Compression Clothing and Running Performance: What’s the Evidence and Recommendation?

Compression Garments are widely used by Athletes to drive Performance and Recovery.
Given the contradictory findings of various publications around compression garments and Running performance and the broad usage for better performance (Ali et al. 2011, Areces et al. 2015) or faster recovery (Hill et al. 2014, Armstrong et al. 2015) a recent study aimed to review the available literature, calculate effect sizes of compression garments and identify evidence to come up with scientific recommendations regarding the use (or dismissal) of compression clothing (Engel et al. 2016). 32 publications included both an experimental and control group, focused on Running, were peer reviewed and included physiological, biomechanical and / or performance parameters.


To make a long story short: Compression clothing had either no or little only positive effect on Running Performance reflected in Marathon, Half Marathon, 15k, 10k or 5k or 400m Sprint times.


BUT: Running Economy was positively affected on a small but positive scale as well as Biomechanical Parameters like step frequency, step length, ground contact time and swing time.


And although physiological parameters (peak oxygen concentration, lactate concentration, heart rate, cardiac output and stroke volume) were not affected DURING Running, there was a positive response AFTER Running esp. for the clearance of blood lactate and post-exercise inflammatory and muscle damage markers like Interleukin 6 and C-reactive Protein.


A large positive effect was exerted on post exercise leg soreness as well as the onset of muscle fatigue.


simplify triathlon conclusions: Coaches should be very clear about the limited evidence for compression clothing benefits in regards of improving Running Performance measured by time. On the other hand with the small but positive effects on Running Economy and Biomechanical parameters as well as post-exercise parameters compression garments can add value to Athletes and their perception of effort and post-exercise fatigue as well as supporting their recovery. Given the importance of recovery per se thus compression clothing might be helpful for starting a meaningful conversation about recovery and according measures rather than focusing on performance and finishing times only. Again it might help focus the Athlete’s mindset on his perception and intuition during the training.



Ali A et al. The effect of graduated compression stockings on running performance. J Strength Cond Res. 2011 May;25(5):1385-92.

Areces F et al. The use of compression stockings during a marathon competition to reduce exercise-induced muscle damage: are they really useful? J Orthop Sports Phys Ther. 2015 Jun;45(6):462-70.

 Armstrong SA et al. Compression socks and functional recovery following marathon running: a randomized controlled trial. J Strength Cond Res. 2015 Feb;29(2):528-33.

 Engel FA et al. Is There Evidence that Runners can Benefit from Wearing Compression Clothing? Sports Med. 2016 Dec;46(12):1939-1952.

 Hill JA et al. Influence of compression garments on recovery after marathon running. J Strength Cond Res. 2014 Aug;28(8):2228-35.

More on Load Management: Practical Recommendations to prevent acute Illness.

Acute Illness is often considered less relevant in the context of Load Management but can impede performance significantly.
Building on a former Blog entry on Load Management in the context of increased Risk for injury this is to reflect the recent second publication of the International Olympic Committee on Load Management to prevent acute illness. Very often the least is considered less relevant focusing much more on preventing acute injury. But, very often, acute illness can significantly impede Athlete’s performance (Schwellnuss et al. 2016, Soligard et al. 2016).

High-intensity Training and competition without proper recovery is associated with risk of illness and subclinical changes in the immune system (Walsh at el. 2011, Gleeson and Pyne 2016). In around around 50% of acute illness cases the Respiratory Tract is affected, with the digestive system, skin and subcutaneous tissues and the genitoutinary System being also affected very often (Schwellnus et al. 2012).

There is good evidence that absolute Training Load increases the Risk of acute illness with some evidence that also no training at all can lead to increased illness when compared to moderate levels of Training Load (Spence et al. 2007, Nieman et al. 2011). Furthermore even Training Monotony may be another Risk factor indicating that significant changes in Training Load with remarkable spikes need tob e considered carefully (Heath et al. 1991).

Given that no single method is able to eliminate the risk of illness, Athletes and Coaches need to apply a bouquet of different behavioural, nutritional, training and competing strategies to reduce the risk of acute illness:


Behavioural and life-style Strategies:

  • Minimise contact with infected people and potentially contagious objects
  • Avoid crowded Areas and shaking hands as much as possible beyond your normal social environment
  • Wash your hands regularly before and after meals and everytime you have been in potentially contagious areas
  • Do not share cups, bottles or towels with other people
  • Ensure enough sleep and sleep hygiene to allow for good quality sleep
  • Avoid excessive alcohol esp. before and after Races
  • Wear open footwear in open pool facilities and ensure good drying to avoid skin issues


Medical Strategies:

  • Consider Zinc Lozenges with above 75 mg Zinc per Day
  • Ensure vaccination when traveling
  • Identify high-risk Athletes esp. regarding airway inflammations (e.g. Asthma, Allergy, etc.)


Nutritional Strategies:

  • Develop an individualized nutrional program tailormade tot he Athlete’s caloric and micronutrient needs
  • Allow enough carbohydrate and protein uptake after Training and Racing
  • Ensure enough consumption of fruits and vegetables
  • Evaluate non-alcoholic alternatives (e.g. non-alcoholic beer)


Load-Management Strategies:

  • Regularly and frequently monitor Training and Competition Load including all internal and external factors
  • Increase Load only incrementally (up to 10% per week)
  • Develop individual Resilience Strategies to enable the Athlete cope with sports- and non-sports-rekated stress



Gleeson M, Pyne DB. Respiratory inflammation and infections in high-performance athletes. Immunol Cell Biol. 2016 Feb;94(2):124-31.

Heath GW et al. Exercise and the incidence of upper respiratory tract infections. Med Sci Sports Exerc. 1991 Feb;23(2):152-7.

Nieman DC et al. Upper respiratory tract infection is reduced in physically fit and active adults. Br J Sports Med. 2011 Sep;45(12):987-92.

Schwellnus M et al. Illness during the 2010 Super 14 Rugby Union tournament – a prospective study involving 22 676 player days. Br J Sports Med. 2012 Jun;46(7):499-504.

Schwellnus M et al. How much is too much? (Part 2) International Olympic Committee consensus statement on load in sport and risk of illness.Br J Sports Med. 2016 Sep;50(17):1043-52.

Soligard T et al. How much is too much? (Part 1) International Olympic Committee consensus statement on load in sport and risk of injury. Br J Sports Med. 2016 Sep;50(17):1030-41.

Spence L et al. Incidence, etiology, and symptomatology of upper respiratory illness in elite athletes. Med Sci Sports Exerc. 2007 Apr;39(4):577-86.

Walsh NP et al. Position statement. Part one: Immune function and exercise. Exerc Immunol Rev. 2011;17:6-63.

Power-Up Green Smoothie

Smoothies are a great way for Triathletes and Endurance Sport Athletes to consume healthy calories, proteins as well as essential micronutrients.
This Power-Up Green Smoothie contains Avacado, Spinach, Cucumer as well as Green Salad. Knowing Green Smoothies are kind of – lets’s say special – especially for the “Smoothie Beginner” this one can also be mixed with fresh Orange or Apple Juice adding some extra Vitamins and Minerals as well as convenience.

Avocado is a phytochemical dense food providing potassium, magnesium, folate as well as essential Omega-3-fatty-acids. Avocados are the richest known fruit sources of phytosterols and are often called one of the world’s healthiest foods given its density in nutrients.

Among the World’s Healthiest vegetables spinach also comes out at the top ranking list for nutrient density containing  the anti-oxidative vitamins C and A as well as important micronutrients like Zinc , Magnesium and Potassium. Spinach furthermore provides more than a dozen different anti-inflammatory flavonoid compounds.

Green Salad is low in calories but high in fiber as well as rich in Vitamins A, C, D and E and Folate as well as minerals. Cucumer is for freshness with its high amount of Water but also providing Minerals and Vitamins.


Here is the Recipe:

–                Half of a Green Salad

–                1 little Aviocado

–                Handful of Spinach Leaves

–                Half of a little Cucumber

Put everything with additional Water in a Mixer until there are completely mixed up. Dilute with some fresh juice for convenience if you like.


References for Read and Thought:

Dreher ML and Davenport AJ. Hass avocado composition and potential health effects. Crit Rev Food Sci Nutr. 2013;53(7):738-50.

The Load-Ratio-Model: How much is too much? Consider Your Injury Risk next time you plan your Training Load.

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Poor Load Management is a Risk Factor for Injury and Overtraining Syndrome.
Very recently the International Olympic Committee (IOC) has convened an Expert Group to review the implications of Training Load (Physical Load, Psychological Load, Travel Load, Competition Load) and its Monitoring and Management to come up with a few practical Recommendations to prevent injury and drive Athlete’s wellbeing (Soligard et al. 2016, Schwellnus et al. 2016).

Load is therefore defined as „the sport and non-sport burden (single or mutiple physiological, psychological or mechanical stressors) as a stimulus that is applied to a human biological system […].“ External Load can include Training and competition time and frequency as well as distance and power output (intensity). Internal Load includes Perception of Effort (often measured as Rate of perceived Exerction, RPE), Psychological Factors like motivation, comittment, coping skills, etc.).

It is well known amongst Endurance Coaches that Recovery is an important element to excel in any kind of endurance sports. Unfortunately this knowledge is very often unapplied even amongst well informed Athletes for very different reasons. Proper Load Management is a key to prevent athletes from injury and overtraining syndrome. Training Load and Recovery are thus mutual counteragents ideally shifting athletes on a continuum of increasing performance progressing from homeostasis, acute fatigue and recovery to increased performance and a higher level of fitness (Meeusen 2013).

Monitoring both internal and external Load across all factors is elemental to ensure Athletes’ Health regarding performance, emotional balance and absence of injury.

Measuring External Load includes Training Time, Distance, Frequency as well as every-day stress including travel and non-sports stressors of work for non-professional athletes. Measuring Internal Load includes motivation, comittment, fatigue and Heart Rate (Borrensen and Lambert 2009).

As a guideline the committee is referring to the Acute-to-Chronic-Load-Ratio-Model (Gabbett 2016, Gabbett et al. 2016) describing the acute load oft he last week to the more chronic average load of the rolling last 4 weeks). If in this model the acute load exceeds the chronic load (Ratio exceeding 1.5) the Athlete may be underprepared with an increased risk of injury and OTS if continuously exceeding. Low risk of overtraining and injury has been shown for a Ratio of 0.8-1.3 (Hulin et al. 2016).


simplify triathlon conclusions: The Acute-to-Chronic-Load-Ratio may be a tool to rationalize and structure Load Management and communicate this towatds the Athlete. Load must always be monitored individually and very frequently (daily or at least weekly) with not a single marker covering all factors given the significant interaction of the many internal and external factors contributiong to the overall load. Subjective Load measures including RPE and motivational scales are very useful to cover internal factors and increase the athlete’s awareness for these factors. Load Management strategies include physical as well as psychological measures to increase resilience and deal with non-sport-stress e.g. from work or private life.



Borresen J, Lambert MI. The quantification of training load, the training response and the effect on performance. Sports Med. 2009;39(9):779-95.

Gabbett TJ. The training-injury prevention paradox: should athletes be training smarter and harder? Br J Sports Med. 2016 Mar;50(5):273-80.

Gabbett TJ at el. High training workloads alone do not cause sports injuries: how you get there is the real issue. Br J Sports Med. 2016 Apr;50(8):444-5.

Hulin BT et al. Low chronic workload and the acute:chronic workload ratio are more predictive of injury than between-match recovery time: a two-season prospective cohort study in elite rugby league players. Br J Sports Med. 2016 Aug;50(16):1008-12.

Hulin et al. The acute:chronic workload ratio predicts injury: high chronic workload may decrease injury risk in elite rugby league players. Br J Sports Med. 2016 Feb;50(4):231-6.

Meeusen R. Overtraining Syndrome. In: Mujika I, Hausswirth C, eds. Recovery for performance in Sport. Champaign IL: Human Kinetics, 2013: 9-20.

Soligard T et al. How much is too much? (Part 1) International Olympic Committee consensus statement on load in sport and risk of injury. Br J Sports Med. 2016 Sep;50(17):1030-41.

You might have NEVER expected this: Is the BIKE really most important in Triathlon? New Data is pretty surprising.

The SWIM might be much more decisive than expected before esp. when considering Ironman events.

In one of my former Blog entries the results of decades data is showing that the BIKE split may be most important for Olympic and Ironman distance triathlon when compared to both the SWIM and the RUN. It highlights that it might be more decisive in case of equally strong athletes.

A recent publication  (Santana-Cabrera and Santana-Martin 2015) is telling a surprisingly different story when analyzing to succint Olympic Distance (Volcana Triathlon, non-drafting event) and Ironman Distance (Ironman Lanzarote) over seven years (2007-2013) focusing on overall times and times of the three disciplines SWIM, BIKE and RUN of the top-ten triathletes as well as how often the winners had best times in which of the three disciplines.

Interestingly in 14% of the Olympic Distance event the Winner was the best in all three disciplines. This compares to even none of the winners of the Ironman events being the best across the SWIM, BIKE and RUN. In more than 70% for both distances the winner was best in only ONE oft he three disciplines.

Was this the BIKE? Yes and no. But the no is much more surprising than the yes!

So yes, it was the BIKE (71% for men, 86% for women and 79% overall) for the Olympic Distance events followed by the SWIM (43% for both men and women) with the RUN being more decisive for the women (43%) then the men (29%).

But no, it wasn’t the BIKE for the Ironman Lanzarote, which is intriguing because the finding is contradictive to what has been shown before and what we would expect on the first view with the BIKE having the longest split oft he whole event. So for the male Athletes oft he Ironman Lanzarote the SWIM was much more decisive (57%) than the BIKE (43%) or even the RUN (29%). For the women it was opposite with the RUN being the determinant (86%) compared to both the SWIM (43%) and the RUN (14%).

Overall across male and female athletes the SWIM and the RUN are equally decisive (50% vs. 57%) nearly doubling the importance of the BIKE (29%).


simplify triathlon conclusions: Triathlon being a relatively new sport with a range of very different distances from Sprint- (500-750m SWIM / 20k BIKE, 5k RUN) to Olympic- (1.5k / 40k / 10k) to Half-Ironman (1.9k / 90k / 21k) and full Ironman (3.8k / 180k / 42k) requires very different Training and Pacing approaches depending on the event. Although especially the BIKE has long been considered most important for the longer races this data shows the SWIM’s importance might be significantly underestimated for winning an Ironman event. In any case the RUN is equally important for both the shorter (Olympic) and longer (Ironman) Triathlon Races and should thus be an important focus beside the SWIM.



Santana-Carera J, Santana-Cabrera FS. Long-Distance, short-distance: Triathlon. One name: Two Ways. Procedia Engineering. 2015 (112): 244-249.

QUICK NEWS UPDATE: The „Athletic Heart Syndrome“-Dilemma of Endurance Sports. Is it all justified?

2012-06-08 07.21.47
High Intensity and strenous Endurance Exercise might potentially put your Athlete’s Heart at Risk.
A former Blog-Entry discusses these potential „cons“ of strenous endurance exercise. In their recent 2016 publication Kindermann and Scharhag refer to the article of Sanchis-Gomar et al. 2016 regarding the „Athletic Heart Syndrome“-Dilemma of Endurance Sports questioning what of the data is truly supported by evidence based data.

For an example the association between strenous endurance exercise and atrial fibrosis is based on animal experiments in rats (Benito et al. 2011) which equate to a human athete training 10 years at 90% of maximal heart rate. Even no elite athlete is able to do that.

Furthermore the often discussed left ventricular hypertrphy may not be a „con“ of strenous endurance exercise but more a physiological outcome restoring the mass-to-volume ratio reducing the myocarial wall stress (Urhausen and Kindermann 1999, Scharhag et al. 2004, Bohm et al. 2016, Pelliccia et al. 2002). Thus it could be a physiological prerequisite for high performance in endurance sport sep. given these changes regress as the training is reduced.


simplify triathlon conclusions: The „Athletic Heart Syndrome“ may not be generally accepted for all Athletes. Still given the controversy of the discussion Athletes and Coaches need to have a close eye on Training Intensities, Training Load and reasonable Recovery Times.



Benito B et al. Cardiac arrhythmogenic remodeling in a rat model of long-term intensive exercise training. Circulation. 2011 Jan 4;123(1):13-22.

Bohm P et al. Right and Left Ventricular Function and Mass in Male Elite Master Athletes: A Controlled Contrast-Enhanced Cardiovascular Magnetic Resonance Study. Circulation. 2016 May 17;133(20):1927-35.

Kindermann W, Scharhag J. High-Level Endurance Exercise: Are All Potential ‘Cons’ Justified? Sports Med. 2016 Aug;46(8):1191-2.

Pelliccia A at al. Remodeling of left ventricular hypertrophy in elite athletes after long-term deconditioning. Circulation. 2002 Feb 26;105(8):944-9. 

Sanchis-Gomar F et al. Endurance Exercise and the Heart: Friend or Foe? Sports Med. 2016 Apr;46(4):459-66.

Scharhag J at al. No difference in N-terminal pro-brain natriuretic peptide (NT-proBNP) concentrations between endurance athletes with athlete’s heart and healthy untrained controls. Heart. 2004 Sep;90(9):1055-6.

Urhausen A, Kindermann W. Sports-specific adaptations and differentiation of the athlete’s heart. Sports Med. 1999 Oct;28(4):237-44.