In the first blog in this series on recovery we discussed the key concept of the stress recovery balance and how both physical and psychological stressors play a part. In today’s blog we’ll cover something very important – planning and implementing recovery strategies. I think this is essential not only for athletes but for many non-athletic patients and even for ourselves. It’s also part of a broader issue in healthcare and in creating change; knowing what to do and doing it are not the same thing!

We want to achieve a balance between stress and recovery and maximise fitness while minimising fatigue. This isn’t just about creating a to do list of strategies for someone, it’s about giving careful consideration to how they’re implemented and overcoming common barriers.

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Planning recovery

Many athletes put a great deal of thought into maximising their training but relatively few plan their recovery in the same detail. Training is often planned in the short term (‘Microcycle’ e.g. weekly training structure), medium term (‘Mesocycle’ e.g. over the next 3 to 4 weeks) and longer term (‘Macrocycle’ e.g. the competitive season or year as a whole). We can approach recovery in a similar way;

  • Short term recovery – consider recovery strategies for each session such as cool downs, pre and post-run fuelling and modifying sleep. Plan recovery within the weekly training schedule, including where to place recovery days to manage fatigue and what to do within those days.
  • Medium term recovery – plan training and recovery over a 3 to 4 week period and beyond to ensure that training increases gradually and recovery is modified to suit this change. In essence, if you train more, recover more! This might include a planned ‘recovery week’ every fourth week where training load is reduced. This is common in endurance athletes but has also been suggested for reducing hamstring injury related to high speed running;

“Planned decreased mean high-speed running session distances in the fourth week of each mesocycle may offer the ‘balance’ between injury prevention and performance.” Duhig et al. (2016)

  • Long term recovery – periodising training across a whole year to prepare for key competitions can help optimise performance and reduce fatigue. International athletes, for example, will plan periods of altitude training, strength and conditioning, high volume/ high intensity training and tapering around their race schedules.

Planning recovery goes beyond athletes and racing. I think it’s something many of us can benefit from. Consider it yourself, are you tired? Do you get enough ‘downtime’? Could you use a little extra sleep? I know I could! Planning our time and ensuring we’re fresh and well recovered for the more challenging days in our week or more stressful weeks in our year can place us in a much better position to cope with the demands we face.

Monitoring fatigue

A key role of recovery is to reduce the fatigue associated with training. Planned recovery, as discussed above, can achieve this by including regular periods of recovery within the training programme. In addition to this proactive approach we may also need to be reactive in response to changes in fatigue and signs of performance impairment. As explained in part 1 of this series an unexplainable decrease in performance is a key indicator of overtraining syndrome.

The Rate-of-Fatigue Scale has recently been developed and validated (Micklewright et al. 2017 – Open Access) and may be a simple method to monitor fatigue levels;

Rate-of-Fatigue Scale. Micklewright et al. (2017)

There may be parallels between fatigue and pain in sport. Short term fatigue during and shortly after training is to be expected but prolonged fatigue may be a sign of excessive training or under-recovery (especially if associated with impaired performance). Likewise, pain during sport is fairly common and if it settles quickly with no lasting effects on function we’re unlikely to be concerned. Prolonged pain that continues long after activity or is associated with restrictions in sport or daily functions may warrant further assessment and treatment.

Both pain and fatigue may be influenced by the Central Nervous System as well as social, cultural, psychological and environmental factors (O’Sullivan et al. 2017). Our approach to both may include education, reduced perception of threat, modifying training load and optimising recovery. For further discussion of this see O’Sullivan et al. (2017).

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Planning and performance

Performance = fitness – fatigue

This equation is a simplification of the relationship between performance, fitness and fatigue which I believe was originally introduced Bannister and colleagues and has recently been discussed by Tim Gabbett and others. When recovery is inadequate fatigue levels are likely to be high and performance may suffer. I suspect this is the case in clinic when working with an athlete with high training load that isn’t seeing improvements in performance or strength testing or is seeing a decline in their results. Better recovery between exercise sessions may lead to reduced fatigue, increased work capacity and improved performance (Bishop et al. 2008). High training load creates many positives in terms of building fitness and the physical and psychological qualities that can lead to improved performance and reduced injury risk. It’s important though to match this training load with adequate recovery and build up to it in a way that allows enough time for adaptation.

One example of where planned recovery can improve performance is the use of a pre-race taper. During this period training volume is reduced to allow recovery but intensity is maintained to preserve performance. This helps to strike a balance between recovery and detraining. The timescale of a taper will vary, between 4 and 28 days is considered optimal and can improve performance by an estimated 0.5% to 6% (Bishop et al. 2008).

Implementing change

Creating lasting change in training and recovery behaviours is not easy. I don’t want to go all deep and profound on you but I suspect part of the human condition is that we don’t tend to follow advice! Evidence on the limited effects of education on behaviour change supports this, for example for 1 person to give up smoking we may have to advise 50 to 120 (Thornton et al. 2016).

It’s important we recognise and overcome barriers to change. In runners this may include underlying beliefs about training, especially seeing rest as having a negative influence (e.g. “rest is rust”) or the influence of attitudes of their coaches or athletes within their training group. These and other psychosocial factors may be key in training error and the development of running injury as discussed in detail here. We may need to challenge these beliefs and highlight that optimal recovery is likely to improve their performance and reduce their risk of injury.

Change often involves sacrifice and it’s important we acknowledge this and empathise with the patient. As we’ll touch upon in the next blog in this series sleep is vital for recovery. I worked with an athlete recently who typically got just 5 hours of sleep per night. He had a stressful job and a young family and his only downtime was in the evening once the kids had gone to bed. He’d stay up late to get some time to himself but be up early for a long commute. In order to sleep more he’d need to sacrifice some of this downtime. I could totally understand his reluctance to do this and empathise with him (we have a toddler!). He had a choice to make as to what his priority was and whether there were other ways to improve his recovery and gain more time to relax.

Making choices is a big part of change. We can’t make those choices for people but we can educate and empower people to make informed decisions.

Setting recovery goals and monitoring the results can really help motivate people. For example, a simple goal for sleep-deprived athlete above might be to increase his sleep to 6 hours per night and monitor changes in fatigue levels and performance. Stephen Bird advocates a 100-point weekly recovery checklist (Bird 2011). While this might prove excessive for some it could be adapted to suit the individual and it reinforces the idea that recovery isn’t something that just happens, it can be planned and optimised.

Family and social support are also especially important in training, recovery and making positive lifestyle changes. Mark Beaumont who has just broken the world record by cycling around the world in under 80 days highlighted this in a recent interview for the BBC,

“Make sure you’ve got friends, family those close to you around your ambition. No man or lady is an island… the heart of what I do is family and a great team… get people to buy into your ambition because it’ll make you so much stronger.”

What if we can’t or won’t change? There are times in our life that we can’t accomodate change. There are also patients who have very strong beliefs that may not be altered. If we can’t change behaviour (in terms of training or recovery) then we may need to alter expectations (both for us and the patient). If someone is going to continue a lifestyle of high stress (either physical or psychological) and inadequate recovery they may need to alter their expectations of the results and what they’ll be able to achieve. For example, should you expect to beat your marathon time when you’re training at a stage of your life when you’re working 80 hours a week? Should we expect pain to improve if a patient remains stressed and sleep-deprived and that drives their symptoms?

Closing thoughts: Planning of both training and recovery we can help the patient create a progressive training programme with optimal recovery that results in high levels of fitness, low levels of fatigue and peak performance. For best results do this within a multidisciplinary team and consider goals and needs of the individual as well as their injury history. Jeffreys (2005) highlighted that recovery is multidimensional, will vary between individuals and requires careful planning. Over the coming blogs in this series we’ll cover some of these key recovery strategies including sleep, nutrition, hydration and mental wellbeing. Watch this space…

Missed part 1? Catch up here