Compression garments are everywhere in recovery, but the evidence base has lagged behind the marketing. Most studies pool off-the-shelf (OTS) products of varying fit, measure peripheral outcomes, and treat compression as a single intervention. Garments are just fitted per manufacturer’s recommendations. The result is a literature that is broadly supportive but rarely specific, and clinicians are left to make prescription decisions on intuition.
A new PhD program led by Samuel Lewis at QUT and QAS is doing the work to change that. A strong supervisory team is headed by Vincent Kelly and Jonathan Peake at QUT, with Allan Hahn and Meghan Shephard at QAS. Study 1 of the program directly compared CAPE Bionics custom-fit garments against off-the-shelf equivalents of premium major brands and a no-garment control, with 21 participants in a repeated-measures design across both supine and standing positions. Pressure was measured at three anatomical sites, and cardiac stroke volume was estimated using suprasternal cardiac imaging (SMICG).
Several findings from that study are worth flagging for the clinical and performance community.
1. CAPE Custom-fit tights were the only condition with a credible positive effect on stroke volume
This is the major finding and is a validation that custom-fit is superior over OTS garments. After Bayesian linear hierarchical regression modelling (which is a more conservative way of estimating effects than traditional null-hypothesis testing), CAPE Bionics tights were the only garment with a positive 95% credible interval for stroke volume. CAPE tights were able to increase central haemodynamic flow of 3.5 mL/beat.
Extrapolated across a 24-hour day at an average heart rate of 75 bpm, that 3.5 mL/beat translates to roughly 378 L of additional cardiac output per day. For a recovery window, the implication is meaningful: more volume returning to the heart per beat means more nutrient and oxygen delivery, faster clearance of metabolic by-products, and reduced secondary ischaemic load on damaged tissue.
2. The pressure profile sits in a sensible range
CAPE Bionics tights applied significantly more pressure than the off-the-shelf tights at all three sites (medial calf, posterior calf and mid-anterior thigh, all p < 0.0001). They also produced a graduated profile with significantly less pressure at the mid-anterior thigh than at the calf, which is consistent with the classical clinical principle of distal-to-proximal gradient.
There is a clinical reading of this. The OTS tights in the comparison were arguably under-pressured for a therapeutic effect; the OTS calf sleeves were so tight enough that Lewis noted in his data summary that “I don’t believe there was much room for variation in pressures”. CAPE Bionics garments sat between the two, applying the balance of pressure to be biomechanically active without compromising fit, and addressing the regime that the literature extols.
3. Inter-individual pressure consistency was better
A custom-fit garment should, in principle, produce more consistent pressure across people of different shapes than a sized OTS product. The data supports this. At the medial calf in standing, the percentage standard deviation across participants was 17.2% for CAPE Bionics tights versus 25.7% for the OTS tights. In the supine position, the same comparison was 17.3% versus 21.6%.
This matters clinically because pressure consistency is what allows a prescriber to expect that what worked for one patient will work for another. It also matters for the literature: a large portion of the variability in compression research outcomes can be attributed to garments fitting different participants differently.
4. Surface area coverage looks like the second-most-important variable
Lewis’s strength-recovery data showed CAPE Bionics tights recovering strength well across all post-exercise time points, particularly within the two-hour window. The custom-fit calf sleeves recovered strength less well than the full tights but still better than no garment, which is a pattern consistent across the protocol.
The interpretation Lewis offers is mechanistic: after interface pressure, surface area coverage appears to be the next most influential variable in driving the blood-flow augmentation that supports recovery. This is a useful prescription heuristic. For an athlete or patient where recovery speed is the priority, full-coverage tights at an appropriate pressure should outperform local sleeves; for more targeted indications, sleeves remain useful but should be expected to do less.
What this means in practice
Three short take-aways for clinicians and performance staff thinking about prescription.
The custom-fit hypothesis has independent support. The stroke-volume result is, to our knowledge, the first time a custom-fit garment has been tested, and shown to produce a credible positive central haemodynamic effect at rest in a head-to-head comparison with branded, premium off-the-shelf alternatives. It does not replace the broader literature on compression and venous return, but it adds a layer of specificity that has been missing.
Pressure alone is not the whole story. The OTS calf sleeves produced higher absolute pressure than the CAPE Bionics tights and did not produce the same stroke-volume effect. Pressure that is too high can restrict rather than augment flow; pressure that is too low does not engage the mechanism at all. The middle of the curve is where the work happens.
Coverage matters. If recovery is the goal, tights are doing more than sleeves. If the indication is more local, however, sleeves remain a reasonable choice, especially with other considerations such as thermal, donning/doffing and cost preferences.
Sources and acknowledgements
The findings summarised here are from Samuel Lewis’s Study 1, conducted at the School of Biomedical Sciences, Queensland University of Technology, with co-authors Vincent Kelly and Jonathan Peake. The work was presented at the European College of Sport Science annual congress in Rimini, 2025, and supported by the Queensland Academy of Sport. Studies 2 and 3 of the joint protocol are now underway.
We are grateful to Sam and the QUT team for the rigour of their methodology and for choosing to put custom-fit compression to an honest, head-to-head test. We will share Studies 2 and 3 results when they are available.
Lewis S, Kelly V, Peake J. (2025) Effects of custom-fit compression garments on stroke volume and blood flow regulation. The 30th European College of Sport Science (ECSS) Annual Congress, Rimini, Italy, July 1–4.