Recovery: The Rest of the Story
Why the time after we exercise is more important than the workout itself.
The health and fitness world confronts a complex paradox.
Exercise causes consternation and elation, angst and joy. It can prevent—and lead to—illness and injury. Workouts can keep you out of a hospital and put you into one.
Exercise scientists have investigated this paradox extensively and have concluded that exercise alone is not the problem. The real issue is too much exercise and not enough rest. The science tells us that the quality of rest from a workout is as important as the quality of the workout. As purveyors of exercise’s benefits, fitness specialists need to understand the interrelationship of recovery and training.
Training is simple. It’s what we do and have been taught to do in countless courses, workshops, articles and videos. The message is clear: Training improves health and physical performance.
The problem is that improving our physical performance requires us to add new stressors that stimulate the body’s physiology to change. Workouts have to challenge homeostasis—the internal balance of all the physiological processes at the chemical, molecular and tissular levels. Exercise stressors alert the body that more strength, speed and cardiovascular fitness will be needed to survive in a new and challenging environment.
A new workout deliberately damages muscle contractile tissue, causing a short-term reduction in strength, speed and oxygen delivery. Inflammation and immune system hormones and chemicals begin circulating to minimize and repair the damage. Swelling and muscle soreness complete the process (Flores et al. 2011; Tiidus 2008).
An exercise challenge can dramatically alter homeostasis and put the body into allostasis, a disrupted, out-of-balance physiological state. A reasonable workout that matches an exerciser’s condition and ability and that follows specific recovery protocols will trigger an adaptive process that enables the body to heal, rebuild, and achieve a higher level of conditioning.
As fitness increases, new blood vessels and muscle fibers connect to improved neuromuscular pathways. An adapted metabolic chemical-response system is designed to stay in check the next time a similar challenge is attempted. These are the positives of exercise.
If a workout is too strenuous or prolonged for the condition and ability of the exerciser, and no recovery protocols are followed, the body stays allostatic for much longer than it should. That can lead to injuries—the negatives of exercise.
These negatives can put 13 members of a collegiate football team into a hospital after an intensive squat workout that releases too much myoglobin into the bloodstream for the kidneys to process, resulting in rhabdomyalisis (Smoot et al. 2013).Endurance training also has its pitfalls: 51% of all marathon finishers have elevated levels of cardiac troponin, a substance associated with cardiac muscle damage, and 23% of this population have levels higher than heart attack sufferers. This condition abates after 1–3 weeks with good recovery protocols. Without recovery, it can result in chronic inflammation and a suppressed immune system (Legge 2013).
Proper recovery is designed to minimize accumulation of the byproducts of physical stressors from workouts. It also accounts for byproducts from mental, emotional and environmental stressors in the exerciser’s life.
The Key: Plan to Train, and Plan to Recover
Recovery from training is more important than the training itself, as repair and rebuilding of damaged muscle tissue can occur only during a recovery period. The recovery process involves three critical steps:
- Establish a flexible, well-thought-out training plan that includes significant recovery workouts and workout cycles.
- Adhere to the healthful-lifestyle behaviors of proper sleep, nutrition and nonexercise stress reduction (see the sidebars “Sleep: The Ultimate Recovery” and “Nutrition: Fueling Recovery”).
- Understand how training affects internal physiology in real time—and respond with proper recovery periods (see the sidebar “The Importance of Physiological Feedback”).
Developing a Periodization Schedule
The training plan must accurately establish current conditioning levels and set realistic goals. It should follow a specific periodization schedule with periods of increased intensity interspersed with recovery periods within each week and throughout a cycle of weeks (see the sidebar “Recovery Types”).
A periodization schedule can be linear or nonlinear. Linear periodization stretches out over a long time frame and consistently increases effort. For instance, effort rises in each week of a 3-week cycle and then gives way to a recovery week—a pattern repeated over several months to a whole year. Nonlinear periodization follows similar buildup and recovery patterns but may increase intensities sooner in an undulating manner.
Linear is good for athletes who have specific seasons, while nonlinear can be better for fitness clients whose schedules tend to be affected by life’s random pattern. Both formats have proved effective in improving performance (Simão et al. 2012).
Whichever method you choose, the client’s baseline fitness level and end goals must be founded in reality and determined by a current maximal or submaximal effort. A 5- to 10-repetition resistance training set at best weight (5- to 10-RM) or an hourlong cardiovascular sequence for best distance or average speed can provide the foundation of the training program.
Periodically measuring baseline components is a good way to quantify progress, but you need to make sure your retesting procedure is structured so that a maximum-effort test does not require intensive recovery.
Baseline measurements are also critical for assessing how well recovery training sessions are progressing; everybody’s physiology recovers differently from workout protocols. One study found that it took between 5 and 89 days for participants to return to full strength after an intensive weight-training program (Sayers & Clarkson 2001).
Gender response to recovery varies. Men and women suffer the same amount of muscle soreness after intensive weightlifting, but women have a lower inflammatory response. Women also take longer to return to peak strength and range of motion (Flores et al. 2011).
Genetic differences matter as well. Some genotypes can return to baseline quicker than others after strenuous eccentric exercise (Venckunas et al. 2012).
Lifestyle Conditions and the Recovery Plan
Before we discuss specific exercise recovery techniques, we need to touch on lifestyle conditions that can support or derail a good training plan.
Over the past decade, research has paid more attention to how nonexercise stressors affect athletes and exercisers. Because these stressors use the same chemical pathways as exercise to repair and restore the body to homeostasis, coaches and trainers have begun to factor nonexercise stressors into recovery training.
Whether an athlete is responding to a new weightlifting or endurance level during a workout, is dieting for weight loss or is worrying about a personal problem, the brain’s hypothalamic-pituitary-adrenal axis will act on the stimuli by producing adrenaline, cortisol and other hormones. These hormones adjust internal physiologies to increase heart rate, process fuel, and begin repairing areas damaged by a stressor (Fuqua & Rogol 2013).
A fascinating comparison of two studies on training intensities of cyclists showed different results from similar training. The first study (Halson et al. 2002) found typical symptomatic markers of overtraining—a decrease in power output, an increase in time-trial performance, a decrease in maximum heart rate, and an increase in perceived exertion.
The second study (Slivka et al. 2010), with similar training conditions, elicited similar overtraining responses with one exception—there was no decrease in performance.
The primary difference between the two studies was that the 2010 participants trained in a camp setting with optimal sleep and nutrition. There were no everyday-life distractions. The 2002 participants performed their exercise under normal life conditions—which included jobs and unregulated sleep and nutrition (Ward 2012).
This suggests that under ideal recovery conditions, the body can respond to and repair damage from intensive training. But under real-life conditions, it is more likely that negative factors will inhibit recovery.
Camps are a luxury for most exercisers, but the lesson of figuring out how to manage life’s demands while in a training plan is important. We must always take a global approach to stress recovery, whether the stress results from an increased workout goal, a new job or a new relationship.
Nonexercise Stress Management
Our neuromuscular systems can handle only so much stress. Sometimes training intensity and volume must decrease to accommodate work or other personal demands.
The decrease can be incorporated into recovery or technique-building phases that will pay off down the line. Exercising at moderate intensity for less than 75 minutes can reduce inflammation and increase levels of positive neurotransmitters like serotonin and endorphin, thereby improving brain chemistry. Moderate intensities also stimulate nerve and circulatory growth factors that produce new brain cells and promote capillary growth to muscles (Ratey 2008).
As long as exercisers embrace the need for these training adjustments, the altered training plan can become an asset to overall quality of life.
Specific Recovery Techniques
Once a training plan has proper feedback protocols and adjusts for lifestyle issues, the next step is to address specific recovery techniques. These are mostly designed to speed the vascular system’s ability to help remove waste products and to repair and rehabilitate damaged tissue into stronger, faster and more powerful neuromuscular units.
Techniques such as active exercise recovery, neuromuscular electrical stimulation, thermal manipulation, manual therapy and compression garments are specifically designed to stimulate vascular pumping.
While active recovery—exercising at low intensities postsession or as a specific workout—is supported by research, other techniques have produced conflicting results. This may reflect the paucity of reliable long-term studies rather than the methods’ efficacy.
Active recovery often takes the form of “cooling down” after intensive exercises such as swimming, track-and-field events and vigorous workouts. The primary focus is to keep the heart pumping below maximum, but above resting levels, to help the body process metabolites faster.
Active recovery seems to do the most good as an in-training device, as it reduces lactate levels and acidosis in between all-out sprints during a workout. The effectiveness of this method at reducing metabolites in training-week and training-cycle recovery periods has been mixed when used as the only recovery protocol, but it has improved recovery when combined with other methods (Hausswirth & Mujika 2013).
An active-recovery workout on the day after a challenging workout can enable exercisers to continue their training (and keep contributing to aerobic capacity) without increasing allostatic load. The workouts should be conducted at a level deter- mined by experience and based ideally on physiological feedback from resting heart rate or heart rate variation measurements.
The intensity of active recovery should depend on the individual. Research has found that sustained 30- to 90-minute efforts at 50%–70% of VO2max have positive effects on physiology (Borer 2003). Indeed, low-intensity exercise has been shown to reduce chronic inflammatory markers (Brandt & Pedersen 2010).
It may also be more effective to ensure that active recovery consists of low-impact concentric contractions and minimal eccentric contractions via exercises like swimming, cycling and rowing. With swimming, it has been suggested that the hydrostatic effect of water immersion helps increase the blood-pumping mechanism needed for metabolite clearance (Hausswirth & Mujika 2013).
Neuromuscula Electrical Stimulation
Neuromuscular electrical stimulation (NMES) has been used in physical therapy to help heal and strengthen injured muscles through pulsing electronic charges that force the muscles attached to the electrodes to contract concentrically. This contraction stimulates blood flow, and one study found that blood lactate levels returned to baseline levels more quickly with NMES than with passive recovery (Hausswirth & Mujika 2013).
NMES research is limited but growing, though results are not definitive. The method has been shown to increase quadriceps and latissimus dorsi strength, heighten lactate clearance and decrease delayed-onset muscle soreness, or DOMS (Laughman et al. 1983; Girold 2012; Neric et al. 2009; Westcott et al. 2011).
Recently, track-and-field coaches and some NFL trainers have begun using NMES as an active-recovery and strengthening technique to stimulate muscles without placing more stress on joints or the central nervous system. It is theorized that the nonimpact contractile stimuli from a source outside the central nervous system trigger enough neuromuscular activity to provide strength gains in a specific muscle group and also speed recovery by increasing circulatory processes (Lee 2011; Hansen 2012).
Proponents say NMES use is best for extending or implementing active-recovery sessions when time, energy and space limit an exerciser’s ability to cool down properly from a session. The “passive” nature of this active-recovery technique allows for muscle stimulation while sedentary (Hansen 2012).
From a strength standpoint, NMES can provide a moderate, low-impact stimulus to muscles that are limited because joint injury prevents movement above or below the injury. The method can also prevent overuse when athletes need strength maintenance without sacrificing time from other aspects of training (Hansen 2012).
Nonactive Recovery Strategies
Nonactive strategies are used to speed recovery. “Nonactive” recovery is distinguished from “passive” recovery, which is essentially defined as recovering only by resting after an exercise session. Though recovery research is new and relatively inconclusive about many issues, most techniques fare better than passive recovery (Hausswirth & Mujika 2013).
Nonactive recovery strategies of thermotherapy, manual therapy and compression garments will be examined.
Hot and cold compresses, sweat lodges and ice plunges, hot and cold ointments and balms, and other thermal manipulative therapies have long histories. They are designed primarily to affect the metabolic process of the areas involved and to make use of opposite physiological responses.
Cold therapies primarily rely on acute effects that decrease metabolic activity, promote capillary vasoconstriction, reduce swelling and inflammation, and alleviate pain through nerve analgesia. Heat therapies increase metabolic activity, promote capillary vasodilation and increase muscle pliability (Hausswirth & Mujika 2013).
Cold therapy’s ability to reduce swelling, along with the immediate vasodilation that occurs after the cold stimulus is removed, probably makes it the more effective of the two. Its combined effects most likely speed the vascular shuttling process for the removal of muscle damage byproducts and the insertion of tissue repair agents. This theoretical model of vascular shuttling is also practiced in the alternating of cold and heat therapies known as contrast therapy (Hausswirth & Mujika 2013).
Cooling garments are an intriguing new development in recovery over the past 10 years, especially in regard to hot- weather performance. Numerous studies have shown the advantage of precooling before an endurance event by wearing a vest or jacket with compartments filled with ice packs. Precooled subjects show lower core temperatures, lower heart rates and greater power outputs at the end of a specific workout (Hausswirth & Mujika 2013).
Heat therapy tends to have the most benefit the day, or days, after an intensive effort, mainly owing to heat’s ability to reduce DOMS. Because heat therapy can reduce perceived pain and increase muscle pliability and length, it is a good partner to manual therapy techniques (Hausswirth & Mujika 2013).
Manual therapy, in the form of massage or self-myofascial- release techniques, has a unique ability to stimulate blood flow in a localized area, making it reasonable to expect that research studies would support its ability to remove exercise waste byproducts. Unfortunately for advocates, manual therapy appears to be effective mainly at relieving DOMS. That’s why most research points toward the psychological benefits of manual therapy (Hausswirth & Mujika 2013).
In fact, most positive results from research—longer time to fatigue, lower rating of perceived exertion, higher level of per- ceived recovery and better overall performance—have been attributed to the increased sense of well-being people get from massage post- or pre-exercise. This does not invalidate the use of manual therapy, as the reduction of DOMS and increased ROM cited in some studies indicate that it assists in recovering to a performance-ready state (MacDonald et al. 2014; Grieve et al. 2013).
Long used to promote circulation in bed-ridden hospital patients, compression garments have made their way into the athletic arena as a recovery tool. Venous activity (blood return to the heart) is stimulated by muscle contraction, which moves the blood toward the heart at greater speeds. Research on the tangible benefits has been mixed, with one study indicating that knee-high lower-leg compression stockings improved lactate clearance in cross-country runners but also increased running time over a previously tested distance (Rider et al. 2013). This suggests a postexercise benefit rather than a performance gain.
Other studies have been unequivocal in ranking compression garments behind other techniques like active recovery or cold-water immersion. There is also much debate regarding the amount of pressure and treatment length of time that may be effective or contraindicative. A recent review found studies with pressure ranges of 10–30 millimeters of mercury (Sperlich et al. 2013).
Because the research is so new in this area, compression garments may be best applied postexercise as an ancillary tool used along with other techniques; evaluation on a case-by-case basis would be prudent.
Recovery Is In The Body Of The Beholder
Scientific examination of specialized recovery techniques seems to point exercisers toward the ones that provide most relief from post- workout soreness. To that end, people’s perception of the effectiveness of a technique becomes the optimum research result.
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