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Frontiers in Nutrition··2 min read
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BackgroundExercise-induced muscle damage (EIMD) commonly follows strenuous exercise and is marked by delayed onset muscle soreness (DOMS), reduced muscle strength, and increased creatine kinase (CK) and C-reactive protein (CRP), which may impair recovery and subsequent training....
Kai-Xuan Xu
BackgroundExercise-induced muscle damage (EIMD) commonly follows strenuous exercise and is marked by delayed onset muscle soreness (DOMS), reduced muscle strength, and increased creatine kinase (CK) and C-reactive protein (CRP), which may impair recovery and subsequent training. Plant-derived polyphenols such as anthocyanins or flavanols are widely used to support recovery, but their comparative effects remain uncertain.MethodsWe conducted a systematic review and network meta-analysis (NMA) following established methodological guidance. PubMed, Web of Science, CENTRAL, and Embase were searched from inception to January 2026 for randomized controlled trials in healthy adults with acute EIMD that compared plant-derived anthocyanin- or flavanol-rich supplements with placebo or control conditions. Primary outcomes were DOMS, muscle strength, CK, and CRP at 48 h post-exercise; 24 h and 72 h outcomes were secondary. Frequentist random-effects network meta-analysis was performed in Stata 19.5, with interventions ranked using SUCRA. Pairwise meta-analyses, subgroup analyses, and sensitivity analyses were conducted for the main 48 h outcomes. Risk of bias and certainty of evidence were assessed using RoB 2.0 and CINeMA.ResultsThirty trials involving 595 participants and eight supplement types were included. In the primary analysis, only pomegranate and tart cherry significantly reduced 48 h DOMS vs. the placebo node, ranking first and second, respectively. No intervention showed a clear advantage for 48 h muscle strength, CK, or CRP. Pairwise meta-analyses were generally consistent with the network findings. For secondary outcomes, tart cherry was the only supplement associated with significant DOMS reduction at both 24 h and 72 h. No consistent benefits were observed for muscle strength, CK, or CRP at these time points. Sensitivity analyses did not materially alter the conclusions, although some estimates varied by supplementation protocol, outcome definition, or comparator characteristics. Certainty of evidence was generally low.ConclusionPlant-derived polyphenol supplements did not provide consistent benefits across all recovery outcomes after EIMD. Their main potential value appears to lie in reducing DOMS, with tart cherry showing the most consistent favorable pattern and pomegranate showing potential benefit. These supplements should therefore be considered as targeted options for subjective soreness relief rather than universal strategies for accelerating objective physiological recovery.Systematic review registration:https://www.crd.york.ac.uk/PROSPERO/view/CRD420261340555, identifier CRD420261340555.
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