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Brendon P. McDermott, Douglas J. Casa, Susan W. Yeargin, Matthew S. Ganio, Lawrence E. Armstrong and Carl M. Maresh


To describe the current scientific evidence of recovery and return to activity following exertional heat stroke (EHS).

Data Sources:

Information was collected using MEDLINE and SPORTDiscus databases in English using combinations of key words, exertional heat stroke, recovery, rehabilitation, residual symptoms, heat tolerance, return to activity, and heat illness.

Study Selection:

Relevant peer-reviewed, military, and published text materials were reviewed.

Data Extraction:

Inclusion criteria were based on the article’s coverage of return to activity, residual symptoms, or testing for long-term treatment. Fifty-two out of the original 554 sources met these criteria and were included in data synthesis.

Data Synthesis:

The recovery time following EHS is dependent on numerous factors, and recovery length is individually based and largely dependent on the initial care provided.


Future research should focus on developing a structured return-to-activity strategy following EHS.

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Michael Kellmann, Dieter Altenburg, Werner Lormes and Jürgen M. Steinacker

Training stress and adequate recovery have been identified as important factors to enhance performance in sports and to avoid overtraining. Research dealing with training monitoring and overtraining is mostly based on the Profile of Mood Stales (POMS). Recently, Kellmann and Kallus (2000, 2001) published the Recovery-Stress-Questionnaire for Athletes (RESTQ-Sport), which assesses training effects from the perspective of stress and recovery. During a six-week training camp before and at the World Championships, 24 female and 30 male rowers of the German Junior National Rowing Team completed the RESTQ-Sport and the POMS six times. Results of selected MANOVA’s revealed significant increases of stress and decreases of recovery when training load expands, and vice versa. Changes in mood, creatine kinase, and ergometer performance reflect the alteration and success of training. These results suggest that the RESTQ-Sport is a potential alternative to the POMS in evaluating the impact of various training schedules.

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Eduard Kurz, Christoph Anders, Mario Walther, Philipp Schenk and Hans-Christoph Scholle

To judge a person’s maximum trunk extension performance as either age-appropriate or deconditioned is challenging. The current study aimed at determining age and anthropometrically adjusted maximum voluntary contraction (MVC) of back extensors considering the number and recovery time between trials. Thirty-one younger (20–30 years) and 33 older (50–60 years) healthy males performed five repetitions of maximal isometric trunk extensions in an upright standing position with randomized recovery times ranging between one to five minutes at one minute intervals. Torque values were normalized according to the individual’s upper body mass resulting in upper body torque ratios (UBTR). To evaluate the impact of age, recovery time, and fatigue on UBTR we applied a linear mixed-effects model. Based on surface EMG data muscular fatigue could be excluded for both groups. For all MVC trials, UBTR levels differed significantly between age groups (range of mean values: younger: 2.26–2.28, older: 1.78–1.87, effect size: 1.00) but were independent from recovery time. However, the older males tended to exert higher UBTR values after shorter recovery periods. The study provides normative values of anthropometrically and age-group adjusted maximum back extensor forces. For the investigated groups, only two MVC trials with a recovery time of about one minute seem appropriate.

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Anis Chaouachi, Monoem Haddad, Carlo Castagna, Del P. Wong, Fathi Kaouech, Karim Chamari and David G. Behm

The objective of this study was to examine the response and recovery to a single set of maximal, low and high angular velocity isokinetic leg extension-flexion contractions with boys. Sixteen boys (11–14 yrs) performed 10 isokinetic contractions at 60°.s−1 (Isok60) and 300°.s−1 (Isok300). Three contractions at both velocities, blood lactate and ratings of perceived exertion were monitored pretest and at 2, 3, 4, and 5 min of recovery (RI). Participants were tested in a random counterbalanced order for each velocity and recovery period. Only a single contraction velocity (300°.s−1 or 60°.s−1) was tested during recovery at each session to remove confounding influences between the recovery intervals. Recovery results showed no change in quadriceps’ power at 300°.s−1, quadriceps’ power, work and torque at 60°.s−1 and hamstrings’ power and work with 60°.s−1. There was an increase during the 2 min RI in hamstrings’ power, work and torque and quadriceps’

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Abd-Elbasset Abaïdia, Julien Lamblin, Barthélémy Delecroix, Cédric Leduc, Alan McCall, Mathieu Nédélec, Brian Dawson, Georges Baquet and Grégory Dupont


To compare the effects of cold-water immersion (CWI) and whole-body cryotherapy (WBC) on recovery kinetics after exercise-induced muscle damage.


Ten physically active men performed single-leg hamstring eccentric exercise comprising 5 sets of 15 repetitions. Immediately postexercise, subjects were exposed in a randomized crossover design to CWI (10 min at 10°C) or WBC (3 min at –110°C) recovery. Creatine kinase concentrations, knee-flexor eccentric (60°/s) and posterior lower-limb isometric (60°) strength, single-leg and 2-leg countermovement jumps, muscle soreness, and perception of recovery were measured. The tests were performed before and immediately, 24, 48, and 72 h after exercise.


Results showed a very likely moderate effect in favor of CWI for single-leg (effect size [ES] = 0.63; 90% confidence interval [CI] = –0.13 to 1.38) and 2-leg countermovement jump (ES = 0.68; 90% CI = –0.08 to 1.43) 72 h after exercise. Soreness was moderately lower 48 h after exercise after CWI (ES = –0.68; 90% CI = –1.44 to 0.07). Perception of recovery was moderately enhanced 24 h after exercise for CWI (ES = –0.62; 90% CI = –1.38 to 0.13). Trivial and small effects of condition were found for the other outcomes.


CWI was more effective than WBC in accelerating recovery kinetics for countermovement-jump performance at 72 h postexercise. CWI also demonstrated lower soreness and higher perceived recovery levels across 24–48 h postexercise.

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Christos K. Argus, James R. Broatch, Aaron C. Petersen, Remco Polman, David J. Bishop and Shona Halson


An athlete’s ability to recover quickly is important when there is limited time between training and competition. As such, recovery strategies are commonly used to expedite the recovery process.


To determine the effectiveness of both cold-water immersion (CWI) and contrast water therapy (CWT) compared with control on short-term recovery (<4 h) after a single full-body resistance-training session.


Thirteen men (age 26 ± 5 y, weight 79 ± 7 kg, height 177 ± 5 cm) were assessed for perceptual (fatigue and soreness) and performance measures (maximal voluntary isometric contraction [MVC] of the knee extensors, weighted and unweighted countermovement jumps) before and immediately after the training session. Subjects then completed 1 of three 14-min recovery strategies (CWI, CWT, or passive sitting [CON]), with the perceptual and performance measures reassessed immediately, 2 h, and 4 h postrecovery.


Peak torque during MVC and jump performance were significantly decreased (P < .05) after the resistance-training session and remained depressed for at least 4 h postrecovery in all conditions. Neither CWI nor CWT had any effect on perceptual or performance measures over the 4-h recovery period.


CWI and CWT did not improve short-term (<4-h) recovery after a conventional resistance-training session.

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Sebastian Altfeld, Clifford J. Mallett and Michael Kellmann

The development of burnout in the vocation of sports coaching is a process that can take months or even years. Unfortunately, there is a paucity of longitudinal examination of coaches’ burnout, stress, and recovery. The present study investigated burnout, stress, and recovery of full and part-time coaches to examine possible changes during the course of the season. Twenty-five full-time and 45 part-time active German coaches of different sports and competition levels completed the German coaches’ version of the MBI and the RESTQ for Coaches at three time points. Inferential statistical analysis revealed significant changes of full-time coaches’ stress and recovery scores over the course of the season. Moreover, the work hours per week were significantly higher at the end of the season. Post hoc analysis revealed that full-time coaches whose values of perceived success decreased over the season showed increased emotional stress and decreased recovery values. Part-time coaches reported consistent stress experiences. Consequently, findings suggest that full-time coaches experienced increased emotional stress, invested more time, and had insufficient recovery during the season. Thus, the results highlighted the significant role of recovery for full-time coaches and were particularly important to enhance the understanding of coaches’ work.

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Hugh H.K. Fullagar, Rob Duffield, Sabrina Skorski, Aaron J. Coutts, Ross Julian and Tim Meyer

While the effects of sleep loss on performance have previously been reviewed, the effects of disturbed sleep on recovery after exercise are less reported. Specifically, the interaction between sleep and physiological and psychological recovery in team-sport athletes is not well understood. Accordingly, the aim of the current review was to examine the current evidence on the potential role sleep may play in postexercise recovery, with a tailored focus on professional team-sport athletes. Recent studies show that team-sport athletes are at high risk of poor sleep during and after competition. Although limited published data are available, these athletes also appear particularly susceptible to reductions in both sleep quality and sleep duration after night competition and periods of heavy training. However, studies examining the relationship between sleep and recovery in such situations are lacking. Indeed, further observational sleep studies in team-sport athletes are required to confirm these concerns. Naps, sleep extension, and sleep-hygiene practices appear advantageous to performance; however, future proof-of-concept studies are now required to determine the efficacy of these interventions on postexercise recovery. Moreover, more research is required to understand how sleep interacts with numerous recovery responses in team-sport environments. This is pertinent given the regularity with which these teams encounter challenging scenarios during the course of a season. Therefore, this review examines the factors that compromise sleep during a season and after competition and discusses strategies that may help improve sleep in team-sport athletes.

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Daniel Hammes, Sabrina Skorski, Sascha Schwindling, Alexander Ferrauti, Mark Pfeiffer, Michael Kellmann and Tim Meyer

The Lamberts and Lambert Submaximal Cycle Test (LSCT) is a novel test designed to monitor performance and fatigue/recovery in cyclists. Studies have shown the ability to predict performance; however, there is a lack of studies concerning monitoring of fatigue/recovery. In this study, 23 trained male cyclists (age 29 ± 8 y, VO2max 59.4 ± 7.4 mL · min−1 · kg−1) completed a training camp. The LSCT was conducted on days 1, 8, and 11. After day 1, an intensive 6-day training period was performed. Between days 8 and 11, a recovery period was realized. The LSCT consists of 3 stages with fixed heart rates of 6 min at 60% and 80% and 3 min at 90% of maximum heart rate. During the stages, power output and rating of perceived exertion (RPE) were determined. Heart-rate recovery was measured after stage 3. Power output almost certainly (standardized mean difference: 1.0) and RPE very likely (1.7) increased from day 1 to day 8 at stage 2. Power output likely (0.4) and RPE almost certainly (2.6) increased at stage 3. From day 8 to day 11, power output possibly (–0.4) and RPE likely (–1.5) decreased at stage 2 and possibly (–0.1) and almost certainly (–1.9) at stage 3. Heart-rate recovery was likely (0.7) accelerated from day 1 to day 8. Changes from day 8 to day 11 were unclear (–0.1). The LSCT can be used for monitoring fatigue and recovery, since parameters were responsive to a fatiguing training and a following recovery period. However, consideration of multiple LSCT variables is required to interpret the results correctly.

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Ida A. Heikura, Louise M. Burke, Antti A. Mero, Arja Leena Tuulia Uusitalo and Trent Stellingwerff

We investigated one week of dietary microperiodization in elite female (n = 23) and male (n = 15) runners and race-walkers by examining the frequency of training sessions and recovery periods conducted with recommended carbohydrate (CHO) and protein availability. Food and training diaries were recorded in relation to HARD (intense or >90min sessions; KEY) versus RECOVERY days (other-than KEY sessions; EASY). The targets for amount and timing of CHO and protein around KEY sessions were based on current nutrition recommendations. Relative daily energy and CHO intake was significantly (p < .05) higher in males (224 ± 26 kJ/kg/d, 7.3 ± 1.4 g/kg/d CHO) than females (204 ± 29 kJ/kg/d, 6.2 ± 1.1 g/kg/d CHO) on HARD days. However, when adjusted for training volume (km), there was no sex-based difference in CHO intake daily (HARD: 0.42 ± 0.14 vs 0.39 ± 0.15 g/kg/km). Females appeared to periodize energy and protein intake with greater intakes on HARD training days (204 ± 29 vs 187 ± 35 kJ/kg/d, p = .004; 2.0 ± 0.3 vs 1.9 ± 0.3 g/kg/d protein, p = .013), while males did not periodize intakes. Females showed a pattern of periodization of postexercise CHO for KEY vs EASY (0.9 ± 0.4 vs 0.5 ± 0.3 g/kg; p < .05) while males had higher intakes but only modest periodization (1.3 ± 0.9 vs 1.0 ± 0.4; p = .32). There was only modest evidence from female athletes of systematic microperiodization of eating patterns to meet contemporary sports nutrition guidelines. While this pattern of periodization was absent in males, in general they consumed more energy and CHO daily and around training sessions compared with females. Elite endurance athletes do not seem to systematically follow the most recent sports nutrition guidelines of periodized nutrition.