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Flavonoid Containing Polyphenol Consumption and Recovery from Exercise-Induced Muscle Damage: A Systematic Review and Meta-Analysis

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Abstract

Background

Flavonoid polyphenols are bioactive phytochemicals found in fruits and teas among other sources. It has been postulated that foods and supplements containing flavonoid polyphenols may enhance recovery from exercise-induced muscle damage (EIMD) through upregulation of cell signalling stress response pathways, particularly the nuclear factor erythroid 2–related factor 2 (NRF2) pathway.

Objectives

This study aims to investigate the ability of polyphenol treatments containing flavonoids to enhance recovery of skeletal muscle strength, soreness and creatine kinase post EIMD.

Methods

Medline (Pubmed), Embase and SPORTdiscus were searched from inception to August 2020 for randomised placebo-controlled trials which assessed the impact of 6 or more days of flavonoid containing polyphenol ingestion on skeletal muscle recovery in the 96-h period following a single bout of EIMD. A total of 2983 studies were screened in duplicate resulting in 26 studies included for analysis. All meta-analyses were undertaken using a random-effects model.

Results

The pooled results of these meta-analyses show flavonoid polyphenol treatments can enhance recovery of muscle strength by 7.14% (95% CI [5.50–8.78], P < 0.00001) and reduce muscle soreness by 4.12% (95% CI [− 5.82 to − 2.41] P = 0.00001), no change in the recovery of creatine kinase concentrations was observed.

Conclusion

These results indicate that ingestion of polyphenol treatments which contain flavonoids has significant potential to improve recovery of muscular strength and reduce muscle soreness in the 4-day period post EIMD. However, the characterisation of polyphenol dosage and composition of study treatments should be prioritised in future research to facilitate the development of specific guidelines for the inclusion of flavonoid-rich foods in the diet of athletes and active individuals.

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Abbreviations

EIMD:

Exercise-induced muscle damage

CI:

Confidence interval

Ca2 + :

Calcium ion

ROS:

Reactive oxygen species

DOMS:

Delayed onset muscle soreness

RCTs:

Randomised controlled trials

VAS:

Visual Analogue Scale

CK:

Creatine kinase

MVC:

Maximal voluntary contraction

SEM:

Standard error of mean

SD:

Standard deviation

MD:

Mean difference

CMJ:

Countermovement jump

RSI:

Reactive Strength Index

NRF2:

Nuclear factor erythroid 2–related factor 2

PPT:

Pressure pain threshold

EFSA:

European Food Safety Authority

TPC:

Total phenolic content

PI:

Prediction interval

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Authors and Affiliations

  1. Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, University College Cork, Cork, Ireland

    Conor C. Carey & Alice Lucey

  2. Department of Sport and Exercise Science, Waterford Institute of Technology, Waterford, Ireland

    Lorna Doyle

Authors
  1. Conor C. Carey
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  2. Alice Lucey
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  3. Lorna Doyle
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Correspondence to Lorna Doyle.

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Funding

Information that explains whether and by whom the research was supported: the research leading to these results was funded by the Irish Department of Agriculture, Food and the Marine, under the Food Institutional Research Measure (FIRM) Agreement no. 17F277 (2018-2022).

Conflict of interest

Conor C. Carey, Alice Lucey, and Lorna Doyle declare that they have no conflict of interest.

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Availability of data and material

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

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All authors contributed to the study conception and design. Duplicate screening of studies was performed by Conor C. Carey and Lorna Doyle. Data analysis was undertaken by Conor C. Carey. The first draft of the manuscript was written by Conor C. Carey and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Carey, C.C., Lucey, A. & Doyle, L. Flavonoid Containing Polyphenol Consumption and Recovery from Exercise-Induced Muscle Damage: A Systematic Review and Meta-Analysis. Sports Med 51, 1293–1316 (2021). https://doi.org/10.1007/s40279-021-01440-x

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