Keywords

Introduction

Elite endurance athletes specializing in different endurance sports e.g. cycling, running, or cross country skiing wear socks, sleeves, shorts, tights, and/or shirts or long sleeves shirts or whole body suits with compression to improve their performance and facilitate recovery. Companies promote the application of compression clothing and advertise ergogenic effects, improved recovery and perception. Accordingly, athletes and coaches consider compression clothing as an external aid to provide benefits for endurance performance and recovery.

Various mechanisms have been suggested to explain the ergogenic potential and improved recovery in endurance athletes including: diminished muscular microtrauma due to reduced tissue vibrations during exercise (Friesenbichler et al. 2011; Valle et al. 2013); reduced muscle fiber recruitment causing less energy expenditure (Bringard et al. 2006; Kraemer et al. 1998); improved neuromechanics (i.e. reduced presynaptic inhibition) (Perlau et al. 1995; Bernhardt and Anderson 2005) and enhanced coordinative function (Birmingham et al. 1998). During recovery improved hemodynamics (venous return) (Ibegbuna et al. 2003; Lawrence and Kakkar 1980); arterial inflow (Bochmann et al. 2005) and lymphatic outflow (Kraemer et al. 2001) are thought to accelerate removal of metabolic waste products and reduce edema (Hirai et al. 2002; Partsch et al. 2008; Bovenschen et al. 2013). The improved perception by wearing compression clothing (Ali et al. 2007; Cipriani et al. 2014) increases the general comfort during exercise and reduces perceived exertion (Sperlich et al. 2010; Rugg and Sternlicht 2013).

However, to date most studies revealed no effects of compression clothing on performance variables (Del Coso et al. 2014; Barwood et al. 2013; Areces et al. 2015; Bieuzen et al. 2014; Born et al. 2014; Rider et al. 2014; Sperlich et al. 2014; MacRae et al. 2012; Ali et al. 2011), on oxygen uptake (Born et al. 2014; Rider et al. 2014; Sperlich et al. 2014; Dascombe et al. 2011; Rimaud et al. 2010), or on heart rate (Bieuzen et al. 2014; Vercruyssen et al. 2014; Rimaud et al. 2010) during or following endurance exercise.

The aims of this chapter is (i) to review the literature concerning compression garments applied during or following endurance dominated sports; (ii) to summarize the effects associated with various markers related to performance and recovery; (iii) to identify evidence-based application of compression in connection with endurance dominated disciplines; and (iv) to develop recommendations concerning the use of compression for endurance athletes and coaches.

Data Sources and Literature Searching

A comprehensive computerized search of the electronic databases PubMed, MEDLINE, SPORTDiscus, and Web of Science was performed during December of 2015 employing the following key words: athlete, endurance, endurance running, endurance cycling, blood flow, blood lactate, compression, compression clothing, compression garment, compression stockings, running, long distance running, exercise, fatigue, garments, heart rate, muscle damage, pain, swelling, oscillation, oxygenation, oxygen uptake, performance, perceived exertion, power, recovery, strength, stroke volume, textiles, thermoregulation, time to exhaustion, and time trial. In addition, the reference lists of the articles thus identified and from other relevant articles as which we were previously aware were examined for additional relevant titles.

Study Selection and Quality Assessment

Original research articles in peer-reviewed journals that investigated any kind of compression garment (i.e., knee-high socks, sleeves, shorts, tights, shirts, long sleeve shirts or whole body compression garment) during and/or after endurance dominated exercise were included. These studies assessed physiological, psychological, and/or performance parameters. Only those articles presenting absolute values (means and measures of variability) of an experimental (compression) and a control group (non-compression) of participants at any level of performance (from untrained to elite) or where such missing data could be obtained from the authors were analyzed. Finally, only data concerning participants without any cardiovascular, metabolic, or musculoskeletal disorders were considered (Fig. 1).

Fig. 1
figure 1

Pathway of identified and subsequent excluded or reviewed articles

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Results

Characteristics of the Studies Analyzed

Of the 648 studies initially identified, 55 were examined in detail (Fig. 1). The participants as well as kind of compression clothing, parameters measured, and protocols of each study are summarized in Tables 1, 2 and 3.

Table 1 Summary of the studies included: investigations on the effect of compression clothing on performance during and recovery from long-distance running
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Table 2 Summary of the Studies Included: Investigations on the Effect of Compression Clothing on Performance during and Recovery from Cycling exercise
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Table 3 Summary of the Studies Included: Investigations on the Effect of Compression Clothing on Performance during and Recovery from other endurance dominated exercise
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The examined studies involved different protocols in following endurance dominated sports: running (n = 36), cycling (n = 15), triathlon (n = 1), kayak (n = 1), ice speed skating (n = 1), cross-country skiing (n = 1). Analyzed 55 studies involved a total of 788 participants (approx. 686 men and approx. 102 women (in two cases, the number of women was not reported)) (Ali et al. 2011; Cipriani et al. 2014). Forty-one studies included only male participants, one only woman, and the remaining 13 both sexes. The mean sample size was 14.3 ± 7.8 (mean ± SD, range: 6–36) and mean age was 28.7 ± 9.9 (19–63) years.

The compression garments applied included knee-high socks (n = 22), tights (n = 17), knee-high calf sleeves (n = 5), shorts (n = 4), shirt (n = 2), long sleeve shirt (n = 2), whole-body compression consisting of tights and a long-sleeve shirt (n = 2), respective whole body compression suit (n = 1), kind of compression garment not indicated (n = 1). Thirty studies included highly-trained (national/international level and VO2max > 65 mL kg−1 min−1) or well-trained subjects (VO2max ≥ 50 mL kg−1 min−1), 22 moderately trained or recreational athletes, and three involved untrained participants. In 40 of these investigations graduated compression, i.e. pressure decreasing in the distal to proximal direction, was applied. Moreover, 44 investigations provided information concerning the level of pressure exerted (6–45 mm Hg), 11 included no such information, and 13 referred to the manufacturer’s information (Tables 1, 2 and 3).

Analysis of Endurance Performance

None of the considered studies revealed significant improvements of compression clothing on running performance (Areces et al. 2015; Zaleski et al. 2015; Bieuzen et al. 2014; Del Coso et al. 2014; Venckūnas et al. 2014; Vercruyssen et al. 2014; Ali et al. 2007; Barwood et al. 2013; Ali et al. 2011) (Table 1), as reflected in the times for a marathon, half marathon during a triathlon, 15-km trail running, 5- and 10-km runs and 400-m sprint. Of the 13 studies in which the time to exhaustion (TTE) in incremental or step tests or runs until exhaustion were analyzed, three reported small significant improvements of TTE as a result of compression garments (Armstrong et al. 2015; Sear et al. 2010; Kemmler et al. 2009). Eight studies found no alteration of TTE with the application of compression (Wahl et al. 2012; Ali et al. 2011; Dascombe et al. 2011; Goh et al. 2010; Menetrier et al. 2011; Varela-Sanz et al. 2011; Sperlich et al. 2010; Berry and McMurray 1987) and one study documented a negative effect on TTE (Rider et al. 2014).

The cycling performance in five studies improved with the application of compression clothing (Argus et al. 2013; Driller and Halson 2013; Ménétrier et al. 2013; de Glanville and Hamlin 2012; Chatard et al. 2004). Whereas, six different cycling trials in four studies detected no changes in variables related to performance (Burden and Glaister 2012; MacRae et al. 2012; de Pauw et al. 2011; Scalan et al. 2008) (Table 2).

The studies which applied protocols in ice speed skating (Born et al. 2014), triathlon (Del Coso et al. 2014), double poling on a cross country skiing ergometer (Sperlich et al. 2014), and on an kayak ergometer (Dascombe et al. 2013) revealed no influence of compression clothing on the respective endurance performance (Table 3).

Physiological Parameters During Running

Maximal or peak oxygen uptake was not affected in any of the considered studies during running (Priego et al. 2015; Dascombe et al. 2011; Rider et al. 2014; Wahl et al. 2012; Varela-Sanz et al. 2011; Sperlich et al. 2010; Kemmler et al. 2009; Berry and McMurray 1987), cycling (Scalan et al. 2008), ice speed skating (Born et al. 2014), cross country skiing (Sperlich et al. 2014) and kayaking (Dascombe et al. 2013). Whereas, two studies identified increased oxygen uptake during submaximal running (Lovell et al. 2011; Bringard et al. 2006) and four studies found no changes in submaximal oxygen uptake (Priego et al. 2015; Varela-Sanz et al. 2011; Ali et al. 2010; Sperlich et al. 2010) and three studies showed both increased and decreased amounts of oxygen uptake during submaximal running (Dascombe et al. 2011; Sperlich et al. 2011; Sear et al. 2010). During cycling, none of the studies revealed alterations in submaximal oxygen uptake (Leoz-Abaurrea et al. 2015; Burden and Glaister 2012; de Glanville and Hamlin 2012; Scalan et al. 2008).

No significant differences for blood lactate concentration were detected during running (Areces et al. 2015; Rider et al. 2014; Vercruyssen et al. 2014; Wahl et al. 2012; Ali et al. 2011; Dascombe et al. 2011; Varela-Sanz et al. 2011; Sperlich et al. 2011; Ali et al. 2010; Cabri et al. 2010; Sear et al. 2010; Sperlich et al. 2010; Kemmler et al. 2009), cycling (Driller and Halson 2013; Ménétrier et al. 2013; Burden and Glaister 2012; de Glanville and Hamlin 2012; de Pauw et al. 2011; Scalan et al. 2008), ice speed skating (Born et al. 2014) and kayaking (Dascombe et al. 2013) between the conditions with or without compression clothing. Three studies documented reductions in blood lactate concentration while wearing compression garments during submaximal running (Lovell et al. 2011), 10 km cycling time trial (Burden and Glaister 2012) and cross country skiing (Sperlich et al. 2014).

Four studies revealed improved post exercise lactate removal due to wearing compression clothing (Rider et al. 2014; Rimaud et al. 2010; Chatard et al. 2004; Berry and McMurray 1987). One study showed no effect on blood lactate elimination following submaximal running (Cabri et al. 2010).

In most of the studies the heart rate was not influenced during running by the compression garments (Armstrong et al. 2015; Priego et al. 2015; Priego Quesada et al. 2015; Bieuzen et al. 2014; Ferguson et al. 2014; Rider et al. 2014; Venckūnas et al. 2014; Vercruyssen et al. 2014; Wahl et al. 2012; Ali et al. 2011; Dascombe et al. 2011; Ménétrier et al. 2011; Varela-Sanz et al. 2011; Ali et al. 2010; Kemmler et al. 2009; Ali et al. 2007), although two studies observed positive effects on heart rate during submaximal treadmill running (Sperlich et al. 2011), respectively during a 5 km submaximal run (Cabri et al. 2010). One study reported contradictory, partially decreased and partially increased heart rates, during 30-min submaximal treadmill running (Lovell et al. 2011).

In most of the studies heart rate during cycling was not altered by wearing compression clothing (Leoz-Abaurrea et al. 2015; Ménétrier et al. 2013; Burden and Glaister 2012; de Pauw et al. 2011; Rimaud et al. 2010; Scalan et al. 2008). Although, two studies reported a decreased heart rate during recovery from cycling (Leoz-Abaurrea et al. 2015; de Glanville and Hamlin 2012) and one an improved cardiac output during cycling (MacRae et al. 2012). Only one study reported a reduced heart rate during cycling (Driller and Halson 2013).

During ice speed skating (Born et al. 2014), cross country skiing (Sperlich et al. 2014) and kayaking (Dascombe et al. 2013) heart rate was not influenced by compression clothing.

Neither blood saturation nor partial pressure of oxygen were influenced to any great extent by the compression garments during running (Venckūnas et al. 2014; Wahl et al. 2012; Sperlich et al. 2011; Sperlich et al. 2010), ice speed skating (Born et al. 2014), double poling (Sperlich et al. 2014) and kayaking (Dascombe et al. 2013). However, three studies observed positive effects on tissue oxygen saturation during rest and recovery following running (Ménétrier et al. 2011), muscle oxygenation during cycling (Scalan et al. 2008) and tissue oxygen saturation during and following submaximal cycling (Boucourt et al. 2014).

Body and Perceived Temperature

Body core temperature during running (Bringard et al. 2006; Venckūnas et al. 2014), cycling (Leoz-Abaurrea et al. 2015; MacRae et al. 2012) and triathlon (Del Coso et al. 2014) was not affected by compression clothing, whereas skin temperature was elevated by compression during running (Priego Quesada et al. 2015; Venckūnas et al. 2014) and cycling (MacRae et al. 2012). In one study skin temperature was not affected by compression (Leoz-Abaurrea et al. 2015). The perceived temperature during running with compression was not altered in two studies (Venckūnas et al. 2014; Barwood et al. 2013).

Psychological Variables While Exercise

There was no significant effect of compression clothing on perceived exertion in most studies during running (Bieuzen et al. 2014; Rider et al. 2014; Rugg and Sternlicht 2013; Venckūnas et al. 2014; Vercruyssen et al. 2014; Barwood et al. 2013; Ménétrier et al. 2011; Varela-Sanz et al. 2011; Ali et al. 2007, 2010, 2011; Sperlich et al. 2010; Bringard et al. 2006; Areces et al. 2015; Miyamoto and Kawakami 2014; Armstrong et al. 2015; Priego et al. 2015; Priego Quesada et al. 2015). Only in three studies compression clothing influenced perceived exertion during running (Rugg and Sternlicht 2013; Sperlich et al. 2010; Miyamoto and Kawakami 2014) and one study revealed positive and negative effects of compression (Ali et al. 2011).

Positive effects of compression on perceived exertion were neither shown during cycling (Leoz-Abaurrea et al. 2015; Ménétrier et al. 2013; de Glanville and Hamlin 2012; de Pauw et al. 2011; Rimaud et al. 2010) nor during triathlon (Del Coso et al. 2014), cross country skiing (Sperlich et al. 2014) or ice speed skating (Born et al. 2014).

Perceived Muscle Soreness

Compression exerted positive effects on post-running leg soreness and delay in the onset of muscle fatigue in most studies (Bieuzen et al. 2014; Areces et al. 2015; Valle et al. 2013; Hill et al. 2014a, b; Ali et al. 2007; Ferguson et al. 2014). In three studies compression clothing had no effect on post running leg soreness (Bovenschen et al. 2013; Sperlich et al. 2010; Trenell et al. 2006). Leg compression clothes reduced muscle soreness following cycling in two studies (Ménétrier et al. 2013; Chatard et al. 2004) with no effect in another study (Driller and Halson 2013). Following a half ironman triathlon compression socks had no influence on perceived muscle soreness (Del Coso et al. 2014).

Discussion

Due to the methodological diversity of analyzed studies regarding sample sizes [n = 6–36], age [19–63 years], gender [male n = 41 studies, female n = 1 study, mixed gender n = 13 studies], type of compression clothing [knee-high socks n = 22, tights n = 17, knee-high calf sleeves n = 5, shorts n = 4, shirt n = 2, long sleeve shirt n = 2, whole-body compression n = 3], variations in timing and duration of application, as well as amount of compression [6–45 mm Hg], and training level of participants [well-trained vs. recreational athletes and untrained individuals], we have refrained from meta-analysis. However, the fairly large number of studies [n = 55] and participants [n = 788] involved provides an adequate overview (Tables 1, 2 and 3) of the impact of compression clothing on parameters related to performance and physiological processes during endurance dominated exercise.

The findings of the present investigation were that compression clothing had no significant impact on: (i) performance parameters during running, ice speed skating, triathlon, cross country skiing and kayaking; (ii) physiological parameters VO2max, VO2peak, blood lactate concentration, heart rate and blood saturation or partial pressure of oxygen during exercise in almost all analyzed studies; (iii) body core temperature; (iv) perceived exertion in most studies. Compression clothing revealed significant effects on: (i) improvement of performance in five out of eleven cycling trials; (ii) decline in post-exercise leg soreness and delayed onset of muscle fatigue in eight out of 13 studies; (iii) increase in skin temperature in two out of three studies; (iv) improvement of post exercise lactate elimination in four studies.

As reflected in running times (400 m–42.195 km) compression clothing does not assist to improve running performance (Areces et al. 2015; Zaleski et al. 2015; Bieuzen et al. 2014; Del Coso et al. 2014; Venckūnas et al. 2014; Vercruyssen et al. 2014; Ali et al. 2007; Barwood et al. 2013; Ali et al. 2011). The time to exhaustion in incremental or step tests or runs until exhaustion was improved by compression in three (Armstrong et al. 2015; Sear et al. 2010; Kemmler et al. 2009) out of 13 studies, therefore runners do not seem to benefit from any kind of compression clothing in respect to performance improvements during running competitions. Furthermore, this seems to be in line with other findings reported by Beliard et al. (2015) and Born et al. (2014).

However, cycling performance seems to be more positively affected by compression clothing, as five studies showed significant improvements of cycling performance, e.g. in repeated Wingate Anaerobic Tests (Argus et al. 2013), time trail performance of different lengths [5 min (Driller and Halson 2013); 15 min (Ménétrier et al. 2013); 40 km (de Glanville and Hamlin 2012); 2 × 5 min (Chatard et al. 2004)]. Therefore, wearing compression clothing during cycling competitions could be an effective strategy for performance improvements.

Since the performance during ice speed skating (Born et al. 2014), triathlon (Del Coso et al. 2014), cross country skiing (Sperlich et al. 2014) and kayaking (Dascombe et al. 2013) was not increased significantly, the application of compression clothing in these kind of endurance exercise may not be promising. However, the number of participants in three studies (Born et al. 2014 [n = 10]; Sperlich et al. 2014 [n = 10]; Dascombe et al. [n = 7]) was considerable low. Only Del Coso et al. (2014) displayed a sufficient high number of participants (n = 36). Therefore, general recommendations to the application of compression clothing in these kinds of exercise cannot be made and during half ironman triathlon, compression socks seem to have no influence on performance.

The results clearly reflect that physiological parameters such as VO2max, VO2peak, submaximal oxygen uptake, blood lactate concentration, heart rate, blood saturation and partial pressure of oxygen are mostly not altered by wearing compression clothing during endurance exercise. Since endurance performance is partly determined by physiological parameters such as the athlete’s VO2peak, velocity or power output at the lactate threshold (Støren et al. 2013) and economy of locomotion (Coyle et al. 1988; Williams and Cavanagh 1987) endurance athletes will most probably not benefit from compression garments.

A potential benefit of compression clothing is displayed during the immediate recovery from intense cycling (Rimaud et al. 2010; Chatard et al. 2004; Berry and McMurray 1987) and running (Rider et al. 2014) since blood lactate concentrations were reduced during this period.

Since compression clothing covers a large portion of the body surface the clothing may contribute to increased body temperature since it represents a barrier to heat transfer and sweat evaporation. Since elevated skin and body temperature or hyperthermia may cause impaired endurance performance (Nybo et al. 2014) there is a potential risk of decreased performance while wearing compression clothing in hot conditions during endurance exercise. Whereas, all analyzed studies showed no significant effect of compression clothing on body core temperature (Bringard et al. 2006; Venckūnas et al. 2014; Leoz-Abaurrea et al. 2015; MacRae et al. 2012; Del Coso et al. 2014), three studies revealed increased skin temperature with compression clothing (Priego Quesada et al. 2015; Venckūnas et al. 2014; MacRae et al. 2012) with no influences on performance.

Compression appears to exert positive effects on perceived leg or muscle soreness and delayed onset of muscle fatigue following running and cycling. The positive impact appears mostly within the following 24 h after exercise if compression clothing is worn during running (Areces et al. 2015; Bieuzen et al. 2014; Valle et al. 2013; Ali et al. 2007). When compression clothing is applied merely for recovery purposes following exhaustive running for twelve (Ferguson et al. 2014) or 72 h (Hill et al. 2014a, b), or after high-intensity cycling (Ménétrier et al. 2013; Chatard et al. 2004) athletes experience less leg soreness. Presumably, the leg compression clothing exerts a protective effect on muscle fibers during running due to reducing muscle oscillation (Doan et al. 2003; Kraemer et al. 2004) and impact forces (Doan et al. 2003; Valle et al. 2013). The placebo effect could account for the positive effect of compression clothing on improved post exercise leg muscle soreness, too. Since it is difficult to create a placebo condition for compression garments, it cannot be excluded that improved psychological parameters are influenced by improved perceptions and a result of the participants’ intuitions of expected findings.

Nevertheless, the protective characteristics of leg compression clothing on muscle fibers has been demonstrated by Valle et al. (2013). The application of compression shorts during downhill running reduced the amount of histological muscle injury, as shown by biopsies (measuring intracellular albumin, lymphocytes CD3+, neutrophils intra/interfibrillar infiltrates) of vastus lateralis by 25 %. This indicates a possible benefit of compression garments for running competitions taking place for multiple days and containing amounts of eccentric muscle contractions during downhill sections like in trail run events. Furthermore, the positive impact of compression clothing on perceived post exercise muscle pain may be caused by the external pressure gradient which reduces the space for swelling (Davies et al. 2009; Kraemer et al. 2004), diminishes structural damage to the muscles (Valle et al. 2013) and facilitates clearance of metabolites through improved blood flow (Davies et al. 2009) and lymphatic outflow (Kraemer et al. 2001). Additionally, the analytical review by Hill et al. (2014a) found moderate effect size values for reductions in post-exercise levels of creatine kinase and delayed onset muscle soreness, but their investigation involved vertical jumping, repeated sprinting and resistance training, rather than running.

The application of compression clothes had no significant influence on perceived exertion during running in 18 studies and in all included studies which applied cycling and other endurance exercise. Only three studies reported improved perceived exertion during running (Rugg and Sternlicht 2013; Sperlich et al. 2010; Miyamoto and Kawakami 2014). These results clearly reflect the limited impact of compression clothing on this parameter.

Conclusions

On the basis of 55 studies, it seems that the use of compression has no effect on performance in running (400 m–42.195 km), ice speed skating, triathlon, cross country skiing and kayaking. Apparently, by wearing compression garments cyclists might slightly improve variables related to time trial performance.

A risk of impaired performance due to hyperthermia could not be confirmed when wearing compression, however compression clothing increased skin temperature.

Furthermore, the present results show that physiological parameters like VO2max, VO2peak, submaximal oxygen uptake, blood lactate concentration, heart rate, blood saturation and partial pressure of oxygen are mostly not altered by wearing compression clothing during endurance exercise.

If compression clothing is worn during and following intense or prolonged endurance exercise athletes should benefit from improved lactate elimination, reduced muscle pain, damage and inflammation during recovery. These processes are likely due to reductions of muscle oscillation during exercise, improvements in clearance of metabolites through improved blood flow, lymphatic outflow and reduced space for swelling. Potentially, this might improve recovery and enhance subsequent performance.