Table 1.
Characteristics and results of the included reviews
| Review | Type | Studies included within review/N | Included endurance studies/N | Outcomes | |
|---|---|---|---|---|---|
| Heterogeneity (I2) | Main results | ||||
| Alcantara et al. [25] | Pas1,a | 11/194 | 1/8 | NR | No quantitative pooling: The effects of cow’s milk consumption on exercise performance and muscle function recovery were controversies and deprivation |
| Amiri et al. [26] | Pas1,c | 12 /130 | 8/82 |
TTE NR Serum lactate I2 = 0, p = 0.661 |
Pooled results: There was no effect of CM consumption on TTE, RPE, HR, serum lactate, and CK compared to placebo or other sports drinks (p > 0.05). Subgroup analysis: CM increased TTE (MD = 0.78 min; 95% CI 0.27 to 1.29; p = 0.003) and a significant decrease in serum lactate compared to placebo (MD = − 1.2 mmol/L; 95% CI − 2.06 to − 0.34; P = 0.006) |
| Ammar et al. [27] | Pas1,a | 11/274 | 5/112 | NR | No quantitative pooling: POM can potentially improve sports performance (endurance and strength), in antioxidant and anti-inflammatory effects before and after exercise, enhance cardiovascular response and accelerate recovery from high-intensity training |
| Bleakley et al. [28] | Pas3,c | 17/366 | 3/29 |
Muscle soreness 1 h, I2 = 2%, P = 0.41 24 h, I2 = 64%, P = 0.03 48 h, I2 = 57, P = 0.02 |
Pooled results: Muscle soreness showed statistically significant effects in favour of CWI after exercise at 24 h (SMD = − 0.55; 95% CI − 0.84 to − 0.27; 10 trials), 48 h (SMD = − 0.66; 95% CI − 0.97 to − 0.35; 8 trials), 72 h (SMD = − 0.93; 95% CI − 1.36 to − 0.51; 4 trials) and 96 h (SMD = − 0.58; 95% CI − 1.00 to − 0.16; 5 trials) follow-ups |
| Brown et al. [29] | Pas4,b | 23/348 | 8/132 |
Strength recovery I2 = 64%, p < 0.001 Resistance exercise I2 = 79%, p < 0.001 Metabolic I2 = 0%, p = 0.58 |
Pooled results: The greatest benefit from CG is the recovery of strength (ES = 0.62; 95% CI 0.39 to 0.84; p < 0.001) from 2 to 8 h ES = 1.14; 95% CI 0.72 to 1.56; p < 0.001) and 24 h (ES = 1.03; 95% CI 0.48 to 1.57; p < 0.001). Recovery with CG showed the greatest, very likely benefit at the 24 h (ES = 1.33; 95% 0.80 to 1.85; p < 0.001) time point after resistance exercise (ES = 0.49; 95% CI 0.37 to 0.61; p < 0.001). Recovery from metabolic exercise with CG improved cycling performance at 24 h (ES = 1.05; 95% CI 0.25 to 1.85; p = 0.01). In general, CG was most effective for long-term recovery, especially in 24 h recovery after training |
| Costello et al. [30] | Pas3,c | 4/64 | 1/9 |
Muscle soreness 1 h, I2 = 0%, p = 0.45 24 h, I2 = 64%, p = 0.06 48 h, I2 = 53%, p = 0.12 72 h, I2 = 87%, p = 0.005 |
Pooled results: There is insufficient evidence to determine whether utilized WBC reduces muscle soreness (pain at rest, VAS) compared to the control group. However, some evidence supports that WBC reduces muscle soreness at 1 h (SMD = − 0.77; 95% CI − 1.42 to − 0.12; p = 0.02; n = 20, 2 studies), 24 h (SMD = − 0.57, 95% CI − 1.48 to 0.33; p = 0.21; n = 38, 3 studies), 48 h (SMD = − 0.58, 95% CI − 1.37 to 0.21; p = 0.15; n = 38, 3 studies), and 72 h (SMD = − 0.65, 95% CI − 2.54 to 1.24; p = 0.50; n = 29, 2 studies) post-exercise |
| Davis et al. [31] | Pas2,c | 29/1012 | 5/204 |
Flexibility I2 = 90% DOMS I2 = 86% |
Pooled results: No evidence was found that massage improved the measures of strength, jump, sprint, endurance, or fatigue, but massage may improve flexibility (SMD = 1.07; 95% CI 0.21 to 1.93; p = 0.01; n = 246; studies = 7) and DOMS (SMD = 1.13; 95% CI 0.44 to 1.82; n = 311; p < 0.005; studies = 10) to some extent |
| Engel et al. [24] | Pas4,a | 32/494 | 24/361 | NR | No quantitative pooling: By wearing CG, runners can improve running economy, biomechanical variables, perception, muscle temperature, and variables related to endurance performance (i.e., TTE). Wearing CG can also result in less muscle pain, injury, and inflammation during recovery |
| Hendricks et al. [32] | Act6,a | 49/632 | 4/74 | NR | No quantitative pooling: FR has been shown to decrease muscle stiffness and DOMS and should be combined with dynamic stretching and an active warm-up before training. FR improves ROM and PPT. To achieve maximum flexibility, FR should be used for at least 90 to 120 s |
| Kloby Nielsen et al. [33] | Pas1,c | 43/326 | 22/231 |
TTE I2 = 33%, p = 0.06 TT I2 = 29%, p = 0.01 ≥ 8 h I2 = 5%, p = 0.35 |
Pooled results: When ingested CHO-PRO, a significant overall effect on TTE (MD = 3.62; 95% CI 0.44 to 6.79; p = 0.03) and TT (MD = − 1.50; 95% CI − 2.37 to − 0.63; p = 0.0007) performance compared to ingested CHO only. Subgroup analysis showed that long-term recovery (i.e., 8 h) consumed CHO-PRO significantly enhanced TTE compared to CHO only (MD = 10.59; 95% CI 4.18 to 17.01; p = 0.001); however, no effect was observed when less than 8 h |
| Lakićević [34] | Pro7,a | 12/127 | 3/31 | NR | No quantitative pooling: Alcohol consumption after resistance exercise does not affect biological, physical measures, and muscle function. However, if alcohol is consumed consistently during recovery this can lead to increased cortisol levels, decreased testosterone levels, and lower muscle protein synthesis rates, resulting in compromised long-term muscle adaptation |
| Loureiro et al. [35] | Pas1,a | 9/89 | 8/76 | NR | No quantitative pooling: Milk has no advantage over a combination of carbohydrates and protein in terms of muscle glycogen recovery and subsequent exercise performance. However, a milk drink with sufficient carbohydrate additions, such as chocolate milk, may be an option to improve performance as described above |
| Malta et al. [36] | Pas3,c | 8/470 | 2/43 | NR | Pooled results: Use of CWI has harmful effects on resistance training adaptations which include one-repetition maximum, maximum isometric strength, and strength endurance performance (SMD = − 0.60; 95% CI 0.87 to − 0.33; p < 0.0001), as well as on ballistic efforts performance (SMD = − 0.61; 95% CI − 1.11 to − 0.11; p = 0.02). On the other hand, selected studies verified no effect of CWI associated with endurance training on time-trial (mean power), maximal aerobic power in graded exercise test performance (SMD = − 0.07; 95% CI − 0.54 to 0.53; p = 0.71), or time-trial performance (duration) (SMD = 0.00; 95% CI − 0.58 to 0.58; p = 1.00) |
| McCartney et al. [37] | Pas1,c | 67/745 | 25/271 |
Mean power output (CHO + W vs. W) I2 = 43.9% Mean power output (PRO + CHO + W vs. W) I2 = 72.9% |
Pooled results: Ingesting CHO + W (102 ± 50 g CHO; 0.8 ± 0.6 g·CHO kg−1·h−1) improved exercise performance compared with W (1.6 ± 0.7 L) in mean power output (CHO + W vs. W, MD = 4.97; 95% CI 3.2 to 4.7; p = 0.000; n = 486). The enhancement was reduced when participants were ‘Fed’ (having a meal 2–4 h before the initial session) compared to being ‘Fasted’ (p = 0.012). Ingesting PRO + CHO + W (35 ± 26 g PRO; 0.5 ± 0.4 g PRO kg−1) did not have a significant impact on exercise performance compared to CHO + W (115 ± 61 g CHO; 0.6 ± 0.3 g CHO·kg body mass−1 h−1;1.2 ± 0.6 L) in mean power output (PRO + CHO + W vs. CHO + W, MD = 4.97; 95% CI − 0.5 to 1.6; p = 0.31; n = 125) CHO (and water) intake should be prioritized during and/or after the initial exercise session to enhance performance in subsequent tasks involving endurance and/or anaerobic activity. Protein intake is unlikely to be beneficial or detrimental to subsequent endurance exercise performance |
| Moore et al. [38] | Pas3,c | 52/1191 | 3/51 |
Muscular power 24 h, I2 = 0% 24 h HIIT, I2 = 74.6% CK 24 h, I2 = 58.6% Muscle soreness 24 h, I2 = 77.4% Perceived recovery 24 h HIIT, I2 = 34.3% |
Pooled results: CWI improved the recovery of muscular power 24 h after eccentric exercise (SMD = 0.34; 95% CI 0.06 to − 0.62; p = 0.018) and after high-intensity exercise (SMD = 0.22; 95% CI 0.004 to − 0.43; p = 0.046), and reduced serum CK (SMD = − 0.85; 95% CI − 1.61 to 0.08; p = 0.030) 24 h after high-intensity exercise. CWI also improved muscle soreness (SMD = − 0.89; 95% CI − 1.48 to 0.29; p = 0.003) and perceived feelings of recovery (SMD = 0.66; 95% CI 0.29 to 1.03; p = 0.001) 24 h after high-intensity exercise |
| Mota et al. [39] | Pas4,a | 21/411 | 15/324 | NR | No quantitative pooling: Wearing below-knee CS after exercise has been shown to increase actual performance in a few studies. On the other hand, wearing CS may benefit measures of lower muscle fatigue and muscle soreness several hours later (e.g., 48 h) |
| Murray and Cardinale [40] | Pas3,c | 17/221 | 1/10 |
Subjective I2 = 72.51%, p = 0.000 |
Pooled results: The effects of CWI on young athletes appear to be minimal or non-existent in the acute phase or the days following exercise (i.e., > 96 h). The current literature provides only a small number of studies describing acute and chronic responses to CWI and CWT in adolescent athletes. In adolescent athletes, the overall effect size of CWI is negligible. In terms of acute outcomes, the only significant benefit appears to be in subjective outcome measures (ES = 0.41; 95% CI − 0.12 to 0.94). Overall, it is difficult to draw clear conclusions |
| Ortiz et al. [41] | Act5,a | 26/471 | 8/104 | NR | No quantitative pooling: Active recovery results were generally inconsistent, making it difficult to draw particular conclusions. The review concludes that 6- to 10-min active recovery treatments had a persistent favorable effect on performance. The data are unclear about the optimal intensity of AR sessions; nevertheless, blood lactate clearance appears to be an unreliable indicator of recovery. According to the review, active recovery seems to have beneficial psychological effects |
| Poppendieck et al. [42] | Pas3,b | 21/216 | 2/23 | NR | Pooled results: All studies determined the effect of cooling on performance and calculated the effect size (g). The effect sizes from highest to lowest, were sprint performance (2.6%, g = 0.69; 95% CI 0.48 to 0.90; n = 186), endurance parameters of time trials (2.6%, g = 0.19; 95% CI − 0.09 to 0.47; n = 100), jump (3.0%, g = 0.15; 95% CI − 0.07 to 0.38; n = 157), and strength (1.8%, g = 0.10; 95% CI − 0.07 to 0.27; n = 267). On average, cooling had a negligible impact on recovery in trained athletes (2.4%, g = 0.28). This effect was most significant when evaluating performance 96 h after exercise (4.3%, g = 1.03). However, some studies contradict the finding that cooling produces beneficial effects |
| Poppendieck et al. [43] | Pas2,b | 22/270 | 3/40 | NR | Pooled results: Massage has a minor and mostly unknown influence on sports performance recovery. Massage seems most effective for short-term recovery periods of less than 10 min. Short recovery times of up to 10 min (+ 7.9%, g = 0.45) had a bigger impact than longer recovery periods (+ 2.4%, g = 0.08). Massages lasting less than 12 min (+ 1.0%, g = 0.06) had a higher effect (+ 6.6%, g = 0.34) than massages lasting more than 12 min (+ 1.0%, g = 0.06). In addition, massage is more effective after high-intensity mixed exercise (+ 14.4%, g = 0.61), but the effects were reduced after strength (+ 3.9%, g = 0.18) and endurance (+ 1.3%, g = 0.12) exercise. In addition, untrained athletes benefited more from massage (+ 2.3%, g = 0.17) than trained athletes (+ 6.5%, g = 0.23) |
| Ranchordas et al. [44] | Pas1,c | 50/1089 | 12/261 |
Muscle soreness 6 h, I2 = 53%, P = 0 24 h, I2 = 5%, P = 0.39 48 h, I2 = 47%, P = 0 72 h, I2 = 27%, P = 0.1 96 h, I2 = 31%, P = 0.11 |
Pooled results: Following DOMS, antioxidants did not result in clinically relevant reductions in muscle soreness at 6- (SMD = − 0.30; 95% CI − 0.56 to − 0.04; p = 0.03; n = 525; studies = 21), 24- (SMD = − 0.13; 95% CI − 0.27 to − 0.00; p = 0.05; n = 936; studies = 41), 48- (SMD = − 0.24; 95% CI − 0.42 to − 0.07; p = 0.01; n = 1047; studies = 45), 72- (SMD = − 0.19, 95% CI − 0.38 to − 0.00; p = 0.04; n = 657; studies = 28), and 96-h (SMD = − 0.05; 95% CI − 0.29 to 0.19; p = 0.68; n = 436; studies = 17) post-exercise. There is no evidence of subjective recovery and only limited evidence of the adverse effects of antioxidant supplements |
| Suhett et al. [45] | Pas1,a | 11/197 | 2/58 | NR | No quantitative pooling: Most studies have demonstrated that curcumin supplementation benefits athletes. Curcumin supplementation reduced inflammation, oxidative stress, pain, and muscle damage, enhanced recovery, and muscular performance, improved psychological and physiological (thermal and cardiovascular) responses during training, and improved gastrointestinal function |
Act, active recovery strategies; CG, compression garments; CHO, carbohydrates; CI, confidence interval; CK, creatine kinase; CM, chocolate milk; CS, compression stockings; CWI, cold-water immersion; CWT, contrast water therapy; DOMS, delayed onset muscle soreness; FR foam roller; g effect sizes (Hedges’ g); HIIT, high-intensity interval training; HR, heart rate; MD, mean difference; NR, not reported; Pas, passive recovery strategies; POM, pomegranate; Pro, proactive recovery strategies; PRO, protein; PPT, pressure pain threshold; ROM, range of motion; RPE, rate of perceived exertion; SMD, standardised mean difference; TT, time trial; TTE, time to exhaustion; VAS, visual analogue scale; W, water; WBC, whole-body cryotherapy
aSystematic review; bmeta-analysis; csystematic review and meta-analysis; 1supplements; 2massage; 3cryotherapy; 4compression garments; 5active recovery; 6foam roller; 7alcohol