Comparison of Different Forms of Recovery on the Functionality After Physical Exercise

Study Overview
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Brief Summary
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Delayed onset muscle soreness (DOMS) and decrease of musculoskeletal function are due to high intensity training and / or sports activities. These occur due to micro lesions of muscle tissue resulting in nociceptor sensitization. Non-pharmacological interventions to attenuate DOMS and favor muscle recovery have been studied. These interventions aim to maintain performance levels, especially in competitions. Among these interventions, cryotherapy (cold water immersion) and active recovery already have good clinical evidence. Currently a new proposal has been gaining ground for myofascial self-release (foam roller), however its mechanisms and clinical evidence are not yet well established. The aim of the present research is to compare the effects of passive recovery, active recovery, cold water immersion recovery and recovery through myofascial self-release on DOMS and the functionality of healthy volunteers undergoing resistance exercise.

Detailed Description
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The volunteers included in the study will perform an evaluation to verify the eligibility criteria, physical evaluation (weight, height, systemic blood pressure) and functional capacity to determine the exercise parameters. After will be presented to the four interventions, ie the recovery techniques after the exercises favoring their adaptation. There will be four resistance exercise sessions followed by interventions with a one week interval between each session. Interventions (passive recovery = 1, active recovery = 2, recovery with IAF = 3 and recovery with myofascial self-release = 4) will be randomized. Functionality assessments will be performed before and one hour after the intervention protocol. DOMS will be evaluated 24 and 72 hours after the exercise protocol. Evaluators will be blind to interventions.

Official Title
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Comparison of Different Forms of Recovery on the Functionality After Physical Exercise: Randomized Clinical Trial

Conditions
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Massage, Inflammatory Response, Muscle, Skeletal, Cryotherapy Effect, Functional Disturbance

Intervention / Treatment
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* Other: Foam Roller Recovery
* Other: Active recovery
* Other: Immersion in cold water
* Other: Passive recovery


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Male, Literate, Normotensive volunteers, Aged minimum18 to maximum 35 years old, Physically active (IPAQ scale). Body mass index (BMI: kg / m2) greater than 30 Exclusion Criteria: Use of food supplements and medication Consume alcoholic beverages (+ once a week) Present of musculoskeletal disorders, Previous diagnosis of diseases (rheumatologic, cardiovascular diseases, as well as neurological, oncological, immunological and hematological diseases) Psychiatric and / or cognitive problems. On the day of the exams will be excluded: Volunteers who present symptoms of musculoskeletal disorders, Consume ergogenic substances (24h), Consume alcoholic beverages and foods containing alcohol or caffeine (24h) Have performedintense physical activities 72 hours before the exam.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 35 Years

Sexes Eligible for Study
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Male

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Crossover Assignment
Interventional Model Description: The four interventions will be randomized.
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Exercise session followed passive recovery<br>Prior each to the exercises sessions (4), volunteers will undergo specific warm-up in each exercise adopted (a series of 15 repetitions with 40% of the maximum load obtained in the 10RM test). The exercise sessions will consist of four sets for 10RM, with an interval of one minute between sets and two minutes between exercises. The exercise sequence (extension chair, squat and leg press) will be randomized through a closed brown envelope draw. Prior to the 10RM test and data collection, standardized instructions regarding the experimental procedure and exercise technique will be provided. Verbal stimuli to the volunteer will be performed during the evaluations and exercises (TEIXEIRA et al., 2014a, 2014b). The interval between each exercise session will be one week. Volunteers will not perform any form of recovery for 20 min after resistance exercise session (TEIXEIRA et al., 2014a, 2014b). | Other: Passive recovery<br>* Volunteers will be seated for 20 min after the resistance exercise session (TEIXEIRA et al., 2014a, 2014b).<br>* Other names: Control;|
| Active Comparator: Exercise session followed active recovery<br>The interval between each exercise session will be one week. Prior each to the exercises sessions (4), volunteers will undergo specific warm-up in each exercise adopted (a series of 15 repetitions with 40% of the maximum load obtained in the 10RM test). The exercise sessions will consist of four sets for 10RM, with an interval of one minute between sets and two minutes between exercises. The exercise sequence (extension chair, squat and leg press) will be randomized through a closed brown envelope draw. Prior to the 10RM test and data collection, standardized instructions regarding the experimental procedure and exercise technique will be provided. Verbal stimuli to the volunteer will be performed during the evaluations and exercises (TEIXEIRA et al., 2014a, 2014b). Active recovery for 20 minutes (MIKA et al., 2016; CRISAFULLI et al., 2003; FAIRCHILD et al., 2003; VANDERTHOMMED; MAKROF; DEMOULIN, 2010); | Other: Active recovery<br>* Active recovery for 20 minutes (MIKA et al., 2016) will consist of pedaling on a stationary bike at a speed of 50 to 60 rpm. The load (49 ± 9 W) will be adjusted individually so that the heart rate is close to 100 bpm (about 50% of the theoretical maximum heart rate). This effort intensity is similar to that used in the literature (CRISAFULLI et al., 2003; FAIRCHILD et al., 2003; VANDERTHOMMED; MAKROF; DEMOULIN, 2010)<br>* Other names: Exercise;|
| Active Comparator: Exercise session followed immersion in cold water recovery<br>The interval between each exercise session will be one week. Prior each to the exercises sessions (4), volunteers will undergo specific warm-up in each exercise adopted (a series of 15 repetitions with 40% of the maximum load obtained in the 10RM test). The exercise sessions will consist of four sets for 10RM, with an interval of one minute between sets and two minutes between exercises. The exercise sequence (extension chair, squat and leg press) will be randomized through a closed brown envelope draw. Prior to the 10RM test and data collection, standardized instructions regarding the experimental procedure and exercise technique will be provided. Verbal stimuli to the volunteer will be performed during the evaluations and exercises (TEIXEIRA et al., 2014a, 2014b). Volunteers will be immersed in cold water immediately after exercise protocol (MACHADO et al., 2016b; MCDERMOTT et al., 2009). | Other: Immersion in cold water<br>* Immersion in cold water will consist of the individual sitting in a plastic pool with water at the water level of the umbilical scar. Water temperature is between 11 and 15ºC, for a period between 10 and 15 minutes immediately after the exercise protocol (MACHADO et al., 2016b; MCDERMOTT et al., 2009). Water temperature will be controlled by adding or removing ice. This method has been applied by studies conducted by our research group (MISSAU; SIGNORI, 2017).<br>* Other names: Cryotherapy;|
| Active Comparator: Exercise session followed foam roller recovery<br>The interval between each exercise session will be one week. Prior each to the exercises sessions (4), volunteers will undergo specific warm-up in each exercise adopted (a series of 15 repetitions with 40% of the maximum load obtained in the 10RM test). The exercise sessions will consist of four sets for 10RM, with an interval of one minute between sets and two minutes between exercises. The exercise sequence (extension chair, squat and leg press) will be randomized through a closed brown envelope draw. Prior to the 10RM test and data collection, standardized instructions regarding the experimental procedure and exercise technique will be provided. Verbal stimuli to the volunteer will be performed during the evaluations and exercises (TEIXEIRA et al., 2014a, 2014b). Volunteers will undergo an FR session immediately after resistance exercise session (PEARCEY et al., 2015). | Other: Foam Roller Recovery<br>* Myofascial self-release will be developed through the foam roller (FR), where participants will use a custom-made foam roller constructed from a hollow polyvinyl chloride tube that will have an outside diameter of 10cm and a thickness of 0.5cm and will be surrounded by neoprene foam with a thickness of 1cm. Each volunteer will be shown the technique for the 5 muscle groups involved and the technique used for each muscle group. FR will consist of 45s of rolling for each muscle in the left lower extremity, 15s of rest, 45s in the lower right extremity. They will be instructed to begin with the practice on the most distal portion of the muscle. They will be instructed to place as much tolerable body mass on the FR at all times and to roll their body mass back and forth along the roller as smoothly as possible at a rate of 50 beats per minute (ie , 1 rolling motion for 1 to 2s). The total technique time is estimated at 10 to 15min (PEARCEY et al., 2015).<br>* Other names: Foam Roller;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Isometric peak torque | Isometric peak torque will be measured by a load cell of a tensile-compression dynamometer (EMGSystem, São José dos Campos, Brazil), with a capacity of 500 Kgf and a resolution of 0.1 kg, a set of fixing cables, a A/D converter board (EMGSystem, São José dos Campos, Brazil), connected to a computer and analyzed by the software EMGSystem Lab V1.2_ 2010. For each muscle group, a minimum of 4 and a maximum of 10 measurements of each movement will be performed. This variation in the number of measurements is so that the last measurement is not the highest value during the test and so that the three highest values differ by less than 5%. For analysis will be considered the highest value (NELLESSEN et al., 2015). During the evaluations, standardized and vigorous verbal encouragement will be performed during the maneuver, with the aim of stimulating the individual to exert maximum effort during the entire muscle contraction time.Data will be presented in kgf. | 30 minutes after the interventions | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Subjective exertion perception | Subjective exertion perception ny the Borg scale (FOSTER et al. 2001). The scale ranges from 0 (no pain) to 10 (maximum bearable pain). Data will be presented in points average. | 30 minutes after the interventions | 
| Flexibility | The flexibility will be assessed by the Bank of Wells and Dilon (SIGNORI et al., 2008) and Lunge Test (CHISHOLM et al. 2012). Data will be presented in centimeter (cm). | 30 minutes after the interventions | 
| Muscle power | Muscle power will be assessed by single-limb general function (Single Hop Test) (BOLGLA; KESKULA, 1997). Data will be presented in centimeter (cm). | 30 minutes after the interventions | 
| Agility | Agility will be assessed by t-test (LATORRE ROMÁN ; VILLAR MACIAS; GARCÍA PINILLOS, 2017). Data will be presented in seconds (s) | 30 minutes after the interventions | 
| Speed | Speed will be evaluated by 30-meter test (PEARCEY et al., 2015). Data will be presented in seconds (s). | 30 minutes after the interventions | 
| Muscle endurance | Muscle fatigue strength will be assessed by the sit-up test (TVETER et al., 2014). Data will be presented by the number of repetitions. | 30 minutes after the interventions | 
| Systemic blood pressure | Blood pressure (BP) monitoring (Systolic blood pressure - SBP, Diastolic Blood Pressure - DBP and Mean Blood Pressure - MBP) will be performed using a multiparametric monitor (Dixtal, model 2021, Manaus, Brazil). The cuff will be positioned on the right arm with the patient positioned in the supine position on the stretcher. Data will be presented in mmHg. | 60 minutes after the interventions | 
| Heart rate variability | Heart rate variability (HRV) will be assessed before exercise and after interventions. The autonomic balance will be evaluated by the HRV, for the acquisition of the signal will be used a Polar frequency pulse model 810i (GAMELIN; BERTHOTOIN; BOSQUET, 2016). The acquisition of the electromyographic signal (ECG sampling rate - 1 kHz) of the RR interval time series will be acquired by continuous interval and will occur before and immediately after the interventions. For data collection the volunteer will remain lying supine at rest for 10 minutes and after standing for the same period of time, after the procedure will be repeated with breath control (16 movements per minute; I / E: 2 / 3) (NARDI et al., 2017). The analysis will be done by spectral power density (European Society of Cardiology & The North American Society of Pacing and Electrophysiology, 1996). Data will be presented absolute units (ms2) and your normalized units (n.u.). | 60 minutes after the interventions | 
| Delayed onset muscle soreness | Delayed onset muscle soreness (DOMS) will be evaluated by visual analog scale (EVA). The scale ranges from 0 (no pain) to 10 (maximum bearable pain). | DOMS will be evaluated 24, 48 and 72 hours after the exercise protocol. |