88
Journal of Exercise Physiologyonline
February 2016
Volume 19 Number 1
Official Research Journal of
Editor-in-Chief
Tommy
the American
Boone, PhD,
Society
MBA
of
Exercise
Physiologists
Review
Board
Todd Astorino, PhD
ISSN 1097-9751
Julien Baker,
PhD
Steve Brock, PhD
Lance Dalleck, PhD
Eric Goulet, PhD
Robert Gotshall, PhD
Alexander Hutchison, PhD
M. Knight-Maloney, PhD
Len Kravitz, PhD
James Laskin, PhD
Yit Aun Lim, PhD
Lonnie Lowery, PhD
Derek Marks, PhD
Cristine Mermier, PhD
Robert Robergs, PhD
Chantal Vella, PhD
Dale Wagner, PhD
Frank Wyatt, PhD
Ben Zhou, PhD
Official Research Journal
of the American Society of
Exercise Physiologists
ISSN 1097-9751
JEPonline
Effects of Lower-Body Compression Garment in CycleErgometer Maximal Exercise Test: Preliminary Data
Jacqueline Souza dos Santos1, Caio Victor de Sousa1, Rafael dos
Reis Vieira Olher1, José Morais Souto Filho1, Márcio Rabelo Mota2
1
Graduate Program in Physical Education, Universidade Católica de
Brasília, Distrito Federal, Brazil; 2Faculty of Health and Education
Sciences, Centro Universitário de Brasília, Distrito Federal, Brazil
ABSTRACT
Santos JS, Sousa CV, Olher RRV, Filho JMS, Mota MR. Effects of
Lower-Body Compression Garment in Cycle-Ergometer Maximal
Exercise Test: Preliminary Data. JEPonline 2016;19(1):88-95. The
purpose of this study was to determine the effects of wearing
compression stockings during a maximal cycle ergometer exercise
test (CT) on metabolic and perceptual variables in recreational
cyclists. Five subjects underwent three days of testing in random
order: (a) placebo (PL, lower-body garment without compression);
and (b) compression (CP, lower-body (knee to ankle) compression
garment). The tests were performed on a mechanical cycle
ergometer, starting at a 90-watt (W) workload with 30 W increments
every 3-min while maintaining 60 rev·min-1 until volitional exhaustion.
Lactate concentration ([LAC]), heart rate (HR), oxygen uptake (VO2),
and rate of perceived exertion (RPE) were registered at rest and in
the final 30-sec of each stage. There were no significant differences
across the three exercise sessions (CT, PL, and CP). Moreover, the
power output at lactate threshold was not statistically different
between the sessions, as well as the duration of each test. We
conclude that lower-body compression garment (knee-to-ankle) does
not improve physiological performance in trained subjects during an
incremental exercise test.
Key Words: Exercise testing, Compression stockings, Ergogenic
89
INTRODUCTION
Several studies have focused on investigating the effects of different ergogenic aids on
athletic performance (1,7,23,29). The ingestion of dietary supplements (26,28) as well as
stimulants and anabolic steroids (17,28) have been the most common ergogenic strategies to
increase exercise performance. However, aside from being expensive, the efficacy of some
ergogenic aids has been questioned (9,10,21,29,31,32). Moreover, adverse effects of some
ergogenic substances have also been reported (13). Given these outcomes, it is reasonable
to expect more research on new ergogenic aids in order to safely improve exercise
performance.
Compression garments, among these, compression stockings are increasingly popular
among professional and recreational athletes (3). The possible beneficial effects seems to be
contested in scientific community due to a great heterogeneity of protocols and divergent
results (16). The physiological mechanisms involved in a possible performance improvement
seems to be a reduction in micro-trauma and muscle damage (30), less muscle vibration and,
consequently, less energy expenditure that results in a greater economy of movement (6)
and greater comfort. (2). In addition, Bringard (5) reports that lower-body compression can
also improve venous return, which may increase the oxygen delivery to the tissue and
generate a greater power output.
In that regard, Kemmler and colleagues (12) submitted 21 trained men to a stepwise treadmill
test up to a voluntary maximum with and without below-knee compressive stocking. Time
under load and total work were significantly higher with compression stockings compared
with running socks. Running performance at the anaerobic threshold and aerobic thresholds
was significantly higher using compression stockings. Thus, they concluded that stockings
with constant compression in the area of the calf muscles significantly improved running
performance at different metabolic thresholds. Similarly, Scanlan et al. (24), submitted 12
cyclists to two randomly ordered stepwise incremental tests and two randomly ordered 1-hr
time trials on the cycle ergometer. They reported no improvement of performance by wearing
a waist-to-ankle compression garment. It is reasonable to infer that the possible physiological
benefits may only be realized at submaximal stages, which elevates the chronotropic reserve
and reduces the perceived exertion.
Additionally, incremental tests using cycle ergometers seem to elicit a higher metabolic stress
in submaximal stages in comparison to treadmill tests (19,20). This consideration suggests
that exercise performed using the cycle ergometer can be more sensitive to physiological
changes caused by the use of compressive garments when compared to treadmill protocols.
To the best of our knowledge, there is only one study (24) that investigated the effects of
lower-body compression during incremental cycle ergometer test using a waist-to-ankle
garment in professional cyclists, which may be less sensitive to ergogenic aids due their high
fitness level.
The purpose of this study was to verify the effects of wearing compression stockings during a
maximal exercise test on a cycle ergometer on metabolic [lactate concentrations ([LAC]),
hemodynamic (HR and VO2) and perceptual variables [rate perceived of exertion (RPE)] in
recreational cyclists. To the best of our knowledge, this has not yet been investigated. We
90
hypothesize that a lower-body compression garment may improve muscle comfort, leading to
lower production of blood lactate ([LAC]), and lowering the RPE in submaximal stages, which
could lead to a higher power output.
METHODS
Subjects
After approval by local ethics committee (protocol: 16253413.9.0000.0023), five trained men
(mean ± SD age, 2.4 ± 5 yrs; mass, 80.8 ± 11 kg; height, 179 ± 6 cm; VO2 peak, 44 ± 4.9
mL.kg-1.min-1) volunteered to participate. The subjects were not under use of pharmacological
treatment, and they did not have a history of cardiovascular diseases. All subjects were
informed about the risks and benefits of the study and signed an informed consent form prior
to the study getting underway. All procedures were carried out in accordance with the
resolution 466/2012 of the Brazilian National Health Council and to the Declaration of Helsinki
for experiments to be conducted on humans.
General Procedures
The subjects were given instructions to maintain their normal training regimen with the
exception of not performing high-intensity exercise for 24 hrs before the test. Additionally, the
subjects were instructed to avoid alcohol and caffeine on the test day and to avoid food at
least 2 hrs before testing. Each subject underwent 3 test sessions that were separated by at
least 48 hrs; all sessions were completed within a 2-wk period.
The subjects’ first testing day consisted of: (a) taking anthropometric measures; and (b) the
performance of the first cycle ergometer exercise test (CT) to exhaustion (IT). The additional
two visits were: (a) the placebo (PL, lower-body garment without compression); and (b) the
compression (CP, lower-body compression garment (knee to ankle), with adequate sizes and
compression (approximately 20 mmHg) according to the manufacturer instructions
(FLETS®X3X Ultra, Brazil). Both the PL and the CP sessions were carried out in random
order.
Incremental Test
All tests were conducted in a controlled environment (temperature, 20-22 ºC; humidity, 40 to
50%) accompanied by a cardiologist in order to identify any abnormality during the maximal
exercise tests. The tests were performed on a mechanical cycle ergometer (Monark® 828E;
Valburg, Sweden). The test was started at a 90 Watts (W) workload with increments of 30 W
every 3 min while maintaining 60 rev·min-1 until volitional exhaustion.
During the pre-exercise resting period and the last 20 sec of each incremental stage, a 25 μL
sample of capillarized blood was collected from the ear lobe trough heparinized and
calibrated glass capillaries, being deposited in microtubes (Eppendorf) containing 50 μL of
sodium fluoride (NaF) 1% for latter analyses of the [lac] through an electro-enzymatic method
(Yellow Springs 2.700 STAT, OH, USA). The blood lactate kinetics during the IT stages
identified the lactate threshold (LT), which was considered an exercise intensity above which
an over proportional increase in blood lactate was observed in relation to the increasing
workload (27).
Expired gases were also measured during the IT using a gas analyzer (Metalyzer 3B, Cortex
91
Biophysik, Germany) that was previously calibrated with a 3-L syringe (flow calibration) and a
standard mixed gas containing 4.9% CO2 and 17% O2 (gas calibration). The oxygen uptake
(VO2), heart rate (HR), and rate of perceived exertion (RPE) (4) were continuously monitored
and recorded during the last 20 sec of each 3-min stage.
Statistical Analyses
A Shapiro–Wilk and Levene’s test verified normality and homogeneity of data, respectively.
The data are presented as means ± SD. A multivariate ANOVA was applied in order to
compare the three exercise sessions in more than three moments. A repeated measures
ANOVA were used to assess differences in workload at lactate threshold (LT), peak power
output (PPO), and duration of test among the sessions. The Greenhouse–Geisser correction
was used when sphericity was violated (Mauchly’s test, P<0.05). The Bonferroni post hoc
was used in both variance analyses. The alpha level was set at 5% (P<0.05). All statistical
procedures were performed using the Statistical Software for the Social Sciences (SPSS 21).
RESULTS
Comparison between the groups indicated no significant difference among the CT, PL, or CP
sessions for any of the moments (Figure 1). Moreover, the power output at LT, PPO showed
no statistical difference between the tests, as well as the duration of each TI (Table 1).
Figure 1. Heart Rate (HR), Rate Perceived of Exertion (RPE), Blood Lactate [LAC], and VO2
during the CT, PL, and CP Sessions. Data expressed as mean ± standard deviation.
92
Table 1. Workload Values at LT, PPO, and Duration of the Tests.
Cycle Test
Placebo
Compression
CT
PL
CP
LT (W)
138 ± 26.8
150 ± 30
138 ± 34.2
PPO (W)
264 ± 25.1
264 ± 39.1
252 ± 40.2
1141 ± 164
1119 ± 198
1119 ± 211
Duration (sec)
Data expressed as mean ± SD; LT: lactate threshold; PPO: peak power output.
DISCUSSION
The major finding in this study is that the lower body compression garment (knee-to-ankle)
did not improve exercise performance. Also, it is interesting that the compression garment did
not decrease the subject’s physiological stress during the submaximal workloads of the
incremental cycle ergometer test. These findings are in agreement with the work of Scanlan
et al. (24). They reported no improvement in performance when wearing a waist-to-ankle
compression garment. Conversely, the findings in the present study disagree with Driller and
Halson (8) who submitted their subjects to wearing a waist-to-ankle compression and found
that mean exercise HR was reduced with a higher mean power output.
As an ergogenic aid, it is believed that the benefit of wearing a lower-body compression
garment is related to the improved venous hemodynamics (11,22) that increases enddiastolic volume and cardiac output (14,25), although such changes are not always observed
when the subject is not lying down (15,18). There is also the anticipated improvement in O2
delivery to the tissues that appears not to have happened and may be the explanation for the
results of the present study (5).
While the use of compressive garments by athletes is increasing, it is likely that the idea of
improving performance is more psychological than physiological with obvious difficulties in
analyzing the effects if any (16). The present results indicated a visually lower perceived
exertion in submaximal workloads, but there were no statistical differences. This finding may
be partially explained for the decreased vibration on the target muscle that could make the
exercise movements more comfortable, but not necessarily sufficient to translate into an
increased economy of energy expenditure.
Limitation of the Study
A possible limitation of the present study was that the applied pressure of the lower-body
compression garment was not measured, and only reported the approximated value indicated
by the manufacturer. Nonetheless, regarding the potential benefits as an ergogenic aid,
Beliard (3) states that the results do not seem to be related to the pressure applied (low or
high pressure). This suggests that the reason for this performance improvement in some
athletes and absolutely no effects in other athletes remains unknown. We conclude that
lower-body compression garment (knee-to-ankle) does not appear to improve performance in
93
trained men during incremental exercise test. Future studies should test the use of this aid in
submaximal intensities with fixed velocity protocols.
CONCLUSIONS
There were no significant differences across the three exercise sessions (CT, PL, and CP).
Moreover, the power output at lactate threshold was not statistically different between the
sessions, as well as the duration of each test. We conclude that lower-body compression
garment (knee-to-ankle) does not improve physiological performance in trained subjects
during an incremental cycle ergometer exercise test.
ACKNOWLEDGMENTS
The authors are thankful to Mr. Renan Renato Cruz dos Santos for their technical assistance,
and to Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) and
Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) for granting the
scholarships in undergraduate research level (CNPq), MSc (CAPES), and PhD (CAPES).
The authors have no conflicts of interest.
Address for correspondence: Caio Victor de Sousa. EPTC, QS07, LT1 s/n Building G,
Room 15. Graduate Program in Physical Education, Universidade Católica de Brasília,
Distrito Federal, Brazil. Zip Code: 72030-170. E-mail: [email protected]
REFERENCES
1. Ahrendt DM. Ergogenic aids: Counseling the athlete. Am Fam Physician. 2001;63
(5):913-922.
2. Ali A, Caine MP, Snow BG. Graduated compression stockings: Physiological and
perceptual responses during and after exercise. J Sports Sci. 2007;25(4):413-419.
3. Beliard S, et al. Compression garments and exercise: No influence of pressure
applied. J Sports Sci Med. 2015;14(1):75-83.
4. Borg G. Borg's Perceived Exertion and Pain Scales. Human Kinetics, 1998.
5. Bringard A, Denis, R, Belluye N, Perrey S. Effects of compression tights on calf
muscle oxygenation and venous pooling during quiet resting in supine and standing
positions. J Sports Med Phys Fit. 2006;46(4):548-554.
6. Bringard A, Perrey S, Belluye N. Aerobic energy cost and sensation responses during
submaximal running exercise--positive effects of wearing compression tights. Intern J
Sports Med. 2006;27(5):373-378.
94
7. Congeni J, Miller S. Supplements and drugs used to enhance athletic performance.
Pediatr Clin North Am. 2002;49(2):435-461.
8. Driller MW, Halson SL. The effects of wearing lower body compression garments
during a cycling performance test. Int J Sports Physiol Perform. 2013;8:300-306.
9. Elashoff JD, et al. Effects of anabolic-androgenic steroids on muscular strength. Ann
Intern Med. 1991;115(5):387-393.
10. Fiedl KE. Effect of anabolic steroid use on body composition and physical
performance. Anabolic Steroids in Sport and Exercise. Human Kinetics,
Champaign, IL, 2000;139-174.
11. Ibegbuna V, Delis K, Nicolaides AN. Effect of lightweight compression stockings on
venous haemodynamics. Int Angiol. 1997;16(3):185-188.
12. Kemmler W, von Stengel S, Kockritz C, Mayhew J, Wassermann A, Zapf J. Effect of
compression stockings on running performance in men runners. J Strength Cond
Res. 2009;23(1):101-105.
13. Kuhn CM. Anabolic steroids. Recent Prog Horm Res. 2002;57:411-434.
14. Lawrence D, Kakkar VV. Graduated, static, external compression of the lower limb: A
physiological assessment. Br J Surg. 1980;67(2):119-121.
15. Lord RSA, Hamilton D, Graduated compression stockings (20−30 mmHg) do not
compress leg veins in the standing position. ANZ J Surg. 2004;74(7):581-585.
16. MacRae BA, Cotter JD, Laing RM. Compression garments and exercise: Garment
considerations, physiology and performance. Sports Med. 2011;41(10):815-843.
17. Maughan RJ. Legal ergogenic aids? Curr Sports Med Rep. 2009;8(4):165-166.
18. Mayberry JC, et al. The influence of elastic compression stockings on deep venous
hemodynamics. J Vasc Surg. 1991;13(1):91-99.
19. Miles DS, Critz JB, Knowlton RG. Cardiovascular, metabolic, and ventilatory
responses of women to equivalent cycle ergometer and treadmill exercise. Med Sci
Sports Exerc. 1980;12(1):14-19.
20. Millet GP, Vleck VE, Bentley DJ. Physiological differences between cycling and
running: lessons from triathletes. Sports Med. 2009; 39(3):179-206.
21. O’Connor LH, Cicero TJ. Anabolic steroids: misuse or abuse. Hormonally Induced
Changes in Mind and Brain. Academic Press: San Diego, CA, 1993;129-156.
22. Partsch B, Partsch H. Calf compression pressure required to achieve venous closure
from supine to standing positions. J Vasc Surg. 2005;42(4):734-738.
95
23. Robert-McComb JJ, Jordan SL. Ergogenic aids and the female athlete. In: The Active
Female. Springer, 2008;311-321.
24. Scanlan AT, Dascobe B, Reaburn P, Osborne, M. The effects of wearing lower-body
compression garments during endurance cycling. Int J Sports Physiol Perform.
2008;3(4):424-438.
25. Sigel B, et al. Type of compression for reducing venous stasis. A study of lower
extremities during inactive recumbency. Arch Surg. 1975;110(2):171-175.
26. Silver MD. Use of ergogenic aids by athletes. J Am Acad Orthop Surg. 2001;9(1):6170.
27. Svedahl K, MacIntosh BR. Anaerobic threshold: The concept and methods of
measurement. Can J Appl Physiol. 2003;28(2):299-323.
28. Thein LA, Thein JM, Landry GL. Ergogenic aids. Phys Ther. 1995;75(5):426-439.
29. Tokish JM, Kocher MS, Hawkins RJ. Ergogenic aids: A review of basic science,
performance, side effects, and status in sports. Am J Sports Med. 2004;32(6):15431553.
30. Trenell MI, et al. Compression garments and recovery from eccentric exercise: A
(31)P-MRS Study. J Sports Sci Med. 2006;5(1):106-114.
31. Wilson JD. Androgen abuse by athletes. Endocr Rev. 1988;9(2):181-199.
32. Wilson JD, Androgens. Goodman and Gilman’s Experimental
Therapeutics. New York, NY: McGraw-Hill, 1996;1441-1457.
Basis
of
Disclaimer
The opinions expressed in JEPonline are those of the authors and are not attributable to
JEPonline, the editorial staff or the ASEP organization.