In order to perform at your best as an athlete, it is important that recovery is incorporated into your training plan. Not leaving sufficient time to recover between training sessions or competitions could lead to poor performance.

In this post adapted from NSCA’s Essentials of Sport Science we explore different recovery strategies for athletes.

The Recovery Pyramid

The recovery pyramid below outlines the main recovery strategies currently being used in high-performance sport. The recovery pyramid is built on the foundation of sleep, followed by nutrition and hydration. These three areas have the potential for the greatest impact on athletic performance. This foundation can then be built upon by incorporating other strategies such as hydrotherapy, compression, and massage, which have been the focus of less research attention. The top of the pyramid includes strategies based on minimal or no evidence and may be considered fads that are momentarily popular.

Let’s explore some of the key foundational elements of the recovery pyramid in greater detail.

Sleep

Sleep is considered the foundation of the recovery pyramid due to its importance for athlete performance and wellbeing. Sleep deprivation has been shown to have negative effects on performance, mood state, metabolism, and immune and cognitive function (1). Research in elite athletes suggests that their sleep quality, quantity, or both are often less than optimal (2, 3) and that improvement in sleep is warranted in many athletes. Training and competition times (4, 5) and travel, as well as stress and anxiety (6), may contribute to poor sleep in athletes. However, appropriate education and behavior change strategies are often needed to minimize the influence of social media or video games on sleep. Smartphones and video games emit blue wavelength light (which can decrease melatonin release) and may also be a source of stress, worry, or competition at a time when light and stimulation should be avoided before sleep.

The intensity of training may also influence sleep; while sleep would be expected to improve during intensified training (due to an increased need), evidence suggests that this does not occur (7, 8). Other factors such as caffeine consumption, muscle soreness, injury, jet lag, and travel (i.e., sleeping in foreign environments) are anecdotally reported to have a negative effect on an athlete’s sleep if not managed appropriately. Only a small number of studies have investigated the effects of sleep extension in athletes; however, based on the available information it is suggested that a minimum of one week of increased sleep duration results in improvements in a range of performance metrics in athletes.

The image below describes the objectives and presents some recommendations for obtaining quality sleep in athletes.

Nutrition

Postexercise recovery is a hot topic in sports nutrition, with interest in the quantity and the timing of intake of nutrients to optimise recovery issues such as refueling, rehydration, and protein synthesis for repair and adaptation. Recovery processes that help to minimize the risk of illness and injury are also important and are covered separately. In some cases, there is little effective recovery until nutrients are supplied, while in others, the stimulus for recovery is strongest in the period immediately after exercise. Recovery between exercise sessions may have two separate goals:

1. Restoration of body losses or changes caused by the first session to restore performance levels for the next.
2. Maximising the adaptive responses to the stress provided by the session to gradually make the body better at the features of exercise that are important for performance.

Lack of appropriate nutritional support can interfere with the achievement of one or both of these goals. However, a side effect of the interest in recovery eating is an industry that appears to promote an aggressive and one-size-fits-all approach to postexercise nutrition, when in fact, the optimal approach is individual to each session and each athlete. Each athlete should use a cost–benefit analysis of the various approaches to recovery following different types of exercise and then periodize different recovery strategies into training or competition programs. An understanding of the needs of each training session or event and the overall goals of the program will help the athlete to distinguish between scenarios in which a proactive approach to recovery eating is warranted and the situations in which it may actually be beneficial to withhold nutritional support. See the table below for further information around refuelling.

	Refuelling
Strategies to maximize goal	– Start carbohydrate intake soon after the session finishes; aim for a meal or snack providing ~1 g/kg body mass of carbohydrate. – Continue with more snacks, drinks, or meals to achieve a carbohydrate target of 1-1.5 g ∙ kg−1 ∙ h−1 for the first 3-4 hours of recovery, then resume an eating pattern that meets overall fuel and energy goals; total carbohydrate requirements can range from 3-12 g/kg body mass per day. – Choose carbohydrate forms consistent with other goals (e.g., energy needs, benefits of ingesting fluids and protein at the same time). – Choose carbohydrate-rich foods according to appetite and practicality.
Benefits	Maximises muscle fuel for next demanding workout or event.
When should it be undertaken?	– After races or fuel-depleting training sessions when the athlete is backing up for the next session in 8 hours or less. – When total fuel needs are high—high-volume training, demanding competition schedule (e.g., cycling tour, tennis tournament).
Downsides	– May encourage intake of more kilojoules than needed (leading to weight gain) or a pattern of eating that is more risky for dental health. – May encourage the intake of nutrient-poor foods since these are more accessible or easy to eat immediately after exercise. – May reduce the period of enhanced adaptation after exercise.
When is it expendable?	– When sessions are light or low in intensity and muscle glycogen is not likely to become depleted or limit performance. – When the available recovery eating choices are low in nutritional value, and it makes more sense to wait a little until the athlete can have a more nutritious meal or snack. – When the athlete has periodized some “train low” sessions into the training program, which may require a delay in refueling in the attempt to prolong the adaptation to the session just done, or commence the next session with depleted glycogen stores.

Water Immersion

The use of water immersion or hydrotherapy has been a highly popular area of recovery for many years. A number of water immersion options are used to aid performance recovery. Most commonly athletes will perform cold-water immersion, contrast-water therapy, or hot-water immersion (9, 10). These water immersion strategies have been reasonably well examined in research to date, and the choice of which strategy to implement should be based on what the athletes are trying to recover from and for.

Cold water immersion

Cold-water immersion (CWI) typically involves either full-body (excluding head) or limb-only immersion in water temperatures ranging between 40 °F (5 °C) and 68 °F (20 °C) for up to 20 minutes. This may be performed either continuously or intermittently (10). The main aim of CWI is to reduce body tissue temperatures and blood flow, which then leads to reductions in swelling, inflammation, cardiovascular strain, and pain (11). It is these physiological changes that lead to enhanced recovery by reducing hyperthermia-mediated fatigue, reducing the previously mentioned swelling and inflammation associated with delayed-onset muscle soreness (DOMS) and improving autonomic nervous system function (12).

At present there is no gold standard or optimal combination of water temperature, depth, duration, and mode of immersion (11) for CWI. The choice of protocol for CWI should vary depending on the athlete and what the athlete is recovering from. It has been observed that temperatures between 52 °F (11 °C) and 59 °F (15 °C) for durations of 11 to 15 minutes are optimal for the reduction of muscle soreness (13). However, regarding the use of CWI for the reduction of thermal strain or improving autonomic system function, there is less scientific evidence to suggest an optimal protocol.

Another factor to consider when determining the CWI protocol to use is the physical characteristics of the athletes, since it has been shown that body composition, sex, age, and ethnicity all affect the physiological responses to CWI (9). Less intense protocols (e.g., warmer water temperatures or shorter durations) are recommended for athletes with low body fat and low muscle mass. Female, youth, and masters athletes are also likely to require less intense protocols compared to the average adult male athlete (9).

Practically, CWI is best used in hot environments to aid the recovery from thermoregulatory fatigue, and it may also provide a precooling advantage if subsequent performance is required on the same day. Cold-water immersion is also effective for managing muscle soreness and damage, as is evident from studies examining circulating creatine kinase, which is often used as an indirect marker of muscle damage (1a). Research has shown that CWI significantly enhanced the recovery of squat jump and isometric force and significantly reduced creatine kinase concentration compared to a passive control condition 48 hours after muscle-damaging exercise (40a). Additionally, it has been found that CWI improved the recovery of sprint speed and attenuated the efflux of creatine kinase compared to a control condition during a simulated team sport tournament. Therefore the regular use of CWI in-season or during tournaments is recommended to aid recovery of DOMS and general soreness.

Hot water immersion

Hot-water immersion (HWI) typically involves either full-body (excluding head) or limb-only immersion in water temperatures above 96 °F (36 °C). Hot-water immersion is usually performed in one continuous immersion and often involves the use of underwater jets to massage the muscles (10). When used for recovery purposes, the main aim of HWI is relaxation and easing of muscle tension. Physiologically, HWI leads to increases in body temperatures and blood flow (14). Through this increase in blood flow, HWI is thought to improve the removal of metabolic waste and increase nutrient delivery to and from the cells (15). These physiological responses are believed to aid healing and the recovery of neuromuscular performance (14, 15); however, this is theoretical at present, and future research is required to prove this theory.

There remains minimal research supporting the use of HWI for performance recovery; therefore it is difficult recommend optimal protocols. Similar to findings for CWI, the maximum duration suggested from research is approximately 20 minutes. Despite the lack of scientific evidence to support the benefits of HWI, anecdotally it remains a popular recovery method. Athletes often prefer the use of HWI over CWI because they find it more comfortable and relaxing. Practically, HWI can be used to aid psychological recovery since it provides relaxation benefits. It may also be useful on rest days and before massage to relax tight muscles. However, HWI should be applied with caution when soft tissue injuries are suspected because the increased blood flow may theoretically exacerbate swelling, bruising, and inflammation. Likewise, HWI is not recommended when athletes are in a hyperthymic state postexercise since the warm water will likely maintain elevated body temperatures, prolonging thermoregulatory stress.

Conclusion

Recovery is multifaceted, and both the choice of recovery strategy and the ways in which recovery strategies are combined in athletes involve many considerations. Initial considerations should have to do with the effectiveness of the available recovery strategies and prioritising simple strategies that provide the foundation to recovery, such as sleep and nutrition. Further, the dose of recovery should be considered within the context of the training program and periodized to maximise performance and adaptation.

References

1. Halson, SL. Sleep in elite athletes and nutritional interventions to enhance sleep. Sports Med 44(suppl 1):S13-S23, 2014. 
2. Lastella, M, Roach, GD, Halson, SL, and Sargent, C. Sleep/wake behaviours of elite athletes from individual and team sports. Eur J Sport Sci 15:94-100, 2015.
3. Leeder, J, Glaister, M, Pizzoferro, K, Dawson, J, and Pedlar, C. Sleep duration and quality in elite athletes measured using wristwatch actigraphy. J Sports Sci 30:541-545, 2012.
4. Sargent, C, Halson, S, and Roach, GD. Sleep or swim? Early-morning training severely restricts the amount of sleep obtained by elite swimmers. Eur J Sport Sci 14(suppl 1):S310-S315, 2014.
5. Sargent, C, and Roach, GD. Sleep duration is reduced in elite athletes following night-time competition. Chronobiol Int 33:667-670, 2016.
6.  Juliff, LE, Halson, SL, and Peiffer, JJ. Understanding sleep disturbance in athletes prior to important competitions. J Sci Med Sport 18:13-18, 2015.
7. Killer, SC, Svendsen, IS, Jeukendrup, AE, and Gleeson, M. Evidence of disturbed sleep and mood state in well-trained athletes during short-term intensified training with and without a high carbohydrate nutritional intervention. J Sports Sci35:1402-1410, 2017
8.   Lastella, M, Roach, GD, Halson, SL, Martin, DT, West, NP, and Sargent, C. The impact of a simulated grand tour on sleep, mood, and well-being of competitive cyclists. J Sports Med Phys Fitness 55:1555-1564, 2015.
9. Stephens, JM, Halson, S, Miller, J, Slater, GJ, and Askew, CD. Cold-water immersion for athletic recovery: one size does not fit all. Int J Sports Physiol Perform 12:2-9, 2017.
10. Versey, NG, Halson, SL, and Dawson, BT. Water immersion recovery for athletes: effect on exercise performance and practical recommendations. Sports Med 43:1101-1130, 2013.
11. Stephens, JM, Sharpe, K, Gore, C, Miller, J, Slater, GJ, Versey, N, Peiffer, J, Duffield, R, Minett, GM, Crampton, D, Dunne, A, Askew, CD, and Halson, SL. Core temperature responses to cold-water immersion recovery: a pooled-data analysis. Int J Sports Physiol Perform 13:917-925, 2018.
12. Ihsan, M, Watson, G, and Abbiss, CR. What are the physiological mechanisms for post-exercise cold water immersion in the recovery from prolonged endurance and intermittent exercise? Sports Med 46:1095-1109, 2016.
13. Machado, AF, Almeida, AC, Micheletti, JK, Vanderlei, FM, Tribst, MF, Netto Junior, J, and Pastre, CM. Dosages of cold-water immersion post exercise on functional and clinical responses: a randomized controlled trial. Scand J Med Sci Sports27:1356-1363, 2017.
14. Vaile, J, Halson, S, and Graham, S. Recovery review – science vs practice. J Aust Strength Cond 2(suppl 2):5-21, 2010.
15.  Webb, NP. The use of post game recovery modalities following team contact sport: a review. J Aust Strength Cond 21:70-79, 2013.

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