# data[].attributes.body
- Voi aiheuttaa lihasarkuutta
- Hieronnan ajoittaminen arkeen voi olla haasteellista. Suuri rasitus hienonnan jälkeen ei ole suositeltavaa, koska lihakset ovat palautuneet lepopituuteensa ja voimantuotto on vaikeaa.
- Hinta voi olla liian korkea

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- Nykyään markkinoilla lihashuoltovasaroita, joten lihasten hierontaan on mahdollisuus myös kotona. Urheilumaailmassa ollut näitä käytössä jo pidempään.

- Hieronnassa käyntikerrat ovat yksilöllisiä. Jos lihakset menevät jumiin esimerkiksi toimistotyöstä, hieronnasta kerran kuussa tai kahdessa voi olla hyötyä. Jos on oikein paha lihasjumi, voi olla fiksua käydä hierottavana parikin kertaa viikossa parin viikon ajan.

HIERONTAMUODOT
- Klassinen hieronta
- Urheiluhieronta
- Syväkudoshieronta
- Kuumakivihieronta
- Mobilisoiva hieronta
- Purentalihasten hieronta
- Faskiahieronta
- Triggerpistehieronta

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Taulukossa tiivistetysti hyödyistä & haitoista

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Taulukossa tiivistetysti hyödyistä & haitoista

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Juhanhieronta.com
Tikis.fi
https://yle.fi/uutiset/3-11667234
Iltalehti.fi
Lihasleipuri.fi
https://www.fysios.fi/palvelut/hieronta
Hieronta auttaa lievittämään kipua ja stressiä | Terveystalo

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Turvotuksen väheneminen

Nesteiden läpivirtauksen lisääntyminen

Lihaskipujen väheneminen

Lihasväsymyksen väheneminen

Hyödynnetään fysioterapiassa asento ja liikeaisteja voimistavien vaikutusten vuoksi ja syvätunnon herättämisen vaikutuksiin perustuen

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Tukevat lihaksia

Tehostavat verenkiertoa

Ehkäisevät vammojen syntyä

Nopeuttavat palautumista

Vähentävät lihasten kipeytymistä

Ryhti, lajituntuma, tekniikka ja kehonhahmotus paranevat

Auttaa jaksamaan pitkäkestoiset harjoitukset paremmin

Parantaa suorituskykyä

Laktaatin poisto

Lihasten värähtelemisen väheneminen

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- Kylmähoito nopeuttaa lihasten palautumista, aineenvaihduntaa sekä vähentää turvotusta ja nestekertymää.

- Rauhoittaa tulehduksia ja lievittää kipua.

- Saattaa myös vaikuttaa positiivisesti mielialaan ja rentouttaa.

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- Hetkellinen kylmäalistus kuormittaa sydäntä ja supistaa keuhkoputkia, ja ääreisverenkierto supistuu, mikä nostaa hetkellisesti verenpainetta ja lisää sydämen syketaajuutta seurauksena sydämen kuormittuminen.

- Erityisesti haitat koskevat sydänsairaita.

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- Tutkittua tietoa melko vähän löydettävissä.

- Suomen ladun teettämä kysely (2010) avantouinnista (968 vastaajaa)

Vastaajista:

67% kokenut stressin vähentyneen

61% kokenut, että flunssat vähentyneet

38% kokenut unen laadun parantuneen

36% kokenut saavansa apuja särkyihin

2% kokenut että ei mitään vaikutusta

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Sukat (korkeat ja lyhyet)

Säärystimet

Trikoot

Paidat (lyhyt- ja pitkähihaiset)

Hihat

Shortsit

Käsineet

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- Nähty monien urheilijoiden käyttävän kylmähoitoa (kylmävesiallas, avanto)

- Koettu, että avannossa käynti helpottaa stressiä, parantaa unensaantia, tuo helpotusta levottomiin jalkoihin, sosiaalinen puoli

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Venyttelyn tavoite on palauttaa lihakset lepopituuteensa urheilusuorituksen jälkeen ja ehkäistä lihaskireyttä.

Dynaaminen venyttely kannattaa tehdä heti urheilusuorituksen jälkeen ja pidemmät staattiset venytykset n 2h treenin jälkeen

Palauttavalla venyttelyillä mahdollistetaan lihaksen kehittyminen ja uuden harjoituksen tekeminen (estää lihaskipua ja kireyttä)

Hyvä lihashuolto, mihin kuuluu ahkera venyttely, ehkäisee urheiluvammoja

Palautumisen suhteen tärkeimmät osa-alueet ovat ravinto ja lepo, venyttelyllä voidaan saavuttaa vähäisempiä hyötyjä

Kaikissa lähteissä venyttelyä ei pidetty palautumisen edistäjänä

Omakohtainen tunne on, että hyvät venyttelyt raskaan treenin jälkeen palauttaa huikean hyvin, tähän vaikuttaa varmasti myös lihasten rentoutuminen ja mielenrentous

Venyttely voi vaatia varovaisuutta, jos urheilijalla on ns. yliliikkuvat nivelet

Liian voimakkaat venytykset voivat aiheuttaa myös vammoja esim. mikrorepeämiä lihakseen

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Alun perin käytetty urheilussa ja sen myötä otettu osaksi jokapäiväistä käyttöä.

Keksitty 1950 by Conrad Jobst (Saksalainen insinööri)

Urheiluun ensimmäisenä juoksijoille 1980-luvulla

Eniten kompressiotuotteita on käytetty laskimosairauksien ja arpien hoidossa. Sekä leikkausten jälkeisissä kuntoutuksissa

Jaotellaan paineen mukaan eri luokkiin

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- "Cool down", maitohapon poisto
- Loppuvenyttely palauttaa lihaksen lepopituuteen
- Loppuverryttelyyn voi sisällyttää myös liikkuvuus- ja tasapainoharjoittelua
- Myös sosiaalisia hyötyjä joukkueurheilussa: Joukkuehengen ja yhtenäisyyden nostattaminen - rennompi osio harjoituksista
- Pitkällä aikajänteellä tukee urheilijan fyysistä kehitystä ja kokonaisvaltaisen harjoittelun rutiineja

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- On todettu vähentävän kivun tai säryn tunnetta lihaksissa.
- Vähentää hieman treenin jälkeistä suorituskyvyn laskua. Sprintissä ja voimaharjoittelussa sekä nopeuttaa suorituskyvyn laskusta palautumista
- Pieni parannus sprinttaamiseen ja liikkuvuuteen jos käytetään ennen treeniä.

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Tällä hetkellä saatavilla olevilla empiirisen näytön perusteella aktiiviset jäähdyttely ovat suurelta osin tehottomia parantamaan useimpien harjoituksen jälkeisen palautumisen psykofysiologisia merkkejä, mutta voivat silti tarjota joitain etuja passiiviseen loppuverryttelyyn verrattuna.

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- Pieni lasku hyppytuloksissa

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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6465761/

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Front Physiol. 2019; 10: 376.

Abstract

Foam rolling is thought to improve muscular performance and flexibility as well as to alleviate muscle fatigue and soreness. For this reason, foam rolling has become a popular intervention in all kinds of sport settings used to increase the efficiency of training or competition preparation as well as to speed post-exercise recovery. The objective of this meta-analysis was to compare the effects of foam rolling applied before (pre-rolling as a warm-up activity) and after (post-rolling as a recovery strategy) exercise on sprint, jump, and strength performance as well as on flexibility and muscle pain outcomes and to identify whether self-massage with a foam roller or a roller massager is more effective. A comprehensive and structured literature search was performed using the PubMed, Google Scholar, PEDro, and Cochrane Library search engines. Twenty-one studies were located that met the inclusion criteria. Fourteen studies used pre-rolling, while seven studies used post-rolling. Pre-rolling resulted in a small improvement in sprint performance (+0.7%, g = 0.28) and flexibility (+4.0%, g = 0.34), whereas the effect on jump (−1.9%, g = 0.09) and strength performance (+1.8%, g = 0.12) was negligible. Post-rolling slightly attenuated exercise-induced decreases in sprint (+3.1%, g = 0.34) and strength performance (+3.9 %, g = 0.21). It also reduced muscle pain perception (+6.0%, g = 0.47), whereas its effect on jump performance (−0.2%, g = 0.06) was trivial. Of the twenty-one studies, fourteen used foam rollers, while the other seven used roller massage bars/sticks. A tendency was found for foam rollers to offer larger effects on the recovery of strength performance (+5.6%, g = 0.27 vs. −0.1%, g = −0.01) than roller massagers. The differences in the effects between foam rolling devices in terms of pre-rolling did not seem to be of practical relevance (overall performance: +2.7 %, g = 0.11 vs. +0.4%, g = 0.21; flexibility: +5.0%, g = 0.32 vs. +1.6%, g = 0.39). Overall, it was determined that the effects of foam rolling on performance and recovery are rather minor and partly negligible, but can be relevant in some cases (e.g., to increase sprint performance and flexibility or to reduce muscle pain sensation). Evidence seems to justify the widespread use of foam rolling as a warm-up activity rather than a recovery tool.

Keywords: rolling massage, sprint, jump, strength, flexibility, muscle pain

Introduction

In recent years, foam rolling has become a common practice in all kinds of sport settings and is highly regarded within the strength and conditioning field for increasing the efficiency of training or competition preparation and for accelerating post-exercise recovery (Healey et al., 2014; Jones et al., 2015; Monteiro and Neto, 2016). Foam rolling (FR) is a form of self-massage in which the targeted musculature is rolled and compressed utilizing a FR device (Peacock et al., 2014). Common FR tools include the foam roller and various types of roller massage bars/sticks, which come in several sizes and foam densities.

With foam rollers, athletes use their bodyweight to apply pressure to the soft tissues during the rolling motion, while roller massagers are applied with the upper extremities to the target muscles (Cheatham et al., 2015). The motions place both direct and sweeping pressure on the soft tissue, stretching it and generating friction between it and the FR device. Consequently, FR can be considered a form of self-induced massage because the pressure that the roller exerts on the muscles resembles the pressure exerted on the muscles through manual manipulation by the user himself (Pearcey et al., 2015). Some reasons why self-massage through FR has become a popular intervention technique used by both elite athletes and recreationally active individuals may be its affordable, easy, and time-efficient applicability as well as its close relationship to massage, which in turn is believed to benefit athletes by enhancing performance and recovery (Weerapong et al., 2005).

However, despite the popularity of FR, no consensus exists on its benefits (Cheatham et al., 2015; Pearcey et al., 2015). This may be partly due to the fact that few studies have examined the underlying physiological mechanisms of FR. Nevertheless, the potential effects of FR have been attributed to mechanical, neurological, physiological, and psychophysiological parameters (Aboodarda et al., 2015; Cavanaugh et al., 2017; Monteiro et al., 2018; Phillips et al., 2018). The mechanical mechanisms are comprised of a number of sub-mechanisms, such as reduction in tissue adhesion, altered tissue stiffness, and thixotropic responses (Aboodarda et al., 2015; Kelly and Beardsley, 2016). Within neurological models, it is theorized that FR may potentiate analgesic effects and muscular recovery by mediating pain-modulatory systems (e.g., nociceptor and mechanoreceptor sensitivity and/or diffuse noxious inhibitory control) (Cavanaugh et al., 2017; Jo et al., 2018). The proposed physiological mechanisms are increased blood flow and parasympathetic circulation, as well as inflammatory responses and associated trigger-point break down (Aboodarda et al., 2015; Kelly and Beardsley, 2016). Psychophysiological responses may include improved perceptions of well-being and recovery due to the increase of plasma endorphins, decreased arousal level, an activation of the parasympathetic response and/or placebo effect (Weerapong et al., 2005; Phillips et al., 2018).

Due to the potential underlying physiological mechanisms, it is believed that FR can improve both acute athletic performance as well as recovery from an intensive bout of physical activity (Cheatham et al., 2015). Therefore, studies on the effects of FR have either determined whether massage-like mechanical pressure with a foam roller or roller massager prior to activity affects muscle performance (i.e., pre-rolling as a warm-up activity), or whether FR after an intense bout of exercise enhances muscle recovery (i.e., post-rolling as a recovery tool). Unfortunately, the literature on FR that does exist is equivocal and insufficient, which is why the widespread use of FR is to date not fully supported by the available empirical data. In addition, there is currently no meta-analysis that has evaluated the literature and calculated the pooled effects of FR. This creates a gap in the translation from research to practice for strength and conditioning coaches who use FR tools and recommend these products to their athletes (Cheatham et al., 2015). Accordingly, the aims of the study were to conduct a meta-analytical review of the effects of pre-rolling and post-rolling on performance, flexibility, and muscle pain outcomes in healthy and physically active individuals and to identify whether self-massage with a foam roller or a roller massager is more effective.

Methods

Search Strategy

A comprehensive and structured search of articles were performed using the PubMed, Google Scholar, PEDro, and Cochrane Library search engines. Different sets of seven key terms ("self-massage," "foam rolling," "roller massage," "roller massager," "self-myofascial release," "performance," "recovery") were combined by Boolean logic ("AND," "OR"), and the results were limited to human subjects that were healthy and physically active as well as to articles written in English. Each database was searched from the earliest available article up to December 2017. We also searched the reference lists of all incoming articles and extracted the appropriate publications. From the 954 abstracts reviewed, 110 potentially suitable articles were identified ( Figure 1 ).

Selection Criteria

The selection of articles for inclusion in this meta-analysis was based on the following criteria. First, only publications that appeared in an international, peer-reviewed scientific journal were selected. Second, a FR intervention had to have been done as part of the analysis, regardless of which type of FR device was used for the intervention. Third, the FR intervention had to have been used either as a warm-up or a recovery routine. Fourth, before and after the FR intervention, measurements of performance, flexibility, and/or muscle pain outcomes had to have been conducted. Fifth, there had to have been a control condition, where athletes were subdivided either as their own controls or randomly into an intervention and control group. The first author was responsible for the study selection. After the selection process, all studies were discussed among three authors. In case of disagreement about the inclusion of a study, a voting process was used to determine if a study should be included or not. Figure 1 provides a flow chart of the literature search.

Classification and Quality Assessment of the Studies

The inclusion criteria were met by 21 studies, 14 of which used pre-rolling as an exercise warm-up routine, while seven used post-rolling to enhance recovery mechanisms. For further analysis, the studies were categorized according to the type of FR device used (i.e., foam roller or roller massager). Several studies were included more than once in the analysis. This was the case, for example, when several follow-up examinations were carried out (e.g., after 24 and 48 h) or several types of performance indicators were measured. The Cochrane risk of bias tool (Higgins et al., 2011) was used to assess the quality of each included study.

Statistical Analysis and Assessment of Effect Sizes

A standardized form was used to extract all relevant data and important methodological details from the studies. For each study, relative changes in performance, flexibility, and muscle pain were calculated for the treatment condition and the control condition. By subtracting the two values, the net effect of the treatment on changes in performance, flexibility, and muscle pain was calculated. Effect sizes (ES, Hedges' g values) were estimated according to the following formula:

g=c P (M p o s t,  f o a m   r o l l i n g− M p r e,  f o a m   r o l l i n g) (M p o s t,  c o n t r o l− M p r e,  c o n t r o l)S D p r e

where c p is a bias factor recommended for small sample sizes (Morris, 2008), M pre, foamrolling, M post, foamrolling, M pre, control, and M post, control are the respective mean values of performance, flexibility, and muscle pain, and SD pre is the pooled pre-test standard deviation. This method was chosen because it has been suggested for the ES calculation of controlled pre-test-post-test study designs in meta-analyses (Higgins et al., 2011). Negative effects on performance, flexibility, and muscle pain are marked with a minus sign ES deviations and 95% confidence intervals were calculated as described by Borenstein et al. ( 2011). In addition, the ES was converted to percentiles as described by Coe ( 2002). For example, an ES of 0.5 means that the score of the average subject in the FR group is 0.5 standard deviations above the average subject in the control group, and hence exceeds the score of 69%. The value of 69% indicates that the average subject in the FR group would score higher than 69% of the control group that was initially equivalent.

If more than one parameter of performance was measured, a combined effect was calculated by averaging the relative change and the ES, and calculating the combined ES variance (Borenstein et al., 2011). In this context, a correlation coefficient of 0.9 was used based on the values reported in studies by Harbo et al. ( 2012) and Nuzzo et al. ( 2008).

The total results for the analyzed conditions were determined by the calculation of inverse-variance-weighted g-values (Borenstein et al., 2011). For nine of the twenty-one studies, more than one result was included in the analysis because several follow-up examinations were performed (e.g., after 24 and 48 h). In these cases, the respective results were combined as described above, assuming correlation coefficients of 0.9. To combine the different types of sprint, jump, and strength performances, a correlation coefficient of 0.6 was used.

The data of each individual study as well as weighted-average values are presented in forest plots. The magnitude of g was categorized according to Cohen ( 1992) (i.e., 0.00-0.19 = negligible effect, 0.20-0.49 = small effect, 0.50-0.79 = moderate effect, ≥0.80 = large effect). The values are given with 95% confidence intervals to express the uncertainty of the true effect. ES can be interpreted as evidence of the benefit of pre-rolling or post-rolling when the average and 95% confidence intervals are above zero.

Results

Included Studies

Twenty-one studies with a total number of 454 subjects met the inclusion criteria, fourteen of which used pre-rolling as an exercise warm-up strategy ( n = 306), while seven used post-rolling to enhance recovery ( n = 148). Of the twenty-one studies, fourteen used foam rollers, while the other seven used roller massage bars/sticks. The characteristics of the included studies are summarized in Supplementary Table 1 (studies using pre-rolling) and Supplementary Table 2 (studies using post-rolling). The calculated ES for the effects of FR on performance, flexibility, and muscle pain outcomes are shown in Figures 2 - 9.

The use of the Cochrane risk of bias tool (Higgins et al., 2011) showed a comparable bias level for most of the included studies. Regarding selection bias, almost all studies mentioned a random assignment of their subjects into either a FR or control group. Accordingly, the risk of selection bias was considered low. However, in the research article by Sullivan et al. ( 2013), it was not explicitly stated how the participants were assigned to the different groups. Here, the selection bias remained unclear. The blinding of the subjects was not possible due to the nature of the FR technique. Consequently, the risk of a placebo bias was comparatively high. Mikesky et al. ( 2002) imposed blinding on researchers and participants during testing. Griefahn et al. ( 2017) stated that only the examiners were blinded during outcome assessments, whereas Cheatham et al. ( 2017) imposed blinding only on subjects. None of the other research articles provided any information on blinding. Regarding attrition bias, only one study reported on drop-outs ( n = 2; Bushell et al., 2015).

Furthermore, to minimize possible learning effects, twelve studies (Mikesky et al., 2002; MacDonald et al., 2013; Healey et al., 2014; Jones et al., 2015; Pearcey et al., 2015; Zorko et al., 2016; Cavanaugh et al., 2017; Cheatham et al., 2017; D'Amico and Gillis, 2017; Grabow et al., 2017; Casanova et al., 2018; Phillips et al., 2018) provided participants an organized familiarization with performance tests prior to the first testing session; in nine studies (MacDonald et al., 2013; Peacock et al., 2014; Jones et al., 2015; Pearcey et al., 2015; Cheatham et al., 2017; D'Amico and Gillis, 2017; Grabow et al., 2017; Casanova et al., 2018; Phillips et al., 2018), the participants were instructed to avoid strenuous exercise before and/or during the experimental period; in seven studies (MacDonald et al., 2013; Pearcey et al., 2015; Cavanaugh et al., 2017; D'Amico and Gillis, 2017; Grabow et al., 2017; Rey et al., 2017; Phillips et al., 2018), diet control was mentioned and/or the subjects were asked to maintain their normal dietary intake and to refrain from nutritional supplements and alcohol intake during the experimental period; and in six studies (Mikesky et al., 2002; Macdonald et al., 2014; Zorko et al., 2016; Cavanaugh et al., 2017; Cheatham et al., 2017; Rey et al., 2017), it was explicitly stated that each participant was always examined at approximately the same time of day.

Overall, based on the quality assessment of the studies included in this meta-analysis, none of the studies was considered to have a high risk of bias, except for the high risk of placebo bias that can be inevitable for this kind of studies.

Pre-rolling

Pre-rolling resulted in a small improvement in sprint performance (+0.7%, g = 0.28) and flexibility (+4.0%, g = 0.34), whereas the effect on jump (−1.9%, g = 0.09) and strength performance (+1.8%, g = 0.12) was negligible. The weighted-average overall performance change due to pre-rolling was +1.5% ( g = 0.20). Of the fourteen studies investigating the effects of pre-rolling on performance and flexibility, 10 (MacDonald et al., 2013; Healey et al., 2014; Peacock et al., 2014; Bushell et al., 2015; Jones et al., 2015; Murray et al., 2016; Cheatham et al., 2017; Griefahn et al., 2017; Sagiroglu et al., 2017; Phillips et al., 2018) used a cylindrical foam roller (overall performance: +2.7%, g = 0.11; flexibility: +5.0%, g = 0.32), while the remaining four studies (Mikesky et al., 2002; Sullivan et al., 2013; Cavanaugh et al., 2017; Grabow et al., 2017) used a type of roller massage bar/stick (overall performance: +0.4%, g = 0.21; flexibility: +1.6%, g = 0.39).

Post-rolling

Post-rolling slightly attenuated exercise-induced decreases in sprint (+3.1%, g = 0.34) and strength performance (+3.9%, g = 0.21). It also reduced muscle pain perception (+6.0%, g = 0.47), whereas the effect on jump performance (−0.2%, g = 0.06) was trivial. The weighted-average overall performance change in response to post-rolling was +2.0% ( g = 0.19). The effects of post-rolling using a cylindrical foam roller (strength performance: +5.6%, g = 0.27; muscle pain: +6.0%, g = 0.55) were examined by four studies (Macdonald et al., 2014; Pearcey et al., 2015; Zorko et al., 2016; Fleckenstein et al., 2017), while the remaining three studies (D'Amico and Gillis, 2017; Rey et al., 2017; Casanova et al., 2018) used a type of roller massage bar/stick (strength performance: −0.1%, g = −0.01; muscle pain: +5.8%, g = 0.20).

Discussion

There is a growing body of literature examining the use of FR as a warm-up activity (i.e., pre-rolling) or as a recovery strategy (i.e., post-rolling); however, the effectiveness of FR is still in question in both scenarios. The variation in methodological design, combined with the differences in FR intervention, exercise modality, and training status of the populations investigated, has perhaps contributed to the apparently inconsistent findings. This study used a meta-analytical approach to (1). Explore whether the use of pre-rolling and post-rolling are effective tools to improve sprint, jump, and strength performance as well as flexibility and muscle pain outcomes and (2). To identify whether self-massage with a foam roller or a roller massager is more effective. The results indicate that pre-rolling causes a small acute improvement in sprint performance and flexibility, while its effect on jump and strength performance was negligible. Second, when foam rolling is used as a recovery tool, participants experience slightly reduced decrements in sprint and strength performance and a small reduction in the severity of muscle pain. Third, a tendency was found for foam rollers to offer larger recovery effects than roller massagers, while the differences in the effects between FR devices in terms of pre-rolling did not seem to be of practical relevance.

Pre-rolling

Relevant effect sizes for average improvements in performance due to pre-rolling were found only for sprinting. The total Hedges' g of 0.28 ( Figure 2 ) indicates that with the use of pre-rolling, 58% of the population is likely to experience increased sprint performance (Coe, 2002). However, the average percentage improvement in sprint performance was only 0.7%. In this context, Hopkins et al. ( 1999) defined the smallest worthwhile performance enhancement (i.e., in the case of the present study, the minimum improvement making pre-rolling worthwhile) as the value increasing the chance of victory for an athlete by 10%. Based on this definition, they concluded that an enhancement as small as 0.3-0.4 of the within-athlete standard deviation known as the coefficient of variation (CV) is important for at least the best athletes. For sprinting, Malcata and Hopkins ( 2014) as well as Tanner and Gore ( 2013) reported CVs of ~0.8%. The smallest important change in sprint performance thus corresponds to ~0.3%. This shows that although the effect size was rather small from a purely statistical point of view, when within-athlete variability is taken into account, the average improvement in sprint performance induced by pre-rolling is within a range that is relevant for elite athletes.

However, for recreational athletes, a change in sprint performance as small as ~0.3% may be barely noticeable due to a likely greater within-athlete variability. In this case, the minimum worthwhile enhancement in sprint performance would be greater than the change in sprint performance induced by pre-rolling. Consequently, the effects of pre-rolling on sprint performance seem to be more relevant for elite athletes, while it is possible that recreationally active individuals may not benefit substantially from pre-rolling. Furthermore, the small average overall effect size for sprint performance is based on only four studies and is mainly due to the studies conducted by Mikesky et al. ( 2002) and Peacock et al. ( 2014) showing effect sizes of 0.66 and 0.70, respectively. Therefore, it can be speculated that sprint performance does not, per se, benefit more from pre-rolling than the other performance components and that the slightly larger effect sizes found for sprinting are, rather, due to methodological aspects and/or aberrations in the data. Consequently, sprint performance results should be interpreted with caution, as the number of available studies was limited and only two of them showed a clear positive effect.

Several potential physiological effects of FR could explain the trend of improved sprint performance following pre-rolling. One possibility is that FR immediately prior to sprinting breaks up what are known as barrier trigger-points (Bonci and Oswald, 1993). These are identified as inflexible bands of muscle containing knots resulting from muscle spasm. Barrier trigger-points are typically painless and can result in muscle weakness, muscle fatigue, and muscle stiffness (Mikesky et al., 2002). All of these factors could obviously have an impact on sprinting. FR may break up these trigger-points. Decreasing muscle spasms would not only decrease the amount of internal resistance to muscle movement, but also enable the previously spasmodic tissue to contribute to the athletic activity being performed (Mikesky et al., 2002). However, this explanation remains highly speculative, and there is no concrete evidence proving that the release of trigger-points makes FR effective.

Alternative explanations for acute benefits in performance could be a potential warm-up and/or placebo effect. Self-massage with a foam roller necessitates supporting one's partial body weight with the upper body, similar to with planking exercises. These exercises primarily involve isometrically holding the body in a prone position and are typically used to strengthen the core. Isometric exercises such as planking are in some ways similar to FR because the body position is maintained in an analogous manner, requiring similar isometric actions to support one's body weight. Planking in turn would have a warm-up effect through possible increased skin and muscle temperature, increased blood flow, and enhanced flexibility/mobility (Healey et al., 2014). Moreover, the observed effect of FR might have been confounded by a potential psychosomatic disorder, meaning the subjects may have performed better following FR treatment simply because they believed it would improve their performance (Jo et al., 2018).

It should also be noted that sprint performance mainly depends on muscle strength and neuromuscular coordination. However, similar to the findings of Cheatham et al. ( 2015), the effects of pre-rolling on jump ( g = 0.09) and strength performance ( g = 0.12) were negligible ( Figures 3 , ​,4). 4 ). Thus, it cannot be definitively determined if the observed effects on sprint performance were really due to FR. For example, it is possible that the trend toward improved sprint performance was the result of a placebo effect, as FR can hardly be blinded. The reason the other measures of physical performance did not show trends toward improvements is unclear. Mikesky et al. ( 2002) suggested that the measures of jump capacity and strength are rather one-dimensional when compared with the complexity and coordination required to sprint. As such, large improvements in more isolated tasks are not as remarkable, while the combined effects on more complex, repetitive tasks become more evident. Although it is a coordinated task, jumping is so brief in duration, at least compared to sprinting, that any combined improvements are not afforded a chance to be revealed.

The largest average effect of pre-rolling was related to flexibility. The overall Hedges' g of 0.34 ( Figure 5 ) indicates that 62% of the population will experience short-term improvements in flexibility when using pre-rolling as a pre-exercise warm-up (Coe, 2002). Cheatham et al. ( 2015) assumed that the effects of FR on flexibility would be attributed to the altered viscoelastic and thixotropic properties of the fascia (i.e., remobilizing the fascia back to a gel-like state), as well as increases in intramuscular temperature and blood flow due to the friction created by the foam roller and the mechanical breakdown of scar tissue. However, this is merely speculation by the authors and is not based on direct scientific observations. In addition, hypotheses related to the mechanisms of pressure-associated changes in myofascial properties have been questioned. The pressure that is required to deform firm fascial tissue is greater than the physical range that is usually achieved by FR (Schleip, 2003). Therefore, a change in the thixotropic property of the fascia surrounding the muscle may be more likely (Phillips et al., 2018). This change is possible because the fascia is composed of colloidal substances that can become more gelatinous when they encounter heat and mechanical stress (de Souza et al., 2019). However, in colloidal substances, the thixotropic effect only lasts as long as the pressure or heat is applied, and within minutes, the substance returns to its original gel state (Schleip, 2003). Therefore, it is unlikely that FR would have a sustained effect on flexibility by changing the thixotropic property of the fascia.

Apart from this, FR may increase flexibility due to a process known as autogenic inhibition. As the FR device applies pressure to the muscle tissue, it is believed that mechanoreceptors called Golgi tendon organs (GTO) send a message to the central nervous system that substantial tension is being placed on the muscle, causing the central nervous system to relax that muscle to prevent it from tearing (Larson, 2014). However, Edin and Vallbo ( 1990) found that GTOs were insensitive to the tension produced on the tendon through stretching. If stretch-induced GTO inhibition exists, it is more likely to occur with large-amplitude stretches and not from the small tensile forces that are exerted during FR. Furthermore, any possible GTO inhibition subsides almost immediately after the cessation of tension in the tendon (Behm, 2018). Therefore, it seems unlikely that this mechanism would contribute to increased flexibility following FR. The most plausible explanation for short-term improvements in flexibility could be the effect of FR on the central pain-modulatory systems. For example, constant and vigorous pressure exerted on the soft tissues may overload the skin receptors, thus inhibiting or minimizing pain sensation and increasing stretch tolerance (Kelly and Beardsley, 2016; de Souza et al., 2019). This hypothesis is supported by the findings of Aboodarda et al. ( 2015) and Cavanaugh et al. ( 2017) who have shown that FR can improve pain perception.

Apart from the study by Sagiroglu et al. ( 2017), which has shown that pre-rolling has a harmful effect on jump performance, the research suggests that pre-rolling may offer small short-term benefits in promoting flexibility without negatively affecting muscle performance. This is an important finding to consider when putting together a menu of warm-up activities, since training and competition preparation should always aim to enhance performance. Nevertheless, additional research is necessary to identify different FR protocols that are relevant to different sports and to develop guidelines that ensure FR routines do not impair performance. For example, despite causing an acute increase in range of motion in the joints, prolonged static stretching of more than 60 s per muscle is likely to result in significant performance impairment (Kay and Blazevich, 2012; Behm et al., 2015; Reid et al., 2018). Therefore, one might assume that prolonged static stretching is not recommended during pre-event warm-up activities, especially when performance is required immediately after stretching. However, in studies that conducted performance tests >10 min after static stretching, performance changes were typically statistically trivial unless extreme stretch protocols were used (Behm et al., 2015). Moreover, Blazevich et al. ( 2018) and Reid et al. ( 2018) reported that potential performance decrements caused by static stretching are insignificant with shorter stretching durations (i.e., <60 s) and appear to be resolved after a complete, progressive pre-exercise warm-up routine. Therefore, strong evidence supports the deleterious effects of static stretching prior to performance (Behm and Chaouachi, 2011), but when used properly, static stretching can promote flexibility and injury prevention without negatively affecting muscle performance (Behm et al., 2015; Reid et al., 2018).

Post-rolling

The current review demonstrates that post-rolling recovers exercise-induced decreases in sprint and strength performance more quickly than passive recovery. The overall Hedges' g of 0.34 and 0.21 for sprint and strength ( Figures 6 , ​,8) 8 ) indicate that 62 and 58%, respectively, of the population will experience the accelerated recovery of sprint and strength performance when using post-rolling (Coe, 2002). The average sprint and strength performance improvements were 3.1 and 3.9%, respectively, reflecting a range that is clearly higher than the smallest worthwhile change defined by Hopkins et al. ( 1999).

Prolonged impairments in muscular function have been attributed to a multifaceted process from central factors involving the central nervous system and nervous pathways to peripheral factors occurring within the muscle itself. However, it is assumed that subsequent fatigue after intensive exercise would account for about 80% of the impairments originating from a peripheral factor (Wiewelhove et al., 2017). Peripheral fatigue includes physical signs, such as the ultrastructural damage of connective tissue and muscle tissue, as well as an increase in muscle soreness. Nevertheless, previous research has indicated that ultrastructural damage does not always occur following intensive exercise that leads to muscle soreness (Yu et al., 2002). Therefore, it seems reasonable that reduced voluntary muscle activation (e.g., central fatigue due to inhibition caused by muscle soreness, swelling, and stiffness) also contributes to a reduction in muscular function (Byrne et al., 2004). Considering this, the recovery of dynamic performance measures with the use of post-rolling is due to either the facilitated process of soft-tissue restoration, the accelerated restoration of central factors, or both.

Although Pearcey et al. ( 2015) did not directly investigate the physiological mechanisms of FR, they speculated that post-rolling might enhance post-exercise recovery of dynamic performance measures via systemic biomechanical effects. These include: increased levels of circulating neutrophil; smaller increases in post-exercise plasma creatine kinase; activated mechano-sensory sensors that signal transcription of COX7B and ND1, indicating that new mitochondria are being formed, which presumably accelerate the healing of the muscle; and less active heat-shock proteins and immune cytokines, thus reflecting less cellular stress and inflammation. Furthermore, the reduced perception of pain may positively affect the short-term recovery process of muscular function (Zorko et al., 2016), and improved perception of muscle soreness may be critical for the restoration of exercise performance, since muscular function is impaired in the presence of muscle pain (Graven-Nielsen et al., 2002). These mechanisms will be described in more detail below.

However, the effects of post-rolling on performance should again be interpreted with caution, as the overall effects on sprint ( p = 0.12) and strength performance ( p = 0.28) were not significant and the number of available studies was limited. Merely one study found a clear benefit of post-rolling for sprint performance (D'Amico and Gillis, 2017), while only two studies showed post-rolling had a clear positive effect on strength performance (Zorko et al., 2016; Fleckenstein et al., 2017). In addition, the effects of post-rolling on jump capacity were negligible ( Figure 7 ), although research has demonstrated a clear relationship between sprint, jump, and strength performance in athletes (Comfort et al., 2014). Therefore, it remains questionable whether the average post-rolling-induced enhancements of performance recovery were really due to a true physiological effect of FR or whether the placebo effect or methodological aspects contaminated these results.

The largest average effects of FR in general and post-rolling in particular were found for the alleviation of perceived muscle pain. The total Hedges' g of 0.47 ( Figure 9 ) indicates that with the use of post-rolling, 66% of the population is likely to experience reduced muscle pain (Coe, 2002). In terms of athletic performance, muscle soreness, as previously described, can have negative consequences. It may result in altered muscle functions. These alterations may substantially reduce the performance or optimal training intensity of athletes (Pearcey et al., 2015). For example, Byrne et al. ( 2004) reported the negative effects of perceived muscle pain on sprint, jump, and strength performance, all of which are important during many athletic events.

Several theories have been proposed to explain the underlying mechanisms of exercise-induced muscle soreness. Some authors suggest that perceived muscle pain arises from disruption to the muscle fiber and surrounding connective tissue, while others suggest that it is associated with the inflammatory response, and other suggest that it is a combination of both (Hill et al., 2014). However, since muscle enzyme efflux and myofibrillar damage are not correlated with the actual sensation of muscle soreness, it has been postulated that exercise-induced muscle soreness may be more related to connective tissue damage and the inflammatory response rather than the actual muscle cell damage incurred (Macdonald et al., 2014). For example, damaged connective tissue stimulates mechanically sensitive receptors, giving rise to pain when stretched or pressed, while the inflammatory response, which follows tissue damage, creates an increase in tissue osmotic pressure that sensitizes the nociceptors, also resulting in the sensation of pain (Hill et al., 2014; Macdonald et al., 2014).

In this regard, FR-like treatments in animal models have been shown to induce an anti-nociceptive response by mediating an endogenous release of oxytocin into the plasma and in the central grey matter located around the cerebral aqueduct in the midbrain (Agren et al., 1995; Lund et al., 2002; Jay et al., 2014). Thus, one plausible mechanism to explain the reduction in muscle soreness following FR is the activation of descending inhibitory pathways, using the central gray matter-opioid system and oxytocin (Jay et al., 2014). Moreover, it has been proposed that FR-like mechanical stress may remove trigger points from the muscle tissue, leading to improved pain perception. Myofascial trigger points are a common source of musculoskeletal pain. It is thought that application of massage-like mechanical pressure on trigger points can prevent the unnecessary firing of muscle spindles afferent discharges from the trigger point, can reduce trigger point-induced muscle spasms, and ultimately decrease pain (Aboodarda et al., 2015). However, this explanation remains highly speculative because there is no concrete evidence for the effectiveness of brief rolling massages for trigger point therapy.

As proposed by Aboodarda et al. ( 2015) and Cavanaugh et al. ( 2017), the most plausible explanation for the mediation of perceived muscle pain following FR could be the effect of rolling massages on the central pain-modulatory systems. Their findings suggest that FR performed on muscles that contain a hypersensitive tender spot and FR performed on the contralateral muscle group can both provide an acute increase in the pain threshold. Since the increase in the pain threshold has a transient and non-localized effect, they suggest that massage-like mechanical pressure can provide analgesic effects through the ascending pain inhibitory system (gate theory of pain) and the descending anti-nociceptive pathway (diffuse noxious inhibitory control), respectively. Although the physiological mechanisms underlying the analgesic effect of FR have yet to be demonstrated empirically, a reduction in the sensation of muscle soreness is beneficial to athletes and may improve their readiness to participate in physical activity (Hill et al., 2014).

Foam Rollers vs. Roller Massagers

Although pre-rolling effects were greater with the use of roller massagers, larger average percentage changes were seen with the use of foam rollers. Due to this contradictory finding, it is difficult to conclude whether pre-rolling with foam rollers or with roller massagers is superior. On the other hand, post-rolling showed both larger effects and greater percentage changes when it was administered with foam rollers, while the benefits of pre-rolling with roller massagers were less significant. Consequently, post-rolling seems to be more effective if foam rollers are used. However, as the number of high-quality and well-designed studies on FR is limited, the conclusions drawn above should be treated cautiously. Further studies would be necessary to confirm that different FR devices lead to different effects.

Limitations

The results from the present meta-analysis provide evidence that the effects of FR on performance and recovery are rather minor and partly negligible, but can be relevant in some cases (e.g., to increase flexibility or to reduce muscle pain sensation). However, any meta-analysis is limited by the data available and there are several limitations for this analysis. First, most of the included studies contain small sample sizes, which result in reduced statistical power. Second, none of the included studies were able to blind their patients to the treatment due to the nature of the FR technique. As such, the placebo effect cannot be eliminated. Third, the methodology varied widely between the studies. For example, the majority of the published studies have not standardized and/or measured the applied pressure of the rolling action, while only a few studies have used a kind of pressure roller apparatus to maintain a constant rolling intensity. Consequently, there may be large ranges in the pressure exerted through FR. Furthermore, the FR procedures differed in terms of the duration of the application, the FR device used, and the muscles targeted. Fourth, with respect to the subjects' training status, the studies recruited both elite athletes and recreationally active or untrained individuals. Overall, these differences may explain some of the inconsistent findings within the current literature and future research should account for this inconsistency by at least directly measuring as well as reporting and standardizing the degree of pressure induced through FR. Finally, the statistical analysis is based only on articles that were published before January 2018. However, the vast majority of articles published since January 2018 confirm the pooled effects of FR, which are calculated in this meta-analysis. For example, Cheatham and Stull ( 2018), de Souza et al. ( 2019), Hall and Chadwick Smith ( 2018), Killen et al. ( 2018), Macgregor et al. ( 2018), Madoni et al. ( 2018), Monteiro et al. ( 2018, 2019a, b), and Smith et al. ( 2018, 2019) were able to confirm that FR can improve flexibility, perceived muscle pain perception, and/or the recovery of strength performance, while Madoni et al. ( 2018) found that FR had no effect on jump performance.

Conclusion

In conclusion, this meta-analysis illustrates that pre-rolling seems to be an effective strategy for short-term improvements in flexibility without decreasing muscle performance. The review has also shown that the improvement of sprint performance to be expected from the use of pre-rolling, as well as the recovery rate of the performance measures of speed and strength with post-rolling, are significant enough to be relevant for at least elite athletes. The underlying mechanisms, however, remain elusive and the effects are in part contradictory. While the effects of FR on muscle function were less clear, the positive effects of alleviating muscle soreness with a larger body of evidence endorse the utilization of post-rolling. As psychological aspects play an important role in most sports, the fact that an athlete feels less pain after pre-rolling might be sufficient to justify its use despite the absence of measurable physiological benefits (Poppendieck et al., 2016). In addition, the almost complete absence of side effects might favor recovery-supporting FR intervention.

However, since the physiological mechanisms of the potential benefits of FR are not fully understood, care should be taken by athletes and coaches, particularly when considering that potential harmful side effects are also suggested when FR is applied (Freiwald et al., 2016). Further, it must be noted that in the available studies, different FR intervention protocols (e.g., different FR devices) were combined with different types of fatigue-inducing exercises and outcome measures, making it difficult to compare the results. In addition, there are not enough high-quality and well-designed studies on FR to draw any definite conclusions. Finally, due to the heterogeneity of the methodological designs among the included studies, there is no consensus on the optimal FR intervention (i.e., in terms of treatment time, pressure, and cadence, etc.). The existing literature thus provides some evidence to support the utilization of FR interventions in sports practice. However, the limited evidence should be considered prior to integrating foam rolling as a warm-up activity and/or a recovery tool.

Author Contributions

TW and AD searched and reviewed studies, extracted and analyzed the data, and drafted and proofed the manuscript. CS contributed to data collection, statistical analyses, and reviewed the manuscript. LH reviewed and edited the manuscript. TM, MK, MP, and AF directed the project and contributed to discussion as well as reviewed and edited the manuscript.

Conflict of Interest Statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Footnotes

Funding. The current meta-analysis was initiated and funded by the German Federal Institute of Sport Science. The research was realized within REGman-Optimization of Training and Competition: Management of Regeneration in Elite Sports (IIA1-081901/17-20). Moreover, we acknowledge support by the DFG Open Access Publication Funds of the Ruhr University Bochum.

References

Behm D. G. (2018). The Science and Physiology of Flexibility and Stretching : Implications and Applications in Sport Performance and Health. Routledge. Available online at: https://www.routledge.com/The-Science-and-Physiology-of-Flexibility-and-Stretching-Implications/Behm/p/book/9781138086913 (accessed March 6, 2019).

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Articles from Frontiers in Physiology are provided here courtesy of Frontiers Media SA

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A Meta-Analysis of the Effects of Foam Rolling on Performance and Recovery

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Foam rolling is thought to improve muscular performance and flexibility as well as to alleviate muscle fatigue and soreness. For this reason, foam rolling has become a popular intervention in all kinds of sport settings used to increase the efficiency ...

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https://www.theseus.fi/bitstream/handle/10024/342677/Kompressiotuotteiden%20vaikutus%20ty%c3%b6hyvinvointiin%20ja%20palautumiseen.pdf?sequence=2&isAllowed=y

https://www.theseus.fi/bitstream/handle/10024/137981/launonen_tiia_ryynanen_noora_sipponen_salla.pdf;jsessionid=F49DAC469C7DC31A0F682C5496BDD092?sequence=1

Tuotelistaus
https://www.zpcompression.com/fi/shop_fi/

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www.terveurheilija.fi
www.selkakanava.fi
www.ukkinstituutti.fi
www.teamfysiopt.fi

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https://terveurheilija.fi/ajankohtaista/loppuverryttelyn-hyodyt-onko-niita/

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Usein väitetään, että suorituksen jälkeen tehtävä loppuverryttely nopeuttaa palautumista ja estää seuraavien päivien lihaskipuja. Tutkimusnäyttö näiden väitteiden taustalla on toistaiseksi vähäistä tai olematonta. Miksi sitten loppuverryttely kannattaa tai ei kannata tehdä? Päivitimme tietoa verryttelystä ja palautumisesta verkkosivuillemme.

Useimmat urheilijat ovat tottuneet tekemään harjoituksista ja kilpailuista palautumisen nopeuttamiseksi loppuverryttelyn (jäähdyttely). Tutkimusnäyttö loppuverryttelyn vaikutuksista suorituskyvyn tai palautumisen edistämiseen on kuitenkin vähäistä.

Loppuverryttelyillä on mahdollista lisätä matalatehoisen aerobisen liikunnan ja esimerkiksi liikkuvuus- ja liikehallintaharjoitusten määrää vuositasolla. Siksi loppuverryttely kannattaa useimmissa tapauksissa sisällyttää harjoituksiin.

Loppuverryttelyn tarvetta ja hyödyllisyyttä kannattaa pohtia yksilöllisesti suorituksen vaatimukset ja käytettävissä oleva palautumisajan pituus huomioiden. Kilpaurheilijoiden tarpeet voivat olla erilaiset kuin kuntoliikkujien.

Infograafi (pdf)

Miksi ja miten kannattaa jäähdytellä?

Kun kovatehoisten suoritusten välissä on vain hetki, jäähdyttelyllä ja liikkeessä pysymisellä voidaan ylläpitää lihasten verenkiertoa, edistää laktaatin poistumista lihaksista ja siten mahdollisesti edistää seuraavaan suoritukseen palautumista.

Loppuverryttely kannattanee tehdä ainakin kovatehoisen harjoituksen tai kilpailun jälkeen.

Loppuverryttelyn kesto kannattaa pitää kohtuullisena (yleensä alle 30 minuuttia), jotta sillä ei merkittävästi hidasteta glykogeenivarastojen täyttymistä.

Loppuverryttely on yksi hyvä tapa lisätä matalatehoisen harjoittelun määrää ja hyvä hetki lisätä liiketaito- ja/tai liikkuvuusharjoittelua.

Vinkkejä loppuverryttelyyn:

Sisällytä loppuverryttelyyn harjoituksessa kuormitettujen lihasryhmien dynaamista, matalatehoista liikettä.

Vältä voimakasta iskutusta ylimääräisten lihasvaurioiden ja -kipujen estämiseksi.

Sisällytä toiminnallisia liikkuvuusharjoitteita staattisten venyttelyiden sijasta.

Loppuverryttely on hyvä hetki myös liiketaitoharjoittelulle. Liiketaitoja kannattaa harjoitella välillä myös väsyneessä tilassa.

Huomioi harjoituksen kokonaiskuormitus. Jäähdyttelyn tarkoitus ei ole aiheuttaa tarpeetonta lisäkuormitusta.

Tutustu päivitettyihin sisältöihin osioissa Lämmittely ja jäähdyttely sekä Palautuminen.

Asiantuntija: Piia Kaikkonen, LitT

Lähde: Van Hooren B., Peake JM. Do We Need a Cool-Down After Exercise? A Narrative Review of the Psychophysiological Effects and the Effects on Performance, Injuries and the Long-Term Adaptive Response. Sports Med 2018;48:1575-1595.

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Loppuverryttelyn hyödyt - onko niitä? - Terveurheilija

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Useimmat urheilijat ovat tottuneet tekemään harjoituksista ja kilpailuista palautumisen nopeuttamiseksi loppuverryttelyn (jäähdyttely). Tutkimusnäyttö loppuverryttelyn vaikutuksista suorituskyvyn tai palautumisen edistämiseen on kuitenkin vähäistä. Loppuverryttelyillä on mahdollista lisätä matalatehoisen aerobisen liikunnan ja esimerkiksi liikkuvuus- ja liikehallintaharjoitusten määrää vuositasolla. Siksi loppuverryttely kannattaa useimmissa tapauksissa sisällyttää harjoituksiin.

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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5999142/

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Sports Medicine (Auckland, N.z.)

Sports Med. 2018; 48(7): 1575-1595.

Abstract

It is widely believed that an active cool-down is more effective for promoting post-exercise recovery than a passive cool-down involving no activity. However, research on this topic has never been synthesized and it therefore remains largely unknown whether this belief is correct. This review compares the effects of various types of active cool-downs with passive cool-downs on sports performance, injuries, long-term adaptive responses, and psychophysiological markers of post-exercise recovery. An active cool-down is largely ineffective with respect to enhancing same-day and next-day(s) sports performance, but some beneficial effects on next-day(s) performance have been reported. Active cool-downs do not appear to prevent injuries, and preliminary evidence suggests that performing an active cool-down on a regular basis does not attenuate the long-term adaptive response. Active cool-downs accelerate recovery of lactate in blood, but not necessarily in muscle tissue. Performing active cool-downs may partially prevent immune system depression and promote faster recovery of the cardiovascular and respiratory systems. However, it is unknown whether this reduces the likelihood of post-exercise illnesses, syncope, and cardiovascular complications. Most evidence indicates that active cool-downs do not significantly reduce muscle soreness, or improve the recovery of indirect markers of muscle damage, neuromuscular contractile properties, musculotendinous stiffness, range of motion, systemic hormonal concentrations, or measures of psychological recovery. It can also interfere with muscle glycogen resynthesis. In summary, based on the empirical evidence currently available, active cool-downs are largely ineffective for improving most psychophysiological markers of post-exercise recovery, but may nevertheless offer some benefits compared with a passive cool-down.

Key Points

Many individuals regularly perform 5-15 min of low- to moderate-intensity exercises within approximately 1 h after their practice and competition (i.e., active cool-downs) in an attempt to facilitate recovery.

An active cool-down is largely ineffective at improving sports performance later during the same day when the time between successive training sessions or competitions is > 4 h. It is most likely ineffective at improving sports performance during the next day(s), but some beneficial effects have been observed.

An active cool-down does likely not attenuate the long-term adaptive response or prevent injuries.

Introduction

It is widely assumed that promoting physiological and psychological recovery after exercise allows individuals to perform better during subsequent training sessions or competition, and lowers the risk of injuries. Various recovery interventions are therefore used to facilitate recovery after exercise. The best known and most widely used post-exercise recovery intervention is (arguably) the active cool-down, which is also known as an active recovery or warm-down. Several surveys show that many team sport players and athletes participating in individual sports regularly perform 5-15 min of low- to moderate-intensity exercises within approximately 1 h after their practice and competition to facilitate recovery [ 1- 8]. For example, a recent survey among collegiate athletic trainers in the USA found that 89% of the trainers recommended a cool-down, with 53% of these trainers recommending jogging as the preferred active cool-down method [ 1]. There is currently no formal definition of an active cool-down; here, we define it as an activity that involves voluntary, low- to moderate-intensity exercise or movement performed within 1 h after training and competition. Examples of active cool-down interventions and their suggested effects are shown in Fig. 1 . The effects of recovery interventions such as cold-water immersion [ 9, 10], compression garments [ 11, 12], and cryotherapy [ 13, 14] have been reviewed extensively. By contrast, the active cool-down has never been thoroughly reviewed. It remains largely unknown whether an active cool-down offers any benefits compared with a passive cool-down (i.e., no cool-down), and thus whether it is an appropriate or effective recovery intervention.

The primary aim of this review is to synthesize the evidence as to whether an active cool-down enhances sports performance more effectively than a passive cool-down when performance is measured after approximately > 4 h after the initial exercise. This review also compares the physiological and psychological effects of an active cool-down to a passive cool-down, and discusses the effects of an active cool-down on injuries and the long-term adaptive responses to exercise training. The value of static stretching and foam rolling as cool-down interventions is briefly discussed in separate sections because these interventions are both frequently performed in combination with an active cool-down.

Methods

There are various passive cool-down interventions such as sitting rest, saunas, pneumatic leg compression, and electrostimulation (see Table 1 for an overview) [ 15- 23]. However, most non-elite athletes do not have access to a sauna or equipment for the other interventions, and most practitioners also lack the necessary knowledge about how best to apply these interventions (partly because of a lack of evidence-based guidelines). Even elite team sport players do not always have access to these recovery interventions when they play away games [ 24]. In the current review, we have therefore only included studies that have compared an active cool-down with a passive cool-down that consists of sitting, lying, or standing (without walking). Active cool-downs that combine exercise with cold water immersion [ 25] are also excluded. We have also restricted the review to studies that have investigated the effects of performing an active cool-down within approximately 1 h after exercise, because findings from a recent survey suggest that this most closely replicates the cool-down procedure of many recreational and professional athletes [ 7]. Studies that have applied an active recovery for several days after exercise are only discussed if they have (1) applied the active recovery within 1 h after exercise (i.e., active cool-down) and (2) evaluated recovery before applying the active recovery on the next day. Finally, we primarily focus on how active cool-downs influence performance and psychophysiological variables during successive exercise sessions or competitions [i.e., approximately > 4 h after exercise, or during the next day(s)]. This type of recovery has also been referred to as 'training recovery' [ 26]. Studies that have investigated the effects of active recovery between bouts of exercise with relatively short rest periods (e.g., 20 min) are excluded from the review. As such, the findings of this review will be of primary interest to athletes and practitioners who regularly use an active cool-down to facilitate recovery between training sessions or competitions, but are interested in what evidence exists that supports the use of an active cool-down compared with a passive cool-down. Relevant studies have been searched in the electronic databases of Google Scholar and Pubmed using combinations of keywords and Booleans that included (cool-down OR active recovery OR warm-down) AND (sports performance OR recover OR recovery OR physiological OR physiology OR psychological OR psychology OR injury OR injuries OR long-term adaptive response OR adaptation). Forward citation and reference lists of relevant articles were examined, and databases with e-published ahead of print articles from relevant journals were searched to identify additional articles.

Table 1

Sitting, standing, or lying rest

Cold-water immersion

Sauna

Hot-water immersion

Massage

Contrast-water therapy

Pneumatic leg compression

Cryotherapy

Peristaltic pulse dynamic compression

Crycompression therapy

External counterpulsation therapy

Flotation Restricted Environmental Stimulation

Compression garments

Hyperbaric oxygen therapy

Intermittent negative pressure

Foam rolling a

Vascular occlusion

Static stretching a

Local or whole-body vibration therapy

Neuromuscular electrical stimulation

Ultrasound therapy

Sustained heat treatment

Photo-/light-emitting diodes therapy

Effects on Sports Performance

In principle, better psychophysiological recovery following exercise may attenuate or prevent performance decrements-or even enhance performance-during a subsequent training session or competition [ 27]. The following sections discuss the effects of an active cool-down on measures of physical performance such as vertical jump height and sprint performance measured later during the same day or during the next day(s).

Same-Day Performance

Elite athletes often train or compete more than once a day, so recovery interventions between training sessions or events may help to restore exercise performance. This section only discusses studies that have investigated the effects of an active cool-down after at least 4 h of rest between training sessions or competitions to reflect the effects of an active cool-down on 'training recovery' [ 26].

Relatively few studies have investigated the benefits of active cool-downs on performance measured > 4 h after exercise, and these studies generally found trivial (statistically non-significant effects), and sometimes even small (non-significant) detrimental effects of an active cool-down on performance [ 15, 28- 30] (Table  2 ). For example, Tessitore et al. [ 28] compared a 20-min active cool-down (consisting of either land-based or water-based aerobic exercises and stretching) with a passive cool-down following a standardized soccer training in elite youth players. After a 4-h rest period, the athletes performed several anaerobic performance tests. Both active cool-down protocols had trivial to small (negative) non-significant effects on anaerobic performance, such as 10-m sprint time and vertical jump height. In a later study on futsal players, similar cool-down interventions also had trivial to small (negative) non-significant effects anaerobic sports performance measured 4.5 h after a friendly match compared with a passive cool-down [ 29]. Therefore, whereas active recovery generally does benefit sports performance when the time between successive performances is short (10-20 min) [ 31- 35], the findings from the studies above indicate overall that an active cool-down does not improve sports performance later on the same day when time between successive performances is > 4 h and may even have small detrimental effects. However, more research on the effects of active cool-downs following others forms of exercise is needed.

Table 2

Study

Participants (mean age ± standard deviation)

Fatiguing exercise

Active cool-down duration, modality, and intensity

Interval between end cool-down and subsequent performance (h)

Outcome measures

Results (% difference; ± 90% CIs for between-group comparison [when available], qualitative description of the probability and effect magnitude)*

Same day performance

Cortis et al. [ 15]

8 military men (21.9 ± 1.3 years)

Incremental running test

16 min shallow water-aerobic exercises at 60% HR max and 4 min stretching

4.5

CMJ

Pre-afternoon training: 0.0%, trivial
Post-afternoon training: 0.0%, trivial

VO ₂ at various running velocities

6 km/h: − 5.1%, small
8 km/h: 4.7%, small
10 km/h: − 3.1%, small
12 km/h: − 5.6%, small

Tessitore et al. [ 28]

12 young professional male soccer players (18.1 ± 1.2 years)

100 min standardized soccer training

16 min low-intensity dry-aerobic exercises and 4 min stretching or 16 min shallow water exercises and 4 min stretching

4

SJ

Dry: − 1.2%, trivial
Water: 1.5%, trivial

Tessitore et al. [ 29]

10 male futsal players (23 ± 2 years)

1 h futsal game

16 min low-intensity dry-aerobic exercises and 4 min stretching or 16 min shallow water exercises and 4 min stretching

4.5

CMJ

Dry: − 2.8%, small
Water: − 4.6%, small

Reader et al. [ 30]

8 male and 1 female elite weightlifters (26.5 ± 4.8 years)

Olympic weightlifting exercises and various derivatives such as back squat and push press

15 min supervised rowing ergometer at 1 W/kg body weight and stroke frequency of < 20/min

4.25

CMJ

Session 1-2: − 4.6; ± 3.2%, likely small
Session 3-4: 1.7; ± 3.9%, unclear, possibly trivial

Next day performance

Vanderthommen et al. [ 36]

19 healthy men (23.4 ± 2.1 years)

3 × 25 isometric contractions of the knee extensors at 60 55 and 50% of MVC

25 min pedaling on stationary bicycle at 60 rpm (approx. 50% HR max)

24

MVC

4.7; ± 8.0%, unclear, possibly small

Peak torque at 60˚/s

− 7.5%, small

Rey et al. [ 38]

31 professional male soccer players (23.5 ± 3.4 years)

45 min standardized soccer training

20 min low-intensity exercises (12 min running at 65% maximum aerobic velocity and 8 min stretching)

24

CMJ

6.6; ± 5.3%, unclear, likely moderate

20-m sprint

− 0.6; ± 3.5%, unclear, possibly trivial

Balsom agility test

− 0.7; ± 0.7%, likely trivial

Lane and Wenger [ 39]

10 physically active men (26.3 ± 6.3 years)

18-min intermittent cycling protocol

15 min cycling at 30% VO 2max

24

Work completed during a cycling protocol

1.7%, trivial

Takahashi et al. [ 40]

10 male long-distance runners (20 ± 1 years)

3 sets of 5-min downhill treadmill running at a speed corresponding to their individual best 5000 m time

30 min of aqua exercises (walking, jogging, jumping)

24

Muscle power of leg extensors in leg press

15; ± 12%, unclear likely moderate

Whole-body reaction time

− 2.4%, trivial

Dawson et al. [ 41]

17 Western Australian Football League (WAFL) players (24.2 ± 2.9 years)

Football matches

15 min of pool walking

14

6-s cycle sprint peak power

3.2; ± 2.7%, likely small

6-s cycle sprint time to peak power

− 2.7%, small

6-s cycle sprint total work

3%, small

CMJ

8.1; ± 6.7%, unclear likely moderate

King and Duffield [ 42]

10 trained female netball players (19.5 ± 1.5 years)

4 × 15 min intermittent-sprint exercise circuit

15 min low-intensity exercise at 40% of maximum aerobic speed

24

5 CMJs in 20 s

Pre-exercise: − 25%, small
Post-exercise: − 29%, small

Wahl et al. [ 43]

20 male sport students (24.4 ± 2.2 years)

300 ×  maximal effort CMJs

30 min aqua biking at 65-75 rpm

24, 48, and 72

MVIC

24 h: 4.0% †, small
48 h: 2.2% †, trivial
72 h: 3.1% †, small

Repetitions with 30% MVIC

24 h: 4.7% †, trivial
48 h: 14% †, small
72 h: 11% †, trivial

20-m sprint

− 18%, moderate

Marquet et al. [ 45]

11 world-class elite BMX riders (7 male, 4 female; 20.9 ± 2.1 years)

High-intensity interval training and maximum intensity resistance training

Pedaling at 70% VO 2max for 2 × 5 min separated by 5 min passive recovery

Next day, but hours are not reported

Maximum power

Pre-training: 0.2%, trivial
Post-training: 1.7%, trivial

Maximum cadence

Pre-training: − 2.1%, trivial
Post-training: − 0.8; ± 0.6%, most likely trivial

MVIC

9.7%, trivial

Vertical jump

Significant improvement by 2.5 cm in active cool-down compared to deterioration by 1 cm in passive cool-down at 24 h. Difference remained significant at 48 h

3 30-m sprints

0.22 s (5%) slower in passive cool-down group at 24 h and 0.6 s at 48 h

Sprint-fatigue test (7 30-m sprints with 20 s rest)

At 48 h, mean performance was not significantly different from baseline in active cool-down group

Crowther et al. [ 25]

34 recreationally active males (27 ± 6 years)

3 × 15 min simulated team-game circuit

14 min jogging at 35% of peak speed obtained during maximum sprints ††

24 and 48

Time on repeated-sprint test

24 h: 0.4; ± 1.4%, unclear, possibly trivial
48 h: − 0.9; ± 1.8%, possibly trivial

CMJ relative peak power (best jump)

24 h: − 1.9; ± 1.6%, likely trivial
48 h: − 0.6; ± 1.4%, very likely trivial

CMJ relative peak power (average of jumps)

24 h: − 2.2; ± 1.7%, possibly trivial
48 h: − 1.2; ± 1.6%, likely trivial

Reader et al. [ 30]

8 male and 1 female elite weightlifters (26.5 ± 4.8 years)

Olympic weightlifting exercises and various derivatives such as back squat and push press

15 min supervised rowing ergometer at 1 W/kg body weight and stroke frequency of < 20/min

16

CMJ

Session 2-3: − 0.32; ± 4.4%, likely trivial
Session 4-after: 0.92; ± 3.5%, possibly trivial

Next-Day(s) Performance

Conflicting findings have been reported with regard to the effects of an active cool-down on next-day(s) performance, with some studies reporting small to moderate magnitude benefits of an active cool-down compared with a passive cool-down, and others reporting trivial effects or small decreases (Table  2 ) [ 25, 30, 39- 49]. Most studies, however, report trivial effects, with some studies reporting beneficial effects and only a few studies reporting harmful effects. For example, a study on sport students found that an aqua cycling active cool-down had small to trivial effects on recovery of maximum voluntary isometric contraction (MVIC) force and muscular endurance at 24, 48, or 72 h post-exercise compared with a passive cool-down [ 45]. In contrast, in a group of female netball players, a 15-min active cool-down consisting of low-intensity running resulted in a moderate magnitude decrease of 20-m sprint time and a small decrease in vertical jump height 24 h after a simulated netball game compared with a passive cool-down [ 44]. Interestingly, a study on well-trained long-distance runners found that muscle power (as measured during a leg press movement) was likely higher 1 day after downhill running in the group that performed a water-based active cool-down compared with the group that performed a passive cool-down, while whole-body reaction time showed a small decrease [ 40]. Finally, a study on professional soccer players found that an active cool-down had a likely beneficial effect on countermovement jump performance 24 h after a standardized training session, while 20-m sprint and agility performance showed small harmful and trivial effects, respectively [ 50]. Overall, these conflicting findings may be related to the type of cool-down performed, the exercise that precedes the cool-down, the training experience of the individuals and the individual preferences and believes. It should be noted that all studies investigated high-intensity performances such as jumping and sprinting and more research is required on endurance performance.

Physiological Effects of an Active Cool-Down

An active cool-down is believed to have many physiological benefits compared with a passive cool-down, such as a faster recovery of heart rate, less muscle soreness, and more rapid reduction of metabolic by-products [ 7]. The evidence for these supposed physiological benefits is reviewed in the following sections.

Removal of Metabolic By-Products

High-intensity exercise can lead to an accumulation of metabolic by-products in muscle such as lactate, which has traditionally been associated with fatigue [ 51]. As a result, the rate at which the lactate concentration is reduced in blood-and to a lesser extent, muscle tissue-has frequently been used as an objective indicator of recovery from exercise. A large body of research has shown that a variety of low- to moderate-intensity active cool-down protocols are more effective than a passive cool-down for removing lactate from blood [ 52- 69] and muscle tissue [ 58, 64]. However, there are some conflicting findings, with some studies reporting no significant difference-and sometimes even a slower removal of lactate in blood [ 44, 70] or muscle [ 66, 68]-as a result of an active cool-down. Regardless, the functional benefit of faster lactate removal is debatable. For example, several studies found no significant difference between an active cool-down and a passive cool-down in the blood lactate concentration measured more than 20 min after exercise [ 45, 67]. Blood lactate returns to resting levels after high-intensity exercise within approximately 20-120 min-even without any post-exercise activity [ 55, 60, 71]. Even elite athletes do not usually perform another training session within 90 min after the preceding session; faster removal of lactate by an active cool-down may therefore be largely irrelevant [ 72]. A decrease in blood lactate concentration may also not be an appropriate indicator of recovery following exercise [ 51, 72]. Among those studies that have reported a faster removal of blood lactate following an active cool-down, subsequent exercise performance was not always improved [ 67, 72].

In summary, compared with a passive cool-down, an active cool-down generally leads to a faster removal of blood lactate when the intensity of the exercise is low to moderate. However, the practical relevance of this effect is questionable. Lactate is not necessarily removed more rapidly from muscle tissue with an active cool-down. Finally, an active cool-down leads to a faster recovery of pH to resting levels.

Delayed-Onset Muscle Soreness

An active cool-down increases the blood flow to muscles and skin [ 58, 75] (see Sect.  4.8). This increase in blood flow may reduce the accumulation of metabolic by-products and factors associated with muscle soreness (e.g., cyclo-oxygenase and glial cell line-derived neurotrophic factor [ 76]) and accelerate muscle repair and remodeling. Several studies have investigated whether an active cool-down does indeed attenuate delayed-onset muscle soreness. It should be noted, though, that some studies [ 40, 45, 48, 77, 78] used exercise protocols that induce severe delayed-onset muscle soreness, but are seldom used in everyday athletic training. Therefore, the findings of these studies do not necessarily apply to 'normal' training sessions that induce less delayed-onset muscle soreness.

Most studies among both recreationally active individuals and professional athletes have found no significant effect of an active cool-down on delayed-onset muscle soreness or tenderness at different times following exercise (i.e., ranging from immediately after exercise up to 96 h after exercise) compared with a passive cool-down [ 15, 25, 29, 40, 41, 45, 46, 48, 49, 77- 80]. For example, Law and Herbert [ 77] compared the effects of an active cool-down consisting of uphill walking versus a passive cool-down on delayed-onset muscle soreness in healthy adults following backwards downhill walking on an incline treadmill (to induce muscle damage). The active cool-down did not significantly reduce delayed-onset muscle soreness or tenderness at 10 min, 24, 48 or 72 h following exercise. Interestingly, a study on netball players found that an active cool-down consisting of low-intensity running after a simulated netball match actually resulted in greater muscle soreness immediately after the active cool-down compared with a passive cool-down, but there was no significant difference 24 h after the match [ 44]. The running cool-down itself may have caused extra muscle damage, resulting in the higher rating of muscle soreness immediately after the cool-down. Higher impact weight-bearing cool-down activities such as running may therefore exacerbate delayed-onset muscle soreness immediately after exercise, but more research is required to substantiate this notion.

In contrast with the studies above, another study involving young professional soccer players reported that the mean subjective rating of muscle soreness was significantly lower 4-5 h after an active cool-down consisting of low-intensity exercises such as jogging compared with a passive cool-down [ 28]. Interestingly, there was no significant difference in muscle soreness compared with a passive cool-down when these same exercises were performed in water, suggesting that any hydrostatic effects of water immersion did not reduce muscle soreness. Similarly, a study on world-class BMX riders found that an active cool-down consisting of 2 × 5 min of cycling at 70% of the maximum aerobic power reduced muscle soreness during the next day when compared with a passive cool-down [ 47]. It could be argued that these conflicting findings are related to differences in the physical fitness of the individuals. For example, the netball players were not as highly trained as the soccer players and BMX riders. For non-elite athletes, an active cool-down therefore generally has no effect on delayed-onset muscle soreness, whereas it may have a beneficial effect for better trained individuals. However, other studies among well-trained individuals have also reported no beneficial effects of active cool-down on delayed-onset muscle soreness [ 29, 41, 80], while a study among student soccer players reported beneficial effects of an active cool-down combined with stretching and a 'leg shake down' on muscle soreness [ 42]. These findings suggest that other factors such as the intensity and duration of the exercise and cool-down, and the timing of soreness assessment may also influence the effectiveness. In summary, these findings indicate that an active cool-down is generally not effective for reducing delayed-onset muscle soreness following exercise.

Indirect Markers of Muscle Damage

The perception of muscle soreness does not necessary reflect actual muscle damage [ 81, 82]. Therefore, even though an active cool-down is generally not effective for reducing delayed-onset muscle soreness, it may have beneficial effects on other markers of muscle damage.

Studies that have investigated the effects of an active cool-down on indirect markers of muscle damage from immediately after exercise up to 84 h after exercise have reported conflicting findings. Two studies observed significantly faster recovery of these markers as a result of an active cool-down [ 70, 83], whereas three other studies found no significant difference [ 40, 45, 84]. For example, Gill et al. [ 83] reported a significantly faster recovery of creatine kinase activity in interstitial fluid in elite rugby players between 1 and 4 days after a rugby match combined with a cycling-based active cool-down compared with a passive cool-down. By contrast, a study comparing an aqua-cycling active cool-down and a passive cool-down in sport students found no significant difference in serum creatine kinase and lactate dehydrogenase activity, or myoglobin concentrations at 4, 24, 48, or 72 h after exercise [ 45]. These conflicting findings may be related to differences in the severity of muscle damage induced by exercise, the individual markers of muscle damage, and the type of cool-down protocol. It should be noted that frequently used indirect markers of muscle damage (e.g., creatine kinase activity) may not accurately reflect actual muscle damage [ 85- 88]. Malm et al. [ 85] suggested that serum creatine kinase activity is more related to muscle adaptation than to muscle damage. Therefore, it is debatable whether a faster recovery of these indirect markers accurately reflects enhanced recovery.

Measures of strength and power are also frequently used as indirect markers of muscle damage. A study on untrained females found no significant effect of an active cool-down consisting of upper body ergometry on the recovery of the MVIC and peak torque 24 h after eccentric exercise of the elbow flexors [ 48]. Similar results were found in other studies on sport science students [ 45], physically active men [ 43], and healthy men [ 49]. However, most studies usually reported a slightly (non-significant) better recovery compared with the passive cool-down group (Table  2 ).

In summary, there are conflicting findings with regard to the effects of an active cool-down on indirect markers of muscle damage, with most studies reporting no significant beneficial effect of an active cool-down. Moreover, the relation of some of these markers with actual muscle damage is questionable-that is, a faster recovery of these markers does not necessarily correspond to a faster reduction in actual muscle damage.

Neuromuscular Function and Contractile Properties

High-intensity exercise can induce central and peripheral fatigue, which may impair exercise performance during subsequent training or competition. Compared with a passive cool-down, Lattier et al. [ 89] did not find a significant effect of an active cool-down consisting of 20 min of running on the recovery of neuromuscular function (e.g., central activation, twitch mechanical, and M-wave characteristics) up to 65 min after high-intensity exercise. Similarly, a study on professional soccer players found no significant effect of an active cool-down consisting of combined low-intensity running and static stretching on muscular contractile properties such as biceps femoris contraction time and maximal radial displacement time (as measured by tensiomyography) 24 h after exercise [ 80]. Finally, an active cool-down consisting of aqua exercises also did not significantly affect whole-body reaction time, muscle contraction time or nerve reaction time in long-distance runners 24 h after exercise [ 40].

In summary, these findings indicate that an active cool-down does not significantly affect the recovery of neuromuscular function or contractile properties. However, in all studies there were generally small but non-significant positive effects of the active cool-down recovery on the recovery of neuromuscular function and contractile properties.

Stiffness and Range of Motion

Damage to musculotendinous tissue as a result of exercise-specifically eccentric exercise-can increase the stiffness of the musculotendinous unit. This stiffness can persist for several days following exercise [ 90]. The increased passive musculotendinous stiffness can reduce the range of motion during subsequent training or competition [ 90], and this may impair performance. Researchers and trainers frequently use perceived flexibility and measures of flexibility such as the sit-and-reach test to assess recovery [ 91]. Another common belief for using an active cool-down is that it attenuates the decrease in range of motion [ 7] and increase in musculotendinous stiffness following exercise.

The scientific evidence available suggests that an active cool-down does not significantly attenuate the decrease in range of motion and perceived physical flexibility, or attenuate the increase in musculotendinous stiffness up to 72 h after exercise [ 25, 40, 41, 45, 50, 67, 92]. Takahashi et al. [ 40] found that an active cool-down consisting of 30 min of water exercises did not significantly affect sit-and-reach score, ankle range of motion, stride length, or calf and thigh musculotendinous stiffness measured 1 day after 3 × 5 min of downhill running. Similarly, a study among professional soccer players found no significant effect of an active cool-down consisting of 12 min submaximal running combined with 8 min of static stretching on lower limb flexibility 24 h after a standardized training program (consisting of 15 min of maximal intensity intermittent exercises and a 30 min of specific aerobic endurance drill) [ 50].

In summary, these findings indicate that an active cool-down does not attenuate the decrease in range of motion or the increase in musculotendinous stiffness following exercise.

Muscle Glycogen Resynthesis

High-intensity exercise can deplete muscle glycogen storage, and this can impair subsequent high-intensity exercise performance up to 24 h post-exercise [ 93]. Strategies that enhance the resynthesis of glycogen may therefore attenuate the decrease in performance and even enhance performance. Athletes often consume carbohydrates after exercise. An active cool-down may theoretically enhance glycogen resynthesis, because an increased blood flow and elevated muscle temperature could increase glucose delivery to muscle tissue [ 94], while muscle contraction may increase the expression of the GLUT-4 glucose transporter. However, studies have found either no significant difference in the rate of glycogen resynthesis between an active cool-down and passive cool-down [ 58, 66, 95], or less glycogen resynthesis during an active cool-down [ 64, 68, 96- 98]. During the active cool-down, these studies provided no carbohydrate [ 58, 64, 66, 68, 95], less carbohydrate [ 96], or more carbohydrate [ 97, 98] than what is recommended (1.2 g/kg/h [ 99]) for restoring muscle glycogen. Therefore, these findings suggest that an active cool-down may interfere with muscle glycogen resynthesis, particularly within type I muscle fibers [ 64], because these fibers are preferentially recruited during a low- to moderate-intensity active cool-down. Although this effect may be beneficial to enhance cellular responses and adaptation during a subsequent low- to moderate- intensity training (i.e., 'train low' [ 100]), it may also decrease performance during high-intensity training or competition. It should be noted that several studies applied active cool-downs for a duration that is rarely used in daily practice (e.g., 45 min up to 4 h) [ 64, 66, 96- 98]. For example, Kuipers et al. compared glycogen resynthesis between a passive cool-down and an active cool-down in which participants cycled for 2.5 h at 40% of their maximum workload [ 97], or 3 h at 40% of their maximum workload [ 64, 66, 96, 98]. In contrast, studies that reported no significant (but also lower) difference in the rate of glycogen resynthesis between an active cool-down and passive cool-down usually applied shorter active cool-down durations (i.e., 10, 15, and 45 min [ 58, 66, 95]), suggesting that shorter active cool downs interfere less with glycogen resynthesis.

Recovery of the Immune System

During the recovery period from high-intensity or prolonged exercise, there can be a temporary depression of the immune system (also referred to as an 'open window') during which microbial agents such as viruses have an increased chance to cause an infection or illness [ 101]. A faster recovery of the immune system following exercise can potentially reduce the chance of upper respiratory illnesses. A small number of studies have investigated the effects of an active cool-down on the recovery of the immune system up to 72 h after exercise.

In summary, these findings suggest that an active cool-down may partially prevent the depression of circulating immune cell counts immediately after exercise, but this effect is probably negligible > 2 h after exercise. No studies have investigated the effects of regular active cool-downs, so it remains unknown whether this leads to fewer illnesses.

Cardiovascular and Respiratory Variables

The cardiovascular and respiratory systems are highly active during exercise to supply the exercising muscles with blood and oxygen. These systems do not immediately return to resting levels after exercise, but remain activated for a considerable amount of time. For example, heart rate remains slightly elevated above resting heart rate for a relatively long time after exercise, with the exact period dependent on the intensity and duration of the exercise [ 104]. An active cool-down is frequently performed in an attempt to restore normal activity of these systems after exercise [ 7].

In a comparison between a passive cool-down and two cycling-based active cool-down protocols, Takahashi and Miyamoto [ 104] found that heart rate initially recovered in a nearly identical way, but 10 min after the exercise (3 min after the active cool-down), heart rate was significantly lower for the active cool-down interventions. A later study confirmed these findings, and suggested that this response to active cool-down reflected a faster restoration of vagal and sympathetic tone [ 105]. In one additional subject, it was shown that the heart rate following a passive cool-down was still higher 30 min after exercise than the resting heart rate, whereas it had returned to resting levels after the active cool-down [ 104]. By contrast, other studies found a slower heart rate recovery during an active cool-down compared with a passive cool-down. Nevertheless, these studies only monitored the heart rate for 60 s [ 106] or 5 min [ 107, 108] after exercise, and the practical relevance of these findings with regard to 'training recovery' is therefore limited.

An active cool-down has also been reported to lead to a faster recovery of respiratory variables such as minute expiratory ventilation, although this primarily occurred during the initial 20 s of the cool-down [ 109]. Other studies found a lower breathing frequency (non-significant) after an active cool-down [ 105] and a faster recovery of oxygen debt during an active cool-down [ 55].

Finally, the period right after exercise can be considered as a vulnerable period during which individuals can experience post-exercise syncope, with symptoms such as lightheadedness, tunnel vision, and blurred vision [ 110]. In severe circumstances, individuals may lose consciousness completely during this post-exercise period. It has been suggested that an active cool-down may prevent post-exercise syncope and cardiovascular complications by: (1) increasing blood flow to the heart and brain due to the contractions of the muscles [ 108, 110], (2) decreasing blood pooling in the lower extremities [ 104], and (3) theoretically preventing an increase in the partial pressure of arterial carbon dioxide [ 111]. Indeed, an active cool-down has been reported to result in a higher blood flow to the legs [ 58, 104] and forearm [ 75], but whether these effects prevent post-exercise syncope and cardiovascular complications remains unknown.

In summary, these findings suggest that an active cool-down may result in a faster recovery of the cardiovascular and respiratory system after exercise. However, it is unknown whether this also leads to a reduction in the incidence of post-exercise syncope and cardiovascular complications.

Sweat Rate and Thermoregulation

Hormone Concentrations

It has been proposed that the rate at which hormone concentrations return to resting levels can be used to characterize physiological stress [ 43] and psychological recovery [ 29]. The findings of four studies suggest that an active cool-down does not facilitate the recovery of hormone concentrations compared with a passive cool-down [ 29, 43, 64, 102]. A study on well-trained futsal players, for example, found no significant effect of an active cool-down on hormone concentrations measured 5 h after a futsal game or measured the next morning [ 29]. An active cool-down consisting of uphill treadmill running actually resulted in a slower acute restoration of plasma adrenaline, noradrenaline and cortisol concentrations compared with a passive cool-down [ 102]. However, from 30 min post-exercise onwards, there were no significant differences in the hormone concentrations. The relevance of this finding is therefore questionable. A later study reported similar findings, with the hormonal concentrations returning more slowly to resting levels compared with a passive cool-down, but there was no significant difference beyond 30 min post-exercise [ 64]. Finally, Taipale et al. [ 43] reported that an active cool-down consisting of 10 × 10 repetitions of leg press at 30% of the 1 repetition maximum did not result in significant between-group differences for several hormonal concentrations during the next morning.

In summary, these findings suggest that an active cool-down may result in a slower recovery of hormone concentrations immediately after exercise, but does not significantly affect the recovery of hormonal concentrations beyond 30 min post-exercise compared with a passive cool-down. In support of this, plasma concentrations for several hormones have been reported to return to resting levels within 60-120 min post-exercise even with a passive cool-down [ 117].

Mood State, Self-Perception, and Sleep

Most research has investigated the physiological effects of an active cool-down and a passive cool-down, yet psychological effects are intimately linked to the physiological effects, and are also of major importance for performance. A recent systematic review even proposed that subjective measures of well-being better reflect training loads than do objective measures [ 118]. Therefore, the psychological effects of an active cool-down are also important to consider in relation to recovery.

Most studies have not reported any significant effect of an active cool-down on measures of psychological recovery such as the score on the Profile of Mood States (POMS) or rest-Q sport questionnaire. Nevertheless, the participants usually perceived an active cool-down as more beneficial than a passive cool-down [ 15, 25, 29, 30, 39, 41, 46, 47, 67, 119]. For example, a study among well-trained futsal players reported that the players perceived the active cool-down consisting of low-intensity exercises on land and especially the active cool-down consisting of water-based exercises as more beneficial than a passive cool-down-even though there was no significant effect on the recovery-stress state and the amount of sleep [ 29]. Another study among military men also did not demonstrate any significant effect of an active cool-down consisting of water exercises on sleep, rest-recovery score or rating of perceived exertion during submaximal exercise after a 6-h rest period [ 15]. However, the participants in this study did rate the water-based active cool-down as more beneficial than the passive cool-down. Interestingly, a study on sport students found no significant difference between a passive cool-down and an aqua-cycling active cool-down for perceived physical state 4, 24, 48, or 72 h after performing 300 countermovement jumps, but the perceived physical fitness and energy were slightly lower 24 h after the active cool-down [ 45]. Similarly, a study on recreational netball players reported that rating of perceived exertion was significantly higher following a 15-min running-based active cool-down compared with a passive cool-down [ 44]. These findings possibly reflect the greater energy expenditure associated with an active cool-down versus a passive cool-down. By contrast, a study among 15 rugby players found that the 'tension' score on the POMS questionnaire was significantly lower two days after a rugby match in the group that performed a 1-h active cool-down once a day compared with another group that performed a passive cool-down [ 84]. However, there was no significant effect on any of the other POMS scores, and no significant difference on the day after the match, when only one active cool-down session was performed. These findings imply that an active cool-down can potentially interfere with psychological recovery in untrained or recreationally trained individuals, whereas it likely has no (or a slight) positive effect on psychological recovery in better trained individuals. In support of this, even though most individuals perceive an active cool-down as more beneficial, some (recreationally active) individuals may perceive it as 'more exercise' or increasing stiffness [ 25]. This may explain why elite rugby players rated an active cool-down as more effective than amateur rugby players in a recent survey [ 6].

In summary, an active cool-down generally does not substantially influence measures of psychological recovery after exercise, but most individuals nevertheless perceive an active cool-down as more beneficial than a passive cool-down. Reasons reported for doing an active cool-down include relaxation, socializing and time to reflect on the training or match [ 7]. Not all of these aspects are specifically assessed with the POMS and rest-Q. Therefore, it is debatable whether questionnaires such as the POMS and rest-Q sport do adequately assess psychological recovery. However, the perceived benefit could also reflect a placebo effect, whereby individuals believe that the active cool-down is more beneficial than a passive cool-down due to the popularity in society and its proposed benefits. Cook and Beaven [ 27] for example found a correlation between the perception of the effectiveness of a recovery modality and subsequent performance that was of similar magnitude to the correlation observed between physiological recovery and performance, suggesting that the perception of a recovery modality can also have a major influence on its effects.

Long-Term Effects of an Active Cool-Down

All studies discussed so far have investigated the acute or short-term (< 1 week) effects of an active cool-down and a passive cool-down. In the following two sections we discuss the long-term effects of an active cool-down on injuries and the adaptive response.

Injury Prevention

An active cool-down can theoretically reduce the risk of injuries during a subsequent training session, because a better recovery may result in less neuromuscular fatigue (see small, non-significant positive effects in Sect.  4.4) and thereby decrease injury risk. Only a few studies have investigated the effects of an active cool-down on injuries, and this has usually been investigated in combination with stretching and a warm-up. In three prospective cohort studies on runners, regular use of a cool-down did not significantly reduce the incidence of running injuries [ 120- 122]. In another prospective study on runners, a health education intervention program consisting of a warm-up, cool-down, and stretching exercises also did not significantly reduce the incidence of running injuries [ 123]. However, a potential confounder in this study was that most participants in the control group also already performed these practices of their own volition. Finally, performing a regular cool-down after exercise was also not significantly associated with a reduction in injuries among triathletes [ 124] or with finishing a marathon versus not finishing a marathon in recreational runners [ 125]. In contrast with the evidence from the studies above, a study on dance aerobics instructors found a significant association between the duration of the cool-down and the number of injuries. Specifically, the group performing a 15-min cool-down showed a lower injury rate than the 5- and 10-min cool-down groups [ 126], but no control group was included for comparison. Therefore, a cool-down generally does not affect injury rates, although more research is required to investigate the effects of the type of cool-down, its duration, and the type of sport.

Long-Term Adaptive Response

Exercise stimulates the release of various biochemical messengers that activate signaling pathways, which in turn regulate molecular gene expression that elicits an adaptive response [ 100]. Some recovery interventions such as antioxidant supplementation, nonsteroidal anti-inflammatory drugs, and cold-water immersion can influence signaling pathways, thereby attenuating the long-term adaptive response to exercise [ 100, 127, 128]. For example, several studies have shown that cold-water immersion after each training session reduces blood flow and influences signaling pathways, thereby leading to reduced gains in muscular strength and endurance compared to an active cool-down or passive cool-down [ 129- 133]. Similarly, chronic intake of some antioxidants can also have a harmful effect on mitochondrial biogenesis and performance [ 100, 127, 134]. Preliminary evidence suggests that an active cool-down consisting of 15 min moderate-intensity jogging does not attenuate the long-term adaptive response in well-trained intermittent sport athletes [ 135]. Interestingly, the group that regularly performed an active-cool down after training even obtained a higher anaerobic lactate threshold after 4 weeks of training compared with the passive cool-down group. This could be related to the extra training volume completed during an active cool-down. However, conflicting evidence for the attenuating effects of other recovery modalities such as cold-water immersion has been reported [ 136], and more research investigating the effects of an active cool-down on the long-term adaptive response with other exercise modalities (e.g., following strength training and using swimming or cycling during the active cool-down) and populations (e.g., untrained individuals, elderly) is therefore required.

Combination with Other Recovery Interventions

This review has focused on the effects of an active cool-down consisting of low-intensity exercises such as cycling or running on measures of sports performance, psychophysiological recovery, injuries, and the long-term adaptive response. However, most individuals usually perform a combination of recovery interventions, and this combination may have different effects than an active cool-down in isolation. Two recovery interventions that are frequently performed in combination with an active cool-down are stretching and, more recently, foam rolling. The effects of these cool-down interventions are briefly discussed in the following sections.

Static Stretching

Stretching-especially static stretching-is frequently incorporated in an (active) cool-down [ 15, 28, 29, 42] (Table  2 ). For example, a study among recreational marathon runners reported that 64% of the runners performed stretching after training [ 122]. Another survey on elite adolescent athletes found that 23% of the Asian and 68% of the UK athletes used stretching after a training session [ 91]. Finally, a survey among collegiate athletic trainers in the USA found that 61% recommended static stretching to be included as a recovery method after exercise [ 1]. Surveys among coaches from other sports report similar results [ 2, 3, 5, 137].

Stretching is usually performed to reduce muscle soreness and increase range of motion. Many practitioners also believe that stretching reduces the risk of injuries and improves performance [ 1, 3- 5]. Contrary to common belief, however, static stretching performed either before or after exercise does not reduce muscle soreness [ 41, 138]. Although stretching can reduce muscle stiffness (when performed as constant-torque stretching [ 139]) and increase the range of motion [ 67], these effects are also not always in the athlete's interest. Long-distance runners with a better running economy are (for example) actually less flexible, and increasing flexibility can potentially negatively affect running economy [ 72, 140]. Finally, although static stretching may have some effects on strain injuries [ 141], an increasing body of research suggests that it has little to no effect on the prevention of degenerative injuries [ 140]. Therefore, although stretching is historically a widely practiced cool-down activity, it may not necessarily aid recovery from exercise.

Foam Rolling

Conclusions and Practical Applications

Although there are many proposed benefits of an active cool-down compared with a passive cool-down (Fig. 1 ), this review shows that only a few of these benefits are supported by research (Fig. 2 ). Most importantly, we have provided evidence that an active cool-down generally does not improve and may even negatively affect performance later during the same day when the time between successive training sessions or competitions is > 4 h. Similarly, an active cool-down has likely no substantial effects on next-day(s) sports performance, but can potentially enhance next-day(s) performance in some individuals (Table  2 ). With regard to the long-term effects, a cool-down does likely not prevent injuries, and preliminary evidence suggests that an active cool-down after every training sessions does not attenuate and may even enhance the long-term adaptive response.

Several psychophysiological mechanisms are believed to underlie the potential beneficial effects of an active cool-down. This review shows that an active cool-down does generally lead to a faster removal of lactate in blood, but the practical relevance of this findings is questionable, especially because lactate is not necessarily removed faster from muscle tissue and because lactate may not be the cause of metabolic acidosis. Furthermore, an active cool-down can partially prevent the depression of circulating immune cells counts after exercise. However, it is unknown whether this also leads to fewer infections and illnesses. An active cool-down can also result in a faster recovery of the cardiovascular and respiratory system after exercise, but it remains unknown whether this leads to a reduction in the number of post-exercise syncopes and cardiovascular complications. In contrast, an active cool-down generally does not significantly reduce delayed-onset muscle soreness or improve the recovery of indirect markers of muscle damage. It also does not significantly alter the recovery of the neuromuscular and contractile properties, improve range of motion, or attenuate musculotendinous stiffness following exercise, and may even interfere with glycogen resynthesis. Furthermore, an active cool-down does generally not significantly facilitate the recovery of hormonal concentrations, and it also does not affect measures of psychophysiological recovery. However, most individuals nevertheless perceive an active cool-down as more beneficial than a passive cool-down. The effectiveness of an active cool-down may differ depending on the individual preferences and beliefs; recovery interventions should therefore be individualized [ 28, 30]. Some athletes may benefit more from an active cool-down, whereas others may prefer to perform no cool-down at all.

The mode, intensity, and duration of a cool-down and activity preceding the cool-down will likely influence the effectiveness of the cool-down on recovery and these effects may also differ between individuals. It is therefore difficult to recommend one optimal active cool-down protocol for all individuals in all situations. Some general guidelines can, however, be provided. An active cool-down should: (1) involve dynamic activities performed at a low to moderate metabolic intensity to increase blood flow, but prevent development of substantial additional fatigue; (2) involve low to moderate mechanical impact to prevent the development of (additional) muscular damage and delayed-onset muscle soreness; (3) be shorter than approximately 30 min to prevent substantial interference with glycogen resynthesis; and (4) involve exercise that is preferred by the individual athlete. Some evidence also suggests that an active cool-down should involve the same muscles as used during the preceding activity [ 145].

More research is required to investigate the differences between different active cool-down interventions (e.g., land-based vs. water-based active cool-downs), the effects of different exercise protocols that precede the cool-down, and the effect of active cool-downs in various populations (e.g., elderly). It is also important to consider that most studies have investigated the effects on untrained or recreationally trained individuals, because the detrimental effects of training are easier to induce (to show greater effects of recovery interventions). These findings may not necessarily transfer to better trained athletes. Finally, several studies have used protocols that are rarely used in daily practice and more research is required on practical active cool-downs and the effects of active cool-downs on endurance performance.

Acknowledgements

The authors would like to thank Björn Ekblom from the Swedish School of Sport and Health Sciences for his comments on a preliminary version of this manuscript, Will Hopkins from Victoria University for his suggestions on the statistical analysis of the data in Table 2, and Bianca Cattelini contracted through the Queensland Academy of Sport for her assistance with the infographic.

Author contributions

BVH conceived the study and wrote the first draft of the manuscript. JMP provided suggestions, revisions, and edits.

Compliance with ethical standards

Conflicts of interest

Bas Van Hooren and Jonathan Peake declare that they have no conflicts of interest.

Funding

The Open Access fee was paid by Maastricht University. No other funding was received for this manuscript.

References

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135. Wiewelhove T, Schneider C, Schmidt A, Raeder C, Döweling A, Ferrauti A (eds). Regular active recovery during a high-intensity interval-training mesocycle does not attenuate training adaptation. In: 22nd Annual congress of the European College of Sport Science; 2017; Bochum, Germany.

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Do We Need a Cool-Down After Exercise? A Narrative Review of the Psychophysiological Effects and the Effects on Performance, Injuries and the Long-Term Adaptive Response

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Sports Medicine (Auckland, N.z.) Sports Med. 2018; 48(7): 1575-1595. It is widely believed that an active cool-down is more effective for promoting post-exercise recovery than a passive cool-down involving no activity. However, research on this topic has never been synthesized and it therefore remains largely unknown whether this belief is correct.

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https://www.suomenlatu.fi/ulkoile/lajit/talviuinti/talviuinnin-terveysvaikutukset.html

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Suomen Reumaliitto ry Iso Roobertinkatu 20-22 A 00120 Helsinki (09) 476 155 etunimi.sukunimi@reumaliitto.fi Y-tunnus 0201969-6 Tietosuoja- ja saavutettavuusselosteet

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