Re: Pilot Study Reports that a Polyphenol-rich Proprietary Extract Alleviates Delayed Soreness and Markers of Muscle Damage after Exercise

TensLess Muscle Soreness and Recovery Exercise Date: 07-13-2018 HC# 121712-596 Romain C, Freitas TT, Martinez-Noguera FJ, et al. Supplementation with a polyphenol-rich extract, TensLess®, attenuates delayed onset muscle soreness and improves muscle recovery from damages after eccentric exercise. Phytother Res. November 2017;31(11):1739-1746. Delayed onset muscle soreness (DOMS) is a type of muscle strain injury that manifests as pain and stiffness lasting for up to several days after unaccustomed or strenuous exercise. Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used after exercise to reduce the symptoms of DOMS. However, NSAIDs have significant toxicities and some studies have suggested that NSAID use is of little value for DOMS or may be detrimental to muscle repair after injury. Therefore, natural alternatives to DOMS management are desired. Polyphenolic compounds have demonstrated antioxidant and anti-inflammatory benefits that make them appealing candidates. This randomized, double-blind, placebo-controlled, crossover pilot study investigated the efficacy of the polyphenol-rich food supplement product TensLess (Fytexia SAS; Vendres, France) in the management of DOMS. Eighteen "recreationally active" subjects (12 men and 6 women, >20 years of age) were recruited from the Catholic University of Murcia, Spain. Study dates were not given. Participants were excluded if they had an allergy to supplement ingredients, were involved in high-intensity training, had health problems or recent (<1 year) orthopedic problems, or used potentially interfering medications or supplements. Subjects were randomly assigned to the control (n=9) or experimental group (n=9). Subjects received either the supplement (three 500 mg capsules daily) or placebo for five days following performance of an eccentric exercise protocol. The protocol included eight sets of 8-repetition maximum half-squats, with loads adjusted as needed to complete the sets. After this, they entered a 3-week washout period. They then underwent another exercise session and began another 5-day supplementation period in which they received the other treatment. They reported to the UCAM Research Center for High Performance Sport every day during the supplementation periods. Perceived muscle soreness was measured using a visual analog scale (VAS) before, immediately after, and one hour after exercise sessions and during follow-up visits on days two through five. Blood samples were also collected on the same schedule to measure plasma creatinine concentration, plasma creatine kinase (CK) activity, and serum myoglobin concentration. TensLess consists of hydroethanolic extracts of mangosteen (Garcinia mangostana, Clusiaceae) fruit and pomegranate (Punica granatum, Lythraceae) fruit, as well as elderberry (Sambucus nigra, Adoxaceae) fruit juice concentrate. The bioactive constituent analysis was performed with high-performance liquid chromatography (HPLC) and revealed a composition of 8.64% (dry mass) ellagic acid and derivatives, 5.67% xanthone and derivatives, and 0.3% anthocyanin for a total bioactive content of 14.61%. The placebo was a 500 mg capsule containing 100% polyphenol-free maltodextrin. Among the 18 subjects that participated in the study, five did not follow up due to personal reasons or schedule conflicts. Thirteen subjects completed the entire protocol and were included in the statistical analysis. Perceived DOMS baseline and immediately post-exercise did not differ between placebo and supplemented groups. At one-hour post-exercise, perceived DOMS in the placebo group increased but remained stable in the supplemented group. There was a difference of -31% but this was not statistically significant. DOMS symptoms were rated significantly lower in the supplemented group for the first two days after exercise (-33%, P = 0,008 on day 2; -29%, P = 0.045 on day 3; cumulative score, or area under the curve [AUC], for days 1-3 was -31%, P = 0.005). DOMS symptoms declined on days 4 and 5, and the differences between groups were not significant on those days. The total AUC for days 1-5 remained statistically significant (-28%, P = 0.002). Similarly, serum myoglobin levels, plasma creatinine, and plasma CK did not significantly differ between groups at baseline and immediately post-exercise. Serum myoglobin peaked in both groups one hour following exercise, increasing 279% in the placebo group vs. 114% in the supplemented group (P = 0.044 for the difference between groups). Plasma creatinine peaked in both groups immediately post-exercise, with no significant difference between groups, and gradually decreased in both groups, being significantly lower in the supplemented group at one hour after exercise (P = 0.024) and on day 2 (P = 0.015). CK activity peaked on day 2 in both groups, at which time mean values were virtually identical; however, CK declined from that peak on days 3-5 (P = 0.018, 0.004, and 0.032 respectively), returning to near-baseline levels, while remaining elevated through day 5 in the placebo group. The authors conclude that post-exercise supplementation with TensLess may enhance muscle recovery and reduce perceived DOMS. This effect may be due to direct antinociceptive, as well as anti-inflammatory activities of phenolic compounds. These findings complement a cited publication by Trombold et al,1 wherein consumption of ellagitannins for several days preceding exercise reduced the earliest symptoms of DOMS. More studies are needed to explore the mechanisms of action of phenolic compounds in relation to muscle injury and to confirm these effects in a larger population. The study was funded by Fytexia, the manufacturer of TensLess, and two of the authors are Fytexia employees. —Renee Davis RH(AHG) Reference 1Trombold JR, Barnes JN, Critchley L, Coyle EF. Ellagitannin consumption improves strength recovery 2-3 d after eccentric exercise. Med Sci Sports Exerc. March 2010;42(3):493-498.