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Effects of Acupuncture
Stimulation on Recovery Ability of
Male Elite Basketball Athletes

Article in The American Journal of Chinese Medicine · February 2009

Impact Factor: 2.76 · DOI: 10.1142/S0192415X09006989 · Source: PubMed

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The American Journal of Chinese Medicine, Vol. 37, No. 3, 471–481

© 2009 World Scientific Publishing Company
Institute for Advanced Research in Asian Science and Medicine

Effects of Acupuncture Stimulation

on Recovery Ability of Male
Elite Basketball Athletes

Zen-Pin Lin,∗,‡ Lawrence W. Lan,† Tsung-Ying He,§ Shi-Pin Lin,¶ Jang-Geng Lin,//
Tsong-Rong Jang†† and Tsung-Jung Ho¶,∗∗
∗Department of Holistic Wellness

†Department of Global Marketing and Logistics, MingDao University, Taiwan

‡College of Acupuncture, Moxibustion and Tuina

Nanjing University of Chinese Medicine, China

§Institute of Medical and Molecular Toxicology, Chung Shan Medical University, Taiwan

¶Chinese Medicine Department, China Medical University Beigang Hospital, Taiwan

//Graduate Institute of Acupuncture Science

∗∗School of Chinese Medicine, College of Chinese Medicine

China Medical University, Taichung, Taiwan

††Athletics Department and Graduate School

National Taiwan Sport University, Taichung, Taiwan

Abstract: Developing effective methods for helping athletes recover from muscle fatigue
is deemed essential, particularly on the eves’ important competitions. This study aimed to
investigate the effects of acupuncture stimulation on athletes’ recovery abilities. Subjects
were selected from 30 male elite university basketball players who were randomly assigned
to 3 groups: acupuncture group, sham group, and normal (control) group, each containing 10
subjects. Acupuncture was carried out on each athlete in acupuncture group at the Neiguan
(PC6) and Zusanli (ST36) acupoints, beginning at 15 min prior to exercise and continuing
until exhaustion of the subject. Similar acupuncture was also carried out on each athlete in
the sham group but the positions were 1 cm away from the PC6 and ST36 acupoints. No
acupuncture was conducted on the athletes in the normal group. During the experiments, each
subject performed separate runs on the treadmill. The data of heart rate (HRmax ), oxygen
consumption (VO2max ), and blood lactic acid were measured during the rest period and at 3
recovery points of time (5th, 30th and 60th min) post-exercise. The results showed that the
acupuncture group (PC6 and ST36) has significantly lower HRmax , VO2max and blood lactic

Correspondence to: Dr. Tsung-Jung Ho, School of Chinese Medicine, College of Chinese Medicine, China
Medical University, 91 Hsueh-Shih Road, Taichung 404, Taiwan. Tel: (+886) 4-2205-3366 (ext. 3120), Fax: (+886)
4-2201-3703, E-mail: tjho@mail.cmu.edu.tw
The last three authors contributed equally to this work.

471
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472 Z.-P. LIN et al.

acid than both the sham and normal groups at the 30th min post-exercise. Blood lactic acid
of the acupuncture group was also significantly lower than that of the other two groups in the
60th min post-exercise. Our findings have shed some light on the development of effective
acupuncture schemes to enhance the recovery ability for elite basketball athletes.

Keywords: Acupuncture; Basketball; Heart Rate; VO2max ; Blood Lactic Acid; Neiguan (PC6);
Zusanli (ST36).

Introduction

In the athletic world, many nations have long strived for developing competitive advantages
in sports by employing various scientific methods to improve the athletes’ peak perfor-
mance in hope of winning competitions. Developing effective methods to help the athletes
quickly recover from muscle fatigue after exercise training or fierce competitions and to
help them achieve the best physiological situations is deemed essential, especially prior to
international competitions. Acupuncture, one of the traditional Chinese medicine (TCM)
techniques, has long been used in clinic to treat illnesses or release pains for thousands
of years; it was also known to help in recovering from muscle fatigue after exercise. For
instance, the World Health Organization (WTO) has acknowledged that acupuncture can
treat more than 50 illnesses (Lin et al., 1996). Liang et al. (2003) found that acupuncture can
enhance the rate of recovery in terms of both subjective feeling (rate of perceived exertion
and self-report emotional state) and objective evidence (isokinetic muscle power output).
Itoh et al. (2008) reported that acupuncture can reduce inflammation and decrease pain in
delayed onset muscle soreness (DOMS). Moreover, Knardahl et al. (1998) demonstrated
that electroacupuncture (applying electric stimulation on the needles during acupuncture)
can increase pain threshold. Ulett et al. (1998) also showed that electroacupuncture appears
to be more effective than manual acupuncture in producing analgesic effects. Recently, tran-
scutaneous electrical acupoint stimulation (TEAS) has been used to treat various clinical
conditions and the reports indicated that TEAS appears to be effective in reducing post-
operative nausea and vomiting (Coloma et al., 2002; White et al., 2002; 2005). On the other
hand, Qu et al. (1993) found that acupuncture treatment to a fatigued muscle immediately
after 3 hours of continuous contraction can result in a 5% improvement in muscle tension
output. Lin et al. (1995) demonstrated that ear acupressure is effective in increasing oxygen
uptake and lowering lactic acid following exercise. Wang et al. (1999) also reported that
acupuncture can enhance the recovery of muscle force capacity after exercise.
From the scientific perspective, athletic ability can be a combination of various elements,
including muscular strength, speed, power, muscular and cardiopulmonary endurance, flex-
ibility, agility, and balance and coordination, among others. Cardiopulmonary endurance is
perhaps the most essential element for all types of sports. VO2max is a fundamental indica-
tor for measuring the cardiovascular endurance. The level of VO2max is one of the critical
elements for succeeding in endurance sports because an upper limit of oxygen consumption
does exist for each person. In choosing the athletes, however, each element of the proceed-
ing developments of competitive exercise is closely related and is as equally important as
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EFFECTS OF ACUPUNCTURE ON RECOVERY ABILITY OF MALE ATHLETES 473

any other element. Thus, researchers of physical science tried to find out all kinds of bio-
characteristics of athletes in distinct ways to reach the most effective training. During the
normal exercise training, it is important to properly adjust the quantity of exercise, according
to the regularity of dynamic changes in athletes, to prevent them from excessive exercise train-
ing or unbearable load. Prior to competitions, however, designing effective methods to help
the athletes achieve the best situation so as to outperform others is immediately necessary.
Since muscle fatigue was reported to closely relate to human performance (Bigland-Ritchie
and Woods, 1984; So et al., 2007) and acupuncture has been regarded as an effective method
to improve the rate of muscle recovery after exercise (Ehrlich and Haber, 1992; Qu et al.,
1993; Lin et al., 1995; Wang et al., 1999), this study aimed to conduct scientific experiments
on selected athletes to investigate in-depth the effects of acupuncture stimulation on recovery
abilities.

Methods

Participants

Thirty elite basketball athletes (all male, aged = 21.1 ± 0.6 years, height = 182.3 ± 2.1 cm,
and weight = 82.1 ± 4.0 kg) from the University of Physical Education in Taiwan were
selected to participate in this study (Table 1). These athletes were randomly divided into 3
groups: acupuncture group (n = 10), sham group (n = 10), and normal group (n = 10).

Procedure

In the first phase, all subjects were to conduct the experiment without laboratory control. In
the second phase, subjects were randomly divided into 3 groups: acupuncture group (AG),
sham group (SG), and normal group (NG), each group containing 10 athletes. Acupuncture
was carried out for each athlete in the AG at the PC6 and ST36 acupoints beginning 15 min
prior to exercise and continuing until exhaustion, which was determined by the subject.
Similar acupuncture was also carried out on each athlete in the SG, but the positions were
1 cm away from the PC6 and ST36 acupoints. No acupuncture was conducted on the NG
athletes.
The following equipment and instruments were used: (1) SENSOR MEDICS Vmax29
Gas Meter; (2) YSI2300 PLUS Lactate Analyzer; (3) 586 PIII Computer and Laser Printer;
(4) POLAR Mobile Heart Rate Recorder; (5) Stopwatch; (6) Hygrometer. Each subject was
required to wear a mask and a breathing collector. All participants warmed up their muscles

Table 1. The Basic Characteristics of Study Subjects

Height (cm) Weight (kg) Age (Year) Training Duration (Year)

Mean ± SD Mean ± SD Mean ± SD Mean ± SD

182.3 ± 2.1 82.1 ± 4.0 21.1 ± 0.6 7.5 ± 0.8

(n = 30).
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474 Z.-P. LIN et al.

on the bicycle till the RQ indicator reached 0.7 ∼ 0.8 on the Vmax29c before the experiment
took place. There was a time lag of 24 hours between the pre-experiment and post-experiment
graded exercise tests so as to wash out time to reduce the cross-over effects. It potentially
provided better comparison of the effects of stimulation. During the experiment, each subject
rode the bicycle until completely exhausted. Initially, the speed was set 60 RPM with power
120 W and it was increased by 30 W every 2 min.
The investigation was mainly on the variations during the rest period and the 3 recovery
periods (5th, 30th and 60th min post-exercise). Wireless heart recorder (POLAR), Vmax29
gas analyzer, and YSI2300 lactic acid analyzer were to analyze the heart rate, oxygen con-
sumption, and blood lactic acid, respectively. In addition, we drew their blood and measured
their serum biochemistry data in resting state, 5th, 30th, and 60th min post-exercise, and
then observed the differences. All the serum biochemical data for each subject, including
heart rate, oxygen consumption, and blood lactate acid were measured on each stage.

Data Analysis

SPSS 12.0 for Windows was used for the data analyses. First, a descriptive analysis on the
age, height and weight of the participants was conducted. Then the one-way ANOVA and
repeated Schfee’ way methods were used to test the differences of VO2max , HRmax , and
blood lactic acid among different groups, prior to and after the exercise at 3 different points
of time. The level of statistical significance was set at p < 0.05.

Results

The one-way ANOVA and repeated Schfee’ way test results showed that the HRmax , VO2max ,
and blood lactic acid in the AG athletes were significantly lower than those of the SG and
NG athletes in the 30th min post-exercise (Table 2). Blood lactic acid in AG was also found
significantly lower than those in the other 2 groups in the 60th min post-exercise. However,
there is no significant difference of HRmax, VO2max , and blood lactic acid between SG and NG
athletes in the 5th, 30th, and 60th min post-exercise. These results indicated that acupuncture
at Neiguan (PC6) and Zusanli (ST36) could significantly stimulate the post-exercise recovery
of heart rate, oxygen consumption, and blood lactic acid for the elite basketball athletes. Our
findings indicate that it is beneficial to carry out acupuncture at PC6 and ST36 acupoints,
particularly on the eves of competitions, as to enhance the recovery ability for elite basketball
athletes. This study has made an inspiring attempt to understand in-depth of the recovery
system and physiological profile of basketball athletes by acupuncture. It would facilitate
the coaches to provide more appropriate training schemes and recovery plans for the elite
basketball athletes.

Discussion

The following factors have been considered to influence the effectiveness of acupuncture:
acupoint selection, matching compatibility, timing of acupuncture, skill of supplement of
the insufficiency of acupuncture, depth of acupuncture needling, and length of time and
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EFFECTS OF ACUPUNCTURE ON RECOVERY ABILITY OF MALE ATHLETES 475

Table 2. A Comparison of Cardiopulmonary Endurance Among Acupuncture Group (AG), Sham Group
(SG) and Normal Group (NG)

Variables Acupuncture Group (AG) Sham Group (SG) Normal Group (NG)
Mean ± SD Mean ± SD Mean ± SD

HR (bpm)
Rest 68.3 ± 1.31 69.4 ± 1.77 68.3 ± 1.05
P5 118.9 ± 2.84 119.0 ± 2.40 117.8 ± 1.39
P30 80.0 ± 1.24a 82.3 ± 1.25 83.4 ± 1.89
P60 75.2 ± 2.69 75.6 ± 1.64 75.8 ± 1.68
VO2max (ml/kg/min)
Rest 4.4 ± 0.5 4.3 ± 0.10 4.3 ± 1.6
P5 23.4 ± 1.31 23.7 ± 1.15 22.8 ± 1.31
P30 7.37 ± 0.35a 7.86 ± 0.45 7.9 ± 0.39
P60 4.19 ± 0.01 4.23 ± 0.15 4.29 ± 0.14
Blood lactic acid (mmol/l)
Rest 0.83 ± 0.01 0.82 ± 0.01 0.8 ± 0.01
P5 8.65 ± 0.17 8.45 ± 0.10 8.54 ± 0.28
P30 3.89 ± 0.29a 4.78 ± 0.16 4.74 ± 0.12
P60 1.20 ± 0.11a 1.62 ± 0.11 1.67 ± 0.14
aStatistically significant (p < 0.05) when compared with SG and NG.

connection between non-acupoints and acupoints, among others (Chen et al., 1990; Ernst
et al., 2007). This is the reason acupuncture deserves further exploration today despite that
its use in clinical treatment for thousands of years. In our recent work, we have attempted
to control a similar experimental condition, yet we were still unable to avoid the influences
of some of the factors mentioned above. We found that acupuncture is effective in lowering
the resting heart rate and carbon dioxide production and that there is a significant differ-
ence between the acupuncture group and the control group (Lin et al., 1996). Following
nonparametric testing, Hübscher et al. (2008) observed that there were no significant differ-
ences between various groups in outcome measures at baseline and after 72 hours, however
pain perception (VAS) was significantly lower in the acupuncture subjects than in the sham
acupuncture and control subjects. Although acupuncture seemed to have no effects on the
mechanical pain threshold or muscle function, it has been proven to reduce perceived pain
raised from exercise-induced muscle soreness. Similarly, Itoh et al. (2008) also found that
there were significant differences in visual analog scores for pain between the control group
and tender point group immediately after treatment and 3 days after exercise (p < 0.05,
Dunnetts multiple test) and that tender point acupuncture relieves muscle pain of DOMS.
A few studies have discussed acupuncture for VO2max changes in the national elite bas-
ketball athletes. Bentley et al. (2001) found that the determination of physiological variables,
such as the anaerobic threshold (AT), maximal oxygen uptake (VO2max ) through incremen-
tal exercise testing, and relevance of these variables to endurance performance, is a major
requirement for coaches and athletes. Many medical institutions recognized the importance
of this traditional method and were devoted to research on acupuncture theory and clinical
experimentation (Lin et al., 1996). Niu et al. (2000) investigated that when acupuncture
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476 Z.-P. LIN et al.

was applied on the superficial personal nerve after strenuous running exercise, blood lactate
removal rate was significantly faster than that of the control group. Xiang et al. (1998) demon-
strated an increase in the rate of lactate removal. Richardson and Vincent (1986) found that
there is good evidence from controlled studies on the short-term effectiveness of acupunc-
ture in relieving clinical pain in each of the areas they reviewed. This pain control effect of
acupuncture might also contribute to the enhanced recovery rate after strenuous exercise.
Koo et al. (2002) demonstrated that an analgesic effect could be induced by electroacupunc-
ture points located at a remote site on the body in a stimulus point-specific manner. The
suggestion that pain relief or analgesic effect will mediate the adverse feeling after strenu-
ous exercise is echoed by Craig et al. (1999) who indicated that acupuncture therapy might
represent a beneficial treatment for the reduction of the muscle damage and soreness asso-
ciated with intense exercise. Such phenomenon is also in line with the models proposed by
Noakes et al. (2005) and St Clair Gibson et al. (2006).
Acupuncture stimulation has also been an internationally recognized alternative ther-
apy proven to have substantial improvement on the cardiopulmonary functions (Samuels,
2000; Asamoto and Takeshige, 1992; Matthees, 2001). In these studies, auricular stimula-
tion enhanced the physical capabilities of athletes. The results showed that aerobic function
indicators such as VO2max and VEmax improved significantly with stimulation. Based on
these findings, auricular stimulation could be used to improve the performance results for
marathons, 400 meter sprints, and 800 meter long distance runs. Furthermore, significant
differences were observed between participants’ body temperatures prior to stimulation and
following auricular stimulation. Previous research reported that rising body temperature
could not only increase the enzyme activities, muscular blood volume, and oxygen intake
level but also increase the time between contraction and relaxation of muscles, thus enhanc-
ing performance and avoiding injuries (Mohr et al., 1998; McNair and Stanley, 1996). These
findings demonstrated that in addition to improved functioning of elements necessary for
athletic performance, stimulation on the auricular acupuncture points before exercising can
also decrease the warm-up time, which can prevent injuries due to insufficient warm-ups
and essentially enhance the athletes’ overall performance.
Furthermore, auricular acupuncture is both a diagnostic and treatment system, based on
normalizing the body’s dysfunction through stimulation of definite points on the ear and its
reflex systems, which does not correlate with modern knowledge of anatomy and physiology.
Auricular acupuncture stimulation significantly improved oxygen intake in athletes. The
VO2max per min was higher in athletes with auricular acupuncture stimulation than in those
without. Similar results were found by Sa and Lin (1990) who gave stimulations to subjects
using auricular acupuncture patches on the related points to the lung, kidney, spleen, Sen-
joug, adrenal cortex and endocrine with an aim of improving the VO2max during aggressive
exercise. Their results showed that VO2max was only significantly different between the
pre-experiment and post-experiment measurements in the acupuncture group but not in the
control group. Moreover, many other researchers have also used VO2max as an important
indicator for evaluating aerobic ability and sporting performances (Adams et al., 1975; Atomi
et al., 1986; Hill and Rowell, 1996; Helgerud et al., 2001). Based on the discussion above, it
was concluded that auricular acupuncture stimulation could potentially enhance the aerobic
ability of athletes, thus improving sport performance.
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EFFECTS OF ACUPUNCTURE ON RECOVERY ABILITY OF MALE ATHLETES 477

Muscle fatigue has been defined as any exercise-induced loss of ability to produce force
with a muscle or muscle group and it involves processes at all levels of the motor pathway
between the brain and the muscle (Taylor et al., 2006). Søgaard et al. (2006) regarded human
muscle fatigue as a loss of force-generating capacity in voluntary contractions. According
to the Chinese medicine theory, fatigue is caused by deficiency or imbalance in life energy
(also known as “Qi”) and recovery is promoted through the mechanism of “tonifcation” of
Qi, which focuses on boosting the “lung” and “spleen” functions (Li et al., 2004). Notice-
able progress has been made in biochemistry, hematological changes, neurophysiology, and
clinical treatment and acupuncture has an adjusting and controlling effect on some body
functions, allowing the physiological activity of the human body to reach a constant state
(Lin et al., 1996). Research in acupuncture analgesia and anesthesia indicated that acupunc-
ture cannot only modify the heart rate and blood flow of coronary arteries, but also lower fat
and cholesterol levels (Lin et al., 1996). Acupuncture can be used to improve gas metabolism
and pulmonary respiratory function (Plummer, 1981; Chang, 1982; Wang and Wang, 1989;
Liu, 1990; Wang and Jin, 1990). In particular, evidence showed that electroacupuncture at
PC6 and ST36 acupoints after vigorous exercise, can increase the clearance rate of sarco-
lactic acid, thus leaving a perception of improved results (Lin, 1991). Moreover, Lin et al.
(1996) also reported that acupuncture at both PC6 and ST36 acupoints can decrease resting
heart rate and carbon dioxide production.
Generally, performing low-intensity aerobic exercise (active recovery) during the imme-
diate post-exercise period is more effective in accelerating lactate clearance than that in
inactive rest (passive recovery). Hagberg (1984) pointed out that blood lactic acid, while
still important from the exercise physiologist’s viewpoint, now is known to contribute much
less than originally believed to the regulation of human’s physiological responses to exercise.
Martin et al. (1998) showed that lactate metabolism and its rate of elimination from blood
and muscle are important components of recovery following maximal exercise. It is well
known that impairment of performance resulting from muscle fatigue differs according to the
types of contraction involved, the muscular groups tested, and the exercise duration/intensity.
For instance, Millet and Leoers (2004) focused on the origin of muscle fatigue after a pro-
longed exercise, lasting 30 min to several hours, and found that strength loss with fatigue
can originate from different sites: from the motor cortex to the contractile elements, and
this was termed “task dependency of muscle fatigue.” They found that electrically-evoked
contractions and associated electromyostimulation (EMS) can help characterize peripheral
fatigue. Søgaard et al. (2006) indicated that recovery from fatigue caused by weak con-
tractions differs from that caused by maximal contractions. Many others also found that,
after fatiguing maximal efforts, changes in the responses to stimulation of the motor cortex
during contraction would recover to control levels and voluntary activation would recover in
1–2 min (Gandevia et al., 1996; Taylor et al., 1996; Todd et al., 2005; Søgaard et al., 2006).
More recently, Pallard (2008) indicated that both EMS and voluntary muscle contraction
(VC) constitute different modes of muscle activation, which induce different acute physio-
logical effects on the neuromuscular system. Long-term application of each mode of muscle
activation can produce different muscle adaptations.
There are some potential limitations of this study. First, this experiment was designed for
a relatively small group of athletes (only 30) since the experiment required that participants
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478 Z.-P. LIN et al.

exercise on the treadmill training machines till exhausted. It required a high degree of will-
ingness of subjects to volunteer and cooperate. The participants of this research were primar-
ily competitive elite athletes who desired eagerly to improve the competition performance
through acupuncture stimulation. Enriching the subjects to draw more robust conclusions is
necessary for future studies. Secondly, the lifestyle of participants could potentially impact
the athletic performance. Therefore, in future studies, the athletes’ lifestyle may need to
be closely monitored to decrease the external variations that could affect the experimental
results. Thirdly, this study was conducted in a laboratory environment to eliminate inter-
ference variables, and therefore it might yield different results from otherwise observed in
an uncontrolled environment under competition circumstances. Design of a future study to
test the findings of this research in the context of athletic competition is suggested. Lastly,
this study did not intend to provide the validation of the direct relation between acupuncture
stimulation and sporting performance. Future studies can explore this issue in more depth.
In conclusion, it was believed that if the quality and quantity of training intensity, cardio-
respiratory function, energy consumption, and blood lactate system during training as well
as the body weight and physical ability can be well controlled, the athletes should be able to
elaborate their potential and maintain their peak performance. To recover the physiological
characteristics during training and competition periods, acupuncture stimulation could be
used for all kinds of sports training and for obtaining desirable competition results. To keep
the athletes in the best situations, it is important to design effective schemes to help them
achieve their peak performance and to recover quickly in the competition phase. This study
demonstrated that the acupuncture group (PC6 and ST36) had significantly lower HRmax ,
VO2max and blood lactic acid than both the sham group and the normal group in the 30th
min post-exercise. Blood lactic acid of the acupuncture group was also significantly lower
than that of the other 2 groups in the 60th min post-exercise. Our findings have shed some
light on the development of effective acupuncture schemes to enhance the recovery ability
for elite basketball athletes. It can be used to improve subjects in future sport performance.

Acknowledgments

The authors are indebted to anonymous referees for their insightful and constructive com-
ments to level up the quality of the original work. This study has been supported/sponsored by
the Chinese Taipei Olympic Committee, MingDao University and China Medical University
VS Beigang Hospital.

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