Effect of polyphenol-rich foods, juices, and concentrates on recovery from exercise induced muscle damage:a systematic review and meta-analysis

Objectives. To determine the effects of consuming polyphenol-rich foods, juices and concentrates on recovery from exercise-induced muscle damage (EIMD). Method. Eligibility criteria. Randomised and quasi-randomised placebo-controlled trials with a parallel or cross-over design evaluating the effects of consuming polyphenol-rich foods, juices and concentrates on recoveryfrom EIMD in humans. Eligible studies included at least one of the primary outcome measures: maximal isometric voluntary contraction; MIVC, delayed onset muscle soreness; DOMS, or countermovement jump; CMJ. Information sources. AMED, Cochrane Central Register of Controlled Trials, International Clinical Trials Registry Platform, PUBMED, SCOPUS (Elsevier), SPORTDiscus(EBSCO), and the UK Clinical Trials Gateway were searched from inception to September 2020. Risk of bias and quality of evidence. Risk of bias was assessed using Cochrane Risk of Bias 2 tool. Quality of the evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation framework. Synthesis of results. Random effects models were used todetermine the effect of polyphenol supplementation on recovery from EIMD. Data are presented as standardised mean differences (SMD) with 95% confidence intervals (CI). Results. Included studies. Twenty-five studies were included; 15 had a parallel, and 10 had a cross-over design. A total of 527 participants (male: n = 425; female: n = 102) were included in the meta-analysis. Synthesisof results. Consumption of polyphenol-rich foods, juices and concentrates accelerated recovery of MIVC immediately post-exercise (SMD = 0.23, 95% CI 0.04, 0.42; p = 0.02; low-quality evidence), 24 h (SMD = 0.39, 95% CI 0.15, 0.62; p = 0.001; low-quality evidence), 48 h (SMD = 0.48, 95% CI 0.28, 0.67;p < 0.001; moderate-quality evidence), 72 h (SMD = 0.29, 95% CI 0.11, 0.46; p = 0.001; low-quality evidence) and 96 h post-exercise (SMD = 0.50, 95% CI 0.16, 0.83; p = 0.004; very low-quality evidence). DOMS was reduced at 24 h (SMD = −0.29, 95% CI −0.47, −0.11; p = 0.002; low-quality evidence), 48 h (SMD = −0.28, 95% CI −0.46, −0.09; p = 0.003; low-quality evidence) and 72 h post-exercise (SMD = −0.46, 95% CI −0.69, −0.24; p < 0.001; very low-quality evidence). CMJ height was greater immediately post-exercise (SMD = 0.27, 95% CI 0.01, 0.53; p = 0.04; low-quality evidence), at 24 h (SMD = 0.47, 95% CI 0.11, 0.83; p = 0.01; very low-quality evidence), 48 h (SMD = 0.58, 95% CI 0.24,0.91; p < 0.001; very low-quality evidence) and 72 h post-exercise (SMD = 0.57, 95% CI 0.03, 1.10; p = 0.04; very low-quality evidence). Polyphenol supplementation did not alter creatine kinase, c-reactive protein, and interleukin−6 at any time points. At 72 h post-exercise, protein carbonyls(SMD = −0.64, 95% CI −1.14, −0.14; p = 0.01) were reduced. Discussion. Limitations of evidence. Risk of bias was high for 10 studies and moderate for 15. Sensitivity analyses excluding the high risk of bias studies reduced the SMDs for MIVC and DOMS, and for CMJ effects at 24 and 48 h were no longer statistically significant. Interpretation. Consuming polyphenol-rich foods, juices andconcentrates accelerated recovery of muscle function while reducing muscle soreness in humans. Maximal benefit occurred 48–72 h post-exercise, however, the certainty of the evidence was moderate to very low. Supplementation could be useful when there is limited time between competitive events and impaired recovery could negatively impact performance