recovery - prepare acsm health & fitness summit 2013 handout · 2013-03-13 · pre-training...

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Sports Medicine Research Laboratory

The University of North Carolina at Chapel Hill

PREPARE for Optimum Recovery Planned Recovery to Enhance Performance And Regenerate

Darin A. Padua, PhD, ATC @DarinPadua

Barnett S. Frank, MA, ATC @BarnettFrank

Mary Ellen Bingham, MS, RD, CSSD @WeFuelTheHeels

#PREPARE

Overview •  Fatigue vs. Over-Training

–  Factors & mechanisms –  Performance & injury

•  Evidence based solutions for combating fatigue & over-training

–  3 R’s

•  Implementing an integrated and systematic recovery program

–  PREPARE

Combatting the Effects of Fatigue on Performance

Muscle Performance

•  Muscle strength •  Muscle power •  Muscle contractile

velocity

Exercise Performance

•  Speed •  Power output •  Balance / Stability •  Movement

Competition Performance

•  Work rate during competition

•  Decision making •  Anticipation

Competitive Performance Measures References

! Work rate (1st vs 2nd half, quarters, consecutive days)

Mohr et al, J Sports Sci, 2005; Reilly et al, Sports Med, 2008; Spencer et al, J Sci Med Sport, 2005; Carling et al, Sports Med, 2008; Mohr et al, J Sports Sci, 2003

! total distance covered%! percentage of time spent sprinting (! 40% in final 15 min)%" percentage of time spent standing or walking%

" Repeated sprint / sport-related agility%

Stuart et al, Med Sci Sport Exerc, 2005; Small et al, Int J Sport Med, 2009; Perrey et al, Eur J Appl Physiol, 2010; Montgomery et al, J Sports Sci, 2008; Baker et al, Med Sci Sports Exerc, 2007; Winnick et al, Med Sci Sports Exerc, 2005; McGregor et al, J Sports Sci, 1999; Krustup et al, Med Sci Sports Exerc, 2006; Edwards et al, Br J Sports Med, 2007

! Joint motion% Small et al, Int J Sports Med, 2009; Appiantono et al, J Sports Sci, 2006

! Technique execution Reilly et al, Sports Med, 2008; Stuart et al, Med Sci Sports Exerc, 2005; Royal et al, J Sports Sci, 2006; Gabbett et al, J Strength Cond Res, 2008; Appiantono et al, J Sports Sci, 2006; Kellis et al, Scand J Med Sci Sports, 2006

! rugby tackling skills%! water polo shooting skills%! soccer kicking motion%

! Technique outcome Stuart et al, Med Sci Sports Exerc, 2005; Appiantono et al, J Sports Sci, 2006; Kellis, Scand J Med Sci Sports, 2006; Montgomery et al, J Sports Sci, 2008; Baker et al, Med Sci Sports Exerc, 2007; Winnick et al, Med Sci Sports Exerc, 2005; Ali et al, Med Sci Sports Exerc, 2007; Devlin et al, J Sci Med Sport, 2001

! rugby tackling skills%! rugby tackling skills%! rugby tackling skills%! rugby tackling skills%

" RPE (15-19)%Royal et al, J Sports Sci, 2006; Gabbett et al, J Strength Cond Res, 2008; McGregor et al, J Sports Sci, 1999; Edwards et al, Br J Sports Med, 2007; Ali et al, Med Sci Sports Exerc, 2007

" Sense of generalized fatigue% Montgomery et al, J Sports Sci, 2008; Baker et al, Med Sci Sports Exerc, 2007; Winnick et al, Med Sci Sports Exerc, 2005

" Muscle soreness% Montgomery et al, J Sports Sci, 2008

Mechanisms of Fatigue

Peripheral Factors •  Carbohydrate availability

–  Glucose –  Glycogen

•  Hypoxia / Hypoxaemia •  Acidosis (lactate) •  Hyperkalaemia

–  K+ release from working muscle fibers into interstitium / plasma

•  Dehydration •  Hyperthermia

Central Factors •  Neural drive to muscle

–  Voluntary •  Psychological factors •  RPE

–  Involuntary •  Neuro-Chemistry

–  Energy supply –  Neuro-transmitters –  Neuro-modulators

Afferent Feedback

Main Factors Causing Fatigue

Prolonged Exercise (> 60 min)

•  Decreased carbohydrate supply

•  Dehydration •  Central factors

High Intensity Exercise (max

effort)

•  Hyperkalaemia •  Systemic acidosis •  Hypoxia •  Central factors

Exercise in Hostile Environmental

Conditions

•  Hyperthermia •  Dehydration •  Hypoxia •  Central factors

Strong interaction between peripheral and central factors (body-mind) •  Perceived exertion can greatly impact acute fatigue symptoms •  Psychological mind-set can impact response to strenuous exercise

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Central Factors

Peripheral Factors

Afferent Feedback

Muscle Performance

Exercise Performance

Competition Performance

!  Stability

Altered Movement Patterns

" Injury Risk

?

•  High training loads are strongly associated with increased lower extremity injury rates (r=0.86) Gabbett, J Sports Sci, 2004

–  Contact (r=0.82) & non-contact (r=0.82) injuries – ! Training loads # ! Injury rates Gabbett, Br J Sports Med, 2004

•  No compromise in performance improvements

Gabbett & Jenkins, J Sci Med Sport, 2011

Strenuous Exercise

Decreased Muscle

Performance Fatigue Progressive

Decline " Injury Rates

Fatigue is a part of strenuous exercise and unavoidable to

some extent

Must prevent fatigue from causing a

progressive decline in exercise performance

Over-Reaching # Over-Training •  Disturbed stress-regeneration balance

–  Stress: physical and/or mental

Meeusen et al, Eur J Appl Physiol, 2004; Meeusen et al, Eur J Sport Sci, 2006; Nederhof et al, Sports Med, 2006

Altered mood state

Altered sleep

Altered eating

Decreased Performance

Over-Training

Severe Months to a year

Non-Functional Over-Reaching

Mild to moderate Longer recovery

Functional Over-Reaching

Mild to moderate Days to weeks

Strenuous Exercise

!Performance & "Injury Risk

Recovery Behaviors

Over-training is a misnomer and suggests strenuous exercise is a primary cause of fatigue

Re-Fuel

Rest

Retain Movement Efficiency

"Performance & !Injury Risk

+

Under-recovery facilitates negative consequences

Optimum Recovery • Required to maximize benefits (anabolic) & eliminate

consequences (catabolic) of strenuous exercise

Strenuous Exercise

Optimum Recovery

Positive Physiologic Response

“Super-compensation” + =

Catabolic Response

Anabolic Response

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!  Performance (acute / end game)

" Injury Rates

Progressive Performance Improvement

! Injury Rates

Strenuous Exercise

Fatigue

Progressive Performance

Decline

Super-Compensation Recovery Strategies

Optimum Recovery

(3 R’s) Re-Fuel (Nutrition & Hydration)

Supplements (Nutrition & Modalities)

Rest (Sleep, Stress &

Relaxation)


(Pre/Post Training Routine)


• 30 min post • 2-4:1 carb:protein

ratio • Replace water

• High carbs • Moderate protein • Low fat

• Water (3-4 liters/day)

• Replace electrolytes (sodium)

• Eat Breakfast • Regular meals

during day • Well balanced

Meals Hydration

Post-Training Nutrition

Pre-Training Nutrition

Re-Fuel Strategies


6 to 10 g / kg of body wt / day (2.7 to 4.5 g / lb of body wt / day) •  High carbohydrate diet (50-60% of

energy) •  Maintain blood glucose during

exercise •  Replace muscle glycogen

1.2 to 1.7 g / kg of body wt / day (0.5 to 0.8 g / lb of body wt / day)

20 to 30% of total energy intake / day

Joint Position Statement by American Dietetic Association, Dietitians of Canada, and American College of Sports Medicine: Nutrition and Athletic Performance, Med Sci Exerc Sports Sci, 2009

Meals

Carbohydrates

Proteins

Fats

•  Sufficient fluid to maintain hydration •  At least 3-4 hours before exercise, drink ~5-7 mL/kg body

weight (~2-3 mL/lb body weight) of water or sport beverage •  Low in fat and fiber to facilitate gastric emptying •  High in carbohydrates (maximize blood glucose) •  Moderate in protein •  During exercise:

•  Replace fluid loss •  Provide carbohydrates for events > 1 hour (maintain blood

glucose)

Joint Position Statement by American Dietetic Association, Dietitians of Canada, and American College of Sports Medicine: Nutrition and Athletic Performance, Med Sci Exerc Sports Sci, 2009

Pre-Training Nutrition

Post-Training Nutrition •  Replace fluids, electrolytes, carbs and protein (replace muscle

glycogen & enhance protein synthesis) •  1.0 to 1.5 g / kg of body wt (0.5 to 0.7 g / lb of body wt) •  High glycemic index

•  Include protein (amino acid for muscle repair and promote anabolic hormone profile)

•  ~10-20 g •  2 to 4 : 1 carbohydrate to protein ratio

•  Moderate amount of Omega-3’s (regulate inflammatory response)

Sample Post-Exercise Recovery Snack •  Option 1 (645 calories, 94 g CHO, 25 g PRO, 20 g Fat, 3.8:1 CHO:PRO)

–  1 regular bagel –  2 T. peanut butter –  8 oz 1% lowfat chocolate milk –  1 oz (30g) seedless raisins

•  Option 2 (627 calories, 93 g CHO, 39 g PRO, 11 g FAT, 2.4:1 CHO:PRO) –  2 cups flavored soymilk plus 3 heaping tsp whey protein isolate –  4 graham cracker squares –  1 medium apple

•  Option 3 (380-510 CAL, 72-76 g CHO, 22-44 g PRO, 3-8 g FAT, 2-3:1 CHO:PRO)

–  11-17 oz ready to drink commercial protein drink/shake –  2 medium bananas –  Combine into smoothie?

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Re-Fuel Strategies Post-Training Nutrition (cont.) •  Consume within first 30 minutes post-training

–  Repeat every 2 hours for 4-6 hours post-training (replace muscle glycogen stores)

�Without nutrient intervention, the

metabolic window begins to close within

forty-five minutes following exercise�

Ivy, J & Portman, R. Nutrient Timing 2004

0

20

40

60

80

100

120

0 10 20 30 40 50 60 70 80 90 100 110 120

Pote

ntia

l Ana

bolic

Effe

ct (%

)

Time Post-Exercise (minutes)

We compromise PERFORMANCE

when we don’t refuel appropriately

↓ Benefit

↓ Benefit

↓ Benefit

Sweet Spot

Refuel

Ultimately, o

ur goal is to restore

muscle function through nutrient delivery

Improper Re-Fueling

Loss of lean muscle tissue

Compromised function

Dehydration (>2% BW)

Poor nutrient uptake (micro

nutrients)

! Strength ! Endurance

Immune System

Musculoskeletal System

Endocrine System

Metabolic dysfunction

! Resting metabolic rate

! Aerobic exercise performance

Consequences of Improper Re-Fuelling

! Mental / Cognitive performance

Re-Fuel Resources

• Estimating energy requirements: http://www.health.gov/dietaryguidelines/dga2005/report/html/d3_disccalories.htm

• Consulting services for sport nutrition •  Collegiate & Professional Sports Dietitians Association

www.sportsrd.org •  Sports, Cardiovascular & Wellness Nutritionists

(SCAN) www.scandpg.org

Optimum Recovery




Relaxation)




• Rest Strategies


Sleep •  7 to 8 hours of

sleep •  Sleep extension

to 10 hours is beneficial

Relaxation •  60 minutes of

relaxation throughout the day

Stress •  Minimize

psycho-social stress

Hou

rs o

f Sle

ep 8

7

6

5

4

3

2

1

9

10

Consequences of inadequate rest !Cognitive function and memory !Mood !Reaction time !Physical performance !Accuracy and consistent performance !Weight loss (% fat loss vs. % lean muscle mass)

Benefits of proper rest !Daytime sleepiness (alertness) !Reaction time (on field decisions) !Sprinting times (speed) "Performance on accuracy tasks (passing, shooting)


Dinges et al, Sleep, 1997; Carskadon et al, Psychophysiology, 1981; Van Dongen et al, Sleep, 2003; Mougin et al, Eur J Appl Physiol Occup Physiol, 1991; Reilly et al, Ergonomics, 1994; Edwards et al, Chronobiol Int, 2009; Nedeltcheva, Ann Int Med, 2010

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Rest and Muscle Recovery

Sleep Deprivation / Restriction

Anabolic Hormones Catabolic Hormones

Testosterone GH

IGF-1

Myostatin Glucocorticoids

Protein Synthesis Protein Degradation

Muscle Atrophy Worst Satellite Cell Proliferation, Fusion, and Signaling

Worse recovery capacity

Datillo et al, Med Hypoth, 2011 Rest and Performance

Mah et al, Sleep 34(7):943-950, 2011

!Reaction time !Sprint time

"Shooting accuracy •  Free throws •  3-pointers

!Daytime sleepiness

Improved mood profile

10 hours / day over 5-7 weeks

•  6-7 hour average prior to study •  Encouraged to nap if not able to

obtain 10 hours of sleep at night due to travel

Optimum Recovery




Relaxation)




Does Movement Efficiency Matter? Increased number of

overuse injuries (football & soccer)

Increased number of ACL injuries (soccer

& basketball)

Movement Dysfunction

Decreased power output (vertical

jump)

Decreased postural control

(balance) Decreased flexibility

Decreased speed & agility

Repeated Motion / Prolong

Posture

" Activation & Tightness

Reciprocal Inhibition

! Antagonist Activation

Force Couple Alteration

Postural Malalignment

Altered Length – Tension

Relationship

! Muscle Strength

Synergistic Dominance

Muscle Imbalance

Hip Flexion

Hip Flexor Tightness

Gluteus Maximus Inhibition

Anterior Pelvic Tilt

Gluteus Maximus Weakness

Hamstrings, Hip Adductors, Erector Spinae

Systematic, solutions-oriented & science-based approach to optimize

movement efficiency Repeated Motion / Prolong

Posture

" Activation & Tightness

Reciprocal Inhibition

! Antagonist Activation

Force Couple Alteration

Postural Malalignment

Altered Length – Tension

Relationship

! Muscle Strength

Synergistic Dominance

Movement Dysfunction

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Retain Movement Efficiency Strategies

Monitor Movement Efficiency

Dynamic Warm Up

Active Recovery

Training Load


Dynamic Warm-Up & Active Recovery

http://tinyurl.com/b7ztrsf

Dynamic Warm Up • Dynamic stretching • Incorporates balance and core stabilization • Sport specific agility/stability

• Progressive intensity • Focus on proper technique

Active Recovery • Promotes removal of makers associated with post-exercise soreness and muscle damage

• Lactate • Creatine kinase

• Promotes environment for “anabolic” response • Muscle glycogen re-synthesis (energy) • Protein synthesis (muscle repair/growth) • Success dependent upon compliance with re-fueling strategies

Poor Movement Efficiency

Previous Injury History

Identify High Risk Individuals Movement Efficiency Screening

Double Leg Squat

Single Leg Squat

Kinetic Chain Checkpoints: •  Knee valgus / varus •  Toe out / in •  Low back arch / sway •  Trunk flexion

•  Arms fall forward •  Hip shift •  Pronation •  Heel lift

Supporting Evidence

Control Group

Intervention Group

Subjects

Foot / Ankle Muscle Imbalance

Bell & Padua,2012

-8

-6

-4

-2

0

2

4

6

8

Cha

nge

Sco

res

(deg

rees

)

Control

Intervention

*

!0.02

!0.01

0

0.01

0.02

0.03

0.04

1 21 41 61 81 101

Knee$Center$(m)

Squat$Phase$(Percentage)

Control$Group:$Pre$/$Post$

Control0Pre0Test

Control0Post!Test

!0.04

!0.03

!0.02

!0.01

0

0.01

0.02

0.03

0.04

0.05

1 21 41 61 81 101

Knee$Center$(m)

Squat$Phase$(Percentage)

Intervention$Group:$Pre$Test$/$Post$Test

Intervention3Pre3Test

Intervention3Post3Test

Med

ial K

nee

Mot

ion

Med

ial K

nee

Mot

ion

*

Intervention Group •  Improved ankle

dorsi-flexion ROM •  Decrease medial

knee collapse

0

1

2

3

4

5

6

7

8

Pre-test Post-test Retention-test

LESS

Padua et al, AJSM, 2011

Improvements in movement quality are

not permanent

Return to poor movement patterns

within 3 months

Requires repeated assessment and

training for retention

Extended training duration (9 months) required for retention of improved movement quality

Improved movement quality Movement quality retained

Movement quality NOT retained

Traditional duration (3 months)

Extended duration (9 months)

Monitor Training Load •  Record the following information:

(training, practices & games) –  RPE within 30 minutes of

training/game •  Focus on feeling of exertion (not

pain or shortness of breath)

–  Total minutes of exercise

0 Rest

1 Very, very easy

2 Easy

3 Moderate

4 Somewhat hard

5 Hard

6

7 Very hard

8

9

10 Maximal

Training Load

RPE Minutes of Exercise

x =

Gabbett & Jenkins, J Sci Med Sport, 2011; Foster et al, J Str Cond Res, 2001

Training load strongly correlated to injury rates (r=0.86)

NEEDS TO BE MET w/ appropriate

RECOVERY BEHAVIORS

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Training Load and Recovery Behaviors

Strenuous Exercise

Optimum Recovery

Positive Physiologic Response

“Super-compensation” + =

Catabolic Response

Anabolic Response

Optimum Recovery




Relaxation)




Nutritional Supplements

•  post activity •  s/s of muscle damage •  mitigation of

immunosuppression •  during activity

•  fatigue resistance •  power output maintenance

Modality Supplements

•  s/s muscle damage •  Whole body vibration •  Cryotherapy •  Compression •  Massage

Supplemental Recovery Treatments & Behaviors

Recovery Supplements Recovery Supplements

•  Implemented in ADDITION to best practices discussed

• The application of the following recommendations may be dependent on:

1.  Training cycle (meso/micro-cycle goal) 2.  Training load 3.  Injury/health status 4.  Practicality

Nutritional Supplements

Improved fatigue resistance during strenuous activity • Mitigation of power output decrements during strenuous exercise

Reduction in immunosuppression

post strenuous activity

Reduction of s/s associated with

exercise-induced muscle damage

Exercise-Induced Muscle Damage

•  Tissue disruption & catabolism

–  Circulating markers of muscle

catabolism

•  Associated with body’s

inflammatory response

•  Delayed onset muscle soreness

(DOMS)

•  Decreased muscle force output

between bouts of activity

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ANTIOXIDANTS

Vitamin C

Vitamin E

Coenzyme Q10 (ubiquinone)

Phytochemical – Tart Cherry Juice

RATIONALE

Limit secondary muscle cell damage

Reduction in severity of DOMS

Maintenance of force output between activity sessions

Limit muscle tissue catabolism

Supports cardiovascular health-vascular function

Decrease inflammation

May promote tissue healing

Bowtell 2011, Kreider 2010, Kon 2008, Mizuno 2008, Bloomer 2007, Hellsten 2007

•  ANTIOXIDANTS – APPLICATION

–  Loading periods between 10-14 days*

•  Appropriate planning •  Timing is less important than

loading period

–  Accumulating levels in the body $ tissues

–  During scheduled periods of repeated high load training and/or competition

–  Injury management & rehabilitation – tissue healing


•  3 g/day Vitamin C

•  1200 IUs/day Vitamin E

•  150-350 mg/day Coenzyme Q10

•  30 mL/d (2 x day) Tart Cherry Juice

Vitamin D*


DOSAGE

A Note on Vitamin D

APPLICATION

Reduce inflammation

Calcium absorption • Endurance athletes • High training volumes

Mood • Sunlight exposure

DOSAGE* Deficiency? •  “optimal” – 100-250 nmol/L (25(OH)D) • Environment • Individual

Calcium absorption • Endurance athletes • High training volumes

Mood • Sunlight exposure

4000 – 10,000 IUs 3-5 mos

*Lots of debate regarding the optimal dosing, use, effectiveness Powers et al. 2011


AMINO ACIDS

L-Carnitine

Leucine •  HMB (β-hydroxy-β-

methylbutyrate)

RATIONALE

Limits muscle catabolism

Limits the severity of DOMS

Reduction in tissue disruption

Thomas 2011, Kreider 2010, Sharp 2010, Jacobs 2009, Bloomer 2007

Exercise-Induced Muscle Damage •  AMINO ACIDS –

APPLICATION –  During scheduled periods of

repeated high load training and competition

–  May be significant benefits to L-Carnitine supplementation during periods of high-intensity resistance training

•  2g/d L-carnitine

•  0.1g/kgbw/hractivity Leucine

•  1.5 – 3 g/d* •  Loading period* HMB

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• RATIONALE –  Limits inflammation –  May reduce severity of

DOMS

Kreider 2010, Bloomer 2009, Bloomer 2007

• FATTY ACIDS –  Omega-3 Fatty Acids

(EPA & DHA) •  Fish Oil, Krill Oil, Algae-

source, Plant-source (flax

seed)

ALA

EPA

DHA


• FATTY ACIDS –  Omega-3 Fatty Acids

(EPA & DHA) •  Eicosapentaenoic acid

(EPA)$Docosahexaenoic

acid (DHA)

•  Fish Oil, Krill Oil, Algae-source, Plant-source (flax

seed)

• RATIONALE –  Limits inflammation –  May reduce severity of

DOMS

Kreider 2010, Bloomer 2009, Bloomer 2007

*Overall, EPA may have stronger effect in limiting inflammation. Thus as a inflammatory reducing agent may be more important than DHA.


• FATTY ACIDS – APPLICATION

–  During scheduled periods of repeated high load training and competition

–  Injury management & rehabilitation

•  2-4 g/day Fish Oil

•  Most evidence is provided surrounding fish-oil supplementation

•  reaction time Mental fatigue

•  combination of cardiovascular, muscle-level and mental fatigue – commonly measured via “time to exhaustion”

Systemic

•  Local muscle environment Isolated muscle power output

Fatigue Resistance

Fatigue Resistance

SUPPLEMENTS

β-Alanine

Fatty Acids (DHA)

Coenzyme Q10

L-Arginine

RATIONALE

Improved “buffering” of blood acidosis – increased tolerance to low blood pH (β-Alanine) • Improved muscular endurance, power output, time to exhaustion

Support for reduced mental fatigue • Reaction time (fatty acids – DHA) • Mood-state/perceived fatigue (Coenzyme Q10)

Increased time to exhaustion & decreased metabolic cost(L-Arginine)

Guzman 2011, Kreider 2010, Bailey 2010, Bloomer 2009, Kon 2008, Mizuno, 2008, Bloomer 2007

Fatigue Resistance • APPLICATION

–  During scheduled periods of repeated high load training and competition

–  Reconditioning $ returning to exercise/play

•  post-injury/illness

–  Periods for high susceptibility for for sleep deprivation

•  Travel concerns (Coenzyme Q10 timing*)

•  4-6 g/day β-Alanine

•  2-4 g/day Fatty Acids

•  150-350 mg/day Coenzyme Q10

•  6g prior to exercise •  Acute Response L-Arginine

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Reduction of Immunosuppression

• After bouts of high levels of physical exertion there is a transient period of reduction in the body’s immune system function

• There is a significant body of evidence suggesting that L-glutamine supplementation reduces the severity of immunosuppression

Hoffman 2012, Kreider 2010, Smith 2008, Bloomer 2007, Castell 2003, Petibois 2002

Reduction of Immunosuppression

• DOSEAGE

– L-glutamine – 6g/ day •  Loading/adaptation phase – 6g / 1-serving / day

•  Maintenance phase – 3g / 2x / day –  higher concentrations may lead to parathesia side-effect

–  dividing dose up over course of the day will limit the potential for parathesia

Nutritional Supplement Summary

Use •  Exercise-Induced Muscle Damage •  Fatigue Resistance •  Combat Immunosupression

Loading Concerns •  Appropriate length •  Planning

Supplements not to be used as replacements •  To work in conjunction with macronutrient best practices

Nutritional Supplements Resources

–  NSF International www.nsfsport.com* –  Informed Choice www.informed-choice.org –  Consumer Labs www.consumerlabs.com –  Natural Medicines Database

http://naturaldatabase.therapeuticresearch.com/home.aspx –  US Pharmacopeia www.usp.org –  The National Center for Drug-Free Sport www.drugfreesport.com –  NCAA www.ncaa.org

Modality Supplements

•  Whole body vibration

•  Massage

•  Compression garments

•  Cryotherapy

–  Cold-water immersion

Limit DOMS

Limit Catabolism

Limit Strength

Loss Limit ROM

Loss

Whole Body Vibration

PARAMETERS

1-2 sets of ~60s

static stretch or contact massage

30-50 Hz(frequency is proportional to conditioning level)

APPLICATION

If available, can be applied after each

training or competition session

Travel may be a concern with athletes* •  Do not want to establish

“mental dependence”

Kosar 2011, Lau 2011, Aminian-Far 2011. Rhea 2009

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Massage

PARAMETERS

Applied as soon as possible post activity

Types include (petrissage, effleurage, muscle “shaking”)

Time applied is variable range 10 mins to >1 hr

Some reported evidence of non-isolated application

APPLICATION

Need to determine if realistic for player/org

Repeated high-intensity play

Applied within 2 hrs of activity cessation

Conjunction with active w/u & c/d

Mancinelli 2006, Brooks 2005, Lane 2004, Hilbert 2003, Smith 1994

*Limited evidence regarding best practices

Compression Garments

PARAMETERS

Worn as soon as possible post-activity

Worn for 24 hours post-activity* • Best not to remove

APPLICATION

Benefits in all post-activity scenarios

Individually applied (low clinician maintenance)

Research supports UE & LE benefits

Air travel

de Glanville 2012, Duffield 2010, Jakeman 2010 Kraemer 2010, Davies 2009

Cold Water Immersion

PARAMETERS

Within 1 hr post-activity

1-4 applications with 72 hour period

10-15 minute immersion period

10-15ºC (50-59ºF)

Proposed benefit to water agitation • Reduction of thermopanes

APPLICATION

After bouts of high-intensity activity

Heavy resistance training*

Eccentric & plyometric training

Bleakley 2012, Leeder 2012 *Presence of limiter of anabolic effect has been disputed.

.

Whole Body Vibration • 1-2 sets of ~60s •  static stretch or contact

massage • 30-50 Hz

Massage • Applied as soon as

possible post activity • 10 mins - >1 hr

Compression Garments • Applied as soon as

possible post-activity • 24 hours post-activity

Cold Water Immersion • 1 hr post-activity • 1-4 in 72 hrs • 10-15 minutes 10-15ºC

(50-59ºF) • Water agitation

DOMS Strength loss Catabolism ROM loss

• Putting it all together • Requires an integrated and systematic approach

1.  Educate 2.  Access 3.  Monitor


Educate # Empowerment

• Provide consistent messaging –  Meals & hydration –  Post-training nutrition**

•  30-minute window of opportunity

–  Sport nutrition consultant •  Individual assessments and plans •  Supplement advice

–  Impact of rest & movement efficiency on recovery

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Access • Fueling stations

–  Pre & Post training –  Regulate pre & post training re-

fuel strategies •  2-4 : 1 Carb to Protein ratio •  Difficult to regulate meals, but pre

& post training may be easier

• Recovery modalities –  Foam roller –  Cryotherapy –  Compression garments –  Whole body vibration

Monitor •  Movement efficiency

–  Continual re-assessment –  Guide corrective exercise

•  Training load –  Minutes x RPE

•  Within 30 minutes –  Age and injury history likely

impact the relative training load •  Recovery Behaviors (PREPARE

Score) –  Behavior modification and

educational tool

How PREPARE’d are you? http://bit.ly/Yib0aG

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0 10 20 30 40 50 60 70 80 90

100 Re-Fuel

Rest Retain

Movement Efficiency

PREPARE Score •  Range 0 to 100

•  Optimum recovery = 100 •  Score for each recovery

domain •  Re-Fuel (0-100) •  Rest (0-100) •  Retain Movement

Efficiency (0-100)

PREPARE%Score%Interpreta0on%<%50% Not%PREPAREd%

51%6%70% Under%PREPAREd%71%6%90% Moderately%PREPAREd%>%90% Well%PREPAREd%


Catabolic Response

Anabolic Response

Training Load Movement Efficiency

Injury History 0 10 20 30 40 50 60 70 80 90

100 Re-Fuel

Rest Retain

Movement Efficiency

PREPARE Score


Implement Preventive & Recovery

Training

Monitor Recovery

Behaviors & Training

Load

Poor movement # CEx

Injury History # CEx

4 steps to prevent over-training and reduce non-contact lower extremity injury rates by 50% in 18 months

Sadoghi et al, J Bone Jt Surg, 2012; Longo et al, Am J Sports Med, 2012

Key Points

•  Fatigue is a physiologic stimulus for anabolic response, if recovery is optimized

–  Under-recovery leads to catabolic response

•  3 R’s of optimum recovery –  Re-fuel, Rest, Retain Movement

Efficiency, Supplemental Modalities

•  4 steps for preventing over-training & injury

Implement Preventive &

Recovery Training

Monitor Recovery

Behaviors & Training Load

Poor movement # CEx

Injury History # CEx

3/12/13%

14%

Darin A. Padua, PhD, ATC [email protected]

@DarinPadua

Barnett Frank, MA, ATC [email protected]

@BarnettFrank

Copy of presentation slides:

peakcontrol.wordpress.com

recovery - prepare acsm health & fitness summit 2013 handout · 2013-03-13 · pre-training...

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