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

Abstract

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.

Keywords:

• Ascorbic acid
• alpha-tocopherol
• physical exercise
• healthy volunteers
• inflammation
• oxidative stress

Acknowledgements

The authors thank the Postgraduate Program in Functional Rehabilitation. We would also like to thank the authors who kindly provided additional information needed for the analysis.

Availability of data and material

All of the extracted data are included in the manuscript and supplementary files. Data are available on request are available from the corresponding author.

Disclosure statement

Katieli Santos de Lima, Felipe Barreto Schuch, Natiele Camponogara Righi, Patrícia Chagas, Mireli Hemann Lamberti, Gustavo Orione Puntel, Antonio Marcos Vargas da Silva, Luis Ulisses Signori declare that they have no conflicts of interest relevant to the content of this review.

Additional information

Funding

This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior – Brasil (CAPES) – Finance Code 001 and the Foundation for Research Support of the State of Rio Grande do Sul – FAPERGS – Public Notice 05/2020 – Master.