Recovery Strategies in Endurance Athletes

n order to achieve optimal performance, endurance athletes need to implement a variety of recovery strategies that are speci c to their training and competition. Recovery is a multidimensional process involving physiological, psychological, emotional, social, and behavioral aspects. The purpose of the study was to examine current implementation, beliefs, and sources of information associated with recovery strategies in endurance athletes. Participants included 264 self-identi ed endurance athletes (male = 122, female = 139) across 11 different sports including placing top three overall in competition (n= 55) and placing in the top three in their age group or division (n= 113) during the past year. Endurance athletes in the current study preferred hydration, nutrition, sleep, and rest in terms of use, belief, and effectiveness of the recovery strategy. Female endurance athletes use more recovery strategies for training than males (p= 0.043,d= 0.25), but not in competition (p= 0.137,d= 0.19). For training, top three nishers overall (p< 0.001,d= 0.61)

division (n= 113) during the past year. Endurance athletes in the current study preferred hydration, nutrition, sleep, and rest in terms of use, belief, and effectiveness of the recovery strategy. Female endurance athletes use more recovery strategies for training than males (p= 0.043,d= 0.25), but not in competition (p= 0.137,d= 0.19). For training, top three nishers overall (p< 0.001,d= 0.61) and by division (p< 0.001,d= 0.57), used more recovery strategies than those placing outside the top three. Similar ndings were reported for competition in top three nishers overall (p= 0.008,d= 0.41) and by division (p< 0.001,d= 0.45). These athletes are relying on the people around them such as coaches (48.3%) and fellow athletes (47.5%) along with websites (32.7%) for information and recommendations. Endurance athletes should be educated on other strategies to address the multidimensionality of recovery. These ndings will be useful for healthcare professionals, practitioners, and coaches in understanding recovery strategies with endurance athletes. Keywords:running; cycling; triathlons; recovery modalities; hydration; nutrition; sleep 1. Introduction Participating in sport, whether at the professional or recreational level, is often a high demanding endeavor [1]. Endurance athletes traditionally undertake large training volumes to enhance adaptations and subsequently improve performance [2]. Endurance athletes place a great emphasis on their performance and spend a signi cant amount of time and money ensuring that they are in the best position to succeed in their respective sport, regardless of competition level. Prioritizing high-level performance entails high training loads, often leading to an imbalance between stress and recovery [3]. Stress is de ned as the destabilization or deviation from the norm in a biological and/or psychological system [4]. Physical stress refers to the physical fatigue induced during training and/or competition [5]. Physical stress with endurance athletes can be quanti ed in terms of training loads including external and internal training loads [6]. External training loads are objective measures of the work performed during training or competition (e.g., distance completed). Internal training loads assess the biological stress imposed on the athlete by the training or competition. Besides physical stress, other factors including psychological stress and mental fatigue J. Funct. Morphol.

ed in terms of training loads including external and internal training loads [6]. External training loads are objective measures of the work performed during training or competition (e.g., distance completed). Internal training loads assess the biological stress imposed on the athlete by the training or competition. Besides physical stress, other factors including psychological stress and mental fatigue J. Funct. Morphol. Kinesiol.2022,7, 22.

J. Funct. Morphol. Kinesiol.2022,7, 22 2 of 19 in uence an athlete's ability to recover and readiness to train [7] Psychological stress occurs when people perceive that the demands from external situations were beyond their coping capacity [8]. An athlete with high emotional stress experiences irritation, aggression, anxiety, and inhibition [4], which can have a strong effect on the total stress and may negatively impact performance [9]. Therefore, endurance athletes need to monitor both physical and psychological stress. Recovery is a multidimensional process involving a number of systems [9]. More speci cally, recovery is de ned as an inter- and intra-individual multi-level process for the re-establishment of performance abilities that can be systematically used to optimize situational conditions, to build up and re ll personal resources, and buffers [4]. This de - nition demonstrates the complexity and multidisciplinary nature of the recovery process. Therefore, recovery programs should incorporate a variety of personalized and stressor- speci c strategies focused on achieving a balance in psychosociophysiological components such as regaining physiological, psychological, emotional, social, and behavioral aspects of intensive training [4]. Recovery strategies can be divided into active and passive meth- ods [3]; each strategy addresses either regenerative (the physiological aspect of recovery) or psychological components of recovery (mental and emotional stress) [5]. Active recov- ery strategies can consist of moderate exercise during the recovery process like walking, assisted squatting, sled dragging and pushing, mobility training, or de-loaded resistive training sessions. Passive recovery strategies include treatments such as massages, hot and cold baths, or just sitting or lying quietly. Despite the importance and use of recovery strategies within athletics, speci cally endurance athletes, recovery remains an under-researched area compared to training principles and competition strategies [10]. More speci cally, the effects of gender on recovery have only recently gained research attention [11]. Due to sex differences in the physiological effects of exercise, it is important to customize recovery strategies accordingly. Female athletes bene t from using cooling recovery methods, such as cold-water immersion (CWI) due to their lower thermolytic capacities than males. Additionally, active recovery would be bene cial for female athletes

gender on recovery have only recently gained research attention [11]. Due to sex differences in the physiological effects of exercise, it is important to customize recovery strategies accordingly. Female athletes bene t from using cooling recovery methods, such as cold-water immersion (CWI) due to their lower thermolytic capacities than males. Additionally, active recovery would be bene cial for female athletes since they have a greater decrease in arterial blood pressure after exercise compared to males. Furthermore, additional research is needed to examine differences in recovery strategies in athletes at varying skill levels to reduce the potential effects of overtraining syndrome [12], injury [1,13], mental fatigue [14], and impaired sleep [15]. Bezuglov and colleagues [16] reported that higher-tier endurance athletes utilize more recovery strategies, speci cally massage, daytime nap, and sleep. Currently, there is no clear protocol in terms of recovery strategies [5] and many athletes implement strategies based on personal experience rather than evidenced-based research [17]. Additionally, athletes may not be aware of the intended physical effects of a speci c recovery strategy [18]. There is a need to understand the strategies that endurance athletes are utilizing and where they are receiving the information to enhance recovery from training and competition. Furthermore, few studies have examined the attitudes and beliefs of these recovery practices. For example, Murray and colleagues [10] showed that only 24% of the athletes utilized sleep as a recovery strategy despite it being rated and perceived as the most effective in Division I athletes suggesting a potential disconnect between athletes' belief in the recovery strategy and their implementation. However, there are limited studies that have investigated this discord, particularly in endurance athletes. In order to extend and develop upon the existing literature, the purpose of the study was to examine current implementation, attitudes, beliefs, and sources of information associated with recovery strategies in endurance athletes. 2. Materials and Methods 2.1. Participants Participants included 264 self-identi ed endurance athletes (male = 122, female = 139, non-binary = 1, preferred not to answer = 1, and did not answer = 1) across 11 different sports (cycling = 55, paracycling

was to examine current implementation, attitudes, beliefs, and sources of information associated with recovery strategies in endurance athletes. 2. Materials and Methods 2.1. Participants Participants included 264 self-identi ed endurance athletes (male = 122, female = 139, non-binary = 1, preferred not to answer = 1, and did not answer = 1) across 11 different sports (cycling = 55, paracycling = 1, Nordic skiing = 1, running = 99, race walking = 1,

J. Funct. Morphol. Kinesiol.2022,7, 22 3 of 19 rowing = 8, swimming = 7, triathlon = 89, wheelchair racing = 1, snowshoeing = 1, and aquabiking = 1) including professional athletes (n= 14), current collegiate athletes (n= 41), and former collegiate athletes (n= 42). The participants ranged in age from 18 to 79 years old (M= 39.82,SD= 13.84) and were primarily white (n= 231). Additionally, the majority of participants currently reside in the United States (n= 219). Placement in races during the past year included placing top three overall in competition (n= 55) and placing in the top three in their age group or division (n= 113). 2.2. Instruments Participants completed an online questionnaire through Qualtrics that was based on the previous work of Murray et al. [19] and Murray et al. [10] to establish current practices, attitudes/beliefs towards recovery, and sources of information in endurance athletes. Mod- i cations were made to the questionnaire to include additional recovery strategies along with additional questions regarding where the athletes receive their information regarding recovery strategies, what strategies have been recommended to the athlete and by whom, and what strategies they would recommend for other athletes. A combination of open and closed questions was used to provide more detail and elaborate on the closed question answers [20,21]. The questionnaire was comprised of ve sections—demographics and sport/training information, current practices, beliefs, evidence, and sources of information. 2.2.1. Demographics and Sport/Training Information Participants provided basic demographic information including age, gender, race, and country of residence. Additional sport and training information was collected including the participant's primary sport, the current level of the athlete (i.e., professional, collegiate, recreational), if they followed a training program, had a coach, the number of days per week training, hours per week training, and their top three nishes in the last year. 2.2.2. Closed Questions The rst closed question section asked participants to select what current recovery strategies they used during practice and competition on a range of recovery strategies. Par- ticipants were then asked why they currently undertook the speci ed recovery strategery from a choice of evidence, experience,

per week training, and their top three nishes in the last year. 2.2.2. Closed Questions The rst closed question section asked participants to select what current recovery strategies they used during practice and competition on a range of recovery strategies. Par- ticipants were then asked why they currently undertook the speci ed recovery strategery from a choice of evidence, experience, or both. Subsequently, they were asked to rate their opinion on a range of recovery strategies' effectiveness. Their belief of the effectiveness was assessed in terms of their perceived bene t of a strategy. A 5-point scale was used of neutral (indifferent/unsure), no effect, minor effect, moderate effect, or major effect. The answers were assigned a numerical value (5 = most bene t, 2 = no bene t, and1 = neutral). If the athlete rated effectiveness as 4 or 5 then this was coded as a bene t and if they rated a 2 or 3, this was coded as no bene t, and 1 was coded as neutral. The nal closed questions asked participants where they received their information regarding recovery strategies. Participants selected all of their sources from a range of people (e.g., coach, health care providers, fellow athletes) to places (e.g., website, research or professional organization, social media, podcasts). The last questions asked participants what recovery strategies have been recommended to them and by whom as well as what strategies they would recommend to other endurance athletes or athletes, and who has asked them for recommendations on recovery strategies along with what they advised. 2.2.3. Open Questions The open questions allowed participants to provide additional information to the closed questions. First, participants were able to select 'other' in the current recovery strategies for practice and competition as well as sources of information, and then they were asked to specify. Participants were provided an optional expansion on the limited responses of why the athlete used these recovery strategies (i.e., experience, evidence, or both). The primary open-ended question asked participants to state how they knew they had recovered from training and competition.

well as sources of information, and then they were asked to specify. Participants were provided an optional expansion on the limited responses of why the athlete used these recovery strategies (i.e., experience, evidence, or both). The primary open-ended question asked participants to state how they knew they had recovered from training and competition.

J. Funct. Morphol. Kinesiol.2022,7, 22 4 of 19 2.3. Procedure Before the study began, Institutional Review Board (IRB) approval was con rmed. Participants were recruited and identi ed from a global endurance athlete population using digital iers and advertisements sent through several online channels including email, social media groups (i.e., Facebook groups, Twitter, etc.), and online organizations used to facilitate communications between endurance athletes, their teams, and their coaches. Participants consented to participation by e-signing their informed consent prior to starting the online survey. Participants who signed the informed consent form were then instructed to complete an anonymous survey that asked multiple-choice and open-ended questions regarding demographic information, information about their respective sports, and recovery strategies (described above). Participants submitted their survey through Qualtrics upon completion and were thanked for their participation in the research study. 2.4. Data Analysis Responses were reported as a percent of the total for each question. The most common recovery strategies were identi ed as a total prevalence of 15% for training or competition unless smaller distributions were necessary to explain larger themes. Responses that met the 15% threshold were analyzed by sex and previous competition outcomes (top three overall/division) using Chi-square (X 2 ) tests. A 20% threshold was used for questions regarding information sources and recommendations. Three participants were removed from sex comparisons due to non-response (n= 261). Yates corrections for continuity were used for all 2 2 analyses. Adjusted standard residuals (ASR) were used if initial X 2 tests were signi cant to determine differences from expected for 3 2 analyses with a threshold of 2. An independent samples t-test was used to compare total strategy use by sex and competition outcomes. Mann Whitney U non-parametric tests were used to compare ratings of effectiveness by sex and competition outcomes. Statistical signi cance was set atp< 0.050. Data were analyzed using IBM SPSS version 27 (IBM, Armonk, NY, USA). Open-ended questions were coded in N.Vivo Release 1.5.2 Software (QSR International) into subcategories for subsequent analysis of the frequency of occurrence. 3. Results 3.1. Participant Characteristics Participant characteristics for the total sample are presented

of effectiveness by sex and competition outcomes. Statistical signi cance was set atp< 0.050. Data were analyzed using IBM SPSS version 27 (IBM, Armonk, NY, USA). Open-ended questions were coded in N.Vivo Release 1.5.2 Software (QSR International) into subcategories for subsequent analysis of the frequency of occurrence. 3. Results 3.1. Participant Characteristics Participant characteristics for the total sample are presented in Table. The majority of the participants were female (52.65%), white (87.5%), and recreational athletes (63.26%). Table 1.Participant characteristics. M SD orn(%) Total (n= 264) Male ( n= 122) Female ( n= 139) Age (y) 39.82 13.84 43.2 14.28 36.58 12.78 Race American Indian or Alaskan Native 4 (1.5) 2 (1.6) 2 (1.4) Asian 13 (4.9) 3 (2.5) 10 (7.2) Black or African American 4 (1.5) 1 (0.8) 3 (2.2) Native Hawaiian or Paci ca Islander 1 (0.4) 0 1 (0.7) White 231 (87.5) 111 (91.0) 118 (84.9) Multiracial 7 (2.7) 4 (3.3) 3 (2.2) Not reported 4 (1.5) 1 (0.8) 2 (1.4) Total (n= 264) Male ( n= 122) Female ( n= 139) Ethnicity Hispanic or Latino 27 (10.5) 13 (11.0) 14 (10.3)

J. Funct. Morphol. Kinesiol.2022,7, 22 5 of 19 Table 1.Cont. M SD orn(%) Sport Cycling 55 (20.8) 42 (34.4) 13 (9.4) Paracycling 1 (0.4) 0 1 (0.7) Nordic skiing 1 (0.4) 1 (0.8) 0 Running 99 (37.5) 29 (23.8) 68 (48.9) Race walking 1 (0.4) 0 1 (0.7) Rowing 8 (3.0) 4 (3.3) 4 (2.9) Swimming 7 (2.7) 3 (2.5) 4 (2.9) Triathlon 89 (33.7) 42 (34.4) 46 (33.1) Wheelchair racing 1 (0.4) 0 1 (0.7) Snowshoeing 1 (0.4) 0 1 (0.7) Aquabiking 1 (0.4) 1 (0.8) Competition Level Professional 14 (5.3) 7 (5.7) 7 (5.0) Collegiate Athlete 41 (15.5) 12 (9.8) 29 (20.9) Former Collegiate Athlete 42 (15.9) 21 (17.2) 21 (15.1) Placing Top 3 Overall 55 (20.8) 24 (19.7) 31 (22.3) Top 3 Division 113 (42.8) 42(34.4) 70 (50.4) * * = distribution signi cantly higher than expected atp< 0.05. 3.2. Use The use of each individual strategy for training and competition is reported in Table. The most common recovery strategies for training and competition included hydration, nutrition, sleep, rest, stretching, foam rolling, active recovery, self-massage, traditional massage, socializing, compression garments, and mindfulness. A 10% difference between use during training (T) and use during competition (C) was observed for foam rolling (T = 58.9%; C = 48.3%), active recovery (T = 47.1%; C = 34.2%), and self-massage (T = 44.9%; C = 30.8%); all of which were higher for training than competition. Although it did not meet the 10% threshold, hydration was more common after training (Difference = 9.5%) and a traditional massage was more common after a competition (Difference = 9.9%). Table 2.Use of recovery strategy (%). Recovery Strategry Training Competition Hydration 90.9% 81.4% Nutrition 79.5% ‡ 78.3% Sleep 79.1% 78.3% Rest 74.9% 66.5% ‡ Stretching 68.1% ‡ 59.7% * Foam Rolling 58.9% †,‡ 48.3% ‡ Active Recovery 47.1% †,‡ 34.2% Self-Massage 44.9% † 30.8% Massage 22.4% * ,†,‡ 32.3% ‡ Socializing 19.4% †,‡ 18.3% †,‡ Compression Garment 19.0% †,‡ 19.4% †,‡ Mindfulness 16.7% 11.4% Relaxation 14.4% 10.6% Ice Bath 12.2% 13.7% Compress Massage 11.4% 11.4% Taping 8.4% 7.2% Heat 7.2% 5.7%

The study examines recovery strategies used by endurance athletes.