The prevention and treatment of exercise-induced muscle damage

Identification of EIMD Level Differences Between Long- and Short Head of Biceps Brachii Using Echo Intensity and GLCM Texture Features

Purpose: This study aimed to compare the time-course changes of exercise-induced muscle damage (EIMD) levels in the long head of biceps brachii (LHB) and short head of the biceps brachii (SHB) using echo intensity (EI) and to determine the efficiency of the gray level co-occurrence matrix (GLCM) texture parameters. Methods: The participants performed 30 maximal eccentric contractions of the elbow flexor. Along with muscle damage indicators, including circumference, range of motion, muscle soreness, and maximal voluntary isometric contraction (MVIC), the EI and GLCM texture features of the LHB and SHB was also assessed using B-mode ultrasonography. All measurements were assessed pre- and immediately post-exercise and after 24, 48, 72, and 96 h. Results: The muscle damage indicators indicated significant changes after the eccentric contractions (p < 0.01 for circumference, range of motion, muscle soreness, and MVIC). The EI of LHB significantly increased following the contractions (p < 0.01), but that of SHB did not (p > 0.05). In contrast, for the GLCM texture parameters, there were significant changes in the SHB (p < 0.01 for homogeneity, energy, and entropy). Conclusion: Thus, this study demonstrated that EIMD severity is different between LHB and SHB even within the same muscle. In the GLCM features, the time course of SHB after eccentric contraction revealed different patterns compared with those of LHB. Therefore, even if there are no changes in EI within a target muscle following muscle contractions, new information on muscle quality can be obtained through GLCM analysis.

Can pre-exercise photobiomodulation improve muscle endurance and promote recovery from muscle strength and injuries in people with different activity levels? A meta-analysis of randomized controlled trials

Photobiomodulation therapy (PBMT) was introduced as an ergogenic aid for sport performance in healthy individuals is still controversial. The main aim of this study is to assess the potential enhancements in muscle endurance and recovery from muscle strength and injuries mediated by PBMT among individuals exhibiting diverse activity levels. Randomized controlled trials (RCT) of PBMT interventions for healthy people (both trained and untrained individuals) exercising were searched (up to January 16, 2024) in four electronic databases: Web of Science, PubMed, Scopus and Embase. Primary outcome measures included muscle endurance, muscle strength and creatine kinase (CK) levels; secondary outcome measure included Lactate dehydrogenase (LDH) levels. Subgroup analyses based on physical activity levels were conducted for each outcome measure. Thirty-four RCTs were included based on the article inclusion and exclusion criteria. Statistical results showed that PBMT significantly improved muscle endurance (standardized mean difference [SMD] = 0.31, 95%CI 0.11, 0.51, p < 0.01), indicating a moderate effect size. It also facilitated the recovery of muscle strength (SMD = 0.24, 95%CI 0.10, 0.39, p < 0.01) and CK (mean difference [MD] = -77.56, 95%CI -112.67, -42.44, p < 0.01), indicating moderate and large effect sizes, respectively. Furthermore, pre-application of PBMT significantly improved muscle endurance, recovery of muscle strength and injuries in physically inactive individuals and athletes (p < 0.05), while there was no significant benefit for physically active individuals. Pre-application of PBMT improves muscle endurance and promotes recovery from muscle strength and injury (includes CK and LDH) in athletes and sedentary populations, indicating moderate to large effect sizes, but is ineffective in physically active populations. This may be due to the fact that physically active people engage in more resistance training, which leads to a decrease in the proportion of red muscle fibres, thus affecting photobiomodulation.

Themes and trends in marathon performance research: a comprehensive bibliometric analysis from 2009 to 2023

Background: When marathon runners break the 2-h barrier at the finishing line, it attracts global attention. This study is aimed to conduct a bibliometric analysis of publications in the field of marathon running, analyze relevant research contributors, and visualize the historical trends of marathon performance research over the past 15 years. Methods: On 8 December 2023, we extracted high-quality publication data from the Web of Science Core Collection spanning from 1 January 2009 to 30 November 2023. We conducted bibliometric analysis and research history visualization using the R language packages biblioshiny, VOSviewer, and CiteSpace. Results: A total of 1,057 studies were published by 3,947 authors from 1,566 institutions across 63 countries/regions. USA has the highest publication and citation volume, while, the University of Zurich being the most prolific research institution. Keywords analysis revealed several hotspots in marathon research over the past 3 years: (1) physiology of the elite marathon runners, (2) elite marathon training intensity and pacing strategies, (3) nutritional strategies for elite marathon runners, (4) age and sex differences in marathon performance, (5) recovery of inflammatory response and muscle damage. Conclusion: This study presents the first comprehensive bibliometric analysis of marathon performance research over the past 15 years. It unveils the key contributors to marathon performance research, visually represents the historical developments in the field, and highlights the recent topical frontiers. The findings of this study will guide future research by identifying potential hotspots and frontiers.

Nutritional interventions for exercise-induced muscle damage: an umbrella review of systematic reviews and meta-analyses of randomized trials

CONTEXT

Several meta-analyses have been conducted on the effect of nutritional interventions on various factors related to muscle damage. However, the strength of the evidence and its clinical significance are unclear.

OBJECTIVES

This umbrella review aimed to provide an evidence-based overview of nutritional interventions for exercise-induced muscle damage (EIMD).

DATA SOURCES

PubMed, Scopus, and ISI Web of Science were systematically searched up to May 2022.

DATA EXTRACTION

Systematic reviews and meta-analyses of randomized controlled trials investigating nutritional interventions' effects on recovery following EIMD were included. The certainty of the evidence was rated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE).

RESULTS

Fifty-three randomized controlled trial meta-analyses were included, evaluating 24 nutritional interventions on 10 different outcomes. The results revealed a significant effect of hydroxymethylbutyrate (HMB) supplementation and l-carnitine supplementation for reducing postexercise creatine kinase; HMB supplementation for reducing lactate dehydrogenase; branched-chain amino acids and leaf extract supplementation for reducing the delayed onset of muscle soreness; and l-carnitine, curcumin, ginseng, polyphenols, and anthocyanins for reducing muscle soreness, all with moderate certainty of evidence.

CONCLUSIONS

Supplementation with HMB, l-carnitine, branched-chain amino acids, curcumin, ginseng, leaf extract, polyphenols, and anthocyanins showed favorable effects on some EIMD-related outcomes.

PROTOCOL REGISTRATION

PROSPERO registration no. CRD42022352565.

Glycaemic Effects of a 156-km Ultra-trail Race in Athletes: An Observational Field Study

BACKGROUND

Ultra-trail running races pose appreciable physiological challenges, particularly for glucose metabolism. Previous studies that yielded divergent results only measured glycaemia at isolated times.

OBJECTIVES

We aimed to explore the impact of an ultra-endurance race on continuously measured glycaemia and to understand potential physiological mechanisms, as well as the consequences for performance and behavioural alertness.

METHODS

Fifty-five athletes (78% men, 43.7 ± 9.6 years) ran a 156-km ultra-trail race (six 26-km laps, total elevation 6000 m). Participants wore a masked continuous glucose monitoring sensor from the day before the race until 10 days post-race. Blood was taken at rest, during refuelling stops after each lap, and after 24-h recovery. Running intensity (% heart rate reserve), performance (lap times), psychological stress, and behavioural alertness were explored. Linear mixed models and logistic regressions were carried out.

RESULTS

No higher risk of hypo- or hyperglycaemia was observed during the exercise phases of the race (i.e. excluding stops for scientific measurements and refuelling) compared with resting values. Laps comprising a greater proportion of time spent at maximal aerobic intensity were nevertheless associated with more time > 180 mg/dL (P = 0.021). A major risk of hyperglycaemia appeared during the 48-h post-race period compared with pre-race (P < 0.05), with 31.9% of the participants spending time with values > 180 mg/dL during recovery versus 5.5% during resting. Changes in circulating insulin, cortisol, and free fatty acids followed profiles comparable with those usually observed during traditional aerobic exercise. However, creatine phosphokinase, and to a lesser extent lactate dehydrogenase, increased exponentially during the race (P < 0.001) and remained high at 24-h post-race (P < 0.001; respectively 43.6 and 1.8 times higher vs. resting). Glycaemic metrics did not influence physical performance or behavioural alertness.

CONCLUSION

Ultra-endurance athletes were exposed to hyperglycaemia during the 48-h post-race period, possibly linked to muscle damage and inflammation. Strategies to mitigate muscle damage or subsequent inflammation before or after ultra-trail races could limit recovery hyperglycaemia and hence its related adverse health consequences.

TRIAL REGISTRATION NUMBER

NCT05538442 2022-09-21 retrospectively registered.

Physical Therapies for Delayed Onset Muscle Soreness: A Protocol for an Umbrella and Mapping Systematic Review with Meta-Meta-Analysis

BACKGROUND

Delayed onset muscle soreness (DOMS), also known as exercise-induced muscle damage (EIMD), is typically caused by strenuous and/or unaccustomed physical exercise. DOMS/EIMD manifests itself in reduced muscle strength and performance levels, increased muscle soreness, swelling, and elevated levels of inflammatory biomarkers. Numerous randomised controlled trials (RCTs) and systematic reviews (SRs) of a wide variety of physiotherapy interventions for reducing the signs and symptoms of DOMS/EIMD have been published. However, these SRs often arrive at contradictory conclusions, impeding decision-making processes.

OBJECTIVE

We will systematically review the current evidence on clinical outcomes (efficacy, safety) of physiotherapy interventions for the treatment of DOMS/EIMD in healthy adults. We will also assess the quality of the evidence and identify, map, and summarise data from the available SRs.

METHOD

Umbrella review with evidence map and meta-meta-analyses. MEDLINE, Embase, Cochrane Database of Systematic Reviews, Epistemonikos and PEDro will be searched from January 1998 until February 2024. SRs of RCTs of any treatment used by physiotherapists (e.g., low-level laser therapy, electrical stimulation, heat/cold therapy, ultrasound, magnets, massage, manual therapies) to treat DOMS/EIMD in healthy adults will be eligible. Narrative/non-systematic reviews, studies of adolescents/children and medically compromised individuals, of complementary therapies, dietary, nutritional, or pharmacological interventions, as well as self-administered interventions, or those published before 1998, will be excluded. AMSTAR 2 will be used to evaluate the methodological quality of the included SRs. Corrected covered area, will be computed for assessing overlaps among included SRs, and an evidence map will be prepared to describe the credibility of evidence for interventions analysed in the relevant SRs.

DISCUSSION

DOMS/EIMD is a complex condition, and there is no consensus regarding the standard of clinical/physiotherapeutic care. By critically evaluating the existing evidence, we aim to inform clinicians about the most promising therapies for DOMS/EIMD. This umbrella review has the potential to identify gaps in the existing evidence base that would inform future research. The protocol has been registered at PROSPERO (CRD42024485501].

Effects of Percussive Massage Treatments on Symptoms Associated with Eccentric Exercise-Induced Muscle Damage

Percussive massage (PM) is an emerging recovery treatment despite the lack of research on its effects post-eccentric exercise (post-EE). This study investigated the effects of PM treatments (immediately, 24, 48, and 72 h post-EE) on the maximal isometric torque (MIT), range of motion (ROM), and an 11-point numerical rating scale (NRS) of soreness of the nondominant arm's biceps brachii from 24-72 h post-EE. Seventeen untrained, college-aged subjects performed 60 eccentric elbow flexion actions with their nondominant arms. Nine received 1 minute of PM, versus eight who rested quietly (control [CON]). In order, NRS, ROM, and MIT (relative to body mass) were collected pre-eccentric exercise (pre-EE) and after treatment (AT) at 24, 48, and 72 h post-EE. NRS was also collected before treatment (BT). Electromyographic (EMG) and mechanomyographic (MMG) amplitudes were collected during the MIT and normalized to pre-EE. There were no interactions for MIT, EMG, or MMG, but there were interactions for ROM and NRS. For ROM, the PM group had higher values than the CON 24-72 h by ~6-8°, a faster return to pre-EE (PM: 48 h, CON: 72 h), and exceeded their pre-EE at 72 h by ~4°. The groups' NRS values did not differ BT 24-72 h; however, the PM group lowered their NRS from BT to AT within every visit by ~1 point per visit, which resulted in them having lower values than the CON from 24-72 h by ~2-3 points. Additionally, the PM group returned their NRS to pre-EE faster than the CON (PM: BT 72 h, CON: never). In conclusion, PM treatments may improve ROM without affecting isometric strength or muscle activation 24-72 h post-EE. Although the PM treatments did not enhance the recovery from delayed onset muscle soreness until 72 h, they consistently provided immediate, temporary relief when used 24-72 h post-EE.

Age-Associated Differences in Recovery from Exercise-Induced Muscle Damage

Understanding the intricate mechanisms governing the cellular response to resistance exercise is paramount for promoting healthy aging. This narrative review explored the age-related alterations in recovery from resistance exercise, focusing on the nuanced aspects of exercise-induced muscle damage in older adults. Due to the limited number of studies in older adults that attempt to delineate age differences in muscle discovery, we delve into the multifaceted cellular influences of chronic low-grade inflammation, modifications in the extracellular matrix, and the role of lipid mediators in shaping the recovery landscape in aging skeletal muscle. From our literature search, it is evident that aged muscle displays delayed, prolonged, and inefficient recovery. These changes can be attributed to anabolic resistance, the stiffening of the extracellular matrix, mitochondrial dysfunction, and unresolved inflammation as well as alterations in satellite cell function. Collectively, these age-related impairments may impact subsequent adaptations to resistance exercise. Insights gleaned from this exploration may inform targeted interventions aimed at enhancing the efficacy of resistance training programs tailored to the specific needs of older adults, ultimately fostering healthy aging and preserving functional independence.

Blood Flow Restricted Electrical Stimulations to Prevent or Attenuate Symptoms of Muscle Damage

The objective of this study was to determine if performing electrical stimulations (E-STIM) under blood flow restriction (BFR) would result in a greater protective effect against symptoms of muscle damage. 18 individuals (9 females) completed a damaging bout of exercise followed by a low frequency E-STIM treatment protocol on both arms, one of which was completed under BFR. The treatment protocol was then repeated 24-hours post-exercise. There were main effects of time for muscle thickness (pre: 3.5 cm; 48 h post: 3.8 cm; BF10 = 88.476), discomfort (pre: 0.0 au; 48 h post: 4.2 au; BF10 = 241.996), and isometric strength (pre: 278 N; 48 h post: 232 N; BF10 = 10,289.894) which all changed as a result of the damaging exercise protocol, but there were no differences between conditions [all Bayes Factors (BF10) < 0.28]. The effectiveness of low frequency E-STIM for preventing the onset of exercise-induced muscle damage would not appear to be enhanced if performed under BFR.

Effect of foam rolling recovery on pain and physical capacity after resistance exercises: A randomized crossover trial

OBJECTIVES

To compare the effects of passive recovery (PR), active recovery (AR), and recovery through self-massage with the aid of foam rolling (FRR) on pain and physical capacity in healthy volunteers after a resistance exercise (RE) session.

METHODS

The sample of this randomized crossover trial comprised 37 physically healthy men who underwent three sessions of RE (squat, leg press, and leg extension), involving four sets of 10 repetitions with 80% of 10MR, with an interval of seven days between sessions. PR consisted of sitting for 20min, AR included a cycle ergometer for 20min at 50% maximum heart rate, and FRR involved 10 repetitions per target body area, followed by 1min rest. Variables of physical capacity (strength, power, agility, joint range of motion, flexibility, speed, and fatigue resistance) were assessed 1h after RE, whereas pain was assessed 24h, 48h, and 72h after RE.

RESULTS

In the dominant lower limb, the percentage of strength decreased (p < 0.001) by 16.3% after RE but improved (p < 0.001) by 5.2% after AR and FRR in relation to PR. Similar results were observed in the non-dominant lower limb. Agility was enhanced (p < 0.001) by 3.6% in AR and 4.3% in FRR compared with the baseline assessment. The recoveries for the other physical variables were similar. Only FRR reduced (p < 0.001) pain at 24h (22.8%), 48h (39.2%), and 72h (59.7%) compared to PR.

CONCLUSIONS

Self-massage using a foam roll reduced pain and improved agility and muscle strength during recovery after exercise.

TRIAL REGISTRATION NUMBER

NCT04201977.

Grass-Fed and Non-Grass-Fed Whey Protein Consumption Do Not Attenuate Exercise-Induced Muscle Damage and Soreness in Resistance-Trained Individuals: A Randomized, Placebo-Controlled Trial

Eccentric muscle contractions can cause structural damage to muscle cells resulting in temporarily decreased muscle force production and soreness. Prior work indicates pasture-raised dairy products from grass-fed cows have greater anti-inflammatory and antioxidant properties compared to grain-fed counterparts. However, limited research has evaluated the utility of whey protein from pasture-raised, grass-fed cows to enhance recovery compared to whey protein from non-grass-fed cows. Therefore, using a randomized, placebo-controlled design, we compared the effect of whey protein from pasture-raised, grass-fed cows (PRWP) to conventional whey protein (CWP) supplementation on indirect markers of muscle damage in response to eccentric exercise-induced muscle damage (EIMD) in resistance-trained individuals. Thirty-nine subjects (PRWP, n = 14; CWP, n = 12) completed an eccentric squat protocol to induce EIMD with measurements performed at 24, 48, and 72 h of recovery. Dependent variables included: delayed onset muscle soreness (DOMS), urinary titin, maximal isometric voluntary contraction (MIVC), potentiated quadriceps twitch force, countermovement jump (CMJ), and barbell back squat velocity (BBSV). Between-condition comparisons did not reveal any significant differences (p ≤ 0.05) in markers of EIMD via DOMS, urinary titin, MIVC, potentiated quadriceps twitch force, CMJ, or BBSV. In conclusion, neither PRWP nor CWP attenuate indirect markers of muscle damage and soreness following eccentric exercise in resistance-trained individuals.

The use of sand as an alternative surface for training, injury prevention and rehabilitation in English professional football and barriers to implementation: a cross-sectional survey of medical staff

PURPOSE

The purpose of the present study was to investigate the use of sand as an alternative surface for training, injury prevention and rehabilitation interventions in English professional football. A Secondary aim was to explore the potential barriers to implementation.

MATERIALS AND METHODS

All 92 teams from the male English professional football pyramid during the 2021-22 season were eligible to take part. A cross-sectional survey of the medical personnel (one per club) was conducted between June 2021 and December 2021 based on the RE-AIM framework. A total of 58 respondents (63% of all clubs) completed the survey.

RESULTS AND CONCLUSIONS

Only 18 (31%) of the clubs surveyed used sand-based interventions across the last 3 seasons. Respondents felt sand-based interventions would be effective at improving physiological gains (median 4, interquartile range [IQR] 4-5) and as part of injury prevention and rehabilitation strategies (4, IQR 3-4) but were indifferent in relation to its potential to improve sporting performance (3, IQR 3-4). Barriers to implementation of sand-based interventions within wider football were a lack of facilities, lack of awareness of its potential benefits, lack of high-quality evidence and the surface not being specific to the sport. Medical staff also did not perceive that coaches' positively viewed sand interventions as a training or injury management strategy.

Probing muscle recovery following downhill running using precise mapping of MRI T2 relaxation times

PURPOSE

Postexercise recovery rate is a vital component of designing personalized training protocols and rehabilitation plans. Tracking exercise-induced muscle damage and recovery requires sensitive tools that can probe the muscles' state and composition noninvasively.

METHODS

Twenty-four physically active males completed a running protocol consisting of a 60-min downhill run on a treadmill at -10% incline and 65% of maximal heart rate. Quantitative mapping of MRI T2 was performed using the echo-modulation-curve algorithm before exercise, and at two time points: 1 h and 48 h after exercise.

RESULTS

T2 values increased by 2%-4% following exercise in the primary mover muscles and exhibited further elevation of 1% after 48 h. For the antagonist muscles, T2 values increased only at the 48-h time point (2%-3%). Statistically significant decrease in the SD of T2 values was found following exercise for all tested muscles after 1 h (16%-21%), indicating a short-term decrease in the heterogeneity of the muscle tissue.

CONCLUSION

MRI T2 relaxation time constitutes a useful quantitative marker for microstructural muscle damage, enabling region-specific identification for short-term and long-term systemic processes, and sensitive assessment of muscle recovery following exercise-induced muscle damage. The variability in T2 changes across different muscle groups can be attributed to their different role during downhill running, with immediate T2 elevation occurring in primary movers, followed by delayed elevation in both primary and antagonist muscle groups, presumably due to secondary damage caused by systemic processes.

Determination of the Effects of a Series of Ten Whole-Body Cryostimulation Sessions on Physiological Responses to Exercise and Skin Temperature Behavior following Exercise in Elite Athletes

The present study investigated the effects of a series of 10 whole-body cryostimulation (WBC) sessions (3 min; -110 °C) on physiological and thermal responses to a submaximal exercise test in 17 elite athletes. Participants performed an exercise test twice at similar levels of intensity before and after a series of ten WBC sessions. Before and during the test, each participant's oxygen uptake (VO2), heart rate (HR), internal temperature (Ti), and skin temperature in selected areas of the skin were measured, and the mean arterial pressure (MAP), physiological strain index (PSI), and mean skin temperature (Tsk) were calculated. The results show that during exercise, increases in Ti and the PSI were significantly lower after the WBC sessions, and although there were no significant changes in HR or the MAP, the Tsk was significantly higher. Following exercise, an increase in skin temperature asymmetry over the lower-body muscles was detected. A series of WBC sessions induced a tendency toward a decrease in temperature asymmetry over the thigh muscles. In conclusion, a series of ten WBC sessions does not induce significant modifications in physiological variables but does influence the PSI and Ti during exercise. Moreover, a series of ten WBC sessions influences the distribution of skin temperature and the magnitude of temperature asymmetries in the early phase of recovery.

Effects of stretch-shortening cycle fatigue protocol on lower limb asymmetry and muscle soreness in judo athletes

This study aimed to analyse unilateral countermovement jumps (CMJ) performance and muscle soreness in lower limbs, as well as to compare lower limb asymmetry over 48h after a stretch-shortening cycle (SSC) fatigue protocol. Fourteen judo athletes performed unilateral CMJ on each leg before, and after the 5th and 10th sets over 24h and 48h of an SSC-fatigue protocol. The SSC protocol reduced CMJ performance after the 5th set and 10th sets, especially in the weaker limb (p < 0.05), but returned to the baseline values after 24h. Asymmetry increased for peak force, peak power, and mean power after the 5th set compared to the baseline (p < 0.05) and remained higher for peak force after the 10th set (p = 0.019), returning to the baseline values after 24h (p < 0.05). Soreness increased for the lower body at post, 24h, and 48h compared to the baseline (p < 0.05). In conclusion, a fatiguing SSC protocol can result in increased bilateral asymmetries in judo athletes, but after 24h and 48h of the protocol the bilateral asymmetry returned to the baseline values, with only muscle soreness still elevated.

Effects of High-Intensity, Eccentric-Only Muscle Actions on Serum Biomarkers of Collagen Degradation and Synthesis

ABSTRACT

Neltner, TJ, Sahoo, PK, Smith, RW, Anders, JPV, Arnett, JE, Ortega, DG, Schmidt, RJ, Johnson, GO, Natarajan, SK, and Housh, TJ. Effects of high-intensity, eccentric-only muscle actions on serum biomarkers of collagen degradation and synthesis. J Strength Cond Res 37(9): 1729-1737, 2023-The purpose of this study was to examine the effects of high-intensity, eccentric-only muscle actions of the leg extensors on (a) serum biomarkers of collagen degradation (hydroxyproline [HYP] and C-terminal telopeptide of type I collagen [C1M]) and synthesis (pro-c1α1) and (b) the time course of changes in maximal voluntary isometric contraction (MVIC) and ratings of muscle soreness after the eccentric-only exercise bout. Twenty-five recreationally active men (mean ± SD: age = 21.2 ± 2.0 years) completed 5 sets of 10 bilateral, eccentric-only dynamic constant external resistance muscle actions of the leg extensors at a load of 110% of their concentric leg extension 1 repetition maximum. Analysis of variances (p < 0.05) and a priori planned pairwise comparisons using Bonferroni corrected (p < 0.0167) paired t tests were used to examine mean changes in blood biomarkers from baseline to 48 hours postexercise as well as in MVIC and soreness ratings immediately, 24 hours, and 48 hours postexercise. There were increases in HYP (3.41 ± 2.37 to 12.37 ± 8.11 μg·ml-1; p < 0.001) and C1M (2.50 ± 1.05 to 5.64 ± 4.89 μg·L-1; p = 0.003) from preexercise to 48 hours postexercise, but no change in pro-c1α1. Maximal voluntary isometric contraction declined immediately after the exercise bout (450.44 ± 72.80 to 424.48 ± 66.67 N·m; p = 0.002) but recovered 24 hours later, whereas soreness was elevated immediately (6.56 ± 1.58; p < 0.001), 24 hours (3.52 ± 1.53; p < 0.001), and 48 hours (2.60 ± 1.32; p = 0.001) postexercise. The eccentric-only exercise bout induced increases in collagen degradation but had no effect on collagen synthesis. These findings provide information for clinicians to consider when prescribing exercise after an acute injury or surgery.

Effects of a Tart Cherry Supplement on Recovery from Exhaustive Exercise

The aim of this study was to investigate the effects of a tart cherry supplement on recovery from exercise-induced muscle damage. Seventeen recreationally active women (mean age ± SD = 22.2 ± 3.3 years, height = 162.0 ± 6.0 cm, body mass = 65.1 ± 11.1 kg, BMI = 24.7 ± 3.5 kg·m2) supplemented with 1000 mg of concentrated tart cherry or a placebo for eight consecutive days. An overload protocol of 8 sets of 10 repetitions of maximal effort concentric and eccentric muscle actions of the leg extensors at a velocity of 60°·s-1 was performed on the fourth day of supplementation. Testing sessions consisted of a muscle function test (MFT) to examine pre- and post-testing peak torque, peak power, total work, time-to-peak torque, mean power, muscle activation of the quadriceps, and muscle soreness at baseline and post-testing at 0 h, 24 h, 48 h, and 72 h. A second trial of testing was repeated two weeks later using the opposite supplement to the one assigned for the first trial. No significant interaction for time × condition × velocity (p = 0.916) and no significant main effect for condition (p = 0.557) were demonstrated for peak torque. However, there were main effects for time and velocity for concentric quadriceps peak torque (p < 0.001). For muscle soreness, there was no two-way interaction for time x condition (p > 0.05) and no main effect for condition (p > 0.05), but there was a main effect for time (p < 0.001). In conclusion, a tart cherry supplement did not attenuate losses in isokinetic muscle peak torque, peak power, total work, time-to-peak torque, muscle soreness, or quadriceps muscle activation.

Effects of far-infrared radiation lamp therapy on recovery from muscle damage induced by eccentric exercise

The present study investigated the effects of a far-infrared radiation (FIR) lamp therapy on changes in muscle damage and proprioception markers after maximal eccentric exercise of the elbow flexors (EF: Study 1) and the knee flexors (KF: Study 2) in comparison to a sham treatment condition. In each study, 24 healthy sedentary women were assigned to a FIR or a sham treatment group (n = 12/group). They performed 72 maximal EF eccentric contractions (Study 1) or 100 maximal KF eccentric contractions (Study 2) with their non-dominant limbs. They received a 30-min FIR (wavelength: 8-14 µm) or sham treatment at 1, 25, 49, 73 and 97 h post-exercise to the exercised muscles. Maximum voluntary isometric contraction (MVC) torque, muscle soreness, plasma creatine kinase activity, and proprioception assessed by position sense, joint reaction angle, and force match were measured before, and 0.5, 24, 48, 72, 96 and 120 h post-exercise. The outcome measures showed significant changes (P < 0.05) at 0.5-hour post-exercise (before treatment) similarly (P > 0.05) between the conditions in both studies. However, changes in all measures at 24-120 h post-exercise were smaller (P < 0.05) for the FIR than sham condition in both studies. For example, MVC torque returned to the baseline by 72 h post-exercise for the FIR condition in both studies, but was still 19 ± 6% (Study 1) or 17 ± 12% (Study 2) lower than the baseline at 120 h post-exercise for the sham condition. These results suggested that the FIR lamp therapy was effective for accelerating recovery from muscle damage.

Astaxanthin Supplementation Does Not Affect Markers of Muscle Damage or Inflammation After an Exercise-Induced Muscle Damage Protocol in Resistance-Trained Males

ABSTRACT

Waldman, HS, Bryant, AR, Parten, AL, Grozier, CD, and McAllister, MJ. Astaxanthin supplementation does not affect markers of muscle damage or inflammation after an exercise-induced muscle damage protocol in resistance-trained males. J Strength Cond Res 37(7): e413-e421, 2023-It is well documented that exercise-induced muscle damage (EIMD) decreases exercise performance by elevated inflammation and subjective discomfort. Due to its potent antioxidative properties, astaxanthin (AX) may serve as a potential dietary supplement strategy for mitigating delayed-onset muscle soreness (DOMS) and enhancing recovery and performance. This study aimed to investigate the effects of AX on markers of muscle damage, inflammation, DOMS, and anaerobic performance and substrate metabolism. Thirteen resistance-trained men (mean ± SD , age, 23.4 ± 2.1 years) completed a double-blind, counterbalanced, and crossover design with a 1-week washout period between 2, 4-week supplementation periods at 12 mg·d -1 of AX or placebo. After each supplementation period, subjects completed 2 trials, with trial 1 including a graded exercise test (GXT) and a 30-second Wingate and trial 2 including an EIMD protocol followed by the collection of fasting blood samples (pre-post) to measure creatine kinase, advanced oxidative protein products, C-reactive protein, interleukin-6, insulin, and cortisol. Astaxanthin supplementation had no statistical effects on markers of substrate metabolism during the GXT, Wingate variables, or markers of muscle damage, inflammation, or DOMS when compared with placebo (all p > 0.05). However, 4 weeks of AX supplementation did significantly lower oxygen consumption during the final stage of the GXT (12%, p = 0.02), as well as lowered systolic blood pressure (∼7%, p = 0.04), and significantly lowered baseline insulin values (∼24%, p = 0.05) when compared with placebo. Collectively, these data suggest that 4 weeks of AX supplementation at 12 mg·d -1 did not affect markers of muscle damage, inflammation, or DOMS after an EIMD protocol in a resistance-trained male cohort.

Effectiveness of 448-kHz Capacitive Resistive Monopolar Radiofrequency Therapy After Eccentric Exercise-Induced Muscle Damage to Restore Muscle Strength and Contractile Parameters

CONTEXT

Exercise-induced muscle damage (EIMD) is prevalent especially in sports and rehabilitation. It causes loss in skeletal muscle function and soreness. As there are no firm preventive strategies, we aimed to evaluate the preventive efficacy of nonthermal 448-kHz capacitive resistive monopolar radiofrequency (CRMRF) therapy after eccentric bouts of EIMD response in knee flexors.

DESIGN

Twenty-nine healthy males (age: 25.2 [4.6] y) were randomized in control group (CG; n = 15) and experimental group (EG; n = 14) where EG followed 5 daily 448-kHz CRMRF therapies. All assessments were performed at baseline and post EIMD (EIMD + 1, EIMD + 2, EIMD + 5, and EIMD + 9 d). We measured tensiomyography of biceps femoris and semitendinosus to calculate contraction time, the maximal displacement and the radial velocity of contraction, unilateral isometric knee flexors maximal voluntary contraction torque, and rate of torque development in first 100 milliseconds.

RESULTS

Maximal voluntary contraction torque and rate of torque development in first 100 milliseconds decreased more in CG than in EG and recovered only in EG. Biceps femoris contraction time increased only in CG (without recovery), whereas in semitendinosus contraction time increased in EG (only at EIMD + 1) and in CG (without recovery). In both muscles, tensiomyographic maximal displacement decreased in EG (in EIMD + 1 and EIMD + 2) and in CG (without recovery). Furthermore, in both muscles, radial velocity of contraction decreased in EG (from EIMD + 1 until EIMD + 5) and in CG (without recovery).

CONCLUSION

The study shows beneficial effect of CRMRF therapy after inducing EIMD in skeletal muscle strength and contractile parameters in knee flexors.

The effect of dietary anthocyanins on biochemical, physiological, and subjective exercise recovery: a systematic review and meta-analysis

Anthocyanins (ACN), the sub-class of (poly)phenols responsible for the red-blue-purple pigmentation of fruit and vegetables, have gained considerable interest in sport and exercise research due to their potential to facilitate exercise recovery. A systematic literature search was performed using PubMed, The Cochrane Library, MEDLINE, SPORTDiscus and CINAHL. Thirty nine studies were included and the standardized mean difference (Hedges g) for creatine kinase (CK), anti-oxidative and inflammatory markers, strength, power and delayed onset muscle soreness (DOMS) indices were pooled in separate meta-analyses; meta-regression was also performed on reported ACN dose. Immediately post-exercise there was an increase in antioxidant capacity (g: 0.56) and reduced C reactive protein (g: -0.24) and tumor necrosis factor α (g: -40); p ≤ 0.02. Strength was improved with ACN at all time points (g: 0.45-0.67). DOMS (g: -0.23) was lower 24 hours post-exercise and power was improved 24 hours (g: 0.62) and 48 hours (g: 0.57) post exercise. The CK was lower 48 hours post-exercise (g: -0.31) and there was a trend for a positive association with ACN dose (p = 0.057). This systematic review provides new data showing ACN-rich foods promote functional and subjective recovery likely due to the antioxidant and anti-inflammatory properties of ACN.

Biomarkers of post-match recovery in semi-professional and professional football (soccer)

High-level football (soccer) players face intense physical demands that result in acute and residual fatigue, impairing their physical performance in subsequent matches. Further, top-class players are frequently exposed to match-congested periods where sufficient recovery times are not achievable. To evaluate training and recovery strategies, the monitoring of players' recovery profiles is crucial. Along with performance and neuro-mechanical impairments, match-induced fatigue causes metabolic disturbances denoted by changes in chemical analytes that can be quantified in different body fluids such as blood, saliva, and urine, thus acting as biomarkers. The monitoring of these molecules might supplement performance, neuromuscular and cognitive measurements to guide coaches and trainers during the recovery period. The present narrative review aims to comprehensively review the scientific literature on biomarkers of post-match recovery in semi-professional and professional football players as well as provide an outlook on the role that metabolomic studies might play in this field of research. Overall, no single gold-standard biomarker of match-induced fatigue exists, and a range of metabolites are available to assess different aspects of post-match recovery. The use of biomarker panels might be suitable to simultaneously monitoring these broad physiological processes, yet further research on fluctuations of different analytes throughout post-match recovery is warranted. Although important efforts have been made to address the high interindividual heterogeneity of available markers, limitations inherent to these markers might compromise the information they provide to guide recovery protocols. Further research on metabolomics might benefit from evaluating the long-term recovery period from a high-level football match to shed light upon new biomarkers of post-match recovery.

Curcumin-Added Whey Protein Positively Modulates Skeletal Muscle Inflammation and Oxidative Damage after Exhaustive Exercise

(1) Background: Exhaustive exercise can induce muscle damage. The consumption of nutritional compounds with the ability to positively influence the oxidative balance and an exacerbated inflammatory process has been previously studied. However, little is known about the nutritional value of curcumin (CCM) when mixed with whey protein concentrate (WPC). This study was developed to evaluate the effect of CCM-added WPC on inflammatory and oxidative process control and histopathological consequences in muscle tissue submitted to an exhaustive swimming test (ET). (2) Methods: 48 animals were randomly allocated to six groups (n = 8). An ET was performed 4 weeks after the start of the diet and animals were euthanized 24 h post ET. (3) Results: WPC + CCM and CCM groups reduced IL-6 and increased IL-10 expression in muscle tissue. CCM reduced carbonyl protein after ET compared to standard AIN-93M ET and WPC + CCM ET diets. Higher nitric oxide concentrations were observed in animals that consumed WPC + CCM and CCM. Consumption of WPC + CCM or isolated CCM reduced areas of inflammatory infiltrate and fibrotic tissue in the muscle. (4) Conclusions: WPC + CCM and isolated CCM contribute to the reduction in inflammation and oxidative damage caused by the exhaustive swimming test.

Effects of Acute Vitamin C plus Vitamin E Supplementation on Exercise-Induced Muscle Damage in Runners: A Double-Blind Randomized Controlled Trial

Considering the existing controversy over the possible role of acute antioxidant vitamins in reducing exercise-induced muscle damage (EIMD), this doubled-blind, randomized and controlled trial aimed to determine whether supplementation with vitamins C and E could mitigate the EIMD in endurance-trained runners (n = 18). The exercise protocol involved a warm-up followed by 6 to 8 bouts of 1 km running at 75% maximum heart rate (HRmax). Two hours before the exercise protocol, participants took the supplementation with vitamins or placebo, and immediately afterwards, blood lactate, rate of perceived exertion and performance were assessed. At 24 h post-exercise, CK, delayed onset muscle soreness and performance were determined (countermovement jump, squat jump and stiffness test). The elastic index and vertical stiffness were calculated using a stiffness test. Immediately after the exercise protocol, all participants showed improved maximum countermovement jump, which only persisted after 24 h in the vitamin group (p < 0.05). In both groups, squat jump height was significantly greater (p < 0.05) immediately after exercise and returned to baseline values after 24 h. The elastic index increased in the vitamin group (p < 0.05), but not in the placebo group. In both groups, lactate levels increased from pre- to immediately post-exercise (p < 0.05), and CK increased from pre- to 24 h post-exercise (p < 0.05). No significant differences between groups were observed in any of the variables (p > 0.05). Vitamin C and E supplementation does not seem to help with EIMD in endurance-trained individuals.

The Acute Effects of Milk Consumption on Systemic Inflammation after Combined Resistance and Plyometric Exercise in Young Adult Females

High-intensity/impact exercise elicits a transient increase in inflammatory biomarkers. Consuming nutrient-dense wholefoods, like milk, following exercise may modulate post-exercise inflammation and aid recovery. We examined the effect of post-exercise skim milk consumption (versus an isoenergetic, isovolumetric carbohydrate [CHO] drink) on acute exercise-induced inflammation in untrained females. Using a randomized crossover design, 13 healthy females (age = 20 ± 2.3 y; BMI = 21.0 ± 1.1 kg/m²) completed two bouts of combined resistance/plyometric exercise followed by either skim milk (MILK) or CHO at 5-min and 1 h post-exercise. Serum interleukin [IL]-1β, IL-6, IL-10, and tumor necrosis factor-alpha (TNF-α) concentrations were measured at pre-exercise, 15-min, 75-min, 24 h, and 48 h post-exercise. IL-6 increased 15-min post-exercise vs. all other timepoints (time effect, p = 0.017). Between 24 and 48 h, IL-10 decreased and increased in the MILK and CHO conditions, respectively (interaction, p = 0.018). There were no significant effects for IL-1β or TNF-α. Relative concentrations of IL-1β (p = 0.049) and IL-10 (p = 0.028) at 48 h post-exercise were lower in MILK vs. CHO. Milk post-exercise did not influence the absolute concentration of pro-inflammatory cytokines; however, there were divergent responses for the anti-inflammatory cytokine, IL-10, and milk reduced the relative inflammatory response at 48 h (vs. CHO) for IL-1β and IL-10. This demonstrates the potential for milk to modulate inflammation post-exercise in this sample.

Branched-Chain Amino Acids Supplementation Does Not Accelerate Recovery after a Change of Direction Sprinting Exercise Protocol

BCAAs supplementation has been widely used for post-exercise recovery. However, no evidence is currently available to answer the question of whether BCAAs supplementation can attenuate muscle damage and ameliorate recovery after a bout of change of direction (COD) sprinting, which is an exercise motion frequently used during team sport actions. This study aimed to assess the effect of BCAAs supplementation on muscle damage markers, subjective muscle soreness, neuromuscular performance, and the vascular health of collegiate basketball players during a 72 h recovery period after a standardized COD protocol. Participants orally received either BCAAs (0.17 g/kg BCAAs + 0.17 g/kg glucose) or placebo (0.34 g/kg glucose) supplementation before and immediately after a COD exercise protocol in a randomized, crossover, double-blind, and placebo-controlled manner. Creatine kinase increased immediately after exercise and peaked at 24 h, muscle soreness remained elevated until 72 h, whilst arterial stiffness decreased after exercise for both supplemented conditions. A negligibly lower level of interleukin-6 was found in the BCAAs supplemented condition. In conclusion, the results of this study do not support the benefits of BCAAs supplementation on mitigating muscle damage and soreness, neuromuscular performance, and arterial stiffness after COD for basketball players.

Exercise-Induced Muscle Damage and Protein Intake: A Bibliometric and Visual Analysis

Numerous studies have covered exercise-induced muscle damage (EIMD) topics, ranging from nutritional strategies to recovery methods, but few attempts have adequately explored and analyzed large volumes of scientific output. The purpose of this study was to assess the scientific output and research activity regarding EIMD and protein intake by conducting a bibliometric and visual analysis. Relevant publications from 1975-2022 were retrieved from the Web of Science Core Collection database. Quantitative and qualitative variables were collected, including the number of publications and citations, H-indexes, journals of citation reports, co-authorship, co-citation, and the co-occurrence of keywords. There were 351 total publications, with the number of annual publications steadily increasing. The United States has the highest total number of publications (26.21% of total publications, centrality 0.44). Institutional cooperation is mostly geographically limited, with few transnational cooperation links. EIMD and protein intake research is concentrated in high-quality journals in the disciplines of Sport Science, Physiology, Nutrition, and Biochemistry & Molecular Biology. The top ten journals in the number of publications are mostly high-quality printed journals, and the top ten journals in centrality have an average impact factor of 13.845. The findings of the co-citation clusters and major keyword co-occurrence reveal that the most discussed research topics are "exercise mode", "nutritional strategies", "beneficial outcomes", and "proposed mechanisms". Finally, we identified the following research frontiers and research directions: developing a comprehensive understanding of new exercise or training models, nutritional strategies, and recovery techniques to alleviate EIMD symptoms and accelerate recovery; applying the concept of hormesis in EIMD to induce muscle hypertrophy; and investigating the underlying mechanisms of muscle fiber and membrane damage.

Role of macrophages during skeletal muscle regeneration and hypertrophy-Implications for immunomodulatory strategies

Skeletal muscle is a plastic tissue that regenerates ad integrum after injury and adapts to raise mechanical loading/contractile activity by increasing its mass and/or myofiber size, a phenomenon commonly refers to as skeletal muscle hypertrophy. Both muscle regeneration and hypertrophy rely on the interactions between muscle stem cells and their neighborhood, which include inflammatory cells, and particularly macrophages. This review first summarizes the role of macrophages in muscle regeneration in various animal models of injury and in response to exercise-induced muscle damage in humans. Then, the potential contribution of macrophages to skeletal muscle hypertrophy is discussed on the basis of both animal and human experiments. We also present a brief comparative analysis of the role of macrophages during muscle regeneration versus hypertrophy. Finally, we summarize the current knowledge on the impact of different immunomodulatory strategies, such as heat therapy, cooling, massage, nonsteroidal anti-inflammatory drugs and resolvins, on skeletal muscle regeneration and their potential impact on muscle hypertrophy.

Exercise as an Aging Mimetic: A New Perspective on the Mechanisms Behind Exercise as Preventive Medicine Against Age-Related Chronic Disease

Age-related chronic diseases are among the most common causes of mortality and account for a majority of global disease burden. Preventative lifestyle behaviors, such as regular exercise, play a critical role in attenuating chronic disease burden. However, the exact mechanism behind exercise as a form of preventative medicine remains poorly defined. Interestingly, many of the physiological responses to exercise are comparable to aging. This paper explores an overarching hypothesis that exercise protects against aging/age-related chronic disease because the physiological stress of exercise mimics aging. Acute exercise transiently disrupts cardiovascular, musculoskeletal, and brain function and triggers a substantial inflammatory response in a manner that mimics aging/age-related chronic disease. Data indicate that select acute exercise responses may be similar in magnitude to changes seen with +10–50 years of aging. The initial insult of the age-mimicking effects of exercise induces beneficial adaptations that serve to attenuate disruption to successive “aging” stimuli (i.e., exercise). Ultimately, these exercise-induced adaptations reduce the subsequent physiological stress incurred from aging and protect against age-related chronic disease. To further examine this hypothesis, future work should more intricately describe the physiological signature of different types/intensities of acute exercise in order to better predict the subsequent adaptation and chronic disease prevention with exercise training in healthy and at-risk populations.

Senolytic treatment rescues blunted muscle hypertrophy in old mice

With aging, skeletal muscle plasticity is attenuated in response to exercise. Here, we report that senescent cells, identified using senescence-associated β-galactosidase (SA β-Gal) activity and p21 immunohistochemistry, are very infrequent in resting muscle, but emerge approximately 2 weeks after a bout of resistance exercise in humans. We hypothesized that these cells contribute to blunted hypertrophic potential in old age. Using synergist ablation-induced mechanical overload (MOV) of the plantaris muscle to model resistance training in adult (5-6-month) and old (23-24-month) male C57BL/6 J mice, we found increased senescent cells in both age groups during hypertrophy. Consistent with the human data, there were negligible senescent cells in plantaris muscle from adult and old sham controls, but old mice had significantly more senescent cells 7 and 14 days following MOV relative to young. Old mice had blunted whole-muscle hypertrophy when compared to adult mice, along with smaller muscle fibers, specifically glycolytic type 2x + 2b fibers. To ablate senescent cells using a hit-and-run approach, old mice were treated with vehicle or a senolytic cocktail consisting of 5 mg/kg dasatinib and 50 mg/kg quercetin (D + Q) on days 7 and 10 during 14 days of MOV; control mice underwent sham surgery with or without senolytic treatment. Old mice given D + Q had larger muscles and muscle fibers after 14 days of MOV, fewer senescent cells when compared to vehicle-treated old mice, and changes in the expression of genes (i.e., Igf1, Ddit4, Mmp14) that are associated with hypertrophic growth. Our data collectively show that senescent cells emerge in human and mouse skeletal muscle following a hypertrophic stimulus and that D + Q improves muscle growth in old mice.

The effect of date seed (Phoenix dactylifera) supplementation on inflammation, oxidative stress biomarkers, and performance in active people: A blinded randomized controlled trial protocol

Introduction

High-intensity interval training (HIIT) is an efficient training method to improve vascular function, maximal oxygen consumption, and muscle mitochondrial capacity while maximizing muscular damage. Recently, functional foods have been considered a practical approach to avoiding HIIT damage and improving sports performance. Thus, the present study will evaluate the effectiveness of date seed powder as a functional food on the nutritional, oxidative stress, anti/inflammatory status, mental health, and performance of active people.

Methods

This study is a double-blind, randomized, placebo-controlled trial, which will be conducted among recreational runners at Tabriz stadiums, Iran. Thirty-six recreational runners will be randomly selected into two groups to consume 26 g/d date seed powder or placebo for 14 days. Both groups will do HIIT workouts. Body composition, food intake, total antioxidant capacity (TAC), oxidative stress index (OSI), total oxidant status (TOS), superoxide dismutase (SOD), glutathione peroxidase (GPx), malondialdehyde (MDA), 8-iso-prostaglandin F2α (8-iso-PGF2α), uric acid, protein carbonyl (PC), catalase (CAT), glutathione (GSH), nitric oxide (NO), high-sensitivity C-reactive protein (hs-CRP), tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), interleukin-10 (IL-10), IL-6/IL-10, creatine kinase (CK), lactate dehydrogenase (LDH), myoglobin (MYO), brain-derived neurotrophic factor (BDNF), insulin-like growth factor-1 (IGF-1), irisin, cortisol, muscle pain, aerobic and anaerobic performance will be evaluated at the beginning, end of the intervention and 24 h later.

Ethics and dissemination

This study was approved by the Medical Ethics Committee of TBZMED (No.IR.TBZMED.REC.1399.1011). This research's findings will be published in a peer-reviewed journal and presented at international conferences.

Trial registration

Iranian Registry of Clinical Trials website (www.IRCT.ir/, IRCT20150205020965N9).

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Date seed powder may have the potential to improve exercise performance in healthy and active subjects performing HIIT bouts.

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The date seed is known as an excellent functional food due to its being high in polyphenols, and total dietary fiber.

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The consumption of date seed powder would improve oxidative stress, inflammation, mental health and performance.

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The results of this trial can be used to provide evidence-based recommendations for recreational runners, and nutritionists.

Monitoring Psychometric States of Recovery to Improve Performance in Soccer Players: A Brief Review

In order to maximize adaptations and to avoid nonfunctional overreaching syndrome or noncontact injury, coaches in high-performance sports must regularly monitor recovery before and after competitions/important training sessions and maintain well-being status. Therefore, quantifying and evaluating psychometric states of recovery during the season in sports teams such as soccer is important. Over the last years, there has been substantial growth in research related to psychometric states of recovery in soccer. The increase in research on this topic is coincident with the increase in popularity obtained by subjective monitoring of the pre-fatigue state of the players before each training sessions or match with a strong emphasis on the effects of well-being or recovery state. Among the subjective methods for players’ control, the Hooper index (HI) assesses the quality of sleep during the previous night, overall stress, fatigue, and delayed-onset muscle soreness. Additionally, the total quality of recovery (TQR) scale measures recovery status. The HI and TQR recorded before each training session or match were affected by the variability of training load (TL) and influenced the physical and technical performances, and the affective aspects of soccer players. Researchers have recommended wellness monitoring soccer players’ psychometric state of recovery before each training session or match in order to detect early signs of fatigue and optimize high-level training performance. This method allows for better detecting signs of individual fatigue and allows coaches to adapt and readjust the TL, and avoid physical and technical gaps in order to improve the performance of soccer players.

The effects of date seed (Phoenix dactylifera) supplementation on exercise-induced oxidative stress and aerobic and anaerobic performance following high-intensity interval training sessions: a randomised, double-blind, placebo-controlled trial

High-intensity interval training (HIIT) is an efficient method to improve vascular function, maximal oxygen consumption, and muscle mitochondrial capacity. However, acute HIIT overstresses the oxidative system and causes muscle soreness and damage. The aim of the present study was to investigate the effects of date seeds on exercise-induced oxidative stress and aerobic and anaerobic performance following HIIT sessions. Thirty-six physically active men and women aged 18-35 years were assigned to take 26 g/d of date seed powder (DSP, n 18) or wheat bran powder (placebo, n 18) before and after HIIT workouts for 14 d. Total antioxidant capacity (TAC), oxidative stress index (OSI), total oxidant status (TOS), superoxide dismutase (SOD), glutathione peroxidase (GPx), uric acid, malondialdehyde (MDA), and 8-iso-PGF2α were determined at baseline, at the end of the intervention, and 24-h post-intervention. We used the Cooper and running-based anaerobic sprint test to assess aerobic and anaerobic performance at the study's beginning and end. Independent-samples Student's t tests, ANCOVA and repeated-measures ANOVA were used to compare the quantitative variables. Positive changes were observed in TAC, TOS, OSI, GPx, MDA and visual analogue scale after intervention and at 24-h post-exercise (P < 0·05). Likewise, peak power and fatigue index were significantly improved in DSP in comparison with the placebo group. Levels of SOD, uric acid, 8-iso-PGF2α, VO2 max and average power were not changed after training. Our results showed that date seed supplementation in active participants performing HIIT bouts ameliorated oxidative stress and improved performance parameters.

Etiology and Recovery of Neuromuscular Function Following Academy Soccer Training

Aim: To profile the etiology and recovery time-course of neuromuscular function in response to a mixed-content, standard training week in professional academy soccer players. We concurrently examined physical performance, cognitive function, and perceptual measures of mood and wellness states to identify a range of simple tests applied practitioners could use in the field as surrogate measures of neuromuscular function.

Methods: Sixteen professional academy soccer players completed a range of neuromuscular, physical, perceptual, mood, and cognitive function tests at baseline and after a strenuous training day (pitch and gym), with retest at 24, 48, and 72 h, and further pitch and gym sessions after 48 h post-baseline. Maximal voluntary contraction force (MVC) and twitch responses to electrical stimulation (femoral nerve) during isometric knee-extensor contractions and at rest were measured to assess central nervous system (voluntary activation, VA) and muscle contractile (potentiated twitch force, Q_tw,pot) function.

Results: Strenuous training elicited decrements in MVC force post-session (−11%, p = 0.001) that remained unresolved at 72 h (−6%, p = 0.03). Voluntary activation (motor nerve stimulation) was reduced immediately post-training only (−4%, p = 0.03). No change in muscle contractile function (Q_tw,pot) was observed post-training, though was reduced at 24 h (−13%, p = 0.01), and had not fully recovered 72 h after (−9%, p = 0.03). Perceptions of wellness were impaired post-training, and recovered by 24 h (sleepiness, energy) and 48 h (fatigue, muscle soreness, readiness to train). Countermovement jump performance declined at 24 h, while RSI (Reactive Strength Index) decrements persisted at 48 h. No changes were evident in adductor squeeze, mood, or cognitive function.

Conclusion: Elite youth soccer training elicits substantial decrements in neuromuscular function, which are still present 72 h post-strenuous exercise. Though central processes contribute to post-exercise neuromuscular alterations, the magnitude and prolonged presence of impairments in contractile function indicates it is the restitution of muscular function (peripheral mechanisms) that explains recovery from strenuous training in academy soccer players.

Changes in torque complexity and maximal torque after a fatiguing exercise protocol

Torque outputs exhibit non-random fluctuations in their temporal structure, i.e., complexity. Fatigue has been shown to alter this structure. The torque outputs typically become more regular, resulting in decreased adaptability. Importantly, torque complexity was shown a different recovery pattern after fatigue compared to maximal torque. However, it remains to be understood if these uncoupled patterns of recovery are muscle dependent. In addition, it also remains to be investigated if changes in maximal torque and complexity are correlated. This study investigated (i) the effects of a fatiguing protocol on the complexity and maximal torque from plantar flexors and (ii) the relationship between changes in these two outputs. Ten participants visited the laboratory, and measures were taken at baseline, immediately after, 1 h after and 24 h after the fatiguing protocol. Maximum voluntary contraction, isometric contractions at 30% of maximum and pain pressure threshold were collected. Both legs were assessed, but only one was given the fatiguing protocol. Two-way ANOVAs and correlations were conducted. The fatiguing protocol decreased torque complexity (~35%) and maximal torque (~20%), and they exhibited uncoupled patterns of recovery. Moreover, the correlation analysis showed no correlation between changes in these parameters. These findings support that these parameters are independent of each other.

Can Compression Garments Reduce the Deleterious Effects of Physical Exercise on Muscle Strength? A Systematic Review and Meta-Analyses

Background

The use of compression garments (CGs) during or after training and competition has gained popularity in the last few decades. However, the data concerning CGs’ beneficial effects on muscle strength-related outcomes after physical exercise remain inconclusive.

Objective

The aim was to determine whether wearing CGs during or after physical exercise would facilitate the recovery of muscle strength-related outcomes.

Methods

A systematic literature search was conducted across five databases (PubMed, SPORTDiscus, Web of Science, Scopus, and EBSCOhost). Data from 19 randomized controlled trials (RCTs) including 350 healthy participants were extracted and meta-analytically computed. Weighted between-study standardized mean differences (SMDs) with respect to their standard errors (SEs) were aggregated and corrected for sample size to compute overall SMDs. The type of physical exercise, the body area and timing of CG application, and the time interval between the end of the exercise and subsequent testing were assessed.

Results

CGs produced no strength-sparing effects (SMD [95% confidence interval]) at the following time points (t) after physical exercise: immediately ≤ t < 24 h: − 0.02 (− 0.22 to 0.19), p = 0.87; 24 ≤ t < 48 h: − 0.00 (− 0.22 to 0.21), p = 0.98; 48 ≤ t < 72 h: − 0.03 (− 0.43 to 0.37), p = 0.87; 72 ≤ t < 96 h: 0.14 (− 0.21 to 0.49), p = 0.43; 96 h ≤ t: 0.26 (− 0.33 to 0.85), p = 0.38. The body area where the CG was applied had no strength-sparing effects. CGs revealed weak strength-sparing effects after plyometric exercise.

Conclusion

Meta-analytical evidence suggests that wearing a CG during or after training does not seem to facilitate the recovery of muscle strength following physical exercise. Practitioners, athletes, coaches, and trainers should reconsider the use of CG as a tool to reduce the effects of physical exercise on muscle strength.

Trial Registration Number

PROSPERO CRD42021246753.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40279-022-01681-4.

Effect of Caffeine Ingestion on Indirect Markers of Exercise-Induced Muscle Damage: A Systematic Review of Human Trials

The effect of caffeine on mitigating exercise-induced muscle damage (EIMD) is still poorly understood, but it was hypothesized that caffeine could contribute to decreasing delayed onset muscle soreness, attenuating temporary loss of strength, and reducing circulating levels of blood markers of muscle damage. However, evidence is not conclusive and beneficial effects of caffeine ingestion on EIMD are not always observed. Factors, such as the type of exercise that induces muscle damage, supplementation protocol, and type of marker analyzed contribute to the differences between the studies. To expand knowledge on the role of caffeine supplementation in EIMD, this systematic review aimed to investigate the effect of caffeine supplementation on different markers of muscle damage. Fourteen studies were included, evaluating the effect of caffeine on indirect muscle damage markers, including blood markers (nine studies), pain perception (six studies), and MVC maximal voluntary contraction force (four studies). It was observed in four studies that repeated administration of caffeine between 24 and 72 h after muscle damage can attenuate the perception of pain in magnitudes ranging from 3.9% to 26%. The use of a single dose of caffeine pre-exercise (five studies) or post-exercise (one study) did not alter the circulating blood levels of creatine kinase (CK). Caffeine supplementation appears to attenuate pain perception, but this does not appear to be related to an attenuation of EIMD, per se. Furthermore, the effect of caffeine supplementation after muscle damage on strength recovery remains inconclusive due to the low number of studies found (four studies) and controversial results for both dynamic and isometric strength tests.

Functional Properties of Meat in Athletes’ Performance and Recovery

Physical activity (PA) and sport play an essential role in promoting body development and maintaining optimal health status both in the short and long term. Despite the benefits, a long-lasting heavy training can promote several detrimental physiological changes, including transitory immune system malfunction, increased inflammation, and oxidative stress, which manifest as exercise-induced muscle damages (EIMDs). Meat and derived products represent a very good source of bioactive molecules such as proteins, lipids, amino acids, vitamins, and minerals. Bioactive molecules represent dietary compounds that can interact with one or more components of live tissue, resulting in a wide range of possible health consequences such as immune-modulating, antihypertensive, antimicrobial, and antioxidative activities. The health benefits of meat have been well established and have been extensively reviewed elsewhere, although a growing number of studies found a significant positive effect of meat molecules on exercise performance and recovery of muscle function. Based on the limited research, meat could be an effective post-exercise food that results in favorable muscle protein synthesis and metabolic performance.

The Effect of Pressotherapy on Performance and Recovery in the Management of Delayed Onset Muscle Soreness: A Systematic Review and Meta-Analysis

Background: It has been demonstrated that pressotherapy used post-exercise (Po-E) can influence training performance, recovery, and physiological properties. This study examined the effectiveness of pressotherapy on the following parameters. Methods: The systematic review and meta-analysis were performed according to PRISMA guidelines. A literature search of MEDLINE, PubMed, EBSCO, Web of Science, SPORTDiscus, and ClinicalTrials has been completed up to March 2021. Inclusion criteria were: randomized control trials (RCTs) or cross-over studies, mean participant age between 18 and 65 years, ≥1 exercise mechanical pressotherapy intervention. The risk of bias was assessed by the Cochrane risk-of-bias tool for RCT (RoB 2.0). Results: 12 studies comprised of 322 participants were selected. The mean sample size was n = 25. Pressotherapy significantly reduced muscle soreness (Standard Mean Difference; SMD = −0.33; CI = −0.49, −0.18; p < 0.0001; I2 = 7%). Pressotherapy did not significantly affect jump height (SMD = −0.04; CI = −0.36, −0.29; p = 0.82). Pressotherapy did not significantly affect creatine kinase level 24−96 h after DOMS induction (SMD = 0.41; CI = −0.07, 0.89; p = 0.09; I2 = 63%). Conclusions: Only moderate benefits of using pressotherapy as a recovery intervention were observed (mostly for reduced muscle soreness), although, pressotherapy did not significantly influence exercise performance. Results differed between the type of exercise, study population, and applied treatment protocol. Pressotherapy should only be incorporated as an additional component of a more comprehensive recovery strategy. Study PROSPERO registration number—CRD42020189382.

Effects of the combination of vitamins C and E supplementation on oxidative stress, inflammation, muscle soreness, and muscle strength following acute physical exercise: meta-analyses of randomized controlled trials

Background:The combined supplementation of vitamins C and E potentially can mitigate oxidative stress (OS) and accelerate recovery following exercise. However, there is little evidence and a lack of consensus on the effects of these vitamins for this purpose. The objective of this systematic review was to summarize the evidence on the effects of the combined supplementation of vitamins C and E in OS, inflammatory markers, muscle damage, muscle soreness, and musculoskeletal functionality following acute exercise. Methods: The search was carried out from inception until March 2021, on MEDLINE, EMBASE, Cochrane CENTRAL, Web of Science, and SPORT Discus. We included placebo-controlled randomized clinical trials (RCTs) that evaluated the effects of combined supplementation of vitamins C and E in OS, inflammatory markers, muscle damage, muscle soreness, and muscle strength following a single bout of exercise. Random-effect meta-analyses were used to compare pre to post-exercise mean changes in subjects who received supplementation with vitamins C and E or placebo versus controls. Data are presented as standard mean difference (SMD) and 95% confidence interval (95% CI). Results: Eighteen RCTs, accounting for data from 322 individuals, were included. The use of vitamins attenuated lipid peroxidation (SMD= -0.703; 95% CI= -1.035 to -0.372; p < 0.001), IL-6 (SMD= -0.576; 95%CI= -1.036 to -0.117; p = 0.014), and cortisol levels (SMD= -0.918; 95%CI= -1.475 to -0.361; p = 0.001) immediately, and creatine kinase levels 48 h following exercise (SMD= -0.991; 95%CI= -1.611 to -0.372; p = 0.002). Supplementing the combination of vitamins had no effects on protein carbonyls, reduced/oxidized glutathione ratio, catalase, interleukin-1Ra, C-reactive protein, lactate dehydrogenase, muscle soreness, and muscle strength. Conclusion: Prior supplementation of the combination of vitamins C and E attenuates OS (lipid peroxidation), the inflammatory response (interleukin-6), cortisol levels, and muscle damage (creatine kinase) following a session of exercise.

Evaluating the Effects of Increased Protein Intake on Muscle Strength, Hypertrophy and Power Adaptations with Concurrent Training: A Narrative Review

Concurrent training incorporates dual exercise modalities, typically resistance and aerobic-based exercise, either in a single session or as part of a periodized training program, that can promote muscle strength, mass, power/force and aerobic capacity adaptations for the purposes of sports performance or general health/wellbeing. Despite multiple health and exercise performance-related benefits, diminished muscle hypertrophy, strength and power have been reported with concurrent training compared to resistance training in isolation. Dietary protein is well-established to facilitate skeletal muscle growth, repair and regeneration during recovery from exercise. The degree to which increased protein intake can amplify adaptation responses with resistance exercise, and to a lesser extent aerobic exercise, has been highly studied. In contrast, much less focus has been directed toward the capacity for protein to enhance anabolic and metabolic responses with divergent contractile stimuli inherent to concurrent training and potentially negate interference in muscle strength, power and hypertrophy. This review consolidates available literature investigating increased protein intake on rates of muscle protein synthesis, hypertrophy, strength and force/power adaptations following acute and chronic concurrent training. Acute concurrent exercise studies provide evidence for the significant stimulation of myofibrillar protein synthesis with protein compared to placebo ingestion. High protein intake can also augment increases in lean mass with chronic concurrent training, although these increases do not appear to translate into further improvements in strength adaptations. Similarly, the available evidence indicates protein intake twice the recommended intake and beyond does not rescue decrements in selective aspects of muscle force and power production with concurrent training.

Circulating Concentration of Chemical Elements During Exercise-Induced Muscle Damage and the Repeated Bout Effect

The objective of the study was to evaluate the circulating levels of chemical elements after exercise-induced muscle damage (EIMD) followed by the repeated bout effect (RBE). Seven physically active subjects (26.5 ± 4.0 years) performed two sessions of EIMD (5 sets of 20 drop jumps), the second session 14 days after the first for RBE assessment. Blood collections, countermovement jump (CMJ), squat jump (SJ), and delayed-onset muscle soreness (DOMS) were performed before (Pre), after (Post), and 24, 48, and 72 h after the exercise session. Creatine kinase (CK) was detected by biochemical analysis and the concentration of chemical elements by total reflection X-ray fluorescence (TXRF). Differences between time points and sessions were assessed with two-way ANOVA and the effect size (ES). EIMD induced a reduction in the CMJ at 24 h (P < 0.05) and an increase in DOMS at 24 h (P < 0.01) and 48 h (P < 0.01), and CK at 72 h (P < 0.05). RBE alleviated all symptoms of EIMD in the second session (P > 0.05). EIMD induced a large to very large ES for Zn reduction at 24 h (- 1.37) and 72 h (- 0.93) and Br (- 0.83) at 72 h. RBE presented large to very large ES for the increase in P at 48 h (0.92); Cl at 24 h (1.04); K at 24 h (0.91), 48 h (1.10), and 72 h (0.96); Ca at 72 h (0.92); and Fe at 24 h (0.85). RBE influenced the concentration of elements associated with fatigue (K, Ca, Cl), inflammatory response, and glucose metabolism (Zn).

Transcriptomic adaptation during skeletal muscle habituation to eccentric or concentric exercise training

Eccentric (ECC) and concentric (CON) contractions induce distinct muscle remodelling patterns that manifest early during exercise training, the causes of which remain unclear. We examined molecular signatures of early contraction mode-specific muscle adaptation via transcriptome-wide network and secretome analyses during 2 weeks of ECC- versus CON-specific (downhill versus uphill running) exercise training (exercise 'habituation'). Despite habituation attenuating total numbers of exercise-induced genes, functional gene-level profiles of untrained ECC or CON were largely unaltered post-habituation. Network analysis revealed 11 ECC-specific modules, including upregulated extracellular matrix and immune profiles plus downregulated mitochondrial pathways following untrained ECC. Of 3 CON-unique modules, 2 were ribosome-related and downregulated post-habituation. Across training, 376 ECC-specific and 110 CON-specific hub genes were identified, plus 45 predicted transcription factors. Secreted factors were enriched in 3 ECC- and/or CON-responsive modules, with all 3 also being under the predicted transcriptional control of SP1 and KLF4. Of 34 candidate myokine hubs, 1 was also predicted to have elevated expression in skeletal muscle versus other tissues: THBS4, of a secretome-enriched module upregulated after untrained ECC. In conclusion, distinct untrained ECC and CON transcriptional responses are dampened after habituation without substantially shifting molecular functional profiles, providing new mechanistic candidates into contraction-mode specific muscle regulation.

Effect of repeated eccentric exercise on muscle damage markers and motor unit control strategies in arm and hand muscle

To examine the contralateral repeated bout effect (CL-RBE) on muscle damage markers and motor unit (MU) control strategies, seventeen healthy adults performed two bouts of 60 eccentric contractions with elbow flexor (EF group; n ​= ​9) or index finger abductor (IA group; n ​= ​8) muscles, separated by 1 week. All participants randomly performed eccentric exercise on either the right or left arm or hand muscles, and muscle damage markers and submaximal trapezoid contraction tests were conducted pre, post, 1- and 2-day post eccentric protocol. One week after the first bout, the same exercise protocol and measurements were performed on the contralateral muscles. Surface electromyographic (EMG) signals were collected from biceps brachii (BB) or first dorsal interosseous (FDI) during maximal and submaximal tests. The linear regression analyses were used to examine MU recruitment threshold versus mean firing rate and recruitment threshold versus derecruitment threshold relationships. EMG amplitude from BB (bout 1 vs. bout 2 ​= ​65.71% ​± ​22.92% vs. 43.05% ​± ​18.97%, p ​= ​0.015, d ​= ​1.077) and the y-intercept (group merged) from the MU recruitment threshold versus derecruitment threshold relationship (bout 1 vs. bout 2 ​= ​−7.10 ​± ​14.20 vs. 0.73 ​± ​16.24, p ​= ​0.029, d ​= ​0.513) at 50% MVIC were significantly different between two bouts. However, other muscle damage markers did not show any CL-RBE in both muscle groups. Therefore, despite changes in muscle excitation and MU firing behavior, our results do not support the existence of CL-RBE on BB and FDI muscles.

Quantifying Fatigue in the Rugby Codes: The Interplay Between Collision Characteristics and Neuromuscular Performance, Biochemical Measures, and Self-Reported Assessments of Fatigue

Locomotor and collision actions that rugby players complete during match-play often lead to substantial fatigue, and in turn, delays in recovery. The methods used to quantify post-match fatigue and recovery can be categorised as subjective and objective, with match-related collision characteristics thought to have a primary role in modulating these recovery measures. The aim of this review was to (1) evaluate how post-match recovery has been quantified in the rugby football codes (i.e., rugby league, rugby union, and rugby sevens), (2) to explore the time-course of commonly used measures of fatigue post-match, and (3) to investigate the relationships between game-related collisions and fatigue metrics. The available evidence suggests that upper-, and lower-body neuromuscular performance are negatively affected, and biomarkers of muscular damage and inflammation increase in the hours and days following match-play, with the largest differences being at 12–36 h post-match. The magnitude of such responses varies within and between neuromuscular performance (Δ ≤ 36%, n = 13 studies) and tissue biomarker (Δ ≤ 585%, n = 18 studies) measures, but nevertheless appears strongly related to collision frequency and intensity. Likewise, the increase in perceived soreness in the hours and days post-match strongly correlate to collision characteristics across the rugby football codes. Within these findings, there are specific differences in positional groups and recovery trajectories between the codes which relate to athlete characteristics, and/or locomotor and collision characteristics. Finally, based on these findings, we offer a conceptual model of fatigue which details the multidimensional latent structure of the load to fatigue relationship contextualised to rugby. Research to date has been limited to univariate associations to explore relationships between collision characteristics and recovery, and multivariate methods are necessary and recommended to account for the latent structures of match-play external load and post-match fatigue constructs. Practitioners should be aware of the typical time windows of fatigue recovery and utilise both subjective and objective metrics to holistically quantify post-match recovery in rugby.

Effect of Daily Oral Lactobacillus plantarum PS128 on Exercise Capacity Recovery after a Half-Marathon

A half-marathon (HM) is a vigorous high-intensity exercise, which could induce lower extremity musculoskeletal injury risks for recreational runners. They usually consume nonsteroidal anti-inflammatory drugs (NSAIDs) in order to shorten their return to play but ignore the side effects, such as peptic ulcers and renal and vascular disorders. Lactobacillus plantarum PS128 (PS128) could improve inflammation and oxidative stress by modulating the gut microbiota, thus potentially improving muscle damage and recovery. However, few studies have addressed the PS128 exercise capacity recovery 96 h after HM. Thus, this study aimed to investigate the effect of PS128 on exercise capacity and physiological adaptation after HM. A double-blind, randomized, placebo-controlled, counterbalanced, crossover trial was used for the experiment. HM was conducted at the beginning and end of the 4-week nutritional supplement administration. Eight recreational runners took two capsules (3 × 10¹⁰ CFU/capsule) of PS128 each morning and evening before meals for 4 weeks as the PS128 treatment (LT), or they took two capsules of placebo for 4 weeks as the placebo treatment (PT). In both treatments, an exercise capacity test (lower extremity muscle strength, anaerobic power, lower extremity explosive force, and aerobic capacity) and blood test (muscle fatigue, muscle damage, oxidative stress, and renal injury) were performed before the administration of the nutritional supplement (baseline), 48 h before HM (pre), and 0 h (0 h post), 3 h (3 h post), 24 h (24 h post), 48 h (48 h post), 72 h (72 h post), and 96 h (96 h post) after HM. There was no significant difference in the total duration of HM between PT and LT, but PT was found to be significantly higher than LT at Stage 4 (15,751–21,000 m) of HM (3394 ± 727 s vs. 2778 ± 551 s, p = 0.02). The lower extremity muscle strength measured using an isokinetic dynamometer in PT was significantly lower than that in LT at 72 h after HM. The lower extremity explosive force from the countermovement jump (CMJ) in PT was significantly decreased compared to 24 h prior. There was no significant difference between anaerobic power and aerobic capacity between the two treatments after HM. After HM, LT had lower muscle damage indices, such as myoglobin (3 h post-PT vs. -LT: 190.6 ± 118 ng/mL vs. 91.7 ± 68.6 ng/mL, p < 0.0001) and creatine phosphokinase (24 h post-PT vs. -LT: 875.8 ± 572.3 IU/L vs. 401 ± 295.7 IU/L, p < 0.0001). Blood urea nitrogen recovered in 24 h (24 h pre- vs. post-LT, p > 0.05) and higher superoxide dismutase was found in LT (96 h post-PT vs. -LT: 0.267 ± 0.088 U/mL vs. 0.462 ± 0.122 U/mL, p < 0.0001). In conclusion, PS128 supplementation was associated with an improvement in muscle damage, renal damage, and oxidative stress caused by HM through microbiota modulation and related metabolites but not in exercise capacity.

Regular, but not acute, green tea supplementation increases total antioxidant status and reduces exercise-induced oxidative stress: a systematic review

This systematic review aims to investigate the effects of green tea supplementation on exercise-induced oxidative stress. Four electronic databases were searched from inception to December 2020: SPORTDiscuss, PubMed, Scopus, and Web of Science. The search strategy was established in the following manner: (green tea) (Title/Abstract) AND (exercise OR training) (Title/Abstract) AND (oxidative stress OR antioxidant OR oxidation) (Title). After the application of inclusion and exclusion criteria 11, randomized or non-randomized control trials were included, 6 with a parallel design and 5 with a crossover design. Study methodological quality was assessed with the PEDro scale, and all studies were considered of moderate quality. Overall, acute green tea ingestion does not appear to influence antioxidant status or reduce exercise-induced oxidative stress. In contrast, green tea supplementation before exercise, for periods of more than 1 week, in a dose range of 400 to 800 mg of catechins per day, appears to be efficacious to increase total antioxidant status and protect cells against exercise-induced oxidative stress. Future investigations should focus on beginning green tea supplementation more than 7 days before exercise and completing it 2 or 3 days after while monitoring the change of markers of oxidative stress up to 48-72 h after exercise.