Table 1.

Positive effects of PBM in physical activities.

No	References	Type of Study	Type of Light/Devices for Biostimulation	PBM Before/After Activity	Trial Protocol	PBM Characteristics	Total Energy (J) Applied	Types of Physical Activities	Stimulated Muscles	Time of Assessments	Analyzed Parameters	Brief Results
				Before
[11]	Antonialli, F.C.; De Marchi, T.; Tomazoni, S.S.; et al. Phototherapy in skeletal muscle performance and recovery after exercise: Effect of combination of super-pulsed laser and light-emitting diodes. Lasers Med. Sci. 2014, 29, 6, 1967–1976. doi:10.1007/s10103-014-1611-7.	RCT	Laser +LEDs	Pre-exercise PBM	Forty male healthy untrained volunteers	Twelve diodes (4 of 905 nm lasers = 0.3125 mW/each), 4 of 875 nm LEDs = 17.5 mW/each, and 4 of 670 nm LEDs = 15 mW/each.	10 J, 30 J, and 50 J or placebo	Eccentric exercise protocol to induce fatigue	Six sites on quadriceps	Before, 1 min, 1 h, 24 h, 48 h, 72 h, and 96 h	MVC DOMS CK	MVC ↑ (p < 0.05) immediately after to 96 h (best results) with 30 J dose. DOMS ↓ (p < 0.05) with 30 J dose from 24 h to 96 h after exercise DOMS ↓ (p < 0.05) with 50 J dose from immediately after to 96 h after exercise CK ↓ (p < 0.05) compared to placebo with all doses from 1 h to 96 h after exercise (except for 50 J dose at 96 h). Conclusion: Pre-exercise PBM (combined laser and LEDs), mainly with 30 J dose, significantly increases performance, decreases DOMS, and improves biochemical marker related to skeletal muscle damage.
[12]	Vanin, A.A.; De Marchi, T.; Tomazoni, S.S. et al. Pre-exercise infrared low-level laser therapy (810 nm) in skeletal muscle performance and postexercise recovery in humans. What is the optimal dose? A randomized, double-blind, placebo-controlled clinical trial. Photomed. Laser Surg. 2016, 34, 10, 473–482. doi:10.1089/pho.2015.3992.	RCT	Laser	Before	Twenty-eight high-level soccer athletes volunteer	Cluster with 5 diodes, 810 nm, 200 mW	10 J, 30 J, or 50 J on six sites, in total: 60 J 180 J 300 J	Eccentric exercise protocol	Six sites on quadriceps	Before exercise protocols, after 1 min, and 1, 24, 48, 72, and 96 h after the end of eccentric exercise protocol used to induce fatigue	MVC, DOMS, CK, and interleukin-6 (IL-6)	MVC ↑ after exercise to 24 h with 50 J MVC ↑ from 24 h to 96 h with 10 J dose PBM had no effect in decreasing DOMS. CK↓ and IL-6 ↓ with 10 J and 50 J (better results). No differences (p > 0.05) for 30 J dose in any of the measured results. Conclusion: Pre-exercise PBM, mainly with 50 J, significantly increases performance and improves biochemical markers related to skeletal muscle damage and inflammation.
[13]	Pinto, H.D.; Vanin, A.A.; Miranda E.F.; et al. Photobiomodulation therapy improves performance and accelerates recovery of high-level rugby players in field test: A randomized, crossover, double-blind, placebo-controlled clinical study. J. Strength Cond. Res. 2016, 30, 12, 3329–3338. doi:10.1519/JSC.0000000000001439.	COD	Laser diodes + LEDs	Before pre-exercise PBMT: 20 min before Bangsbo sprint test (BST).	Twelve males high-level rugby athletes	Cluster with 12 diodes (4 laser diodes of 905 nm, 4 light emitting diodes (LEDs) of 875 nm, and 4 LEDs of 640 nm IR + RED: 905 nm +875 nm + 640 nm	30 J per site (30 J × 17 = 510 J for each lower limb)	Three test phases, administered 1 week apart, were performed on the same day of the week (Tuesday) and time (1–5 PM)	Seventeen sites of each lower limb, i.e., quadriceps (9 points) Hamstrings (6 points) Triceps surae (2 points)	Bangsbo sprint test (BST) at familiarization phase (week 1); at weeks 2 and 3.	Perceived fatigue score (from a questionnaire); mean sprint time (ST-mean), best sprint time (ST-best) and fatigue index from Bangsbo sprint test (BST). Blood lactate levels were assessed at baseline, and at 3, 10, 30, and 60 min after BST.	Time of sprints (ST-mean) ↓ for PBMT Fatigue index during BST ↓ for PBMT Blood lactate levels ↓ in PBMT group Perceived fatigue was significantly lower in PBMT group comparatively with placebo (p ≤ 0.05). Conclusions: Pre-exercise PBMT with the combination of super-pulsed laser (low-level laser), red LEDs, and infrared LEDs can enhance performance and accelerate recovery of high-level rugby players in field test. This opens a new avenue for wide use of PBMT in real clinical practice in sports settings. Potential use of PBMT as a prophylactic strategy for performance and recovery enhancement of high-level athletes.
[14]	De Oliveira, A.R.; Vanin, A.A.; Tomazoni, S.S.; et al. Pre-exercise infrared photobiomodulation therapy (810 nm) in skeletal muscle performance and postexercise recovery in humans: What is the optimal power output? Photomed. Laser Surg. 2017, 35, 11, 595–603. doi:10.1089/pho.2017.4343.	RCT	Five IR laser diodes	Before the eccentric contraction protocol	Twenty-eight high-level soccer players	Cluster with 5 diodes, (810 nm) and output power of 100, 200, 400 mW per diode.	10 J/site Total = 300 J	PBMT or placebo before isokinetic exercise	Six sites of knee extensors (quadri-ceps)	Eccentric contractions of knee extensors	MVIC, DOMS, CK and LDH, inflammation (IL-1β, IL-6, and TNF-α), and oxidative stress (catalase, superoxide dismutase, carbonylated proteins, and thiobarbituric acid) were evaluated before isokinetic exercise, as well as at 1 min and at 1, 24, 48, 72, and 96 h, after the eccentric contraction protocol.	PBMT positive results for 100 mW (best) and 200 mW output power (p < 0.05): MVIC ↑ DOMS ↓ CK ↓ and LDH ↓ inflammation ↓ (IL-1β, IL-6, and TNF-α), and oxidative stress ↓. Conclusions: PBMT with 100 mW power output per diode (500 mW total) before exercise achieves best outcomes in enhancing muscular performance and post-exercise recovery. Higher output power is not preferable.
[15]	Rossato, M.; Dellagrana, R.A.; Sakugawa, R.L.; et al. Time response of photobiomodulation therapy on muscular fatigue in humans. J. Strength Cond. Res. 2018, 32, 11, 3285–3293. doi:10.1519/JSC.0000000000002339.	RCT	Laser/ LEDs	PBMT applied immediately before the test	Sixteen male volunteers (26 ± 6.0 years, 81 ± 12 kg, and 181 ± 7.4 cm)	Laser (850 nm), 5 diodes, 100 mW output power/each, spot size = 0.06 cm2, power density = 1666.6 mW/cm2; CW. Energy = 3.2 J/each. LED (670 nm), 12 diodes, 10 mW output power/each, spot size = 1.92 cm2; power density = 5.20 mW/cm2; CW. Energy = 0.3 J/each. LED (880 nm), 8 diodes, 25 mW output power/each, spot size = 1.28 cm2; power density = 19.53 mW/cm2; CW. Energy= 0.5 J/each. LED (950 nm), 8 diodes, 15 mW output power/each, 1.28 cm2; 11.71 mW/cm2; CW. Energy = 0.5 J/each.	30 J/site Total = 270 J	PBMT applied both 6 h before and immediately before the test.	Nine sites	Protocol in 5 sessions. Fatigue of knee extensors	Maximal isometric voluntary contraction (MIVC) was assessed before and after an isokinetic fatigue (45 flexion-extension concentric at 180°·s), associated with electromyography (root mean square [RMS] and median of frequency [MF]).	Peak torque during MIVC (pre to post) was reduced in 6 h before + immediately before treatment (26%) compared with control (33%), placebo (29%), and immediately before (32%). Conclusion: PBMT applied with 6 h + directly before exercises is capable to diminish the tiredness.
[16]	De Marchi, E.C.P.; Leal-Junior, K.C. Lando et al., “Photobiomodulation therapy before futsal matches improves the staying time of athletes in the court and accelerates post-exercise recovery,” Lasers Med. Sci. 2019, 34, 139–148. doi:10.1007/s10103-018-2643-1.	Randomized, triple-blinded, placebo-controlled, crossover clinical trial.	A cluster with 12 diodes (4 laser diodes of 905 nm, 4 LEDs of 875 nm, and 4 LEDs of 640 nm)	PBM was administered at each match before matches (40 min)	Six healthy men, futsal athletes, with an average age of 26.16 ± 6.91 years, participated in this study. The athlete’s performance was quantified according to the time on the field. The videos were analyzed to quantify the athletes spent on the field and the distance they covered.	Four super-pulsed IR Lasers 905 (±1) nm Frequency = 250 Hz. Peak power 12.5 W/each. Average mean optical output = 0.3125 mW/each. Power density = 0.71 mW/cm2/each. Energy density = 0.162 J/cm2/each. Dose = 0.07125 J/each. Spot size of laser = 0.44 cm2/each. Four red LEDs (nm) 640 (±10) Frequency = 2 Hz. Average optical output = 15 mW/each. Power density = 16.66 mW/cm2/each Energy density = 3.8 J/cm2/each. Dose = 3.42 J/each. Spot size of red LED = 0.9 cm2/each. Four IR LEDs 875(±10) nm 16 Hz Average output power 17.5 mW/each. Power density = 19.44 mW/cm2/each. Energy density = 4.43 J/cm2/each. Dose = 3.99 J/each. Spot size of LED = 0.9 cm2/each. Irradiation time per site = 228 s. Total dose per site = 30 J. Total dose applied per lower limb = 510 J Aperture of device = 20 cm2.	30 J per site	The study was conducted in two different team matches in a time interval of approximately 2 weeks between the first and second interventions.	Phototherapy was performed at nine different knee extensor and hip flexor muscle locations, six knee flexor muscle and hip extensor muscle locations, and two plantar flexor muscle locations of both lower limbs	Seventeen sites of each lower limb were irradiated. Each site of irradiation received a 30-J dose delivered in 228 s (3 min and 48 s per site).	Levels of CK, TBARS, CP, LDH, and lactate, were considered in blood samples collected before, immediately after, and 48 h after a match. The time on pitch and the distance covered by the athletes on the pitch were also taken into account. Time on pitch Moderate Distance covered	PBMT significantly increased the time of staying in the pitch and triggered a significant improvement in all the biochemical markers evaluated. No statistically significant difference was found for the mileage. Pre-exercise PBMT can successfully increase the workout and speed up the rehabilitation process.
[17]	Dornelles, M.P.; Fritsch, C.G.; Sonda, F.C.; et al. Photobiomodulation therapy as a tool to prevent hamstring strain injuries by reducing soccer-induced fatigue on hamstring muscles. Lasers Med. Sci. 2019, 34, 6, 1177–1184. doi:10.1007/s10103-018-02709-w.	COD	One hundred and fifty-two IR LEDs (880 nm)	PBMT was applied on the hamstring muscles before the simulated football match.	Twelve male amateur soccer players (~ 25 years) participated in this randomized, crossover, double-blinded, placebo-controlled trial. The volunteers were evaluated in two sessions, with a minimum 7-day interval. At each session, volunteers received either PBMT (300 J per thigh) or placebo treatment on the hamstrings prior to the simulated soccer match.	The device contains 152 infrared LEDs (880 nm) distributed evenly over an area of 252 cm2 (10.5 cm × 24 cm) CW Power density (mW) − each= 33 Spot size (cm2) each = 0.1357; Power density (mW/cm2) − each = 243.8	At each session, volunteers received either PBMT (300 J per thigh) or placebo treatment on the hamstrings prior to the simulated soccer match.	Volunteers performed isokinetic concentric and eccentric tests by submaximal contractions. Two sets of three maximal knee extensors concentric contractions and two sets of three maximal knee flexors were eccentric contractions conducted	The hamstrings’ muscle; quadriceps	The PBMT device used in the current study required 60 s to deliver that energy amount to each hamstring muscle (i.e., a 2 min treatment per player), so it is a feasible therapy for application before a soccer match or even during the half-time interval.	Isokinetic dynamometry and countermovement jump (CMJ) tests, respectively, before and immediately after the simulated soccer match. Quadriceps CON CMJ height (cm) Hamstring ECC H:Q functional ratio	PBMT applied immediately on the muscles of the posterior thigh before a simulated football match proves effective in attenuation of fatigue-related disorders in hamsters’ maximal eccentric resistance, H: Q resistance ratio and CMJ performance. These results advocate PBMT as an encouraging instrument to attenuate hamstring muscle tiredness and thus stopping hamstring stretch lesions that usually occur in football players.
[18]	Jówko, E.; Płaszewski, M.; Cieśliński, M.; et al. The effect of low-level laser irradiation on oxidative stress, muscle damage and function following neuromuscular electrical stimulation. A double blind, randomised, crossover trial. BMC Sports Sci. Med. Rehabil. 2019, 11, 38. doi:10.1186/s13102-019-0147-3.	COD	Laser	PBMT before NMES session.	Twenty-four moderately active, healthy men aged 21–22 years, divided into two groups.	Cluster, 4 semiconducting lasers (830 nm, 200 mW output power each)	30 J each area Total energy delivered per muscle = 180 J	PBMT or placebo before NMES, intercrossed between the 2 groups after 8-day washout period.	Six sites on quadriceps femoris muscle	Forty-five electrically evoked tetanic, isometric contractions of the quadriceps femoris (NEMS), preceded by PBMT or sham-PBMT.	MIVC—maximal (isometric) voluntary contraction; S1—pain severity measurement—pressure test; S2—pain severity measurement –squat test. Collected blood samples for: SOD in erythrocytes, the activity of GPx in the whole blood, the TAC of plasma, and the level of MDA in plasma, taken prior to the NMES session (at baseline), immediately (0), 24, 48, 72, and 96 h after NMES.	NMES-evoked contractions induced oxidative stress, increased lipid peroxidation and impairments in enzymatic antioxidant system. PBMT had a protective effect on NMES-induced decrease in enzymatic antioxidant defense and shortened the duration of inflammation. Conclusions: PBMT may protect from impairments in enzymatic antioxidant system and may shorten inflammation induced by a single NMES session in moderately active, healthy men. However, the effects of PBMT on redox state and inflammatory processes do not seem to affect muscle damage and recovery of muscle function after NMES.
[19]	Tomazoni, S.S.; Machado, C.D.S.M.; De Marchi, T.; et al. Infrared low-level laser therapy (photobiomodulation therapy) before intense progressive running test of high-level soccer players: Effects on functional, muscle damage, inflammatory, and oxidative stress markers—A randomized controlled trial. Oxid. Med. Cell. Longev. 2019, 6239058. doi:10.1155/2019/6239058.	RCTtriple-blind	810 nm IR; Five-diode laser cluster CW	PBMT or placebo, the volunteers performed a standardized high-intensity progressive running test (ergospirometry test) until exhaustion. PBMT applied before a progressive running test	Twenty-two high-level male soccer players from the same team were recruited and treated with active PBMT and placebo. 5 diodes and 17 different sites were irradiated, a total of 85 points were irradiated in each lower limb, with a total of 850 J of energy delivered per lower limb (50 J per site). The study was performed in two stages, since it was a crossover study, with a washout period of 14 days between stages	810 nm IR; 5 diods. Optical output (per diode) 100 mW or 0 mW (placebo) Spot size (per diode) 0.0364 cm2 Power density (per diode) 2.75 W/cm2 or 0.00 W/cm2 (placebo) Energy (per diode) 10 J Energy density (per diode) 275 J/cm2 or 0 J/cm2 (placebo)	850 J (450 J on knee extensor muscles, 300 J on knee flexor muscles, and 100 J on plantar flexor muscles) Cluster area 9.6 cm2	High-level footballers from the same team were recruited; volunteers performed a standardized high-intensity progressive operation test (ergospirometric test)	PBMT contact with the skin at nine different sites of the knee extensor muscles (three medial, three lateral, and three central sites), six different sites of the knee flexor muscles (three medial and three lateral sites), and two different sites of the ankle plantar flexor muscles (one medial and one lateral site) of both lower limbs	Exposure time 100 s Number of irradiated sites per lower limb 9 sites on knee extensor muscles (3 medial, 3 lateral, and 3 central) 6 sites on knee flexor muscles (3 medial and 3 lateral) 2 sites on plantar flexor muscles (1 medial and 1 lateral)	Before extent and intervention (active PBMT or placebo) and then, exactly 5 min after the intense progressive run test (ergospirometry test), was analyzed rates of oxygen uptake (VO2 max) and blood samples for: CK, LDH, levels IL-1-β, IL-6, TNF-α, CAT, TBARS, SOD, carbonylated proteins	Results demonstrated that pre-exercise PBMT as a stand-alone therapy was able to improve the athletic presentation and the biochemical markers related to muscle impairment and inflammation in high-level athletes. Pre-exercise PBMT had a remarkably antioxidant effect, attenuating the oxidative stress generated by the physical activity, suggesting that this could be one of the possible mechanisms of action through which PBMT promotes ergogenic and protective effects for the skeletal muscles.
[20]	Da Cunha, R.A.; Pinfildi, C.E.; de Castro Pochini, A.; et al. Photobiomodulation therapy and NMES improve muscle strength and jumping performance in young volleyball athletes: A randomized controlled trial study in Brazil. Lasers Med. Sci. 2020, 35, 3, 621–631. https://doi.org/10.1007/s10103-019-02858-6.	RCT	850 nm 50 mW CW. NMES Burst 2 ms Frequency modulation 70 Hz.	Before undergoing strength and plyometric training.	Thirty-six athletes were included in the jump training program. All three groups (control, photobiomodulation therapy, and NMES) participated in all 18 sessions, for a total of 648 sessions. In addition, no athletes were lost in the follow-ups at 6 or 8 weeks.	Total average radiant power 150 mW. Radiant energy per diode 2 J. Radiant energy per point 6 J. NMES Duty cycle 10% T-on 10 s T-off 30 s. Intensity maximum tolerable	Total radiant energy 36 J.	Jump training	PBM was applied bilaterally and continuously immediately before the six-seat training session on the surface of the femoral quadriceps muscles. The quadriceps femoris muscle was electrically elicited with two self-adhesive electrodes (8 × 13 cm, for an area of 104 cm2). One electrode was positioned on the rectus femoris muscle, 20 cm from the anterior superior iliac spine; the other was positioned on the oblique vastus medialis muscle, 5 cm from the patella superior pole.	Exposure duration laser per point 40 s. Output power 290 mW. Energy density per point 0.8 J/cm2. NMES T-on 10 s. The NMES group additionally underwent NMES-based quadriceps femoris muscle strength training (base frequency 1 kHz, frequency modulation 70 Hz, intensity maximum tolerable).	The following parameters were analyzed: dominant strength of the lower limbs (N/kg), jumping capacity (cm), jumping frequency (n) and general impression (−5 to +5). Baseline (pre-training), post-workout (6 weeks) and 8-week follow-up for the control group, for PBMT and NMES.	This study found that, for volleyball athletes, PBMT and NMES both promoted benefits in terms of muscle-strength gain. These benefits were maintained for 2 weeks even after training was interrupted. Dominant lower limb strength improved in the NMES group compared to the control. Non-dominant lower limb strength increased in both the PBMT group and the NMES group compared to the control group, but the NMES group improved significantly more than the PBMT group; the NMES group also improved in global impression of jumps compared to the control group.
[21]	Rossato, M.; Dellagrana, R.A.; Sakugawa, R.L.; et al. Dose-Response Effect of Photobiomodulation Therapy on Muscle Performance and Fatigue During a Multiple-Set Knee Extension Exercise: A Randomized, Crossover, Double-Blind Placebo-Controlled Trial. Photobiomodul. Photomed. Laser Surg. 2020, 38, 12, 758–765. doi:10.1089/photob.2020.4820.	Crossover double-blind RCT.	Cluster with 5 lasers and 28 LEDs, as follows: 5 IR lasers (850 nm), Twelve red LEDs (670 nm), 8 IR LEDs (880 nm) and 8 IR LEDs (950 nm).	PBM 6 h before and immediately before the exercise protocol.	Eighteen (26 ± 6.0 years; 82 ± 11 kg; and 186 ± 7.3 cm) physically active men were evaluated and a minimum of 15 subjects were randomised to investigate the effects of PBMT versus the placebo.	Five lasers (850 nm, 1666.6 mW/cm2), 12 LEDs (670 nm, 5.20 mW/cm2), 8 LEDs (880 nm, 19.53 mW/cm2), and 8 LEDs (950 nm, 11.71 mW/cm2), CW. Exposure duration: 16, 32, or 64 s; Radiant exposure = 0.9933 J/cm2; Radiant energy: 15, 30, or 60 J. Number of points irradiated = 9 Area irradiated = 30.2 cm2. Application technique: cluster.	Total energy over the entire treatment course 270, 540, or 1080 J.	Isokinetic exercise protocol (5 sets of 10 knee extension repetitions, maximum contractions at 60° s−1) in 6 sessions, one week apart. Control condition (no PBMT/placebo treatments) was applied at the first and sixth sessions.	Nine sites on quadriceps.	Placebo or PBMT with 135, 270, or 540 J/quadriceps was randomly applied from the second to fifth sessions.	The isometric and isokinetic concentric peak torques were assessed before and after the exercise protocol.	Knee extension exercise performance was not affected by PBMT compared with placebo. All PBMT doses led to likely positive effects on isometric peak torque (IPT), concentric peak torque (CPT), and concentric work (W) compared to placebo. Conclusion: PBMT with 135, 270, and 540 J applied 6 h before and immediately before exercise was efficient to produce the same total work with lower fatigue, facilitating possible additional sets for performance (i.e., higher workout volume).
				After
[22]	Zagatto, A.M.; de Paula Ramos, S.; Nakamura, F.Y.; et al. Effects of low-level laser therapy on performance, inflammatory markers, and muscle damage in young water polo athletes: A double-blind, randomized, placebo-controlled study. Lasers Med. Sci. 2016, 31, 3, 511–521. doi:10.1007/s10103-016-1875-1.	RCT	Laser	PBM 5–40 min immediately after each daily training session.	Twenty young male water polo players (15.4 ± 1.2 years, body mass 68.3 ± 10.5 kg, height 173.9 ± 5.9 cm, and body mass index 22.5 ± 2.6 kg/m2).	810 nm.	48 J (i.e., 24 J per leg).	Training routine: 6 days per week, 4 h sessions per day: 2 h of swimming training and 2 h of water polo training, except Saturday—match simulation.	Eight points on the adductor magnus and adductor longus muscles (spot size area of 0.028 cm2) = 16 points.	Pre- and post- PBM, for 5 days.	Performance: was measured by a 200-m maximal swimming (P200) and a 30-s crossbar jump test (30 CJ) every day before training, and blood samples pre- and post- PBM, to measure interleukins (IL) (i.e., interleukin-1 beta, interleukin-10, and tumor necrosis factor-alpha) and muscle damage markers (i.e., CK and LDH).	No significant change in the P200 exercise Moderate improvement in the 30 CJ (8.7 ± 2.6 %). IL-1β↑ and TNF-alpha↑ (p < 0.016) 48 h after last PBMT, compared to pre-, 0, and 24 h, but did not differ between groups. IL-10↑ increased over time in the placebo group and reached a moderate effect compared to the PBM group. CK↓ significantly (p = 0.049) over the time in the PBM group, but there was no significant change in LDH (p = 0.150). Conclusion: PBM resulted in small to moderate effect on inflammatory and muscle damage markers, and a moderate effect on performance in water polo players. Lack of positive results could be due to the small area covered by irradiation, and this should be considered in future studies.
[23]	De Paiva, P.R.; Tomazoni, S.S.; Johnson, D.S.; et al. Photobiomodulation therapy (PBMT) and/or cryotherapy in skeletal muscle restitution, what is better? A randomized, double-blinded, placebo-controlled clinical trial. Lasers Med. Sci. 2016, 31, 9, 1925–1933. doi:10.1007/s10103-016-2071-z.	RCT	One laser diode + 8 LEDs	Three minutes after high-intensity eccentric contractions.	Fifty healthy male volunteers were randomized into 5 groups (PBMT, cryotherapy, cryotherapy + PBMT, PMBT + cryotherapy, or placebo).	Cluster with one IR laser diode (905 nm), 4 red LEDs (640 nm) and 4 IR LEDs (875 nm).	Total energy per limb: 240 J.	Treatments repeated at 24 h, 48 h and 72 h.	Six points per limb, as follows: Two points on vastus medialis Two points on vastus laterallis Two points on rectus femoris.	Eccentric contractions of knee extensor muscles in an isokinetic dynamometer.	Post-exercise assessments: Exercise performance (maximum voluntary isometric contraction MVIC). Delayed onset muscle soreness (DOMS). Muscle damage (CK). Pain on visual analogue scale (VAS). Assessments were performed at baseline; immediately after; and at 1 h, 24 h, 48 h, 72 h, and 96 h.	PBMT alone was optimal for post-exercise recovery with: MVIC ↑, DOMS ↓, CK activity ↓ (p < 0.05) from 24 h to 96 h compared to placebo, cryotherapy, and cryotherapy + PBMT. In the PBMT + cryotherapy group, the effect of PBMT was decreased (p > 0.05) but demonstrated significant improvement in MVIC↑, DOMS↓, CK activity↓ (p  <  0.05). Cryotherapy as single treatment and cryotherapy + PBMT were similar to placebo (p > 0.05). Conclusion: PBMT used as single treatment is the best modality for enhancement of post-exercise restitution, leading to complete recovery to baseline levels from 24 h after high-intensity eccentric contractions.
[24]	De Marchi, T.; Schmitt, V.M.; Machado, G.P.; et al. Does photobiomodulation therapy is better than cryotherapy in muscle recovery after a high-intensity exercise? A randomized, double-blind, placebo-controlled clinical trial. Lasers Med. Sci. 2017, 32, 2, 429–437. doi:10.1007/s10103-016-2139-9.	RCT	LEDs	PBMT and/or cryotherapy was applied, 2 min after post-exercise MVC test.	Forty volunteers were randomly divided into five groups: placebo group (PG); PBMT group (PBMT); cryotherapy group (CG); cryotherapy-PBMT group (CPG); and PBMT-cryotherapy group (PCG).	Cluster of 69 LEDs (34 red LEDs and 35 infrared LEDs), with 660 nm and 850 nm, 10 mW (red) and 30 mW IR output power (each diode).	Total = 41.7 J (for 30 s of irradiation)	PBMT or placebo after muscle fatigue-inducing protocol (MFIP). Application of ice was limited to 20 min.	Cluster (69 sites) on the muscle belly of the biceps, i.e., elbow flexors (biceps brachii).	Four sessions of MFIP at 24 h intervals. Exactly 30 s after the MFIP, volunteers were subjected to a new MVC following the parameters of the MVCs prior to MFIP. The value found in this isolated MVC will be considered the maximum capacity of power generation of the volunteer after the exercise (post-MVC). MVC was evaluated 24 h (MVC24), 48 h (MVC48), and 72 h (MVC72) after the execution of MFIP.	Isometric assessment (MVC) and blood collection in the pre-exercise period, and after 5- and 60-min post-exercise, and 24 h, 48 h, and 72 h later.	MVC↑ in PBMT, CPG, and PCG in comparison with both PG and CG (p < 0.05). Significant decrease in the concentrations of the biochemical markers of oxidative damage in all groups and CK↓ in the PBMT, PCG, and CPG compared with the PG (p < 0.01). Conclusion: Use of PBMT is more effective than the use of cryotherapy for muscle recovery, additionally cryotherapy decreases PBMT efficacy.
[25]	Vassão P.G.; Baldini, G.S.; Vieira, K.V.S.G.; et al. Acute Photobiomodulation Effects Through a Cluster Device on Skeletal Muscle Fatigue of Biceps Brachii in Young and Healthy Males: A Randomized Double-Blind Session. Photobiomodul. Photomed. Laser Surg. 2020, 38, 12, 773–779. doi:10.1089/photob.2019.4786.	RCT double blind.	Fourteen LEDs, as follows: 7 red diodes (630 nm) and 7 IR diodes (850 nm).	PBM immediately after the fatigue protocol.	Thirty-two males aged 18 to 25 years, clinically healthy, and classified as active were randomized into the control group (CG), red PBM group (RPG), and infrared PBM group (IPG).	A PBM cluster device with: 7 red diodes (630 nm), 7 IR diodes (850 nm), 100 mW/diode, 2 W/cm2 power density; 91 J/cm2 energy density; 4 J per point; 28 J total energy, 40 s.	28 J total energy per application.	PBMT with red LEDs, or IR LEDs, or placebo.	The cluster device was positioned 2 cm above the elbow joint, covering the biceps brachii surface of the dominant upper limb.	Fatigue protocol consisted of a maximum voluntary isotonic contraction of elbow flexion–extension with 75% of one-repetition maximum until exhaustion.	Muscle fatigue was analyzed by surface electromyography (EMG) recorded from the long head of biceps brachii, blood lactate concentration, and evaluation of the rate of perceived exertion (RPE) using the Borg Scale. Electromyography fatigue index (EMGFI) was calculated from EMG data.	EMGFI ↓ in the CG; RPE ↑ and lactate concentration ↑ significantly in all groups. Conclusion: Electromyography fatigue index delta value was greater in the IPG compared with the CG, suggesting that infrared could be more effective than red in decreasing muscle fatigue.
[26]	De Carvalho, G.; Gobbi, A.; Gobbi, R.B.; et al. Photobiomodulation by light emitting diode applied sequentially does not alter performance in cycling athletes. Lasers Med. Sci. 2020, 35, 8, 1769–1779. doi:10.1007/s10103-020-02973-9.	RCT	LEDs	PBMT on the second, third, and fourth day of collection, 24 h after data collection at baseline.	Forty-eight Cyclists (male, mean age 33.77 years), divided into 4 groups: IR RED IR + RED Placebo	Special cluster designed with dimensions of 25 × 42 cm2, with equidistant distribution between the LEDs (1 × 1 cm): Infrared (IR 940 ± 10 nm), red (RED 620 ± 10 nm), mixed Red, and IR (RED/IR 620 + 940 nm).	180 J per thigh, in total = 360 J		PBMT with infrared (IR 940 ± 10 nm), red (RED 620 ± 10 nm), mixed Red, and IR (RED/IR 620 + 940 nm) on 3 consecutive days, applied to the quadriceps femoris bilaterally.	Isokinetic contraction test. Exhaustion test.	Isokinetic dynamometer test. Incremental test until volitional exhaustion; maximum oxygen consumption (VO2max). Concentration of blood lactate. Thermographic evaluation 10 min before the test. Reevaluations were performed 24 h after the last application, with 1 week of follow-up.	Peak torque↑ in IR/RED group compared with sham, 24 h after the last application. A large effect size was observed for total time to exhaustion (ES = 1.98) and for VO2max (ES = 6.96), and a moderate effect size was seen for anaerobic threshold (ES = 0.62) in the IR/RED group, compared with sham. Conclusions: PBMT, when not associated with training, was not able to produce a cumulative effect on the performance of cycling athletes. However, the association of two wavelengths seems to be better for increased performance.
				Before and After
[27]	Vanin, A.A.; Miranda, E.F.; Machado, C.S.; et al. What is the best moment to apply phototherapy when associated to a strength training program? A randomized, double-blinded, placebo-controlled trial: Phototherapy in association to strength training. Lasers Med. Sci. 2016, 31, 8, 1555–1564. doi:10.1007/s10103-016-2015-7. Erratum in: Lasers Med. Sci. 2017, 32, 253. https://doi.org/10.1007/s10103-016-2121-6.	RCT	Laser + LEDs	PBM either before and/or after each training session.	Forty-eight male volunteers mean age of 26 years old (± 5.24), height of 174.5 cm (± 7.59), and body mass 76.5 kg (± 10.8) divided in 4 groups (12 volunteers per group): GA: PBM before and after GB: PBM before, placebo after GC: Placebo before and PBM after GD: Placebo before and after.	Cluster probes with four super-pulsed laser diodes of 905 nm, four LEDs of 875 nm, and four LEDs of 640 nm	30 J (0.285 J of 905 nm, 13.68 J of 640 nm, 15.96 J of 875 nm) in total treatment time of 228 s (3 min and 48 s).	Twelve weeks strength training protocol in Leg extension and Leg press (5 × 10 repetitions 80% of 1-RM), 2 sessions a week on non-consecutive days (72 h of rest) for 12 consecutive weeks (total of 24 training sessions) and the workload was adjusted by retesting the 1-RM test at 4th and 8th week.	Six different sites of the anterior muscle of the thigh (two centrally—rectus femoris and vastus intermedius, two laterally—vastus lateralis, and two medially—vastus medialis) for both legs.	Baseline, 4 weeks, 8 weeks, and 12 weeks. Time length between irradiation and the exercise protocol both to pre- and post-treatments was 5 to 10 min.	Peak torque reached in MVC test, load in 1-RM test and thigh circumference (perimetry) at larger CSA.	No significant differences (p > 0.05) at baseline for all 4 groups for MVC, 1-RM test, or perimetry. No significant differences (p > 0.05) were observed between groups for any experimental time regarding perimetry. MVC↑, both in absolute and percentages, (p < 0.05) by pre-exercise PBM. 1-RM test ↑, with the leg press and leg extension. Conclusions: Pre-exercise PBM increased muscle strength in the case of training twice a week for 12 weeks. PBM before exercise increased isometric strength in 39% to 46%, while only 14% to 15% in the placebo group.
[28]	Felismino, A.S.; Costa, E.C.; Aoki, M.S.; et al. Effect of low-level laser therapy (808 nm) on markers of muscle damage: A randomized double-blind placebo-controlled trial. Lasers Med. Sci. 2014, 29, 933–938. doi:10.1007/s10103-013-1430-2.	RCT	IR Laser	Between the sets of the biceps curl exercise.	Twenty-two physically active men were randomized into two groups: placebo (n = 11) and laser (n = 11).	Laser (808 nm; 100 mW; 35.7 W/cm2, 357.14 J/cm2 per point, 10 s), or placebo.	1 J per point applied for 10 s on four points of the biceps brachii of each arm.	Exercise-induced muscle damage protocol for biceps brachii (biceps curl, 10 sets of 10 repetitions with load of 50% of one-repetition maximum test (1 RM).	Arms muscles.	1. All volunteers were submitted to one-repetition maximum test (1 RM) of elbow flexion-extension (biceps curl) (visit 1); 2. Seven days after the 1 RM test, all volunteers returned to the laboratory and were measured the CK levels in the blood (plasma). Subsequently, they performed the exercise-induced muscle damage protocol plus laser irradiation (active or placebo) between the sets of this protocol on both upper limbs (visit 2); 3. Re-measurement of CK levels in the blood and the strength performance test (1 RM) after the visit at 24 h (visit 3), 48 h (visit 4), and 72 h (visit 5).	Creatine kinase (CK) activity and maximum strength performance (1 RM) were measured before, immediately after, 24 h, 48 h, and 72 h after the exercise-induced muscle damage protocol.	CK ↑ after the muscle damage protocol in both groups; the increase was diminished in the laser group compared to the placebo group at 72 h. (1 RM) ↓immediately after the muscle damage protocol in both groups, but it returned to the baseline level in both groups at 24 h, 48 h, and 72 h. Conclusion: CK activity was reduced 72 h after the muscle damage protocol in laser group, but no obvious positive effect on strength performance recovery was observed.
[29]	de Brito Vieira, W.H.; Bezerra, R.M.; Queiroz, R.A.; et al. Use of low-level laser therapy (808 nm) to muscle fatigue resistance: A randomized double-blind crossover trial. Photomed. Laser Surg. 2014, 32, 12, 678–685. doi:10.1089/pho.2014.3812.	RCT with crossover design.	IR Laser device (808 nm).	LLLT applied before or after intense exercises.	Seven young men (21 ± 3 years of age) who were clinically healthy, were allocated randomly into two groups: Active laser (LLLT) and placebo laser (Placebo).	Laser device (808 nm, CW, 100 mW). Spot size = 0.0028 cm2. Power density = 35.71 W/cm2. Treatment time per point = 40 s. Energy per point = 4 J. Energy density = 1428.57 J/cm2 Number of irradiation points per muscle: 3 points (rectus femoris); 1 point (vastus medialis); 1 point (vastus lateralis). Total energy delivered per muscle: 12 J (rectus femoris) × 3 times = 36 J. 4 J (vastus medialis) × 3 times= 12 J. 4 J (vast:us lateralis) × 3 times= 12 J.	4 J per point.	3 × 20 RM of knee flexion-extensions.	LLLT in contact mode and perpendicular to the belly of quadriceps femoris muscles at 5 equidistant points. After 1 week (washout period), all volunteers were exchanged among groups and then all assessments were repeated.	Three sets of 20 maximum repetitions (RM) of knee flexion-extension at 60 degrees/s using an isokinetic dynamometer. During rest intervals (between sets of exercise), LLLT or Placebo was applied perpendicularly on the quadriceps femoris muscles exactly over the same points where electrodes were placed for EMG.	Maximum repetitions (RM) using the isokinetic dynamometer was evaluated at 60 degrees/s until exhaustion or fatigue; that is, at the moment that participants were not able to keep muscle contraction throughout a preset range of motion (75 degrees of knee flexion-extension) or when the participants made a voluntary decision to stop. EMG analysis: root mean square (RMS) and median frequency (MF) as two EMG parameters commonly used to conclude muscle fatigue. Electromyography fatigue index (EFI). Heart rate (HR) was recorded at rest and during maximal effort.	LLLT ↑ the maximum number of RM, comparatively with control group. For both groups, MF ↓ significantly for all muscles, comparing pre and post evaluations at baseline and end point. HR between groups had no statistical significance. Conclusion: LLLT increased RM and reduced EFI, compared with the placebo group, helpful for high performance that demand fast return to a normal state and less tiredness.
				Laboratory Settings
[30]	Florianovicz V.C.; Ferraresi, C.; Kuriki, H.U. et al. Effects of Photobiomodulation Therapy and Restriction of Wrist Extensor Blood Flow on Grip: Randomized Clinical Trial. Photobiomodul. Photomed. Laser Surg. 2020, 38, 12, 743–749. doi:10.1089/photob.2019.4800.	RCT, but not double-blind.	Laser equipment (red 660 nm and infrared 830 nm).	PBMT was applied before (approx. 10 min) each workout.	Fifty-eight volunteers (clinically healthy women, aged 18–25 years old) divided into 4 groups: (1) control (2) BFR (strengthening with blood flow restriction), (3) 660 nm + BFR (4) 830 nm + BFR.	660 nm PBMT— 35 mW; 0.05 cm2; 2.10 J/per point; Total energy = 18.9 J Power density = 700 mW/cm2 830 nm PBMT— 32 mW; 0.101 cm2; 1.92 J/per point; Total energy = 17.2 J. Power density = 316.8 mW/cm2	Time of irradiation = 60 s Energy density 42 J/cm2 (red); 19 J/cm2 (IR).	Hypothesis: PBMT + BFR would increase muscle strength gain. 10 sessions: one evaluation session, 8 intervention sessions, and one reevaluation.	Average pressure to promote BFR, as follows: 1. BFR group: 140 ± 12.79 mmHg; 2. 660 nm group 133 ± 6.22 mmHg; 3. 830 nm group 128 ± 8.7 mmHg.	One repetition maximum (1 RM) = largest load that volunteer could perform with complete wrist extension, starting from total wrist flexion. Electromyography (EMG) was performed during the grip strength task.	Handgrip strength, wrist extensor muscle strength, and electromyography (EMG) of the radial carpal extensor muscle.	Wrist extensor strength significantly increased for both the 660 nm group (baseline 6.24 ± 0.84; after 7.77 ± 0.58 kgF) and the BFR group (baseline 6.02 ± 0.84; after 7.54 ± 0.92 kgF) compared with the control group. Conclusion: 660 nm PBMT + BFR was effective in increasing the handgrip strength of wrist extensor muscles, as well as increasing muscle recruitment in healthy subjects.
[31]	Miranda, E.F.; Vanin, A.A.; Tomazoni, S.S.; et al. Using pre-exercise photobiomodulation therapy combining super-pulsed lasers and light-emitting diodes to improve performance in progressive cardiopulmonary exercise tests. J. Athl. Train 2016, 51, 2, 129–35. doi:10.4085/1062-6050-51.3.10.	RCT with crossover design.	Four laser diodes + 8 LEDs	Immediately before a progressive cardiopulmonary test.	Twenty untrained male volunteers. received active PBMT, or placebo at session 1, and the other treatment at session 2.	Cluster with: 4 IR laser diodes (905 nm) 4 IR LEDs (875 nm) 4 red LEDs (640 nm)	30 J per site Total energy = 30 × 17 = 510 J	PBMT or placebo on 2 visits, 1 week apart. A progressive cardiopulmonary exercise test was performed on a motor-driven treadmill 5 to 10 min after each therapeutic administration.	Seventeen sites on each lower limb (9 on the quadriceps, 6 on the hamstrings, and 2 on the gastrocnemius muscles).	A progressive cardiopulmonary treadmill exercise test: running on treadmill until exhaustion.	Distance covered. Time to exhaustion. Ventilatory rate. Dyspnea.	PBMT effects: distance covered ↑, time to exhaustion ↑, ventilatory rate ↑. dyspnea ↓. Conclusion: PBMT with super pulsed lasers and LEDs applied before a progressive cardiopulmonary exercise test on a treadmill increased distance covered, time to exhaustion, and pulmonary ventilation, and decreased dyspnea in healthy volunteers.