The effect of medical grade compression garments on the repeated-bout effect in non-resistance-trained men.

NEW FINDINGS: What is the central question of this study? What are the effects of compression garments on recovery from unaccustomed damaging exercise and subsequent protective adaptations? What is the main finding and its importance? Compression did not influence recovery, but was associated with blunted protective adaptations for isokinetic performance, which were completely absent at high velocities. Based on these findings, the use of compression garments for recovery would not be recommended following unaccustomed exercise, particularly if the maintenance of high-velocity performance following exercise-induced muscle damage is desirable. ABSTRACT: Whilst compression garments (CG) may enhance recovery from exercise-induced muscle damage (EIMD), many recovery strategies can attenuate adaptative responses. Therefore, the effects of CG on recovery from EIMD, and the rapid protective adaptations known as the repeated bout effect (RBE) were investigated. Thirty-four non-resistance-trained males (18-45 years) randomly received class II medical-grade CG or placebo for 72 h following eccentrically-focused lower-body exercise, in a double-blind, randomised controlled trial. Indices of EIMD were assessed at baseline, 0, 24, 48 and 72 h post-exercise, before exercise and testing were repeated after 14 days. Results were analysed using a three-way (time × condition × bout) linear mixed-effects model. Exercise impaired isometric and isokinetic strength, with soreness and thigh circumference elevated for 72 h (P < 0.001). Compression did not enhance recovery (P > 0.05), despite small to moderate effect sizes (ES, reported alongside 90% confidence intervals) for isokinetic strength (ES from 0.2 [-0.41, 0.82] to 0.65 [0.03, 1.28]). All variables recovered faster after the repeated bout (P < 0.005). However, RBE for peak isokinetic force was impaired in CG at 60° s-1 (group × bout interaction: χ2  = 4.24, P = 0.0395; ES = -0.56 [-1.18, 0.07]) and completely absent at 120° s-1 (χ2  = 16.2, P < 0.001, ES = -0.96 [-1.61, -0.32]) and 180° s-1 (χ2  = 10.4, P = 0.001, ES = -0.72 [-1.35, -0.09]). Compression blunted RBE at higher isokinetic velocities without improving recovery in non-resistance-trained males, potentially contraindicating their use following unaccustomed exercise in this population.

Detrimental effects on executive function and mood following consecutive days of repeated high-intensity sprint interval exercise in trained male sports players.

Intensified periods of competition are common in many team sports, potentially leading to increased fatigue and reduced performance. The purpose of this study was to investigate the effect of repeated high-intensity sprint interval exercise on cognitive function, mood and perceptions of energy and fatigue. Twenty-four trained rugby players completed multiple bouts of repeated sprints across two consecutive days. Prior to and following each set of maximal effort sprints or equivalent control duration, a battery of cognitive tasks assessing simple and choice reaction time, visuo-spatial working memory and inhibition were completed as well as visual analogue scales that assessed mood, energy, and fatigue. Accuracy of incongruent Stroop responses was significantly lower across day 2 compared to day 1 and the control condition. Four-choice reaction time was slower across day 2 whilst feelings of alertness, contentedness, and physical and mental energy were reduced while ratings of physical and mental fatigue increased. These findings suggest that intensified periods of high-intensity sprint interval exercise have detrimental effects on executive function, mood and perceptions of physical and mental energy, and fatigue. These deleterious effects have the potential to impact performance and may increase the propensity for injury/accidents in certain sporting and non-sporting contexts.

Custom-Fitted Compression Garments Enhance Recovery From Muscle Damage in Rugby Players.

ABSTRACT: Brown, F, Jeffries, O, Gissane, C, Howatson, G, van Someren, K, Pedlar, C, Myers, T, and Hill, JA. Custom-fitted compression garments enhance recovery from muscle damage in rugby players. J Strength Cond Res 36(1): 212-219, 2022-to evaluate the effects of custom-fitted compression garments (CG) on recovery from muscle damage in rugby players. Forty-five players were tested for lower-body strength, power, and indices of muscle damage before completing a damaging protocol (20 × 20-m sprints with 5-m deceleration, 100 drop jumps). Players were randomly assigned to wear either custom-fitted (CF, n = 13), or standard-sized CG (SSG, n = 16), or to receive sham ultrasound therapy (CON, n = 16) immediately after exercise. Players were retested immediately, then after 24 and 48 hours. Strength recovery was significantly different between groups (F = 2.7, p = 0.02), with only CF recovering to baseline values by 48 hours (p = 0.973). Time × condition effects were also apparent for creatine kinase activity (χ2 = 30.4, p < 0.001) and midthigh girth (F = 3.7, p = 0.005), with faster recovery apparent in CF compared with both CON and SSG (p < 0.05). Custom-fitted CG improved strength recovery and indices of muscle damage in rugby players, compared with controls and standard-sized garments. Athletes and coaches would be advised to use appropriately fitted CG to enhance strength recovery after damaging exercise.

Total body skeletal muscle mass estimated by magnetic resonance imaging and creatine (methyl-d3 ) dilution in athletes.

Creatine dilution (D3 -cr) is a technique for estimating total skeletal muscle mass (SMM) with practical utility, but has not been applied in athletic populations where body composition may differ to that in the normal population. This study aimed to assess the agreement between SMM derived from both D3 -cr and that obtained from whole-body magnetic resonance imaging (MRI) in 15 male and 5 female national level kayakers (stature: 182.0 ± 13.1 and 170.0 ± 9.0 cm; body mass: 80.6 ± 9.9 and 66.4 ± 6.0 kg; V̇O2 peak: 56.5 ± 7.0 and 49.6 ± 4.4 mL kg-1  min-1 , mean ± SD). SMM was determined following 60 mg of dosed D3 -cr and analysis of expelled urine collected on four subsequent days for creatine, creatinine, D3 -cr, and D3 -creatinine using liquid chromatography/mass spectroscopy. SMM was then estimated by assuming a creatine pool size of 4.3 g/kg. During the same time period, a whole-body MRI was undertaken to derive SMM from the analysis of multiple slices taken across the body. A strong positive correlation (F = 74.32; R = 0.90; P < .0001) between the two methods was observed, but the D3 -cr SMM was found to be significantly higher (43.3 ± 6.8 kg) when compared with MRI (36.3 ± 5.8 kg, P < .0001). However, the difference between the methods was removed when a higher intramuscular creatine pool (5.1 g/kg) was assumed. These data show that D3 -cr has potential utility in athletes, as referenced against MRI, but show that assumptions regarding creatine pool size need to be carefully considered.

Oral health and elite sport performance.

While the research base is limited, studies have consistently reported poor oral health in elite athletes since the first report from the 1968 Olympic Games. The finding is consistent both across selected samples attending dental clinics at major competitions and more representative sampling of teams and has led to calls from the International Olympic Committee for more accurate data on oral health. Poor oral health is an important issue directly as it can cause pain, negative effects on appearance and psychosocial effects on confidence and quality of life and may have long-term consequences for treatment burden. Self-reported evidence also suggests an impact on training and performance of athletes. There are many potential challenges to the oral health of athletes including nutritional, oral dehydration, exercise-induced immune suppression, lack of awareness, negative health behaviours and lack of prioritisation. However, in theory, oral diseases are preventable by simple interventions with good evidence of efficacy. The consensus statement aims to raise awareness of the issues of oral health in elite sport and recommends strategies for prevention and health promotion in addition to future research strategies.

Effects of seated and standing cold water immersion on recovery from repeated sprinting.

This study investigated the effects of two different hydrostatic pressures (seated or standing) during cold water immersion at attenuating the deleterious effects of strenuous exercise on indices of damage and recovery. Twenty four male well-trained games players (age 23 ± 3 years; body mass 81.4 ± 8.7 kg: [Formula: see text]O2max 57.5 ± 4.9 ml∙kg(-1)∙min(-1)) completed the Loughborough Intermittent Shuttle Test (LIST) and were randomly assigned to either a control, seated cold water immersion or a standing cold water immersion (14 min at 14°C). Maximal isometric voluntary contraction, counter-movement jump, creatine kinase, C-reactive protein, interleukin-6 and delayed onset muscle soreness (DOMS) were measured before and up to 72 h following the LIST. All dependent variables showed main effects for time (P < 0.05) following the LIST, indicating physiological stress and muscle damage following the exercise. There were no significant group differences between control and either of the cold water immersion interventions. Seated cold water immersion was associated with lower DOMS than standing cold water immersion (effect size = 1.86; P = 0.001). These data suggest that increasing hydrostatic pressure by standing in cold water does not provide an additional recovery benefit over seated cold water immersion, and that both seated and standing immersions have no benefit in promoting recovery following intermittent sprint exercise.

Compression garments and recovery from exercise-induced muscle damage: a meta-analysis.

The purpose of the study was to determine the effects of compression garments on recovery following damaging exercise. A systematic review and meta-analysis was conducted using studies that evaluated the efficacy of compression garments on measures of delayed onset muscle soreness (DOMS), muscular strength, muscular power and creatine kinase (CK). Studies were extracted from a literature search of online databases. Data were extracted from 12 studies, where variables were measured at baseline and at 24 or 48 or 72 h postexercise. Analysis of pooled data indicated that the use of compression garments had a moderate effect in reducing the severity of DOMS (Hedges' g=0.403, 95% CI 0.236 to 0.569, p<0.001), muscle strength (Hedges' g=0.462, 95% CI 0.221 to 0.703, p<0.001), muscle power (Hedges' g=0.487, 95% CI 0.267 to 0.707, p<0.001) and CK (Hedges' g=0.439, 95% CI 0.171 to 0.706, p<0.001). These results indicate that compression garments are effective in enhancing recovery from muscle damage.

Influence of compression garments on recovery after marathon running.

Strenuous physical activity can result in exercise-induced muscle damage. The purpose of this study was to investigate the efficacy of a lower limb compression garment in accelerating recovery from a marathon run. Twenty four subjects (female, n = 7; male, n = 17) completed a marathon run before being assigned to a treatment group or a sham treatment group. The treatment group wore lower limb compression tights for 72 hours after the marathon run, the sham treatment group received a single treatment of 15 minutes of sham ultrasound after the marathon run. Perceived muscle soreness, maximal voluntary isometric contraction (MVIC), and serum markers of creatine kinase (CK) and C-reactive protein (C-RP) were assessed before, immediately after, and 24, 48, and 72 hours after the marathon run. Perceived muscle soreness was significantly lower (p ≤ 0.05) in the compression group at 24 hours after marathon when compared with the sham group. There were no significant group effects for MVIC, CK, and C-RP (p > 0.05). The use of a lower limb compression garment improved subjective perceptions of recovery; however, there was neither a significant improvement in muscular strength nor a significant attenuation in markers of exercise-induced muscle damage and inflammation.

A mixed exercise training programme is feasible and safe and may improve quality of life and muscle strength in multiple myeloma survivors.

BACKGROUND: Exercise programmes are beneficial for cancer patients however evidence is limited in patients with multiple myeloma (MM), a cancer that is characterised by osteolytic bone disease, giving rise to high levels of bone morbidity including fractures and bone pain. METHODS: We conducted a single arm phase 2 study of an exercise programme (EP) as rehabilitation for treated MM patients, to evaluate feasibility, effects on QOL and physiological parameters. Patients were given individualised programmes, comprising stretching, aerobic and resistance exercises, carried out under supervision for 3 months then at home for a further 3 months. RESULTS: Study uptake was high, 60 of 75 (80%) patients approached consented to the study. Screen failures (11, due to fracture risk and disease relapse) and patient withdrawals (12) resulted in a final 37 patients enrolling on the programme. These 37 patients demonstrated high attendance rates in the supervised classes (87%), and high levels of adherence in home exercising (73%). Patients reported better QOL following the EP, with improvement in FACT-G and Fatigue scores over time from baseline (p<0.01 for both, one-way repeated measures ANOVA) to 6 months. Upper and lower limb strength also improved on the EP, from baseline to 6 months (p<0.01 for both). There were no adverse reactions. CONCLUSIONS: An EP in MM patients is feasible and safe, with high attendance and adherence. Benefits in QOL, fatigue and muscle strength await confirmation in randomized studies, prompting urgent evaluation of the benefits of EP in the rehabilitation of MM patients.

Effect of hot water immersion on acute physiological responses following resistance exercise.

Purpose: Hot water immersion (HWI) is a strategy theorised to enhance exercise recovery. However, the acute physiological responses to HWI following resistance exercise are yet to be determined. Methods: The effect of HWI on intramuscular temperature (IMT), muscle function, muscle soreness and blood markers of muscle cell disruption and inflammatory processes after resistance exercise was assessed. Sixteen resistance trained males performed resistance exercise, followed by either 10 min HWI at 40°C or 10 min passive recovery (PAS). Results: Post-intervention, the increase in IMT at all depths was greater for HWI compared to PAS, however this difference had disappeared by 1 h post at depths of 1 and 2 cm, and by 2 h post at a depth of 3 cm. There were no differences between groups for muscle function, muscle soreness or any blood markers. Conclusion: These results suggest that HWI is a viable means of heat therapy to support a greater IMT following resistance exercise. Recovery of muscle function and muscle soreness is independent of acute changes in IMT associated with HWI.

Effect of intensified training on cognitive function, psychological state & performance in trained cyclists.

Athletes often undertake intensified training loads prior to competition with the goal of functionally overreaching for temporary performance enhancement; however, little is known about the impact of this on cognitive function. The aim of this study was to investigate the effect of intensified training induced fatigue on cognitive function, psychological state and performance in trained cyclists. Twenty-three trained male cyclists were randomly assigned to an intensified training group or a control group for two-weeks, followed by a two-week taper period. At baseline, one-week, two-weeks and post-taper, participants undertook a series of cognitive, performance, mood and recovery-stress assessments. The training intervention significantly increased training volume, load and strain by 108%, 116% and 151% respectively. Peak and mean power output on a maximal test and time trial significantly decreased by 4.8% and 9.4% following the two-week training intervention compared to baseline, in addition to a 169% change in total mood disturbance and significant disruption to recovery-stress balance. No change in any cognitive measure was observed across the study period. Following a two-week taper, performance, mood and well-being measures returned to baseline. Two weeks of intensified training resulted in overreaching as identified by performance and psychological measures. Cognitive function was not sensitive to intensified training promoting caution with its use as a measure for the early identification of overreaching.HighlightsTwo-weeks of intensified training significantly increased training volume, load and strain eliciting a state of overreaching in trained male cyclists.Intensified training caused deteriorations in physical performance but did not influence cognitive measures.Mood and recovery-stress balance were negatively affected by intensified training but recovered back to baseline following a two-week taper at a reduced training volume.A two-week taper period following two-weeks of intensified training did not result in improved physiological measures, physical performance parameters or mood above initial baseline values highlighting the need for careful consideration over the purpose, desired outcomes and necessity of intensified training on an individualised basis.

The effect of custom-fitted compression garments worn overnight for recovery from judo training in elite athletes.

This study investigated the effects of custom-fitted compression garments (CG) worn during recovery over a multi-day training camp in elite judo players (judoka). A single blind, placebo-controlled study was carried out in 11 elite judoka, using a two-way crossover design. Two three-day training camps were completed in CG and placebo conditions in a random order. Changes in performance and physiological markers were compared between conditions. Judoka were assessed before training for (maximal) isometric knee extension and grip strength, countermovement jump performance and bench-press velocity, alongside soreness, limb circumferences, plasma creatine kinase activity (CK) and perceived bruising. Measurements were repeated after 12, 36 and 43 h of training, whereupon judoka rated the effectiveness of each intervention. Knee extension and bench-press performance demonstrated significant familiarization (p < 0.001), and were excluded from subsequent analysis. Jump performance was unaffected by training (p > 0.05). Grip strength declined throughout training (p < 0.001), with peak decrements of -9.7% indicating mild muscle damage. Increases in bruising, CK and soreness demonstrated highly variable, if significant (p < 0.001) responses. Although CG were perceived as significantly more effective than placebo for recovery (p = 0.046), no effects were observed for any other outcome (p > 0.05). Compression conferred no statistically significant impact upon recovery markers in elite judoka throughout training. Muscle damage responses were inconsistent in this population. Individual athletes would be advised to monitor habitually-used performance measures while using CG to ascertain whether perceptual benefits translate into enhanced recovery.HighlightsCompression garments were perceived as more effective for recovery than placebo by elite judoka.However, no measures of performance or muscle damage were enhanced by CG.Randori was associated with inconsistent muscle damage responses in elite judoka, while lower-body performance was not impaired.Individual athletes would be advised to monitor habitually-used performance measures while using CG to ascertain whether perceptual benefits translate into enhanced recovery.

Effect of a concentric warm-up exercise on eccentrically induced soreness and loss of function of the elbow flexor muscles.

The aim of this study was to examine the effect of concentric warm-up exercise on eccentrically induced changes in muscle strength, range of motion, and soreness of the elbow flexors. Ten resistance-exercise naive participants performed intermittent incremental eccentric actions (42 in total) of the elbow flexor muscles of each arm to induce muscle damage. The arms of each participant were randomly assigned either to a pre-eccentric exercise warm-up involving intermittent concentric exercise (warm-up) or no prior exercise (control). Strength, range of motion, and ratings of soreness were recorded before and 1, 2, 3, 4, and 7 days after exercise. Strength, range of motion, and soreness during muscular movements changed over time (P at most 0.01; Cohen's d at least 0.51, medium). There was an interaction (P < 0.001) for strength, showing a smaller reduction after exercise for warm-up than control (P < 0.001, d = 2.44, large effect). The decreased range of motion was less for warm-up than control for the arm while extended (P < 0.001), flexed (P = 0.002), and relaxed (P = 0.004). Muscle soreness was reduced for the warm-up group, while the muscle was flexed, extended, and relaxed compared with control (P < 0.001). The results demonstrate that a concentric warm-up exercise attenuates the reduction in loss of strength, range of motion, and muscle soreness after eccentric-exercise-induced muscle damage and might allow higher intensities of training to be performed.

Exercise-induced muscle damage is not attenuated by beta-hydroxy-beta-methylbutyrate and alpha-ketoisocaproic acid supplementation.

The purpose of this study was to examine the effects of combined oral beta-hydroxy-beta-methylbutyrate (HMB) and alpha-ketoisocaproic acid (KIC) supplementation on indices of exercise-induced muscle damage (EIMD) after an acute bout of eccentric-biased exercise. Fourteen male subjects were allocated to 2 groups: a placebo group (3 g.d corn flour, N = 7) or an HMB + KIC group (3 g.d HMB and 0.3 g.d KIC, N = 7). Supplementation commenced 11 days before a 40-minute bout of downhill running and continued for 3 days post-exercise. Delayed-onset muscle soreness, mid-thigh girth, knee extensor range of motion, serum creatine kinase (CK) activity, and isometric and concentric torque were assessed pre-exercise and at 24, 48, and 72 hours post-exercise. Delayed-onset muscle soreness, CK activity, and isometric and concentric torque all changed over the 72-hour period (p < 0.05); however, HMB + KIC had no significant effect on any of the indices of muscle damage. Although 14 days HMB and KIC supplementation did not attenuate indices of EIMD after an acute bout of unaccustomed eccentric-biased exercise, there was a trend for a more rapid rate of recovery in isometric and isokinetic muscle function. beta-hydroxy-beta-methylbutyrate and KIC may therefore provide limited benefit in the recovery of muscle function after EIMD in untrained subjects or after unaccustomed exercise.

Physiological monitoring of the Olympic athlete.

As the winning margin in Olympic competition is so small, there is a continuous quest for improvements in the preparation of athletes at this standard. Therefore, even the smallest physiological improvements that result from modifications in training strategy, preparation regime or ergogenic aids are potentially useful. Unfortunately, there is a lack of research data on elite competitors, which limits our interpretation of current literature to the elite sporting environment. This places extra responsibility on the physiologist to carefully consider the most appropriate physiological variables to monitor, the best protocols to assess those variables, and the accurate interpretation of the test results. In this paper, we address the key issues of ecological validity, measurement error, and interpretation for the most commonly monitored physiological variables. Where appropriate, we also indicate areas that would benefit from further research.

Assessing the usefulness of acute physiological responses following resistance exercise: sensitivity, magnitude of change, and time course of measures.

A variety of strategies exist to modulate the acute physiological responses following resistance exercise aimed at enhancing recovery and/or adaptation processes. To assess the true impact of these strategies, it is important to know the ability of different measures to detect meaningful change. We investigated the sensitivity of measures used to quantify acute physiological responses to resistance exercise and constructed a physiological profile to characterise the magnitude of change and the time course of these responses. Eight males accustomed to regular resistance exercise performed experimental sessions during a "control week", void of an exercise stimulus. The following week, termed the "exercise week", participants repeated this sequence of experimental sessions, and they also performed a bout of lower-limb resistance exercise following the baseline assessments. Assessments were conducted at baseline and at 2, 6, 24, 48, 72, and 96 h after the intervention. On the basis of the signal-to-noise ratio, the most sensitive measures were maximal voluntary isometric contraction, 20-m sprint, countermovement jump peak force, rate of force development (100-200 ms), muscle soreness, Daily Analysis Of Life Demands For Athletes part B, limb girth, matrix metalloproteinase-9, interleukin-6, creatine kinase, and high-sensitivity C-reactive protein with ratios >1.5. Clear changes in these measures following resistance exercise were determined via magnitude-based inferences. These findings highlight measures that can detect real changes in acute physiological responses following resistance exercise in trained individuals. Researchers investigating strategies to manipulate acute physiological responses for recovery and/or adaptation can use these measures, as well as the recommended sampling points, to be confident that their interventions are making a worthwhile impact.

Cold water immersion improves recovery of sprint speed following a simulated tournament.

It is a common requirement in tournament scenarios for athletes to compete multiple times in a relatively short time period, with insufficient recovery time not allowing full restoration of physical performance. This study aimed to develop a greater understanding of the physiological stress experienced by athletes in a tournament scenario, and how a commonly used recovery strategy, cold water immersion (CWI), might influence these markers. Twenty-one trained male games players (age 19 ± 2; body mass 78.0 ± 8.8 kg) were randomised into a CWI group (n = 11) or a control group (n = 10). To simulate a tournament, participants completed the Loughborough Intermittent Shuttle Test (LIST) on three occasions in five days. Recovery was assessed at specific time points using markers of sprint performance, muscle function, muscle soreness and biochemical markers of damage (creatine kinase, CK), inflammation (IL-6 and C-Reactive Protein) and oxidative stress (lipid hydroperoxides and activity of 6 lipid-soluble antioxidants). The simulated tournament was associated with perturbations in some, but not all, markers of physiological stress and recovery. Cold water immersion was associated with improved recovery of sprint speed 24 h after the final LIST (ES = 0.83 ± 0.59; p = .034) and attenuated the efflux of CK pre- and post-LIST 3 (p < .01). The tournament scenario resulted in an escalation of physiological stress that, in the main, cold water immersion was ineffective at managing. These data suggest that CWI is not harmful, and provides limited benefits in attenuating the deleterious effects experienced during tournament scenarios.

The prevention and treatment of exercise-induced muscle damage.

Exercise-induced muscle damage (EIMD) can be caused by novel or unaccustomed exercise and results in a temporary decrease in muscle force production, a rise in passive tension, increased muscle soreness and swelling, and an increase in intramuscular proteins in blood. Consequently, EIMD can have a profound effect on the ability to perform subsequent bouts of exercise and therefore adhere to an exercise training programme. A variety of interventions have been used prophylactically and/or therapeutically in an attempt to reduce the negative effects associated with EIMD. This article focuses on some of the most commonly used strategies, including nutritional and pharmacological strategies, electrical and manual therapies and exercise. Long-term supplementation with antioxidants or beta-hydroxy-beta-methylbutyrate appears to provide a prophylactic effect in reducing EIMD, as does the ingestion of protein before and following exercise. Although the administration of high-dose NSAIDs may reduce EIMD and muscle soreness, it also attenuates the adaptive processes and should therefore not be prescribed for long-term treatment of EIMD. Whilst there is some evidence that stretching and massage may reduce muscle soreness, there is little evidence indicating any performance benefits. Electrical therapies and cryotherapy offer limited effect in the treatment of EIMD; however, inconsistencies in the dose and frequency of these and other interventions may account for the lack of consensus regarding their efficacy. Both as a cause and a consequence of this, there are very few evidence-based guidelines for the application of many of these interventions. Conversely, there is unequivocal evidence that prior bouts of eccentric exercise provide a protective effect against subsequent bouts of potentially damaging exercise. Further research is warranted to elucidate the most appropriate dose and frequency of interventions to attenuate EIMD and if these interventions attenuate the adaptation process. This will both clarify the efficacy of such strategies and provide guidelines for evidence-based practice.

The Role of Intra-Session Exercise Sequence in the Interference Effect: A Systematic Review with Meta-Analysis.

BACKGROUND: There is a necessity for numerous sports to develop strength and aerobic capacity simultaneously, placing a significant demand upon the practice of effective concurrent training methods. Concurrent training requires the athlete to perform both resistance and endurance exercise within a training plan. This training paradigm has been associated with an 'interference effect', with attenuated strength adaptation in comparison to that following isolated resistance training. The effectiveness of the training programme rests on the intricacies of manipulating acute training variables, such as exercise sequence. The research, in the most part, does not provide a clarity of message as to whether intra-session exercise sequence has the potential to exacerbate or mitigate the interference effect associated with concurrent training methods. OBJECTIVE: The aim of the systematic review and meta-analysis was to assess whether intra-session concurrent exercise sequence modifies strength-based outcomes associated with the interference effect. METHODS: Ten studies were identified from a systematic review of the literature for the outcomes of lower-body dynamic and static strength, lower-body hypertrophy, maximal aerobic capacity and body fat percentage. Each study examined the effect of intra-session exercise sequence on the specified outcomes, across a prolonged (≥5 weeks) concurrent training programme in healthy adults. RESULTS: Analysis of pooled data indicated that resistance-endurance exercise sequence had a positive effect for lower-body dynamic strength, in comparison to the alternate sequence (weighted mean difference, 6.91% change; 95% confidence interval 1.96, 11.87 change; p = 0.006), with no effect of exercise sequence for lower-body muscle hypertrophy (weighted mean difference, 1.15% change; 95% confidence interval -1.56, 3.87 change; p = 0.40), lower-body static strength (weighted mean difference, -0.04% change; 95% confidence interval -3.19, 3.11 change; p = 0.98), or the remaining outcomes of maximal aerobic capacity and body fat percentage (p > 0.05). CONCLUSION: These results indicate that the practice of concurrent training with a resistance followed by an endurance exercise order is beneficial for the outcome of lower-body dynamic strength, while alternating the order of stimuli offers no benefit for training outcomes associated with the interference effect.