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Abstract

Compression garments are becoming increasingly popular among sportspeople who wish to improve performance and reduce their exercise discomfort and risk of injury. However, evidence for such effects is scarce. This paper presents the evidence following a review of the literature evaluating the effects of the application of compression garments on sports performance and recovery after exercise. The literature reviewed was the result of a search on the Web of Science, PubMed, and SPORTDiscus electronic databases for studies which analysed the effect of compression garments on physiological, psychological, and biomechanical parameters during and after exercise. These search criteria were met by 40 studies. Most studies do not demonstrate any beneficial effect on performance, immediate recovery, or delay in the appearance of muscle pain. They do, however, show a positive trend towards a beneficial effect during recovery: the subsequent performance improved in five of the eight studies where it was measured, and the perception of muscle damage was reduced in five of six studies. In summary, the use of compression garments during recovery from exercise appears to be beneficial, although the factors explaining this efficacy have yet to be established. No adverse effects of the use of compression garments have been demonstrated.

Keywords

Clothing compression exercise muscle damage hæmodynamics

Introduction

Compression garments, first used in the medical industry for patients with circulatory problems, are becoming increasingly popular among sportspeople, especially amateur runners [1]. However, the benefits on the parameters that determine performance and recovery have yet to be clearly demonstrated in the literature [2,3].

Among the main benefits that have been attributed to compression garments are: improvement in recovery [4], increase in power and improvement in time trial performance [5], reduction in muscle vibration that increases stability [6], increase in blood flow (peripheral flow and venous return) [7], improvements in thermoregulation [8], decreased muscle pain [9], and the elimination of blood lactate [10] and of creatine kinase [1] after exercise. However, not all studies found the use of these compression garments to have beneficial effects on performance [11] and/or recovery [12].

In general, the heterogeneity of the test procedures as well as the differences between the types and levels of compression make comparison of the various studies evaluating compression sportswear difficult [13]. For this reason, the general objective of the present systematic review was to analyse the existing literature in the field of compression garments, so as to be able to identify the benefits attributed to performance and/or recovery. The review focuses specifically on identifying improvements in strength and/or endurance, and in describing the effects on physiological, psychological, and biomechanical parameters.

Methods

The specialized scientific literature analysed was from January 2012 to April 2016. The search was performed on the Web of Science® (WoS), PubMed, and SPORTDiscus databases, using as search strategy the keywords: [compression garments AND (sport OR exercise) AND effects] (Figure 1).

Figure 1.

Criteria for selection and inclusion in the study.

A total of 40 articles were included in this review, as shown in Figure 1:

In 11 articles, the effects of compression garments after exercise were analysed. Most of these studies considered the parameters that could influence recovery, such as: blood markers (lactate, creatine kinase, and interleukin-6 concentrations), strength levels, and the perception of muscle damage and/or fatigue.

In 29 articles, the effects of compression garments during exercise were analysed. The parameters most frequently measured variables were: blood markers (lactate and creatine kinase concentrations), muscle strength and activation levels, circulatory (hæmodynamics) and cardiorespiratory (heart rate and oxygen consumption) parameters, and the perception of exertion/comfort.

Results

The analysis of the results is structured in accordance with their relationship with recovery (Table 1) and sports performance (Table 2 and Table 3) in different phases of application of the compression garment: during exercise, during post-exercise recovery, and in both phases.

Table 1.

Effects of compression garments on recovery.

Reference	When garment was worn	EG vs. CG	Garment type (mmHg)	Experimental protocol	Variable analysed	Effect
Sambaher et al. [15]	EXER	Yes	Stockings (20–30 ankle; 15–20 knee)	Drop jump (30-cm) to exhaustion	Skin T	+
					Force	0
					MVC	0
					EMG calf	0
					Jump pm. (DJ)	0
					Lactate	0
Pereira et al. [14]	EXER	Yes	Sleeves (Ø)	Elbow flexion of 120° at 130°	MVC	0
					Force	0
					PMD	0
					B. markers	0
Armstrong et al. [16]	REC	Yes	Stockings (30–40 ankle; 10–15 knee)	Incremental test (treadmill)	TTE	+
					HR	0
					EPR	0
Goto and Morishima [22]	REC	Yes	Whole body (Ø)	10 repetitions at 70% of 1RM	Force	+
					MVC	+
					B. markers	0
					Lactate	0
					PMD	+
Duffield et al. [23]	REC	Yes	Whole body (Ø)	Training and tennis match (90′) after rest (3 h)	Technique	+
					Force	0
					Jump pm. (CMJ)	+
					HR	0
					Lactate	0
					EPR	+
					PMD	+
Hill et al.[19]	REC	Yes	Stockings (Ø)	Marathon	B. markers	0
					MVC	0
					PMD	+
Argus et al. [21]	REC	Yes	Stockings (18 thigh; 27 calf)	3 maximum 30″ stationary bicycle sprints	Lactate	0
Argus et al. [21]	REC	Yes	Stockings (18 thigh; 27 calf)	3 maximum 30″ stationary bicycle sprints	EPR	0
Pruscino et al. [20]	REC	No	Stockings (Ø)	Hockey exercises and wear garment 24 h post	Lactate	0
					B. markers	0
					EPR	0
					PMD	+
Hamlin et al. [18]	REC	Yes	Stockings (Ø)	Rugby test, rest with stockings (24 h) & speed & resistance test	Total t. sprints	0
Hamlin et al. [18]	REC	Yes	Stockings (Ø)		Total t. 3 km	+
De Glanville and Hamlin [17]	REC	Yes	Stockings (11.8 thigh; 14.7 ankle)	Cycling test (40 km) + 24 h rest with stockings + initial test	Total t.	+
					VO2	0
					EPR	0
Bieuzen et al. [24]	BOTH	Yes	Stockings (20–25)	Cross-country run (15.6 km)	Force	+
					PMD	+
					B. markers	0

Note: EXER/REC/BOTH: wearing the compression garment during exercise, during recovery, or both. EG vs. CG: comparison of an experimental group with a control group. Ø: not reported. 0: no effect (absence or detrimental effect). +: beneficial effect.

T: temperature; MVC: maximum voluntary contraction; EMG: electromyography; Jump pm (type of jump): jump parameters (jump height, take-off speed, and contact time); Lactate: blood lactate concentration; TTE: time to exhaustion; HR: heart rate; VO2: oxygen consumption; EPR: exertion perception ratio; B markers: blood markers of muscle damage; Total t : total time; Technique*: number of errors/strokes; PMD: perception of muscle damage; DJ: drop jump with height; CMJ: counter-movement jump.

Table 2.

Effects of upper body compression garments on performance.

Reference	When garment was worn	EG vs. CG	Garment type (mmHg)	Experimental protocol	Criterion	Effect
Chan et al. [25]	BOTH	Yes	Whole body (Ø)	4-h manual labour tasks	PMD	+
Chan et al. [25]	BOTH	Yes	Whole body (Ø)	4-h manual labour tasks	EPR	+
Brighenti et al. [26]	EXER	Yes	Whole body (Ø)	Stationary bicycle test at 32℃	VO2	0
					HR	0
					TTE	0
					EPR	0
					CPR	0
MacRae [27]	EXER	Yes	Whole body (8–15)	1-h stationary bicycle at 65% of VO2 max and after 6 km test	Hæmodynamics	0
MacRae [27]	EXER	Yes	Whole body (8–15)		Skin T	0
Leoz-Abaurrea et al. [28]	EXER	Yes	T-shirt (Ø)	45′ treadmill run at 60% followed by 80% TTE	TTE	0
					Body T	0
					Body mass	0
					HR	0
					Lactate	0
					CPR	0
Sperlich et al. [29]	BOTH	No	Shirt (20 forearm, 15 triceps)	3 sets of 3′ skiing sprints	Hæmodynamics	0
					Force	0
					VO2	0
					EPR	0
					Lactate	+
Dascombe et al.[30]	EXER	No	Long-sleeved shirt (Ø)	Incremental test of 4′ kayaking	HR	0
					VO2	0
					Force	0
					Distance	0
					Lactate	0
Martorelli et al. [31]	EXER	No	Sleeves (Ø)	6 sets of 6 repetitions 50% 1RM	Force	0
					MVC	0
					Lactate	0
Pereira et al. [14]	EXER	Yes	Sleeves (Ø)	Elbow-flexion isokinetic dynamometry	Force	0
Odenwald and Krumm [35]	EXER	No	Sleeves (23–32 forearm)	6 vibration intensities (20″)	Vibration	0
Pereira et al. [32]	EXER	No	Sleeves (Ø)	Elbow-flexion dynamometry	Force	0
Tsuruike and Ellenbecker [34]	EXER	No	Sleeves (Ø)	Shoulder rotation at 20–30% and 40–50% of isometric MVC	Force	+

T: temperature; MVC: maximum voluntary contraction; EMG: electromyography (measures muscle activation); VAM: maximum aerobic speed; Jump pm (type of jump): jump parameters (jump height, take-off speed, and contact time); Lactate: blood lactate concentration; TTE: time to exhaustion; HR: heart rate; CPR: comfort perception ratio; VO2: oxygen consumption; VE: ventilations per minute; EPR: exertion perception ratio; M blood: blood markers of muscle; Total t : total time; T2: cross-section of the muscle (nuclear magnetic resonance); PMD: perception of muscle damage; O: muscle oxygenation; CMJ: counter-movement jump; V; leg: leg volume; MMG: mechanomyography.

Table 3.

Effects of lower body compression garments on performance.

Reference	When garment was worn	EG vs. CG	Garment type (mmHg)	Experimental protocol	Criterion	Effect
Venckūnas et al. [36]	EXER	Yes	Tights (17–18 calves)	4-km run at 90″/lap (200 m) + 400 m sprint	HR	0
					Hæmodynamics	0
					Skin T	0
					Body T	0
					EPR	0
Wang et al. [37]	EXER	No	Tights (Ø)	Treadmill run, speed 5-7 m/s	EMG calf and rectus femoris	+
Fu et al. [38]	EXER	Yes	Tights (Ø)	5″ of MVC and 25 knee flexions	EMG quadriceps	+
Fu et al. [38]	EXER	Yes	Tights (Ø)	5″ of MVC and 25 knee flexions	MMG	0
Priego et al. [46]	EXER	No	Stockings (20–24 ankles; 16–21 calves)	30′ run at 80% VAM	HR	0
					VO2	0
					VE	0
Lucas-Cuevas et al. [43]	EXER	No	Stockings (20–24 ankles; 16–21 calves)	30′ treadmill run 80% max. intensity	Attenuation	+
					Impact	+
					EPR	0
					CPR	0
Priego Quesada et al. [47]	EXER	No	Stockings (20–24 ankles; 10–15 calves)	20′ run at 75% VAM	Skin T	0
					HR	0
					EPR	0
Areces et al. [39]	EXER	Yes	Stockings (20–24 ankles; 16–21 calves)	Marathon (official competition)	Total t.	0
					Pace	0
					EPR	0
					B. markers	0
Miyamoto and Kawakami [45]	EXER	Yes	Stockings (<14 to >25 ankles and calves)	30′ run at 12 km/h	EPR	0
Miyamoto and Kawakami [45]	EXER	Yes	Stockings (<14 to >25 ankles and calves)	30′ run at 12 km/h	T2	0
Rider et al. [48]	EXER	Yes	Stockings (20–24 ankles; 10–15 calves)	Maximum effort on a treadmill	HR	0
					TTE	0
					VO2	0
					EPR	0
					Lactate	+
Gupta et al. [53]	EXER	No	Stockings (Ø)	Hopping at 2.2 Hz	Jump (one leg)	0
Miyamoto and Kawakami [44]	EXER	Yes	Stockings (<14 to >25 ankles and calves)	30′ run at 12 km/h	T2	+
Born et al.[29]	EXER	No	Stockings (16–21 calves; 20 thigh)	Speed skating 3000 m	Hæmodynamics	0
					VO2	0
					HR	0
					Lactate	0
					EPR	0
Bovenschen et al.[50]	EXER	No	Stockings (>25 ankles; >22 calves)	10-km run Incremental test of speed	V. leg	+
					EPR	0
					CPR	0
Driller and Nelson [42]	EXER	No	Stockings (15–19 ankles; 16–21 calves; 14.9 thigh; 9 buttocks)	1-h bicycle incremental test	Force	+
					Lactate	+
					VO2	0
					O. muscular	0
Rugg and Sternlicht [49]	EXER	Yes	Stockings (15–19 ankles; 10–15 calves; 7 thigh)	15′ treadmill run at 50%, 70% and 85% and after 3 CMJ	Jump pm. (CMJ)	+
					EPR	+
					CPR	+
Barwood et al.[40]	EXER	Yes	Stockings (Ø)	5-km run at 35℃	Skin T	0
					Body T	0
					EPR	0
Faulkner et al.[51]	EXER	Yes	Stockings (Ø)	6 sets of 400 m	HR	0
					Total/partial t.	0
					Lactate	0
					EPR	+
					CPR	+
Coza et al.[52]	EXER	Yes	Stockings (Ø)	Tiptoe exercises (calves)	Muscle O.	+

Note: EXER / REC / BOTH: wearing the compression garment during exercise, during recovery, or both. EG vs. CG: comparison of an experimental group with a control group. Ø: not reported. 0: no effect (absence or detrimental effect). +: beneficial effect.

T: temperature; MVC: maximum voluntary contraction; EMG: electromyography (measures muscle activation); VAM: maximum aerobic speed; Jump pm (type of jump): jump parameters (jump height, take-off speed, and contact time); Lactate: blood lactate concentration; TTE: time to exhaustion; HR: heart rate; CPR: comfort perception ratio; VO2: oxygen consumption; VE: ventilations per minute; EPR: exertion perception ratio; B markers: blood markers of muscle damage; Total t: total time; T2: cross-section of the muscle (nuclear magnetic resonance); PMD: perception of muscle damage; O: muscle oxygenation; CMJ: counter-movement jump; Vleg: leg volume; MMG: mechanomyography.

Effects on recovery

With respect to the effects on recovery after wearing the compression garments during exercise, only two protocols used strength tests [14,15]. They reported no significant improvements either in strength, maximal voluntary contraction and muscle activation [14,15], or in such kinematic parameters as run-up speed, jump height, contact time, and flight time [15]. One detrimental effect observed was worsening of muscle damage as soreness increased [14], and one positive effect was an increase and maintenance of skin temperature during the recovery period [15].

If the compression garment was worn during the recovery phase, different evaluation protocols were applied: endurance tests [16 –20], repeated-sprint test [21], strength tests [22], and protocols specific to tennis based on technique drills and physiological performance at the court [23]. Most of the endurance tests used compression stockings. Their results showed no significant differences in heart rate [16], maximum voluntary contraction [19], oxygen consumption [17], and plasma lactate [20,21] or creatine kinase and interleukin [19,20]. The perception of muscle damage stood out as being beneficial [19,20], while the perception of exertion did not improve in any of the cases [16,17,20,21].

We found one study [24] of the effect of compression garments worn in both phases (during exercise and during recovery). This study was based on an endurance test. It observed significant improvements in muscle recovery and in the perception of muscle damage, while the blood markers of interleukin-6 and creatine kinase remained unchanged [24].

Effects on performance

With respect to the effects of wearing compression garments during exercise, there have been various studies with different types of garment (zone of the body covered).

For full-body garments, three protocols involved an endurance test: one simulating 4 h of industrial manual labour tasks [25], and two a stationary bicycle test [26,27]. A moderate beneficial effect was recorded in the perception of fatigue and muscle damage when the pain was reduced [25]. In the study by Brighenti et al. [26], performed at 32℃, there were no changes in oxygen consumption, heart rate, or the time to exhaustion for the experimental group relative to the control group. Neither were there any changes in perceived exertion or comfort. MacRae et al. [27] did not register significant improvements in skin temperature or blood flow.

For compression shirts, three protocols involved endurance tests: 45 min of treadmill running [28], series of 3 min skiing [29], and an incremental kayaking test [30]. No significant improvements were found in body temperature or weight [28], heart rate [28,30], blood lactate concentration [28,30], muscle strength [28,29], blood flow [29], or oxygen consumption [29,31]. The only beneficial effect found was a decrease in blood lactate concentration in the study by Sperlich et al. [29]. There were no changes in the perception of comfort [28] or fatigue [29] when comparing the experimental group with the control group. No significant improvements were found in the performance parameters. Indeed, while the distance covered in the incremental kayaking test was similar both with and without the compression garment [30], the time to exhaustion was actually significantly reduced in the group wearing compression shirts compared to the control group [28].

With the use of sleeves, four studies based their protocol on strength exercises [31 –34] and another on different frequency intensities of vibration [35]. No significant improvements were found in strength levels [14,31 –33], vibration [35], or maximal voluntary contraction and blood lactate concentration [31]. The only beneficial effect found was improved motor control of external rotation of the glenohumeral joint [34].

With the use of tights, two protocols performed an endurance test [36,37] and another strength exercises [38]. No significant improvements were found in heart rate, blood flow, and skin or body temperature [36]. Neither were there significant changes in the mechanomyography [38]. However, a marked decrease was observed in muscle activation with the calf [37] and quadriceps [37,38] electromyography. There were no changes between the experimental and the control groups in the perception of fatigue [36].

Finally, regarding the use of compression stockings, 10 protocols performed endurance tests [39 –48], 3 combined tests of different types (endurance and strength [49], and endurance and speed [50,51]), and two strength tests [52,53]. The use of compression stockings did not significantly improve heart rate [41,46 –48,51], respiratory parameters with an emphasis on oxygen consumption [41,42,46,48], skin temperature [47], plasma markers of muscle damage [39], blood lactate concentration [41,51], one-leg hop parameters [53], or blood flow and muscle oxygenation [41,42]. Neither were there significant improvements found in performance parameters: the time to exhaustion remained unchanged in the group with compression stockings compared to the control group [48], the partial times of each of the 400 m sets did not show any notable change [51], and the pace and total race time in an official marathon were unaffected [39]. But the use of compression stockings significantly improved attenuation and impact [43], muscle potential [42], blood lactate concentration [42 –48], leg volume [50], counter-movement jump parameters [49], and muscle oxygenation [52]. Two studies [44,45] performed nuclear magnetic resonance imaging to analyse muscle cross section (T2). Their results were contradictory: in the first, Miyamoto and Kawakami [44] reported a reduction in the development of muscular fatigue, but one year later they [45] found no evidence to demonstrate such a reduction. The study of Barwood et al. [40] was performed at 35℃. They confirmed their hypothesis that there would be no changes in body or skin temperature in the experimental group as compared with the control group, and neither was the perception of exertion changed. The findings for this last parameter, the perception of exertion, varied markedly among different studies, with improvements found in two [49,51] but no variation in others [39,41,43,45,47,48,50]. Different results were also reported for the perception of comfort. Bovenschen et al. [50] and Lucas-Cuevas et al. [43] found no changes in their measurements about the development of fatigue, whereas Rugg and Sternlicht [49] and Faulkner et al. [51] recorded major improvements.

Discussion

The present study has tried to know what effect applying compression garments has on sports performance and recovery after exercise, so as to allow any possible benefits to be distinguished. Specifically, the intention was to identify improvements in strength and/or endurance, and to describe the effects on physiological, psychological, and biomechanical parameters.

Whereas we have presented the results following the structure of the effects on recovery and on performance, we shall now take a different approach, considering the effects on physiological and psychological factors, strength and endurance, fatigue, muscle activation and vibration, and impacts. Therefore, as these aspects affect both recovery and performance, they will be discussed together in terms of their effects.

Analysing the 40 research papers, one could argue that currently there are two trends. On the one hand, the literature shows a positive trend in the use of compression garments during the recovery phase, as well as a positive evaluation of the perception of muscle damage. However, this trend should be interpreted with caution because the results are very uneven: the compression garments and the degree of compression exerted on different parts of the body vary considerably among the studies analysed. It should be considered that compression garments are frequently used by runners suffering from tibial periostitis (a common lesion in runners) or by people suffering from chronic venous insufficiency. The results of the present review based on healthy individuals may therefore not be valid for chronically ill or injured subjects who practice some sport [13]. On the other hand, the use of compression garments during the actual exercise seems to have little effect, since most studies have not shown any beneficial effect on immediate performance, regardless of the type of protocol applied (endurance tests, strength tests, or tests with endurance combined with strength or speed).

The effects of compression garments on different factors influencing performance and recovery will be discussed in the following subsections.

Physiological factors

From a physiological standpoint, and depending on the duration and environmental conditions, exercise performance is determined primarily (but not exclusively) by an improvement in hæmodynamics (elevated venous return, and high lymph input and output rates [54], flow rate at lactate threshold, maximum oxygen consumption and heat exchange processes [55]. The literature suggests that applying compression on one part of the body will lead to an increase in blood flow, and consequently increases nutrient supply and elimination of waste metabolites, i.e. improved venous return [10]. Improved venous hæmodynamics points to faster diastolic filling, increasing cardiac ejection volume and cardiac output [9]. Given that the ejection volume is a limiting factor for performance [56], the application of compression garments could serve as an ergogenic aid. In this context, MacRae et al. [27], Sperlich et al. [29], Venckūnas et al. [36], and Born et al. [41] using a compression full-body suit, shirt, tights, and stockings, respectively, obtained results indicating no change in any of the aforementioned parameters. Indeed, no study analysed found any significant improvement in the heart rate [28,30,36,41,46 –48,51]. Exceptionally, there was one study which found improved muscle oxygenation [52], although this result seems to have been influenced by the repetitive exercise of the protocol.

If the applied pressure levels are analysed, there seems to be no clear relationship between the degree of compression and its effect in the different phases of exercise. Improvements in recovery were found when the garments used were progressive, very low compression [57], but also when using decreasing high compression [18], indicative of the level of uncertainty in this regard.

The application of compression garments may improve the elimination of metabolites by reducing the blood lactate concentration [58]. It is worth bearing in mind, however, that decreased lactate concentration is not necessarily a valid indicator of the quality of recovery [59]. When compression garments were applied in the recovery phase, only detrimental effects were found in lactate accumulation [15,20,22,23,33]. But when they were applied during exercise, both beneficial [29,42,48] and detrimental effects [13,28,30,31,51] were recorded. The variability of the data therefore does not allow any clear conclusion to be drawn on which compression garment is most suitable for reducing the blood lactate concentration, but the data do point to an improvement in endurance. In this context, compression lowers blood lactate concentrations after high-intensity exercise by creating an inverse gradient due to lactate retention within the muscle [10,58].

With regard to respiratory parameters, multiple papers identify similar effects in the mean or maximum oxygen consumption in any study, regardless of the degree of compression, garment type, protocol, or environmental condition. Thus, it can be affirmed that sportspeople do not benefit from the use of compression garments in this sense [17,26,29,30,41,42,46,48]. This conclusion coincides with that of another recent review [60].

Another factor to take into account is the body and skin temperature. Since biochemical processes are controlled by temperature, changes in skin temperature may also contribute to differences in physiological and psychological variables [60]. Covering a part of the body with compression garments can influence skin temperature [27,61] and the temperature of the areas in contact with the garment [47]. According to Formenti et al. [62], skin temperature increases as blood flow increases, and greater heat dissipation is required. This relationship was not observed in the present review; however, [27,36] in the study by Sambaher et al., [15] the increase in temperature had a positive effect on recovery. On the contrary, there were results indicating that compression garments help dissipate heat, with Barwood et al. [40] reporting that their use under radiant heat conditions did not increase body or skin temperature in the experimental group compared to the control group. This effect is also reported by other authors [63,64], who found that the compression garments offer much stronger cooling then the free non-compression garments.

Psychological factors

In contrast with the physiological results, compression does appear to have beneficial effects on the psychological parameters examined. The studies that analysed only recovery showed compression garments to improve the perception of muscle damage when reducing discomfort [19,20,22 –24]. This psychological improvement may be due to impact attenuation [6,43], a reduction in the number of working fibres [65], a decrease in structural damage to muscles [66], an improvement in lymph outflow which increases comfort by reducing muscle inflammation [67], and/or simply due to the placebo effect acting directly to intensify the sensations of the sportspeople themselves [1]. Two studies found improvement in the perception of muscle damage to be linked to an improvement in strength [22,24], while in the rest of the papers, the cause of the improvement was unclear since no benefits were found in parameters other than those related to perception. One study found no improvement in pain perception due to increased soreness [33]. It was the only one in which compression sleeves were used, and the protocol applied was exclusively of arm strength.

The perception of exertion is not improved by wearing compression garments [16,17,20,21]. This is likely due to these garments most often being used only during recovery, so that no positive results were obtained when the perception of fatigue was measured without them. As an exception, however, Duffield et al. [23] reported improvements in perceived exertion from wearing a full-body garment for the recovery period between the training and the tennis match established in their protocol.

Considering the performance-related studies separately, on the one hand, one observes that the perception of muscle damage improved [25], although this conclusion cannot be regarded as definitive because it was only measured in one study. On the other hand, the perception of exertion gave unclear results. In endurance tests [40,49,51], perception of exertion was improved, perhaps as a result of better lymph drainage [67]. The studies which reported no benefits had many similarities with those that did: use of compression stockings and endurance tests [39,41,43,47,48]. One has to rule out that this lack of benefit may be due to a deterioration in impact mitigation since Lucas-Cuevas et al. [43] reported beneficial effects on this factor. The importance of compression on the effective cooling effect, thermal absorption and thermal insulation of clothes wet with sweat during the strong physical activity of the wearer must also be taken into account [63,64]. Hes et al. [64] demonstrated how the compression garments offer much stronger cooling then the free non-compression garments. In these free garments, the air gap between the fabric and the skin substantially reduces the required cooling effect, thus causing thermal discomfort of the garment wearer [64].

Finally, the perception of comfort appears to be related to the perception of fatigue since they both either improve together [49,51] or worsen together [26,43,50].

Endurance and strength

The parameters of exercise endurance were improved by wearing compression garments during the recovery phase [16 –18]. This is hard to explain as there were no findings of improvements in the different blood markers of physiological changes. One cannot rule out that the improvement was due to the action of the lymphatic system [67] or to a placebo effect [1]. Indeed, this latter can lead to changes in the perception of exertion during exercise as if it were itself an ergogenic aid. In contrast, no modifications were reported in total times [26,28,48], partial times [51], distance [30], or pace [39] in exercise when wearing compression garments. These findings are consistent with the studies’ physiological and psychological results.

Twelve studies evaluated the development and functionality of compression garments and their influence on strength. The results showed a pattern similar to that of endurance, although the beneficial effects of recovery did not appear in an obvious way. In many cases, the maximum voluntary contraction was also measured, there being a clear relationship between the two variables – either both improved [23] or both worsened [15,31,33]. It has also been customary to evaluate the parameters of different type of jump, because strength is an essential component of their execution. Any significant changes were always recorded with the same type of jump – counter-movement jump (CMJ). It is difficult to find similarities between the protocols of those studies. Duffield et al. [23] used a full-body suit in the recovery phase after an hour and a half of tennis training, while Rugg and Sternlicht [49] used compression stockings during a sub-maximal endurance test followed by measuring the CMJ parameters. The improvement suggests that it occurred as a placebo effect [1], although it cannot be ruled out that there was an improvement in recovery before executing an explosive effort [68]. The studies that did not find significant changes [15,53] followed a practically identical protocol – continuously jumping to the rhythm of a metronome. Probably the fact of converting an explosive jump test into a test of endurance led to there being no positive effects.

Fatigue

Two studies [44,45] applied the same endurance test in their protocols, observing a reduction in inorganic phosphate levels in the major muscles of the lower limbs. In the first of these studies, Miyamoto and Kawakami [44] explained that this fact may reduce the development of muscle fatigue during sub-maximal exertion, but the same authors, a year later, reported that the pressure exerted by compression stockings is not an essential characteristic for reducing the development of muscle fatigue [45]. This different interpretation of such similar results is due to the zones where the compression of the garments used was applied – thigh [44], or ankles and calves [45]. The first study [44] used compression stockings with a uniform level of pressure, and the second [45] used stockings with graduated compression. In obtaining the same results with different garments, the authors considered that the garment type was not the key factor determining a reduction in the development of muscle fatigue.

Muscle activation and vibration

Three studies evaluated muscle activation. Fu et al. [38] and Wang et al. [37] found significant beneficial changes with the use of compression tights, whereas Sambaher et al. [15] did not report any such variation. With the use of the compression garments, the benefit is the greater efficiency, and consequent reduction, of muscle activation delaying the onset of fatigue and lowering the risk of injury [69]. Although the decline of muscle activation has been attributed to stability of the muscle vibrations [70], this theory has not been supported by other work [35,71].

Impacts

A single study analysed attenuation and impact [43]. Its results reflect beneficial effects of the use of graduated compression stockings. These findings concur with those of Doan et al. [6], although in that case the improvement was also due to a reduction in vibration. Reduced impact as a race proceeds is a result of the garment improving the running technique [72], and consequently helping to avoid the risk of injuries from cumulative impacts [73].

Conclusions

From the present review, the following conclusions may be drawn:

The positive or negative effects deriving from the use of compression clothing occur independently of the type of garment and the degree of compression.

Compression garments neither improve performance during exercise nor have a clear influence in delaying the onset of fatigue.

The use of compression garments in recovery after exercise improves the perception of muscle damage and increases performance in subsequent endurance tests.

The use of compression garments in sport does not cause significant changes in venous hæmodynamics, in maximal oxygen consumption, in regulation of skin or body temperature, in the development of force, or in perceived exertion or comfort.

There is no evidence that the application of compression garments decreases lactate concentrations during the performance or recovery phases of exercise.

The use of compression stockings appears to increase attenuation and to reduce impact in running, reducing the risk of overuse and/or overload injuries from cumulative impact.

Electromyography showed reduced muscle activation, although this greater muscle efficiency does not translate into improved performance.

In no case was it shown that the use of compression sportswear is harmful.

Future recommendations

The great variety of compression sportswear employed in the different studies makes it hard to draw reliable conclusions, because they did not use the same garments, degrees of compression, or materials in the manufacture of the garment. Nevertheless, the more recent studies are already proposing to pursue a line of research using stockings with high levels of compression [74,75] and/or with different degrees of compression [76], considering the fatigue of the compression materials themselves [71].

It is also necessary to take the sample size into consideration. Except for four studies, the number of subjects analysed in each experiment was between 2 and 24, often being fewer than 15. Together with the great variability in the garments, such small samples may make it difficult to detect significant changes in the variables analysed. It is therefore recommendable for future research to increase the sample size and unify the characteristics of the compression garments (type and degree of compression of the garment, and the material used in its manufacture), so as to allow future results to be more conclusive.

Footnotes

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

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Influence of compression sportswear on recovery and performance: A systematic review

Abstract

Keywords

Introduction

Methods

Results

Effects on recovery

Effects on performance

Discussion

Physiological factors

Psychological factors

Endurance and strength

Fatigue

Muscle activation and vibration

Impacts

Conclusions

Future recommendations

Footnotes

Declaration of conflicting interests

Funding

References