The effect of underwater massage during hot water immersion on acute cardiovascular and mood responses.

PURPOSE: There is emerging evidence that demonstrates the health benefits of hot water immersion including improvements to cardiovascular health and reductions in stress and anxiety. Many commercially available hot tubs offer underwater massage systems which purport to enhance many benefits of hot water immersion, however, these claims have yet to be studied. METHODS: Twenty participants (4 females) completed three, 30-min sessions of hot-water immersion (beginning at 39 °C) in a crossover randomized design: with air massage (Air Jet), water massage (Hydro Jet) or no massage (Control). Cardiovascular responses comprising; heart rate, blood pressure and superficial femoral artery blood flow and shear rate were measured. State trait anxiety, basic affect, and salivary cortisol were recorded before and after each trial. Data were analysed using a mixed effects model. RESULTS: Post immersion, heart rate increased (Δ31bpm, P < 0.001, d = 1.38), mean arterial blood pressure decreased (Δ16 mmHg, P < 0.001, d = -0.66), with no difference between conditions. Blood flow and mean shear rate increased following immersion (P < 0.001, Δ362 ml/min, d = 1.20 and Δ108 s-1, d = 1.00), but these increases were blunted in the Air Jet condition (P < 0.001,Δ171 ml/min, d = 0.43 and Δ52 s-1, d = 0.52). Anxiety and salivary cortisol were reduced (P = 0.003, d = -0.20, P = 0.014, d = -0.11), but did not vary between conditions. Enjoyment did not vary between conditions. CONCLUSION: These data demonstrate positive acute responses to hot water immersion on markers of cardiovascular function, anxiety, and stress. There was no additional benefit of water-based massage, while air-based massage blunted some positive vascular responses due to lower heat conservation of the water.

Post exercise hot water immersion and hot water immersion in isolation enhance vascular, blood marker, and perceptual responses when compared to exercise alone.

Exercise and passive heating induce some similar vascular hemodynamic, circulating blood marker, and perceptual responses. However, it remains unknown whether post exercise hot water immersion can synergise exercise derived responses and if they differ from hot water immersion alone. This study investigated the acute responses to post moderate-intensity exercise hot water immersion (EX+HWI) when compared to exercise (EX+REST) and hot water immersion (HWI+HWI) alone. Sixteen physically inactive middle-aged adults (nine males and seven females) completed a randomized cross-over counterbalanced design. Each condition consisted of two 30-min bouts separated by 10 min of rest. Cycling was set at a power output equivalent to 50% V̇o2 peak . Water temperature was controlled at 40°C up to the mid sternum with arms not submerged. Venous blood samples and artery ultrasound scans were assessed at 0 (baseline), 30 (immediately post stressor one), 70 (immediately post stressor two), and 100 min (recovery). Additional physiological and perceptual measures were assessed at 10-min intervals. Brachial and superficial femoral artery shear rates were higher after EX+HWI and HWI+HWI when compared with EX+REST (p < 0.001). Plasma nitrite was higher immediately following EX+HWI and HWI+HWI than EX+REST (p < 0.01). Serum interleukin-6 was higher immediately after EX+HWI compared to EX+REST (p = 0.046). Serum cortisol was lower at 30 min in the HWI+HWI condition in contrast to EX+REST (p = 0.026). EX+HWI and HWI+HWI were more enjoyable than EX+REST (p < 0.05). Irrespective of whether hot water immersion proceeded exercise or heating, hot water immersion enhanced vascular and blood marker responses, while also being more enjoyable than exercise alone.

The effect of age and mitigation strategies during hot water immersion on orthostatic intolerance and thermal stress.

NEW FINDINGS: What is the central question of this study? The aim was to characterize adverse responses to whole-body hot water immersion and to investigate practical strategies to mitigate these effects. What is the main finding and its importance? Whole-body hot water immersion induced transient orthostatic hypotension and impaired postural control, which recovered to baseline within 10 min. Hot water immersion was well tolerated by middle-aged adults, but younger adults suffered from a greater frequency and severity of dizziness. Cooling the face with a fan or not immersing the arms can mitigate some of these adverse responses in younger adults. ABSTRACT: Hot water immersion improves cardiovascular health and sporting performance, yet its adverse responses are understudied. Thirteen young and 17 middle-aged adults (n = 30) were exposed to 2 × 30 min bouts of whole-body 39°C water immersion. Young adults also completed cooling mitigation strategies in a randomized cross-over design. Orthostatic intolerance and selected physiological, perceptual, postural and cognitive responses were assessed. Orthostatic hypotension occurred in 94% of middle-aged adults and 77% of young adults. Young adults exhibited greater dizziness upon standing (young subjects, 3 out of 10 arbitrary units (AU) vs. middle-aged subjects, 2 out of 10 AU), with four terminating the protocol early owing to dizziness or discomfort. Despite middle-aged adults being largely asymptomatic, both age groups had transient impairments in postural sway after immersion (P < 0.05), but no change in cognitive function (P = 0.58). Middle-aged adults reported lower thermal sensation, higher thermal comfort, and higher basic affect than young adults (all P < 0.01). Cooling mitigation trials had 100% completion rates, with improvements in sit-to-stand dizziness (P < 0.01, arms in, 3 out of 10 AU vs. arms out, 2 out of 10 AU vs. fan, 4 out 10 AU), lower thermal sensation (P = 0.04), higher thermal comfort (P < 0.01) and higher basic affect (P = 0.02). Middle-aged adults were predominantly asymptomatic, and cooling strategies prevented severe dizziness and thermal intolerance in younger adults.

The Relationship Between Neuromuscular Function and the W' in Elite Cyclists.

PURPOSE: To assess the association between the W' and measures of neuromuscular function relating to the capacity of skeletal muscle to produce force in a group of elite cyclists. METHODS: Twenty-two athletes specializing in a range of disciplines and competing internationally volunteered to participate. Athletes completed assessments of maximum voluntary torque (MVT), voluntary activation, and isometric maximum voluntary contraction to measure rate of torque development (RTD). This was followed by assessment of peak power output (PPO) and 3-, 5-, and 12-minute time trials to determine critical power. Pearson correlation was used to examine associations with critical power and W'. Goodness of fit was calculated, and significant relationships were included in a linear stepwise regression model. RESULTS: Significant positive relationships were evident between W' and MVT (r = .82), PPO (r = .70), and RTD at 200 milliseconds (r = .59) but not with RTD at 50 milliseconds and voluntary activation. Correlations were also observed between critical power and RTD at 200 milliseconds and MVT (r = .54 and r = .51, respectively) but not with PPO, voluntary activation, or RTD at 50 milliseconds. The regression analysis found that 87% of the variability in W' (F1,18 = 68.75; P < .001) was explained by 2 variables: MVT (81%) and PPO (6%). CONCLUSIONS: It is likely that muscle size and strength, as opposed to neural factors, contribute meaningfully to W'. These data can be used to establish training methods to enhance W' to improve cycling performance in well-trained athletes.

A systematic review of the role of heat therapy for patients with intermittent claudication due to peripheral artery disease.

Intermittent claudication (IC) is associated with impairments in quality of life and walking ability. Heat therapy is an emerging cardiovascular therapy, which may improve walking in patients with IC. We undertook a systematic review to establish current evidence for heat therapy for patients with IC. We searched five databases (Ovid Medline / PubMed, Embase, Scopus / Web of Science, Cochrane Library and Health Technology Assessment Databases). A total of 6751 records were screened with 76 full-text articles assessed for eligibility. We included three randomised control trials and three acute interventions. For chronic interventions, three different heat therapy interventions were used. The 6-minute walk distance significantly improved following whole-body immersion (p = 0.03; ES 0.94, 95% CI: 0.06-1.82), but not after Waon therapy or a water-perfused garment. Ankle-brachial pressure indices were significantly improved following whole-body immersion (p = 0.01; ES 1.10, 95% CI: 0.20-1.99) but not after other therapies. No form of heat therapy demonstrated statistical improvements in quality of life or brachial blood pressure. Acute interventions were characterised by large increases in limb blood flow and core temperature, and transient reductions in blood pressure post-heating. At present there are only three randomised controlled trials assessing heat therapy for patients with IC. Moreover, each of those randomised controlled trials utilised different heat therapies. There is also very limited study of the acute physiological responses to different heat therapy interventions in these populations. Future research should establish appropriate heat therapy protocols and implement more randomised trials to understand its effectiveness. PROSPERO: CRD42020187941.

The health benefits of passive heating and aerobic exercise: To what extent do the mechanisms overlap?

Exercise can induce numerous health benefits that can reduce the risk of chronic diseases and all-cause mortality, yet a significant percentage of the population do not meet minimal physical activity guidelines. Several recent studies have shown that passive heating can induce numerous health benefits, many of which are comparable with exercise, such as improvements to cardiorespiratory fitness, vascular health, glycemic control, and chronic low-grade inflammation. As such, passive heating is emerging as a promising therapy for populations who cannot perform sustained exercise or display poor exercise adherence. There appears to be some overlap between the cellular signaling responses that are regulated by temperature and the mechanisms that underpin beneficial adaptations to exercise, but detailed comparisons have not yet been made. Therefore, the purpose of this mini review is to assess the similarities and distinctions between adaptations to passive heating and exercise. Understanding the potential shared mechanisms of action between passive heating and exercise may help to direct future studies to implement passive heating more effectively and identify differences between passive heating and exercise-induced adaptations.

Cycling-specific isometric resistance training improves peak power output in elite sprint cyclists.

INTRODUCTION: This study aimed to assess the efficacy of a 6-week cycling-specific, isometric resistance training program on peak power output (PPO) in elite cyclists. METHODS: Twenty-four elite track sprint cyclists were allocated to EXP (n = 13, PPO, 1537 ± 307 W) and CON (n = 11, PPO, 1541 ± 389 W) groups. All participants completed a 6-week training program; training content was identical except participants in the EXP group replaced their usual compound lower body resistance training exercise with a cycling-specific, isometric resistance training stimulus. Cycling PPO, knee extensor and cycling-specific isometric strength, and measures of muscle architecture were assessed pre- and post-training. RESULTS: In EXP, absolute and relative PPO increased (46 ± 62 W and 0.8 ± 0.7 W/kg, P < .05), and the change in relative PPO was different to CON (-0.1 ± 1.0 W/kg, group × time interaction P = .02). The increase in PPO was concurrent with an increase in extrapolated maximal torque in EXP (7.1 ± 6.5 Nm, P = .007), but the effect was not different from the change in CON (2.4 ± 9.7 Nm, group × time P = .14). Cycling-specific isometric strength also increased more in EXP (group × time P = .002). There were no other between-group differences in response to training. CONCLUSION: A 6-week novel, cycling-specific isometric resistance training period improved PPO in a group of elite sprint cyclists by 3%-4%. These data support the use of a cycling-specific isometric resistance training stimulus in the preparation programs of world-class cyclists.

Frequent Carbohydrate Ingestion Reduces Muscle Glycogen Depletion and Postpones Fatigue Relative to a Single Bolus.

The timing of carbohydrate ingestion and how this influences net muscle glycogen utilization and fatigue has only been investigated in prolonged cycling. Past findings may not translate to running because each exercise mode is distinct both in the metabolic response to carbohydrate ingestion and in the practicalities of carbohydrate ingestion. To this end, a randomized, cross-over design was employed to contrast ingestion of the same sucrose dose either at frequent intervals (15 × 5 g every 5 min) or at a late bolus (1 × 75 g after 75 min) during prolonged treadmill running to exhaustion in six well-trained runners (V˙O2max 61 ± 4 ml·kg-1·min-1). The muscle glycogen utilization rate was lower in every participant over the first 75 min of running (Δ 0.51 mmol·kg dm-1·min-1; 95% confidence interval [-0.02, 1.04] mmol·kg dm-1·min-1) and, subsequently, all were able to run for longer when carbohydrate had been ingested frequently from the start of exercise compared with when carbohydrate was ingested as a single bolus toward the end of exercise (105.6 ± 3.0 vs. 96.4 ± 5.0 min, respectively; Δ 9.3 min, 95% confidence interval [2.8, 15.8] min). A moderate positive correlation was apparent between the magnitude of glycogen sparing over the first 75 min and the improvement in running capacity (r = .58), with no significant difference in muscle glycogen concentrations at the point of exhaustion. This study indicates that failure to ingest carbohydrates from the outset of prolonged running increases reliance on limited endogenous muscle glycogen stores-the ergolytic effects of which cannot be rectified by subsequent carbohydrate ingestion late in exercise.

Comparison of Critical Speed and D' Derived From 2 or 3 Maximal Tests.

Purpose: The hyperbolic distance-time relationship can be used to profile running performance and establish critical speed (CS) and D' (the curvature constant of the speed-time relationship). Typically, to establish these parameters, multiple (3+) performance trials are required, which can be highly fatiguing and limit the usability of such protocols in a single training session. This study aimed to compare CS and D' calculated from a 2-trial (2-point model) and a 3-trial (3-point model) method. Methods: A total of 14 male distance runners completed 3 fixed-distance (3600, 2400, and 1200 m) time trials on a 400-m outdoor running track, separated by 30-min recoveries. Participants completed the protocol 9 times across a 12-mo period, with approximately 42 d between tests. CS and D' were calculated using all 3 distances (3-point model) and also using the 3600- and 1200-m distances only (2-point model). Results: Mean (SD) CS for both 3-point and 2-point models was 4.94 (0.32) m·s-1, whereas the values for D' were 123.3 (57.70) and 127.4 (57.34) m for the 3-point and 2-point models, respectively. Overall bias for both CS and D' between 3-point and 2-point model was classed as trivial. Conclusion: A 2-point time-trial model can be used to calculate CS and D' as proficiently as a 3-point model, making it a less fatiguing, inexpensive, and applicable method for coaches, practitioners, and athletes for monitoring running performance in 1 training session.

Relationship between power-duration parameters and mechanical and anthropometric properties of the thigh in elite cyclists.

PURPOSE: The curvature constant (W') and asymptote (critical power; CP) of the power-duration relationship are important parameters for explaining cycling performance. Short-duration endurance cycling events rely more heavily on the W'; however, the full mechanistic underpinning of this parameter is yet to be determined. Evidence suggests both muscle volume and muscle strength may contribute to the magnitude of W'. Therefore, the present study investigated the relationship between power-duration parameters (CP and W') and (1) anthropometric and (2) mechanical properties of thigh muscles in a sample of elite cyclists. METHODS: Eleven elite male cyclists had gross thigh volume (TVOL), quadriceps muscle volume (QVOL), vastus lateralis (VL) muscle pennation angle (PA) and VL muscle thickness (MT) measured. Additionally, maximum torque production of the knee extensors (FMAX) was assessed. The relationship between these anthropometric and mechanical measures and both the CP and W' were determined. RESULTS: W' showed a very strong positive and significant relationship with FMAX (r = 0.87, p < 0.001) and a large positive and significant relationship with TVOL (r = 0.60, p = 0.05). No other anthropometric characteristics were related to the W'. The CP was not associated with any mechanical or anthropometric parameter. CONCLUSION: In addition to muscle size, the maximal evocable force of a muscle (group) appears to be linked to the magnitude of the W' in elite cyclists.