What Do Inflammation Markers After Intense Exercise Tell Us?

Team handball players are the perfect athletes to test response to intense exercise.

In a recent study in the Journal of Strength and Conditioning Research, researchers used a match of team handball to determine how much recovery high-intensity activity requires. The results of the study should be applicable to any sport that requires repeated power efforts, a high degree of mobility, and a blend of aerobic and anaerobic endurance.

Why Team Handball?

If you haven’t checked out this Olympic sport, here are some of the details about it. Elite team handball players cover an average total distance of four to 5.6 kilometers during the course of a game. That’s 2.5 to 3.5 miles. The athletes perform more than 1,400 activity changes, which means they change from standing, to running, to throwing the whole time, which requires a lot of energy. Of these actions, an average of 100 are considered intense, including explosive actions like jumping, throwing, diving, or sprinting.

The researchers theorized that this combination of efforts, especially the intense efforts, result in muscle damage. Muscle damage creates telltale markers in the blood, as well as soreness (what is often called delayed onset muscle soreness, or DOMS), inflammation, and performance decrements. These indicators can all be measured and tell a story of what is occurring in the body as it recovers from exercise. They can also give us ideas of how often to train.

Study Design

The variables the researchers examined were too numerous to list, but I will discuss a few of the more important points. They took blood samples to sample metabolites like lactate and glycerol, which helped determine what energy systems were taxed. In the blood tests they also looked for several markers of muscle damage and inflammation.

The researchers also studied the physical effects of team handball training. They did many performance tests, including strength assessments for the bench press, sprinting, agility, and flexibility. Finally, soreness was evaluated, as well as heart rate and the range of motion of both dominant and non-dominant knees.

The participants in the study were elite team handball players. The researchers took a week to test these variables and see what normal variations were present. Then they took baseline levels at rest before the simulated game began. The values were measured again immediately after a rousing team match and for the next six days. The game was not an official one, but the heart rate and lactate levels were compared to official matches to ensure the intensity was adequate.


Both fat and glucose metabolism markers were high. Lactate, a byproduct of anaerobic metabolism, increased eight-fold. 24 hours out of the game, blood markers of muscle damage and soreness also increased. As far as inflammation, some of the markers rose immediately after exercise and then fell shortly after that, whereas others increased and remained elevated for 24 hours afterward. This shows us the changing landscape of how the body reacts to muscle damage.

The major indicator that remained elevated for longer than 24 hours was soreness. However, the remaining factors increased rapidly, then faded or stayed elevated until a day after, at which point they declined. So a mixed effort requiring a mix of aerobic and anaerobic endurance and power took about 24 hours to recover, although soreness persisted beyond that time frame.

The authors of the study recommend that team handball players (and from my perspective, athletes who play other sports with similar demands) don’t schedule training sessions or meets the day after an intense practice or games. Since inflammation is still going strong and physical ability is weakened, it may stunt technical development and physical performance.


1. A. Chatzinikolaou, et. al., “A Microcycle of Inflammation Following a Team Handball Game,” Journal of Strength and Conditioning Research, 28(7), 2014.

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