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Chinese Medical Journal 2009;122(13):1587-1590

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Brief report
Effect of auricular acupuncture on oxygen consumption of boxing athletes
LIN Zen-Pin, WANG Chung-Yuan, JANG Tsong-Rong, MA Tso-chiang, CHIA Fan, LIN Jaung-Geng, HSU Jen-Jeng and HO Tsung-Jung Keywords: auricular acupuncture; oxygen consumption; boxing athletes oxing is an official sport at the 2008 Beijing Olympic Games and the fast development of world-class high strength training and sport science has made a significant impact on scientific training. Boxing needs high cardio-respiratory function, speed, muscle strength, and anaerobic and intensive physical demands including weight control covering the grading of athletes body weight and balancing physical ability and health. Sport training is important even for talented athletes. Weight cycling is a term used to describe rapid weight loss following self food limitation and/or dehydration. Both gradual (seasonal) and rapid (weekly) weight reduction cycles are used by athletes, and have been investigated for potential effects on nutrition and performance.1 These cycles are used in such sports as wrestling, judo, rowing, and boxing in order to make a weight category. Like the other of these sports, boxing needs repeated efforts and high-intensity physical strength. Only when the cardio-respiratory function, energy expenditure and blood lactate system of athletes are well controlled can they show their potential and maintain high performance.2 Overtraining syndrome, a neuroendocrine disorder, is characterized by poor performance in competition, inability to maintain training loads, persistent fatigue, reduced catecholamine excretion, frequent illness, disturbed sleep and alterations in mood state.3 Sport training is important even for talented athletes. Peaking or the ability of an athlete to have a peak performance during the tough competition or games of the year is also related to strength training. The determination of physiological variables such as the anaerobic threshold (AT) and maximal oxygen uptake (VO2max) through incremental exercise testing and the relevance of these variables to endurance performance is a major requirement for coaches and athletes.4 To maintain good performance throughout the competitive phase, this physiological base must be maintained.5 Bompa5 investigated boxing and martial arts, and found that a quick and powerful start of an offensive skill prevents an opponent from using an effective action. The elastic, reactive component of muscle is of vital importance for delivering quick action and powerful starts. However, auricular acupuncture is a diagnostic and treatment system based on normalizing the bodys

dysfunction by stimulation of definite points on the ear.6 The resultant amelioration of pain and illness is believed to be through the reticular formation and the sympathetic and parasympathetic nervous systems.7 Current clinical and basic research has proved the efficacy of ear acupuncture mostly in the treatment of acute or chronic pain8-12 and anxiety-related disorders.13-15 Therefore, ear acupuncture is a technique similar to reflexology, and is speculated that it works because groups of pluripotent cells contain information from the whole organism and create regional organization centers representing different parts of the body, through the recruitment of more cortex cells dedicated to specific areas of the body.6 The resultant amelioration of pain and illness is believed to be due to the reticular formation and the sympathetic and parasympathetic nervous systems.7 In the contemporary athletic world, nations strive to develop a competitive advantage in sports using various scientific methods to improve the performance of athletes. Designing methods to help athletes to outperform others and win the gold medals in international competitions is the goal for many researchers. From the scientific perspective, various elements including muscular strength, speed, power, muscular and cardiopulmonary endurance, flexibility, agility, balance and coordination were combined to constitute athletic ability. Among these elements, cardiopulmonary endurance is the absolute element for athletes in all types of sports. VO2max as a fundamental
DOI: 10.3760/cma.j.issn.0366-6999.2009.13.022 Department of Holistic Wellness, MingDao University, Taiwan, China (Lin ZP, Chia F and Hsu JJ) Athletics Department & Graduate School, National Taiwan Sport University (Taichung), Taiwan, China (Wang CY and Jang TR) Department of Public Health, China Medical University, Taiwan, China (Ma TC) Graduate Institute of Chinese Medical Science, China Medical University, Taiwan, China (Lin JG) School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan, China (Ho TJ) Chinese Medicine Department, China Medical University Beigang Hospital, Taiwan, China (Ho TJ) Chia-Yi Hospital, Department of Health, Executive Yuan, Taiwan, China (Ho TJ) LIN Zen-Pin, WANG Chung-Yuan and JANG Tsong-Rong contributed equally to this work as co-first author. Correspondence to: Prof. HO Tsung-Jung, School of Chinese Medicine, College of Chinese Medicine, China Medical University, 91 Hsueh-Shih Rd., Taichung 404, Taiwan, China (Tel: 886-4-22053366 ext 3120. Email: tjho@mail.cmu.edu.tw)

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indicator for evaluating cardiovascular endurance is one of the critical elements for succeeding in endurance sports. Auricular stimulation also known as ear acupuncture is an internationally recognized medical method.16 Ear acupuncture was first proposed in 1957 by Nogier, who theorized that acupuncture points on the ear are shaped like an inverted embryo. In 1986, ZHANG Ying-qing described the bio-holographic theory with an ear acupuncture chart and the effects of ear acupuncture. These theories present how ear acupuncture enhances sporting abilities by lowering the heart rates of athletes at rest, decreasing oxygen intake, and expediting excretion of post-exercise blood lactic acids. The present study aimed to investigate the effects of auricular acupuncture and to develop effective methods to help boxing athletes recover quickly from major competition events. METHODS
Figure 1. The distribution of simulative auricular acupoints.

Subjects Thirty male boxing athletes (age (19.81.1) years, height (172.02.5) cm, and weight (66.33.2) kg) from the National Taiwan Sport University (Taichung, China) were selected to participate in the study. Each subject underwent a treadmill training program for complete exhaustion at a starting speed of 15 m/h, followed by an increment of 5 m/h every 2 minutes. These athletes were randomly assigned to three groups: auricular stimulation group (AS group, n=10), acupuncture Neiguan group (PC6 group, n=10) and control group (n=10). Magnetic stud patches were used to stimulate the ear acupuncture points in the AS group for 30 minutes prior to exercise, which was continued until exhaustion determined by the subjects. 3M tape was used on the auricular points without stimulation in the control group. Settings and process of experiment This study was conducted in the physical laboratory of the National Taiwan College of Physical Education. The research equipments included a Quinton ST65 Med track treadmill; a Vmax29c cardiopulmonary measuring device; auricular needles; 3M tape, and an electronic body thermometer. The study included two phases. In the first phase the experiment was conducted without laboratory control. Magnetic stud patches were used to stimulate such acupuncture points as Shen-men, heart, lung, liver, Triple warmer, adrenal cortex and endocrine on both ears in the AS group (Figure 1). In the second phase, thirty male boxing athletes were randomly assigned to three groups: AS group, PC6 group, and control group (Figure 2). 3M tape was stuck on the same acupoints on both ears of the subjects of the control group without stimulation for 30 minutes prior to the exercise. The subjects were fully informed of the experimental procedures and the use of

Figure 2. Experiment process flowchart for AS group, PC6 group and control group.

equipments. To prevent injury during the experiment, the subjects got prepared for sufficient warm-up before exercise. In the second phase, body temperature of the subjects was measured after use of auricular stimulation patches and 3M tape for detecting the body temperature reaction during the experiment. With the graded jogging program proposed by Jackson and Pollock in 1978,17 the treadmill was set at a constant speed, and a slope program was set to raise the treadmill by a 2.5% grade every two minutes. Each of the participants was asked to provide feedback in accordance with the self-awareness chart during the last 5 seconds of each stage. Each participant was required to wear a mask and a breathing collector. All participants warmed up their muscles on the treadmill till the RQ indicator was 0.70.8 on the Vmax29c before the start of the experiment. The time lag was 24 hours between each experiment (an experiment including pre-experiment and post-experiment graded exercise tests) as the time was passed to reduce the cross-over effects. It potentially provided a better comparison for the effects of stimulation. Statistical analysis SPSS 12.0 for Windows was used for data analysis. First, a descriptive analysis was made of the age, height and weight of the participants. One-way analysis of variance (ANOVA) and Schfee way method were repeated to analyze the age, height, weight, VO2max, body temperature, VEmax, TV and RR before and after the experiment to determine if there are statistically significant differences in the measurements. The statistical significance was set at P <0.05.

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RESULTS The VO2max of the AS group was significantly higher than that of the control and acupuncture PC6 groups (Table) respectively. However, the VE2max, TV, RR, and body temperature in both the acupuncture PC6 and control groups were not significantly different.
Table. Difference of cardiopulmonary endurance for AS group, acupuncture PC6 group and control group (n=30)
Acupuncture PC6 Control group group -1 -1 * VO2max (ml kg min ) 58.861.03 53.451.21 53.380.93 VEmax (L/min) 141.7014.59 135.4014.73 136.5713.89 TV (L) 2.282.28 2.240.31 2.290.32 RR 53.5010.91 58.106.57 56.806.72 Body temperature (C) 36.940.84 36.901.05 36.770.74 * P <0.05 when compared with control group; P <0.05 when compared with acupuncture PC6 group. Variables AS group

showed that VO2max was only significantly different between the pre-experiment and post-experiment measurements in the AS group, but not in the control group. Many researchers, however, used VO2max as an important indicator for evaluating aerobic ability and sport performance.19-22 From the present study we conclude that auricular acupuncture stimulation could potentially enhance the aerobic ability of athletes while improving sport performance. Acupuncture stimulation is an internationally recognized alternative therapy for substantial improvement of cardiopulmonary function.23,24 In this study, auricular stimulation enhanced the physical capabilities of athletes including the improvement of indicators of aerobic function such as VO2max and VEmax. Thus we suggest that auricular stimulation could improve the performance results of athletes who are devoted to marathons, 400 meter sprints, and 800 meter long distance runs. Furthermore, significant differences were observed in the present study in body temperatures of athletes before and after auricular stimulation. Previously the rising body temperature was reported to increase enzyme activities, muscular blood volume, oxygen intake and the time between contraction and relaxation of muscles to enhance the performance and avoid injuries.26,27 The acupoints Neiguan (PC6) and Zusanli (ST36) can decrease the resting heart rate and carbon dioxide production.28 In the present study, the levels of HRmax, VO2max and blood lactic acid were significantly lower in the acupuncture group (stimulating acupoints PC6 and ST36) than in the sham and normal groups 30 minutes after exercise. The level of blood lactic acid of the acupuncture group was also significantly lower than that of the other two groups 60 minutes after exercise. These results have been implemented in developing effective acupuncture schemes to enhance the recovery ability of basketball athletes.29 Our study also demonstrated that in addition to improve the function of elements necessary for athletic performance, stimulation at auricular acupoints before exercise also decreases the warm-up time necessary for athletes so as to prevent any injuries. Limitations of this study included: (1) a relatively small group of athletes were enrolled because the experiment required the participants to exercise on the treadmill training machine till exhaustion; (2) the participants were primary competitive athletes who desired to improve their competition performance through auricular stimulation; and (3) the lifestyle of participants could potentially influence athletic performance. The lifestyles of athletes need to be closely monitored to decrease external variations that could affect the result of the study. Auricular stimulation has significant effects on the maximal oxygen intake (VO2max). Understanding these effects during competition would also help to improve the aerobic capabilities and performance results of athletes in addition to cardiopulmonary function. The stimulation is recommended to use appropriately in the three phases of

Obviously, auricular acupuncture could significantly enhance the recovery after exercise oxygen consumption. Auricular acupuncture at the Shen-men point, heart point, lung point, liver point, Triple warmer, adrenal cortex and endocrine helped improve the ability of recovery of elite boxing athletes. Understanding the effects of auricular acupuncture on the recovery and profile of boxing athletes is important because it will help coaches in training and athletes in recovery. DISCUSSION There are few studies on auricular acupuncture involving VO2max changes in boxing athletes. But during competition phases it is important to ensure a peak performance and a quick recovery for athletes. The finding can be used to improve the sport performance of athletes. The determination of physiological variables such as AT and VO2max shown by incremental exercise testing and relevance of these variables to endurance performance is thought to be advisable for both athletes and coaches.4 Bompa5 found that a quick and powerful start of an offensive skill prevents an opponent from an effective action. The elastic, reactive component of muscle is of vital importance for delivering a quick action and a powerful start. However, auricular acupuncture is a diagnostic and treatment system based on normalizing the body's dysfunction through stimulation of definite points on the ear, and its reflex system does not correlate with modern knowledge of anatomy and physiology. Auricular acupuncture stimulation can significantly improve oxygen intake in athletes. The VO2max per minute is higher in athletes with auricular acupuncture stimulation than in those without the stimulation. Similar results were found by Sa and Lin.18 In their research, six males from physical education were given stimulation from auricular acupuncture patches on points of the lung, kidney, spleen, Triple warmer, adrenal cortex and endocrine, attempting to improve VO2max during aggressive exercise. The results

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Chin Med J 2009;122(13):1587-1590 Eckardt A, et al. Auricular acupuncture for dental anxiety: a randomized controlled trial. Anesth Analg 2007; 104: 295-300. Sok SR, Kim KB. Effects of auricular acupuncture on insomnia. Korean Elderly Taehan Kanho Hakhoe Chi 2005; 35: 1014-1024. Wang SM, Peloquin C, Kain ZN. The use of auricular acupuncture to reduce preoperative anxiety. Anesth Analg 2001; 93: 1178-1180. Kitade T, Hyodo M. The effects of stimulation of ear acupuncture points on the body's pain threshold. Am J Chin Med 1979; 7: 241-252. Jackson AS, Pollock ML. Generalized equations for predicting body density of men. Br J Nutr 1978; 40: 497-504. Sa LS, Lin DF. The effect of stimulation of auricular acupuncture on the VO2max in strenuous exercise. The National Society of Physical Education, Taipei, Taiwan. Phys Educ J 1990; 12: 159-157. Helgerud J, Engen LC, Wisloff U, Hoff J. Aerobic endurance training improves soccer performance. Med Sci Sports Exerc 2001; 33: 1925-1931. Hill DW, Rowell AL. Running velocity at VO2max. Med Sci Sports Exerc 1996; 28: 114-119. Adams WC, Bernauer EM, Dill DB, Bomar JB, Jr. Effects of equivalent sea-level and altitude training on VO2max and running performance. J Appl Physiol 1975; 39: 262-266. Atomi Y, Iwaoka K, Hatta H, Miyashita M, Yamamoto Y. Daily physical activity levels in preadolescent boys related to VO2max and lactate threshold. Eur J Appl Physiol Occup Physiol 1986; 55: 156-161. Samuels N. Chronotherapy in traditional Chinese medicine. Am J Chin Med 2000; 28: 419-423. Asamoto S, Takeshige C. Activation of the satiety center by auricular acupuncture point stimulation. Brain Res Bull 1992; 29: 157-164. Mohr KJ, Pink MM, Elsner C, Kvitne RS. Electromyographic investigation of stretching: the effect of warm-up. Clin J Sport Med 1998; 8: 215-220. McNair PJ, Stanley SN. Effect of passive stretching and jogging on the series elastic muscle stiffness and range of motion of the ankle joint. Br J Sports Med 1996; 30: 313-317. Lin JG, Ho SJ, Lin JC. Effect of acupuncture on cardiopulmonary function. Chin Med J 1996; 109: 482-485. Lin ZP, Lan WL, He TY, Lin SP, Lin JG, Jang TR, et al. Effects of acupuncture stimulation on recovery ability for male elite basketball athletes. Am J Chin Med 2009; In press.

training: adjustment, training and competition since it will be effective in improving the training efficiency and performance. This study was conducted in a laboratory environment so as to eliminate interference variables, which may be different from those observed in real competition circumstances. Our future studies will focus on the validation of the direct relationship between auricular stimulation and sport performance.
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(Received February 10, 2009) Edited by QIAN Shou-chu and WANG Mou-yue