Beetroots have antioxidant and anti-inflammatory properties, which may help attenuate inflammation and oxidative stress, enhancing recovery from exercise-induced muscle damage (EIMD).
Objective:
To evaluate the effects of beetroot supplementation on oxidative stress, inflammation, and recovery after EIMD.
Data Sources:
SPORTDiscus, PubMed, Web of Science, and Scopus databases were searched, and hand-searching was performed by looking to relevant studies that were cited in other studies.
Study Selection:
For a study to be included in this review, the following inclusion criteria had to be met: (1) research conducted with human participants, (2) original articles in peer-reviewed publications, (3) original studies that had investigated beetroot supplementation intervention on muscle damage and recovery, (4) research conducted with 1 control/placebo group, and (5) articles published from inception to October 2020.
Study Design:
Systematic review using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement.
Level of Evidence:
Level 3.
Data Extraction:
Two of the 4 authors independently extracted data and assessed the methodological quality of the articles with the PEDro scale. All discrepancies were resolved through a consensus meeting.
Results:
A total of 9 studies were included in this review. The methodological quality of the included studies ranged from moderate to high. Most of the studies found a better recovery of functional variables and muscle soreness, but improvements in markers of muscle damage, inflammation, and oxidative stress were not reported.
Conclusion:
The existing evidence suggests that a short-term beetroot supplementation has the potential to accelerate recovery of functional measures and muscle soreness, but further research is needed to clarify if a longer supplementation period (with some days before exercise and some days after) could also promote recovery of markers of muscle damage, inflammation, and oxidative stress.
AmmarABaileySJChtourouH, et al. Effects of pomegranate supplementation on exercise performance and post-exercise recovery in healthy adults: a systematic review. Br J Nutr. 2018;120:1201-1216.
2.
AoiWNaitoYTakanamiY, et al. Oxidative stress and delayed-onset muscle damage after exercise. Free Radic Biol Med. 2004;37:480-487.
3.
BellPGStevensonEDavisonGWHowatsonG. The effects of Montmorency tart cherry concentrate supplementation on recovery following prolonged, intermittent exercise. Nutrients. 2016;8:441.
4.
BloomerRJGoldfarbAH. Anaerobic exercise and oxidative stress: a review. Can J Appl Physiol. 2004;29:245-263.
5.
BotwellJLSumnersDPDyerAFosPMilevaKN. Montmorency cherry juice reduces muscle damage caused by intensive strength exercise. Med Sci Sports Exerc. 2011;43:1544-1551.
6.
Buchwald-WernerSNakaIWilhelmMSchützESchoenCReuleC. Effects of lemon verbena extract (Recoverben®) supplementation on muscle strength and recovery after exhaustive exercise: a randomized, placebo-controlled trial. J Int Soc Sports Nutr. 2018;15:5.
7.
ByrneCTwistCEstomR. Neuromuscular function after exercise-induced muscle damage. theoretical and applied implications. Sports Med. 2004;34:49-69.
8.
CarrikerCRRombachPStevensBMVaughanRAGibsonAL. Acute dietary nitrate supplementation does not attenuate oxidative stress or the hemodynamic response during submaximal exercise in hypobaric hypoxia. Appl Physiol Nutr Metab. 2018;43:1268-1274.
9.
CarrikerCRVaughanRAVanDusseldorpTA, et al. Nitrate-containing beetroot juice reduces oxygen consumption during submaximal exercise in low but not high aerobically fit male runners. J Exerc Nutrition Biochem. 2016;20:27-34.
10.
ChazaudB. Inflammation during skeletal muscle regeneration and tissue remodeling: application to exercise-induced muscle damage management. Immunol Cell Biol. 2016;94:140-145.
11.
CliffordTAllertonDMBrownMA, et al. Minimal muscle damage after a marathon and no influence of beetroot juice on inflammation and recovery. Appl Physiol Nutr Metab. 2017:42:263-270.
12.
CliffordTBellOWestDJHowatsonGStevensonEJ. The effects of beetroot juice supplementation on indices of muscle damage following eccentric exercise. Eur J Appl Physiol. 2016;116:353-362.
13.
CliffordTBerntzenBDavisonGWWestDJHowatsonGStevensonEJ. Effects of beetroot juice on recovery of muscle function and performance between bouts of repeated sprint exercise. Nutrients. 2016;8:506.
14.
CliffordTBowmanACapperT, et al. A pilot study investigating reactive oxygen species production in capillary blood after a marathon and the influence of an antioxidant-rich beetroot juice. Appl Physiol Nutr Metab. 2018;43:303-306.
15.
CliffordTHowatsonGWestDJStevensonEJ. Beetroot juice is more beneficial than sodium nitrate for attenuating muscle pain after strenuous eccentric-bias exercise. Appl Physiol Nutr Metab. 2017;42:1185-1191.
16.
DaabWBouzidMALajriMBouchibaMSaafiMARebaiH. Chronic beetroot juice supplementation accelerates recovery kinetics following simulated match play in soccer players. J Am Coll Nutr. 2020;3:1-9.
17.
DrobnicFRieraJAppendinoG, et al. Reduction of delayed onset muscle soreness by a novel curcumin delivery system (Meriva®): a randomised, placebo-controlled trial. J Int Soc Sports Nutr. 2014;11:31.
18.
EsatbeyogluTWagnerAEMotafakkerazadRNakajimaYMatsugoSRimbachG. Free radical scavenging and antioxidant activity of betanin: electron spin resonance spectroscopy studies and studies in cultured cells. Food Chem Toxicol. 2014;73:119-126.
19.
Fernández-LázaroDMielgo-AyusoJSecoJCórdovaACaballeroAFernandez-LazaroCI. Modulation of exercise-induced muscle damage, inflammation, and oxidative markers by curcumin supplementation in a physically active population: a systematic review. Nutrients. 2020;12:501.
20.
FilippinLIMoreiraAJMarroniNPXavierRM. Nitric oxide and repair of skeletal muscle injury. Nitric Oxide. 2009;21:157-163.
21.
FridenJLieberRL. Serum creatine kinase level is a poor predictor of muscle function after injury. Scand J Med Sci Sports. 2001;11:126-127.
22.
GathercoleRJSporerBCStellingwerfTSleivertGG. Comparison of the capacity of different jump and sprint field tests to detect neuromuscular fatigue.J Strength Cond Res. 2015;29:2522-2531.
23.
GeorgievVGWeberJKneschkeEMDenevPNBleyTPavlovAI. Antioxidant activity and phenolic content of betalain extracts from intact plants and hairy root cultures of the red beetroot Beta vulgaris cv. Detroit dark red. Plant Food Hum Nutr. 2010;65:105-111.
24.
HordNGTangYBryanNS. Food sources of nitrates and nitrites: the physiologic context for potential health benefits. Am J Clin Nutr. 2009;90:1-10.
25.
HowatsonGMcHughMPHillJA, et al. Influence of tart cherry juice on indices of recovery following marathon running. Scand J Med Sci Sports. 2010;20:843-852.
26.
HowatsonGvan SomerenKA. The prevention and treatment of exercise-induced muscle damage. Sports Med. 2008;38:483-503.
27.
JacksonMJVasilakiAMcArdleA. Cellular mechanisms underlying oxidative stress in human exercise. Free Radic Biol Med. 2016;98:13-17.
28.
JonvikKLNyakayiruJvan LoonLJCVerdijkLB. Can elite athletes benefit from dietary nitrate supplementation?J Appl Physiol (1985). 2015;119:759-761.
29.
KaminskiHJAndradeFH. Nitric oxide: biologic effects on muscle and role in muscle diseases. Neuromuscul Disord. 2001;11:517-524.
30.
KozłowskaLMizeraOGromadzinskaJ, et al. Changes in oxidative stress, inflammation, and muscle damage markers following diet and beetroot juice supplementation in elite fencers. Antioxidants. 2020;9:571.
31.
LambKLRanchordasMKJohnsonEDenningJDowningFLynnA. No effect of tart cherry juice or pomegranate juice on recovery from exercise-induced muscle damage in non-resistance trained men. Nutrients. 2019;11:E1593.
32.
LarsenFJSchifferTAEkblomB, et al. Dietary nitrate reduces resting metabolic rate: a randomized, crossover study in humans. Am J Clin Nutr. 2014;99:843-850.
33.
LeversKDaltonRGalvanE, et al. Effects of powdered Montmorency tart cherry supplementation on an acute bout of intense lower body strength exercise in resistance trained males. J Int Soc Sports Nutr. 2015;12:41.
34.
LiberatiAAltmanDGTetzlaffJ, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Ann Intern Med. 2009;151:65-94.
35.
LundbergJOGovoniM. Inorganic nitrate is a possible source for systemic generation of nitric oxide. Free Radic Biol Med. 2004;37:395-400.
36.
MasonBCLavalleeME. Emerging supplements in sports. Sports Health. 2012;4:142-146.
37.
MontenegroCFKwongDAMinowZADavisBALozadaCJCasazzaGA. Betalain-rich concentrate supplementation improves exercise performance and recovery in competitive triathletes. Appl Physiol Nutr Metab. 2017;42:166-172.
38.
MorenoBSotoKGonzálezD. El consumo de nitrato y su potencial efecto benéfico sobre la salud cardiovascular. Rev Chil Nutr. 2015;42:199-205.
39.
NakhostinBNasirvandABolboliL. Influence of curcumin supplementation on exercise-induced oxidative stress. Asian J Sports Med. 2017;8:e35776.
40.
OwensDJTwistCCobleyJNHowatsonGCloseGL. Exercise-induced muscle damage: what is it, what causes it and what are the nutritional solutions?Eur J Sport Sci. 2019;19:71-85.
ProskeUMorganDL. Muscle damage from eccentric exercise: mechanism, mechanical signs, adaptation and clinical applications. J Physiol. 2001;537:333-345.
43.
RadakZPucsokJMecsekiSCsontTFerdinandyP. Muscle soreness induced reduction in force generation is accompanied by increased nitric oxide content and DNA damage in human skeletal muscle. Free Radic Biol Med. 1999;26:1059-1063.
44.
ReidMB. Redox modulation of skeletal muscle contraction: what we know and what we don’t. J Appl Physiol. 2001;90:724-731.
45.
RojanoDMolinaAMoyaHBerralFJ. Tart cherry and pomegranate supplementations enhance recovery from exercise-induced muscle damage: a systematic review. Biol Sport. 2021;38:97-111.
46.
Rojas-ValverdeDMontoya-RodríguezJAzofeifa-MoraCSánchez-UrenaB. Effectiveness of beetroot juice derived nitrates supplementation on fatigue resistance during repeated-sprints: a systematic review. Crit Rev Food Sci Nutr. 2020;25:1-12.
47.
StamleJSMeissnerG. Physiology of nitric oxide in skeletal muscle. Physiol Rev. 2001;81:209-237.
48.
TidballJG. Inflammatory processes in muscle injury and repair. Am J Physiol Regul Integr Comp Physiol. 2005;288:R345-R353.
49.
ToumiHBestTM. The inflammatory response: friend or enemy for muscle injury?Br J Sports Med. 2003;37:284-286.
50.
VerhagenAPde VetHCde BieRAKesselsAGBoersMBouterLMKnipschildPG. The Delphi list: a criteria list for quality assessment of randomized clinical trials for conducting systematic reviews developed by Delphi consensus. J Clin Epidemiol. 1998;51:1235-1241.
51.
WhitfieldJLudzkiAHeigenhauserGJF, et al. Beetroot juice supplementation reduces whole body oxygen consumption but does not improve indices of mitochondrial efficiency in human skeletal muscle. J Physiol. 2016;594:421-435.
52.
WrussJWaldenbergerGHuemerS, et al. Compositional characteristics of commercial beetroot products and beetroot juice prepared from seven beetroot varieties grown in Upper Austria. J Food Compos Anal. 2015;42:46-55.
53.
ZamaniHde JoodeMEJRHosseinIJ, et al. The benefits and risks of beetroot juice consumption: a systematic review. Crit Rev Food Sci Nutr. 2021;61:788-804.
54.
Zembron-LacnyAOrysiakJKalinaKMorawinBPokrywkaA. The role of nitric oxide in skeletal muscle regeneration. Trends Sport Sci. 2013;4:173-179.
55.
Zielinska-PrzyjemskaMOlejnikADobrowolska-ZachwiejaAGrajekW. In vitro effects of beetroot juice and chips on oxidative metabolism and apoptosis in neutrophils from obese individuals. Phytother Res. 2009;23:49-55.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
