ELIMINATION OF DELAYED-ONSET MUSCLE

SORENESS BY PRE-RESISTANCE
CARDIOACCELERATION BEFORE EACH SET
W. JACKSON DAVIS,1 DANIEL T. WOOD,2 RYAN G. ANDREWS,2 LES M. ELKIND,3 AND W. BART DAVIS4
1
Division of Physical and Biological Sciences; 2Office of Physical Education, Recreation, and Sports; 3Student Health Services,
University of California at Santa Cruz, Santa Cruz, California; and 4Engineering Division, Lawrence Berkeley National
Laboratory, University of California at Berkeley, Berkeley, California

ABSTRACT exercises therefore rapidly eliminates DOMS during vigorous

We compared delayed-onset muscle soreness (DOMS) in- progressive resistance training in athletes.
duced by anaerobic resistance exercises with and without KEY WORDS muscle recovery, concurrent training, resistance
aerobic cardioacceleration before each set, under the rationale training, weight training, progression, aerobic exercise, integrated
that elevated heart rate (HR) may increase blood perfusion in
muscles to limit eccentric contraction damage and/or speed
muscle recovery. In two identical experiments (20 men, 28 INTRODUCTION

D
women), well-conditioned athletes paired by similar physical elayed-onset muscle soreness (DOMS) is a famil-
condition were assigned randomly to experimental or control iar and widespread adverse consequence of
groups. HR (independent variable) was recorded with HR unaccustomed or unusually intense physical
monitors. DOMS (dependent variable) was self-reported using activity or exercise. Symptoms can appear within
hours, persist for as long as several days, and include pain (41),
Borg’s Rating of Perceived Pain scale. After identical pre-
compromised muscle physiology and recovery (10,18,36,43),
training strength testing, mean DOMS in the experimental and
reduced performance (18,19), increased risk of further injury
control groups was indistinguishable (P $ 0.19) for musculature
(55), and reduced adherence to exercise programs (34,45).
employed in eight resistance exercises in both genders, vali- Substantial research has therefore been devoted to strategies
dating the dependent variable. Subjects then trained three times aimed at reducing DOMS, including behavioral approaches
per week for 9 (men) to 11 (women) weeks in a progressive, (8,23,60,61), diet (12), supplements (37,54), systemic analge-
whole-body, concurrent training protocol. Before each set of sics (3,38), and technological approaches (5).
resistance exercises, experimental subjects cardioaccelerated Despite this research, DOMS has proved resistant to
briefly (mean HR during resistance training, 63.7% HR reserve), amelioration. The most effective strategy for reducing DOMS
whereas control subjects rested briefly (mean HR, 33.5% HR remains preceding exercise, termed the ‘‘repeated bout effect’’
reserve). Mean DOMS among all muscle groups and workouts (44,47). The most successful behavioral strategies include
was discernibly less in experimental than control groups in men yoga (8) and compression therapy (33), whereas the most
effective dietary strategies include ingestion of the phospho-
(P = 0.0000019) and women (P = 0.0007); less for each
lipid phosphatidylserine (30) or a carbohydrate-protein-
muscle group used in nine resistance exercises in both genders,
antioxidant beverage (53). Supplements and analgesics have
discernible (P , 0.025) in 15 of 18 comparisons; and less in
proven generally ineffective, although some technological
every workout, discernible (P , 0.05) in 32% (men) and 55% approaches to DOMS reduction, such as transcutaneous
(women) of workouts. Most effect sizes were moderate. In both nerve stimulation and its combination with cold (16), have
genders, mean DOMS per workout disappeared by the fourth reduced DOMS moderately. Most strategies reported to
week of training in experimental but not control groups. Aerobic reduce DOMS are ameliorative rather than preventive, none
cardioacceleration immediately before each set of resistance has been shown directly to influence muscle recovery, and
none has eliminated DOMS entirely.
Finding a simple, effective, and inexpensive antidote and/or
Address correspondence to W. Jackson Davis, jackson@ prevention for DOMS could help to eliminate a major barrier
MiracleWorkout.com. to physical conditioning and exercise adherence at all levels.
1533-4287/22(1)/212–225 Moreover, any process or procedure that reduces or prevents
Journal of Strength and Conditioning Research DOMS may imply more rapid muscle recovery after an
Ó 2008, National Strength and Conditioning Association exercise stimulus, which could benefit exercisers at all
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levels—competitive athletics, recreational, and rehabilitative. resistance exercises (1). Control subjects performed the same
In a research context, the discovery of an effective remedy for resistance exercises at the same intensity, ensuring identical
DOMS could lead to a better understanding of its causes. We eccentric muscle loading, but they rested briefly before each
therefore explored and report herein a new approach to the set of resistance exercises to lower their HR during the sub-
management and elimination of DOMS induced by resistance sequent resistance training to 20–39% of HRR, typical of
training; namely, aerobic elevation of heart rate (HR), or anaerobic resistance exercises. Therefore, the primary
cardioacceleration, immediately before each set of anaerobic difference between experimental and control groups was HR.
resistance exercises. In both experiments, subjects reported DOMS for muscle
The rationale for this approach to DOMS reduction is groups used in every resistance exercise in every workout
based on its probable causes. DOMS is induced by eccentric during several weeks of concurrent exercise training. The
or lengthening muscle contraction. In both human and animal dependent variable (self-reported DOMS) was validated by
models, eccentric contraction immediately damages the comparing DOMS induced by strength testing before and
muscle cytoskeleton and reduces contractile tension (20,39). after resistance training, which was not discernibly different
Eccentric contraction also immediately compromises the between the experimental and control groups. The in-
muscle membrane system, interfering with excitation- dependent variable (HR) was validated by recording HR
contraction coupling (58), and alters the phospholipid during resistance training and calculating mean values
membrane structure (22) and function (2,49). Eccentric following the training program, which fell within the
exercise disrupts the sarcomere and myofibrils (e.g., 9 and 41, prescribed ranges for experimental and control groups. The
but see 46). The collective cellular injury generates free null hypothesis (elevated HR does not affect DOMS) was
radicals (6,36), edema (10), and inflammation products (17,42) rejected in favor of the alternative hypothesis (elevated HR
that act as cellular mediators (24) to alter muscle sensory reduces DOMS) if the mean DOMS reported by experimen-
systems (42), increase afferent discharge in muscle sensory tal groups during resistance training was discernibly less than
receptors (56) and register centrally as the perception of the mean DOMS reported by control groups at the 5% level
DOMS. (P , 0.05) and effect sizes (ES) were at least moderate.
Elevated HR could intervene at any stage in this pre-
sumptive causal cascade to reduce DOMS and speed muscle Subjects
recovery by increasing cardiac output and systolic blood Identical experiments were conducted in successive years
pressure (1), enhancing muscle perfusion, and re-supplying with 20 men and 28 women, undergraduate student-athletes
nutrients and other substances and clearing waste and injury aged 18–22 years. The institutional review board evaluated
products faster. Resistance exercises that induce DOMS and approved all aspects of the research program before
generally do not increase HR significantly (1), however, implementation. After the recruitment of prospective subjects
because they are largely anaerobic, and the increase in blood from university sport teams, the experiment was explained in
pressure caused by resistance exercises is brief and transient a group setting without divulging its purpose. Each pro-
(40,48). In contrast, brief bouts of aerobic exercise performed spective subject then signed a witnessed informed consent
immediately before each set of resistance exercises can statement describing the risks, benefits, and responsibilities of
accelerate HR significantly, increasing cardiac output and participation, and the option to withdraw at any time without
elevating systolic blood pressure chronically (1). Elevated prejudice. Prospective subjects then underwent laboratory
HR could combine with exercise hyperemia (35,57) to blood tests (lipid panel, electrolytes, fasting blood glucose)
increase muscle perfusion, accelerate sarcolemmal materials and cardiovascular risk stratification (1). Athletes accepted as
flux, reduce or prevent eccentric contraction injury, promote subjects were healthy, generally asymptomatic, and exhibited
faster muscle recovery, and reduce or prevent DOMS. no more than one risk factor for coronary artery disease.
After subjects were matched and assigned to experimental
METHODS and control groups as described below, mean demographics
Experimental Approach to the Problem were compared for the experimental and control groups (two-
Under this experimental rationale, we prospectively tested tailed Wilcoxon matched-pairs sign-ranked tests). These com-
the hypothesis that aerobic cardioacceleration immediately parisons revealed no discernible differences in age, body
before every set of resistance exercises reduces DOMS. weight, height, or maximal aerobic capacity in men (Table 1)
Subjects matched as closely as possible were divided (P = 0.10–0.95) or women (Table 2) (P = 0.11–0.65). Subject
randomly into experimental and control groups for several demographics were therefore similar in the experimental and
weeks of concurrent exercise training. Experimental subjects control groups.
performed brief, vigorous aerobic exercise immediately before
each set of resistance exercises to elevate their HR during Procedures
subsequent resistance training to 60–84% of HR reserve The overall design of this experiment included three phases
(HRR), typical of vigorous aerobic exercise and higher (Figure 1a): pre-training assessments and instruction, con-
than can be achieved generally by conventional anaerobic current exercise training and collection of data on the

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Eliminating Delayed-Onset Muscle Soreness

from sport-related activities. All of the subjects were well-

conditioned athletes, but in view of the specificity principle
TABLE 1. Demographic variables for male subjects. (1), exposure to unaccustomed resistance exercise would be
expected to induce DOMS, as confirmed by the results.
Variable Experimental Control
Subjects were also instructed uniformly in the use of the
Age, y 20.36 6 0.34 20.44 6 0.41 Category-Ratio Rating of Perceived Exertion (RPE) and
Body mass, kg 70.97 6 1.81 76.53 6 1.98 Rating of Perceived Pain (RPP) 11-point scales (7) during pre-
Height, cm 176.65 6 2.07 178.93 6 2.21
_ 2max, training instruction. Directions were read aloud in a group
Vo 52.83 6 2.76 50.37 6 2.45
mL
kg21
min21 setting, quoting the recommended instructional language (1, 7),
and followed by a question-and-answer session. Subjects
Values are mean 6 SEM. were then provided with the written instructional language
and scales and asked to study them. Subjects were subse-
quently trained in the practical application of the RPE and
RPP scales during the pre-training assessments, with feed-
independent variable (HR) and the dependent variable back from trained and certified supervisors.
(DOMS), and post-training assessments and debriefing. Pre-training assessments (Figure 1b) included measure-
Before strength and endurance testing, subjects were ments of: (a) muscle strength (1 repetition maximum weight
instructed uniformly in resistance training form (Figure 1b) or 1RM) for eight machine or free-weight resistance
for each resistance exercise performed in this study. Subjects exercises (seated inclined bilateral leg press, seated leg [knee]
were told to give equal attention to the concentric and the extension, seated leg [knee] flexion or leg curls, seated front
eccentric phases of each resistance exercise using a 4-second lat pull-down, flat bench press, overhead or military press,
duty cycle (2 seconds each for the concentric and eccentric biceps or arm curl, and triceps kickback); (b) muscle endur-
phases). Certified or trained supervisors confirmed that ance (number of repetitions to failure at a fixed percentage of
subjects followed this protocol during training. All subjects 1RM weight) for the same eight exercises; and (c) maximal
restricted resistance training during the experiment to that aerobic capacity (Vo_ 2max), estimated using a graded tread-
prescribed by the program. Fewer than 10% of subjects had mill exercise test (1) and automated using a Technogym
recently participated in resistance training, and these treadmill (The Technogym Wellness Company, Gambettola,
individuals were distributed in both the experimental and Italy). All measurements were conducted following formats,
control groups. Pre-exposure to resistance training therefore procedures, and protocols recommended by the American
did not provide a significant protective effect against DOMS College of Sports Medicine (1). During the 48-hour period
in either group. immediately after the 1RM trials, subjects recorded any
During pre-training instruction in each experiment, sub- DOMS in muscle groups used for the eight exercises per-
jects were instructed as a group in the properties of DOMS, formed during 1RM tests every 12 hours, using purpose-
including the suspected causes, typical effects and sensations, designed forms.
time course, and the muscle groups affected for each At the end of pre-training assessments, a matched-pairs
resistance exercise performed during testing and training. design was implemented (Figure 1b). Subjects were first
All subjects indicated that they had experienced DOMS and ranked according to three measured variables related to
were familiar with its characteristics. Both experiments were initial physical condition: muscle strength adjusted for body
conducted in the off-season for participating athletes, but weight squared or cubed, muscle endurance, and estimated
several of the men reported at the beginning of the concurrent _ 2max. A mean ranked list was prepared from these three
Vo
training phase that they were experiencing moderate DOMS separate rank listings, and adjacent subjects on the composite
list were defined as matched pairs. Members of each matched
pair were then assigned to either the experimental or control
group by a random process (coin flip). Matching subjects as
TABLE 2. Demographic variables for female subjects. closely as possible on the basis of initial physical condition
ensured similar starting points for the experimental and
Variable Experimental Control control groups, eliminating differences between groups
Age, y 19.71 6 0.30 19.40 6 0.21 arising from nonlinear training adaptations and enabling
Body mass, kg 65.78 6 2.50 60.85 6 2.59 more powerful matched-pairs statistical tests to compare
Height, cm 163.69 6 2.92 163.79 6 1.10 means.
_ 2max,
Vo 46.57 6 2.09 47.03 6 2.37 Experimental and control groups then began a 9-week
mL
kg21
min21 (men) or 11-week (women) concurrent training program,
Values are mean 6 SEM. during which data were collected on the independent variable
(HR during resistance training) and dependent variable (self-
reported RPP for DOMS). Each subject wore a Polar A-5 HR
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Figure 1. Graphic portrayal of the experimental design of this study. (a) Overview of the experiment. (b) Pre-training assessment and instruction sequence. (c, d)
Training protocols used for experimental and control subjects, respectively. Within each section, the length of each horizontal bar is proportional to the duration of
the corresponding component. The width of spaces between bars is not significant.

transmitter and wrist receiver during workouts to observe musculature, and recalled and reported most accurately
instantaneous HR, adjust aerobic work rate as required by the immediately upon completing the evaluation.
experimental design, and store mean HR data. DOMS was Under a similar rationale, subjects recorded the RPE for
recorded for muscle groups used for each of the nine each resistance exercise and the RPP for any non-DOMS pain
resistance exercises performed by each group, i.e., the eight experienced during that resistance exercise immediately upon
previously listed and weighted abdominal curl-ups on an concluding the final set. At the end of each workout, subjects
inclined bench (Figure 1a). In every workout, subjects recorded mean HR during the resistance exercise stage,
recorded the RPP for residual DOMS in the muscle group stored in HR monitors; water consumption during the
used for each resistance exercise immediately after the third exercise session, measured to the nearest 0.1 l; data pertinent
(final) set using a purpose-designed workout log (15). The to a number of control variables, including aggregate RPE and
rationale for this procedure was that DOMS can be evaluated RPP for the entire exercise session; and other data. All data
most accurately during an exercise that utilizes the affected were recorded using a purpose-designed workout log (15).

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Eliminating Delayed-Onset Muscle Soreness

Experimental and control subjects performed three (treadmill running), 10 minutes longer than the aerobic
vigorous workouts per week consisting of concurrent aerobic, session of experimental subjects to help to compensate for
resistance, and range-of-motion (ROM) exercise (Figure 1c, d). pre-resistance cardioacceleration time in experimental sub-
Experimental subjects performed integrated concurrent jects and equalize the volume and intensity of aerobic exercise
training divided into three stages (Figure 1c): aerobic, among the experimental and control groups. Control subjects
resistance, and a ROM cool-down. Experimental subjects concluded each exercise session with the same ROM cool-
began each exercise session with a 20-minute aerobic down as experimental subjects.
exercise warm-up (generally treadmill running) in which During concurrent training, experimental and control
they rapidly attained and sustained a HR corresponding to subjects performed the same nine resistance exercises in the
exercise of vigorous intensity, 60–84% of HRR (1), calculated same sequence: lower body (seated inclined bilateral leg press,
using the Karvonen method. The rationale for prolonging the seated leg [knee] extension, seated leg [knee] flexion or leg
warm-up was to induce sufficient cardiovascular fatigue to curl) followed by upper body (seated front lat pull-down, flat
support more rapid subsequent cardioacceleration and to bench press, overhead or military press, biceps or arm curl,
limit subsequent HR recovery in these well-conditioned triceps kickback), and concluded with weighted abdominal
athletes, enabling experimental subjects to achieve and curl-ups (crunches) on an inclined bench. The initial starting
sustain a higher HR during the resistance training that weights for resistance exercises were 65% of 1RMs for men
immediately followed the warm-up. and 50% of 1RMs for women. The rationale for beginning
After the aerobic warm-up, experimental subjects began with these relatively light weights was to minimize the risk of
integrated concurrent resistance training consisting of three injury. The resistance weight was increased rapidly during the
sets each of the nine resistance exercises previously identified first few exercise sessions to accommodate subjects’capacities
in the sequence listed. Immediately before every set of (see below). The use of the same resistance exercises per-
resistance exercises, experimental subjects elevated their formed at the same intensity ensured equivalent eccentric
HR to the upper portion of the vigorous range (60–84% of muscle loading between experimental and control groups.
HRR) (1) by performing a short (0.5–1 minute) bout of The use of different starting levels for resistance exercises
vigorous aerobic exercise (cardioacceleration), enabling them between men and women did not influence the interpretation
to sustain an elevated HR through the subsequent set of of results because all statistical comparisons were performed
resistance exercises. Experimental subjects used the cardio- within genders.
vascular machine or exercise of their choice for cardioaccel- To minimize extraneous variance and ensure equivalent
eration, usually treadmill running. Experimental subjects eccentric muscle loading among groups, experimental and
concluded each exercise session with a cool-down consisting control subjects used the same method of progression during
of 12 ROM exercises during which they reduced their HR resistance training. For the first few exercise sessions, subjects
to the low end of the range corresponding to light exercise in both groups were instructed to increase the weight used for
(20–39% of HRR) (1). each resistance exercise as rapidly as necessary to achieve
Control subjects performed serial concurrent training three sets of eight repetitions for each resistance exercise with
divided into four stages (Figure 1d): warm-up, resistance, an RPE no greater than 5 (‘‘strong’’ exertion) and an RPP no
aerobic, and a ROM cool-down. Control subjects began each greater than 2 (‘‘weak’’ pain). This enabled subjects to increase
exercise session with a brief (5-minute) aerobic exercise workloads rapidly but safely from the relatively light initial
warm-up in which they raised their HR to 60–84% of HRR weight of 50% (women) to 65% (men) of 1RM weight to
using the cardiovascular exercise of their choice, usually a heavier weight more appropriate to their capacities.
treadmill running. The rationale for abbreviating the warm- After subjects reached this level, which occurred in the first
up was to minimize cardiovascular fatigue to support slower two or three exercise sessions, advances in weight or
HR acceleration and faster HR recovery during subsequent repetitions were prescribed for each resistance exercise when
resistance training, enabling control subjects to achieve and the following five criteria were met: (a) the RPE for the
sustain a lower HR during the resistance training that exercise assessed after the third (final) set was ‘‘strong’’ or less
immediately followed the warm-up. (numerical value of 5 or less); (b) the aggregate RPE of the
After the aerobic warm-up, control subjects began resis- corresponding workout, recorded at its conclusion, was 5 or
tance training, consisting of three sets each of the same nine less; (c) the RPP for DOMS during each resistance exercise
resistance exercises performed by experimental subjects and assessed after the third set was ‘‘weak’’ or less (numerical value
in the same sequence. Immediately before every set of of 2 or less); (d) the RPP for non-DOMS pain during each
resistance exercises, control subjects lowered their HR to the resistance exercise assessed after the final set was 2 or less; and
low end of the range corresponding to light-intensity exercise (e) aggregate RPP for the corresponding exercise session was
(20–39% of HRR) by resting briefly (0.5–1 minute) in a seated 2 or less.
position, enabling them to sustain a lowered HR during the When these five criteria were met, either the number of
subsequent set of resistance exercises. Resistance training repetitions per set or the weight per exercise was increased
was followed by 30 minutes of vigorous aerobic exercise and entered immediately into workout logs as the
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prescription for the corresponding resistance exercise in the Quantitative results are reported as the mean 6 standard
next workout. Repetitions per set began at eight, increased on error of the mean.
progression by one or two to a maximum of 12, and reverted
to eight when weight was increased. Weight was increased RESULTS
upon progression by 5 lb for small muscle groups (generally To evaluate and validate the dependent variable (self-reported
upper body) and 10 lb for large muscle groups (seated lat pull- RPP for DOMS), the DOMS induced by identical strength
down and lower body). This method of progression was easy testing was recorded by all subjects every 12 hours for 48
in practice for athletes to learn, and they implemented it hours after both pre-and post-training 1RM trials. DOMS in
without difficulty within one or two workouts. the four measurements was recorded separately for muscle
Several additional control and monitoring procedures were groups used in each of eight resistance exercises listed in the
implemented to minimize extraneous variance and ensure methods (abdominal curl-ups excluded). Before training in
identical eccentric muscle loading among groups. Experi- men, mean DOMS per measurement for all eight muscle
mental and control training protocols were equalized for groups after strength testing was not discernibly different
exercise modes, types, volume, intensity, and duration between experimental and control groups (2.5 6 1.4 and
(approximately 1.8 hours). Experimental and control groups 2.6 6 1.4, respectively; two-tailed Wilcoxon test, n = 9, P =
exercised on different floors of the same training facility 0.19). Similarly, before training in women, mean DOMS
during the same morning hours (6:00 to 10:00 AM) of the per measurement for all eight muscle groups after strength
same days (Tuesday, Thursday, and Saturday). Supervising testing was not discernibly different between experimental
trainers alternated between the two groups several times in and control groups (5.0 6 2.7 and 4.8 6 3.8, respectively;
each exercise session to preclude differential training effects two-tailed Wilcoxon test, n = 13, P = 0.81). After training,
or motivational influences. Prescribed HR ranges for each mean DOMS per measurement for all eight muscle groups
subject were registered in their HR monitor as lower and after strength testing in women was not discernibly different
upper limits to assist compliance with HR prescriptions and (3.5 6 3.1 and 4.5 6 3.5 for experimental and control groups,
were confirmed after training as reported in the results. respectively; two-tailed Wilcoxon test, n = 8, P = 0.78). Mean
Post-training assessments and debriefing (Figure 1a) DOMS after training was not evaluated in men because of an
followed the same format, procedures, and sequence as inadequate sample size resulting from incomplete data and
pre-training assessments, including measurements of muscle withdrawal of some subjects.
strength, muscle endurance, and Vo _ 2max. To conclude each DOMS after pre-training strength testing was then
experiment, every subject completed a written evaluation of analyzed for each of the above eight muscle groups separately.
the training program in the form of a questionnaire that Mean DOMS for lower body exercises exceeded that for
contained an embedded question asking the purpose of the upper body exercises almost 2:1, discernibly different in both
experiment. No subject answered the question correctly, genders (men: two-tailed t-test, n = 9, P = 0.001; women:
indicating that the experimental protocol was blind. Because two-tailed t-test, n = 13, P = 0.001). For each of the muscle
subjects who were unaware of the purpose of the experiment groups corresponding to the eight resistance exercises
also self-reported the dependent variable (DOMS), the performed, the mean DOMS per measurement (Figure 2)
experimental protocol was double-blind. after identical strength testing was in no case discernibly
different between experimental and control groups in either
Statistical Analyses gender (two-tailed Wilcoxon tests; men: n = 9, P = 0.44–0.86;
All data were entered into electronic spreadsheets, and entries women: n = 13, P = 0.23–1.0). Experimental and control
were confirmed by trained personnel before statistical analysis groups in both genders therefore self-reported DOMS
and graphical display. The Wilcoxon test (29) was used for induced by the same relative exercise exertion (maximal)
most comparisons of means. Student’s t-test was used to similarly for every muscle group using the RPP scale. This
compare DOMS means in different exercise sessions (Figure 4) outcome was prerequisite to the use of self-reported DOMS
because the underlying assumptions of normality and inde- as the dependent variable and comprises a necessary and
pendence were justified. All hypotheses were tested at the 5% sufficient validation of the dependent variable (RPP for
level (P # 0.05). Exact probabilities associated with most DOMS) for use in the current experimental application.
tests are reported to permit critical evaluation of differences. To test the main hypothesis (elevated HR reduces DOMS),
ES was calculated using the Cohen d method (51), and DOMS induced by nine resistance exercises during training
differences in means were characterized using the ranges and (the previously listed eight plus abdominal curl-ups) was first
descriptive terminology for highly trained individuals (ES , averaged among all muscle groups and all workouts
0.25, ‘‘trivial;’’ ES = 0.25–0.50, ‘‘small;’’ ES = 0.50–1.0, separately for experimental and control groups. In men, the
‘‘moderate;’’ and ES . 1.0, ‘‘large.’’). Unless otherwise noted, experimental group mean DOMS (1.4 6 0.5) was less than
statistical tests were one-tailed. Sample sizes varied because one-fourth the control group mean (6.3 6 1.4), discernibly
of missing data from some subjects for some tests and are smaller (Wilcoxon test, n = 28 workouts, P = 0.0000019;
therefore reported separately for each statistical test. ES = 0.66, moderate). In women, the experimental group

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Eliminating Delayed-Onset Muscle Soreness

n = 10, P = 0.005–0.046). ES for

the nine comparisons ranged
from 0.31 (small) to 0.70 (mod-
erate). In women (Figure 3b),
mean DOMS during training
for muscle groups used in all
nine resistance exercises was
discernibly smaller in the ex-
perimental group than the con-
trol group (Wilcoxon tests, n =
13, P = 0.0002–0.023). ES for
the nine comparisons ranged
from 0.32 (small) to .0.50
(moderate).
Examination of DOMS data
from individual subjects during
training revealed large intersub-
ject variation. Control subjects
fell into two categories: those
who repeatedly experienced
weak to moderate DOMS
throughout the training period
(‘‘DOMS-susceptible’’; 35.7%
of women, 50.0% of men) and
those who experienced little or
no DOMS after the first 2 or
3 weeks of training (‘‘DOMS-
insusceptible’’). The greater
mean DOMS in control groups
during training represents
mainly the contribution of the
DOMS-susceptible subjects.
The smaller mean DOMS in
experimental groups during
training resulted from the re-
duction of DOMS in the
Figure 2. Mean delayed-onset muscle soreness (DOMS) per measurement in muscle groups used in eight DOMS-susceptible subjects.
resistance exercises over four measurements during the 48 hours immediately after pre-training strength (1RM)
trials in male (a) and female (b) athletes. Open bars = experimental means; shaded bars = control means. Mean
The absence in men of a dis-
DOMS for each exercise was not discernibly different between experimental and control groups for any muscle cernible difference in DOMS
group in either gender (see Results). Error bars represent 2 SEMs. between experimental and con-
trol groups for the three lower-
body resistance exercises (Fig-
mean DOMS (0.3 6 0.3) was less than one-tenth the control ure 3) may therefore be attributable to high intersubject
group mean (3.6 6 1.1) also discernibly smaller (Wilcoxon variation, combined with a relatively small sample size.
test, n = 33 workouts, P = 0.0007; ES = 0.52, moderate). Mean DOMS averaged among all nine resistance exercises
Mean DOMS during the 9- to 11-week concurrent training for each workout and graphed as a time series showed that, in
programs was then calculated separately for muscle groups both genders, experimental groups experienced a smaller
used in each of the nine resistance exercises (Figure 3). In initial rise in mean DOMS during training than control
men, lower body muscle groups showed a tendency toward groups, and a faster decline that tended toward 0 by the end
smaller mean DOMS in experimental groups, but the of the fourth week of training (lower curves in Figure 4a, b).
differences between experimental and control means during Mean DOMS in experimental groups was less than mean
training were not discernible at the 5% level (Wilcoxon tests, DOMS in corresponding control groups in every exercise
n = 10, P = 0.12–0.17). Mean DOMS in men during training session in both genders. In men (Figure 4a), the difference
for each of the six upper body resistance exercises was was discernible in 32% of all exercise sessions (t-tests, n =
discernibly smaller in experimental groups (Wilcoxon tests, 6–10; P , 0.05; *Figure 4a). ES ranged from 0.27 (small) to
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HR during resistance training

of experimental and control
groups was discernibly differ-
ent for men (Wilcoxon test, n =
10, P = 0.003) and women
(Wilcoxon test, n = 13, P =
0.0007). This outcome, which
was anticipated based on in-
structions given to subjects,
validates the independent vari-
able. The HR of experimental
subjects during resistance ex-
ercises was higher than the
mean calculated during resis-
tance training (Table 3) by
10–15% because after pre-
resistance cardioacceleration,
HR declined during and after
resistance sets while HR re-
cording continued. The mean
HR of control subjects during
resistance exercises was similar
to the mean calculated (Table
3) because the resistance exer-
cises alone generally had little
impact on HR.
To further validate the de-
pendent variable (RPP for
DOMS), we analyzed two re-
lated control variables: non-
DOMS pain and RPE during
individual resistance exercises.
Mean non-DOMS pain aver-
aged among all nine resistance
exercises and all exercise ses-
Figure 3. Mean delayed-onset muscle soreness (DOMS) in muscle groups used in nine resistance exercises over sions (Table 4) was not dis-
all exercise sessions during 9 weeks (men; a) to 11 weeks (women; b) of concurrent exercise training. Open bars = cernibly different between
experimental means; shaded bars = control means. Experimental groups (cardioacceleration before each experimental and control
resistance exercise) reported less DOMS than control subjects (rest before each resistance exercise) for all muscle
groups in both genders. *Control means discernibly larger than the corresponding experimental means groups in either gender (two-
(see Results). Error bars represent 2 SEMs. tailed Wilcoxon tests; men: n =
10, P = 0.72; women: n = 13,
P = 0.70). This result reinforces
1.31 (large) and, in most cases (60.7%), was moderate. In the conclusion that subjects evaluated pain from a common
women (Figure 4b), the difference was discernible in 55% of exercise experience similarly using the RPP scale and
all exercise sessions (t-tests, n = 8–14; P , 0.05; *Figure 4b). provides additional, indirect validation of the dependent
ES ranged from 0.25 (small) to 1.0 (large) and, in most cases variable.
(55%), was moderate. Mean RPE averaged among all nine resistance exercises
To confirm expected variation of the independent variable and all exercise sessions (Table 5) was not discernibly
(HR), mean HR during the resistance training portion of all different between experimental and control groups in
workouts (Table 3) was calculated at the end of the either gender (two-tailed Wilcoxon tests; men: n = 10, P =
concurrent training program from values recorded by 0.44; women: n = 13, P = 0.86), as anticipated from the
athletes during each workout. In both genders, the mean balanced experimental design. This result confirms that
HR during the 70-minute period of resistance training fell differences in mean DOMS between experimental and
within the prescribed HR ranges for experimental (60–84% control groups did not arise from differences in actual or
of HRR) and control (20–39% of HRR) groups. The mean perceived exertion.

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Eliminating Delayed-Onset Muscle Soreness

overall workloads and, in

particular, different eccentric
loading of muscles between
experimental and control
groups, which could also con-
tribute to different DOMS be-
tween the groups. Mean
exercise compliance ([exercise
sessions attended/total possi-
ble exercise sessions] 3 100)
(Table 7) was not discernibly
different between experimental
control groups in either gender
(two-tailed Wilcoxon tests;
men: n = 9, P = 0.31; women:
n = 14, P = 0.38).

DISCUSSION
The main finding of this study is
that physiologic DOMS caused
by conventional anaerobic re-
sistance exercises is reduced
immediately and eliminated
within 4 weeks by aerobically
elevating HR before each set in
comparison with control sub-
jects who did not elevate HR.
Several potentially confound-
ing variables, including differ-
ential eccentric muscle loading,
the method of using the RPP
scale to report DOMS, actual
and perceived exercise exer-
tion, water consumption during
Figure 4. Time series showing mean delayed-onset muscle soreness (DOMS) per exercise session summed over exercise sessions, and compli-
all muscle groups used in nine resistance exercises during 9 weeks (men; a) to 11 weeks (women; b) of concurrent
ance with training sessions,
exercise training. Experimental groups (cardioacceleration before each resistance exercise) reported less DOMS
than control groups (rest before each resistance exercise) for every exercise session in both genders. *Control were eliminated. None differed
means discernibly larger than the corresponding experimental means (see Results). Error bars represent 2 SEMs. discernibly between the exper-
imental and control groups. We
conclude that the reduction of
We analyzed two additional potentially confounding DOMS in experimental groups compared with control
variables that could, in principle, lead to different DOMS in groups was caused largely or exclusively by variation of the
the experimental and control groups; namely, water con- independent variable, i.e., by elevated HR. This finding
sumption during workouts and attendance at prescribed implies that elevated HR during resistance training speeds
exercise sessions. Dehydration during exercise can induce or muscle recovery.
exacerbate muscle injury and potentially increase DOMS in The discernible reduction of DOMS in experimental
hyperthermic men (11); therefore, differential water intake groups below that of control means in the first (men) or
during exercise sessions could yield differences in DOMS. second (women) workout suggests that cardioacceleration
Mean water consumption (Table 6) was not discernibly before each set of resistance exercises rapidly reduces any
different, however, between experimental and control groups residual DOMS induced in the corresponding musculature by
in either gender (two-tailed Wilcoxon tests; men: n = 9; P = earlier exercise. Male subjects in particular began the training
0.77; women: n = 14, P = 0.11). program under the influence of residual DOMS induced by
A second potentially confounding variable, differential earlier sport-related activities (see Methods). The smaller
compliance with prescribed exercise sessions between mean DOMS in experimental groups in every exercise session
experimental and control groups, could lead to different after the first could reflect either the reduction of residual
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second experiment, were each

divided into two matched
TABLE 3. Heart rate during the resistance training phase of the exercise program. groups, experimental and con-
trol. Each group received the
Gender Variable Experimental Control
same DOMS model exercise
Male exposure, i.e., resistance train-
HR, b
min21 142.5 6 0.7 108.1 6 1.1 ing using identical program
HR, HRR 62.5% 6 0.5% 35.1% 6 0.8%
variables. The ‘‘treatment,’’ i.e.,
Female
HR, b
min21 151.1 6 0.4 107.9 6 0.5 elevated HR in experimental
HR, HRR 64.8% 6 0.3% 31.9% 6 0.4% groups, reduced and eliminated
DOMS compared with the
Values are mean 6 SEM.
HR = heart rate; HRR = heart rate reserve.
absence of treatment, i.e., lower
HR in control groups. The
discernible difference between
mean DOMS in experimental
and control groups confirmed
DOMS induced by resistance exercises performed in the the hypothesized effect of the treatment, i.e., reduction and
preceding exercise session(s), the blockage of new DOMS elimination of DOMS.
formation in preceding exercise session(s), or both. The This study differs from previous investigations of DOMS,
experimental design of this study did not distinguish among however, in at least five respects. First, DOMS has been
these alternatives. evaluated typically in untrained subjects, because uncondi-
The design of this study also did not distinguish between tioned muscles are more susceptible to DOMS. In contrast,
the effects on DOMS of elevated HR before versus during we examined DOMS in trained athletes. Although the
resistance exercise. Experimental subjects warmed up longer athletes were well conditioned for their respective sports, they
to enable them to sustain an elevated HR during subsequent generally had not participated in resistance training programs
resistance training (see Methods), which could have reduced in the recent past (see Methods); therefore, they had not
DOMS in comparison with control groups. This interpreta- acquired specific protection against DOMS from the repeated
tion seems unlikely, however, because DOMS is not bout effect. The specificity principle (1) implies that these
diminished by a warm-up (23,52), although other negative athletes would be expected to experience DOMS in muscles
effects of eccentric exercise may be partially alleviated (52). unaccustomed to resistance exercise, which was confirmed in
Aerobic exercise alone was not responsible for the reduction averaged data.
of DOMS in experimental subjects because the intensity and Second, the majority of studies on DOMS have employed
volume of aerobic exercise performed in each workout was maximal or supramaximal (.1RM weight) eccentric con-
the same for experimental and control groups. We conclude traction to induce maximal muscle injury. In contrast, DOMS
that elevated HR immediately before and during resistance was induced in the present study in both experimental and
training in experimental subjects, and not the longer warm- control groups by the same submaximal resistance exercises,
up, caused the accelerated reduction and elimination of which contained concentric and eccentric components
DOMS in experimental but not control groups. equally. The eccentric loading was therefore physiologic
The experimental design of this study required subjects to and equivalent for the experimental and control groups.
assess cumulative DOMS in muscle groups as they were Accordingly, although the DOMS in the present study was
employed in each resistance exercise and to record DOMS physiologically more realistic, it was also substantially smaller.
immediately after the final (third) set, when their HR was still
elevated from pre-resistance cardioacceleration (see Meth-
ods). It is therefore possible that exercise-induced analgesia
(25,31), mediated perhaps by elevated blood pressure (32), TABLE 4. Self-reported non–delayed-onset muscle
contributed to the reduction of self-reported DOMS in soreness pain per exercise session during resistance
experimental subjects. This interpretation seems unlikely, training averaged among all nine resistance exercises
however, because experimental subjects evaluated and self- and all exercise sessions.
reported DOMS while their HR was only marginally above Gender Experimental Control
the threshold for exercise-induced analgesia (50% of
_ 2max) (25). Moreover, unlike other forms of pain, DOMS
Vo Male 0.09 6 0.19 0.06 6 0.17
seems to be undiminished by exercise-induced analgesia (14). Female 0.57 6 0.15 0.59 6 0.20
The design of this study conforms to the model generally Values are mean 6 SEM.
used in previous controlled studies of DOMS. Groups of
subjects, i.e., men in the first experiment and women in the

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Eliminating Delayed-Onset Muscle Soreness

TABLE 5. Self-reported Rating of Perceived Exertion TABLE 7. Compliance with exercise sessions.
summed among all individual resistance exercises
and all exercise sessions. Gender Experimental Control

Gender Experimental Control Male 76.62 6 3.38 83.24 6 4.35

Female 81.92 6 2.97 84.58 6 2.63
Male 5.43 6 0.10 5.57 6 0.12
Female 5.09 6 0.09 5.11 6 0.11 Values are mean 6 SEM and are expressed as
percentages.
Values are mean 6 SEM.

This much longer time series (Figure 4) revealed that mean

Based on previous studies, it seems likely that DOMS in the cumulative DOMS rose initially and then declined steadily in
present study was induced primarily by the eccentric com- control groups over a few weeks to approximately half the
ponent of the resistance exercises. The design of the present maximum, which then persisted for the remainder of the
experiments did not, however, enable distinction between training program. The initial decline of cumulative DOMS in
eccentric and potential concentric contributions to DOMS. control groups may be attributed to the repeated bout effect,
The impact of elevated HR on the much greater muscle injury which presumably also contributed to the decline of DOMS
and DOMS induced by less physiologic maximal eccentric in experimental groups. Evaluation of data recorded during
contraction was not addressed in this study. training from individual subjects showed that many control
Third, most studies on DOMS have examined one or at subjects ceased experiencing DOMS within 2–3 weeks after
most a few muscles, typically elbow flexors (biceps brachii) or training began, presumably reflecting the protection against
knee extensors (vastus lateralis). In contrast, we examined all DOMS that is afforded by the repeated bout effect. The
major muscle groups used in nine conventional lower and persistence of mean DOMS in control groups resulted
upper body resistance exercises. The results show that from sustained DOMS in a sizeable minority of DOMS-
DOMS affects both upper and lower body musculature and susceptible individuals. The disappearance of DOMS in
that pre-resistance cardioacceleration reduces DOMS in experimental groups resulted from the elimination of DOMS
both. Retroactive (post hoc) comparisons showed that mean in DOMS-susceptible individuals. The design of the present
DOMS in lower body musculature exceeded mean DOMS in study provided no insight, however, into the reasons for the
upper body musculature discernibly after 1RM testing (Figure 2). differences in susceptibility of individual subjects to DOMS,
During training, mean DOMS in experimental groups also which remains to be investigated.
seemed greater in lower body musculature (Figure 3a, b), but Fifth, most studies of DOMS have used either men or
mean DOMS in control subjects seemed similar in lower and women as subjects, preventing evaluation of gender effects. In
upper body musculature (Figure 3). Evidence obtained herein contrast, we studied both male and female subjects in separate
for differential lower versus upper body DOMS is therefore but identical experiments and observed significant similarities
inconclusive. in results (Figures 2–4a, b). In particular, the time course of
Fourth, most studies on DOMS have evaluated muscle DOMS reduction in control groups, and the magnitude and
soreness during the 72-hour period immediately after time course of DOMS reduction and elimination in experi-
eccentric contraction, when DOMS presents with greatest mental groups, were similar in both genders (Figure 4a, b).
intensity. In contrast, we measured cumulative DOMS over Remaining comparisons between genders in the present
several weeks during a vigorous concurrent training program. study may be of limited validity because women used less
relative weight initially during resistance training and trained
for 2 weeks longer. Women nonetheless reported twice the
DOMS per muscle group of men after pre-training 1RM
trials (Figure 2) and half the DOMS of men per workout
TABLE 6. Water consumption during exercise during the several-week training program (Figures 3 and 4).
sessions. These findings are consistent with the conclusion of other
Gender Experimental Control investigators (13) that the outcome of gender comparisons
varies with the method of inducing and measuring DOMS.
Male 1.29 6 0.09 1.21 6 0.12 The present study demonstrates rapid reduction and
Female 1.19 6 0.12 0.96 6 0.12 elimination of DOMS caused by aerobically elevating HR
Values are mean 6 SEM and are expressed as liters. immediately before each set of resistance exercises but does
not address directly the proximate biological causes of
DOMS suppression. The time course of DOMS’ decline
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and disappearance in experimental subjects during training exercises now act on an expanding peripheral vascular bed in
nonetheless provides empirical constraints on models of the skeletal muscles to further enhance muscle perfusion (59),
underlying physiological mechanisms. The rapid initial deliver nutrients and other substances and clear waste and
reduction of DOMS in experimental groups compared with injury products faster, repair the cytoskeleton and sarco-
control groups in both genders (Figure 4) is congruent with lemma more rapidly, restore the metabolic and contractile
the rapid dynamics of increased membrane flux that is machinery, and reduce inflammation, eliminating DOMS
presumably induced in skeletal muscle by the higher cardiac within a period of 4 weeks.
output and greater systolic blood pressure caused by pre- This hypothetical two-stage model is based on the probable
resistance aerobic cardioacceleration (1). The slower disap- causes of DOMS (see Introduction) combined with the
pearance of DOMS by the end of the fourth week in documented responses of muscle to exercise. The model
experimental subjects compared with control subjects in both accounts for all features of the reduction and elimination of
genders (Figure 4), however, suggests a different mechanism DOMS by aerobic elevation of HR before each set of
with a longer time constant, e.g., exercise-induced vascular- resistance exercises observed in experimental groups in the
ization of skeletal muscle. present study. The time course of the reduction in DOMS
Increased muscle capillarization after exercise training is from the repeated bout effect in control subjects was similar to
induced by both resistance and aerobic exercise (4,21,26,35). the attenuation of DOMS in experimental subjects (Figure 4),
High-intensity intermittent endurance training increases the suggesting that this two-stage model could operate in parallel
ratio of capillaries to muscle fibers in 4 weeks (26), similar to with or through the mechanism(s) of the repeated bout effect
the time to disappearance of DOMS in experimental subjects to enhance protection against eccentric contraction injury.
in the present study. Concurrent strength and endurance The proposed model can be readily tested using cardioaccel-
training (but not strength or endurance training separately) eration to regulate DOMS as the independent variable and
significantly increased vascularization in the vastus lateralis physiological, biochemical, and ultrastructural measures as
muscle after 12 weeks of training (4), suggesting that dependent variables.
concurrent training accelerates muscle vascularization dispro-
portionately. The increased capillarization of leg muscle PRACTICAL APPLICATIONS
(tibialis anterior) in response to exercise is similar in men and This study has two practical applications. First, it utilizes
women (50), consistent with the similar time course of DOMS a new method of progression during resistance training,
reduction and elimination observed in our male and female which optimizes exertion (RPE) and minimizes pain (RPP)
experimental groups (Figure 4). The known properties and during sets of resistance exercises. This method promotes the
time course of muscle angiogenesis in response to a strong fastest possible advances in training adaptations consistent
exercise stimulus are therefore congruent with the dynamics with balancing the two competing goals of exercise programs:
of long-term DOMS reduction and disappearance observed in maximizing effects and minimizing the risk of injury or
experimental groups of both genders in the present study. overtraining. The training protocols used in this study were
We propose the following hypothetical two-stage model to designed to increase general strength and endurance by
account for the reduction and elimination of DOMS caused combining medium weight, repetitions, and velocity with
by elevated HR during resistance exercises in experimental strong exertion. The method of progression used herein can
subjects. In the first (early) stage, aerobic elevation of HR be adapted, however, to specialized training purposes such as
immediately before each set of resistance exercises increases athletic strength and power conditioning or patient re-
the flow of blood to skeletal muscle, enhancing muscle habilitation by raising or lowering, respectively, the RPE
perfusion during resistance exercises (35,57), which accel- threshold for progression.
erates lactate/H+ release from stressed muscle (27,28) and re- Second, this study documents a new training protocol,
supplies nutrients such as glucose/glycogen and other integrated concurrent exercise (15), which rapidly eliminates
substances more rapidly. In this first stage, therefore, the DOMS. The rapid attenuation of DOMS during integrated
increased muscle perfusion induced by pre-resistance concurrent training implies faster recovery of skeletal muscle
cardioacceleration retards cellular destruction induced by after a strong exercise stimulus, which should support more
eccentric contraction and/or accelerates tissue repair, limit- frequent training and faster progression during all high-
ing muscle inflammation and therefore reducing DOMS in intensity training modes, including endurance, strength,
the first few workouts. power, and agility. Even when DOMS is not an issue in a
In the second (late) stage of this hypothetical model, training program, integrated concurrent training would be
continued aerobic elevation of HR immediately before each expected to support faster development. The present experi-
set of resistance exercises during integrated concurrent ments entailed vigorous training with well-conditioned
training stimulates longer-term angiogenesis, accelerating athletes, but integrated concurrent exercise may also reduce
the capillarization of skeletal muscle. The increased HR, DOMS in medium- and low-intensity training applications
cardiac output, and systolic blood pressure induced by with recreational exercisers, the elderly, and rehabilitating
continuing cardioacceleration before each set of resistance patients. In this case, the prescription of integrated

VOLUME 22 | NUMBER 1 | JANUARY 2008 | 223

Eliminating Delayed-Onset Muscle Soreness

concurrent exercise could help to eliminate a demonstrated 7. Borg, G. G. Borg’s Perceived Exertion and Pain Scale. Champaign, IL:
barrier to exercise initiation, adherence, and progression at all Human Kinetics, 1998.
levels and ages and could have potential clinical applications. 8. Boyle, CA, Sayers, SP, Jensen, BE, Headley, SA, and Manos, TM.
The effects of yoga training and a single bout of yoga on delayed
onset muscle soreness in the lower extremity. J Strength Cond Res 18:
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Biological Sciences and the Office of Physical Education,
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