Original Article

https://doi.org/10.12965/jer.1735088.554 Journal of Exercise Rehabilitation 2017;13(5):541-545

Effect of compression garments on delayed-onset muscle

soreness and blood inflammatory markers after eccentric
exercise: a randomized controlled trial
Jieun Kim, Jooyoung Kim, Joohyung Lee*
Health and Rehabilitation Major, Kookmin University, Seoul, Korea

The purpose of this study was to investigate how compression gar- and 3, 6, 24, and 48 hr after exercise. A repeated measures analysis of
ments, applied after eccentric exercise, can affect delayed onset mus- variance was used for statistical analysis. The CG group reported faster
cle soreness (DOMS) and inflammatory markers. Sixteen healthy male recovery of maximal isometric strength following exercise (P < 0.001)
university students enrolled in this study and were randomly assigned and lower muscle soreness during the recovery period than the control
to either the compression garment group (CG, n= 8) or control group group (P< 0.05). However, there were no significant differences in either
(CON, n= 8). All participants performed two sets of eccentric exercise CK activity or TNF-α levels between the two groups (P> 0.05). In conclu-
using elbow flexor with 25 repetitions per set on a modified preacher sion, wearing compression garments during the postexercise period
curl machine. Maximal isometric strength was measured before exer- can be an effective way to reduce DOMS and accelerate the recovery
cise and immediately, 24, 48, 72, and 96 hr after eccentric exercise. of muscle function.
Muscle soreness was measured before exercise and 24, 48, 72, and 96
hr after eccentric exercise. Creatine kinase (CK) activity and tumor ne- Keywords: Compression garments, Delayed-onset muscle soreness,
crosis factor-alpha (TNF-α) levels were also measured before exercise Eccentric exercise, Inflammatory response

INTRODUCTION 2017; Urakawa et al., 2015).

In particular, compression garments, which are mainly required
High-intensity eccentric exercise can cause muscle damage, if for vascular pathology and plastic surgery (Berjeaut et al., 2015;
the exercise is repeated (Fulford et al., 2015). Delayed-onset mus- Gottrand et al., 2016), are increasingly being used in sporting
cle soreness (DOMS) is the most common symptom of exer- disciplines for the purpose of improving not only exercise perfor-
cise-induced muscle damage (Lieber and Friden, 2002). In gener- mance but also postexercise recovery (Driller and Halson, 2013;
al, DOMS occurs between 24–48 hr after exercise and eventually Hill et al., 2014). In addition to the fact that compression gar-
induces a reduction in muscle function and range of motion with ments are easy and convenient to carry, they have also been report-
a concomitant increase in creatine kinase (CK) activity, thus caus- ed to be effective in relieving DOMS (Jakeman et al., 2010; Krae-
ing psychological discomfort (Evans et al., 1986; Kim and Lee, mer et al., 2001). For example, Kraemer et al. (2001) reported a
2014; Serinken et al., 2013). Several interventions are recom- reduction of DOMS in untrained women who wore compression
mended for reducing DOMS, including cold-water immersion, garments following eccentric exercise. In another study, Jakeman
heat, manual therapy, vibration therapy, compression garments, et al. (2010) confirmed a reduction of DOMS in physically-active
and nutritional supplements (Cochrane, 2017; Fonseca et al., women who used compression garments following plyometric ex-
2016; Jakeman et al., 2010; Kim and Lee, 2014; Petrofsky et al., ercise and described the application of such garments as an effec-

*Corresponding author: Joohyung Lee https://orcid.org/0000-0001-8279-3830 This is an Open Access article distributed under the terms of the Creative Commons At-
Sport, Health and Rehabilitation Major, College of Physical Education, Kookmin tribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/)
University, 77 Jeongneung-ro, Seongbuk-gu, Seoul 02707, Korea which permits unrestricted non-commercial use, distribution, and reproduction in any
medium, provided the original work is properly cited.
Tel: +82-2-910-5254, Fax: +82-2-910-4789, E-mail: [email protected]
Received: September 4, 2017 / Accepted: October 12, 2017

Copyright © 2017 Korean Society of Exercise Rehabilitation 541 http://www.e-jer.org pISSN 2288-176X
eISSN 2288-1778
Kim J, et al. • Compression garments and delayed-onset muscle soreness

tive strategy for recovery. to place their elbow flexor on a modified preacher curl machine
Several studies have indicated inflammatory responses as a po- and execute an eccentric contraction of the muscle. Each eccentric
tential mechanism to explain the reduction of DOMS (Hill et al., muscle contraction was performed for 3 sec, according to signals
2014; Kraemer et al., 2001). Nonetheless, only a limited number from the investigator, followed by a 12-sec rest period. Each par-
of studies have directly measured changes in inflammatory re- ticipant completed two sets, performing 25 reps per set with a
sponse indicators. Given the well-established hypothesis that 5-min rest period between sets.
DOMS is caused by inflammatory response (Cheung et al., 2003;
Kim and Lee, 2014; Smith, 1991), an attempt to measure DOMS Compression garments
and inflammatory markers could be advantageous in clarifying The compression sleeves applied in this study were based on
the effectiveness of compression garments as a postexercise recov- those described by Kraemer et al. (2001). These arm sleeves (PRO
ery measure. In addition, the exercise using elbow flexor could Racing Arm Sleeve, Compressport International, S.A., Nyon,
provide new insights into the effects of compression garments on Switzerland) provided compression of 5–10 mmHg (Fig. 1). Be-
small muscles because most previous studies in this area used ex- fore initiation of the study, the biceps muscle and wrist of all par-
ercise models involving lower limb muscles. It is important to ticipants were measured to ensure they were fitted with the ap-
consider that muscle size is a factor that affects DOMS and in- propriate size of compression garment. As suggested by Goto and
flammatory responses following muscle damage (Jamurtas et al., Morishima (2014), the compression sleeves were applied for 24 hr
2005; Peake et al., 2005). as soon as the eccentric exercise was finished.
Therefore, the aim of this study was to investigate how wearing
compression garments after eccentric exercise using elbow flexor Maximal isometric strength
could change DOMS and inflammatory response. In this study, maximal isometric strength (MIS) was measured
using a strain gauge (Jackson Strength Evaluation System, Model
MATERIALS AND METHODS 32628CTL, Lafayette Instrument Co., Lafayette, IN, USA), which
was attached to the modified preacher curl machine. With the el-
Participants bow flexor positioned against the preacher bench pad, the partici-
This study was conducted on 16 healthy male university stu- pant started pulling the pad with maximal force, upon a signal
dents who met our specific inclusion criteria, which included no from the investigator, and maintained each contraction for 3 sec.
participation in any resistance exercise on a regular basis over the MIS was measured twice and a mean of the two measurements
last 6 months, no intake of dietary supplements such as creatine,
whey proteins or vitamins, taking no medication and no history
of musculoskeletal diseases. All participants voluntarily provided
informed written consent before enrolment study and were ran-
domly assigned to either a compression garment group (CG,
n=8) or a control group (CON, n=8). Characteristics of partici-
pants are given in Table 1.

Eccentric exercise
The eccentric exercise applied in this study was based on a pre-
vious study by Clarkson et al. (2005). Participants were instructed
Table 1. Characteristics of participants
Group Age (yr) Height (cm) Weight (kg) Body fat (%)
CON (n= 8) 23.13± 3.76 174.13± 10.91 75.44± 12.01 21.01± 6.96
CG (n= 8) 24.25± 1.28 175.63± 2.62 74.58± 10.41 15.54± 4.98
Values are presented as mean± standard deviation.
No significant difference between groups.
CON, control group; CG, compression garments group. Fig. 1. Compression garment used in the study.

542 http://www.e-jer.org https://doi.org/10.12965/jer.1735088.554

Kim J, et al. • Compression garments and delayed-onset muscle soreness

Table 2. Change of maximal isometric strength after eccentric exercise (unit: %)

Group Pre Post 24 Hr 48 Hr 72 Hr 96 Hr P-value
CON (n= 8) 100± 0.0 39.3± 27.3 33.0± 26.3 42.5± 23.0 42.7± 23.6 55.0± 21.3 0.000
CG (n= 8) 100± 0.0 57.7± 16.9 68.9± 12.9** 74.3± 21.5* 89.4± 18.7** 99.8± 21.0**
Values are presented as mean± standard deviation.
CON, control group; CG, compression garments group.
*P< 0.05. **P< 0.01.

Table 3. Change of muscle soreness after eccentric exercise (unit: mm)

Group Pre 24 Hr 48 Hr 72 Hr 96 Hr P-value
CON (n= 8) 0.6± 1.7 48.8± 19.1 55.6± 22.9 50.5± 27.5 37.0± 21.4 0.038
CG (n= 8) 0.6± 1.7 29.6± 10.5* 36.6± 19.9 21.9± 18.9* 7.4± 11.8**
Values are presented as mean± standard deviation.
CON, control group; CG, compression garments group.
*P< 0.05. **P< 0.01.

Table 4. Change of creatine kinase after eccentric exercise (unit: U/L)

Group Pre 3 Hr 6 Hr 24 Hr 48 Hr P-value
CON (n= 8) 118.2± 50.02 133.0± 44.5 143.8± 53.7 217.6± 146.4 447.0± 530.4 0.554
CG (n= 8) 173.2± 80.6 178.3± 76.4 193.8± 91.0 213.0± 122.5 337.8± 365.1
Values are presented as mean± standard deviation.
CON, control group; CG, compression garments group.

Table 5. Change of tumor necrosis factor-α after eccentric exercise (unit: pg/mL)
Group Pre 3 Hr 6 Hr 24 Hr 48 Hr P-value
CON (n= 8) 0.8± 0.6 0.8± 0.6 0.5± 0.4 0.2± 0.3 0.4± 0.6 0.443
CG (n= 8) 0.4± 0.2 0.7± 0.4 0.8± 0.8 0.3± 0.2 0.3± 0.2
Values are presented as mean± standard deviation.
CON, control group; CG, compression garments group.

was calculated. Measurements were taken before exercise and im- Tumor necrosis factor-alpha
mediately, 24, 48, 72, and 96 hr after exercise (Table 2). Tumor necrosis factor-alpha (TNF-α) level was also assessed
from the same blood samples collected from the brachial vein.
Muscle soreness TNF-α was analyzed using a commercial assay kit (ProcataPlex
Muscle soreness was assessed using the visual analogue scale mix & match human 2-plex, Affymetrix eBioscience, Wien,
(VAS). Participants were asked to draw a vertical line across the Austria) in accordance with manufacturer’s instructions. The anal-
VAS scale to indicate the level of soreness they felt. Muscle sore- ysis was completed with a clinical diagnostics instrument (Lu-
ness was measured before exercise and 24, 48, 72, and 96 hr after minex 200 System, Luminex Corp., Austin, TX, USA). TNF-α
exercise (Table 3). levels were assessed before exercise and 3, 6, 24, and 48 hr after
exercise (Table 5).
CK activity
A blood sample of 3 mL was collected from the brachial vein to Statistical analysis
assess CK activity. Blood samples were centrifuged and then CK Data were analyzed using IBM SPSS Statistics ver. 21.0 (IBM
activity were measured using a commercial assay kit (AceChem Co., Armonk, NY, USA) and presented as means and standard de-
CK Kit, YD-Diagnostics Corp., Yongin, Korea) and automated viations. A repeated measures analysis of variance was used to de-
clinical chemistry analyzers (Miura One, I.S.E. S.r.l., Rome, Italy) termine interactions between group and time. If an interaction
before exercise and 3, 6, 24, and 48 hr after exercise (Table 4). was present, an independent-samples t-test was used to determine

https://doi.org/10.12965/jer.1735088.554 http://www.e-jer.org 543

Kim J, et al. • Compression garments and delayed-onset muscle soreness

the differences between the groups at different time points. The resistance exercise and drop jumps. However, resulting changes in
level of significance was set at P<0.05. CK and IL-6 were not statistically significant. These findings sup-
port the possibility that inflammatory response is not associated
RESULTS with the reduction of DOMS induced by compression garments.
Several previous studies claimed that compression garments can
Maximal isometric strength reduce inflammatory response (Hill et al., 2014; Kraemer et al.,
Statistical analysis revealed significant main effects of time 2001); although these claims were not hypothesis tested. Valle et
(P<0.001), group (P<0.01), and the interaction between time al. (2014) further reported that compression garments reduced the
and group for MIS (P<0.001). Specifically, the CG group demon- levels of infiltration by inflammatory cells such as lymphocytes
strated faster recovery than the control group between 24 and 96 CD3+ and neutrophils and helped prevent DOMS in soccer play-
hr after exercise. ers following eccentric exercise. However, in the study by Valle et
al. (2014), compression garments were applied during exercise.
Muscle soreness Thus, the application time and the exercise model are very differ-
There were significant main effects of time (P<0.001), group ent from those described in this current study. Hence, further
(P<0.01), and the interaction between time and group (P<0.05) studies are now required to investigate changes in inflammatory
for muscle soreness. The CG group showed lower muscle soreness responses at the molecular or cellular levels, as carried out by Valle
during the recovery period, compared with the control group. et al. (2014). The fact that postexercise plasma cytokine levels are
affected by circulation or blood flow also supports such investiga-
CK activity tions (Hirose et al., 2004). If these issues are addressed in future
There were no significant changes in CK activity with respect studies, the association between compression garments and
to time, group and the interaction between time and group DOMS could be further clarified.
(P>0.05). In this study, it is possible that the reduction of DOMS was af-
fected by other factors in addition to the compression garments.
Tumor necrosis factor-alpha Some previous studies reported that compression garments re-
No significant changes were observed in TNF-α level with re- duced muscle oscillation and stabilized the array of muscle fibers
spect to time, group and the interaction between time and group during the recovery period (Kraemer et al., 2001; MacRae et al.,
(P>0.05). 2011). Another study pointed out that reduced muscle oscillation
could ease mechanical stress on tissues (Valle et al., 2014). This
DISCUSSION particular role of compression garments appears to eventually re-
duce additional injuries that may occur after eccentric exercise.
This study aimed to identify the effects of compression gar- However, this assumption needs to be verified by appropriate ex-
ments, applied after eccentric exercise, on DOMS and inflamma- perimentation. Another possibility involves potential psychologi-
tory markers. Our analysis showed that compression garments ef- cal effects. Duffield and Portus (2007) suggested that psychologi-
fectively reduced DOMS and helped the recovery of MIS. Howev- cal recovery, as promoted by the application of a compression gar-
er, the effects of compression garments upon CK activity and ment, triggered reduced levels of muscle soreness which occurred
TNF-ɑ levels were not statistically significant. 24-hr postexercise.
These results are consistent with those reported in previous Overall, the use of compression garments for 24 hr following
studies. For example, Goto and Morishima (2014) reported that eccentric exercise reduced DOMS and accelerated the recovery of
compression garments led to lower muscle soreness and faster re- muscle function, but failed to influence the levels of key inflam-
covery of maximal strength after resistance exercise and that matory markers. These results provide evidence that compression
changes in CK, interleukin 6 (IL-6), interleukin 1 receptor antag- garments are effective in promoting postexercise recovery, thus
onist were not significant in the intervention group, when com- highlighting the fact that compression garments are useful tools
pared with the control group. More recently, Goto et al. (2017) for sport-related individuals including coaches, trainers, and ath-
reported reduced muscle soreness in a compression garment group letes who perform high-intensity exercise repeatedly.
after high intensity exercise composed of repeated sprint exercise,

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Kim J, et al. • Compression garments and delayed-onset muscle soreness

CONFLICT OF INTEREST surgery. Ann Chir Plast Esthet 2016;61:589-597.

Hill J, Howatson G, van Someren K, Leeder J, Pedlar C. Compression gar-
No potential conflict of interest relevant to this article was re- ments and recovery from exercise-induced muscle damage: a me-
ported. ta-analysis. Br J Sports Med 2014;48:1340-1346.
Hirose L, Nosaka K, Newton M, Laveder A, Kano M, Peake J, Suzuki K.
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