Comparison of Active Recovery in Water and Cold-Water Immersion After Exhaustive Exercise
Abstract
Athletes engage in activities that necessitate use of recovery strategies from exhaustive exercise. Although the benefits of cold-water immersion have been extensively studied, active recovery in water for submaximal-effort exercise has received limited consideration. The purpose of this study was to compare the influence of active recovery, passive recovery, and cold-water immersion on speed, power, and perceived soreness after exhaustive exercise. Twenty-three NCAA Division I athletes matched by sport, position, and sex were randomized into 3 groups: passive recovery, cold-water immersion, or active recovery. Dependent measures of perceived muscular soreness, maximum vertical-jump height, and 20-meter sprint time were recorded at baseline, postexercise, and 24 hours postintervention. Separate repeated measures analysis of variance was used to analyze the effect of group and time on the dependent measures. Cold-water immersion and active and passive recovery were not found to produce significant differences regarding the recovery of speed, power, or perceived soreness. [Athletic Training & Sports Health Care. 2013;5(4):169–176.]
Introduction
The physiological demands and effects of intense exercise necessitate athletes to use methods that aid with the restoration of power and the preparation for subsequent training and competition sessions. Robust consequences of high-intensity exercise include muscle damage,1 loss of strength,2 muscle soreness,1–3 and fatigue3 and can impose negative effects on subsequent performance.1–3 To abate the repercussions of intense exercise, several recovery strategies may be used postexercise, including cold-water immersion (CWI), active recovery (AR) exercise, massage, compression, stretching, contrast-temperature water immersion, and electromyostimulation, among others.4 Although CWI is commonly used by athletes as part of their postpractice or postcompetition routine and has undergone considerable scientific investigation,5–9 less is known about the influence of AR submaximal exercise on recovery and its comparison with CWI.
Cold-water immersion is proposed to attenuate muscle damage, as reduced tissue temperature and concomitant vasoconstriction decreases swelling, inflammation, and metabolic activity.10 In addition, CWI provides the benefit of hydrostatic pressure, producing influential compressive force.11 This force is theorized to influence muscular and vascular compression and thus fluid movement, particularly in the lower extremities. As a consequence of fluid movement, an additional benefit is decreased swelling and inflammation, thereby providing extra assistance with performance recovery.5,9,11,12
Despite the proposed thermal and mechanical benefits of CWI, the ideal parameters required to reduce pain and perceived soreness, identify markers of muscle damage, and improve recovery of performance are unclear.5–9 Short CWI exposure (⩽5 minutes) at temperatures below 15°C significantly decreases skin temperature, but it does not appear to have a substantial effect on body core temperature or muscle temperature5; therefore, it is less likely to affect muscle soreness. Longer CWI exposure (10 minutes), although it reduces perceived soreness and recovery of strength after intermittent exercise,8 appears to be ineffective in moderating perceived soreness, isometric strength, or markers of muscle damage (eg, creatine kinase) after exercise-induced muscle damage as a consequence of heavy eccentric exercise.6 Extending CWI exposure to 15 minutes appears to provide the most robust influence on recovery of isometric strength and inflammation reduction (as evidenced by blood markers) after exhaustive intermittent exercise9 (eg, countermovement jumps and rowing). However, it is less clear whether a 15-minute exposure to CWI can aid with the restoration of power in highly trained athletes, as determined by countermovement vertical-jump performance. Vertical-jump performance has been reported to be improved within 1 hour of CWI at a temperature of 10°C compared with control (rest) and thermoneutral water immersion,9 whereas CWI at 12°C did not attenuate power loss subsequent to exhaustive intermittent exercise and intervention.13 Based on what is known about CWI, it appears that temperatures of 10°C to 15°C for at least 10 minutes of exposure are required to influence performance recovery. These effects appear to be more robust when implemented after exhaustive exercise, which is not directly intended to induce the significant muscular soreness that is similar to the effects experienced after heavy eccentric training.7–9
The physiological effects of CWI are dependent on water temperature, length of immersion, and the amount of the body immersed. Regardless of the length of treatment time, immersion of the body in water below 15°C is not tolerated well by some individuals and thus negatively affects compliance with this method of recovery. In addition, the initial period of CWI produces significant increases in heart rate, systolic and diastolic blood pressure, oxygen consumption, and cortisol levels.5 Although these effects appear to be transient and reversible, the cardiovascular and respiratory stress may be detrimental to optimal recovery.
AR has been recently proposed as a viable treatment technique to aid restoration subsequent to intense training and consists of the use of exercise at a submaximal intensity between exercise sessions to maintain performance.2,14,15 Although limited research is available validating the benefits of AR, proposed advantages include accelerated recovery time of neuromuscular and biochemical blood markers following intensive exercise.16 In addition to assisting with glycogen restoration, AR is also theorized to aid lactate and edema removal as the result of facilitation of the lymphatic system via adjacent muscular contraction.4
Implementation of AR between sets of maximal-effort performance has been found to improve power in bicyclists and to reduce the blood lactate and heart rate in mountain climbers in subsequent acute exercise bouts, compared with control participants who did not engage in interset submaximal exercise.14 However, use of AR after the conclusion of athletic competition does not appear to significantly influence recovery. In a study of female soccer players, the use of submaximal cycling and low-intensity resistance training after a soccer match was not more effective in the recovery of muscular strength, functional power (vertical jump), reduction of markers of muscle damage (creatine kinase), or perceived muscular soreness compared with passive recovery.2
Although there is evidence supporting the efficacy of intrasession AR,14,17 the impact of the effectiveness of intersession AR is less clear and may be the catalyst for recent investigations that have combined AR submaximal exercise with immersion in water.15 Theoretically, AR in water would allow for the mechanical benefits of hydrostatic pressure, while integrating cyclical movement patterns in an environment that decreases the impact and stress on joints. Early evidence suggests that although AR while immersed in water does not significantly improve blood biochemistry associated with markers of inflammation and muscle damage, it does elevate participants’ overall mood and perceived relaxation compared with passive rest.15 Because CWI can be an uncomfortable experience for some individuals, further identifying the potential for AR submaximal exercise in water at a temperature closer to one’s normal core temperature (thermoneutral) could benefit individuals with cold intolerance who desire a useful method of recovery when training and competing.
Further evidence assessing AR in water is needed to quantify its recovery potential. Is it a viable alternative to CWI and therefore an attractive substitution when individuals have cold intolerance? To our knowledge, there are no similar studies comparing CWI and AR in water after exhaustive exercise to date. Our study was designed to determine whether AR in water influences perceived muscle soreness and recovery of speed and explosive power in collegiate athletes when compared with CWI and passive recovery following a bout of training exercise. We hypothesized that AR in water would decrease muscle soreness and facilitate faster recovery of performance measures better than or equal to CWI following a bout of intense physical training and that both recovery strategies would be superior to a matched period of complete rest.
Method
Participants (N = 23) were Division I collegiate athletes (13 men, mean height = 188.3 ± 10.2 cm, mean mass = 113.2 ± 20.2 kg; 10 women, mean height = 176.9 ±10.7 cm, mean mass = 74.1 ± 14.3 kg) who were recruited 2 weeks prior to the study at a scheduled summer workout session. Inclusion criteria required current participation in the summer workout program organized by the strength and conditioning coach at the participating university. Participants with a history of injury within 1 month before the testing session, which precluded their participation in normal training or competition or resulted in modification of their training levels, were excluded from the study. Participants were healthy with no restrictions at the time of data collection. All participants completed and signed informed consent procedures, and the study was approved by the institution’s Office for the Protection of Human Subjects. Initially, 30 participants were identified, but 7 dropped out due to injury or lack of participation, leading to a final total of 23 participants.
One week prior to the treatment day, participants reported to the athletic medicine facility for initial orientation and baseline testing prior to the scheduled team weight-lifting time. All participants self-reported their sport and position to the primary investigator (C.N.G.). Participants then underwent measurements of height using a Healthometer wall-mounted stadiometer (Jarden Corporation, Providence, Rhode Island) and measurements of mass using a Befour scale (Befour Inc, Saukville, Wisconsin). Baseline testing measures of perceived muscular soreness, maximum vertical-jump height, and 20-meter sprint time were recorded 1 week before the treatment session. Before baseline performance testing began, participants completed a visual analogue scale for perceived soreness (VAS-PS) of the following body areas: calves, quadriceps, hamstrings, hip adductors, hip abductors, and low back.18 The VAS-PS was summarized as a score of 60 maximum points, with each of the 6 muscle groups receiving a score based on a scale of 1 to 10, with 10 indicating the most soreness. In addition, participants took part in their normal athletic warm-up supervised by a strength and conditioning coach. The warm-up lasted approximately 10 minutes and consisted of jogging, light skipping, carioca hops, and dynamic walking drills for range of motion.
After the dynamic warm-up, participants were randomly assigned to 1 of 2 groups for the counterbalanced measurement of maximum vertical jump or 20-meter sprint. Vertical-jump height was measured to the nearest half-inch using a Vertec jump measuring device (Power Systems, Knoxville, Tennessee). Participants started at a standing reach height and then performed a countermovement jump off of 2 feet, reaching for the mobile vanes attached to the Vertec device. Participants were allowed 1 to 2 practice trials at submaximal effort before completing 3 testing trial jumps with 20 seconds of rest between trials, and the best jump height was then recorded for analysis.
The 20-meter sprint was performed on a rubber track surface and was recorded using a digital-gated, electronic timing system (Sparq Digital Timing System; Freelap, Pleasanton, California). This system relies on infrared technology to trigger the start and stop of the movement, and participants were allowed to initiate the start of the sprint of their own volition. Sprint times were synchronized to a handheld receiver and were recorded to the nearest 100th of a second. After 1 to 2 practice trials at submaximal speed, participants completed 2 sprints with 1 minute of rest between the trials, and the best trial was used for analysis. Participants wore their preferred daily running shoes for conditioning and training in the vertical-jump height and 20-meter sprint testing trials.
On the experimental treatment day, these measures were repeated for all participants after their normal conditioning routine, as well as approximately 24 to 28 hours after the treatment intervention and prior to their next workout, which varied by 4 hours, depending on their next workout session. Each data collection session lasted approximately 15 minutes for each participant.
In preparation for the experimental treatment day, we used a randomized block design to effectively assign participants into 3 groups: CWI, AR, or control. Sport cohorts included football (N = 18), women’s volleyball (N = 10), and women’s basketball (N = 2), whereas position cohorts included football lineman (N = 10) compared with all others in football (N = 8). We attempted, as best as possible, to match participants based on sex, sport, and position, thus effectively improving equitable representation of all sports, sex, and position across the 3 groups.
Relative timing and sequencing of data collection and intervention are detailed in the Figure. Although there was slight variability in the exact exercises performed during the lifting session to accommodate the different needs of the athletes by sport, the conditioning session in the afternoon was at a similar level of intensity for all participants and was considered the most intense training day of the week during the summer sessions. Participants began with a warm-up consisting of dynamic and technical work, such as knees-to-chest, straight-leg kicks, multidirectional lunging, forward skipping, slide kicks, lateral shuffles, skipping, backpedaling, and backward shuffles. All participants then completed the workout described in Table 1.
| ACTIVITY | DOSAGE | ACTIVITY BETWEEN SET RECOVERY |
|---|---|---|
| Sprinting (maximum speed) | 8 reps × 70 yards | 70-yard walk back |
| Plyometrics | ||
| Alternating bounds | 3 sets × 10 to 12 reps | Walk back to start |
| Single-leg hops | 2 sets ×10 to 12 reps | Walk back to start |
| Carioca hops | 3 sets × 4 to 6 reps | Walk back to start |
| Side hops to acceleration, 10 yards | 3 sets × 6 to 8 reps | Walk back to start |
| Sprinting (position/sport specific) | 2 sets | Walk back to start |
| Cool down | ||
| 50-yard wave run | 2 sets | Backward strides back to start |
| 50-yard forward power cuts | 2 sets | Backward strides back to start |
Schedule of study data collection and intervention. Abbreviations: w, week; m, meter; VJ, vertical-jump height; VAS-PS, visual analogue scale for perceived soreness; h, hour.
After workout testing of vertical-jump height and 20-meter sprint, the VAS-PS was conducted for all participants within 10 minutes of the conclusion of the conditioning session. Immediately after the post-workout testing was completed, participants began a post-workout intervention. Participants in the CWI group (n = 7) sat quietly in a tub of cold water at approximately 10°C for 10 minutes. Participants were submerged to approximately chest deep. Simultaneously, the AR group (n = 8) performed 2 sets of 30-second cycles of forward walking, back pedaling, side steps (both right and left directions), and lateral crossover walking (both right and left directions) at 1.5 mph, knee-to-chest and heel-to-glutes movements, forward lateral hip rotation, and backward hip rotation walking at 1.0 mph on a HydroWorx underwater treadmill (HydroWorx Inc, Middletown, Pennsylvania). The water temperature of the underwater treadmills was 23°C, which was typical of the water temperature used clinically in the facility. Participants were grouped across 3 available underwater treadmills based on height so that all participants were submerged to a chest-level depth. The control group (n = 8) sat quietly at the same facility as the CWI and AR groups during the same duration. Room temperature was 21°C in this area and was centrally controlled and set according to the facility manager. All participants were directly supervised and monitored during their recovery treatment in a common area of the athletic medicine facility. Participants completed the VAS-PS questionnaire after postexercise testing, immediately after treatment, and prior to subsequent exercise testing the following day.
Statistical Analysis
Data were analyzed using SPSS version 19 statistical software (IBM Corporation, Armonk, New York). Assessment of speed (20-meter sprint) and power (vertical-jump height) were conducted with 2 separate 3 × 3 (group × time) repeated measures designs. Groups included CWI, AR, and control. Time included baseline, postexercise, and 24 hours posttreatment. Second, we assessed perceived soreness (VAS-PS) using a 3 × 4 (group × time) repeated measures design. An a priori significance of alpha = .05 was used, and post hoc comparisons of a group effect were conducted with Tukey’s test (alpha = .05). Where reported, effect size was calculated by hand, based on the sum of squares for group, time, group × time interaction, and total sum of squares, representative of the eta squared estimate of effect size.19
Results
For vertical-jump height, there was no significant interaction between group and time (P = .75, effect size = 0.06), and no significance for effect of time (P = .28, effect size = 0.6) or group (P = .89, effect size = 0.01) was noted (Table 2). For sprint performance, there was no significant interaction between group and time (P = .36, effect size = 0.07), and no significance for effect of group (P = .17, effect size = 0.16) was noted. A significant effect of time on sprint performance was noted (P = .001, effect size = 0.31). Post hoc comparisons indicate 24-hour postintervention speed was significantly slower than baseline (P = .001) and postexercise performance (P = .001) (Table 3). For perceived soreness, there was no significant interaction between group and time (P = .18, effect size = 0.11), and no significance for effect of group (P = .81, effect size = 0.02) was noted. Perceived soreness was significantly different across time (P = .003, effect size = 0.18). Post hoc comparisons indicate postworkout soreness was significantly greater compared with baseline (P = .001) and postintervention (P = .001) conditions (Table 4).
| GROUP | MEAN BASELINE (SD) | 95% CIa | MEAN POSTEXERCISE (SD) | 95% CIa | MEAN 24 HOURS POSTTREATMENT (SD) | 95% CIa |
|---|---|---|---|---|---|---|
| Control (n = 8) | 295.11 (22.68) | 279.39–310.84 | 296.55 (21.58) | 281.59–311.50 | 296.23 (22.01) | 280.98–311.48 |
| CWI (n = 7) | 295.37 (29.43) | 273.56–317.17 | 298.63 (23.80) | 281.00–316.26 | 293.91 (25.55) | 274.99–312.84 |
| AR (n = 8) | 299.56 (7.66) | 294.25–304.37 | 300.51 (7.34) | 295.42–305.60 | 300.67 (7.99) | 295.13–306.21 |
| Total (N = 23) | 296.74 (20.57) | 298.56 (17.96) | 297.07 (18.99) | |||
| 95% CIb | 287.32–306.03 | 290.39–306.74 | 288.36–305.52 |
| GROUP | MEAN BASELINE (SD) | 95% CIa | MEAN POSTEXERCISE (SD) | 95% CIa | MEAN 24 HOURS POSTTREATMENT (SD) | 95% CIa |
|---|---|---|---|---|---|---|
| Control (n = 8) | 2.19 (0.60) | 1.76–2.60 | 2.19 (0.55) | 1.80–2.57 | 2.99 (0.57) | 2.60–3.39 |
| CWI (n = 7) | 2.48 (0.45) | 2.14–2.81 | 2.40 (0.58) | 1.96–2.83 | 2.75 (0.41) | 2.44–3.05 |
| AR (n = 8) | 2.38 (0.56) | 1.99–2.77 | 2.77 (0.39) | 2.49–3.04 | 3.09 (0.36) | 2.83–3.343 |
| Total (N = 23) | 2.34 (0.53) | 2.45 (0.55) | 2.96 (0.46)b | |||
| 95% CIc | 2.23–2.68 | 2.30–2.78 | 2.52–2.97 |
| GROUP | MEAN BASELINE (SD) | 95% CIb | MEAN POSTEXERCISE (SD) | 95% CIb | MEAN POSTTREATMENT (SD) | 95% CIb | MEAN 24 HOURS POSTTREATMENT (SD) | 95% CIb |
|---|---|---|---|---|---|---|---|---|
| Control (n= 8) | 11.19 (13.26) | 1.10–20.38 | 13.73 (14.76) | 3.49–23.17 | 11.99 (15.37) | 1.33–22.64 | 10.63 (10.81) | 3.13–18.11 |
| CWI (n = 7) | 9.49 (6.28) | 4.84–14.13 | 19.73 (10.81) | 11.72–27.73 | 10.51 (4.69) | 7.03–13.99 | 16.33 (11.28) | 7.97–24.68 |
| AR (n = 8) | 15.03 (11.76) | 6.87–23.17 | 17.51 (9.30) | 11.06–23.95 | 10.71 (8.24) | 5.00–16.42 | 14.87 (7.63) | 9.58–20.15 |
| Total (N = 23) | 12.00 (10.78) | 16.87 (11.62)c | 11.10 (10.16) | 13.83 (9.82) | ||||
| 95% CId | 7.09–16.71 | 11.80–22.17 | 6.44–15.71 | 9.59–18.28 |
Discussion
The purpose of this study was to determine the benefits of AR in water compared with CWI and passive recovery. Although research on the influence of CWI has produced inconsistent outcomes, it is a recovery technique that is commonly used by athletes after exhaustive exercise. We anticipated that the combined benefits of water immersion and AR would positively influence recovery after 20-meter sprint, vertical-jump height, and VAS-PS; however, there were no benefits of using this technique when compared with CWI or passive recovery in this study.
The lack of recovery of the 20-meter sprint in this study is consistent with previous reports in the literature.7,8 All participants, regardless of the treatment group, were slower at 24 hours posttreatment when compared with baseline and postexercise measurements of the 20-meter sprint. This decrement may be attributed to fatigue caused by the training day. Although we expected that sprint times for all groups would be significantly slower when measured immediately after the training session, there was no significant change between baseline and postexercise speed. This outcome may be the result of the influence of the particular conditioning session, which focused directly on absolute speed and power with adequate intersprint and interset plyometric bout recovery, compared with training that emphasizes speed endurance (ie, shorter recovery between sprint intervals). Previous literature shows that athletes can perform repeated 15-meter sprints without a decrement in performance when proper rest intervals are used.17 However, the same study demonstrated fatigue in 30- and 50-meter sprints. It is possible our sprint training distance was long enough to manifest a decrease in performance, but the total volume of training, in addition to adequate between-repetition rest, circumvented desirable acute fatigue effects for this study.
Vertical-jump performance was unaffected by the type of recovery technique used in this study. Similarly, Ascensão et al7 found no differences in countermovement jumps between CWI and thermoneutral groups, and Bailey et al8 reported no effect of cryotherapy on vertical-jump height. As with the 20-meter sprint, we anticipated that vertical-jump height would decrease across all groups postexercise to exemplify a decrease in performance as a result of the intensity of the training stimulus. Instead, vertical-jump height was not significantly different postexercise or at 24 hours post-treatment; therefore, the lack of change from baseline to postexercise may suggest vertical-jump height was a poor outcome measure for our study. Ascensão et al7 and Bailey et al8 found that CWI had an effect on maximal voluntary isometric contraction, which may have proven to be a better outcome measure for our study. Thus, future studies should investigate an alternate measure to test power or should use a more robust training stimulus aimed at creating acute fatigue to capture subsequent performance changes.
The VAS-PS used in this study was similar to those reported in the literature on CWI.7,8,20 Mattacola et al18 found that the use of a visual analogue scale was sufficient at demonstrating levels of perceived soreness when used repetitively. Therefore, we are confident that the significant 41% increase in the reported perceived soreness immediately postexercise across all groups in our study is accurate. This increase in soreness was then followed by a 34% reduction in soreness after treatment for all groups, compared with their postworkout VAS-PS, demonstrating recovery toward baseline feelings of soreness regardless of treatment. Although no significant differences were found between groups for the VAS-PS, anecdotal reports from participants suggest they favored the AR protocol to their previous experiences with CWI. This feedback suggests useful subjective information may have been discovered had the Profile of Mood States21 tool been used to demonstrate how participants felt about their treatment and how their levels of anxiety and tension changed posttreatment. The Profile of Mood States effectively demonstrates athletes’ mood in regard to performance and sport.22 Tension levels decrease in athletes who engage in AR postexercise, as evidenced through the use of the Profile of Mood States.15 Although we did not incorporate this assessment tool into the current study, future studies should consider its benefits.
We encountered several limitations over the course of this study. Although we purposefully stratified treatment groups to make them as heterogeneous as possible, the AR group had less variability for both vertical-jump height and 20-meter sprint performances compared with the CWI and control groups. In addition, although the training day was categorized as the most intense of the week, it was not enough to elicit the degree of fatigue needed to produce decrements in speed and power, as often reported with intermittent exhaustive exercise, even though there was reported associated muscle soreness. Finally, starting with baseline data of 30 participants, the final analysis was conducted on only 23 due to injuries experienced between baseline and treatment or self-withdrawal from continued participation. Future studies, with equal and larger group sizes than those used in our study, should reexamine whether AR in water and CWI are desirable methods of recovery. In addition, a study using a crossover design extending the length of the study but allowing each participant to complete each treatment condition would control for differences in pain perception.
Implications for Clinical Practice
Cold-water immersion is routinely used as an intervention to influence the reduction of perceived soreness and fatigue after training and competition by a variety of athletes. Although there is some evidence of its positive influence on acute recovery of performance, the efficacy is dependent on several factors. Temperature and duration of exposure appear to be instrumental in affecting desired physiological adaptations; however, the mechanical contribution of hydrostatic pressure should not be ignored. As such, AR while submerged in relatively thermoneutral water should offer the combined benefit of fluid compression force, submaximal exercise, and improved tolerance of the intervention, thus facilitating performance recovery. On the basis of our investigation, neither CWI or AR while immersed were deemed as more advantageous in the recovery of speed or power, compared with passive recovery when implemented after routine conditioning and training. This outcome lends itself to the need to identify whether longer exposure in either immersion environment or relative intensity of the AR exercise bout can suitably influence recovery. More importantly, does either type of intervention provide advantage or disadvantage in the conditions in which athletes have experienced exhaustive exercise compared with routine training and conditioning? Finally, we suggest that future investigations consider the influence on strength, power, and perceived soreness over the course of a season of repeated CWI exposure or AR while submerged.
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