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Getting Better at Recovery
By Andrew Stuart, MS and Len Kravitz, PhD

Introduction: Recovery, the Growing Target of Physiological Research
A fundamental aspect of successful personal training for recreational enthusiasts and competitive athletes is determining how much recovery is needed between workouts. Bessa et al. (2016) explain that the personal trainer and coach need to be able to assess the physiological impact of an exercise session on the client, and then effectively employ a satisfactory recovery, limiting the potential for overtraining. The current research on recovery is a growing target for researchers, particularly in learning ways to measure and enhance the recovery process. New research on assessing and managing recovery are discussed in this column.

Fatigue and Recovery: Breaking it Down
Fatigue and recovery are interactive and multifactorial aspects of exercise training (Sands et al., 2016). Sands and colleagues define fatigue as a decline in one or more of the biological systems, which is a reversible phenomenon. The researchers continue that fatigue is traditionally viewed from a central and peripheral fatigue perspective. Central fatigue involves the messaging from the cerebrum to the motor unit (i.e., the nerve and muscle fibers innervated by the nerve). Peripheral fatigue focuses on fatigue factors at motor neuron into the exercising muscle.
In regards to recovery, Sands et al. (2016) explain that it is a physiological repair state involving the process of restoring the athlete from fatigue to a state of less fatigue or no fatigue. The researchers further expand, summarizing recovery literature, that recovery is the reestablishment of the exerciser (or athlete) to a renewed ability to meet and/or exceed a previous performance. Additionally, Sands et al. explain other recovery research denotes that recovery also includes the process of growth and physiological adaptation.

New Research Directions in Recovery: Metabolic Assessment Has Arrived!
Bessa et al. (2016) highlight that traditional research has investigated recovery using functional measures of strength, peak power output and subjective measures of the athletes (i.e., how they feel post-workout). A very new direction of recovery research is now quantifying key blood biomarkers of inflammation and muscle damage along a 'timecourse' post-exercise. Bessa et al explain that evaluating markers of muscle damage and inflammation from an exercise session are most accurate and indicative of the state of recovery from the exercise session. However, at this time, scientists are only at the initial stages of research in identifying the recovery timecourse from appearance to clearance of these biomarkers during recovery. Bessa and colleagues are one of the first research teams to explore this new timecourse recovery of key biomarkers. In their study, the researchers had 19 top-level amateur male cyclists (29 years, 178 lbs, VO2 peak=61 ml O2/kg/min, which is a superior level) perform the following: 6 sets of maximum repetitions of deep squats with 85% of their 1RM alternating with 6 sets of maximum repetitions of bench presses performed with 85% of there 1RM. This strength workout was immediately followed by one hour of cycling at 85% of the participants VO2 peak. The researchers collected blood biomarker samples immediately before and then 3, 6, 12, 48 and 72 hours after the exercise protocol.

This study is unique in that it measured biomarkers of muscle damage (creatine kinase and lactate dehydrogenase), inflammation (leukocytes, lymphocytes and neutrophils) and oxidative stress (proinflammatory and anti-inflammatory cytokines) that can easily be measured by competitive athletic teams, to assess athletes for exercise intensity and recovery status during the course of a competitive season. This descriptive pioneer study sets the stage and assessment protocols for many competitive athletes in all types of aerobic, anaerobic and combined (aerobic/anaerobic) sports to know which biomarkers should be considered valuable to monitor during a competitive season.

What are the Ways to Enhance Recovery Following Training?
Sands et al. (2016) state that almost anything that enhances local and/or systemic circulation is likely to aid in recovery. The following are recovery enhancing methods that have become popular in the recent years: Compression Garments, Sleep, Self-Myofascial Release, and Cold-Water Immersion.

Compression Garments
Compression garments (CGs) include lower body and upper body garments with options ranging from short sleeves, sleeveless, full cover long sleeves, shorts, long shorts and full length pants (Sakadjian, 2015). According to Sakadjian (2015), wearing compression CGs, during and after a workout (for 12 to 48 hours), is associated with reduced muscle soreness, decreased muscle swelling, improved proprioception and sensory feedback, and improved blood flow to and away from the exercising muscles (referred to as venous and arterial hemodynamics). Sakadjian adds that CGs also have been shown to reduce a person's perceived exertion for performing a similar task. The optimal desired compression, reported in mmHg has not been established by the research. Compression garments vary from low (15mmHg), mild (15-21mmHg), and moderate (25-32mmHg) pressures. A medical grade compression (for specific clinical conditions) garment is usually >30mmHg of pressure. In summary, Sakadjian observes that CGs may provide minor physiological benefits to performance and recovery, and there is no evidence that CGs will be detrimental in any way.

Athletes and exercise enthusiasts have an increased need for sleep for optimal recovery from their training. Interestingly, one of the most prominent problems athletes identify for feelings of fatigue and tiredness is not getting adequate sleep (Bird, 2013). The general recommendations suggest 7-9 hours of nightly sleep, to ensure adequate physiological and psychological recovery following training. Of the suggested 7-9 hours, 80-90% should be during the night (Bird). Bird also states that adequate sleep is particularly important for athletes and exercisers who are injured, traveling, or in heavy phases of training or competition. Sufficient sleep leads to improved cognitive and motor performance and faster reaction times. For some sleep hygiene recommendations for your students, please refer to Table 1.

Table 1. Practical Sleep Hygiene Tactics to Follow
1) Increase sleep to 7-9 hours per day. Adolescents undertaking heavy training may need up to 10 hours of sleep per night.
2) Ensure time going to bed at night and morning waking time are around the same times each day.
3) Napping is fine; however, keep naps up to 30min and not late in the afternoon.
4) If you are unable to get to sleep in 15 min, get up and complete a mundane task.
5) Avoid alcohol and coffee in the hours before bed.
6) Avoid watching TV, eating, working or reading in bed.
7) Maintain a cool room temperature for sleeping.
8) Be mindful of fluid and food intake right before bedtime.
9) From previous research, Bird suggests incorporating relaxation techniques, such as positive suggestions and creative visualizations as part of the sleep routine, to ensure a clear mind and relaxed state when going to bed.
10) Allow breathing to become slower and deeper to reduce any anxiety before sleeping.
Source: Bird (2013)

Self-Myofascial Release (Foam Rolling)
Self-myofascial release (SMR), using a foam roller and roller massager, has become a popular method to enhance mobility, flexibility, and recovery amongst exercise enthusiasts. Although the literature on the effects and reliability of SMR is still emerging, it has been shown to be an effective method for enhancing joint range of motion with no deleterious affect on exercise performance (Cheatham et al, 2015). Cheatham et al. also state, from their review article, that current researchers with SMR hypothesize that it does positively affect recovery by reducing swelling in the target areas, enhancing blood flow to the exercising muscle and removing metabolic byproducts of exercise. Cheatham and colleagues summarize that at this time point there is no consensus in the research for the optimal

SMR program interventions.
Cold-Water Immersion and Cryotherapy Interventions
Cold-water immersion is an easy, affordable, and common strategy for enhancing recovering. In their review article, White and Wells (2013) summarize that the reduction in tissue temperature exerts local effects on blood flow, cell swelling, metabolic reactions, and neural conductance speed, while altering blood flow during recovery following high-intensity exercise. White and Wells synthesize that these physiological changes may likely improve recovery from exercise. The researchers also note that the long-term effect of chronic cold-water immersion have yet to be elucidated. White and Wells also suggest trying other forms of cryotherapy (extreme cold), including ice or cold gel pack application, ice massage or any other local or general application of cold for therapeutic purposes. Alas, the researchers recap that an optimal target temperature for cold-water immersion, or other cryotherapy interventions has yet to be identified.

Recovery Final Thoughts
As a science, it appears that recovery research is embarking on some new, very unique metabolic directions. However, for a practical application take-home for clients wanting to enhance recovery, all of the interventions discussed in this column may help contribute to recovery from exercise. Due to a lack of 'best dose' in most of these interventions (from the research), personal trainers may wish to introduce the recovery intervention, just as they do with an exercise program, PROGRESSIVELY.

Andrew Stuart M.S. Kinesiology, CSCS, USAW-SPC, CF-L1, an Exercise Science doctoral student and graduate assistant athletic performance coach with University of New Mexico Athletic Performance. His specific interests include strength and conditioning, sports performance, velocity based training, and long term athletic development.

Len Kravitz, PhD, CSCS is the program coordinator of exercise science and a researcher at the University of New Mexico, where he received the Outstanding Teacher of the Year award. In addition to being a 2016 inductee into the National Fitness Hall of Fame, Len was awarded the 2016 CanFitPro Specialty Presenter Award.

Bessa, A.L., Oliveira, V.N., Agostini, G.G., et al. (2016). Exercise intensity and recovery. Journal of Strength and Conditioning Research, 30(2), 311-319.
Bird, S.P. (2013). Sleep, recovery, and athletic performance. Strength and Conditioning Journal, 35(5), 43-47.
Cheatham, S.W, Kolber, M.J, Cain, M., & Lee, M. (2015). The effects of self-myofasical
release using a foam roll or roller massager on joint range of motion, muscle recovery, and performance: A Systematic Review. The International Journal of Sports Physical Therapy, 10(6), 827-838.
Sakadjian, A. (2015). Effects of compression garments on performance and recovery:
A review of the literature. Journal of Australian Strength and Conditioning, 23(3), 60-65.
Sands, W.A, Apostolopoulos, N., Kavanaugh, A.A, & Stone, M.H. (2016). Recovery
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White, G.E. and Wells, G.D. (2013). Cold-water immersion and other forms of cryotherapy: physiological changes potentially affecting recovery from high-intensity exercise. Extreme Physiology & Medicine20132:26