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Nutritional interventions for reducing the signs and symptoms of exercise-induced muscle damage and accelerate recovery in athletes: current knowledge, practical application and future perspectives

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  • Published:
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Abstract

Purpose

This review provides an overview of the current knowledge of the nutritional strategies to treat the signs and symptoms related to EIMD. These strategies have been organized into the following sections based upon the quality and quantity of the scientific support available: (1) interventions with a good level of evidence; (2) interventions with some evidence and require more research; and (3) potential nutritional interventions with little to-no-evidence to support efficacy.

Method

Pubmed, EMBASE, Scopus and Web of Science were used. The search terms ‘EIMD’ and ‘exercise-induced muscle damage’ were individually concatenated with ‘supplementation’, ‘athletes’, ‘recovery’, ‘adaptation’, ‘nutritional strategies’, hormesis’.

Result

Supplementation with tart cherries, beetroot, pomegranate, creatine monohydrate and vitamin D appear to provide a prophylactic effect in reducing EIMD. β-hydroxy β-methylbutyrate, and the ingestion of protein, BCAA and milk could represent promising strategies to manage EIMD. Other nutritional interventions were identified but offered limited effect in the treatment of EIMD; however, inconsistencies in the dose and frequency of interventions might account for the lack of consensus regarding their efficacy.

Conclusion

There are clearly varying levels of evidence and practitioners should be mindful to refer to this evidence-base when prescribing to clients and athletes. One concern is the potential for these interventions to interfere with the exercise-recovery-adaptation continuum. Whilst there is no evidence that these interventions will blunt adaptation, it seems pragmatic to use a periodised approach to administering these strategies until data are in place to provide and evidence base on any interference effect on adaptation.

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Fig. 1
Fig. 2

adapted from Howatson et al. (2016). Hormesis theory in the context of nutritional interventions for the management of EIMD. This framework suggests that the adaptive response to EIMD presents as a bell-shaped curve. A positive effect of the exercise stress exists to a point when the exposure becomes too great, and thereafter there is an impaired adaptive response. Using this theory, we suggest a conceptual region for intervention (yellow text box) where the exercise stress impairs timely return to training and competition or is detrimental to adaptation

Fig. 3

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Abbreviations

EIMD:

Exercise-induced muscle damage

ROM:

Range of motion

CK:

Creatine kinase

LDH:

Lactate dehydrogenase

MYO:

Myoglobin

CRP:

C-reactive protein

ACTN3:

Gene that encodes the α-actinin-3 protein

TNF:

Tumour necrosis factor

IL-6:

Interleukin-6

IGF2:

Insulin-like growth factor 2

ECM:

Extracellular matrix

RBE:

Repeated bout effect

E-C:

Excitation contraction

NGF:

Nerve growth factor

GDNF:

Glial cell line-derived neurotrophic factor

PLA2 :

Phospholipase A2

FFA:

Free fatty acids

EPA:

Eicosapentaenoic acid

DHA:

Docosahexaenoic acid

CMJ:

Countermovement jump

RSI:

Reactive strength index

BCAA:

Branched chain amino acids

CMJ:

Counter movement jump

AST:

Aspartate aminotransferase

ALT:

Alanine aminotransferase

1-RM:

One-repetition-maximum

MDA:

Malondialdehyde

PC:

Protein carbonyls

MSM:

Methylsulfonylmethane

RONS:

Reactive oxygen and nitrogen species

MVC:

Maximal voluntary contraction

PNS:

Polar-nonpolar-sandwich

VAS:

Visual analogic scale

TBARS:

Thiobarbituric acid reactive substances

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Authors and Affiliations

  1. Department of Health, Performance and Recovery, Parma Calcio 1913, Parma, Italy

    Tindaro Bongiovanni

  2. Medical Department Manchester City Football Club, Manchester, UK

    Federico Genovesi

  3. Nutrition Department Liverpool Football Club, Liverpool, UK

    Monika Nemmer

  4. Centre for Elite Performance, French Football Federation, 75015, Paris, France

    Christopher Carling

  5. Department of Biomedical Sciences for Health, Università Degli Studi Di Milano, Milano, Italy

    Tindaro Bongiovanni & Giampietro Alberti

  6. Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, UK

    Glyn Howatson

  7. Water Research Group, North West University, Potchefstroom, South Africa

    Glyn Howatson

Authors
  1. Tindaro Bongiovanni
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  2. Federico Genovesi
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  3. Monika Nemmer
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  4. Christopher Carling
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  5. Giampietro Alberti
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  6. Glyn Howatson
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Contributions

TB: had the original idea of the paper. FG, TB, MN and CC: substantial contribution to conception and design and interpretation of data; drafting the work and revising it critically. GA and GH substantial contribution to revising it critically. All authors gave final approval of the version to be published and agree to be accountable for all aspects of the work.

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Correspondence to Tindaro Bongiovanni.

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Bongiovanni, T., Genovesi, F., Nemmer, M. et al. Nutritional interventions for reducing the signs and symptoms of exercise-induced muscle damage and accelerate recovery in athletes: current knowledge, practical application and future perspectives. Eur J Appl Physiol 120, 1965–1996 (2020). https://doi.org/10.1007/s00421-020-04432-3

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