Reduction of Muscle Injuries and Improved Post-exercise Recovery by Branched-Chain Amino Acid Supplementation: A Systematic Review and Meta-Analysis

Document Type: Review Article

Authors

1 Nutrition and Metabolic Diseases Research Center, Ahvaz Junishapur University of Medical Sciences, Ahvaz, Iran

2 Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran

Abstract

This meta-analysis and systematic review aimed to attain specific data on the effect of branched-chain amino acids (BCAAs) administration on muscle injuries and the indices of delayed-onset muscle soreness (DOMS) after exercise. Literature search was performed in databases such as Scopus, ISI, Web of Science, Scientific Information Database (SID), Cochrane Controlled Register of Trials (CENTRAL), and Cochrane library for the articles published until January 2017. The clinical trials examining the effects of BCAA administration on athletes were considered eligible. In total, 42 studies were evaluated in terms of eligibility, 26 of which were excluded from the meta-analysis. According to the meta-analysis, BCAA supplementation significantly reduced the levels of creatine kinase 24 hours post-exercise (mean difference: -129.55 [95% CI: -237.02--22.07] IU/l; P=0.018). However, BCAA administration could not decrease lactate dehydrogenase promptly (mean difference: -10.11 [95% CI: -21.76-1.53] IU/l; P=0.08) 24 hours post-exercise (mean difference: -14.66 [95% CI: -32.16-2.83] IU/l; P=0.10). Therefore, it could be concluded that BCAA consumption is inversely associated with DOMS at 24 hours (standardized mean difference [SMD] =-0.43 [95% CI: -0.71--0.16]; P=0.002), 48 hours (SMD=-0.55 [95% CI: -0.81--0.29]; P<0.0001), and 72 hours post-exercise (SMD=-0.44 [95% CI: -0.72--0.16]; P=0.002). Furthermore, the findings of the systematic review and meta-analysis indicated that BCAA supplementation could alleviate muscle damage within the first 24 hours after exercise, and it seems that the consumption of daily doses of BCAA is more effective in the recovery of athletes compared to the periodic doses.

Keywords


  1. Friden J, Kjörell U, Thornell LE. Delayed muscle soreness and cytoskeletal alterations: an immunocytological study in man. Int J Sports Med. 1984; 5(1): 15-8.
  2. Cheung K, Hume P, Maxwell L. Delayed onset muscle soreness: treatment strategies and performance factors. Sports Med. 2003; 33(2): 145-64.
  3. Clarkson PM. Exertional rhabdomyolysis and acute renal failure in marathon runners. Sports med. 2007; 37(4-5): 361-3.
  4. Smith JE, Garbutt G, Lopes P, Tunstall Pedoe D. Effects of prolonged strenuous exercise (marathon running) on biochemical and haematological markers used in the investigation of patients in the emergency department. Br J Sports Med. 2004; 38(3): 292-4.
  5. Del Coso J, Fernández de Velasco D, Abián-Vicen J, Salinero JJ, González-Millán C, Areces F, et al. Running pace decrease during a marathon is positively related to blood markers of muscle damage. PloS One. 2013; 8(2): e57602.
  6. Cleak MJ, Eston RG. Delayed onset muscle soreness: mechanisms and management. J Sports Sci. 1992; 10(4): 325-41.
  7. Coombes JS, McNaughton LR. Effects of branched-chain amino acid supplementation on serum creatine kinase and lactate dehydrogenase after prolonged exercise. J Sports Med Phys Fitness. 2000; 40(3): 240-6.
  8. Shimomura Y, Yamamoto Y, Bajotto G, Sato J, Murakami T, Shimomura N, et al. Nutraceutical effects of branched-chain amino acids on skeletal muscle. J Nutr. 2006; 136(2): 529S-32S.
  9. Shimomura Y, Inaguma A, Watanabe S, Yamamoto Y, Muramatsu Y, Bajotto G, et al. Branched-chain amino acid supplementation before squat exercise and delayed-onset muscle soreness. Int J Sport Nutr Exerc Metab. 2010; 20(3): 236-44.
  10. Garlick PJ. The role of leucine in the regulation of protein metabolism. J Nutr. 2005; 135 (6 Suppl): 1553S-6S.
  11. Jackman SR, Witard OC, Jeukendrup AE, Tipton KD. Branched-chain amino acid ingestion can ameliorate soreness from eccentric exercise. Med Sci Sports Exerc. 2010; 42(5): 962-70.
  12. Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials. 1996; 17(1): 1-12.
  13. DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986; 7(3): 177-88.
  14. Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions: John Wiley & Sons; 2011.
  15. Hsu MC, Chien KY, Hsu CC, Chung CJ, Chan KH, Su B. Effects of BCAA, arginine and carbohydrate combined drink on post-exercise biochemical response and psychological condition. Chin J Physiol. 2011; 54(2): 71-8.
  16. Knechtle B, Mrazek C, Wirth A, Knechtle P, Rüst CA, Senn O, et al. Branched-chain amino acid supplementation during a 100-km ultra-marathon-A randomized controlled trial. J Nutr Sci Vitaminol (Tokyo). 2012; 58(1): 36-44.
  17. Nosaka K, Sacco P, Mawatari K. Effects of amino acid supplementation on muscle soreness and damage. Int J Sport Nutr Exerc Metab. 2006; 16(6): 620-35.
  18. [18] Sharp CP, Pearson DR. Amino acid supplements and recovery from high-intensity resistance training. J Strength Cond Res. 2010; 24(4): 1125-30.
  19. Apró W, Moberg M, Hamilton DL, Ekblom B, Rooyackers O, Holmberg HC, et al. Leucine does not affect mechanistic target of rapamycin complex 1 assembly but is required for maximal ribosomal protein s6 kinase 1 activity in human skeletal muscle following resistance exercis. FASEB J. 2015; 29(10): 4358-73.
  20. Atherton PJ, Kumar V, Selby AL, Rankin D, Hildebrandt W, Phillips BE, et al. Enriching a protein drink with leucine augments muscle protein synthesis after resistance exercise in young and older men. Clin Nutr. 2017; 36(3): 888-95.
  21. Church D, Schwarz N, Spillane M, McKinley S, Andre T, Willoughby DS. A comparison of the effects of ursolic acid and l-leucine supplementation on IGF-1 receptor and AKT-mTOR signaling in response to resistance exercise in trained men. J Int Soc Sports Nutr. 2014; 11 (Suppl 1): P19.
  22. Churchward-Venne TA, Breen L, Di Donato DM, Hector AJ, Mitchell CJ, Moore DR, et al. Leucine supplementation of a low-protein mixed macronutrient beverage enhances myofibrillar protein synthesis in young men: A double-blind, randomized trial. Am J Clin Nutr. 2014; 99(2): 276-86.
  23. Crowe MJ, Weatherson JN, Bowden BF. Effects of dietary leucine supplementation on exercise performance. Eur J Appl Physiol. 2006; 97(6): 664-72.
  24. da Luz CR, Nicastro H, Zanchi NE, Chaves DF, Lancha AH Jr. Potential therapeutic effects of branched-chain amino acids supplementation on resistance exercise-based muscle damage in humans. J Int Soc Sports Nutr. 2011; 8: 23.
  25. Dickinson JM, Gundermann DM, Walker DK, Reidy PT, Borack MS, Drummond MJ, et al. Leucine-enriched Amino acid ingestion after resistance exercise prolongs myofibrillar protein synthesis and amino acid transporter expression in older men. J Nutr. 2014; 144(11): 1694-702.
  26. Dudgeon WD, Kelley EP, Scheett TP. In a single-blind, matched group design: Branched-chain amino acid supplementation and resistance training maintains lean body mass during a caloric restricted diet. J Int Soc Sports Nutr. 2016; 13: 1.
  27. Freyssenet D, Berthon P, Denis C, Barthelemy JC, Guezennec CY, Chatard JC. Effect of a 6-week endurance training programme and branched-chain amino acid supplementation on histomorphometric characteristics of aged human muscle. Arch Physiol Biochem. 1996; 104(2): 157-62.
  28. Kephart WC, Wachs TD, Thompson RM, Brooks Mobley C, Fox CD, McDonald JR, et al. Ten weeks of branched-chain amino acid supplementation improves select performance and immunological variables in trained cyclists. Amino Acids. 2016; 48(3): 779-89.
  29. MacLean DA, Graham TE, Saltin B. Branched-chain amino acids augment ammonia metabolism while attenuating protein breakdown during exercise. Am J Physiol. 1994; 267 (6 Pt 1): E1010-22.
  30. Moberg M, Apró W, Ekblom B, Van Hall G, Holmberg HC, Blomstrand E. Activation of mTORC1 by leucine is potentiated by branched-chain amino acids and even more so by essential amino acids following resistance exercise. Am J Physiol Cell Physiol. 2016; 310(11): C874-84.
  31. Moberg M, Apró W, Ohlsson I, Pontén M, Villanueva A, Ekblom B, et al. Absence of leucine in an essential amino acid supplement reduces activation of mTORC1 signalling following resistance exercise in young females. Appl Physiol Nutr Metab. 2014; 39(2): 183-94.
  32. Rowlands DS, Nelson AR, Raymond F, Metairon S, Mansourian R, Clarke J, et al. Protein-leucine ingestion activates a regenerative inflammo-myogenic transcriptome in skeletal muscle following intense endurance exercise. Physiol Genomics. 2016; 48(1): 21-32.
  33. Samuelsson H, Moberg M, Apró W, Ekblom B, Blomstrand E. Intake of branched-chain or essential amino acids attenuates the elevation in muscle levels of PGC-1α4 mRNA caused by resistance exercise. Am J Physiol Endocrinol Metab. 2016; 311(1): E246-51.
  34. Tang FC. Influence of branched-chain amino acid supplementation on urinary protein metabolite concentrations after swimming. J Am Coll Nutr. 2006; 25(3): 188-94.
  35. Trabal J, Forga M, Leyes P, Torres F, Rubio J, Prieto E, et al. Effects of free leucine supplementation and resistance training on muscle strength and functional status in older adults: A randomized controlled trial. Clin Interv Aging. 2015; 10: 713-23.
  36. Areces F, Salinero JJ, Abian-Vicen J, González-Millán C, Gallo-Salazar C, Ruiz-Vicente D, et al. A 7-day oral supplementation with branched-chain amino acids was ineffective to prevent muscle damage during a marathon. Amino Acids. 2014; 46(5): 1169-76.
  37. Hasan M, Maghsoud P, Fatemeh M. The effect of one period HIIT training and BCAA supplementation on indicators muscle damage in non-athlete men. Eur J Exp Biol. 2012; 2(6): 2001-3.
  38. Liu JH, Zhou ZH, Ou MH, Wang K, Shi YQ. Effects of branched-chain amino acid supplementation on training-induced muscle damage in rowing athletes. Chinese Journal of Clinical Rehabilitation. 2003; 7: 3402-3.
  39. Bregani ER, Aliberti S, Guariglia A. Creatine combined with branched-chain amino acids supplement in speleological practice. A scientific controlled trial. Med Sport (Roma). 2005; 58(3): 233-9.
  40. Myojin C, Ueshima S, Kawanishi M, Tokimoto M, Matsunami T, Sagawa K, et al. Reducing Effects of branched-chain amino acids and the citric acid on fatigue caused by exercise. Japanese Pharmacology and Therapeutics. 2016; 44(2): 227-34.
  41. Coombes JS. The effects of branched chain amino acid supplementation on indicators of muscle damage after prolonged strenuous exercise [dissertation]. University of Tasmania - Launceston. 1993.
  42. Fouré A, Nosaka K, Gastaldi M, Mattei JP, Boudinet H, Guye M, et al. Effects of branched-chain amino acids supplementation on both plasma amino acids concentration and muscle energetics changes resulting from muscle damage: A randomized placebo controlled trial. Clin Nutr. 2016; 35(1): 83-94.
  43. Greer BK, Woodard JL, White JP, Arguello EM, Haymes EM. Branched-chain amino acid supplementation and indicators of muscle damage after endurance exercise. Int J Sport Nutr Exerc Metab. 2007; 17(6): 595-607.
  44. Kim DH, Kim SH, Jeong WS, Lee HY. Effect of BCAA intake during endurance exercises on fatigue substances, muscle damage substances, and energy metabolism substances. J Exerc Nutrition Biochem. 2013; 17(4): 169-80.
  45. Koba T, Hamada K, Sakurai M, Matsumoto K, Hayase H, Imaizumi K, et al. Branched-chain amino acids supplementation attenuates the accumulation of blood lactate dehydrogenase during distance running. J Sports Med Phys Fitness. 2007; 47(3): 316-22.
  46. Koo GH, Woo J, Kang S, Shin KO. Effects of Supplementation with BCAA and L-glutamine on Blood Fatigue Factors and Cytokines in Juvenile Athletes Submitted to Maximal Intensity Rowing Performance. J Phys Ther Sci. 2014; 26(8): 1241-6.
  47. Matsumoto K, Koba T, Hamada K, Sakurai M, Higuchi T, Miyata H. Branched-chain amino acid supplementation attenuates muscle soreness, muscle damage and inflammation during an intensive training program. J Sports Med Phys Fitness. 2009; 49(4): 424-31.
  48. Waldron M, Whelan K, Jeffries O, Burt D, Howe L, Patterson SD. The effects of acute branched-chain amino acid supplementation on recovery from a single bout of hypertrophy exercise in resistance-trained athletes. Appl Physiol Nutr Metab. 2017: 42(6): 630-6.
  49. Amirsasan R, Nikookheslat S, Sari-Sarraf V, Kaveh B, Letafatkar A. The Effects of Two Different Dosages of BCAA Supplementation on A Serum Indicators of Muscle Damage in Wrestlers. International Journal of Wrestling Science. 2011; 1(2): 32-6.
  50. Howatson G, Hoad M, Goodall S, Tallent J, Bell PG, French DN. Exercise-induced muscle damage is reduced in resistance-trained males by branched chain amino acids: a randomized, double-blind, placebo controlled study. J Int Soc Sports Nutr. 2012; 9: 20.
  51. Ra SG, Miyazaki T, Ishikura K, Nagayama H, Komine S, Nakata Y, et al. Combined effect of branched-chain amino acids and taurine supplementation on delayed onset muscle soreness and muscle damage in high-intensity eccentric exercise. J Int Soc Sports Nutr. 2013; 10(1): 51.
  52. Leahy DT, Pintauro SJ. Branched-chain amino acid plus glucose supplement reduces exercise-induced delayed onset muscle soreness in college-age females. ISRN Nutr. 2013; 2013: 921972.
  53. Sousa M, Teixeira VH, Soares J. Dietary strategies to recover from exercise-induced muscle damage. Int J Food Sci Nutr. 2014; 65(2): 151-63.
  54. Rahimi MH, Shab-Bidar S, Mollahosseini M, Djafarian K. Branched chain amino acid supplementation and exercise induced muscle damage in exercise recovery: a meta-analysis of randomized clinical trials. Nutrition. 2017; 42: 30-6.
  55. Sorichter S, Puschendorf B, Mair J. Skeletal muscle injury induced by eccentric muscle action: muscle proteins as markers of muscle fiber injury. Exerc Immunol Rev. 1999; 5: 5-21.
  56. Clarkson PM, Kearns AK, Rouzier P, Rubin R, Thompson PD. Serum creatine kinase levels and renal function measures in exertional muscle damage. Med Sci Sports  Exerc. 2006; 38(4): 623-7.
  57. Howatson G, van Someren KA. The prevention and treatment of exercise-induced muscle damage. Sports Med. 2008; 38(6): 483-503.
  58. Mena P, Maynar M, Campillo JE. Changes in plasma enzyme activities in professional racing cyclists. Br J Sports Med. 1996; 30(2): 122-4.
  59. Priest JB, Oei TO, Moorehead WR. Exercise-induced changes in common laboratory tests. Am J Clin Pathol. 1982; 77(3): 285-9.
  60. Nosaka K, Clarkson PM, Apple FS. Time course of serum protein changes after strenuous exercise of the forearm flexors. J Lab Clin Med. 1992; 119(2): 183-8.
  61. Friden J, Sfakianos PN, Hargens AR. Blood indices of muscle injury associated with eccentric muscle contractions. Journal of Orthopaedic Research. 1989; 7(1): 142-5.
  62. Radák Z, Pucsok J, Mecseki S, Csont T, Ferdinandy P. 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(7-8): 1059-63.
  63. Malm C. ExerciseÔÇÉinduced muscle damage and inflammation: fact or fiction? Acta Physiol Scand. 2001; 171(3): 233-9.
  64. Proske U, Morgan DL. Muscle damage from eccentric exercise: mechanism, mechanical signs, adaptation and clinical applications. J Physiol. 2001; 537(Pt 2): 333-45.
  65. Shimomura Y, Inaguma A, Watanabe S, Yamamoto Y, Muramatsu Y, Bajotto G, et al. Branched-chain amino acid supplementation before squat exercise and delayed-onset muscle soreness. Int J Sport Nutr Exerc Metab. 2010; 20(3): 236-44.
  66. Matsumoto K, Koba T, Hamada K, Sakurai M, Higuchi T, Miyata H. Branched-chain amino acid supplementation attenuates muscle soreness, muscle damage and inflammation during an intensive training program. J Sports Med Phys Fitness. 2009; 49(4): 424-31.
  67. Howatson G, Hoad M, Goodall S, Tallent J, Bell PG, French DN. Exercise-induced muscle damage is reduced in resistance-trained males by branched chain amino acids: a randomized, double-blind, placebo controlled study. J Int Soc Sports Nutr. 2012; 9: 20.
  68. Koba T, Hamada K, Sakurai M, Matsumoto K, Hayase H, Imaizumi K, et al. Branched-chain amino acids supplementation attenuates the accumulation of blood lactate dehydrogenase during distance running. J Sports Med Phys Fitness. 2007; 47(3): 316-22.
  69. Shimomura Y, Yamamoto Y, Bajotto G, Sato J, Murakami T, Shimomura N, et al. Nutraceutical effects of branched-chain amino acids on skeletal muscle. J Nutr. 2006; 136(2): 529S-32S.
  70. Koo GH, Woo J, Kang S, Shin KO. Effects of supplementation with bcaa and l-glutamine on blood fatigue factors and cytokines in juvenile athletes submitted to maximal intensity rowing performance. J Phys Ther Sci. 2014; 26: 1241-6.
  71. Ra SG, Miyazaki T, Ishikura K, Nagayama H, Suzuki T, Maeda S, et al. Additional effects of taurine on the benefits of BCAA intake for the delayed-onset muscle soreness and muscle damage induced by high-intensity eccentric exercise.  Adv Exp Med Biol. 2013; 776: 179-87.
  72. Greer BK, Woodard JL, White JP, Arguello EM, Haymes EM. Branched-chain amino acid supplementation and indicators of muscle damage after endurance exercise. Int J Sport Nutr Exerc Metab. 2007; 17(6): 595-607.
  73. Jackman SR, Witard OC, Jeukendrup AE, Tipton KD. Branched-chain amino acid ingestion can ameliorate soreness from eccentric exercise. Med Sci Sports Exerc. 2010; 42(5): 962-70.
  74. Barzegari A. Comparing the Effect of Two Dosage of BCAA Supplement on Muscle Serum Damage Indices. World Appl Sci J. 2011; 15(10): 1445-8.
  75. Kim DH, Kim SH, Jeong WS, Lee HY. Effect of BCAA intake during endurance exercises on fatigue substances, muscle damage substances, and energy metabolism substances. J Exerc Nutrition Biochem. 2013; 17(4): 169-80.
  76. Amirsasan R, Nikookheslat S, Sari-Sarraf V, Kaveh B, Letafatkar A. The Effects of Two Different Dosages of BCAA Supplementation on A Serum Indicators of Muscle Damage in Wrestlers. International Journal of Wrestling Science. 2011; 1(2): 32-6.
  77. Fouré A, Nosaka K, Gastaldi M, Mattei JP, Boudinet H, Guye M, et al. Effects of branched-chain amino acids supplementation on both plasma amino acids concentration and muscle energetics changes resulting from muscle damage: A randomized placebo controlled trial. Clin Nutr. 2016; 35(1): 83-94.