Optimizing Recovery in Tactical Athletes: The Impact of Intermittent Pneumatic Compression on Fatigue and Pain

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Intermittent pneumatic compression (IPC) emerges as a promising alternative, but there are doubts about the ideal pressure. Objective To analyze the effect of IPC on the fatigue index and pain in tactical athletes. Method Transversal research with 31 Brazilian Army soldiers completed an 8 km march with full equipment. Initially, preliminary data collection procedures and body assessment were performed, followed by the march. Afterwards, to analyze the fatigue index was used the hemoglobin levels (THb) and oxygen saturation (Sm O₂) that were measured in the left (VLE) and right (VLD) vastus lateralis muscles. Then IPC was performed, and the sample was randomized into three groups: IPC 110 mmHg (Recovery - Rec A), IPC 140 mmHg (Rec B), and passive recovery without boots (Rec C), lasting 15 minutes. Finally, data were collected post-recovery. Results The paired t-test revealed differences in group Rec A in Sm O₂ at VLE (Δ=+8.22 ± 5.94; p = 0.003) and VLD (Δ=+6.20 ± 6.27; p < 0.001), and in THb at VLE (Δ=+0.13 ± 0.19; p = 0.002). In group Rec B, an increase in Sm O₂ was observed at VLE (Δ=+5.83 ± 6.26; p = 0.001) and VLD (Δ=+4.47 ± 6.78; p < 0.001). A 3x2 ANOVA with repeated measures revealed that group Rec A showed a difference when compared to groups Rec B and Rec C. Conclusion IPC was effective in improving acute Sm O₂ levels, with IPC at 110 mmHg achieving better recovery values when compared to passive recovery at 140 mmHg and without a boot, demonstrating that it is a useful tool in reducing the fatigue index of the tactical athlete. military fatigue intermittent pneumatic compression devices recovery Figures Figure 1 Figure 2 Figure 3 INTRODUCTION Combat readiness is one of the fundamental requirements for the preparation of the Armed Forces [ 1 ]. To enhance the readiness of its tactical athletes, the U.S. Army defines five major training domains considered essential for optimal performance on the front line: mental, nutritional, physical, spiritual, and sleep domains [ 2 ]. Although operational readiness is critical, injuries sustained during training can directly compromise this capability. Ensuring safety during training is essential, as excessive physical stress can lead to overtraining and a subsequent increase in injury incidence among soldiers [ 3 ]. Muscle injuries (MIs) represent a significant burden for this population, as the need for recovery time and medical care results in socioeconomic losses [ 4 ] and measurable health-related impairments that affect performance [ 5 ]. The consequences of MIs extend beyond financial costs and physical limitations—physical activity promotes physiological and psychosocial benefits such as improved work readiness, reduced stress, increased self-confidence, and stronger interpersonal relationships. Therefore, MIs can directly impact motivation and productivity [ 6 ]. Santos [ 7 ] estimated that workdays lost due to illness among firefighters in the Federal District resulted in more than R $ 39 million in costs, with MIs alone accounting for over R $ 11 million in public expenses. These data highlight how absences due to MIs impose substantial impacts, while also representing only part of the overall burden associated with these conditions [ 7 ]. Understanding how training-induced physiological changes disrupt the homeostasis of tactical athletes may support injury prevention strategies [ 8 ]. In this context, intermittent pneumatic compression (IPC) emerges as a relevant intervention. Historically, IPC has been used successfully in clinical settings to treat lymphedema by increasing lymphatic transport and reducing pain associated with swelling [ 9 , 10 ]. As a result, the use of IPC for recovery purposes has attracted growing interest and has been increasingly investigated [ 11 – 13 ]. Although some studies report minimal or no positive effects of IPC on performance [ 14 , 15 ] or skeletal muscle glycogen resynthesis [ 16 ], other investigations have shown findings that may be relevant for recovery-adaptation responses when IPC is applied concomitantly with training [ 10 , 17 – 19 ]. IPC devices promote increased blood flow, lymphatic drainage, and metabolite clearance, mechanisms considered key factors in recovery and athletic performance [ 20 ]. Despite this, evidence regarding the practical and effective benefits of IPC remains unclear [ 21 , 22 ], particularly within a military context. The number of individuals using IPC continues to grow; however, scientific research evaluating its effectiveness in post-exercise recovery is still scarce [ 23 ]. Even fewer studies have assessed IPC in military personnel performing routine occupational tasks. Considering this gap, we believe IPC is a promising recovery strategy for the military environment, but further research is required to determine the optimal pressure settings for this population. Thus, the objective of this study was to analyze the effects of different IPC pressures on the fatigue index and perceived pain of tactical athletes following an 8-km military march. METHODS Type of search Experimental study with data collected in field research, using purposive sampling, transverse design and quantitative analysis [ 24 ]. Participants The sample consisted of 31 Brazilian Army soldiers, all male, aged between 18 and 25 years. The inclusion criteria were: a) being enrolled in a physical training program and b) being apparently healthy, without chronic diseases or medical conditions that could interfere with the study results. The following criteria were adopted for exclusion from this research: a) individuals with any type of osteoarticular, musculoskeletal injury and/or other clinical conditions that prevented them from performing any of the assessments, that limited movement, or that were undergoing restrictive medical treatment; b) military personnel who were using any substance or drug capable of altering the analyses in question; c) individuals with burns on the skin in the lower limb region; d) individuals who were undergoing any local treatment on the lower limbs with creams, ointments, and lotions; e) individuals who were already experiencing pain and/or fever in the week prior to the start of the assessment; f) individuals who were using analgesics, anti-inflammatories, vasodilators, hormonal medications, and anesthetics; and g) individuals who suffered from anemia or had lower hemoglobin levels, caused by iron deficiency, chronic diseases, or blood loss. For this study, participants were randomized into three groups: Recovery Rec A (Passive recovery CPI 110mmHg) (n = 10), Rec B (Passive recovery CPI 140mmHg) (n = 10), or Rec C (Passive recovery without CPI) (n = 11). The sample size (n) calculation was performed using G*Power software, version 3.1.9.7 (Faul et al., 2007), and considering a probabilistic error (β) of 80% and a significance level (α) of 95%, the estimated n was 28 participants in total. However, due to the possibility of dropouts, the estimated n was increased by 3 participants for the study (Beck, 2013). There were no dropouts. Therefore, the study was completed with 31 individuals. Ethics The research project was submitted to and approved by the Ethics and Research Committee of the Army Physical Training Center (CEP-CCFEX) under CAAE number (81463924.2.0000.9433). Study design The volunteers were evaluated only once, at five distinct moments, as described in the flowchart (Fig. 1 ). Legend TCLE = Informed Consent Form; RPE = Rating of Perceived Exertion; THb = Hemoglobin Level; Sm O 2 = Oxygen Saturation; EVA = Visual Analogue Scale; Rec A = Recovery A (110 mmHg); Rec B = Recovery B (140 mmHg); Rec C = Recovery C (passive). Preliminary guidelines As soon as the participants arrived at the data collection site, preliminary procedures were carried out, in which the volunteers were informed about the procedures and guidelines for data collection for this research. Following this, and after agreeing to participate, the Informed Consent Form (Annex 01) was completed. For this study, participants were instructed to arrive at the data collection site rested and hydrated, and to avoid strenuous exercise for up to 48 hours before the test. All tests were performed in an indoor gymnasium, except for the walking test, which was performed outdoor. This test lasted approximately 25 minutes. The characteristics of the participants are presented in Table 1 . Moment 1: Initially, the participants' body mass and height were collected. The military personnel underwent anthropometric analysis using a digital electric scale (G-Tech Balgl 10 brand), and total body mass (kg) was assessed. For the assessment of the sample's height, a fixed vertical stadiometer (Standard Sanny ES2030) was used. Moment 2: Following this, an eight-kilometer administrative march was conducted, armed and wearing the 9th C2 uniform and standard Brazilian Army combat equipment (helmet, backpack, full canteen, standard weaponry, and suspender belt), carrying approximately 15 kg of weight. All volunteers completed the route within the CCFEx sports complex. The march aimed to generate a level of exertion in the sample that was compatible with their combat activities, and their Subjective Perception of Effort (SPE) was measured as a physiological control factor. SPE was measured every kilometer of the route by a researcher using the Borg Scale, which assessed the intensity of effort from 0 (none) to 10 (maximum) (Appendix 04) (McGuigan, 2017). In each assessment, the participant indicated the level of effort perceived subjectively using a table previously printed by the researcher accompanying the evaluated group. A medical team was available to provide assistance to participants at any time during the research. All assessments were performed at the same time (at the end of each group's walk) in order to control for diurnal variations in temperature and humidity. The eight-kilometer course was completed in two four-kilometer laps. The total time to complete the walk ranged from 95 minutes (Rec B) to 103 minutes (Rec C), and this phase lasted approximately two hours. Moment 3: Next, THb and Sm O2 were assessed using the Moxy Sm O2 Monitor® biosensor (Fortiori Design LLC) on both legs of the individuals. This biosensor allows for reading muscle oxygenation through approximately 12 mm of skin and fat, using near-infrared spectroscopy (NIRS) technology, in addition to measuring hemoglobin and myoglobin in capillaries and muscle tissues with a portable monitor using its own algorithm (Feldmann et al., 2019). The military personnel were assessed in the supine position and already divided into the intervention groups (Rec A, B, or C). The sensor was placed in the vastus lateralis muscle (Wilson et al., 2018), two-thirds between the anterior superior iliac spine and the lateral side of the patella, as recommended by the SENIAM35 project for electromyography measurements (Feldman et al., 2012; Stegeman et al., 2007). The sensor was secured in place using medical-grade adhesive tape (Hypafix; BSN Medical, DE) and then covered with commercially available compatible light protection to eliminate potential ambient light intrusion. Once the measurement was taken, it was automatically recorded by the Moxy Portal App (available at Appstore.com). This phase lasted approximately 15 minutes. Moment 4: Passive recovery was performed with the intermittent pneumatic compression (IPC) boot, defined by randomized assignment: IPC 110mmHg (Rec A), IPC 140mmHg (Rec B) or passive recovery without IPC (Rec C). In all of them, participants remained in the supine position for 15 minutes. The equipment used were the AVABoots 3.0 pneumatic boots, Size L or XL (its use was defined according to the participant's height: size L fits individuals up to 174cm, size XL fits individuals taller than 174cm), Model AVA-700 (Avanutri®) (Rec A and Rec B). The IPC device consists of 2 separate “leg sleeves” containing 5 circumferential inflatable chambers (arranged in a line along the limb) covering the leg from the feet to the hip/groin. The “leg sleeves” are connected to an automated pneumatic pump in which the target inflation pressures for each zone and the duty cycle can be controlled. For passive recovery without a boot (Rec C), volunteers remained in a supine position without using any recovery equipment. The intervention session lasted 15 minutes, as this is considered a consensus in the literature (De Carvalho et al., 2021). The gradual inflation of the chambers occurred starting from the ankles towards the thigh. Each air chamber compressed the limb for 30 seconds and then deflated and inflated, defining the 30/30 second cycle (defined based on the knowledge from study 1 of this work). The alternating cycle remained for the entire stipulated duration (15 minutes). Each session lasted 15 minutes, and the entire session lasted approximately two hours. Moment 5: Sm O 2 saturation and THb measurements were performed using the same protocols described previously. Data analysis The normality and homogeneity of variance of the sample data were analyzed using the Shapiro-Wilk and Bartlett tests, respectively. To determine the effect of the independent variables oxygen saturation and hemoglobin level, in their pre- and post-IPC phases, a repeated measures ANOVA (3x2) was applied, followed by an adjusted Bonferroni post-hoc test to compare the study variables within and between groups (groups: Rec A, Rec B, and Rec C vs. Time: pre- and post-test). A p-value < 0.05 was determined for statistical significance. The effect size (d) was calculated to analyze the clinical impact of the intervention. Data were analyzed using the JASP 0.19.3 statistical software program. RESULTS The characteristics of the participants are presented in Table 1 . Table 1 Anthropometric characteristics of the participants Age (years) Average Sd Minimum Maximum 19,33 1,71 18 25 Body mass (kg) 73,53 9,88 53,70 95,40 Stature (m) 1,73 4,80 1,65 1,83 BMI 24,34 3,62 19,33 32,44 Legend BMI (Body Mass Índex); Sd (Standard Deviation), Kg (kilogram), M (meters). Table 2 contains baseline THb and Sm O 2 concentration data in the vastus lateralis muscle of both legs of the subjects, and represents the data relative to the pre-recovery phase of the study. No differences were observed between the groups at baseline for THb and Sm O 2 . Table 2 – Data on the average initial concentrations of THb and Sm O 2 of the participants Rec Variable Mean Sd Minimum Maximum P-Value (SW) Rec A Sm O 2 73,36 9,39 60,40 92,20 0,089 THb 12,37 0,29 11,76 12,88 0,158 Rec B Sm O 2 83,76 7,35 72,30 96,00 0,073 THb 12,13 0,39 11,36 12,86 0,997 Rec C Sm O 2 77,84 7,02 60,50 90,20 0,369 THb 12,37 0,40 11,56 13,12 0,977 Legenda Sd (Standard Deviation); SW (Shapiro-Wilk); Rec (Recovery); average concentrations between legs E and D relative to the pre-recovery time point; Sm O 2 = oxygen saturation; THb = hemoglobin level; p-value < 0.05. All individuals completed the entire study protocol (8km walk and subsequent recovery) without incident. Figure 4 shows the comparison of Sm O₂ and THb between pre- and post-recovery time points in groups Rec A, Rec B, and Rec C. Legend Sm O 2 = oxygen saturation; THb = hemoglobin level; R = right; L = left; g/dl = grams/deciliter; * = statistically significant values; ANOVA (3x2) with repeated measures, followed by adjusted Bonferroni post hoc test, intragroup comparisons; p-value < 0.05. In group Rec A, an increase in Sm O₂ was observed in the vastus lateralis E (Δ=+8.22 ± 5.94; p = 0.003) and D (Δ=+6.20 ± 6.27; p < 0.001), in addition to an elevation of THb in the vastus lateralis E (Δ=+0.13 ± 0.19; p = 0.002). In group Rec B, an increase in Sm O₂ was observed in the vastus lateralis E (Δ=+5.83 ± 6.26; p = 0.001) and D (Δ=+4.47 ± 6.78; p < 0.001), in addition to an elevation of THb in the vastus lateralis E (Δ=+0.13 ± 0.28; p = 0.034). In the Rec C group, no statistically significant values ​​were found when comparing the pre- and post-Sm O 2 moments in the left (Δ=-1.17 ± 1.36; p = 0.480) and right (Δ=-0.29 ± 1.07; p = 0.871) vastus lateralis; as well as in THb in the left (Δ=+0.52 ± 0.11; p = 0.295) and right (Δ=-0.60 ± 0.07; p < 0.839) vastus lateralis. The performance parameters analyzed (THb and Sm O 2 ) when comparing the 3 groups studied are shown in Table 3 . Table 3 – Comparison of mean Sm O 2 between groups Rec A, Rec B and Rec C Groups Δ Average P-Value 110mm Hg 140mm Hg 5,74 0,001 110mm Hg Rec C 8,01 < 0,001 140mm Hg Rec C 2,27 0,121 Legend Δ = difference; ANOVA (3x2) with repeated measures, followed by adjusted Bonferroni post hoc test, intergroup comparisons, Sm O 2 = oxygen saturation; p-value < 0.05. In group Rec A, and when analyzing Sm O₂, a difference was observed when compared to group Rec B (Δ=+5.74 ± 5.89; p = 0.001) and when compared to group Rec C (Δ=+8.01 ± 5.23; p < 0.001). No differences were found when comparing groups Rec B and Rec C (Δ=+2.27 ± 5.36; p = 0.121). DISCUSSION This study aimed to analyze the effect of IPC (Intermittent Pneumatic Compression) on performance and fatigue index in military personnel undergoing an 8-kilometer march. Firstly, it was found that IPC was effective in improving fatigue parameters (Sm O 2 ) in the tactical athlete when compared to passive recovery. On the other hand, it was found that IPC did not promote differences in THb (Hemoglobin level) in the evaluated limb compared to the group without boots, nor when comparing groups Rec A and Rec B, and also when evaluating the pre- and post-exercise moments of each group. Naturally, it was expected that the THb evaluated in the different groups, time points, and muscle region would not differ when compared to each other. This rate tends to be different in specific population types: people suffering from anemia have lower hemoglobin levels, which can be caused by iron deficiency, chronic diseases, or blood loss [ 33 ]. Other medical conditions can explain a different hemoglobin rate, such as kidney disease [ 34 ], medication use [ 35 ], and in people living at different altitudes [ 36 ]. Although no difference in THb was found in the different groups analyzed by this study, it is known that THb can directly affect Sm O 2 [ 37 ], hence the importance of its evaluation. The inclusion criteria were used to select a homogeneous group, allowing for reliable and trustworthy results. That said, the findings of this work can be directed towards the intramuscular oxygen saturation part. It was observed that, before the proposed recovery intervention, Rec A, Rec B, and Rec C, the Sm O₂ values ​​were similar when comparing the three groups in both muscle groups (vastus lateralis D and E) (Table 2 ), while after the proposed recovery with IPC, a difference was found in the Rec A and Rec B groups (Fig. 10). It was found that IPC at 110 mmHg promoted a significantly greater increase in muscle oxygen saturation (Sm O₂) in the left limb compared to both the 140 mmHg group and the group without a boot. No studies comparing two compressions in the same group of participants have yet been found in the literature, so further studies are needed to confirm the findings presented here. No differences were found when comparing the 140 mmHg and no-boot groups. The reasons for the differences in Sm O 2 in the Rec A group are uncertain. Changes in Sm O₂ during exercise are related to the availability of oxygen in the blood and the use of this oxygen in active muscles (38). Considering that the athletic performance of skeletal muscle depends on oxidative metabolism, muscle oxygen saturation is an excellent variable to correlate problems and improvements in the body's oxidative system and lead to better performance in sports activities [ 39 ], proving that a favorable Sm O₂ rate is associated with increased physical exercise capacity [ 40 ]. Paredes-Ruiz [ 41 ] concluded that the assessment of Sm O₂ between limbs can be influenced by the location of the equipment used, the muscle mass involved, and the subject's fat mass. In this sense, several authors [39; 42; 43] found asymmetries in muscle mass when comparing dominant and non-dominant limbs in active individuals. This difference found in Sm O 2 still requires further study, but lateral dominance asymmetry emerges as an answer to this question. Although there is conflicting data on the causal relationships between the pressure exerted by intermittent pneumatic compression and its effectiveness in the various outcomes studied in the literature, some investigations suggest that the effectiveness of IPC may be related to the immediate preventive nature of the method [21; 44; 15], which corroborates the findings of the present study. To our knowledge, we are the first to investigate the effects of different types of IPC on muscle recovery, assessed through intramuscular Sm O 2 , after a physical intervention. Other studies have shown that IPC acutely favors the removal of creatine kinase (CK) concentration [10; 17], the improvement of subjective perception of recovery (SPR) [ 19 ] and delayed onset muscle soreness (DOMS) [ 45 ] after physical exercise, corroborating that the immediate nature of IPC can be effective. It is important to emphasize that in this study, Sm O₂ and THb were evaluated only immediately before and after a single IPC treatment, regardless of any muscle damage induced by the proposed exercise. This study indicated that when comparing the pre- and post-intervention moments of the three proposed groups, both groups that underwent IPC intervention improved Sm O₂ (Rec A and Rec B). As this gait exercise intervention may not have been exhaustive, the differences in Sm O₂ between groups revealed only that group Rec A obtained an improvement in the evaluated recovery parameters, a difference that probably cannot be explained by a significant change in tissue architecture. Mechanically, as proposed by [ 46 ], muscle tissue has certain thixotropic properties, related to the change of the sarcoplasm from a "gel-like" state to a more "liquid" state, and that, given the nature of IPC, the compression and, therefore, the perturbation of the sarcoplasm of muscle cells could, hypothetically, reduce the viscosity of the medium through which the sarcomere shortens and lengthens, thus increasing intramuscular oxygen saturation. That is, regardless of the pressure exerted by IPC, there would be an increase in Sm O₂. To our knowledge, this is the first study to reveal the effect of IPC on the tactical athlete after intervention with military activity. Based on the evidence, the findings of this study suggest that there may be an “ideal” or “optimal” compression that provides better indicators of recovery measured through Sm O₂, assessed by Rec A (110 mmHg). Among the limitations of the study are the lack of control of hydration and prior physical activity. All participants were instructed not to engage in physical activity in the 48 hours preceding the study, and it is known that the hydration status prior to physical activity can influence Sm O₂ [ 47 ]. Furthermore, controlling the participants' thigh diameter could interfere with the results, an analysis not performed in the present study. Although this is not a requirement in the protocol foreseen by the company supplying the compression boot (Avanutri®), which provides boots in varying sizes, studies suggest that thigh diameter can indeed interfere with the measurement of Sm O 2 [ 48 ]. A greater number of experimental studies comparing Sm O₂ between limbs and analyzing hydration could provide more robustness to the findings found in the present study. CONCLUSION In conclusion, compared to a placebo group, acute intervention through intermittent pneumatic compression in the lower limbs after physical stress resulted in an improvement in oxygen saturation levels measured by a specific biosensor. More specifically, there seems to be an ideal compression level that allows for greater benefits when the main objective is muscle recovery. As a strength, this study revealed that IPC can indeed be a useful tool in reducing the fatigue index of tactical athletes, especially in specific situations, such as operational courses. Further research clarifying the specific mechanisms by which different types of IPC pressure improve these recovery markers is needed. Furthermore, future studies may provide insights into the long-term effects of IPC and allow for a better understanding of the specific dose-response relationships of IPC and the adaptations that influence performance in exercise and/or sport. Declarations ACKNOWLEDGEMENTS The authors express their gratitude for the institutional and scientific support received during the course of this work, especially to the research team and the study volunteers. The authors are also grateful for the support provided by Avanutri® and Moxy Sm O 2 Monitor®. Despite the sponsorship of materials received, no results were influenced in any way. CONFLICT OF INTEREST The authors declared that there is no potential conflict of interest regarding this article. FUNDING DECLARATION This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. References Gullo, Flávio Ramirez. Soberania da Base Industrial de Defesa: prontidão e operacionalidade perante as ameaças futuras. BS thesis. Universidade Federal Fluminense (UFF), 2024; Thompson, Andrew G., et al. 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Centro Universitário Unisales; Cardoso, Leandro Manoel. 2024. “IoT na saúde doméstica: estudos de caso e especificação de uma aplicação.”; Díaz, Alexis, Emil Bautista, and Kevin G McCracken. 2024. “Geographic variation in body size and hematology of the slate-colored coot (Fulica ardesiaca) along the Andes of Peru.” Waterbirds 46 (2–4): 146–160; Ramos, Roberta Pulcheri. "Como a anemia pode influenciar negativamente as trocas gasosas?." Jornal Brasileiro de Pneumologia 43 (2017): 1–2; Ferrari, Marco, Leonardo Mottola, and Valentina Quaresima. 2004. “Principles, techniques, and limitations of near infrared spectroscopy.” Canadian journal of applied physiology 29 (4): 463–487; Hamaoka, Takafumi, Kevin K McCully, Valentina Quaresima, Katsuyuki Yamamoto, and Britton Chance. 2007. “Near-infrared spectroscopy/imaging for monitoring muscle oxygenation and oxidative metabolism in healthy and diseased humans.” Journal of biomedical optics 12 (6): 062105-062105-16; Wilkinson, Thomas J, Alice EM White, Daniel GD Nixon, Douglas W Gould, Emma L Watson, and Alice C Smith. 2019. “Characterising skeletal muscle haemoglobin saturation during exercise using near-infrared spectroscopy in chronic kidney disease.” Clinical and experimental nephrology 23: 32–42; Paredes-Ruiz, María-José, et al. "Oxigenação muscular de quadríceps e gastrocnêmio durante o esforço aeróbico máximo." Revista Brasileira de Medicina do Esporte 27 (2021): 212–217; Araújo, Ana Paula Pinto de. "Força muscular na flexão e extensão de cotovelo e joelho: assimetria entre membro dominante e não dominante em um estudo observacional transversal." (2024); Santos, Thamires Gabriela Silva, et al. "Comparação da assimetria de força manual entre praticantes e não praticantes de musculação." Acta fisiátrica. São Paulo. Vol. 31, n. 3,(2024), p. 140–145. (2024); Wiecha S, Jarocka M, Wiśniowski P, Cieśliński M, Price S, Makaruk B, et al. The efficacy of intermittent pneumatic compression and negative pressure therapy on muscle function, soreness and serum indices of muscle damage: a randomized controlled trial. BMC Sports Science, Medicine and Rehabilitation. 2021;13:1–10; Northey, Joseph M, Ben Rattray, Christos K Argus, Naroa Etxebarria, and Matthew W Driller. 2016. “Vascular occlusion and sequential compression for recovery after resistance exercise.” The Journal of Strength & Conditioning Research 30 (2): 533–539; Sands, William A, Melonie B Murray, Steven R Murray, Jeni R McNeal, Satoshi Mizuguchi, Kimitake Sato, and Michael H Stone. 2014. “Peristaltic pulse dynamic compression of the lower extremity enhances flexibility.” The Journal of Strength & Conditioning Research 28 (4): 1058–1064; Costa, Maria Carolina Barros, et al. "Avaliação do estado de hidratação de um time de atletas de futebol americano do sertão brasileiro." RBNE-Revista Brasileira de Nutrição Esportiva 17.104 (2023): 243–253; e Flamia, Brenda Isabelle, et al. "Profilaxia de tromboembolismo venoso em pacientes cirúrgicos." Revista Eletrônica Acervo Saúde 13.4 (2021): e6878-e6878. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 18 May, 2026 Reviewers agreed at journal 05 May, 2026 Reviewers agreed at journal 02 May, 2026 Reviewers agreed at journal 30 Apr, 2026 Reviewers invited by journal 30 Apr, 2026 Editor assigned by journal 30 Apr, 2026 Submission checks completed at journal 30 Apr, 2026 First submitted to journal 22 Apr, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9496910","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":635028207,"identity":"fbc7e324-c6a9-4240-8552-a6702c3b0603","order_by":0,"name":"Douglas de Castro Jacinto","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABAElEQVRIie3PsUrEMBjA8a8U7pbQ8WgI9A2EQKDc1LxKw0Fv6eAkJxYsCE55gUPxJQ46BwLp0gdQdKiLOOYBFGy85Ya23uiQ//SF5EcSAJ/vP6ZO53h3XKr+HIIAgn7dKTeAys8kIb2+PxKYI1Er2SdUGedEm/jl6S3hK/0+3JIlF/U4wV2XrsFshIyKAu+bD4ZIQQeyYakaJ/S5TGlQhzlCKCW40UKS3BElmnlyy3/J96MjW/sXYX1Q60AixCiuHSnnb8GduQIwrZDdQvSx0Qy9lpcqp9N/idq7g4Xqhi9lqFRc6WT5sD1Yu8uSKTK0IF8jD5487grt7LbP5/P5fgCtMGFVdYLDdgAAAABJRU5ErkJggg==","orcid":"","institution":"Centro de Capacitação Física do Exército","correspondingAuthor":true,"prefix":"","firstName":"Douglas","middleName":"de Castro","lastName":"Jacinto","suffix":""},{"id":635028208,"identity":"1baa81ad-955e-4a25-9bcb-682a66f3a386","order_by":1,"name":"Rodrigo Gomes de Souza Vale","email":"","orcid":"","institution":"Federal University of the State of Rio de Janeiro","correspondingAuthor":false,"prefix":"","firstName":"Rodrigo","middleName":"Gomes de Souza","lastName":"Vale","suffix":""},{"id":635028209,"identity":"4233a7a7-e8c5-4816-901a-52e000b57bf6","order_by":2,"name":"Diego Gama Linhares","email":"","orcid":"","institution":"Federal University of the State of Rio de Janeiro","correspondingAuthor":false,"prefix":"","firstName":"Diego","middleName":"Gama","lastName":"Linhares","suffix":""},{"id":635028210,"identity":"cb204ba3-ba2c-4367-b5e8-0934b7585cb8","order_by":3,"name":"Danielli Braga de Mello","email":"","orcid":"","institution":"Centro de Capacitação Física do Exército","correspondingAuthor":false,"prefix":"","firstName":"Danielli","middleName":"Braga","lastName":"de Mello","suffix":""}],"badges":[],"createdAt":"2026-04-22 13:23:35","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9496910/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9496910/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108843612,"identity":"937cc566-0e79-48c1-ba64-a76de5233dc6","added_by":"auto","created_at":"2026-05-09 02:20:48","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":47304,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFlowchart of the study design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTCLE = Informed Consent Form; RPE = Rating of Perceived Exertion; THb = Hemoglobin Level; Sm O\u003csub\u003e2\u003c/sub\u003e = Oxygen Saturation; EVA = Visual Analogue Scale; Rec A = Recovery A (110 mmHg); Rec B = Recovery B (140 mmHg); Rec C = Recovery C (passive).\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-9496910/v1/8bc9b4ca9c1da59837351824.png"},{"id":108843614,"identity":"d76638a2-5141-4780-8a8b-c391624e5905","added_by":"auto","created_at":"2026-05-09 02:20:48","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":282420,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eIntermittent Pneumatic Compression Devices\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-9496910/v1/4af41ce7f47af3fb9d80cdcb.png"},{"id":108843613,"identity":"1caaca07-fab7-49eb-9d40-22691a10dc80","added_by":"auto","created_at":"2026-05-09 02:20:48","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":65411,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFigure 4 – Pre- and post-recovery comparison of Sm O\u003c/strong\u003e\u003csub\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/sub\u003e\u003cstrong\u003e and THb of groups Rec A, Rec B and Rec C\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSm O\u003csub\u003e2\u003c/sub\u003e = oxygen saturation; THb = hemoglobin level; R = right; L = left; g/dl = grams/deciliter; * = statistically significant values; ANOVA (3x2) with repeated measures, followed by adjusted Bonferroni post hoc test, intragroup comparisons; p-value \u0026lt;0.05.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-9496910/v1/f1b135064d574b5eeaad5da4.png"},{"id":108843615,"identity":"9e893f42-7329-49da-a4ea-2ba3ae7fcf23","added_by":"auto","created_at":"2026-05-09 02:20:53","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":653117,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9496910/v1/ec7ec48f-6de4-4e4c-b138-23fd0a10c5fd.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Optimizing Recovery in Tactical Athletes: The Impact of Intermittent Pneumatic Compression on Fatigue and Pain","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eCombat readiness is one of the fundamental requirements for the preparation of the Armed Forces [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. To enhance the readiness of its tactical athletes, the U.S. Army defines five major training domains considered essential for optimal performance on the front line: mental, nutritional, physical, spiritual, and sleep domains [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Although operational readiness is critical, injuries sustained during training can directly compromise this capability.\u003c/p\u003e \u003cp\u003eEnsuring safety during training is essential, as excessive physical stress can lead to overtraining and a subsequent increase in injury incidence among soldiers [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Muscle injuries (MIs) represent a significant burden for this population, as the need for recovery time and medical care results in socioeconomic losses [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] and measurable health-related impairments that affect performance [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe consequences of MIs extend beyond financial costs and physical limitations\u0026mdash;physical activity promotes physiological and psychosocial benefits such as improved work readiness, reduced stress, increased self-confidence, and stronger interpersonal relationships. Therefore, MIs can directly impact motivation and productivity [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Santos [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] estimated that workdays lost due to illness among firefighters in the Federal District resulted in more than R\u003cspan\u003e$\u003c/span\u003e 39\u0026nbsp;million in costs, with MIs alone accounting for over R\u003cspan\u003e$\u003c/span\u003e 11\u0026nbsp;million in public expenses.\u003c/p\u003e \u003cp\u003eThese data highlight how absences due to MIs impose substantial impacts, while also representing only part of the overall burden associated with these conditions [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Understanding how training-induced physiological changes disrupt the homeostasis of tactical athletes may support injury prevention strategies [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. In this context, intermittent pneumatic compression (IPC) emerges as a relevant intervention.\u003c/p\u003e \u003cp\u003eHistorically, IPC has been used successfully in clinical settings to treat lymphedema by increasing lymphatic transport and reducing pain associated with swelling [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. As a result, the use of IPC for recovery purposes has attracted growing interest and has been increasingly investigated [\u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Although some studies report minimal or no positive effects of IPC on performance [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] or skeletal muscle glycogen resynthesis [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], other investigations have shown findings that may be relevant for recovery-adaptation responses when IPC is applied concomitantly with training [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan additionalcitationids=\"CR18\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. IPC devices promote increased blood flow, lymphatic drainage, and metabolite clearance, mechanisms considered key factors in recovery and athletic performance [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDespite this, evidence regarding the practical and effective benefits of IPC remains unclear [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], particularly within a military context. The number of individuals using IPC continues to grow; however, scientific research evaluating its effectiveness in post-exercise recovery is still scarce [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Even fewer studies have assessed IPC in military personnel performing routine occupational tasks. Considering this gap, we believe IPC is a promising recovery strategy for the military environment, but further research is required to determine the optimal pressure settings for this population.\u003c/p\u003e \u003cp\u003eThus, the objective of this study was to analyze the effects of different IPC pressures on the fatigue index and perceived pain of tactical athletes following an 8-km military march.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eType of search\u003c/h2\u003e \u003cp\u003eExperimental study with data collected in field research, using purposive sampling, transverse design and quantitative analysis [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eParticipants\u003c/h3\u003e\n\u003cp\u003eThe sample consisted of 31 Brazilian Army soldiers, all male, aged between 18 and 25 years. The inclusion criteria were: a) being enrolled in a physical training program and b) being apparently healthy, without chronic diseases or medical conditions that could interfere with the study results.\u003c/p\u003e \u003cp\u003eThe following criteria were adopted for exclusion from this research: a) individuals with any type of osteoarticular, musculoskeletal injury and/or other clinical conditions that prevented them from performing any of the assessments, that limited movement, or that were undergoing restrictive medical treatment; b) military personnel who were using any substance or drug capable of altering the analyses in question; c) individuals with burns on the skin in the lower limb region; d) individuals who were undergoing any local treatment on the lower limbs with creams, ointments, and lotions; e) individuals who were already experiencing pain and/or fever in the week prior to the start of the assessment; f) individuals who were using analgesics, anti-inflammatories, vasodilators, hormonal medications, and anesthetics; and g) individuals who suffered from anemia or had lower hemoglobin levels, caused by iron deficiency, chronic diseases, or blood loss. For this study, participants were randomized into three groups: Recovery Rec A (Passive recovery CPI 110mmHg) (n\u0026thinsp;=\u0026thinsp;10), Rec B (Passive recovery CPI 140mmHg) (n\u0026thinsp;=\u0026thinsp;10), or Rec C (Passive recovery without CPI) (n\u0026thinsp;=\u0026thinsp;11).\u003c/p\u003e \u003cp\u003eThe sample size (n) calculation was performed using G*Power software, version 3.1.9.7 (Faul et al., 2007), and considering a probabilistic error (β) of 80% and a significance level (α) of 95%, the estimated n was 28 participants in total. However, due to the possibility of dropouts, the estimated n was increased by 3 participants for the study (Beck, 2013). There were no dropouts. Therefore, the study was completed with 31 individuals.\u003c/p\u003e\n\u003ch3\u003eEthics\u003c/h3\u003e\n\u003cp\u003e The research project was submitted to and approved by the Ethics and Research Committee of the Army Physical Training Center (CEP-CCFEX) under CAAE number (81463924.2.0000.9433).\u003c/p\u003e\n\u003ch3\u003eStudy design\u003c/h3\u003e\n\u003cp\u003eThe volunteers were evaluated only once, at five distinct moments, as described in the flowchart (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eLegend\u003c/strong\u003e \u003cp\u003eTCLE\u0026thinsp;=\u0026thinsp;Informed Consent Form; RPE\u0026thinsp;=\u0026thinsp;Rating of Perceived Exertion; THb\u0026thinsp;=\u0026thinsp;Hemoglobin Level; Sm O\u003csub\u003e2\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;Oxygen Saturation; EVA\u0026thinsp;=\u0026thinsp;Visual Analogue Scale; Rec A\u0026thinsp;=\u0026thinsp;Recovery A (110 mmHg); Rec B\u0026thinsp;=\u0026thinsp;Recovery B (140 mmHg); Rec C\u0026thinsp;=\u0026thinsp;Recovery C (passive).\u003c/p\u003e \u003c/p\u003e\n\u003ch3\u003ePreliminary guidelines\u003c/h3\u003e\n\u003cp\u003e As soon as the participants arrived at the data collection site, preliminary procedures were carried out, in which the volunteers were informed about the procedures and guidelines for data collection for this research. Following this, and after agreeing to participate, the Informed Consent Form (Annex 01) was completed. For this study, participants were instructed to arrive at the data collection site rested and hydrated, and to avoid strenuous exercise for up to 48 hours before the test. All tests were performed in an indoor gymnasium, except for the walking test, which was performed outdoor. This test lasted approximately 25 minutes. The characteristics of the participants are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eMoment 1:\u003c/h2\u003e \u003cp\u003eInitially, the participants' body mass and height were collected. The military personnel underwent anthropometric analysis using a digital electric scale (G-Tech Balgl 10 brand), and total body mass (kg) was assessed. For the assessment of the sample's height, a fixed vertical stadiometer (Standard Sanny ES2030) was used.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eMoment 2:\u003c/h3\u003e\n\u003cp\u003eFollowing this, an eight-kilometer administrative march was conducted, armed and wearing the 9th C2 uniform and standard Brazilian Army combat equipment (helmet, backpack, full canteen, standard weaponry, and suspender belt), carrying approximately 15 kg of weight. All volunteers completed the route within the CCFEx sports complex. The march aimed to generate a level of exertion in the sample that was compatible with their combat activities, and their Subjective Perception of Effort (SPE) was measured as a physiological control factor. SPE was measured every kilometer of the route by a researcher using the Borg Scale, which assessed the intensity of effort from 0 (none) to 10 (maximum) (Appendix 04) (McGuigan, 2017). In each assessment, the participant indicated the level of effort perceived subjectively using a table previously printed by the researcher accompanying the evaluated group. A medical team was available to provide assistance to participants at any time during the research. All assessments were performed at the same time (at the end of each group's walk) in order to control for diurnal variations in temperature and humidity. The eight-kilometer course was completed in two four-kilometer laps. The total time to complete the walk ranged from 95 minutes (Rec B) to 103 minutes (Rec C), and this phase lasted approximately two hours.\u003c/p\u003e\n\u003ch3\u003eMoment 3:\u003c/h3\u003e\n\u003cp\u003eNext, THb and Sm O2 were assessed using the Moxy Sm O2 Monitor\u0026reg; biosensor (Fortiori Design LLC) on both legs of the individuals. This biosensor allows for reading muscle oxygenation through approximately 12 mm of skin and fat, using near-infrared spectroscopy (NIRS) technology, in addition to measuring hemoglobin and myoglobin in capillaries and muscle tissues with a portable monitor using its own algorithm (Feldmann et al., 2019).\u003c/p\u003e \u003cp\u003eThe military personnel were assessed in the supine position and already divided into the intervention groups (Rec A, B, or C). The sensor was placed in the vastus lateralis muscle (Wilson et al., 2018), two-thirds between the anterior superior iliac spine and the lateral side of the patella, as recommended by the SENIAM35 project for electromyography measurements (Feldman et al., 2012; Stegeman et al., 2007). The sensor was secured in place using medical-grade adhesive tape (Hypafix; BSN Medical, DE) and then covered with commercially available compatible light protection to eliminate potential ambient light intrusion. Once the measurement was taken, it was automatically recorded by the Moxy Portal App (available at Appstore.com). This phase lasted approximately 15 minutes.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eMoment 4:\u003c/h2\u003e \u003cp\u003ePassive recovery was performed with the intermittent pneumatic compression (IPC) boot, defined by randomized assignment: IPC 110mmHg (Rec A), IPC 140mmHg (Rec B) or passive recovery without IPC (Rec C).\u003c/p\u003e \u003cp\u003e In all of them, participants remained in the supine position for 15 minutes. The equipment used were the AVABoots 3.0 pneumatic boots, Size L or XL (its use was defined according to the participant's height: size L fits individuals up to 174cm, size XL fits individuals taller than 174cm), Model AVA-700 (Avanutri\u0026reg;) (Rec A and Rec B). The IPC device consists of 2 separate \u0026ldquo;leg sleeves\u0026rdquo; containing 5 circumferential inflatable chambers (arranged in a line along the limb) covering the leg from the feet to the hip/groin. The \u0026ldquo;leg sleeves\u0026rdquo; are connected to an automated pneumatic pump in which the target inflation pressures for each zone and the duty cycle can be controlled. For passive recovery without a boot (Rec C), volunteers remained in a supine position without using any recovery equipment. The intervention session lasted 15 minutes, as this is considered a consensus in the literature (De Carvalho et al., 2021).\u003c/p\u003e \u003cp\u003eThe gradual inflation of the chambers occurred starting from the ankles towards the thigh. Each air chamber compressed the limb for 30 seconds and then deflated and inflated, defining the 30/30 second cycle (defined based on the knowledge from study 1 of this work). The alternating cycle remained for the entire stipulated duration (15 minutes). Each session lasted 15 minutes, and the entire session lasted approximately two hours.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eMoment 5:\u003c/h2\u003e \u003cp\u003eSm O\u003csub\u003e2\u003c/sub\u003e saturation and THb measurements were performed using the same protocols described previously.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eThe normality and homogeneity of variance of the sample data were analyzed using the Shapiro-Wilk and Bartlett tests, respectively. To determine the effect of the independent variables oxygen saturation and hemoglobin level, in their pre- and post-IPC phases, a repeated measures ANOVA (3x2) was applied, followed by an adjusted Bonferroni post-hoc test to compare the study variables within and between groups (groups: Rec A, Rec B, and Rec C vs. Time: pre- and post-test). A p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was determined for statistical significance. The effect size (d) was calculated to analyze the clinical impact of the intervention. Data were analyzed using the JASP 0.19.3 statistical software program.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eThe characteristics of the participants are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAnthropometric characteristics of the participants\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAverage\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSd\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMinimum\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMaximum\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19,33\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1,71\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBody mass (kg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e73,53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9,88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e53,70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e95,40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStature (m)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1,73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4,80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1,65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1,83\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e24,34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3,62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e19,33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e32,44\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eLegend\u003c/strong\u003e \u003cp\u003eBMI (Body Mass \u0026Iacute;ndex); Sd (Standard Deviation), Kg (kilogram), M (meters).\u003c/p\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e contains baseline THb and Sm O\u003csub\u003e2\u003c/sub\u003e concentration data in the vastus lateralis muscle of both legs of the subjects, and represents the data relative to the pre-recovery phase of the study. No differences were observed between the groups at baseline for THb and Sm O\u003csub\u003e2\u003c/sub\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u0026ndash; Data on the average initial concentrations of THb and Sm O\u003csub\u003e2\u003c/sub\u003e of the participants\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRec\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSd\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMinimum\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMaximum\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eP-Value (SW)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eRec A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSm O\u003csub\u003e2\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e73,36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9,39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e60,40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e92,20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0,089\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTHb\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12,37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0,29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e11,76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e12,88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0,158\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eRec B\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSm O\u003csub\u003e2\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e83,76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7,35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e72,30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e96,00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0,073\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTHb\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12,13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0,39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e11,36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e12,86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0,997\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eRec C\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSm O\u003csub\u003e2\u003c/sub\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e77,84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7,02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e60,50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e90,20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0,369\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTHb\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12,37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0,40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e11,56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e13,12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0,977\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eLegenda\u003c/strong\u003e \u003cp\u003eSd (Standard Deviation); SW (Shapiro-Wilk); Rec (Recovery); average concentrations between legs E and D relative to the pre-recovery time point; Sm O\u003csub\u003e2\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;oxygen saturation; THb\u0026thinsp;=\u0026thinsp;hemoglobin level; p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/p\u003e \u003cp\u003eAll individuals completed the entire study protocol (8km walk and subsequent recovery) without incident. Figure\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e4\u003c/span\u003e shows the comparison of Sm O₂ and THb between pre- and post-recovery time points in groups Rec A, Rec B, and Rec C.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eLegend\u003c/strong\u003e \u003cp\u003eSm O\u003csub\u003e2\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;oxygen saturation; THb\u0026thinsp;=\u0026thinsp;hemoglobin level; R\u0026thinsp;=\u0026thinsp;right; L\u0026thinsp;=\u0026thinsp;left; g/dl\u0026thinsp;=\u0026thinsp;grams/deciliter; * = statistically significant values; ANOVA (3x2) with repeated measures, followed by adjusted Bonferroni post hoc test, intragroup comparisons; p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/p\u003e \u003cp\u003eIn group Rec A, an increase in Sm O₂ was observed in the vastus lateralis E (Δ=+8.22\u0026thinsp;\u0026plusmn;\u0026thinsp;5.94; p\u0026thinsp;=\u0026thinsp;0.003) and D (Δ=+6.20\u0026thinsp;\u0026plusmn;\u0026thinsp;6.27; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), in addition to an elevation of THb in the vastus lateralis E (Δ=+0.13\u0026thinsp;\u0026plusmn;\u0026thinsp;0.19; p\u0026thinsp;=\u0026thinsp;0.002). In group Rec B, an increase in Sm O₂ was observed in the vastus lateralis E (Δ=+5.83\u0026thinsp;\u0026plusmn;\u0026thinsp;6.26; p\u0026thinsp;=\u0026thinsp;0.001) and D (Δ=+4.47\u0026thinsp;\u0026plusmn;\u0026thinsp;6.78; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), in addition to an elevation of THb in the vastus lateralis E (Δ=+0.13\u0026thinsp;\u0026plusmn;\u0026thinsp;0.28; p\u0026thinsp;=\u0026thinsp;0.034). In the Rec C group, no statistically significant values ​​were found when comparing the pre- and post-Sm O\u003csub\u003e2\u003c/sub\u003e moments in the left (Δ=-1.17\u0026thinsp;\u0026plusmn;\u0026thinsp;1.36; p\u0026thinsp;=\u0026thinsp;0.480) and right (Δ=-0.29\u0026thinsp;\u0026plusmn;\u0026thinsp;1.07; p\u0026thinsp;=\u0026thinsp;0.871) vastus lateralis; as well as in THb in the left (Δ=+0.52\u0026thinsp;\u0026plusmn;\u0026thinsp;0.11; p\u0026thinsp;=\u0026thinsp;0.295) and right (Δ=-0.60\u0026thinsp;\u0026plusmn;\u0026thinsp;0.07; p\u0026thinsp;\u0026lt;\u0026thinsp;0.839) vastus lateralis.\u003c/p\u003e \u003cp\u003eThe performance parameters analyzed (THb and Sm O\u003csub\u003e2\u003c/sub\u003e) when comparing the 3 groups studied are shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u0026ndash; Comparison of mean Sm O\u003csub\u003e2\u003c/sub\u003e between groups Rec A, Rec B and Rec C\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eGroups\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eΔ Average\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP-Value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e110mm Hg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e140mm Hg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5,74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0,001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e110mm Hg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRec C\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8,01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0,001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e140mm Hg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRec C\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2,27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0,121\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eLegend\u003c/strong\u003e \u003cp\u003eΔ\u0026thinsp;=\u0026thinsp;difference; ANOVA (3x2) with repeated measures, followed by adjusted Bonferroni post hoc test, intergroup comparisons, Sm O\u003csub\u003e2\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;oxygen saturation; p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/p\u003e \u003cp\u003eIn group Rec A, and when analyzing Sm O₂, a difference was observed when compared to group Rec B (Δ=+5.74\u0026thinsp;\u0026plusmn;\u0026thinsp;5.89; p\u0026thinsp;=\u0026thinsp;0.001) and when compared to group Rec C (Δ=+8.01\u0026thinsp;\u0026plusmn;\u0026thinsp;5.23; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). No differences were found when comparing groups Rec B and Rec C (Δ=+2.27\u0026thinsp;\u0026plusmn;\u0026thinsp;5.36; p\u0026thinsp;=\u0026thinsp;0.121).\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis study aimed to analyze the effect of IPC (Intermittent Pneumatic Compression) on performance and fatigue index in military personnel undergoing an 8-kilometer march. Firstly, it was found that IPC was effective in improving fatigue parameters (Sm O\u003csub\u003e2\u003c/sub\u003e) in the tactical athlete when compared to passive recovery. On the other hand, it was found that IPC did not promote differences in THb (Hemoglobin level) in the evaluated limb compared to the group without boots, nor when comparing groups Rec A and Rec B, and also when evaluating the pre- and post-exercise moments of each group.\u003c/p\u003e \u003cp\u003eNaturally, it was expected that the THb evaluated in the different groups, time points, and muscle region would not differ when compared to each other. This rate tends to be different in specific population types: people suffering from anemia have lower hemoglobin levels, which can be caused by iron deficiency, chronic diseases, or blood loss [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Other medical conditions can explain a different hemoglobin rate, such as kidney disease [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e], medication use [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e], and in people living at different altitudes [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Although no difference in THb was found in the different groups analyzed by this study, it is known that THb can directly affect Sm O\u003csub\u003e2\u003c/sub\u003e [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e], hence the importance of its evaluation. The inclusion criteria were used to select a homogeneous group, allowing for reliable and trustworthy results. That said, the findings of this work can be directed towards the intramuscular oxygen saturation part.\u003c/p\u003e \u003cp\u003eIt was observed that, before the proposed recovery intervention, Rec A, Rec B, and Rec C, the Sm O₂ values ​​were similar when comparing the three groups in both muscle groups (vastus lateralis D and E) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e), while after the proposed recovery with IPC, a difference was found in the Rec A and Rec B groups (Fig.\u0026nbsp;10). It was found that IPC at 110 mmHg promoted a significantly greater increase in muscle oxygen saturation (Sm O₂) in the left limb compared to both the 140 mmHg group and the group without a boot. No studies comparing two compressions in the same group of participants have yet been found in the literature, so further studies are needed to confirm the findings presented here. No differences were found when comparing the 140 mmHg and no-boot groups.\u003c/p\u003e \u003cp\u003eThe reasons for the differences in Sm O\u003csub\u003e2\u003c/sub\u003e in the Rec A group are uncertain. Changes in Sm O₂ during exercise are related to the availability of oxygen in the blood and the use of this oxygen in active muscles (38). Considering that the athletic performance of skeletal muscle depends on oxidative metabolism, muscle oxygen saturation is an excellent variable to correlate problems and improvements in the body's oxidative system and lead to better performance in sports activities [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e], proving that a favorable Sm O₂ rate is associated with increased physical exercise capacity [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. Paredes-Ruiz [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e] concluded that the assessment of Sm O₂ between limbs can be influenced by the location of the equipment used, the muscle mass involved, and the subject's fat mass. In this sense, several authors [39; 42; 43] found asymmetries in muscle mass when comparing dominant and non-dominant limbs in active individuals. This difference found in Sm O\u003csub\u003e2\u003c/sub\u003e still requires further study, but lateral dominance asymmetry emerges as an answer to this question.\u003c/p\u003e \u003cp\u003eAlthough there is conflicting data on the causal relationships between the pressure exerted by intermittent pneumatic compression and its effectiveness in the various outcomes studied in the literature, some investigations suggest that the effectiveness of IPC may be related to the immediate preventive nature of the method [21; 44; 15], which corroborates the findings of the present study. To our knowledge, we are the first to investigate the effects of different types of IPC on muscle recovery, assessed through intramuscular Sm O\u003csub\u003e2\u003c/sub\u003e, after a physical intervention. Other studies have shown that IPC acutely favors the removal of creatine kinase (CK) concentration [10; 17], the improvement of subjective perception of recovery (SPR) [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] and delayed onset muscle soreness (DOMS) [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e] after physical exercise, corroborating that the immediate nature of IPC can be effective. It is important to emphasize that in this study, Sm O₂ and THb were evaluated only immediately before and after a single IPC treatment, regardless of any muscle damage induced by the proposed exercise.\u003c/p\u003e \u003cp\u003eThis study indicated that when comparing the pre- and post-intervention moments of the three proposed groups, both groups that underwent IPC intervention improved Sm O₂ (Rec A and Rec B). As this gait exercise intervention may not have been exhaustive, the differences in Sm O₂ between groups revealed only that group Rec A obtained an improvement in the evaluated recovery parameters, a difference that probably cannot be explained by a significant change in tissue architecture. Mechanically, as proposed by [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e], muscle tissue has certain thixotropic properties, related to the change of the sarcoplasm from a \"gel-like\" state to a more \"liquid\" state, and that, given the nature of IPC, the compression and, therefore, the perturbation of the sarcoplasm of muscle cells could, hypothetically, reduce the viscosity of the medium through which the sarcomere shortens and lengthens, thus increasing intramuscular oxygen saturation. That is, regardless of the pressure exerted by IPC, there would be an increase in Sm O₂.\u003c/p\u003e \u003cp\u003eTo our knowledge, this is the first study to reveal the effect of IPC on the tactical athlete after intervention with military activity. Based on the evidence, the findings of this study suggest that there may be an \u0026ldquo;ideal\u0026rdquo; or \u0026ldquo;optimal\u0026rdquo; compression that provides better indicators of recovery measured through Sm O₂, assessed by Rec A (110 mmHg). Among the limitations of the study are the lack of control of hydration and prior physical activity. All participants were instructed not to engage in physical activity in the 48 hours preceding the study, and it is known that the hydration status prior to physical activity can influence Sm O₂ [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]. Furthermore, controlling the participants' thigh diameter could interfere with the results, an analysis not performed in the present study. Although this is not a requirement in the protocol foreseen by the company supplying the compression boot (Avanutri\u0026reg;), which provides boots in varying sizes, studies suggest that thigh diameter can indeed interfere with the measurement of Sm O\u003csub\u003e2\u003c/sub\u003e [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e]. A greater number of experimental studies comparing Sm O₂ between limbs and analyzing hydration could provide more robustness to the findings found in the present study.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eIn conclusion, compared to a placebo group, acute intervention through intermittent pneumatic compression in the lower limbs after physical stress resulted in an improvement in oxygen saturation levels measured by a specific biosensor. More specifically, there seems to be an ideal compression level that allows for greater benefits when the main objective is muscle recovery. As a strength, this study revealed that IPC can indeed be a useful tool in reducing the fatigue index of tactical athletes, especially in specific situations, such as operational courses. Further research clarifying the specific mechanisms by which different types of IPC pressure improve these recovery markers is needed. Furthermore, future studies may provide insights into the long-term effects of IPC and allow for a better understanding of the specific dose-response relationships of IPC and the adaptations that influence performance in exercise and/or sport.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eACKNOWLEDGEMENTS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors express their gratitude for the institutional and scientific support received during the course of this work, especially to the research team and the study volunteers. The authors are also grateful for the support provided by Avanutri\u0026reg; and Moxy Sm O\u003csub\u003e2\u003c/sub\u003e Monitor\u0026reg;. Despite the sponsorship of materials received, no results were influenced in any way.\u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eCONFLICT OF INTEREST\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declared that there is no potential conflict of interest regarding this article.\u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eFUNDING DECLARATION\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eGullo, Fl\u0026aacute;vio Ramirez. Soberania da Base Industrial de Defesa: prontid\u0026atilde;o e operacionalidade perante as amea\u0026ccedil;as futuras. BS thesis. 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S\u0026atilde;o Paulo. Vol. 31, n. 3,(2024), p. 140\u0026ndash;145. (2024);\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWiecha S, Jarocka M, Wiśniowski P, Cieśliński M, Price S, Makaruk B, et al. The efficacy of intermittent pneumatic compression and negative pressure therapy on muscle function, soreness and serum indices of muscle damage: a randomized controlled trial. BMC Sports Science, Medicine and Rehabilitation. 2021;13:1\u0026ndash;10;\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNorthey, Joseph M, Ben Rattray, Christos K Argus, Naroa Etxebarria, and Matthew W Driller. 2016. \u0026ldquo;Vascular occlusion and sequential compression for recovery after resistance exercise.\u0026rdquo; The Journal of Strength \u0026amp; Conditioning Research 30 (2): 533\u0026ndash;539;\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSands, William A, Melonie B Murray, Steven R Murray, Jeni R McNeal, Satoshi Mizuguchi, Kimitake Sato, and Michael H Stone. 2014. \u0026ldquo;Peristaltic pulse dynamic compression of the lower extremity enhances flexibility.\u0026rdquo; The Journal of Strength \u0026amp; Conditioning Research 28 (4): 1058\u0026ndash;1064;\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCosta, Maria Carolina Barros, et al. \"Avalia\u0026ccedil;\u0026atilde;o do estado de hidrata\u0026ccedil;\u0026atilde;o de um time de atletas de futebol americano do sert\u0026atilde;o brasileiro.\" RBNE-Revista Brasileira de Nutri\u0026ccedil;\u0026atilde;o Esportiva 17.104 (2023): 243\u0026ndash;253; e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFlamia, Brenda Isabelle, et al. \"Profilaxia de tromboembolismo venoso em pacientes cir\u0026uacute;rgicos.\" Revista Eletr\u0026ocirc;nica Acervo Sa\u0026uacute;de 13.4 (2021): e6878-e6878.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"sport-sciences-for-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ssfh","sideBox":"Learn more about [Sport Sciences for Health](http://link.springer.com/journal/11332)","snPcode":"11332","submissionUrl":"https://submission.nature.com/new-submission/11332/3","title":"Sport Sciences for Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"military, fatigue, intermittent pneumatic compression devices, recovery","lastPublishedDoi":"10.21203/rs.3.rs-9496910/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9496910/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction\u003c/strong\u003e: Tactical athletes face situations of high physical exertion, which generates physiological and biochemical changes that compromise operational readiness. Intermittent pneumatic compression (IPC) emerges as a promising alternative, but there are doubts about the ideal pressure.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo analyze the effect of IPC on the fatigue index and pain in tactical athletes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTransversal research with 31 Brazilian Army soldiers completed an 8 km march with full equipment. Initially, preliminary data collection procedures and body assessment were performed, followed by the march. Afterwards, to analyze the fatigue index was used the hemoglobin levels (THb) and oxygen saturation (Sm O₂) that were measured in the left (VLE) and right (VLD) vastus lateralis muscles. Then IPC was performed, and the sample was randomized into three groups: IPC 110 mmHg (Recovery - Rec A), IPC 140 mmHg (Rec B), and passive recovery without boots (Rec C), lasting 15 minutes. Finally, data were collected post-recovery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe paired t-test revealed differences in group Rec A in Sm O₂ at VLE (Δ=+8.22 ± 5.94; p = 0.003) and VLD (Δ=+6.20 ± 6.27; p \u0026lt; 0.001), and in THb at VLE (Δ=+0.13 ± 0.19; p = 0.002). In group Rec B, an increase in Sm O₂ was observed at VLE (Δ=+5.83 ± 6.26; p = 0.001) and VLD (Δ=+4.47 ± 6.78; p \u0026lt; 0.001). A 3x2 ANOVA with repeated measures revealed that group Rec A showed a difference when compared to groups Rec B and Rec C.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIPC was effective in improving acute Sm O₂ levels, with IPC at 110 mmHg achieving better recovery values when compared to passive recovery at 140 mmHg and without a boot, demonstrating that it is a useful tool in reducing the fatigue index of the tactical athlete.\u003c/p\u003e","manuscriptTitle":"Optimizing Recovery in Tactical Athletes: The Impact of Intermittent Pneumatic Compression on Fatigue and Pain","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-09 02:20:31","doi":"10.21203/rs.3.rs-9496910/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-05-18T18:00:01+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"252012655005712394486513308022157533409","date":"2026-05-05T04:22:06+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"184700380572943267351262146382780970300","date":"2026-05-02T21:53:05+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"304426324488453803498068428352572611187","date":"2026-04-30T19:25:21+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-30T19:15:24+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-30T08:21:55+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-30T08:21:22+00:00","index":"","fulltext":""},{"type":"submitted","content":"Sport Sciences for Health","date":"2026-04-22T13:06:57+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"sport-sciences-for-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ssfh","sideBox":"Learn more about [Sport Sciences for Health](http://link.springer.com/journal/11332)","snPcode":"11332","submissionUrl":"https://submission.nature.com/new-submission/11332/3","title":"Sport Sciences for Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"5faf3bf1-52a6-49e2-b489-5f9e42527494","owner":[],"postedDate":"May 9th, 2026","published":true,"recentEditorialEvents":[{"type":"editorInvitedReview","content":"","date":"2026-05-18T18:00:01+00:00","index":25,"fulltext":""},{"type":"reviewerAgreed","content":"252012655005712394486513308022157533409","date":"2026-05-05T04:22:06+00:00","index":23,"fulltext":""},{"type":"reviewerAgreed","content":"184700380572943267351262146382780970300","date":"2026-05-02T21:53:05+00:00","index":21,"fulltext":""},{"type":"reviewerAgreed","content":"304426324488453803498068428352572611187","date":"2026-04-30T19:25:21+00:00","index":20,"fulltext":""},{"type":"reviewersInvited","content":"10","date":"2026-04-30T19:15:24+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-30T08:21:55+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-30T08:21:22+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-09T02:20:31+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-09 02:20:31","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9496910","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9496910","identity":"rs-9496910","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}