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Riasati et al.: Aspirin and delayed onset muscle soreness
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ORIGINAL PAPER (ARTIGO ORIGINAL)
ASPIRIN MAY BE AN EFFECTIVE
TREATMENT FOR EXERCISEINDUCED MUSCLE SORENESS
Sahar Riasati1; Mehrzad Moghadasi1; Ahmad Torkfar1; Rahim Shirazinejad1; Hamid Arvin1
1
Department of Exercise physiology, Islamic Azad University, Shiraz branch, Iran.
Submitted for publication: Jun 2010
Accepted for publication: Aug 2010
ABSTRACT
RIASATI, S.; MOGHADASI, M.; TORKFAR, A.; SHIRAZINEJAD, R.; ARVIN, H. Aspirin may be an effective
treatment for exercise-induced muscle soreness. Brazilian Journal of Biomotricity, v. 4, n. 3, p. 206-213,
2010. Delayed onset muscle soreness (DOMS) refers to the skeletal muscle pain that is experienced
following eccentric exercise. The aim of the present study was to examine the effect of aspirin
supplementation on DOMS after an eccentric exercise. Sixteen healthy female [age, 21.05 ± 3.7 years; body
mass index (BMI), 24.03 ± 0.8 kg/m2; (mean ± SD)] participated as subjects in this study. The subjects were
assigned to either an experimental (200 mg of aspirin; n=8) or a placebo group (Same dosage of lactose;
n=8) using a double-blind research design. Knee range of motion (ROM), perceived pain, thigh
circumference and serum activity of the enzyme creatine kinase (CK) were taken before, immediately, 24
and 48 hours after the eccentric exercise. No differences among groups were observed for thigh
circumference and ROM before, immediately, 24 and 48 hours after the eccentric exercise. Serum CK levels
and pain increased (P<0.05) in the both groups immediately after the eccentric exercise and increased to
maximum at 48 hours after the eccentric exercise. The aspirin supplementation decreased (P<0.05) the
serum CK levels and pain compare to the placebo group at 24 and 48 hours after the eccentric exercise. In
conclusion, aspirin supplementation can be effective to minimize DOMS induced by eccentric exercise.
Key words: Delayed onset muscle soreness, Aspirin, Creatine kinase.
INTRODUCTION
DOMS is the sensation of muscular discomfort and pain during active contractions that
occurs in a delayed fashion after strenuous exercise (BYRNES and CLARKSON, 1986).
Subjects with DOMS have painful, tender, and swollen muscles with reduced range of
motion of adjacent joints especially after unaccustomed exercise (BARLAS et al., 2000;
LIEBER and FRIDEN, 2002). In addition to muscle tenderness with palpation, prolonged
strength loss and a reduced range of motion are observed (MERO et al., 2010). These
symptoms develop 24 to 48 hours after exercise, and they disappear within 5 to 7 days
Brazilian Journal of Biomotricity, v. 4, n. 3, p. 206-213, 2010 (ISSN 1981-6324)
Corresponding author:
Mehrzad Moghadasi (PhD)
Assistant Professor in Exercise Physiology,
Department of Exercise Physiology, Islamic Azad University, Shiraz branch, Iran
Tel: +98-711-2342025 or +98 9177320043,
Fax: +98-711-2334496
PO BOX: 71365-364
E-mail: [email protected]
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Riasati et al.: Aspirin and delayed onset muscle soreness
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(BARLAS et al., 2000; LIEBER and FRIDEN, 2002). The pathophysiology of DOMS
remains still undetermined, but it has been reported that after strenuous exercise muscle
cell damage and inflammatory cells are observed in damaged muscle (CHEUNG et al.,
2003).
Although DOMS is not a serious condition and can be prevented by prior training
(BYRNES et al., 1985), it may discourage further participation in exercise, and it is
possible that muscle injury may result if heavy exercise is performed during the period of
muscle weakness. No simple effective treatment is as yet available for DOMS. There is
some evidence that DOMS may result from an inflammatory process which occurs in the
muscle after exercise (HIKIDA et al., 1983; STAUBER et al., 1988). If this is the case, then
it is possible that anti-inflammatory drugs may be effective in reducing DOMS and muscle
damage; while, the majority of studies have found anti-inflammatory drugs such as
ibuprofen (DONNELLY et al., 1990), prednisilone (HEADLEY et al., 1985), diclofenac
(DONNELLY et al., 1988) and flurbiprofen (KUIPERS et al., 1985) to be ineffective in
reducing DOMS. By our knowledge, attempts to determine aspirin effects on DOMS are
very little. Aspirin (acetylsalicylic acid) is an over-the-counter non-steroidal antiinflammatory drug now commonly used in the treatment of soft-tissue injuries (HERTEL,
1997). The aim of the study was to test the effects of aspirin on muscle soreness, muscle
damage inferred from plasma enzyme activity changes and pain.
MATERIALS AND METHODS
Sixteen healthy female with a mean (±SD) body mass index of 24.03 ± 0.8 kg/m2,
volunteered to participate in this study. The subjects were given both verbal and written
instructions outlining the experimental procedure, and written informed consent was
obtained. The study was approved by the Islamic Azad University Ethics Committee. The
subjects were assigned to either an experimental (200 mg of aspirin; n=8) or a placebo
group (Same dosage of lactose; n=8) using a double-blind research design. The subjects
took 200 mg aspirin or placebo capsules immediately after an eccentric exercise. Both
supplements were powders and powders were scaled and packed ready for the subjects in
1.5 ml Eppendorf tubes.
Anthropometric and body composition
Height, weight and lower leg length were measured, and body mass index (BMI) was
calculated by dividing weight (kg) by height (m2). Thigh circumference was measured by
using a Gulick anthropometric tape in the standing position. The tape was placed
horizontally around the calf at the level of maximal circumference in a plane perpendicular
to the long axis of the calf (MAUD and FOSTER, 2006).
Body composition was assessed via 3-site skinfold (triceps, suprailiac, and thigh) using
Harpendon skinfold calipers (Harpenden, HSK-BI, British Indicators, West Sussex, UK).
Body density was calculated from three-site skinfold using the Jackson and Pollock equation
and percent body fat was calculated using the Siri equation (ACSM, 2005).
Range of motion (ROM)
Knee ROM was determined in the supine position, with the knee in full extension by using
a Jamar goniometer. The stationary arm of the goniometer was aligned with the lateral
midline of the thigh, using the greater trochanter as a reference point. The fulcrum was
placed over the lateral epicondyle of the femur. The moving arm was aligned with the
lateral of the fibula, using the lateral malleolus as a reference point. Knee flexion was
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Subjects
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recorded as the movement of the lower leg from the neutral position to a position in which
the lower leg and heel are maximally drawn toward the buttocks (MAUD and FOSTER,
2006).
Eccentric exercise training
Subjects stepped up on a bench set at 110% of their lower leg length. Exercise was
continued for 10 minutes at a rate of one step per second. The order of steps was right leg
up, left leg up, left leg down, right leg down. This regimen causes greatest soreness in the
right thigh and left calf. If the subject failed to complete the exercise test, this was
recorded.
Nutrition
Before the beginning of the study, each subject was supervised to continue his normal
sport nutrition program. On the testing day the subjects were supervised not to use any
sport or dietary supplements. They were supervised also to keep food diaries for seven
days in the 2-week period for what they were provided with specific verbal and written
instructions and procedures for reporting detailed dietary intake, including how to record
portions by using household measures, exact brand names and preparation techniques.
The nutrient composition was determined by a computer nutritional analysis program
(COMP-EAT 4.0 National Analysis System, London, UK) using the McCance and
Widdowson Food Composition Tables (PAUL and SOUTHGATE, 1978).
Blood samples were taken from an antecubital vein in the sitting position. Ten milliliters
blood from a vein was taken pre- and post-exercise, and at 24 and 48 hours after the
eccentric exercise. Serum was separated and frozen at -200C prior to analysis. CK was
measured on a Technicon RA 1000 (Technicon Ltd, Basingstoke, UK) random access
analyser, using a Technicon test kit.
Score of muscle soreness and pain
After the bench stepping exercise, each subject was given an outcome form, which they
were asked to complete at specified times, immediately, 24 and 48 hours after exercise.
The outcome form consisted of a Likert scale as described by High et al (Figure 1). The
outcome was the mean score of soreness and pain over the tree period.
Please tick the sentence below that best describes your level of muscle soreness over the past 12
hours.
[ ] o A complete absence of soreness
[ ] 1 A light pain felt only when touched/a vague ache
[ ] 2 A moderate pain felt only when touched/a slight persistent pain
[ ] 3 A light pain when walking up or down stairs
[ ] 4 A light pain when walking on a flat surface/painful
[ ] 5 A moderate pain, stiffness or weakness when walking/very painful
[ ] 6 A severe pain that limits my ability to move
Figure 1 - Likert scale of muscle soreness (taken from High et al. 1989).
Statistical analysis
Results were expressed as the mean ± SD and distributions of all variables were assessed
for normality. 2 × 4 repeated measures of ANOVA test was used to evaluate time-course
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Blood sampling
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change in variables. Post hoc analyses (Bonferroni) were then performed when warranted.
The level of significance in all statistical analyses was set at P≤0.05. Data analysis was
performed using SPSS software for windows (version 13, SPSS, Inc., Chicago, IL).
RESULTS
Table 1 - Physical and physiological characteristics (mean ± SD) of the subjects
Aspirin
Placebo
Age (yr)
20.9 ± 3.8
21.2 ± 3.6
Height (cm)
168.2 ± 8.3
165.08 ± 10.1
Body weight (kg)
68.3 ± 6.05
64.9 ± 6.3
24.11 ± 0.6
23.86 ± 0.8
BMI (kg/m2)
Body fat (%)
20.2 ± 4.1
21.7 ± 3.4
Table 2 - Thigh circumference and knee ROM (mean ± SD)
Post-
24h after
48h after
exercise
exercise
exercise
51 ± 3.8
51.7 ± 4
51.1 ± 3.1
51.1 ± 3.8
Left leg
51.1 ± 3.3
53.2 ± 2.9
53.3 ± 2.6
53.3 ± 2.4
Right leg
50.2 ± 3.06
50.9 ± 3.3
50.2 ± 3.06
50.28 ± 3.08
Left leg
5.3 ± 3.07
51 ± 3.02
51 ± 2.8
51.6 ± 2.6
Right leg
143.8 ± 7.3
143.7 ± 7.3
139.6 ± 8.3
140.1 ± 8.2
Left leg
144.5 ± 7.07
144.8 ± 6.7
144.2 ± 5.6
144.6 ± 5.4
Right leg
143 ± 4.7
142.5 ± 4.6
141.2 ± 5.8
141.8 ± 4.5
Left leg
145 ± 5.08
145.1 ± 4.9
145.6 ± 4.6
145.1 ± 5.2
Pre-exercise
Thigh
Placebo
circumference
(cm)
Aspirin
Placebo
o
Knee ROM ( )
Aspirin
Right leg
Brazilian Journal of Biomotricity, v. 4, n. 3, p. 206-213, 2010 (ISSN 1981-6324)
Physical and physiological characteristics of the subjects are presented in Table 1. No
significant differences in any of variables were observed among the two groups. The Thigh
circumference and knee ROM before and after the eccentric exercise are presented in
Table 2. The results showed that the thigh circumference and knee ROM had not
significant change before and after the eccentric exercise and no significant differences
were observed among the two groups. Serum activities of CK increased after the eccentric
exercise in the both groups (P<0.05). The results showed that the serum CK levels
increased in the both groups immediately after the eccentric exercise and increased to
maximum at 48 hours after the eccentric exercise (P<0.05; Figure 2). The aspirin
supplementation decreased (P<0.05) the serum CK levels compare to the placebo group
at 24 and 48 hours after the eccentric exercise. The results showed that the mean score of
muscle soreness and pain decreased (P<0.05) in the experimental group compare to the
placebo group at 24 and 48 hours after the eccentric exercise (Table 3).
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†
Placebo
Serum CK activity (U/l)
Aspirin
170
†
140
†
†*
110
†*
80
†
50
Pre exercise
0
24
48
Time (h)
Figure 2 - Serum CK levels pre- and post-exercise, and at 24 and 48 hours after the eccentric
exercise. Serum CK concentrations 24 and 48 hours after the eccentric exercise were significantly
greater in the placebo group than the aspirin group (P<0.05). * P<0.05 for between-group
differences; † P<0.05, pre exercise vs. post, 24h and 48h after exercise values.
Table 3 - Muscle soreness and pain (mean ± SD) of the subjects
Post-exercise
0.2 ± 0.3
0.2 ± 0.4
2 ± 0.5†
1.6 ± 0.5†
24 h after
exercise
3.6 ± 0.5†
2.3 ± 0.5*†
48 h after
exercise
4.7 ± 1.04†
2.8 ± 0.6*†
* P<0.05 for between-group differences; † P<0.05, pre exercise vs. post, 24h and 48h after exercise values
DISCUSSION
Exercise that results in the development of soreness is associated with the rapid
destruction of muscle tissue (FRIDEN et al., 1983). DOMS is a familiar experience for the
elite or novice athlete. Eccentric activities induce micro-injury at a greater frequency and
severity than other types of muscle actions (BYRNES and CLARKSON, 1986). Up to six
hypothesized theories have been proposed for the mechanism of DOMS, namely: lactic
acid, muscle spasm, connective tissue damage, muscle damage, enzyme efflux and the
inflammation theories (CHEUNG et al., 2003). The inflammation mechanism is not as well
understood, but free radical initiated damage or release of pro-inflammatory substances
has been implicated. The tissue injury appears to initiate an inflammatory response
resulting in a release of cytokines, localized edema due to the migration of monocytes,
macrophages, PGE2, histamines, etc., and increased blood flow and tissue permeability.
The increase in edema and release of the prostaglandins and histamine may contribute to
the pain sensation. The next series of events is the formation of proteases,
phospholipases, and free radicals, which may lead to additional muscle tissue breakdown
and pain. The last stage of events may result in a protective remodeling of the muscle to
prevent muscle soreness with repeated or subsequent exercise (ARMSTRONG, 1990;
CLARKSON and NEWMAN, 1995; MACINTYRE et al., 1995). Therefore, the inflammatory
response may be responsible for the initiation, amplification, and/or resolution of the
skeletal muscle injury.
A number of treatment strategies have been introduced to help alleviate the severity of
DOMS and to restore the maximal function of the muscles as rapidly as possible. Non-
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Placebo
Aspirin
Pre-exercise
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steroidal anti-inflammatory drugs have demonstrated dosage-dependent effects that may
also be influenced by the time of administration (CHEUNG et al., 2003). Aspirin is in a
group of drugs called salicylates and it is used to treat mild to moderate pain, and also to
reduce fever or inflammation (HERTEL, 1997). It is evident from the results of this study
that aspirin at this dosage is effective in ameliorating DOMS after the eccentric exercise.
Hamberg found that therapeutic doses of indomethacin, aspirin and sodium salicylate do
suppress prostaglandin synthesis. Bansil et al reported that aspirin (3g/d) delayed the
appearance of DOMS by 12 to 24 hours. Francis and Hoobler, also, found aspirin effective
in inhibiting prostaglandin synthesis and release. Aspirin blocks the synthesis of all proinflammatory prostaglandins and anti-inflammatory prostaglandins. As Taussig reports,
aspirin inhibits all pro-inflammatory prostaglandin biosynthesis.
CK has commonly been used as an indicator of muscle injury (SORICHTER et al., 1999).
The results showed that the serum CK levels increased in the both groups immediately
after the eccentric exercise and increased to maximum at 48 hours after the eccentric
exercise. The aspirin supplementation decreased (P<0.05) the serum CK levels compare
to the placebo group at 24 and 48 hours after the eccentric exercise. On the other hand,
the mean score of muscle soreness and pain decreased (P<0.05) in the experimental
group compare to the placebo group at 24 and 48 hours after the eccentric exercise. Thus
it seems that the aspirin supplementation may effective in decrease the serum CK levels
and muscle soreness and pain.
Eccentric exercise has been shown to produce muscle cellular damage and decrements in
motor performance as well. These findings suggested that aspirin supplementation may
effective treatment for DOMS and exercise induced muscle soreness.
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AUTHORS BIOGRAPHY
Name: Sahar Riasati
Employment: Department of Exercise Physiology, Islamic Azad University,
Shiraz branch, Iran.
Degree: Master of science.
Research interests: Metabolism and biochemistry.
Email: [email protected]
Name: Mehrzad Moghadasi
Employment: Assistant Professor in Exercise Physiology, Department of Exercise
Physiology, Islamic Azad University, Shiraz branch, Iran.
Research interests: Metabolism and biochemistry, Nutrition and health
promotion.
Email: [email protected]
Name: Ahmad Torkfar
Sport Management, Islamic Azad University, Shiraz branch, Iran.
Research interests: Sport Marketing, Sport Curriculum and Healthy.
Email: [email protected]
Name: Rahim Shirazinejad
Employment: Islamic Azad University, Shiraz branch, Iran.
Degree: Master of science.
Research interests: Sport Marketing, Coaching.
Email: [email protected]
Name: Hamid Arvin
Employment: Department of Exercise Physiology, Islamic Azad University, Shiraz
branch, Iran.
Degree: Master of science.
Research interests: Metabolism and biochemistry.
Email: [email protected]
Brazilian Journal of Biomotricity, v. 4, n. 3, p. 206-213, 2010 (ISSN 1981-6324)
Employment: Assistant Professor in Sport Management; Department of
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