The Effects of Hyperbaric Oxygen and Active Recovery on Lactate Removal and Fatigue Index

The purpose of this study was to compare active recovery and recovery using hyperbaric oxygen on lactate removal and fatigue index. Fatigue index was measured through Running-based Anaerobic Sprint Test (RAST). Lactate clearance was measured using lactate analyzer. Recovery period is important since competitive events are sometimes very close one from the other.The design of this research was randomized pretest posttest control group design. Thirty students were randomly assigned to three groups consisted of 10 students, the fi rst group doing recovery using 1.3 ATA hyperbaric oxygen after doing RAST, the second group doing recovery in 1.8 ATA hyperbaric oxygenafter doing RAST, and the third group doing active recovery with light intensity after doing RAST. Blood lactate concentration was measured before RAST, ten minutes after RAST, and after recovery either using hyperbaric oxygen or active recovery, and then they took RAST again to get the second fatigue index. Data was analyzed through Manova with .05 signifi cant levels. Blood lactate level isthe lowest in those treated with Hyperbaric Oxygen 1.3 ATA has signifi cant diff erence with active recovery (p=.008). Fatigue index of those treated with hyperbaric oxygen 1.3 ATA is the lowest (6.7 watts/second) vs HBO 1.8 ATA (7.85 watts/second) and active recovery (8.56 watts/second). Increasing oxygen supply to musculoskeletal system increases metabolism of waste substances and promotes recovery from fatigue. Hiperbaric Oxygen 1.3 ATA is more eff ective than HBO 1.8 ATA or active recovery in lactate removal.


Introduction
An excellent sport performance is supported by sport skills; strength, power, fl exibility, balance, agility, speed, aerobic and anaerobic capacities, whereas anaerobic work is determined by substrate level and lactate clearance (Monedero & Donne,2000).Increased lactate results in decreased pH and decreased enzymatic work, and eventually ATP production is also slowered, and this condition will cause fatique and inhibit sport performance.So, optimal recovery process and accelerated lactate clearance would be of benefi t to support sport performance.Optimalization of recovery is important to reduce fatique, to increase physiological adaptation to training and to reduce injury risks (Dupont & Moalla, 2004), especially in series competition.Accoding to Falks, Einbinder, Weinstein, Epstein and Karni (1995), lactate clearance is very important, and is done by increasing blood fl ow, and increasing lactate transport to form ATP again, so acceleration of lactate metabolism is crucial.Recovery activity dictates the speed by which lactate is metabolized in muscles as well as in the liver.Anaerobic work induces lactate production, and increase lactate production will decrease pH, and ATP production as well, and this eventually results in fatique, so fast recovery and acceleration of lactate metabolism is necessary for performance maintainance.Optimalization of recovery technique will increase physiological adaptation to sport performance and avoidance of sport injuries (Dupont & Moalla, 2004).
One among several methodes of recovery is using hyperbaric oxygen.Several studies have shown that passive rest in THE EFFECTS OF HYPERBARIC OXYGEN ON LACTATE AND FATIQUE | WIDIYANTO & S. HARTONO hyperbaric oxygen chamber able to speed up lactic acid clearance in the blood (Untari, 2003).Athlete conditioning should be done not only during training, but also during competition, and in between competition (Lattier & Millet, 2004).Hyperbaric oxygen has been used for recovey aft er high intensity activities.Hyperbaric oxygen is able to increase oxygen transport untill tissue level, to increase respiratory function as well as nervous function (Jain, 1996).Th e primary function of hyperbaric oxygen therapy is to accelerate the recovery of soft tissue by means of reducing local hypoxia, infl ammation and edema (Staples & Clement, 1996).Draper and Whyte (1997) developed the Running-based Anaerobic Sprint Test (RAST).

Methods
Th e design of this study was randomized pretest posttest control group design.Th irty badminton student players were randomly selected and randomly assigned to three groups consisted of 10 people.Subject characteristics; all sample were male badminton players, students of School of Sport Sciences, Surabaya State University.Th e age ranged from 19 to 23 years old.All three groups were doing Running-based Anaerobic Sprint Test (RAST) developed by Draper and Whyte (1997) aft er 10 minutes warming up.Th e fi rst group was doing post exercise recovery in hyperbaric oxygen chamber with 1.3 atmospheric pressure (1.3 ATA) for 15 minutes aft er anaerobic test using RAST, the second group was doing post exercise recovery in hyperbaric oxygen chamber with 1.8 atmospheric pressure (1.8 ATA) for 15 minutes aft er anaerobic test using RAST, and the third group was doing active recovery (jogging) for 15 minutes aft er anaerobic test using RAST.Blood lactic acid was measured using lactate analyzer.To measure the effectiveness of hyperbaric oygen as well as active recovery on fatique index, the whole sample were doing Running-based Anaerobic Sprint Test (RAST) for the second time.
Kolmogorov-Smirnov was used to test normality of sample, and Box's Test of Equality was used to test sample homogenity.Data would be analyzed using appropriate statistics.
Th is study was approved in advance by Surabaya State University Board of Ethics with approval number: 10615.IO.Each participant voluntarily provided written informed consent before participating the study
Figure 2 shows fatigue index aft er doing RAST for the second time.Hyperbaric oxygen treatment using 1.3 ATA shows fatigue index of 6.7 watts/second, HBO 1.8 treatment shows 7.85 watts/second, whereas active racovery shows 8.56.So, HBO 1.3 produces the lowest fatigue index, meaning the least fatigue although comparisons of those three treatments against each other are not signifi cantly diff erent.

Discussion
Th is study indicates that mild pressure of hyperbaric oxygen therapy (1.3 ATA) reduces blood lactate concentration signifi cantly against active recovery, and eventhough there is a non signifi cant diff erence in fatique index in second RAST, the score of mild hyperbaric oxygen therapy (1.3 ATA) is the lowest, indicating that it has a tendency to be more eff ective.
A continuous supply of oxygen to all tissues is necessary for the effi cient production of ATP, and this supply is considered suffi cient when aerobic metabolism is maintained (Robertson & Hart, 1999).By performing HBO treatment, more oxygen is dissolved in the plasma, increasing the oxygen reaching the peripheral tissues as well as increasing PaO2.HBO treatment is therefore expected to improve recovery from injury and fatigue (Ishii et al., 2005).Other study of mild pressure hyperbaric oxygen therapy using 1.3 ATA reduces oxidative stress as indicated by a signifi cant decrease in serum reactive oxygen metabolites (p=.006), and a signifi cant decrease of fatique as indicated by visual analog scale scores from 5.0 to 2.1 (p<.001) (Kim, Yukishita, & Lee, 2011).Studying the eff ects of hyperbaric oxygen on muscle fatigue.Shimoda, Enomoto, Horie, Miyakawa and Yagishita (2015) came to a conclusion that hyperbaric oxygen treatment contributes to sustained force production due to suppressing the muscle fatigue progression.In fact, HBO treatment has eff ectively increased recovery from fatigue.Th is was clearly seen at the Nagano Winter Olympics, where sports players experiencing fatigue were successfully treated, enabling the players to continue performing in the games (Ishii et al., 2005).
Aft er high intensity exercise which is an anaerobic work, condition in working muscle is slightly hypoxic since oxygen is used intensively to change the ischemic condition of the working muscle and to metabolize lactate, and as a result oxygen pressure in the tissue drops.Th e haemodynamic and microcirculatory eff ects of hyperbaric oxygen appear to be effective in compensating ischemic conditions.Oxygen pressure in the tissues increase to levels close to normal.Hyperbaric oxygen causes vasoconstriction with a decrease in microcirculatory blood fl ow but with no decrease of oxygen pressure in the tissue.Th is refl exed vasoconstriction is useful to avoid hyperoxic condition with many bad consequences including tissue oxidation (Mathieu, 2009).Increasing oxygen supply to musculoskeletal system increases metabolism of waste substances and promotes recovery from fatigue.Hiperbaric Oxygen 1.3 ATA is more eff ective than HBO 1.8 ATA or active recovery in lactate removal.Th is study shows that HBO 1.3 ATA is optimal in bringing eff ective tissue oxygenation.

Figure 1 .
Figure 1.Blood lactate concentration in mMol/L during start of exercise, 10 minutes after RAST, and after recovery

Table 1 .
Blood lactic acid concentration after recovery in HBO 1.3 and 1.8, and active recovery, and fatique index after second time doing RAST diff erent in group treated with HBO 1.3 against active recovery (p=.008), group treated with HBO 1.8 is not signifi cantly diff erent with active recovery (p=.94), and group treated with HBO 1.3 is not signifi cantly diff erent with HBO 1.8 as well (p=.263),so HBO 1.3 is signifi cantly eff ective in reducing blood lactate compared with HBO 1.8 and active recovery.