Introduction
The professionalization of sport allows elite athletes to perform a greater volume of training and competition; thus, resulting in the need for recovery strategies to enable athletes to cope with increased training load (27). In addition, sports that incorporate tournament style competitions provide a challenge for athletes to recover adequately before the next exercise bout (4). Hydrotherapy, specifically cold water immersion, can enhance recovery after both simulated and actual team-sport competition (9). Recently, Webb et al. (31) observed enhanced recovery in rugby union players after contrast water therapy (alternating hot and cold water immersion). The use of contrast water therapy has also been shown to benefit athletic recovery as evidenced by improved cycling sprint and time-trial performances (28), decreases in rating of perceived exertion and muscle soreness (13), and reductions in localized edema (26). Furthermore, Vaile et al. (26) observed the restoration of dynamic power and isometric force after contrast water therapy in individuals who completed a delayed onset muscle soreness inducing leg press protocol. These findings have increased the popularity of this recovery modality in sport (5); yet, access to facilities can be difficult, specifically when athletes are traveling. Most sporting venues allow athletes access to shower facilities, providing a possible alternative to contrast water therapy through the use of contrast showers (alternating hot and cold showers). To the authors' knowledge, no studies have examined the recovery benefits of contrast showers on athletic performance despite athletes anecdotally using showers as a form of recovery.
The sport of netball is played worldwide with an estimated 20 million participants and is characterized as a fast moving team-sport placing high physical demands on players through repeated jumps, lunges, and rapid accelerations and decelerations (13,22). Furthermore, elite netballers can be required to train or compete multiple times per day in tournament style competitions resulting in large demands placed upon the cardiovascular, metabolic, immune, and musculoskeletal systems (13). For athletes to cope with these demands, appropriate recovery is essential which has led many teams to adopt some form of recovery strategy. In a recent survey of New Zealand sporting teams, 100% of elite New Zealand netball teams reported using contrast water therapy as their recovery modality of choice (12). When coupled with the large travel commitments associated with many elite netball teams, it is likely that the development of alternative contrast water modalities is necessary. The purpose of the present study was to examine the influence of contrast showers and contrast water therapy on recovery after a netball specific exercise circuit. The findings could provide a viable alternative for coaches, athletes, and strength and conditioning specialists who wish to use contrast water therapy as a recovery modality; yet, are limited by available facilities.
Methods
Experimental Approach to the Problem
To determine the recovery benefits of contrast water therapy and contrast showers in elite level netballers, this study examined the influence of 3 recovery conditions (passive, contrast water therapy, and contrast showers) on performance (repeated agility), physiological variables (core and skin temperature and heart rate), and perceptions of effectiveness at 3 time points (acute, delayed, and 24 hours) after a netball specific exercise circuit. Data collection was conducted in a pragmatic manner because participants were currently visiting our laboratory setting to complete a preseason training camp. Consequently, repeated agility was selected as the only performance variable because of its use within netball as a key performance test and its strong association with the physical demands of the sport. The study was conducted using a crossover design in which all participants completed each of the 3 recovery conditions on different days. The order of conditions was randomized for each participant to avoid any order effects that could bias the data.
Subjects
Ten elite female netball athletes (mean ±SD: age, 20 ± 1 years [range, 18.5–20.7 years]; height, 1.82 ± 0.05 m; body mass, 77.0 ± 9.3 kg) volunteered to participate in this study. All participants were Australian representative netballers at either under 19 or under 21 years of age and were in preseason training. The sample size selected for this study was based on a sample of convenience because all participants were attending the laboratory settings as part of a preseason training camp. Before data collection, participants were provided with written documentation of the risks and benefits of participation in the study and signed a document of informed consent. Ethical approval was obtained from the Murdoch University Human Ethics Committee (#2011/015) and the Australian Institute of Sports Human Ethics Committee (#20010206).
Procedures
This study required participants to complete 5 separate sessions: 2 familiarization sessions of the netball circuit to limit any learning or training effects, and 3 experimental testing sessions, during a 4-week period. All experimental and familiarization sessions were conducted in controlled conditions (indoor netball courts and recovery facilities), separated by a minimum of 2 days and were completed at a similar time of day (±1 hour) to control for circadian variability (23). Training workloads prescribed by coaching staff were identical between sessions. Twenty-four hours before testing, participants were asked to refrain from caffeine and alcohol consumption and to ingest a similar diet. All participants were familiar with the performance test protocols and recovery techniques used in this study.
Six hours before the start of each experimental trial, participants ingested a core temperature pill (CorTemp HT150002, HQ, Palmetto, FL, USA). On arrival at the netball courts, participants were fitted with a heart rate monitor (Heart Rate Team Pack; Suunto, Vantaa, Finland) and skin temperature sensors (iButton; Embedded Data Systems, Lawrenceburg, KY, USA) to 4 sites of the body: chest, arm, thigh, and calf and completed baseline psychometric measures. Participants then commenced the exercise session (approximately at 08:45 hours) with a standardized 15-minute warm-up, which consisted of running drills, dynamic stretches, and a series of sprints and jumps. Immediately after the warm-up, participants completed the baseline repeated agility test and commenced the 15-minute simulated netball circuit. Immediately after the simulated netball circuit, agility and psychometric measures were repeated, followed 20 minutes later by one of the 3 designated recovery intervention (passive recovery, contrast water therapy, or contrast showers). Ten minutes after completion of the recovery intervention, participants returned to the netball courts for repeated agility and psychometric measures (acute) after which they completed these tests again at 16:00 (delayed) and 09:00 hours the next day (24 hours) to replicate a typical training day for the athletes.
All recovery conditions were 14 minutes in duration because this is consistent with previous contrast water therapy research (2,30). During the passive recovery condition, participants remained seated with minimal movement in a temperature-controlled room (20.0 ± 0.7° C). The contrast water therapy condition consisted of participants alternating between hot (38.0 ± 0.4° C) and cold water (15.0 ± 0.3° C) full body immersion (excluding head and neck; starting with hot immersion) every minute with a 5-second transfer time between water baths. Water temperatures were controlled using a water tank and heater/chiller pump system custom built as part of the Australian Institute of Sport Recovery Center. Within the current contrast water therapy literature, a multitude of temperatures and durations have been used (2,30). The choice of temperature and duration selected for this recovery intervention is consistent with previous contrast water therapy research within our laboratory (26,28,29). During the contrast showers, participants started with exposure to the hot shower (38.0 ± 1.2° C) and alternated between hot and cold showers (18.0 ± 0.4° C) every minute. Participants immersed their entire body including head under the shower. Participants were required to alternate between 2 showers (one hot and one cold) to eliminate the need to adjust water temperatures. The temperature of the cold shower represented the coldest water available from a standard tap within the recovery center. During all water-based recovery interventions, water temperature was continuously monitored (1 Hz) using an iButton temperature sensor.
The netball specific circuit used in this study was modified from Higgins et al. (10) and comprised of 5 stations spanning the length of the netball court separated by 3.5 m. A “lap” was characterized by running through each station over the length of the court and jogging back in 30 seconds. The stations were comprised of movements such as short explosive sprints, agility, jumps, and backward and sideways movements. The completion of 1 circuit involved 5 laps of the stations in 150 seconds (30 seconds per lap) followed by 30 seconds to complete 5 maximal counter movement jumps with any remaining time provided as rest. Two up and back sprints from baseline to baseline were then completed in 24 seconds, followed immediately by 10 netball chest passes at a wall. Five minutes were allocated to complete 1 circuit. This circuit was completed 3 times, totaling 15 minutes.
The repeated agility test was used as the measure of physical performance and was selected as it represents a measure consistent with the primary physical demands of the sport. Participants were required to start from a stationary position and maneuver in and out of a series of 5 poles 2.5 m apart (21). The test was performed 4 times with participants starting every 20 seconds. The total time of each run was measured by dual-beam electronic timing gates (Speedlight TT; Swift Performance Equipment, Wacol, Australia). The laboratory coefficient of variation for the repeated agility test is 1.2%.
Throughout the netball circuit, mean and maximum heart rates were recorded. Core and skin temperatures were recorded at baseline, after warm-up, postexercise, before recovery, and immediately and 20 minutes postrecovery. Mean skin temperature (Tskin) was calculated using the following equation derived by Ramanathan (19):
;)
Rating of perceived exertion was measured immediately after the netball specific exercise using the Borg scale (3). In addition, perceptions of fatigue were assessed at baseline, postexercise, immediately postrecovery, and at both delayed and 24 hours time point using a 10-point Likert scale (1 = no fatigue and 10 = extreme fatigue) (3). To determine participants' perception of the efficacy of each recovery modality, a preintervention and postintervention questionnaire was used. Before recovery, participants were asked “Do you believe the postexercise recovery modality will accelerate your recovery in this trial?” Immediately postrecovery, participants were asked “Do you believe the postexercise recovery modality has accelerated your recovery in this trial?” Participants answered on a visual analogue scale (100 mm in length) with strongly agree (0 mm) and disagree (100 mm) at each end.
Statistical Analyses
Differences in performance, psychometric and physiological measures between conditions over time were determined using a linear mixed model analysis. Significant main effects or interactions were analyzed using an adjusted Fisher's least significant difference post hoc analysis. The results of the efficacy questions were analyzed using a 1-way analysis of variance to test for differences within the 3 recovery conditions. A pre-post t-test was conducted to analyze differences within each recovery intervention. All statistical analysis was conducted using an SPSS statistical software package (SPSS Statistics v.21, IBM, New York, NY, USA) with the level of significance set to p ≤ 0.05. All data are presented as mean ± SD.
Results
No significant differences were observed for mean heart rate during the netball specific exercise circuit between the contrast water therapy (180 ± 8 b·min−1), contrast showers (181 ± 7 b·min−1), or passive (182 ± 8 b·min−1) recovery conditions. Similarly, no significant differences were observed for the rating of perceived exertion during the netball specific exercise in the contrast water therapy (18 ± 2 units), contrast showers (18 ± 1 units), and passive (19 ± 1 units) recovery conditions.
A main effect for time was observed for the repeated agility test. In all conditions, immediately after the netball specific exercise, repeated agility times were slower when compared with all other time points (Figure 1).
Figure 1: Mean (±SD) repeated agility measured at baseline, immediately postexercise (PostEx), immediately postrecovery (acute), 5 hours postrecovery (delayed), and 24 hours postrecovery (24 h) in the contrast showers (●), contrast water therapy ([Black Square]) and passive ([Black up-pointing triangle]) recovery intervention groups. *PostEx significantly greater than all other time points.
There was a significant interaction between conditions for skin temperature at the immediately and 20 minutes postrecovery time points with a greater mean skin temperature in the passive condition (31.2 ± 1.1° C and 30.6 ± 0.8° C, respectively) when compared with contrast showers (27.4 ± 1.5° C and 25.4 ± 1.7° C, respectively) and contrast water therapy (24.6 ± 2.3° C and 24.9 ± 1.4° C, respectively) (Figure 2). No significant differences between recovery interventions were observed for core temperature. Regardless, the absolute magnitude of change in core temperature measured from immediately to 20 minutes postrecovery was greater after contrast water therapy (−0.3 ± 0.2° C) and contrast showers (−0.4 ± 0.2° C) compared with the passive (−0.1 ± 0.1° C) condition.
Figure 2: Mean (±SD) (A) skin temperature and (B) core temperature after contrast showers (●), contrast water therapy ([Black Square]), and passive recovery ([Black up-pointing triangle]) measured at baseline, postexercise (PostEx), start of recovery (StartRec), end of recovery (EndRec), and 20 minutes postrecovery (20minPost). *Contrast water therapy and contrast showers significantly less than passive condition; #Contrast showers significantly greater than contrast water therapy; **Selected time points significantly greater than baseline; +Selected time points significantly less than PostEx; ¥Significantly less than StartRec.
Participants' perceptions of fatigue are displayed in Table 1. A main effect for condition and time was observed for the fatigue measures with greater fatigue reported in the passive compared with the contrast water therapy conditions. Furthermore, in all conditions, perceived fatigue was lower at baseline and 24 hours compared with all other time points; however, no differences were noted between conditions at any time points. Perceived effectiveness before the recovery intervention was greater for contrast water therapy (20 ± 15) compared with contrast showers (47 ± 15) and passive (69 ± 11) conditions. After recovery, participants perceived contrast water therapy (19 ± 14) and contrast showers (18 ± 13) to provide superior recovery benefits compared with the passive (73 ± 14) condition. A change in positive perception prerecovery to postrecovery intervention was observed for contrast showers only.
Table 1: Mean (±SD) fatigue scores (units) measured at baseline, immediately postexercise, immediately postrecovery, 5 hours (delayed recovery), and 24 hours after recovery in the contrast water therapy, contrast showers, and passive recovery conditions.
Discussion
This study examined the influence of contrast water therapy and contrast showers on recovery after a netball specific exercise circuit in elite netballers. The main findings were: (a) despite inducing fatigue after the netball specific exercise circuit in all conditions, no performance differences were noted between recovery conditions at any time point, (b) core temperature was not different between conditions at any time point, although greater heat removal was observed in both water recovery conditions compared with control from immediately to 20 minutes postrecovery, (c) overall positive perceptions of recovery were observed after contrast water therapy and contrast showers compared with passive recovery, and (d) participants' perceptions of contrast showers changed positively preintervention to postintervention.
The use of either contrast water therapy or contrast showers after the netball specific exercise did not enhance the recovery of performance in comparison with the control condition (Figure 1). Our findings are similar to previous contrast water therapy research (6,13) during which an inability to induce adequate fatigue was suggested as the rational for the null findings. We do not believe this to be the reason for our findings as postexercise increases in agility times indicate fatigue. Furthermore, this netball specific circuit has previously shown to induce a high level of fatigue (10). Contrast water therapy is associated with a reduction of delayed onset muscle soreness after some team sports (e.g., rugby) that have been suggested to indicate recovery (31). It is possible in this study, although not measured, that the muscle damage may have been minimal that would have limited the efficacy of our recovery interventions. Furthermore, current literature indicates contrast water therapy can enhance recovery after team-sport activity; however, this was only observed >24 hours after the intervention (31). As the present study ceased measures at 24 hours to determine the suitability of each recovery intervention in relation to normal netball competition demands, it is possible any recovery benefit may have been missed. In the absence of performance changes after either recovery intervention, we suggest future research is warranted to examine the use of contrast water therapy and contrast showers in netballers after actual competition and repeated performance assessments >24 hours after exercise (11,28).
To the authors' knowledge, this is the first study to examine differences in core and skin temperature responses to both contrast water therapy and contrast showers. Regardless of the difference in the temperature of cold water used during the contrast water therapy (15.0 ± 0.3° C) and contrast showers (18.0 ± 0.4° C); no differences were observed in core temperature between modalities (Figure 2B). This finding is not surprising because Proulx et al. (18) have reported similar core temperatures during postexercise cold water immersion in water ranging 8–20° C. Consistent with previous research (15,16,25), this study's findings are likely a product of peripheral blood vessel vasoconstriction (16,28) upon cold water exposure limiting blood contact with the cooler periphery. Although not observed during the recovery interventions, we did observe a delayed cooling response in contrast showers and contrast water therapy from postrecovery to 20 minutes postrecovery compared with the passive condition. Versey et al. (28) observed a delayed cooling response in 11 trained male cyclists who completed a contrast water therapy intervention (alternating 1 minute hot, 38° C; 1 minute cold, 15° C for 6, 12, and 18 minutes) after a 75-minute cycling protocol (28). This delayed cooling can be explained by the “afterdrop” phenomena (1), the removal of core body heat after exposure to cold conditions because of sustained peripheral muscle cooling after rewarming.
It should be acknowledged that fatigue is a multidimensional phenomena (1,14) consistent with both physiological and psychological changes, which can influence athletic performance (1). In this respect, the efficacy of recovery techniques should be evaluated at both physiological and psychological levels. It is possible for athletes who feel less pain and muscle soreness to have a heightened sense of well-being after recovery and perform better (20). For this reason, the placebo effect can have significant influence on the success of a recovery intervention (7,17). Our participants perceived both contrast water therapy (19 ± 14) and contrast showers (18 ± 13) to accelerate recovery when compared with the passive condition (73 ± 14). These findings are likely due to the change in skin temperature associated with both water interventions (Figure 2A) because skin temperature is an integral component of a human's perception of fatigue and comfort (8,24). An individual's comfort level is shown to improve when the environment allows the return of body temperature toward homeostasis (8). Compared with the contrast water therapy conditions, a perceptual change was observed preintervention to postintervention for contrast showers. The noted change in perception further indicates the influence of skin temperature on perception, while the difference between conditions is likely due to previous exposure. The current group of participants had routinely been exposed to contrast water therapy, thus influencing the perceived benefit; however, contrast showers were not as customary, therefore perceptions of this modality changed only after the initial exposure.
In conclusion, the current study provides novel information regarding contrast showers as a recovery modality and its comparison to contrast water therapy in a simulated team-sport setting. Although no improvements in performance were observed, contrast water therapy and contrast showers resulted in accelerated skin cooling and greater perceptions of recovery. With the continued use of contrast water therapy and possible use of contrast showers in netball, future research is needed to determine the efficacy of these modalities using extended monitoring periods and competition scenarios.
Practical Applications
The large physical demands placed on athletes during both training and competitions compel coaches and strength and conditioning specialists to provide the most appropriate recovery strategies to increase the chance of their athletes' success. Past research indicates contrast water therapy can be an effective recovery modality in a range of sports; yet, practitioners may be limited in the ability to provide this modality due to facilities and logistics. Findings from this study showed 14 minutes of contrast showers (alternating hot and cold each minute) used immediately after netball training provided a similar perception of enhanced recovery when compared with contrast water therapy. Although neither modality resulted in enhanced physical recovery compared with the control condition, we would suggest that the psychological benefits observed could lead to greater athletic success in some circumstances. With the increasing use of contrast water therapy as a recovery modality in team and individual sport, we propose contrast showers could provide a more practical alternative because of the availability of shower facilities at most sporting events.
Acknowledgments
The authors thank all the participants for their participation in the study and coaching staff for their cooperation during the study. None of the authors of this article have any professional relationships with companies or manufacturers who would benefit from the results of the present study.
References
1. Abbiss CR, Laursen PB. Models to explain
fatigue during prolonged endurance cycling. Sports Med 35: 461–465, 2005.
2. Bieuzen F, Bleakley CM, Costello JT. Contrast water therapy and exercise induced muscle damage: A systematic review and meta-analysis. PLoS One 8: e62356, 2013.
3. Borg G. Borg's Perceived Exertion and Pain Scales. Champaign, IL: Human Kinetics, 1998.
4. Buchheit M, Horobeanu C, Mendez-Villanueva A, Simpson B, Bourdon P. Effects of age and spa treatment on match running performance over two consecutive games in highly trained young soccer players. J Sports Sci 29: 591–598, 2011.
5. Cochrane DJ. Alternating hot and cold water immersion for athlete recovery: A review. Phys Ther Sport 5: 26–32, 2004.
6. Coffey V, Leveritt M, Gill N. Effect of recovery modality on 4-hour repeated treadmill running performance and changes in physiological variables. J Sci Med Sport 7: 1–10, 2004.
7. Finberg M, Braham R, Goodman C, Gregory P, Peeling P. Effects of electrostimulation therapy on recovery from acute team-sport activity. Int J Sports Physiol Perform 8: 293–299, 2013.
8. Flouris AD. Functional architecture of behavioural thermoregulation. Eur J Appl Physiol 111: 1–8, 2011.
9. Higgins T, Cameron ML, Climstein M. Acute response to hydrotherapy after a simulated game of rugby. J Strength Cond Res 27: 2851–2860, 2013.
10. Higgins T, Naughton GA, Burgess D. Effects of wearing compression garments on physiological and performance measures in a simulated game-specific circuit for netball. J Sci Med Sport 12: 223–226, 2009.
11. Higgins TR, Heazlewood I, Climstein M. A random control trial of contrast baths and ice baths for recovery during competition in U/20 rugby union. J Strength Cond Res 25: 1046–1051, 2011.
12. Hing W, White SG, Lee P, Boouaphone A. The use of contrast therapy recovery within the New Zealand elite sports setting. NZJSM 37: 8–11, 2010.
13. King M, Duffield R. The effects of recovery interventions on consecutive days of intermittent sprint exercise. J Strength Cond Res 23: 1795–1802, 2009.
14. Knicker AJ, Renshaw I, Oldham AR, Cairns SP. Interactive processes link the multiple symptoms of
fatigue in sport competition. Sports Med 41: 307–328, 2011.
15. Peiffer JJ, Abbiss CR, Nosaka K, Peake JM, Laursen PB. Effect of cold water immersion after exercise in the heat on muscle function, body temperatures, and vessel diameter. J Sci Med Sport 12: 91–96, 2009.
16. Peiffer JJ, Abbiss CR, Watson G, Nosaka K, Laursen P. Effect of a 5-min cold-water immersion recovery on exercise performance in the heat. Br J Sports Med 44: 461–465, 2010.
17. Pollo A, Carlino E, Benedetti F. The top‐down influence of ergogenic placebos on muscle work and
fatigue. Eur J Neurosci 28: 379–388, 2008.
18. Proulx CI, Ducharme MB, Kenny GP. Effect of water temperature on cooling efficiency during hyperthermia in humans. J Appl Physiol (1985) 94: 1317–1323, 2003.
19. Ramanathan N. A new weighting system for mean surface temperature of the human body. J Appl Physiol 19: 531–533, 1964.
20. Stacey DL, Gibala MJ, Martin Ginis KA, Timmons BW. Effects of recovery method after exercise on performance, immune changes, and psychological outcomes. J Orthop Sports Phys Ther 40: 656–665, 2010.
21. Taylor KL, Bonetti DL, Tanner KT. Netball players. In: Tanner R.K., Gore C.J. eds, Physiological Tests for Elite Athletes (2nd ed.). Lower Mitcham, South Australia: Human Kinetics, 2013.
22. Terblanche E, Venter RE. The effect of backward training on the speed, agility and power of netball players. S Afr J Res Sport Phys Educ Recreation 31: 135–145, 2009.
23. Trine MR, Morgan WP. Influence of time of day on psychological responses to exercise. A review. Sports Med 20: 328–337, 1995.
24. Tucker R, Marle T, Lambert EV, Noakes TD. The rate of heat storage mediates an anticipatory reduction in exercise intensity during cycling at a fixed rating of perceived exertion. J Physiol 574: 905–915, 2006.
25. Vaile J, Halson S, Gill N, Dawson B. Effect of hydrotherapy on recovery from
fatigue. Int J Sports Med 29: 539–544, 2008.
26. Vaile J, Halson S, Gill N, Dawson B. Effect of hydrotherapy on the signs and symptoms of delayed onset muscle soreness. Eur J Appl Physiol 102: 447–455, 2008.
27. Vaile J, Halson S, Graham S. Recovery review—Science vs practice. J Aust Strength Cond (Suppl. 2): 5–21, 2010.
28. Versey N, Halson S, Dawson B. Effect of contrast water therapy duration on recovery of cycling performance: A dose–response study. Eur J Appl Physiol 111: 37–46, 2011.
29. Versey NG, Halson SL, Dawson BT. Effect of contrast water therapy duration on recovery of running performance. Int J Sports Physiol Perform 7: 130–140, 2012.
30. Versey NG, Halson SL, Dawson BT. Water immersion recovery for athletes: Effect on exercise performance and practical recommendations. Sports Med 43: 1101–1130, 2013.
31. Webb N, Harris N, Cronin JB, Walker C. The relative efficacy of three recovery modalities following professional rugby league matches. J Strength Cond Res 27: 2449–2455, 2013.
