Australia.

Awards

Young Investigator Award (5th equal), European College of Sports

Science. Jyvaskyla, Finland. Vaile, J. (2007). Effect of hydrotherapy
on the signs and symptoms of delayed onset muscle soreness.

John

Sutton

Award

for

Best

New

Investigator

(Performance

Enhancement and Basic Science). Sports Medicine Australia. Adelaide,

Overview

Achieving adequate and appropriate recovery from exercise is essential in

ensuring optimal performance during repeated bouts of exercise. The use of
various recovery interventions has become popular in an attempt to enhance
subsequent performance and accelerate post-exercise recovery.

The

application of various post-exercise hydrotherapy interventions has become

increasingly popular, however, the majority of current recovery practices appear
to be based largely on anecdotal evidenc

(control) following exercise-induced fatigue and exercise-induced muscle

damage. Rate of recovery was assessed through changes in performance,
core

body

temperature,

thigh

girths,

blood

markers,

and

perceived

exertion/soreness. The results of the combined studies indicate cold water

immersion to be more effective than active recovery when performed
immediately post-exercise between two bouts of high intensity cycling in hot
environmental conditions. Additionally, both cold water immersion and contrast
water therapy were effective in aiding recovery from exercise-induced fatigue
and exercise-induced muscle damage.

Performance variables indicated an

Table of Contents

Overview .............................................................................................................3
Table of Contents................................................................................................5
Acknowledgements.............................................................................................7
Dedication ...........................................................................................................9
List of Tables.....................................................................................................10
List of Figures ...................................................................................................11
List of Abbreviations..........................................................................................14
List of Appendices.............................................................................................15
CHAPTER ONE ................................................................................................16
Introduction .......................................................................................................16
1.0
1.1

Background ........................................................................................17
Statement of

2.8.5
Perceptual Measures...................................................................68
2.8.6
Summary .....................................................................................70
2.9
Significance/influence on athletic performance...................................71
References .......................................................................................................72
CHAPTER THREE............................................................................................83
Effect of cold water immersion on repeat cycling performance and
thermoregulation in the heat. ............................................................................83
CHAPTER FOUR............................................................................................111
Effect of hydrotherapy on recovery from fatigue 83

Acknowledgements
I would like to express my sincere gratitude to the following individuals who
have contributed to the completion of my thesis.

Professor Brian Dawson, I thank you for your mentorship throughout the
duration of my PhD. I am indebted to your cool, calm, and collected attitude
and thank you for your continuous support and wisdom. Dr Shona Halson, I
thank you for the opportunity to complete my PhD at the AIS, and for all of the
amazing opportunities that have come wi

been far too many years to count, I thank you for such sincere friendship and
the amazing times we have had; Laura Ward and Carrie Bradshaw, thank you
for all of the fun times, the silly times, and the laughter, your friendship is so
appreciated; Kristie-Lee, thank you for your support, understanding, and all the
great laughs weve had. I hope I can provide the same throughout your PhD
journey.

Clare and Dan, thank you for being such cool buddies and for

motivating me when I most needed it; Jamie, I truly appreciate your friendship,
thank you for all the laughs and support; Chris and Ryan, thank you for your
unconditional friendship, for being so mu

Dedication

I would like to dedicate this thesis to an amazing woman, my aunty, Denise

Robinson who lost her gallant fight with cancer on January 13th 2006. I am so
proud of you; you taught us the true meaning of courage.

You are an

inspiration, will always be in our hearts, and the beautiful memories of your life
never forgotten.

List of Tables

Chapter Two
Table 2.1. Summary of precooling studies including methods and outcomes
(Marino, 2002)..24
Table 2.2. Cardiac responses to thermoneutral immersion compared with nonimmersion (* = p<0.05) (Wilcock, Cronin, & Hing, 2006)..47
Chapter Three
Table 1. Log transformed absolute values of total work (kJ) completed during
the first 30 min exercise task (E1) and

10

List of Figures

Chapter Two
Figure 2.1. Delayed responses to eccentric exercise. Density of shading in
each bar corresponds to the intensity of the response at the time indicated on
the horizontal axis (Evans & Cannon, 1991). Darker shading indicates the
maximum intensity of the response while lighter shading indicates a lower
intensity of the response.26
Figure 2.2. Potential mechanisms which may explain the repeated bout effect
exercisEvMcHugh, Coon,lly, Est, 1
follnam& Can5n t.ncentric

11

10C, 15C and 20C+ CWI recovery interventions. * Indicates a significant

difference (P <0.05) between all four CWI recovery interventions..97
Figure 4. Changes in mean s blood lactate concentration (mM) during E1,
five min active cool down followed by a 15 min recovery strategy, 40 min
passive rest, and E2. ACT = (Active recovery); 10C, 15C, 20C =
temperature of cold water in intermittent CWI recoveries;

12

significant difference (p<0.03) between HWI vs. CWI, CWT and PAS, CWI vs.
CWT and PAS126
Chapter Five
Figure 1 (a, b, c). Percent change in isometric squat performance (peak force)
following CWI (1a), HWI (1b), and CWT (1c). Performance was assessed pre
and post muscle-damaging exercise as well as 24, 48, and 72 h post-exercise.
* Indicates a significant difference between hydrotherapy intervention and
PAS..148
Figure 2 (a, b, c).

Percent change in squat ju

13

List of Abbreviations

CWI

Cold water immersion

CWT

Contrast water therapy

HWI

Hot water immersion

PAS

Passive recovery (control)

PPO

Peak power output

HR

Heart rate

RPE

Rating of perceived exertion

DOMS

Delayed onset muscle soreness

IL-6

Interleukin-6

CK

Creatine kinase

Mb

Myoglobin

LDH

Lactate dehydrogenase

ROM

Range of motion

bpm

Beats per minute (Heart Rate)

Watts

Newtons

14

List of Appendices

Appendix 1
Visual Analogue Scale, perceived soreness questionnaire173

Appendix 2
Thermal sensations scale174

Appendix 3
Informed consent...175

Appendix 4
Raw data for all experimental studies
Chapter Three176
Chapter Four..184
Chapter Five...194

15

CHAPTER ONE
Introduction

16

17

specifically, the optimal mode of hydrotherapy, water temperature, duration of

exposure, and frequency of treatment remain to be elucidated.

1.1

Statement of the problem

The purpose of the present thesis was to investigate the effects of various
hydrotherapy interventions on the recovery of subsequent performance in hot
environmental conditions, recovery of exercise-induced fatigue, and recovery of
exercise-induced muscle damage.

1.2

Specific aims of the studies

1. Chapter Three: Effect of cold water immersion on repeat cycling
performance and thermoregulation in the heat.

18

3. Chapter Five: Effect of hydrot herapy on the signs and symptoms

of delayed onset muscle soreness.
This chapter incorporates three independent studies designed to examine
the difference between three hydrotherapy interventions (cold water
immersion, hot water immersion, contrast water therapy) compared to
passive recovery, on recovery following a controlled muscle-damaging
exercise task.

The functional and physical symptoms of delayed onset

muscle soreness (DOMS) and recovery of performance were assessed.

19

CHAPTER TWO
Literature Review

20

sweating response, that, while it may improve evaporative heat loss, also
results in a progressive reduction in body water during exercise (Reilly, Drust, &
Gregson, 2006). Effective thermoregulation prevents hyperthermia and assists
in the maintenance of body water stores despite increased sweating, while
allowing exercise to continue at a high level (Reilly et al., 2006).

2.1.1 Responses to exercise in a hot environment

In a hot environment an athletes exercise capacity is often reduced (Armadada-Silva, Woods, & Jones, 2004).

Compared to thermoneutral con-/v-3(sts )2 Com

22

Many studies have investigated the effect of precooling the body on

performance in hot environments (Table 2.1). Precooling strategies involve
reducing core body temperature prior to exercise (Marino, 2002) and are
thought to enhance performance by increasing the overall capacity for heat
storage, therefore reducing cardiovascular and thermoregulatory strain (Kay et
al., 1999). The time taken to reach the critical limiting temperature is also
increased, allowing a longer period until exercise intensity can no longer be
maintained (Marino, 2002). While current

23

Table 2.1. Summary of precooling studies including methods and outcomes

(Marino, 2002; Page 90). * Oesophageal temperature; # rectal temperature;
^ tympanic temperature; Tc core temperature; Tc change in core temperature;
rh relative humidity.

Study

Precooling
Method

24

2.2

Exercise-Induced Fatigue

Fatigue, although well researched, is a complicated phenomenon with many

underlying mechanisms that remain largely unknown. Fatigue has commonly
been defined as a reduced capacity for force development (Fitts & Holloszy,
1976). However, this definition is now considered inappropriate as it does not
acknowledge

the

possibility

of

low-frequency

fatigue

(impairments

in

excitation/contraction coupling, characterised by selective loss of force at low

stimulation frequencies of 10-20Hz)

25

Figure 2.1. The locations of nine processes that may contribute to fatigue
during physical activity (Enoka, 2002; Page 375)
1.

Activation of the primary motor cortex

2.

Central nervous system drive to motor neurons

3.

Muscles and motor units that are activated

4.

Neuromuscular propagation

5.

Excitation-contraction coupling

6.

Availability of metabolic substrates

7.

Intracellular milieu

8.

Contractile apparatur

neurons

26

The causes of fatigue in animals and humans has been well-researched

(MacIntosh & Rassier, 2002; McComas & White, 1996). However, there is
limited research into the mechanisms by which muscle is restored to a prefatigued level. The ability to restore muscle to a pre-fatigued state, enabling
maximal performance capabilities to be achieved again, is an essential
component of sporting performance.

Therefore, recovery interventions

following fatigue-inducing exercise may play a critical role in subsequent

performance.

27

However, while some studies have observed an association between

concentrations of ATP and PCr at fatigue, it is not known if this contributes to
fatigue or is simply a consequence of muscle contraction during exercise
(Roberts & Smith, 1989).

Fatigue has also been found to coincide with muscle glycogen depletion. As
exercise duration increases, the contribution of blood glucose to the total
energy output increases, resulting in a reduction in muscle glycogen
concentration (Fitts, 1994). The consumption of carbohydrate has been shown

28

4) side effects such as nausea and disorientation (Brooks et al., 1996),

5) a reduced release of free fatty acids into the circulation (Brooks et al., 1996),
6) a reduction in cross-bridge attachments (Fitts, 1994),
7) inhibition of ATPase (Fitts, 1994), and
8) an inhibition of the generation of action potentials (Maclaren et al., 1989).

Despite the varied nature of fatigue, future research must investigate the effects
of recovery interventions on the reduction of exercise-induced fatigue and the
facilitation of the recovery process.

This process becomes particularly

29

2006). Lactate threshold has been shown to be an important variable related to

cycling performance and is often included in the assessment of an endurance
athlete (Coyle, 1995; Coyle et al., 1988; McNaughton et al., 2006).

During competitive cycling events, athletes are often required to generate high
power outputs for relatively short periods of time (e.g. climbing, sprinting,
individual time trial). To assess this ability, anaerobic power tests are often

30

1997).

In addition to laboratory based ergometry, SRM Training Systems

(SRM, Schoberer Rad Metechnik, Germany) have frequently been used to

calculate power output from torque and angular velocity.

This technology

involves the use of strain-gauges located between the crank axle and the chain
ring. Their deformation is proportional to the torque generated by each pedal
revolution (Faria, Parker, & Faria, 2005a). The SRM Training System can be

adapted to either laboratory or field settings (Atkinson et al.r.0002cc.1t]sm- 0 TD-arkda

31

the field (competition) has not been adequately investigated, laboratory

measures can be reliable, valid, and repeatable when conducted well.

2.4

Delayed Onset Muscle Soreness (DOMS)

Delayed onset muscle soreness (DOMS) is the sensation of discomfort that

often occurs within a few days of strenuous, unaccustomed exercise
(Crenshaw, Thornell, & Friden, 1994; MacIntyre, Reid, & McKenzie, 1995).
Delayed onset muscle soreness has been shown to be particularly prevalent
after the performance of high-load lengthen

32

in both strength and range of motion as well as monitoring increases in blood

levels of muscle proteins such as creatine kinase and myoglobin (Rinard et al.,
2000). In addition, perceptions of pain and girth measurements have also been
examined.

2.4.1 Aetiology of Muscle Soreness

The aetiology of acute muscle soreness has been attributed to the combination
of ischemia and the accumulation of metabolic by-products (Gulick & Kimura,
1996). The mechanisms by which the symptoms of DOMS occur have proven

33

Figure 2.2. Possible sequence of events involving inflammation that occurs

following a muscle injury (MacIntyre et al., 1995; Page 27). ATP = adenosine
triphosphate; IL = interleukin; LT = leukotriene; PAF = platelet activating factor;
PGE = prostaglandin E; TNF = tumour necrosis factor.

34

In 1996, Gulick and Kimura (1996) identified six theories attempting to explain
the cause of DOMS.

These were lactic acid accumulation theory, muscle

spasm, torn tissue, connective tissue, enzyme efflux, and tissue fluid theories.
In addition to these, Clarkson and Sayers (1999) proposed that mechanical
strain, disturbance of intracellular calcium homeostasis, and the inflammatory
response may be factors responsible for muscular damage following eccentric
exercise.

35

Swelling

36

Connolly et al. (2003) identified that prostaglandin release causes a sensation

of pain by sensitizing type III and IV pain afferents to the effects of chemical
stimuli. Leukotrienes increase the vascular permeability and attract neutrophils
to the site of damage. Swelling is the result of movement of cells and fluid from
the bloodstream into the interstitial spaces and is also thought to contribute to
the sensation of pain (Connolly et al., 2003).

Damage to either the sarcoplasmic re

37

Immediately following intense eccentric exercise, individuals will usually

experience problems controlling movements, a loss of force, increased tremor,
and difficulty fully flexing and extending the affected limb (Jones & Round,
1997). While these experiences are generally not painful, over the next 6-12 h
discomfort will begin to develop in the exercised muscles. The major sensation
is one of muscle tenderness, a feeling similar to a bruise or sprain (Jones &
Round, 1997). When in a state of rest and with no external pressure on the

38

Figure 2.4. Delayed responses to eccentric exercise. Density of shading in

each bar corresponds to the intensity of the response at the time indicated on
the horizontal axis (Evans & Cannon, 1991; Page 100).

Darker shading

indicates the maximum intensity of the response while lighter shading indicates
a lower intensity of the response.

39

2.4.2 Protocols
Many different eccentric muscle-damaging protocols have been used in the
research of muscle soreness and DOMS (Cleak & Eston, 1992; Harrison et al.,
2001; Mair et al., 1995; Sayers et al., 1999). When investigating the effect of
intense eccentric exercise on muscle soreness, swelling, stiffness, and strength
loss, Cleak and Eston (1992) used a protocol consisting of 70 maximum
voluntary contractions of t

40

2.4.3 Adaptation to Eccentric Exercise

It is postulated that a single bout of eccentric exercise may have a prophylactic
effect on muscle soreness, blood variables, and performance capabilities
following a second bout of eccentric exercise (Brown, 1997; Byrnes & Clarkson,
1986; Mair et al., 1995; Nosaka et al., 2001). This has been referred to as the
repeated bout effect (Nosaka & Clarkson, 1995). Although multiple theories

have
TwMcH).,04762
been Reed,
proposed
onn086y,
toTD.5dut
explain
have
TD.7810
thebpabilieen
repeated
0
bout
proposed
Tf2.5
effect, ties
the 1 specific
t7.67T4
idoutspela

41

Adaptation to connective tissue has been proposed as a possible mechanism

for decreased sensations of pain and stiffness following a repeated bout of
eccentric exercise (McHugh et al., 1999). In addition, there is indirect evidence
to support the theory of connective tissue adaptation and the ability to protect
against further muscle damage, the protective effect may be attributed to the
ability of the connective tissue to disperse myofibrillar stresses (Lapier et al.,

1995). Furthermore, following

abidamage,
damaging
.1312eccentric
Tw pain 7c(4)]TJ16.3042.5T3160001
exercise, tissue repair may aw[(s
Tc.w[.022
)]TJT

42

prophylactic effect against muscle damage when the same exercise task was
performed four weeks later.

These results contradict the other findings

reporting an adaptive process following a single session of eccentric exercise

(Byrnes et al., 1985; Nosaka & Clarkson, 1995).

In conclusion, the exact duration of the adaptive effect following an initial bout
of eccentric exercise remains largely unknown, with the findings of the various
studies contradicting one another.

The phenomenon of such adaptation is

43

Initial bout of eccentric

exercise

Muscle Damage

Figure 2.5. Potential mechanisms which may explain the repeated bout effect
following an initial bout of eccentric exercise (McHugh et al., 1999; Page 168).

44

2.5

Treatment and Management Strategies

The majority of scientific research investigating recovery interventions has been

based on models of DOMS, in which muscle damage is induced and recovery
of performance monitored for effectiveness of the intervention.

Numerous

studies have examined the efficacy of methods to promote recovery from

muscle-damaging exercise. Some of these interventions include compression
garments (Ali, Caine, & Snow, 2007; Kraemer et al., 2001), active recovery

45

pressure and temperature of the immersion medium may influence the success
of different hydrotherapy recovery interventions (Wilcock et al., 2006).

Immersion of the body in water can result in an inward and upward

displacement of fluid from the extremities to the central cavity due to hydrostatic
pressure. As identified by Wilcock et al. (2006), the resulting displacement of
fluid may bring about an increase in the translocation of substrates from the
muscle.

Therefore, post-exercise oedema may be lessened and muscle

46

Table 2.2. Cardiac responses to thermoneutral immersion compared with nonimmersion (Wilcock et al., 2006; Page 755).

Study

Immersion
Duration

Change in
SV (%)

11.9 *

Change in
Change in
HR (%) cardiac output (%)

Hip Level Immersion

Farhi and Linnarsson (1977)

-3.9 *

14.0 *

Lllgen et al.

47

2.6.1

Cold Water Immersion

Cryotherapy (normally in the form of an ice-pack) is the most commonly used

strategy for the treatment of acute soft tissue sports injuries, due to its ability to
reduce the inflammatory response and to alleviate spasm and pain (Eston &
Peters, 1999; Meeusen & Lievens, 1986; Merrick et al., 1999).

Multiple

physiological responses to various cooling methods have been observed,

including a reduction in heart rate and

48

strength of the elbow flexors, relaxed arm angle, local muscle tenderness, and
upper arm circumference. Eston and Peters (1999) found CK activity to be
lower and relaxed elbow angle to be greater for the cold water immersion group
on days two and three following the eccentric exercise, concluding that the use
of cold water immersion may reduce the degree to which the muscle and
connective tissue unit becomes shortened after strenuous eccentric exercise.

In a recent study, Bailey et al. (2007) investigated the influence of cold water

immersion on indices of muscle damaTaoc cold we of4(ater immersTw passiv loc4-7.f)-

49

Despite these promising results, some studies have found negligible changes
when investigating the recovery effects of cold water immersion (Paddon-Jones
& Quigley, 1997; Sellwood et al., 2007; Yamane et al., 2006).

In a randomised controlled trial Sellwood et al. (2007) investigated the effect of

ice-water immersion on DOMS. Following a leg extension exercise task (5 10
sets at 120% concentric 1RM) partici

50

exercise cold water immersion following cycling or handgrip exercise. Exercise

tasks were completed 3-4 times per week for 4-6 weeks, with cooling protocols
consisting of limb immersion in 5C (leg) or 10C (arm) water. The control
group showed a significant training effect in comparison to the treatment group,
with the authors concluding that cooling was ineffective in inducing molecular
and humoral adjustments associated with specified training effects (e.g. muscle
hypertrophy, increased blood supply, and myof

51

physiological effects of immersion in hot water remain to be elucidated. One of

the main physiological responses associated with exposure to heat is increased
peripheral vasodilation, resulting in increased blood flow (Bonde-Petersen et
al., 1992; Wilcock et al., 2006).

The effect of hot water immersion on subsequent performance is also poorly

understood. Only one study has investigated the effect of hot water immersion
on post-exercise recovery. Viitasalo et al. (1995) incooor, signifremain5(ant thhig[( CK

52

following which type or intensity of exercise), for the use of hot water
immersion.

Finally, there has been minimal focus on acute fatigue and

performance.

2.6.3 Contrast Water Therapy

During contrast water therapy participants alternate between heat exposure
and cold exposure by immersion in warm and cold water respectively. It has
frequently been used as a recovery intervention in sports medicine (Higgins &
Kaminski, 1998) and is now commonly used within the sporting community.

53

Sanders, 1996). After a series of Wingate tests, it was found that blood lactate
concentrations recovered at similar rates when using either contrast water
therapy or active recovery protocols, and that, after passive rest blood lactate
removal was significantly slower (Sanders, 1996).

Coffey et al. (2004)

investigated the effects of three different recovery interventions (active, passive

and contrast water therapy) on four-hour repeated treadmill running
performance.

Contrast water therapy and active recovery reduced blood

lactate concentration by similar amounts after high

54

indicating lower levels of tissue oedema. These results indicate that symptoms
of DOMS and restoration of strength are improved following contrast water
therapy compared to passive recovery (Vaile et al., 2007). However, Hamlin
(2007) found contrast water therapy to have no beneficial effect on
performance during repeated sprinting. Twenty rugby players performed two
repeated sprint tests separated by one hour; between trials subjects completed
either contrast water therapy or active recovery. While substantial decreases in

55

2.7

Summary

Although all three of these hydrotherapy interventions are being widely used for
recovery from high intensity exercise there are few consistencies in the advice
and methodology of such interventions. Future research should investigate the
optimal water temperatures, duration of exposure, and the number and timing
of rotations completed during the protocol.

In addition, the efficacy of

hydrotherapy as a recovery tool for differing types of activity (e.g. strength vs.
endurance, single day vs. multiple days)

56

2.8.1 Performance Measures

Exercise-induced muscle damage is often quantified by measuring isometric
maximal voluntary contraction (MVC), this being the primary means of
determining muscle function following muscle-damaging exercise (Byrne &
Eston, 2002; Warren et al., 1999). In a review of human studies, Warren et al.
(1999) found MVC was assessed in 50% of the reviewed studies, the third most
frequently used tool, behind the assessment of soreness/pain and blood levels
of myofibril proteins (e.g. CK).

57

effect of hyperbaric oxygen therapy on recovery of DOMS, Mekjavic et al.

(2000) found the isometric strength of the elbow flexors decreased significantly
from pre-exercise levels for both the treatment (47.8%) and the control groups
(50.8%). Over the 10 day recovery period, there was no difference in the rate
of recovery of muscle strength between the two groups, with isometric strength
recovering to 62% and 61% of pre-exercise levels for the hyperbaric oxygen
therapy and control groups respectively (Mekjavic et al.,

58

levels); the overall relative decline in jump squat performance was also
significantly higher than that in drop jump performance (91.6 1.1% compared
to 95.2 1.4%) (Byrne & Eston, 2002).

Electrical stimulation applied during MVCs has demonstrated that motor unit
activation is similar at times when muscles are pain-free (pre-exercise) and
when they are experiencing DOMS (post-exercise) (Byrne & Eston, 2002;
Gibala et al., 1995; Newham et al.

59

2.8.2 Circumference
Exercise often results in hyperemia-induced swelling of the muscle/s (Chleboun
et al., 1998). Under normal conditions this swelling usually subsides relatively
quickly after the cessation of exercise. However, following muscle damage,
swelling tends to have a delayed onset and duration of several days (Chleboun
et al., 1998). Circumference or girth measurements of the exercised limb have
often been used to assess expansion or sw

60

damaging exercise. Following muscle-damaging exercise, circumference has

tended to peak between two and five days after exercise, then to subside to
normal by 10 days post-activity (Cleak & Eston, 1992; Eston & Peters, 1999;
Mekjavic et al., 2000).

2.8.3 Range of Motion

Range of motion (ROM) has been defined as the arc over which a joint may
operate and is determined by the mechanical properties of the skin,
subcutaneous tissue, tendon, articular capsule,

61

elbow joint ROM was also measured, with similar responses found between
groups (50% vs. maximal) immediately post-exercise (approximately 10 for
both exercise groups). However, a further decrease in the ROM was found 48
h (-26.4 4.9) following the maximal exercise task, recovering to -14.6 3.6
of pre-exercise levels after five days.

In contrast, the ROM following 50%

maximal exercise had begun to recover one day after exercise and was close
to pre-exercise values after five da

62

muscle damaging exercise (Athanasios et al., 2005; Chen & Hsieh, 2001;
Childs et al., 2001). Therefore, CK, Mb and IL-6 responses as markers of
muscle damage and post-exercise recovery will be concentrated upon in this
section.

Creatine kinase concentration in the blood has been used extensively to assess
muscle damage.

Attention has focused on CK responses during exercise,

mainly due to the relationship between CK response and damage (Viru & Viru,
2001). Most researchers agree that after muscle damage occurs, CK moves
from the muscle cell into the interstiiam

63

longer time delay in the eccentric group. The quantity of CK released may also
be related to the overall tension of the muscle(s) involved (Clarkson et al.,
1985).

In addition, individual differences in numerous parameters, such as

activity pattern, physical training status, body surface area, diurnal variations
and core temperature response can all influence the release of CK (Hortobagyi
& Denahan, 1989). These variations should be considered when interpreting
changes in CK concentration over time and between studies as they are in

64

dynamometer (maximal eccentric muscle action superimposed every fourth

passive repetition).

Although CK levels were significantly elevated from

baseline values in both the compression sleeve group and the control group
(P<0.05), the control group showed a more dramatic increase in serum CK
concentration at 72 h (~1350 U/L compared to ~480 U/L in the compression
sleeve group).

Byrne and Eston (2002) found significant elevations in CK

activity one hour after exercise (barbell squats, 10 sets of 10 repetitions at 70%
body74 uc) as well as one, two and three days post-exercise. Activity levels
peaked one day after exercise, with values approximately 580% higher than
pre-exercise levels. Furthermore, when investigating the effect of ibuprofen on
DOMS and muscular performance, Tokmakidis et al. (2003) found that CK
levels were significantly higher 48 h post-exercise (6 sets of 10 eccentric
repetitions at 100% concentric 1RM) in the placebo group and that the
ibuprofen treated group produced peak levels at 24 h (rather than 48 h).

In summary, CK levels change during DO

65

Clarkson, 2003). The release of Mb from the muscle may occur as a result of
increased permeability of the myocellular membrane and/or increased
permeability of the intramuscular vasculature (Cannon et al., 1990; Peake et
al., 2005). The time course of the appearance of Mb in the blood differs from
that of CK, possibly due to the differing routes of delivery into the circulation
(Sayers & Clarkson, 2003). Myoglobin is a smaller protein than CK, allowing it
a more direct route into the microvascular endothelium. Therefore, it appears
in the blood at a faster rate than larger protein molecules (Mair, 1999; Sayers &

ill running, Peake et al. (2005) observed an immediate post-

e in plasma Mb concentration (1100%: ES = 4.6; P<0.01), and

was even greater than baseline values (1800%: ES = 4.5;

h post-exercise, the values had decreased, although they
higher than the baseline (ES = 1.9; P<0.01) (Peake et al.

66

In conclusion, Mb levels have frequently been utilized as an indirect marker of

muscle damage. The majority of studies have observed myoglobin to have a
faster release into the blood than CK due to being a smaller molecule.

Exercise-induced muscle damage has also been associated with acute

inflammation. As a result, cytokines are released at the site of inflammation
(Olschewski & Bruck, 1988; Peake et al., 2005; Smith et al., 2000)atem67 1 Tfc-l.

67

than downhill running (-10% treadmill gradient at an intensity of 60% V O2max

for 45 min). In agreement with these findings, Suzuki et al. (2000) observed
significant increases in IL-6 concentration immediately following endurance
exercise (marathon distance race), with the post-exercise IL-6 concentrations
showing a 100-fold increase from baseline values. Smith e

68

Various methods have been used to assess the perception of intensity and
duration of muscle soreness. For example, Cleak and Eston (1992) used a
visual analogue scale (VAS) to measure soreness. The VAS consists of ten
numerically rated descriptions of pain (Cleak & Eston, 1992). When assessing
muscle soreness after intense eccentric exercise, a significant increase
(P<0.01) in perceived soreness in the experimental arm 24 h after exercise was
reported, with muscle soreness peaking

69

Information gained from the assessment of individual responses to pain and

soreness is essential to enable valuable information regarding the time course
of soreness to be monitored. This is particularly important when assessing the
effectiveness of an intervention.

The most common method for assessing

perception of pain is through participant completion of a pain assessment

questionnaire. Pain assessment questionnaires are ideal in the sense that they
take minimal time to administer and provide an insight into the psychological
effects and time course of soreness.

2.8.6 Summary

70

2.9

Significance/influence on athletic performance

The use of recovery interventions, in particular, the use of hydrotherapy

techniques is a topical issue. However, there is insufficient evidence to allow
firm conclusions on their effectiveness and little quality research has been
conducted in this field. Thus, athletes and trainers have been unable to make
informed decisions about which recovery intervention might be most
appropriate for use.

While various hydrotherapy techniques are commonly

used as post-exercise recovery interventions, there seems

71

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Ali, A., Caine, M.P., & Snow, B.G. (2007). Graduated compression stockings:
physiological and perceptual responses during and after exercise. J
Sports Sci, 25(4), 413-419.
Allen, T.J., Dumont, T.L., & MacIntyre, D.L. (2004). Exercise-Induced Muscle
Damage: Mechanisms, Prevention, and Treatment. Physiother Can, 56,
67-79.
Arborelius, M., Jr., Ballidin 0 0 13.C1.15 TD-.0006 Tc.3228 Twd Musc1972J-7

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Brooks, G.A., Fahey, T.D., & White, T.P. (1996). Fatigue During Muscular
Exercise. In Exercise Physiology: Human Bioenergetics and Its
Applications (pp. 701-717). California: Mayfield Publishing Company.
Brown, S., Child, SH., & Donnelly, AE. (1997). Exercise-induced skeletal
muscle damage and adaptation following repeated bouts of eccentric
muscle contractions. J Sports Sci, 15, 215-222.
Brown, S., Day, S., & Donnelly, AE. (1999). Indirect evidence of human skeletal
muscle damage and collagen breakdown after eccentric muscle actions.
0.83

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isometric, eccentric, and concentric exercise. Int J Sports Med, 7(3), 152155.
Clarkson, P.M., Litchfield, P., Graves, J., Kirwan, J., & Byrnes, W.C. (1985).
Serum creatine kinase activity following forearm flexion isometric
exercise. Eur J Appl Physiol Occup Physiol, 53(4), 368-371.
Clarkson, P.M., Nosaka, K., & Braun, B. (1992). Muscle function after exerciseinduced muscle damage and rapid adaptation. Med Sci Sports Exerc,
Clark&24
SayerJ.,S.PByrnes99)., Grave975o

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Enwemeka, C.S., Allen, C., Avila, P., Bina, J., Konrade, J., & Munns, S. (2002).
Soft tissue thermodynamics before, during, and after cold pack therapy.
Med Sci Sports Exerc, 34(1), 45-50.
Eston, R., & Peters, D. (1999). Effects of cold water immersion on the
symptoms of exercise-induced muscle damage. J Sports Sci, 17(3), 231238.
Evans, W., & Cannon, J. (1991). The metabolic effects of exercise-induced
muscle damage. Ex Sport Sci Rev, 19

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Glaister, M., Stone, M.H., Stewart, A.M., Hughes, M.G., & Moir, G.L. (2006).
Aerobic and anaerobic correlates of multiple sprint cycling performance.
J Strength Cond Res, 20(4), 792-798.
Golden, C.L., & Dudley, G.A. (1992). Strength after bouts of eccentric or
concentric actions. Med Sci Sports Exerc, 24(8), 926-933.
Gonzalez-Alonso, J., Teller, C., Andersen, S.L., Jensen, F.B., Hyldig, T., &
Nielsen, B. (1999). Influence of body temperature

76

Jones, D., & Round, J. (1997). Human muscle damage induced by eccentric
exercise or reperfusion injury: a common mechanism? In S.Salmons
(Ed.), Muscle Damage: USA: Oxford University Press Inc.
Kaciuba-Uscilko, H., & Grucza, R. (2001). Gender differences in
thermoregulation. Curr Opin Clin Nutr Metab Care, 4(6), 533-536.
Kaminski, M., & Boal, R. (1992). An effect of ascorbic acid on delayed-onset
muscle soreness. (6), 317-321.
Kay, D., Taaffe, D.R., & Marino, F.E.

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MacIntosh, B.R., & Rassier, D.E. (2002). What is fatigue? Can J Appl Physiol,
27(1), 42-55.
MacIntyre, D.L., Reid, W.D., & McKenzie, D.C. (1995). Delayed muscle
soreness. The inflammatory response to muscle injury and its clinical
implications. Sports Med, 20(1), 24-40.
Maclaren, D.P., Gibson, H., Parry-Billings, M., & Edwards, R.H. (1989). A
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Nielsen, B., & Nybo, L. (2003). Cerebral changes during exercise in the heat.
Sports Med, 33(1), 1-11.
Nielsen, B., Savard, G., Richter, E.A., Hargreaves, M., & Saltin, B. (1990).
Muscle blood flow and muscle metabolism during exercise and heat
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Nielsen, B., Strange, S., Christensen, N.J., Warberg, J., & Saltin, B. (1997).
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Pizza, F.X., Davis, B.H., Henrickson, S.D., Mitchell, J.B., Pace, J.F., Bigelow,
N., et al. (1996). Adaptation to eccentric exercise: effect on CD64 and
CD11b/CD18 expression. J Appl Physiol, 80(1), 47-55.
Pizza, F.X., Mitchell, J.B., Davis, B.H., Starling, R.D., Holtz, R.W., & Bigelow, N.
(1995). Exercise-induced muscle damage: effect on circulating leukocyte
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Plaskett, C., Tiidus, P.M., & Livingston,

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St Clair Gibson, A., & Noakes, T.D. (2004). Evidence for complex system
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Stupka, N., Tarnopolsky, M.A., Yardley, N.J., & Phillips, S.M. (2001). Cellular
adaptation to repeated eccentric exercise-induced muscle damage. J
Appl Physiol, 91(4), 1669-1678.
Suzuki, K., Yamada, M., Kurakake, S., Okamura, N., Yamaya, K., Liu, Qam 9n515 -1.15 T
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Weston, C.F., O'Hare, J.P., Evans, J.M., & Corrall, R.J. (1987). Haemodynamic
changes in man during immersion in water at different temperatures. Clin
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Wilcock, I.M., Cronin, J.B., & Hing, W.A. (2006). Physiological response to
water immersion: a method for sport recovery? Sports Med, 36(9), 747765.
Xing, Z., Gauldie, J., Cox, G., Baumann, H., Jordana, M., Lei, X.F., et al. (1998).

82

CHAPTER THREE
Paper One

Effect of cold water immersion on repeat cycling performance

and thermoregulation in the heat.

Journal article accepted for publication in the

Journal of Sport Sciences March 2008; 26(5): 431-440

Presented here in the journal submission format

Running title: Water immersion and repeat cycling performance

Key Words:

83

Abstract
To assess the effect of cold water immersion (CWI) and active recovery (ACT)
on thermoregulation and repeat cycling performance in the heat, ten welltrained male cyclists completed five trials, each separated by one week. Each
trial consisted of a 30 min exercise task (E1), one of five 15 min recoveries
(intermittent CWI in 10C, 15C and 20C water, continuous CWI in 20C water
and ACT), followed by 40 min passive recovery, before repeating the 30 min
exercise task (E2). Recovery strategy effectiveness was assessed via changes
in total work in E2 compared to E1.

84

Introduction
Cryotherapy is a commonly used post-exercise recovery strategy in a variety of
sports and is thought to be effective when core temperature is significantly
increased (Hadad, Rav-Acha, Heled, Epstein, & Moran, 2004) or for the
treatment of inflammation, spasm and pain (Eston & Peters, 1999; Meeusen &
Lievens, 1986; Merrick et al., 1999).

While various forms of cryotherapy,

including cold water immersion (CWI) have been sugpt(Tc.K.05( et al.)]TJ/TT4 1 Tf3.

85

signals initiating in the active muscles and internal organs as well as the central
nervous system (Gonzalez-Alonso et al., 1999).

Whole body precooling is

thought to enhance the safe temperature margin between the operating

temperature and the critical limiting temperature (Marino, 2002), and therefore
may enhance athletic performance in hot environments.

Active recovery (ACT) is anecdotally reported to be one of the most commonly

performed post-exercise recovery strategies; therefore, active recovery serves

86

symptoms associated with muscle soreness (Eston & Peters, 1999) and fatigue
(Lane & Wenger, 2004) as well as an effective method of precooling prior to
exercise (Kay et al., 1999; Lee & Haymes, 1995; Marsh & Sleivert, 1999).
Therefore, it seems appropriate to investigate the effects of various CWI
protocols on physiological responses to exercise in the heat and cycling
performance repeated within a short duration of time. However, it is important

87

power output (PPO) and V O2peak.

In addition, as subjects were not heat

acclimatised, each individual completed two familiarisation trials prior to the

commencement of testing.

The subjects had access to a fan at all times

throughout the study, with self-selected fan settings maintained at those

selected in each subjects familiarisation session. The identical cycle exercise

88

and consumed during the first 15 min of the exercise task (E1 and E2) as well
as 15 ml.kg-1, consumed throughout the one hour recovery period between
exercise bouts. Subjects performed each exercise trial at the same time of day,
additionally, body mass was recorded prior to each trial to ensure body mass
was stable throughout the duration of the study.

exercise task d E(rst 15 fix9(rinhour)]TJ14uration 18.000..3.4123e25Tj0 -1.725 T15 ml.k

89

Recovery Strategies
Immediately post-exercise, subjects performed five minutes of cycling at an
intensity of 40% V O2peak (McAinch et al., 2004) followed by one of five recovery
strategies:
1) Subjects immersed their entire body (excluding the neck and head) while
seated in 10C water in an inflatable bath for one minute, followed by two
minutes out of the bath, repeated five

90

measured during E2 and E1. Recovery and performance following the CWI and
ACT recovery strategies was also assessed through the measurement of
lactate concentration, ratings of perceived exertion, and ratings of perceived
thermal comfort.

Mean Body Temperature ( T b)

Core temperature was monitored with a disposable rectal probe (Monatherm,

91

T b = 0.87 Tcore + 0.13 T sk

Equation 2. Equation for the calculation of the Mean Body Temperature ( T b)
(Schmidt & Bruck, 1981).

The typical error of measurement for skin temperature was 0.13C (0.45%
TEM), repeat tests of core temperature had an intra-class correlation of 0.86,
with a typical error of 0.11C (0.30% TEM).

Blood Lactate Concentration

92

Thermal Sensation Scale

Subjects rated their perceived thermal comfort on a scale of zero (unbearably
cold) to eight (unbearably hot) (Young, Sawka, Epstein, Decristofano, &
Pandolf, 1987) every five minutes throughout the entire testing session.

Heart Rate (HR)

A Polar heart rate monitor (Polar Electro Oy, Finland) was fitted to the subject
for the duration of the testing session.

Heart rate was recorded every five

minutes throughout both E1 and E2, as well as during the one hour recovery
period between the exercise tasks.

Statistical Analys
SData ae treprt d es mean

93

Results
Performance
When ACT was performed between the two exercise bouts a 4.1 1.8%
decrease (P <0.001) in total work (kJ) was recorded in the second exercise (E2)
bout when compared to the first (E1) (Figure 2). Absolute values of total work
(log transformed kJ) completed are presented in Table 1. However, all CWI
protocols resulted in the maintenance of performance in comparison to ACT, as
they achieved significantly lower percentage differences in work completed from

94

Figure 2.

Work done (mean s) in the second exercise bout (E2) relative to

the first (E1) as a percentage. Dashed line indicates E1=E2. ACT = Active
recovery; 10C, 15C, 20C = temperature of cold water in intermittent CWI
recoveries; 20C+ = continuous CWI recovery in water of this temperature.
* Indicates a significant maintenance/improvement in performance compared to

95

Table 1. Log transformed absolute values of total work (kJ) completed during
the first 30 min exercise task (E1) and the subsequent 30 min exercise task
(E2) performed one hour after E1.

Recovery Condition

E1

E2

Intermittent CWI in 10C

498 48

495 46

Intermittent CWI in 15C

498 47

500 46

96

97

Blood Lactate Concentration

There were no significant differences between recovery treatments during E1 or
E2, however, immediately post ACT blood lactate concentration was
significantly lower (P<0.05) than that observed immediately post all CWI
interventions (Figure 4).

Rating of Perceived Exertion (RPE)

Rating of perceived exertion at the mid-point of exercise during E1 and E2 was
significantly lower following intermittent CWI in 10C (P<0.05; 2.4-5.7 95% CI)
and 15C (P<0.05; 0.3-1.4 95% CI) water as well as continuous CWI in 20C

98

Figure 4.

Changes in mean s blood lactate concentration (mmol.L-1) during

E1, five min active cool down followed by a 15 min recovery strategy, 40 min
passive rest, and E2. ACT = Active recovery; 10C, 15C, 20C = temperature
of cold water in intermittent CWI recoveries; 20C+

99

Thermal Sensation Scale

Following ACT, subjects rating of perceived thermal comfort immediately postrecovery, pre-E2, mid-E2, and end-E2 time points were significantly higher than
those following all CWI protocols (Figure 5). Further, immediately post-recovery
thermal comfort was rated significantly lower in 10C versus 15C and 20C
respectively, as well as for 20C+ versus 20C. In addition, immediately pre-E2
(95 min) thermal comfort ratings were also significantly lower for 10C versus
15C, 20C and 20C+ respectively, as well as for 15C versus 20C+.

Heart Rate (HR)

During both exercise bouts (E

100

Figure 5.

Changes in mean s perceived thermal comfort during E1, five min

active cool down followed by a 15 min recovery strategy, 40 min passive rest,
and E2. ACT = (Active recovery); 10C, 15C, 20C = temperature of cold
water in intermittent CWI recoveries; 20C+ = continuous CWI recovery in water
of this temperature.
* Indicates a significant difference (

101

Discussion
The main finding of the present study was that all CWI protocols were effective
in reducing thermal strain and were more effective in maintaining subsequent
high intensity cycling performance in comparison to ACT. Indeed, no significant
differences in total work (E2 vs. E1) were found between any of the CWI
protocols, and during E1 and E2 there were no significant differences in lactate
concentration between interventions.

The use of CWI as a post-exercise recovery intervention has become

102

performance (Armada-da-Silva et al., 2004; Lee & Haymes, 1995; Marsh &
Sleivert, 1999). Lee and Haymes (Lee & Haymes, 1995) found a significantly
(P<0.01) longer average exercise duration (at 82%

V O2max) following

precooling compared to control. Their precooling protocol consisted of a 30 min

exposure to 5C air (hypothermic) as opposed to 24C air (thermocomfortable);

103

A consistent finding within this study was that there were significant reductions
in T b following all CWI protocols (intermittent CWI in 10C, 15C and 20C
water, and continuous CWI in 20C water), suggesting changes in blood
distribution occurred, likely to be from the peripheral circulation to the central
circulation (Marsh & Sleivert, 1999).

Indeed, it has been suggested that a

critical limiting temperatur

104

A decreased heart rate following precooling strategies has been observed

(Hayashi et al., 2004; Marsh & Sleivert, 1999; Olschewski & Bruck, 1988;
Wilson et al., 2002) and the results of the present study support such findings.
In the present study, heart rate was significantly reduced during 40 min of
passive rest in the heat following all CWI protocols compared to ACT of the
same duration. No significant differences were observed during the second
exercise bout; however, it is important

105

The present study demonstrated a significant reduction in perceived exertion

(RPE) during the mid-point of the second exercise task (E2) following
intermittent CWI in 10C and 15C water as well as continuous CWI in 20C
water (20C+). Not surprisingly, no significant differences were found in RPE
between interventions at the end of E2 as individuals were near exhaustion at
this time point and all subjects were required to complete as much work as
possible in the 15 min time trial in eac

106

temperature gradients, producing a larger margin prior to the previously

reported critical temperature being reached.

Finally, the neural effects

(Meeusen & Lievens, 1986) of cooling and the likely effects of anticipation,
pacing ability and less inhibition of skeletal muscles have all been suggested
following cooling.

The findings of the present study support the use of CWI in various sports at
times when two training sessions a day may be performed in hot environmental
conditions, and during prolonged competitions where oppor

107

References
Armada-da-Silva, P. A., Woods, J. and Jones, D. A. (2004). The effect of
passive heating and face cooling on perceived exertion during exercise
in the heat. Eur J Appl Physiol, 91, 563-71.
Bogdanis, G. C., Nevill, M. E., Lakomy, H. K., Graham, C. M. and Louis, G.
(1996). Effects of active recovery on power output during repeated
maximal sprint cycling. Eur J Appl Physiol Occup Physiol, 74, 461-9.

108

McAinch, A. J., Febbraio, M. A., Parkin, J. M., Zhao, S., Tangalakis, K.,
Stojanovska, L. and Carey, M. F. (2004). Effect of active versus passive
recovery on metabolism and performance during subsequent exercise.
Int J Sport Nutr Exerc Metab, 14, 185-96.
Meeusen, R. and Lievens, P. (1986). The use of cryotherapy in sports injuries.
Sports Med, 3, 398-414.
Merrick, M., Ranin, J., Andres, F. and Hinman, C. (1999). A preliminary

109

Weltman, A. and Regan, J. D. (1983). Prior exhaustive exercise and

subsequent, maximal constant load exercise performance. Int J Sports
Med, 4, 184-9.
Wilcock, I. M., Cronin, J. B. and Hing, W. A. (2006). Physiological response to
water immersion: a method for sport recovery? Sports Med, 36, 747-65.
Wilson, T. E., Johnson, S. C., Petajan, J. H., Davis, S. L., Gappmaier, E.,
Luetkemeier, M. J. and White, A. T. (2002). Thermal regulatory
responses to submaximal cycling

110

CHAPTER FOUR
Paper Two

Effect of hydrotherapy on recovery from fatigue

Journal article accepted for publication in the

International Journal of Sports Medicine 2008; 29: 539-544

Presented here in the journal submission format

Running title:

111

Abstract
The present study investigated the effects of three hydrotherapy interventions
on next day performance recovery following strenuous training. Twelve cyclists
completed four experimental trials differing only in 14 min recovery intervention:
cold water immersion (CWI), hot water immersion (HWI), contrast water therapy
(CWT), or passive recovery (PAS).

Each trial comprised five consecutive

exercise days of 105 min duration, including 66 maximal effort sprints.

Additionally, subjects performed a total of 9 min sustained effort (time trial - TT).
After completing each E

112

Introduction
In elite cycling events, athletes require the ability to maintain a consistently high
level of performance. This is especially important in stage racing where cyclists
are required to produce demanding and consistent performances on multiple
days. However, when athletes are required to perform on consecutive days the
ability to recover well, referring to a period of both physiological and
psychological restoration and regeneration becomes very important.

Anecdotal evidence suggests that the spor

113

concluded that apart from an analgesic effect, there appears to be limited

scientific evidence to suggest any enhancement in post-exercise recovery from
muscle damage by CWI (Cheung et al., 2003). However, the effect of CWI on
repeat high intensity exercise performance has not been fully elucidated.

Hot water immersion (HWI) is a thermotherapeutic intervention in which the

body is immersed in water exceeding 36C (Wilcock et al., 2006). Very little

114

area that needs to be investigated further.

Therefore, the purpose of the

present study was to investigate the effect of three different hydrotherapy

techniques (CWI, HWI, CWT) on the recovery of exercise-induced fatigue and
next day performance.

Methods
Twelve endurance trained male cyclists volunteered to participate in this study.
Their mean standard deviation age, height, body mass, VO

115

the five day trial. Subjects were required to complete a training and food diary
throughout the eight week period, in which training during off weeks was
matched for volume and intensity throughout the study and to ensure food
intake throughout the testing weeks remained consistent.

Figure 1.

116

Fatigue-Inducing Protocol
Subjects completed a 10 min self-paced warm up followed by 3 3 s sprints at
a perceived intensity of 70%, 80% and 90% of maximum effort respectively.
The main exercise task completed daily for five consecutive days totalled
approximately 105 min in duration, consisting of 66 maximal effort sprints of 515 s duration with specific work to rest ratios of 1:6, 1:3, 1:1 (Martin et al.,
2005). Additionally, a total of 9 min of sustained effort

117

10 min warm up
Set 1 12 5 s; 1:6 (Work:Rest)
Set 2 12 5 s; 1:3 (W:R)
Set 3 12 5 s; 1:1 (W:R)
4 min ACT 2 min TT 4 min ACT
Set 4 6 10 s; 1:6 (W:R)
Set 5 6 10 s; 1:3 (W:R)
Set 6 6 10 s; 1:1 (W:R)
4 min ACT 2 min TT 4 min ACT
Set 7 4 15 s; 1:6 (W:R)
Set 8 4 15 s; 1:3 (W:R)
Set 9 4 15 s; 1:1 (W:R)
5 min ACT 5 min TT 5 min ACT
Recovery Intervention (CWI, HWI, CWT, or PAS) 14 min

Figure 2.

Breakdown of the high intensity exercise task performed daily for five

consecutive days. Athletes performed 5 min active recovery betweesC

2-3, 4-5, 5-6, 7-8, and 8-9 (Martin et al., 2005). ACT = Active Recovery.

118

Recovery Interventions
Immediately post-exercise, subjects completed a 5 min cycling warm down at
approximately 40% of individual peak power output followed by one of four
recovery interventions. The same recovery intervention was performed for all
five days of each trial. Cold Water Immersion (CWI): Subjects immersed their
entire body (excluding the neck and head) in a plunge pool set at 15C for 14
min.

Hot Water Immersion (HWI): Subjects immersed their entire body

Sub6t3948 Tw[(the neck ad) inT4 7]TJ11.29 8TD-.0062 Tc.0nd heaspa bathunge

119

Core Temperature
Core temperature was monitored via disposable rectal probe (Monatherm,
Mallinckrodt Medical, St Louis, MO, USA) inserted at least 12 cm beyond the
anal sphincter prior to testing (O'Brien et al., 2000; Zhang & Tokura, 1999).
Core temperature (Zentemp 5000, Zencor Pty Ltd, Victoria, Australia) was
recorded pre- and post-exercise, pre- and post-recovery as well as 15 min post
recovery.

Heart Rate (HR)

120

Results
Sprint Performance
When CWI and CWT was performed following the high intensity exercise bout
on

five

consecutive

days

there

was

significantly

(p<0.01)

better

maintenance/improvement of average power on days four and five compared to

PAS (Figure 3).

However, there were no significant differences (p>0.05)

between other treatments on any of the five days. Across the five exercise days
average power was decreased by 1.7 - 4.9% following PAS, and 0.6 - 3.7%
following HWI, while improvements of 0.

121

and CWI, there were significant differences observed between HWI and PAS
(p=0.02) on day three and between CWT and HWI (p=0.01) on day four of
exercise.

122

Table 1. Absolute values of total work (kJ) completed during the totalled nine
minutes of time trial performed daily on five consecutive days.
* indicates a significant difference (p<0.05) between the stated intervention
(CWI or CWT) and both HWI and PAS.

Work (kJ)
Recovery

Day 1

Day 2

Day 3

Day 4

Day 5

123

124

Rectal Core Temperature

No significant differences (p>0.05) in rectal temperature were observed
between groups at baseline (pre-exercise) or immediately post-exercise (Figure
5). Average pre-exercise rectal temperature regardless of intervention group or
day of exercise was 37.3 0.2C with an average rectal temperature of 38.5
0.2C at the completion of the high-intensity exercise task. Immediately postrecovery rectal temperature was 37.3 0.2C (CWI), 37.6 0.2C (HWI), 37.5
0.2C (CWT), and 37.4 0.2C (PAS). Significant differences (P<0.02) were
observed between HWI vs. CWI and PAS, as

125

126

Rating of Perceived Exertion (RPE)

There were no significant differences or changes in the subjects perception of
exertion throughout the exercise protocol regardless of recovery intervention or
day of trial. The average RPE reported throughout the study (independent of
intervention and day of trial) was observed to be between 8 and 9, on a scale of
0-10 with 10 being maximal exertion.

Discussion
The main finding of the present study was that both CWI and CWT significantly
better maintained performance compared to HWI and PAS throughout the five
consecutive days of testing. Sprint

127

In a similar randomised cross over design Lane and Wenger (2004)

investigated the effect of CWI, active recovery and massage on repeat cycling
performance separated by 24 h. Following the completion of a cycle sprint
protocol, subjects performed one of four 15 min recovery interventions (CWI,
active recovery, massage, or passive recovery/control) then 24 h after the first
exercise session the cycle sprint protocol was repeated. When active recovery,
CWI, and massage were performed between exercise bouts the ability to
maintain power in the second exercise

128

In a recent review (Wilcock et al., 2006), it was noted that a major

contraindication of CWT and its subsequent research is the concurrent
exposure to both hot and cold water, and that outcomes have not been
compared to either hot or cold water immersion protocols independently.
et al.
Therefore, recovery interventions in the present study were selected to
investigate the isolated effect of immersion in hot and cold water individually as
well as when alternated (CWT), with dpcands
identical regardless.m intervention. Results suggest that intermittent
to both hot and cold water.mprescri bed temperats and dpcshould not
be a concern from a physiological or performance viewpoint.

Indeed, the

129

a reduction in core temperature following CWI (Marsh & Sleivert, 1999). While
a reduced HR was not observed in the present study, it must be noted that the
effectiveness of recovery was assessed 24 h post-recovery.

In addition,

reduced perceptions of pain have also been observed (Smith, 1991). Due to
the nature of the exercise task, requiring maximal effort, subjects RPE remained
unchanged throughout the five day exercise period. However, a sub-maximal
exercise component to the protocol may have resulted in a different finding.

130

In addition to temperature aspects, the effects of hydrostatic pressure during

water immersion may be an important aspect of the success of hydrotherapy as
a recovery intervention.

The pressure applied to the body during water

immersion may cause a displacement of fluid from the extremities, increasing

central blood volume (Arborelius et al., 1972; Lollgen, von Nieding,
Koppenhagen, Kersting, & Just, 1981; Wilcock et al., 2006). Although this
beneficial effect of hydrostatic pressure is evident, regardless of temperature, all

131

precise mechanism/s by which this occurs is unclear and requires further

investigation.

Practical applications
The results of the present study suggest that CWI and CWT may be beneficial
recovery interventions following and between events such as track cycling
where the task requires short maximal efforts, as well as longer events such as
stage races where the task requires continuous high intensity efforts on
successive days.

Future research
Future scientific research should be conducted to further investigate the effect
of hydrotherapy techniques, following high intensity exercise, particularly when

132

References
1

Arborelius M, Jr., Ballidin UI, Lilja B,Lundgren CE. Hemodynamic changes in

man during immersion with the head above water. Aerosp Med 1972; 43:
592-8
2
Batterham A,Hopkins W. A Decision Tree for Controlled Trials. Sportscience
2005; 9: 33-39
3
Bonde-Petersen F, Schultz-Pedersen L,Dragsted N. Peripheral and central
blood flow in man dur665 0004old,rmoneutral,
the
and hot water immersion.
Aviat Space Environ Med 1992; 63: 346-50
4
Cheu000K, Hume P,Maxwell L. Delayed onset muscle soreness: treatment665( )]TJ-1

133

20
21

22

Smith LL. Acute inflammation: the underlying mechanism in delayed onset

muscle soreness? Med Sci Sports Exerc 1991; 23: 542-51
Sramek P, Simeckova M, Jansky L, Savlikova J,Vybiral S. Human
physiological responses to immersion into water of different
temperatures. Eur J Appl Physiol 2000; 81: 436-42
Vaile J, Gill N,Blazevich AJ. The effect of contrast water therapy on
symptoms of delayed onset muscle soreness (DOMS) and explosive

134

CHAPTER FIVE
Paper Three

Effect of hydrotherapy on the signs and symptoms of delayed

onset muscle soreness

Journal article accepted for publication in the

European Journal of Applied Physiology. Published online ahead of print
DOI 10.1007/s00421-007-0605-6, (In Press)

135

Abstract
This study independently examined the effects of three hydrotherapy
interventions on the physiological and functional symptoms of DOMS. Strength
trained males (n = 38) completed two experimental trials separated by eight
months in a randomised crossover design; one trial involved passive recovery
(PAS, control), the other a specific hydrotherapy protocol for 72 h post-exercise;
either: 1) cold water immersion (CWI: n

136

Introduction
Delayed onset muscle soreness (DOMS) is a well documented phenomenon,
often occurring as the result of unaccustomed or high intensity eccentric
exercise (Connolly et al., 2003; MacIntyre et al., 1995). Associated symptoms
include muscle shortening, increased passive stiffness, swelling, decreases in
strength and power, localised soreness, and disturbed proprioception (Proske &
Morgan, 2001). Symptoms will often present within 24 h post-exercise and

137

studies suggesting beneficial effects (Bailey et al., 2007; Burke et al., 2000;
Lane & Wenger, 2004) and others indicating negligible changes (Isabell,
Durrant, Myrer, & Anderson, 1992; Paddon-Jones & Quigley, 1997; Sellwood et
al., 2007; Yamane et al., 2006). In contrast, despite limited research in the
area, HWI affects the body differently, resulting in increased HR, cardiac output
and tissue temperatures and may enhance the inflammatory response (Wilcock

138

Methods
Subjects
A total of 38 strength trained males completed two experimental trials separated
by eight months in a randomised crossover design; one trial involved passive
recovery (PAS, control), the other a specific hydrotherapy protocol. Subjects
were randomly assigned to one of three groups differing only in recovery
hydrotherapy intervention: 1) cold water immersion (CWI, 15C, n = 12), 2) hot

water immersion (HWI, 38C, n = 11) or 3) contrast water therapy (CWT,8(Subv.1(o

139

accustomed to resistance training (Viitasalo et al., 1995). A substantial washout period of eight months was chosen to minimise the effect of the first session
of eccentric exercise (athletes were required to continue exercising as per usual
and not perform any specific eccentric training).

Nosaka et al. (2001)

investigated the duration of the protective effect of eccentric exercise-induced

muscle damage, concluding that the repeated bout effect for most measures
appeared to last at least six months.

140

protocol was chosen as eccentric strength has been shown to be approximately

20-60% greater than concentric strength and similar protocols have been
successfully employed to induce DOMS (Hortobagyi & Katch, 1990). During
each eccentric contraction, the load was resisted with both legs from full knee
extension to a 90 knee angle (Vaile et al., 2007) with contractions lasting 3-5 s
in duration

141

exposure. Recovery was performed immediately following the post-exercise

testing session, then 24, 48, and 72 h post-exercise.

Outcome measures
The effects of the exercise task and subsequent recovery were assessed
though the measurement of isometric squat force, squat jump performance,
blood markers (creatine kinase [CK], myoglobin [Mb], interleukin-6 [IL-6], lactate
dehydrogenase [LDH]), thigh circumference and perceived muscle soreness.
Measures were recorded pre-exercise, e, 4M u1-.0003 [(6 Tws p.285 0 TD8, and 72 h

142

Squat Jump (Peak Power)

Subjects were required to perform squat jumps (separated by 2 min) on a Smith
machine which was loaded to a combined weight equivalent of 30% of their
isometric squat force. The best of the three attempts was recorded for analysis.
Subjects were instructed to lower the weighted bar to a 90 knee angle, pause
for 2 s, and then jump upward for maximum height (Vaile et al., 2007). Peak

143

Thigh Circumference
A non-stretch anthropometric measuring tape (Lufkin, USA) was used to
measure circumference at three sites on the upper leg: above-knee, mid-thigh,
and sub-gluteal. Measurement sites were marked with a permanent marker to
ensure re-test reliability (0, 24, 48 and 72 h). Circumference measurements
were taken as an indicator of acute changes in thigh volume (Brown, 1997;
Chen & Hsieh, 2000; Chleboun et al., 1998; Eston & Peters, 1999), likely to

144

Statistical Analysis
Each part of the present study (CWI vs. PAS; HWI vs. PAS; CWT vs. PAS) was
independently analysed. Mean effects were calculated using a spreadsheet via
the unequal-variances t statistic computed for change scores between pre- and
post-tests of the two groups (Batterham & Hopkins, 2005).

Each subject's

change score was expressed as a percentage of baseline score via analysis of

log-transformed values, in order to reduce bias arising from non-uniformity of
error. Baseline values (for all variables

145

following CWI (Figure 2a) and 24, 48, and 72 h post-exercise following CWT
(P<0.01; Figure 2c). However, HWI did not positively influence the recovery of
squat jump performance compared to PAS (Table 1). Production of peak power
72 h post-exercise was significantly reduced below baseline by 8.2 4.1%
following HWI and 7.7 3.2% following PAS; no differences were observed
between HWI and PAS (P>0.05; Figure 2b) at any time point.

146

148

149

Mid-Thigh Girth
Mid-thigh girth was significantly reduced at 24, 48 and 72 h post-exercise
following CWI (P<0.03; Figure 3a) and CWT interventions (P<0.01; Figure 3c)
compared to PAS (Table 1). However, HWI was not effective (P>0.05; Figure
3b) in reducing thigh volume compared to PAS.

Blood Variables
Significant reductions in [CK] were observed 24 (P=0.03) and 72 (P=0.04) h
post-exercise following CWI, and 48 h (P=0.04) post-exercise following HWI
when compared to PAS.

However, wever,lned fBl0.

150

151

152

Discussion
The main findings of the present studies were that following DOMS-inducing
exercise, all three hydrotherapy interventions (CWI, HWI, and CWT) improved
the recovery of isometric force compared to PAS throughout the first 72 h postexercise.

However, compared to PAS, only CWI and CWT significantly

enhanced the recovery of dynamic power (squat jump), while HWI appeared to
have no effect on return of power, following a similar trend to PAS. In addition
to enhancing the recovery of athletic

153

studies, has been shown to increase central blood volume (Hinghofer-Szalkay

et al., 1987; Johansen, Jensen, Pump, & Norsk, 1997; Wilcock et al., 2006) and
increase extracellular fluid volume via intracellular-intravascular osmotic
gradients. Such changes may increase the removal of waste products with the
potential of enhancing recovery from exercise. Although the present studies
observed post-exercise increases in the blood markers analysed, the only postexercise reductions observed between inte

154

various mediums has been shown to stimulate an analgesic effect, resulting in a

decreased perception of pain (Cheung et al., 2003; Meeusen & Lievens, 1986).
While the results of the present study do not indicate an altered perception of
pain compared to PAS, it must be noted that pain ratings were taken prior to
immersion on each of the testing occasions. Therefore, while subjects may
have experienced an acute analgesic effect immediately post-CWI, any such
effect had diminished 24 h post-recovery.

155

increased lactate clearance (Cochrane, 2004), decreased oedema (Vaile et al.,

2007), increased blood flow (Cochrane, 2004), increased stimulation of the
central nervous system and reduced metabolic rate (Coffey et al., 2004; Hamlin,
2007; Vaile et al., 2007). Myrer et al. (1994) and Higgins and Kaminski (1998)
proposed one of the main effects of CWT to be a pumping action stimulated by
vasodilation and vasoconstriction of the blood vessels. No study has observed
any form of vasodilation or vasoconstr

156

References
Allen TJ, Dumont TL, & MacIntyre DL (2004) Exercise-induced muscle damage:
Mechanisms, Prevention, and Treatment. Physiother Can 56 67-79
Bailey DM, Erith SJ, Griffin PJ, Dowson A, Brewer DS, Gant N, et al. (2007)
Influence of cold-water immersion on indices of muscle damage following
prolonged intermittent shuttle running. J Sports Sci 25 11: 1163-1170
Batterham A, & Hopkins W (2005) A

157

Gill ND, Beaven CM, & Cook C (2006) Effectiveness of post-match recovery
strategies in rugby players. Br J Sports Med 40 3: 260-263
Hamlin MJ (2007) The effect of contrast temperature water therapy on repeated
sprint performance. J Sci Med Sport
Harrison BC, Robinson D, Davison BJ, Foley B, Seda E, & Byrnes WC (2001)
Treatment of exercise-induced muscle injury via hyperbaric oxygen
therapy. Med Sci Sports Exerc 33

158

Proske U, & Morgan DL (2001) Muscle damage from eccentric exercise:

mechanism, mechanical signs, adaptation and clinical applications. J
Physiol 537 Pt 2: 333-345
Sellwood KL, Brukner P, Williams D, Nicol A, & Hinman R (2007) Ice-water
immersion and delayed-onset muscle soreness: a randomised controlled
trial. Br J Sports Med 41 6: 392-397
Sramek P, Simeckova M, Jansky L, Savlikova J, & Vybiral S (2000) Human
physiological responses to immers

159

CHAPTER SIX
Thesis summary and future directions

160

However, post-recovery lactate was significantly lower (2.0 0.8 mmol.L-1)

following active recovery compared to all cold water immersion protocols. It
was concluded that subsequent performance was significantly enhanced when
cold water immersion was utilised between two exercise bouts in the heat,
compared to active recovery.

Study two (Chapter Four) investigated the effect of cold water immersion, hot
water immersion, contrast water therapy and passive recovery (control) on the

162

strength, hot water immersion was no more beneficial in reducing recovery time
or enhancing return of performance than passive recovery (control). In addition,
cold water immersion protocols of varying temperature (10C, 15C, 20C
intermittent exposure and 20C continuous exposure for 15 min) appear to be
more beneficial than a 15 min active recovery (40% PPO) when implemented
between two 30 min exercise bouts separated by one hour, performed in hot
environmental conditions (34C).

While it was difficult in the present series of studies to in

163

mechanisms of hot water immersion, cold water immersion, and contrast water
therapy, as previously acknowledged in the literature are presented in Table 2.
Some of the proposed mechanisms appear to be supported by findings from
this series of studies.

The present series of studies contribute to the limited knowledge base of

controlled scientific research investigating the area of post-exercise recovery.
An additional advantage of the present research is the use of controlled
randomised crossover experimental designs. To the authorsdese6i, no(ble)-4led

164

Variable

Hot Water Immersion

Cold Water Immersion

Contrast Water Therapy

Performance

Negative effect on subsequent cycling

performance and return of performance
following muscle-damage (squat jump).
Beneficial effect on return of isometric
strength.

Beneficial effect on subsequent cycling

performance and return of performance
following muscl.8(dWncl)7(e-d e7( icl)sometff)8(r)0

165

-9

iclc

Table 2. Physiological responses to and possible mechanisms of hot water immersion, cold water immersion, and contrast water
therapy.

Hot Water Immersion

Cold Water Immersion

Increased blood flow (vasodilation) (BondePetersen et al., 1992)

Reduction in blood flow potential to reduce

ac.l7 i

Contrast Water Therapy

166

6.2

Practical Applications

Current knowledge and understanding of hydrotherapy recovery interventions

can be used to implement a recovery program. While it is acknowledged that
further research is required to confirm such applications, the following
recommendations are based on current scientific information.

Where possible, full body immersion (excluding head and neck) should
be implemented. More often than not exercise tasks involve the majority

of the body; therefore, a full body recovery of mc-515(rmatich iideal.at)-7.6 Partiic

167

immersion protocol, a cooler temperature (e.g. 10-12C) may be more

effective given the shorter exposure time.

An important outcome of hydrotherapy may be to reduce post-exercise

core body temperature. Investigations into contrast water therapy have
indicated that a 1:1 (hot:cold) ratio may be ideal in stabilising core
temperature following exercise. In addition, isolated hot water immersion
(e.g. spa 38-42C) has been shown to increase core temperature;
therefore it is currently recommended that protocols should avoid
inclusion of

168

studies, making meaningful comparisons difficult. Research should be

conducted utilising similar exercise models incorporating exerciseinduced fatigue or muscle-damage, whilst varying only the hydrotherapy
intervention protocol. It is important to design studies that are compatible
with regard to the levels of muscle damage or fatigue commonly
experienced by athletes so that comparisons and practical applications of
research data can be more easily made.

Additionally, the use of

hydrotherapy

protocols

comparisons

temperature,

duration,

should
and

allow

for

of

water

expo

169

release, muscle oxygenation, tissue oedema, and skin, muscle, and core
temperatures.

4. While the acute effects of the specified interventions have been

investigated within this thesis, the effects of chronic long term exposure
remains to be elucidated. Future research should examine the potential
effects of repetitive long term use of hydrotherapy interventions by
implementing a controlled training regime over a set period of time (e.g.
five months), with selected recovery interventions employed at specific
intervals across the study.

The effect of the specified recovery

170

References

Barcroft, H., & Edholm, O.G. (1943). The effect of temperature on blood flow
and deep temperature in the human forearm. J Physiol, 102(1), 5-20.
Bonde-Petersen, F., Schultz-Pedersen, L., & Dragsted, N. (1992). Peripheral
and central blood flow in man during cold, thermoneutral, and hot water
immersion. Aviat Space Environ Med, 63(5), 346-350.

171

APPENDICES

172

173

Thermal sensations scale

0.0

Unbearably Cold

1.0

Very Cold

2.0

Cold

3.0

Cool

4.0

Comfortable

5.0

Warm

6.0

Hot

7.0

Very Hot

8.0

Unbearably Hot

174

Raw data Chapter Three

Performance (kJ)

Subject
1

10C

10C

15C

15C

20C

20C

20C+

20C+

ACT

ACT

E1

E2

E1

E2

E1

E2

E1

E2

E1

E2

510.5

513.2

515.6

525.2

520.8

517.7

525.0

521.5

521.2

509.0

176

Mean Body Temperature (C)

Raw Data
Rec

Subject

Trials
0

15

Effects
30

50

90

105

120

15-0

500

900

15105

3050

3090

30120

177

5090

90105

20C

36.7

37.3

38.0

35.9

35.9

36.6

37.5

0.6

-0.8

20C

36.4

37.4

38.0

36.5

36.1

37.2

37.7

0.9

0.0

0.8

0.7

2.1

2.2

0.6

178

0.1

-0.8

Blood Lactate (mmol.L-1)

Raw Data
Rec

Sub
ject

Trials
0

15

Effects
30

50

90

105

120

150

50-0

90-0

15105

3050

3090

30-

179

20C
+

1.2

3.1

12.6

2.9

3.3

2.9

11.6

1.9

11.4

9.7

-8.3

1.0

-1.7

1.0

-0.4

180

0.4

Heart Rate (bpm)

Raw Data

Rec

Trials
Subject

15

Effects
30

50

90

105

120

15-0

50-0

900

15105

3050

3090

30120

181

5090

90-

Thermal Sensations Scale

(0 = unbearably cold, 10 = unbearably hot)
Raw Data

Rec

Trials

Subject

15

Effects

30

50

90

105

120

150

500

900

15105

3050

3090

30120

5090

90105

182

Rating of Perceived Exertion

(6 = no exertion at all, 20 = maximal exertion)
Raw Data
Rec

Trials
Subject

15

Effects
30

90

105

120

15-0

900

15-105

30120

10590

120105

183

Raw data Chapter Four

Sprint Performance (W)
Raw Data
Rec

Trials (Days 1-5)

Subject

Effects
3

184

Time Trial Performance (W)

Raw Data
Rec

Trials (Days 1-5)

Subject

Effects
3

185

Total Work (kJ)

Raw Data
Rec

Trials (Days 1-5)

Subject

Effects
3

1-2

1-3

1-4

1-5

186

Core Temperature (C) - Pre-Exercise

Raw Data
Rec

Subject

Trials (Days 1-5)

1

Effects
3

1-2

1-3

1-4

1-5

187

Core Temperature (C) - Post-Exercise

Raw Data
Rec

Subject

Trials
1

Effects
3

1-2

1-3

1-4

1-5

188

Core Temperature (C) - Post-Recovery

Raw Data
Rec

Trials
Subject

Effects
3

1-2

1-3

1-4

189

Core Temperature (C) - 15 min Post-Recovery

Raw Data
Rec

Trials
Subject

Effects
3

1-2

1-3

1-4

190

Rating of Perceived Exertion

(0 = no exertion at all, 10 = maximal exertion)
Raw Data

Trials (Days 1-5)

Subject

PAS

SAP

Treatment

191

Heart Rate (bpm) - Sprint

Raw Data
Treatment

Trials (Days 1-5)

Subject

Effects
3

1-2

1-3

1-4

1-5

192

Heart Rate (bpm) - Time Trial

Raw Data
Treatment

Trials (Days 1-5)

Subject

Effects
3

193

Raw data Chapter Five

Cold water immersion vs. Passive Recovery Isometric Squat Performance (N)
Raw Data
Treatment

Trials
Subject

Pre

Post

Effects
24

48

72

194

Hot water immersion vs. Passive Recovery Isometric Squat Performance (N)
Raw Data
Treatment

Trials
Subject

Pre

Post

Effects
24

48

72

195

Contrast Water Therapy vs. Passive Recovery Isometric Squat Performance (N)
Raw Data
Treatment

Trials
Subject

Pre

Post

Effects
24

48

72

196

Cold Water Immersion vs. Passive Recovery Squat Jump Performance (W)
Raw Data
Treatment

Trials
Subject

Pre

Post

Effects
24

48

72

Post-Pre

197

24-Pre

48-Pre

72-Pre

Hot Water Immersion vs. Passive Recovery Squat Jump Performance (W)
Raw Data
Treatment

Trials
Subject

Pre

Post

Effects
24

48

72

198

Contrast Water Therapy vs. Passive Recovery Squat Jump Performance (W)
Raw Data
Treatment

Trials
Subject

Pre

Post

Effects
24

48

72

Post-Pre

199

24-Pre

48-Pre

72-Pre

Cold Water Immersion vs. Passive Recovery Mid Thigh Circumference (cm)
Raw Data
Treatment

Trials
Subject

Pre

Post

Effects
24

48

72

Post-Pre

200

24-Pre

48-Pre

72-Pre

Hot Water Immersion vs. Passive Recovery Mid Thigh Circumference (cm)
Raw Data
Treatment

Trials
Subject

Pre

Post

Effects
24

48

72

201

Contrast Water Therapy vs. Passive Recovery Mid Thigh Circumference (cm)
Raw Data
Treatment

Trials
Subject

Pre

Post

Effects
24

48

72

Post-Pre

202

24-Pre

48-Pre

72-Pre

Cold Water Immersion vs. Passive Recovery VAS (0 = no pain, 10 = extremely sore)
Raw Data
Treatment

Trials
Subject

Pre

Post

Effects
24

48

72

203

Hot Water Immersion vs. Passive Recovery VAS (0 = no pain, 10 = extremely sore)
Raw Data
Treatment

Trials
Subject

Pre

Post

Effects
24

48

72

Post-. sore)

204

Contrast Water Therapy vs. Passive Recovery VAS (0 = no pain, 10 = extremely sore)
Raw Data
Treatment

Subject

Trials
Pre

Effects
Post

24

48

72

205

Cold Water Immersion vs. Passive Recovery Creatine Kinase (U/L)

Raw Data
Treatment

Trials
Subject

Pre

Post

Effects
24

48

72

Post-Pre

206

24-Pre

48-Pre

72-Pre

Hot Water Immersion vs. Passive Recovery Creatine Kinase (U/L)

Raw Data
Treatment

Trials
Subject

Pre

Post

Effects
24

48

72

Post-Pre

207

24-Pre

48-Pre

72-Pre

Contrast Water Therapy vs. Passive Recovery Creatine Kinase (U/L)

Raw Data
Treatment

Trials
Subject

Pre

Post

Effects
24

48

72

Post-Pre

208

24-Pre

48-Pre

72-Pre

Cold Water Immersion vs. Passive Recovery Myoglobin (ng/mL)

Raw Data
Treatment

Trials
Subject

Pre

Post

Effects
24

209

Hot Water Immersion vs. Passive Recovery Myoglobin (ng/mL)

Raw Data
Treatment

Trials
Subject

Pre

Post

Effects
24

210

Contrast Water Therapy vs. Passive Recovery Myoglobin (ng/mL)

Raw Data
Treatment

Trials
Subject

Pre

Post

Effects
24

211

Cold Water Immersion vs. Passive Recovery Interleukin-6 (pg/mL)

Raw Data
Treatment

Trials
Subject

Pre

Effects
Post

24

212

Hot Water Immersion vs. Passive Recovery Interleukin-6 (pg/mL)

Raw Data
Treatment

Trials
Subject

Pre

Effects
Post

24

213

Contrast Water Therapy vs. Passive Recovery Interleukin-6 (pg/mL)

Raw Data
Treatment

Trials
Subject

Pre

Effects
Post

24

214

Cold Water Immersion vs. Passive Recovery Lactate Dehydrogenase (U/L)

Raw Data
Treatment

Trials
Subject

Pre

Post

Effects
24

48

72

Post-Pre

215

24-Pre

48-Pre

72-Pre

Hot Water Immersion vs. Passive Recovery Lactate Dehydrogenase (U/L)

Raw Data
Treatment

Trials
Subject

Pre

Post

Effects
24

48

72

Post-Pre

216

24-Pre

48-Pre

Contrast Water Therapy vs. Passive Recovery Lactate Dehydrogenase (U/L)

Raw Data
Treatment

Trials
Subject

Pre

Post

Effects
24

48

72

Post-Pre

217

24-Pre

48-Pre

72-Pre