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Tom Clifford

Exercise-induced muscle damage (EIMD) manifests as muscle soreness, inflammation, and reductions in force generating capacity that can last for several days after exercise. The ability to recover and repair damaged tissues following EIMD is impaired with age, with older adults (≥50 years old) experiencing a slower rate of recovery than their younger counterparts do for the equivalent exercise bout. This narrative review discusses the literature examining the effect of nutritional or pharmacological supplements taken to counter the potentially debilitating effects of EIMD in older adults. Studies have assessed the effects of nonsteroidal anti-inflammatory drugs, vitamin C and/or E, or higher protein diets on recovery in older adults. Each intervention showed some promise for attenuating EIMD, but, overall, there is a paucity of available data in this population, and more studies are required to determine the influence of nutrition or pharmacological interventions on EIMD in older adults.

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Bethany Northeast and Tom Clifford

This systematic review and meta-analysis examined the effects of creatine supplementation on recovery from exercise-induced muscle damage, and is reported according to the PRISMA guidelines. MEDLINE and SPORTDiscus were searched for articles from inception until April 2020. Inclusion criteria were adult participants (≥18 years); creatine provided before and/or after exercise versus a noncreatine comparator; measurement of muscle function recovery, muscle soreness, inflammation, myocellular protein efflux, oxidative stress; range of motion; randomized controlled trials in humans. Thirteen studies (totaling 278 participants; 235 males and 43 females; age range 20–60 years) were deemed eligible for analysis. Data extraction was performed independently by both authors. The Cochrane Collaboration Risk of Bias Tool was used to critically appraise the studies; forest plots were generated with random-effects model and standardized mean differences. Creatine supplementation did not alter muscle strength, muscle soreness, range of motion, or inflammation at each of the five follow-up times after exercise (<30 min, 24, 48, 72, and 96 hr; p > .05). Creatine attenuated creatine kinase activity at 48-hr postexercise (standardized mean difference: −1.06; 95% confidence interval [−1.97, −0.14]; p = .02) but at no other time points. High (I2; >75%) and significant (Chi2; p < .01) heterogeneity was identified for all outcome measures at various follow-up times. In conclusion, creatine supplementation does not accelerate recovery following exercise-induced muscle damage; however, well-controlled studies with higher sample sizes are warranted to verify these conclusions. Systematic review registration (PROSPERO CRD42020178735).

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William Abbott, Adam Brett, Emma Cockburn, and Tom Clifford

Purpose: To examine whether consuming casein protein (CP) before sleep would enhance recovery after a nighttime soccer match in professional players. Methods: In a randomized, crossover design, 10 professional soccer players from the reserve squad of a team in the highest tier of English soccer consumed 40 g of CP or 40 g of carbohydrates (CON) 30 min presleep after a soccer match (kick off: 7 PM). To assess recovery, countermovement-jump height, reactive strength index, muscle soreness, and the adapted Brief Assessment of Mood (BAM+) Questionnaire were measured before and 12, 36, and 60 h after each match. Dietary intake across the testing period was also recorded. Results: There were unclear differences in external load in the matches and dietary intake between CON and CP. Casein protein had a most likely and likely beneficial effect on countermovement-jump recovery at 12 and 36 h postmatch (CP −1.6; ±1.2% vs CON −6.6; ±1.7%; −4.1; ±2.3% vs −0.4; ±1.1%, respectively). Reactive strength index recovery was most likely enhanced with CP at 12 and 36 h postmatch, and muscle soreness, as measured with a visual analog scale (in millimeters), was most likely greater in CON versus CP at 12 h postmatch (72; ±17 vs 42; ±20 mm). BAM+ was possibly lower in CON at 36 h postmatch but unaffected at other time points. Conclusions: Presleep CP accelerates functional recovery in professional soccer players and, therefore, provides a practical means of attenuating performance deficits in the days after a match.

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Will Abbott, Callum Brashill, Adam Brett, and Tom Clifford

Purpose: To investigate the effects of tart cherry juice (TCJ) on recovery from a soccer match in professional players. Methods: In a double-blind, placebo-controlled, crossover design, 10 male professional soccer players from the reserve team of an English Premier League Club (age 19 [1] y, height 1.8 [0.6] m, body mass 77.3 [6.4] kg) consumed 2 × 30-mL servings of TCJ or an isocaloric cherry-flavored control drink (CON) before and after a 90-minute match and 12 and 36 hours after the match. Muscle function (countermovement jump height and reactive strength index), subjective well-being, and subjective muscle soreness were measured before and 12, 36, and 60 hours after each match. Results: Countermovement jump height was similarly reduced in the days after the match after TCJ and CON supplementation, with the greatest loss occurring at 12-hour postmatch (−5.9% [3.1%] vs −5.4% [2.9%], of baseline values, respectively; P = .966; η p 2 = .010 ). Decrements in reactive strength index were also greatest at 12-hour postmatch (TCJ −9.4% [8.4%] vs CON −13.9% [4.8%], of baseline values), but no group differences were observed at any time point (P = .097; η p 2 = .205 ). Muscle soreness increased 12- to 60-hour postmatch in both groups, peaking at 12-hour postmatch (TCJ 122 [27] mm vs CON 119 [22] mm), but no group differences were observed (P = .808; η p 2 = .024 ). No interaction effects were observed for subjective well-being (P = .874; η p 2 = .025 ). Conclusions: TCJ did not hasten recovery after a soccer match in professional players. These findings bring into question the use of TCJ as a recovery aid in professional soccer players.

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Tom Clifford, Will Abbott, Susan Y. Kwiecien, Glyn Howatson, and Malachy P. McHugh

Purpose : To examine whether donning lower-body garments fitted with cooled phase change material (PCM) would enhance recovery after a soccer match. Methods : In a randomized, crossover design, 11 elite soccer players from the reserve squad of a team in the second-highest league in England wore PCM cooled to 15°C (PCMcold) or left at ambient temperature (PCMamb; sham control) for 3 h after a soccer match. To assess recovery, countermovement jump height, maximal isometric voluntary contraction (MIVC), muscle soreness, and the adapted Brief Assessment of Mood Questionnaire (BAM+) were measured before 12, 36, and 60 h after each match. A belief questionnaire was completed preintervention and postintervention to determine the perceived effectiveness of each garment. Results : Results are comparisons between the 2 conditions at each time point postmatch. MIVC at 36 h postmatch was greater with PCMcold versus PCMwarm (P = .01; ES = 1.59; 95% CI, 3.9–17.1%). MIVC also tended to be higher at 60 h postmatch (P = .05; ES = 0.85; 95% CI, −0.4% to 11.1%). Muscle soreness was 26.5% lower in PCMcold versus PCMwarm at 36 h (P = .02; ES = 1.7; 95% CI, −50.4 to −16.1 mm) and 24.3% lower at 60 h (P = .04; ES = 1.1; 95% CI, −26.9 to −0.874 mm). There were no between-conditions differences in postmatch countermovement jump height or BAM+ (P > .05). The belief questionnaire revealed that players felt the PCMcold was more effective than the PCMamb after the intervention (P = .004). Conclusions : PCM cooling garments provide a practical means of delivering prolonged postexercise cooling and thereby accelerate recovery in elite soccer players.

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Kirsty M. Reynolds, Tom Clifford, Stephen A. Mears, and Lewis J. James

This systematic review analyzed whether carbohydrate source (food vs. supplement) influenced performance and gastrointestinal (GI) symptoms during endurance exercise. Medline, SPORTDiscus, and citations were searched from inception to July 2021. Inclusion criteria were healthy, active males and females aged >18 years, investigating endurance performance, and GI symptoms after ingestion of carbohydrate from a food or supplement, <60 min before or during endurance exercise. The van Rosendale scale was used to determine risk of bias, with seven studies having low risk of bias. A total of 151 participants from 15 studies were included in the review. Three studies provided 0.6–1 g carbohydrate/kg body mass during 5–45 min precycling exercise (duration 60–70 min) while 12 studies provided 24–80 g/hr carbohydrate during exercise (60–330 min). Except one study that suggested a likely harmful effect (magnitude-based inferences) of a bar compared to a gel consumed during exercise on cycling performance, there were no differences in running (n = 1) or cycling (n = 13) performance/capacity between food and supplemental sources. Greater GI symptoms were reported with food compared with supplemental sources. Highly heterogenous study designs for carbohydrate dose and timing, as well as exercise protocol and duration, make it difficult to compare findings between studies. A further limitation results from only one study assessing running performance. Food choices of carbohydrate consumed immediately before and during endurance exercise result in similar exercise performance/capacity responses to supplemental carbohydrate sources, but may slightly increase GI symptoms in some athletes, particularly with exercise >2 hr.

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Tom Clifford, Eleanor J. Hayes, Jadine H. Scragg, Guy Taylor, Kieran Smith, Kelly A. Bowden Davies, and Emma J. Stevenson

Purpose: This study examined whether a higher protein diet following strenuous exercise can alter markers of muscle damage and inflammation in older adults. Methods: Using a double-blind, independent group design, 10 males and eight females (age 57 ± 4 years; mass 72.3 ± 5.6 kg; height 1.7 ± 6.5 m) were supplied with a higher protein (2.50 g·kg−1·day−1) or moderate protein (1.25 g·kg−1·day−1) diet for 48 hr after 140 squats with 25% of their body mass. Maximal isometric voluntary contractions, muscle soreness, creatine kinase, Brief Assessment of Mood Adapted, and inflammatory markers were measured preexercise, and 24 hr and 48 hr postexercise. Results: The maximal isometric voluntary contractions decreased postexercise (p = .001, η p 2 = .421 ), but did not differ between groups (p = .822, η p 2 = .012 ). Muscle soreness peaked at 24 hr post in moderate protein (44 ± 30 mm) and 48 hr post in higher protein (70 ± 46 mm; p = .005; η p 2 = .282 ); however, no group differences were found (p = .585; η p 2 = .083 ). Monocytes and lymphocytes significantly decreased postexercise, and eosinophils increased 24 hr postexercise (p < 0.05), but neutrophils, creatine kinase, interleukin-6, C-reactive protein, monocyte chemotactic protein-1, and Brief Assessment of Mood Adapted were unchanged by exercise or the intervention (p > .05). Conclusion: In conclusion, 2.50 g·kg−1·day−1 of protein is not more effective than 1.25 g·kg−1·day−1 for attenuating indirect markers of muscle damage and inflammation following strenuous exercise in older adults.

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Malachy P. McHugh, Tom Clifford, Will Abbott, Susan Y. Kwiecien, Ian J. Kremenic, Joseph J. DeVita, and Glyn Howatson

Purpose: To assess the utility of an inertial sensor for assessing recovery in professional soccer players. Methods: In a randomized, crossover design, 11 professional soccer players wore shorts fitted with phase change material (PCM) cooling packs or uncooled packs (control) for 3 h after a 90-min match. Countermovement jump (CMJ) performance was assessed simultaneously with an inertial sensor and an optoelectric system: prematch and 12, 36, and 60 h postmatch. Inertial sensor metrics were flight height, jump height, low force, countermovement distance, force at low point, rate of eccentric force development, peak propulsive force, maximum power, and peak landing force. The only optoelectric metric was flight height. CMJ decrements and the effect of PCM cooling were assessed with repeated-measures analysis of variance. Jump heights were also compared between devices. Results: For the inertial sensor data, there were decrements in CMJ height on the days after matches (88% [10%] of baseline at 36 h, P = .012, effect size = 1.2, for control condition) and accelerated recovery with PCM cooling (105% [15%] of baseline at 36 h, P = .018 vs control, effect size = 1.1). Flight heights were strongly correlated between devices (r = .905, P < .001), but inertial sensor values were 1.8 [1.8] cm lower (P = .008). Low force during countermovement was increased (P = .031) and landing force was decreased (P = .043) after matches, but neither was affected by the PCM cooling intervention. Other CMJ metrics were unchanged after matches. Conclusions: This small portable inertial sensor provides a practical means of assessing recovery in soccer players.

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Liam D. Corr, Adam Field, Deborah Pufal, Jenny Killey, Tom Clifford, Liam D. Harper, and Robert J. Naughton

Polyphenol consumption has become a popular method of trying to temper muscle damage. Cocoa flavanols (CF) have attracted attention due to their high polyphenol content and palatability. As such, this study will investigate whether an acute dose of CF can aid recovery following exercise-induced muscle damage. The study was a laboratory-based, randomized, single-blind, nutrient-controlled trial involving 23 participants (13 females and 10 males). Participants were randomized into either control ∼0 mg CF (n = 8, four females); high dose of 830 mg CF (CF830, n = 8, five females); or supra dose of 1,245 mg CF (CF1245, n = 7, four females). The exercise-induced muscle damage protocol consisted of five sets of 10 maximal concentric/eccentric hamstring curls and immediately consumed their assigned drink following completion. To measure muscle recovery, maximal voluntary isometric contraction (MVIC) of the knee flexors at 60° and 30°, a visual analog scale (VAS), and lower-extremity function scale were taken at baseline, immediately, 24-, 48-, and 72-hr postexercise-induced muscle damage. There was a main effect for time for all variables (p < .05). However, no significant differences were observed between groups for all measures (p ≥ .17). At 48 hr, there were large effect sizes between control and CF1245 for MVIC60 (p = .17, d = 0.8); MVIC30 (p = .26, d = 0.8); MVIC30 percentage change (p = .24 d = 0.9); and visual analog scale (p = .25, d = 0.9). As no significant differences were observed following the consumption of CF, there is reason to believe that CF offer no benefit for muscle recovery when ingested acutely.