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Efficacy of Rhus coriaria (sumac) juice in reducing muscle pain during aerobic exercise

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Abstract

The main target of this study was to measure the influence of sumac juice drink on muscle indices and pain during an acute, intense exercise for 30 days. Forty healthy volunteers (15-25 years) were involved in aerobic exercise program for 4 weeks. Participants ingested sumac juice or placebo drink twice daily for 30 days. All participants were subjected for the evaluation of pain and estimation of serum: creatine kinase (CK), lactic acid dehydrogenase (LDH), troponin I, hydroxyproline (hyp), total antioxidant capacity (TAC), and in vitro antioxidant activity of sumac juice using pre-validated visual analog scale, colorimetric and immunoassays. The participants of both groups, placebo and sumac, showed an increment in pain scores both during exercise and post-exercise intervals. However, the sumac juice group showed a significant smaller increase in the pain scores compared to the placebo group. Participants in the sumac juice group were more willing to use the drink in the future. They achieved a higher satisfaction of sumac juice in ameliorating and the reduction of pain. Also, the sumac group showed a significant enhancement in the level of CK, LDH, troponin I, hyp, along with significant increase in serum (TAC) compared to the placebo group. The protective activity of muscle may relate to the antioxidant activity of phenolic component(s) in sumac juice as measured by 1,1-diphenyl-2-picryl-hydrazyl (DPPH) radical scavenging (87.9%) and β-carotene-linoleic acid (68.7%) assays. These data suggest that oral administration of sumac juice may have a beneficial effect on muscle performance among athletes.
Physiology International, Volume 103 (2), pp. 231242 (2016)
DOI: 10.1556/036.103.2016.2.10
Efcacy of Rhus coriaria (sumac) juice in reducing
muscle pain during aerobic exercise
AH Alghadir
1
, SA Gabr
1,2
1
Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University,
Riyadh, Kingdom of Saudi Arabia
2
Department of Anatomy, Faculty of Medicine, Mansoura University, Mansoura, Egypt
Received: September 15, 2014
Accepted: April 22, 2016
The main target of this study was to measure the inuence of sumac juice drink on muscle indices and pain during
an acute, intense exercise for 30 days. Forty healthy volunteers (1525 years) were involved in aerobic exercise
program for 4 weeks. Participants ingested sumac juice or placebo drink twice daily for 30 days. All participants
were subjected for the evaluation of pain and estimation of serum: creatine kinase (CK), lactic acid dehydrogenase
(LDH), troponin I, hydroxyproline (hyp), total antioxidant capacity (TAC), and in vitro antioxidant activity of
sumac juice using pre-validated visual analog scale, colorimetric and immunoassays. The participants of both
groups, placebo and sumac, showed an increment in pain scores both during exercise and post-exercise intervals.
However, the sumac juice group showed a signicant smaller increase in the pain scores compared to the placebo
group. Participants in the sumac juice group were more willing to use the drink in the future. They achieved a higher
satisfaction of sumac juice in ameliorating and the reduction of pain. Also, the sumac group showed a signicant
enhancement in the level of CK, LDH, troponin I, hyp, along with signicant increase in serum (TAC) compared to
the placebo group. The protective activity of muscle may relate to the antioxidant activity of phenolic component(s)
in sumac juice as measured by 1,1-diphenyl-2-picryl-hydrazyl (DPPH) radical scavenging (87.9%) and β-carotene
linoleic acid (68.7%) assays. These data suggest that oral administration of sumac juice may have a benecial effect
on muscle performance among athletes.
Keywords: muscle fatigue, Rhus coriaria (sumac), exercise, total antioxidant capacity (TAC), troponin I
Introduction
Fatigue in response to exercise training may be related to varying abnormalities including
neurological and non-neurological causes (3,39,50). Exercise induced muscle fatigue
occurred as a result of peripheral muscle contractility during work over time (18,35).
Exercise protocols of short and longer duration have been applied to measure muscle fatigue
tasks. The large diversity in the nature of these exercises, such as variations in duration,
intensity and stimulation frequency, is likely to result in different kinds of muscle fatigue (33,
40,52,54). Regular physical exercise with varying intensities can induce diseases, acute
inammation, injuries and chronic muscle fatigue as a result of overtraining syndrome,
related to partial toxicity of free radicals produced during physical exercise (9,34). Recently,
Corresponding author: Dr. Sami A. Gabr
Department of Rehabilitation Sciences, CAMS, King Saud University
P.O. Box 10219, Riyadh 11433, Kingdom of Saudi Arabia
Phone: +966 562060018; Fax: +966 14698541; E-mails: nadalab2009@hotmail.com;drGabr14@yahoo.com;
sgabr@ksu.edu.sa
2498-602X/$ 20.00 © 2016 Akadémiai Kiad´o, Budapest
the effect of different exercise interventions on the level of disability and endurance of back
muscles, and type 2 diabetes mellitus have been investigated (22,53).
The occurrence and extent of such exercise induced muscle injury is routinely assessed
from increased blood levels of muscle proteins and enzymes, as this provides the simplest
way of studying the effects of exercise on muscles. The proteins usually measured are
creatine kinase (CK), hydroxyproline (hyp), troponin I along with lactic acid dehydrogenase
(LDH) activity, generally allow earlier detection of muscle injury as well as supporting the
theory of muscle soreness (37,38,41,45,47,56). In previous research reports, it was
reported that during competition, most athletes used to take traditional oral nonsteroidal anti-
inammatory drugs (NSAIDs) to conquer or ameliorate muscle pain during race (17,20).
Based on the harmful side effects exerted by synthetic drugs, there is a high tendency of
individuals to use herbal medicines to minimize hazardous effects. Sumac plant as herbal
alternative medicine contains antioxidants, avonoids and hydrolyzable tannins which have
antioxidant and anti-inammatory properties compared to other plants such as blueberry and
Tart cherries (5,11,24,36,43,58). So, it is possible that the use of sumac as herbal
antioxidant remedy before and during vigorous exercise training might have a protective
effect against muscle fatigue, pain and damage (32).
The mechanism by which sumac juice supplementation may reduce exercise-induced
muscle damage is not well understood. So, the purpose of this study was to assess the effects
of sumac juice drink on muscle pain and fatigue biomarkers among healthy subjects
participated in controlled training program for 4 weeks.
Materials and Methods
Subjects
Forty healthy students were invited to participate in a randomized, placebo-controlled study.
Their age ranged between 15 and 25 years. During the study period, all volunteers were
stopped from their normal physical activity (recreational) or any specic training programs.
All participants were non-smokers and had no history of abnormal alcohol intake. All
subjects with body mass index (BMI) more than 25 kg/m
2
, and subjects with ischemic heart
disease, or with severe orthopedic problems had been excluded from participating in this
study. Body fat of each participant was measured using bioelectrical impedance analysis
based body composition analyzer (TBF 105, Tanita Corporation, Tokyo, Japan). Subjects
were informed with the risks and benets of the study before participation. Prior to the
experiment, a written informed consent was obtained from each participant and a medical
check-up was performed to ensure that they were t, healthy and had no physical limitations.
Dietary information of each participant was obtained from food diaries or by extensive
dietary interviews and signicantly referred according to reference dietary intakes (RDIs) for
physically active people (2,33). All participants were instructed not to change their normal
eating habits during the entire period of data collection and to record accurately the amount,
type of food and uid consumed. During the exercise program, the participants were
prevented from any antioxidant containing diets to avoid cross contamination that may
interfere with the data of the proposed study. Participantsdata with possible cross
contamination of sumac or placebo drinks were excluded from this study. The experiment
was conducted in accordance with the ethical guidelines of the 1975 Declaration of Helsinki,
and was reviewed and approved by the ethical committee of Rehabilitation Research Chair
(RRC), King Saud University, Riyadh, Kingdom of Saudi Arabia. The participants were
232 Alghadir and Gabr
Physiology International (Acta Physiologica Hungarica) 103, 2016
classied into two groups according to the exercise test with or without sumac juice
supplementation as shown in Table I.
Preparation of sumac juice
Rhus coriaria L. fruit (sumac) used in this study was obtained from the local spice shop
(Othaim Markets) in Riyadh, Saudi Arabia. A total of 750 g of sumac fruits was soaked
overnight in cold water (1 l), then the fruits were mashed, squeezed several times using hands
or masher, and left for 30 min in water. Actually, more sumac juices will release into the
water. Afterward, cheesecloth (old cloth napkin) was used to separate solid parts of sumac
leaving a clear, red or brown color juice. Finally, the avored beverage of sumac juice was
then pasteurized and bottled into drinking bottles of 300 ml. The concentration of the sumac
extract in each bottle is equal to 75 mg/100 ml (225 mg/300 ml) of the juice. Following the
procedure used, the juice was preserved under cooling conditions until reused. Each sumac
bottle contains a total of 580 mg of phenolic compounds and 80 mg of anthocyanins
expressed as gallic acid and cyanidin-3-glucoside equivalents measured by the methods of
Singleton and Rossi (51) and Giusti and Wrolstad (15), respectively. Finally, the diet
participants were supplemented with sumac juice in bottles (300 ml) twice daily for
7 days/week.
Placebo
According to the instructions of the manufacturer, the placebo drink was prepared as
previously reported (25), about 2 g/l of unsweetened fruit punch soft drink (Kraft Corpora-
tion, Rye Brook, NY, USA; ingredients listed: citric acid, salt, calcium phosphate, red 40,
articial avor, ascorbic acid and blue 1) was dissolved in fresh water.
Exercise training protocol
Participants were involved in supervised aerobic exercise program using treadmill. The
program involved aerobic exercise for 4560 min seven sessions per week, for 4 weeks. The
program was designed in the form of circuit interval training mode. The training intensity of
Table I. The demographics and baseline characteristics of participants
Variable Placebo Sumac
Sample size (M/F) 20 (16/4) 20 (18/2)
Age (years) 24.9 ± 5.1 23.6 ± 3.5
Height (cm) 173.2 ± 8.5 170.2 ± 3.7
Weight (kg) 71.6 ± 2.9 68.9 ± 5.6
BMI (kg/m
2
) 23.9 ± 2.4 23.8 ± 2.1
Body fat (%) 20.2 ± 0.9 22.3 ± 1.5
HbA1c (%) 4.1 ± 0.2 2.6 ± 1.2
VO
2
max (ml/kg min) 65.6 ± 5.3 63.3 ± 6.5
Values are presented as mean ± SD. No differences were detected between groups for any of the parameters listed
(p>0.05). BMI, body mass index
Natural plants and modulating muscle fatigue 233
Physiology International (Acta Physiologica Hungarica) 103, 2016
each individual was calculated as training heart rate of 6575% for moderate intensity
according to Karvonens formula (24).
Assessment of visual analog scale (VAS)
A standard VAS of 100 mm score was used to evaluate the intensity of the pain among
the participants of this study. The assessment of pain scores depends on the validity and
reliability of the scale to chronic and acute pains as previously reported in literature
(2,57). Each participant completed the VAS pain scale before exercise (Pre), during
exercise (after 2 weeks) and post exercise (after 4 weeks). Also, the level of conviction
of individuals in the ability of sumac drinks to relief pain as well as their tendency to use this
drink in future were evaluated using short questionnaire and Likert scale as mentioned
previously (27).
Studies of the in vitro antioxidant activity
Sumac extract was dissolved in methanol and the antioxidant activity was measured at
different concentrations (10, 50, 100, 500 and 1,000 μg/ml) using 1,1-diphenyl-2-picryl-
hydrazyl (DPPH) free radical scavenging and β-carotenelinoleic acid assays as previously
reported (4,29). The antioxidant activity of the sumac extract depends on radical scavenging
ability of the sumac extract against DPPH and β-carotenelinoleic acid. For DPPH and
β-carotenelinoleic acid reagents, the change in color of DPPH radical and β-carotene
linoleic acid due to the addition of sumac extracts results from electron transfer mechanism.
The change in color of these reagents was measured colorimetrically at λ=517 nm for
DPPH, and at 470 nm with 15 min intervals for β-carotenelinoleic acid. Both ascorbic acid
and rutin (1 mg/ml) were used as a standard for antioxidant activity. The radical scavenging
activity and antioxidant activity were calculated from the following equations:
%radical scavenging activity =Abscontrol
Abssample
Abscontrol
×100
%antioxidant activity =ðAbs0
AbstÞ=ðAbs
0
Abs
tÞ×100
where Abs
0
and Abs
0are the absorbance values measured at 0 time of incubation for sample
extract and control, respectively. Abs
t
and Abs
tare the absorbance values for sample extract
and control, respectively, at t=120 min.
Laboratory analyses
Blood samples were collected before (Pre), during (D) and post exercise (PE) every day
after each exercise into sterilized tubes. The freshly withdrawn blood was immediately
centrifuged at 3,000 rpm for 10 min and aliquots of serum samples were separated into cryo
tubes, and given a coded study identication number. Serum CK activity was assayed without
delay and the rest serum samples were shipped frozen for later analysis of LDH, troponin I
and hyp.
CK and LDH activities
Serum CK was measured by a standardized commercially available enzymatic assay
(Granutest 15, Merck, Darmstadt, Germany), and LDH activity was measured by UV
method, provided with Randox Laboratories, Antrim, UK.
234 Alghadir and Gabr
Physiology International (Acta Physiologica Hungarica) 103, 2016
Troponin I and Hyp assay
Serum troponin I concentration was measured by enzymatic immunoassay technique
(EIA) using a sandwich human ELISA kit (Biovendor Research and Diagnostic Co, Cat.
No.: RLF-EK0128R, LLC, Asheville, NC 28806, USA). Serum hydroxyproline was
measured using commercially available colorimetric assay kit (Catalog #K555-100; BioVi-
sion Incorporated, Milpitas, CA, USA). The assay was performed according to manufac-
turers instructions.
Total antioxidant capacity (TAC)
Colorimetric assay kit (Catalog #K274-100; BioVision Incorporated, Milpitas, CA, USA)
was used to evaluate TAC in the serum of participants. The antioxidant equivalent
concentrations were measured at 570 nm as a function of Trolox concentration according
to manufacturers instructions
Sa=Sv =nmol=μl or mM Trolox equivalent
where Sa is the sample amount (in nmol) read from the standard curve and Sv is the undiluted
sample volume added to the wells.
Statistical analysis
A package of SPSS version 16 for windows (SPSS, Chicago, IL, USA) was used for
statistical analysis. The data obtained were expressed as mean ± standard deviation. VAS
pain scores, conviction and tendency to use the drink again were analyzed using [3 (time) ×2
(drink)] mixed-effects regression and independent samples t-tests, respectively. The change
in the variables of muscle fatigue was analyzed using one-way ANOVA followed by post hoc
test (Tukey test). The data were statistically signicant at p<0.05.
Results
Of the 40 participants enrolled in this study, only 20 participants were assigned sumac juice
(twice/day) and 20 were assigned the placebo drink. All subjects performed a regular exercise
training for 7 days per week for 1 month. No difference was detected between groups for any
of the outcomes listed (p>0.05) (Table I).
Daily nutrient intake showed variation in total calorie, macronutrient and micronutrient
intakes of both placebo and sumac groups. However, these parameters are situated in the
recommended interval of RDIs as shown in Table II. Also, it showed no effect on the data of
muscle fatigue markers in baseline period (pre-exercise test period) (Table VI).
Free radical scavenging and antioxidant activity of sumac extract
The antioxidant activity of the sumac was investigated in vitro and evaluated according to the
inhibition of linoleic acid oxidation and DPPH radical scavenging activity. Sumac extract
proved to have a radical scavenging activity of 68.7% and 87.9% particularly at the highest
concentrations of 500 and 1,000 μg/ml, respectively. Also, the same extract had an
antioxidant activity with a mean value of 68.7% regarding to the β-carotene bleaching rate
of sumac extract (Table III).
In the same manner, participants whose diet was supplemented with sumac juice along
with exercise showed signicant increase in the TAC compared to the placebo exercised
group during- and post-exercise training periods (Fig. 1).
Natural plants and modulating muscle fatigue 235
Physiology International (Acta Physiologica Hungarica) 103, 2016
Table II. Dietary record of the subjects (mean ± standard deviation)
Variable Placebo Sumac
Reference dietary
intake (RDI)
Kilocalorie 2,850 ± 450 2,420 ± 527 2,3003,450
Carbohydrate (g) 432.1 (144.0) 432.1 (144.0) 400500
Proteins (g) 104 ± 11.0 89 ± 9.0 70110
Fats (g) 125 ± 12.5 117 ± 10.4 100140
Carbohydrate (%) 54.9 ± 9.2 48.3 ± 7.1 4565%
Proteins (%) 15.6 ± 3.1 12.6 ± 4.1 1030%
Fats (%) 29.7 ± 3.5 27.4 ± 2.1 2535%
Cholesterol (mg/d) 360 ± 185 357 ± 250 <350
Vitamin C (mg/d) 56.7 ± 18.7 46.3 ± 12.4 4070
Vitamin E (mg/d) 7.8 ± 2.5 5.8 ± 1.7 1130
Vitamin A (IU) 1,650 ± 267.0 1,230 ± 156.0 9003,000
Folate (μg/d) 530 ± 75.0 410 ± 63.0 4001,000
Vitamin B12 (μg/d) 6.8 ± 2.5 3.6 ± 1.8 26
Table III. Free radical scavenging activity and antioxidant activity of sumac extract
Plant spices Radical scavenging activity (%)
Total
antioxidant
activity (%)
10 50 100 (μg/ml) 500 1,000 1,000 (μg/ml)
Sumac extract 13.9 34.5 52.3 68.7 87.9 68.7
Ascorbic acid 19.1 85.8 92.3 95.0 94.8
Rutin 91.8
Table IV. Mean pain scores (VAS) at three time points [Pre, during (D) and post-exercise (PE) of participants
(mean ± SD)]
Groups Pre (0 week) During (2 weeks) PE (4 weeks)
Placebo 8.6 ± 7.9 13.4 ± 5.2* 56.3 ± 20.5**
Sumac juice 10.2 ± 8.9 9.6 ± 6.4* 24.1 ± 10.6**
Between groups: *p<0.05; **p<0.001
236 Alghadir and Gabr
Physiology International (Acta Physiologica Hungarica) 103, 2016
Pain (VAS) of participants at pre-, during- and post-exercise
Participants of both sumac and placebo groups showed no change or difference in the mean
VAS scores (p=0.42) at pre-exercise period (0 week). At the same time, more pain scores
were reported in both sumac and placebo groups during the exercise test (2 weeks) and after
completing the exercise interventions (4 weeks). However, participants treated with sumac
juice for 4 weeks showed signicant decrease in pain scores during exercise (p<0.05) and
after completing exercise test (post-exercise; p<0.001) compared to those who received
placebo drink (Table IV).
Participant satisfaction
As shown in Table V, participants who received sumac juice supplements reported a higher
tendency to use the drink again (p<0.001), a higher overall conviction of the drink (p<0.001)
and a higher conviction in the pain reduction they attributed to the drink (p<0.001).
Muscle fatigue biomarkers
There were signicant differences (p<0.05) in muscle fatigue biomarkers among blood
samples of placebo and sumac juice groups, being elevated at D and PE vs. Pre values in the
Fig. 1. The level of total
antioxidant capacity (TAC) at pre-
(Pre), during- (D) and post-
exercise (PE) of adult human
participants (mean ± SD).
*Signicant difference (p<0.05)
between the sumac group and the
placebo group in Pre.
#
Signicant
difference (p<0.05) between
sumac group and exercise
group in D
Table V. Participant satisfaction with drink
Measure Groups Mean score p
Willingness to use drink in
future (1 =very
unwilling; 10 =very
willing)
Placebo 5.7 ± 2.8 <0.001
Sumac juice 9.8 ± 1.5
Drink satisfaction pain
relief (1 =very satised;
5=very dissatised)
Placebo 4.0 ± 1.2 <0.001
Sumac juice 2.9 ± 0.8
Drink satisfaction
overall (1 =very
satised; 5 =very
dissatised)
Placebo 3.9 ± 0.9 <0.001
Sumac juice 2.8 ± 0.6
Natural plants and modulating muscle fatigue 237
Physiology International (Acta Physiologica Hungarica) 103, 2016
placebo group and signicant decrease (p<0.05) in the values of these markers in the sumac
juice group at D and PE vs. pre-exercise (Table V). CK activity was signicantly decreased
(p<0.05) in the sumac group at D and PE (251.93 ± 23.2 and 197.6 ± 23.19 IU/L,
respectively) vs. D and PE of the placebo group (288.9 ± 26.13 and 309.97 ± 23.3 IU/L,
respectively). Also, the LDH activity was signicantly decreased (p<0.05) in the sumac
group at D and PE (32.4 ± 5.2 and 25.7 ± 4.6 IU/L, respectively) vs. D and PE of the placebo
group (45.9 ± 9.6 and 58.3 ± 10.3 IU/L, respectively). Whereas, troponin I concentrations
were signicantly decreased (p<0.05) in the sumac group at D and PE (0.56 ± 0.23 and
0.38 ± 0.21 ng/ml, respectively) vs. D and PE of the placebo group (1.17 ± 0.69 and 1.9 ±
0.9 ng/ml, respectively). Hyp values, shown in Table VI, were decreased (p<0.05) in the
sumac group at D and PE (0.68 ± 0.25 and 0.51 ± 0.19 ng/ml, respectively) vs. D and PE of
the placebo group (2.5 ± 0.62 and 3.9 ± 0.98 ng/ml, respectively).
Discussion
Regular physical activity associated with a balanced diet is known as an important factor for
health. However, exhaustive and/or intense physical activity can induce diseases, acute
inammation, injuries and chronic fatigue (7,9,44), and that the excessive muscle-skeletal
stress associated with intensive physical exercise is a response to overtraining, inducing acute
local inammation (15). It is expected, therefore, that training exercise programs will
experience inammation and pain as result of free radicals production (16). The main target
of this study was the specic effect of sumac juice drink on muscle indices and physical
muscle performance during an acute, intense exercise for 4 weeks. Therefore, the identica-
tion of common dietary substances of natural plant origin capable of affording benecial
protection or modulating muscle fatigue may have important health implications (59).
In this study before studying the improvement activity of sumac juice on muscle fatigue,
free radical scavenging and antioxidant activities of sumac extracts were estimated.
In this study, sumac showed a considerable antioxidative activity when it was subjected
to in vitro antioxidant analysis using both DPPH and β-carotene tests. The data obtained
suggest that the antioxidant activity of sumac extract against free radical oxidative stress and
Table VI. Change in muscle fatigue biomarkers at three time points [Pre, during (D)
and post exercise (PE) of participants (mean ± SD)]
Parameters Pre (0 week) During (2 weeks) PE (4 weeks)
Placebo Sumac juice Placebo Sumac juice Placebo Sumac juice
Creatine
kinase (IU/l)
267.7 ± 2.5 280.7 ± 11.2 288.9 ± 3.7 251.93 ± 8.5* 309.97 ± 7.9 197.6 ± 5.4**
Lactic acid
dehydrogenase
(IU/l)
37.18 ± 5.9 42.7 ± 4.2 45.9 ± 8.1 32.4 ± 3.7* 58.3 ± 11.6 25.7± 2.85**
Troponin I (ng/ml) 0.274 ± 0.12 0.75 ± 0.45 1.17 ± 0.16 0.56 ± 0.06* 1.9 ± 0.18 0.38± 0.04**
Hydroxyproline
(ng/ml)
0.74 ± 0.08 0.8 ± 0.94 2.5 ± 0.11 0.68 ± 0.05* 3.9 ± 0.15 0.48 ± 0.05**
Between groups: *p<0.05; **p<0.001
238 Alghadir and Gabr
Physiology International (Acta Physiologica Hungarica) 103, 2016
lipid peroxidation mechanisms may be related to the presence of tocopherols and other
unknown antioxidant components as well as unsaturated fatty acids (5,24,36).
Previously, it was reported that overtraining syndrome produces diseases, acute
inammation, injuries and chronic muscle fatigue via oxidative free radical mechanism
which may produce a partial toxicity during exercise programs of varying intensities
(9,34,38,42).
In the current study, more pain was reported in the participants of both sumac and
placebo treated groups following exercise interventions for 4 weeks. However, in participants
treated with sumac juice twice daily for 4 weeks, signicant decrease in pain score was
reported compared to that of the placebo group. The reduction in pain scores in the sumac
treated group supports that sumac may have a potential protective role against acute muscle
pain exerted following exhausted exercise programs.
Previous studies reported that oxidative tissue damage is considered one of the most
important factors of acute muscle injury with subsequent release of pain scores. Whereas the
oxidative tissue damage activates muscle tissues for the inammatory response and excessive
production of oxidative free radicals which increase secondary muscle soreness (19,28). So,
nutritional antioxidants of plant origin have been suggested as an alternative treating strategy
for ameliorating muscle pain and soreness following exercise or exhausted overtraining (8).
Previously, it was reported that sumac contains antioxidants, avonoids and hydrolyz-
able tannins which have anticancer, anti-tumor and hypoglycemic properties (5,24,36).
Therefore, the reduction in pain score among participants treated with sumac juice may be due
to the antioxidant effects of anthocyanins of such plants, through inhibition of nitrite peroxide
and isoform of nitric oxide synthase (iNOS) that leads to oxidative damage produced by
different cell cytokines during inammatory stress (10,13). Most studies reported the release
of intramuscular enzymes into blood and its signicance as pivotal indicators for skeletal
muscle damage (10,38), especially the occurrence of enzyme efux in response to over-
training as in unusual eccentric work or long duration strenuous exercise (38,42,60,61).
Also, it has been thought that higher tension may produce a considerable mechanical
damage to the muscle brils which in turn allows the efux of enzymes such as CK and LDH
into the blood. These enzymes are considered as good markers for skeletal muscle damage
(6,42).
In our study, a signicant decrease (enhancement) was reported in the levels of both CK
and LDH in participants who receive sumac juice supplementation twice daily for 4 weeks
compared to the placebo group which showed signicant increase in skeletal muscle enzymes
during exercise and in post-exercise intervals. The improvement in skeletal muscle enzymes
may be related to natural antioxidantspresence in sumac juice (24). Consumption of about
225 mg sumac extract/300 ml sumac juice per day provides signicant reduction in the levels
of the circulated inammatory markers of healthy subjects. The data obtained matched with
other researchersresults who reported a decrement in serum inammatory markers including
C reactive protein (CRP) by 25% after 28 days (8,14,19,21,23,26). The potential of skeletal
troponin I and hyp as markers of muscle injury may be useful for assessing the effects of
intense exercise for soft tissue injuries (31,48,51,55). So, in our study, troponin I and hyp
values were measured in the serum of placebo and sumac groupspre, during and post-exercise
test. The data obtained showed a signicant increase in the placebo group compared to the
sumac group which showed a signicant enhancement in the levels of troponin I and hyp.
Most of the studies have shown that normal physical activity, basketball training and a
treadmill exercise training test can also lead to a troponin and hyp rise in healthy individuals.
Natural plants and modulating muscle fatigue 239
Physiology International (Acta Physiologica Hungarica) 103, 2016
The presence of hydroxyproline amino acids and troponin I in the serum is the result of
collagen ber degradation either by overuse or strained muscle damage (30,45,46,49,51).
However, in sumac juice group, the data obtained indicated that treatment with sumac juice
could enhance protein collagen and troponin I levels in skeletal muscle. This may be related
to the antioxidant and anti-inammatory activity of sumac phenolic constituents (24,36).
In our study, a signicant increase (enhancement) in the TAC in the sumac juice group
receiving the juice twice a day for 30 days compared to the placebo group which showed
signicant reduction in TAC activity. This may be related to the antioxidant and free radical
scavenging activity of sumac constituents which protect the body against the harmful effects
of free radicals produced from exercise (24,27). Although the VAS has consistent and well-
dened clinically meaningful thresholds in the assessment of acute levels of pain (12,25,27,
42), the only methodological limitation of our study was the subjective assessment of pain
scores by VAS.
In conclusion, the data obtained showed that administration of sumac juice for 30 days
induced a signicant reduction in muscle fatigue and pain, and enhanced muscle performance
among healthy subjects following vigorous exercise interventions. Also, the data showed
signicant enhancement in the level of serum biomarkers; CK, LDH, troponin I and hyp
which indicates a benecial effect of oral administration of sumac juice on muscle perfor-
mance among athletes. Further research is needed to examine the mechanism by which the
sumac can improve collagen ber degradation.
Acknowledgement
The authors would like to extend their sincere appreciation to the Deanship of Scientic Research at King Saud
University for funding this research through the research group no. RGP-VPP-209.
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... Sumac (Rhus spp.), a flowering plant that grows in temperate and tropical regions, contains over 250 individual species worldwide [15]. It is usually used as spice and a medicinal herb in most of the world, particularly for its antiviral [16,17], antimicrobial, antibacterial, antioxidant, and wound-healing [18][19][20][21][22][23][24][25][26] properties. e antiviral activity of Rhus spp., particularly Rhus chinensis, has been explored in many studies. ...
... e review study demonstrated that sumac could be useful in COVID-19 infection due to its versatile activities as anti-inflammatory, antimicrobial, antioxidant, and antimalarial effects [48]. In addition, the review article along with others mentioned that use of sumac as syrup or in capsules with different concentrations has no toxicity on human life and could be recommended in treatment protocol for COVID-19 patients [18,[48][49][50][51]. ...
... Regarding previous molecular docking studies [12,18,36,[44][45][46][47][48][49][50][51][52], we are trying to explore the potential inhibitory effects of some Rhus spp. (sumac) constituents against the SARS-CoV-2 main protease enzyme using molecular docking, drug likeness, and synthetic accessibility score analysis. ...
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Background: The outbreak of coronavirus disease 2019 (COVID-19) induced by the novel coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) originated in China and spread to cover the entire world with an ongoing pandemic. The magnitude of the situation and the fast spread of the new and deadly virus, as well as the lack of specific treatment, led to a focus on research to discover new therapeutic agents. Aim: In this study, we explore the potential inhibitory effects of some active polyphenolic constituents of Rhus spp. (sumac) against the SARS-CoV-2 main protease enzyme (Mpro; 6LU7). Methods: 26 active polyphenolic compounds of Rhus spp. were studied for their antiviral activity by molecular docking, drug likeness, and synthetic accessibility score (SAS) as inhibitors against the SARS-CoV-2 Mpro. Results: The results show that all tested compounds of sumac provided good interaction with the main active site of SARS-CoV-2 Mpro, with better, lower molecular docking energy (kcal/mol) compared to the well-known drugs chloroquine and favipiravir (Avigan). Only six active polyphenolic compounds of Rhus spp. (sumac), methyl 3,4,5-trihydroxybenzoate, (Z)-1-(2,4-dihydroxyphenyl)-3-(3,4-dihydroxyphenyl)-2-hydroxyprop-2-en-1-one, (Z)-2-(3,4-dihydroxybenzylidene)-6-hydroxybenzofuran-3(2H)-one, 3,5,7-trihydroxy-2-(4-hydroxyphenyl)chroman-4-one, 2-(3,4-dihydroxyphenyl)-3,5-dihydroxy-7-methoxy-4H-chroman-4-one, and 3,7-dihydroxy-2-(4-hydroxyphenyl)chroman-4-one, were proposed by drug likeness, solubility in water, and SAS analysis as potential inhibitors of Mpro that may be used for the treatment of COVID-19. Conclusion: Six phenolic compounds of Rhus spp. are proposed for synthesis as potential inhibitors against Mpro and have potential for the treatment of COVID-19. These results encourage further in vitro and in vivo investigations of the proposed ligands and research on the preventive use of Rhus spp. against SARS-CoV-2.
... The study reported no side effects in the groups. 41 In another study, the safety profile of the Sumac extract was determined. It was found that the extract did not impair the integrity of the intestinal epithelial cell layer, did not significantly decrease Lactobacillus viability, and did not demonstrate any cytotoxic effects on vaginal keratinocytes. ...
... Sumac juice could be consumed two bottles (300 mL) per day for 7 days. 41 ...
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Sumac is an herbal product, commonly consumed as a spice and was used for medical treatment for centuries. The phytochemical structure of Sumac was studied extensively, and it was established that the herb contained tannins, polyphenols, flavonoids, organic acids, and essential oils. Various scientific studies demonstrated that Sumac had a free oxygen radical-scavenging effect, a protective effect against liver damage, antihemolytic, leukopenia, and antifibrogenic effects, along with its antiviral, antimicrobial, anti-inflammatory, and antioxidant properties. Recently, several scientific studies described the pathophysiology, clinical course, and the treatment of COVID-19 infection. The examination of the characteristics of COVID-19 infection revealed via the clinical studies suggests that Sumac extract could be useful in the treatment of COVID-19. Given the scientific studies focusing on the beneficial effects of Sumac, the present review aims to provide an encouraging viewpoint to investigate whether Sumac is effective in treating COVID-19 infection.
... Rhus coriaria consists of compounds such as tannins, phenolic acids, flavonoids, terpenoids, and essential oil composed of monoterpenes that have numerous biological activities, which are used as hair cleaning solutions or anti-dandruff agents for the improvement of dermatological problems [16,17]. It has antimicrobial, antiviral, antifungal, antioxidant, anti-inflammatory, and anticancer activities [18,19]; it is also used orally for reducing blood glucose, uric acid, and cholesterol levels [20][21][22]. ...
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Background: The present study aimed at determining the efficacy of applying Rhus coriaria (Sumac) solution for the treatment of Permethrin-resistant head louse in patients, who used permethrin for at least 2 consecutive periods, but have not been cured. Methods: This study is a before-after clinical trial performed on 100 patients with pediculosis aged between 2 and 50 years old and both sexes. All patients had used Permethrin at least twice consecutively (with at least 14 days intervals) according to correct instructions (on the first and 7 the day), but they have not been cured. Each patient received 60ml of Rhus coriaria solution for 3 consecutive days, and the treatment was repeated for another 3 days; then, the patients were followed-up on the 4 the, 10 the, and14 the days after the treatment. Results: The results showed a significant difference in the severity of head lice infection and itching before the treatment and 14 days after the treatment (P<0.001).
... [OSI (arbitrary units) = [TOA/TAC] × 100 14 ]}20,21 In this experiment, a commercially available colorimetric assay kit (Catalog #K555-100; BioVisionIncorporated, Milpitas, CA, USA) was used to estimate serum hydroxyproline according to manufacturer instructions.41 In addition, a commercially immuno assay ELIAS kit (Hangzhou Eastbiopharm Company, Hangzhou, China) was used to identify SPEA in serum samples of all subjects.42 ...
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Objective: The current case-control study aimed to evaluate generalized joint hypermobility (GJH) and its association with pain intensity, cellular oxidative stress, and collagen-associated disorders in university students aged 18-25 years old. Background: Joint hypermobility has been recognized in healthy subjects and people who are carriers of cellular disorders in connective tissues. Cellular tissue oxidative stress and collagen-associated disorders were shown to be associated with joint hypermobility (JH). Materials and methods: A total of 300 university students aged 18-25 years were randomly invited from different medical and science faculties in Mansoura university, Mansoura, Egypt to participate in this case-control study. Only 280 university students who had no exclusion criteria like chronic health problems, physical disability, musculoskeletal disorders, and body mass index (BMI) of ≥25 underwent an initial clinical interview and Beighton scoring as measures of GJH. Pain intensity, physical activity, oxidative stress parameters; TAC, TOC, OSI, and collagen-associated parameters; cellular prolidase activity and hydroxyproline were evaluated by using a prevalidated questionnaire, colorimetric, and immunoassay techniques. Results: GJH was significantly reported in 57.1% of the study population, and most of them are females. Compared to men, females with GJH showed poor physical activity, lower TAC, and significantly higher levels of TOC, OSI, cellular prolidase activity, and hydroxyproline. Based on our findings, a high Beighton score is closely related to the tissue levels of prolidase, hydroxyproline, antioxidant activity, pain intensity, and poor physical activity in the female with GJH compared to men. Conclusion: GJH was significantly reported in 57.1% of the study population, and most of them are females. The incidence of GJH showed to be associated with poor physical activity, abnormal cellular oxidative stress, and collagen abnormalities measured by significant increase in change in cellular prolidase activity and hydroxyproline.
... 63 , Rhus coriaria L. 66 59 , Rhazya stricta Decne. 63 , Rhus coriaria L. 67 . Utilization of traditional medicine among the Iranian people has a wide range of 10% to 75% depending on the diversity of populations [76][77][78][79] . ...
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Objectives: Oral mucositis is among the complications of cancer therapy that affects quality of life and imposes remarkable financial costs for patients with cancer. This study aimed to explore, preserve, and scientifically investigate the ethnomedicinal knowledge of traditional healers for treatment of oral mucositis in Zahedan, Iran. Materials and methods: Field surveys were performed from September 2018 to October 2018 in Zahedan. Data was collected using a structured questionnaire in Persian. All species recorded for the treatment of oral mucositis were sampled. Samples were identified by a botanist and a voucher specimen of them was deposited in the Herbarium Center of the Faculty of Pharmacy in Kerman, Iran. Information, such as scientific name, family, local name, parts used, and preparation method, were also provided. Literature review on available data on effect of the addressed plant species on mucositis and other relative pharmacological actions, such as wound healing and anti-inflammatory properties, was performed. Results: A total of 29 informants (attars) were interviewed and 18 medicaments were recommended, of which three samples were of synthesis or mineral origin and 15 samples were of herbal origin. Drugs were administered both topically and orally. According to recent studies, two herbs were evaluated for their direct effect on mucositis. Some pharmacological properties related to mucositis treatment by the other 11 samples have been confirmed. Conclusion: This study provides information on the characteristics of medicinal plants from Zahedan, Iran based on their ethnopharmacological knowledge and pharmacological properties for mucositis treatment.
... Rhus coriaria consists of compounds such as tannins, phenolic acids, flavonoids, terpenoids, and essential oil composed of monoterpenes that have numerous biological activities, which are used as hair cleaning solutions or anti-dandruff agents for the improvement of dermatological problems [16,17]. It has antimicrobial, antiviral, antifungal, antioxidant, anti-inflammatory, and anticancer activities [18,19]; it is also used orally for reducing blood glucose, uric acid, and cholesterol levels [20][21][22]. ...
Article
Full-text available
Background: The present study aimed at determining the efficacy of applying Rhus coriaria (Sumac) solution for the treatment of Permethrin-resistant head louse in patients, who used permethrin for at least 2 consecutive periods, but have not been cured. Methods: This study is a before-after clinical trial performed on 100 patients with pediculosis aged between 2 and 50 years old and both sexes. All patients had used Permethrin at least twice consecutively (with at least 14 days interval) according to correct instructions (on the first and 7th day), but they have not been cured. Each patient received 60ml of Rhus coriaria solution for 3 consecutive days, and the treatment was repeated again for another 3 days; then, the patients were followed-up on the 4th, 10th, and14th days after the treatment. Results: The results showed a significant difference in the severity of head lice infection and itching before the treatment and 14 days after the treatment (P
... Alghadir et al. investigated the effects of sumac juice after acute, intense exercise for 30 days and showed reduced muscle indices and pain in the treatment group. The protective activity on muscle was discussed as being related to the antioxidant activity of phenolic components in sumac juice (Alghadir & Gabr, 2016). The most important goal in NEC treatment is to reduce oxidant stress (Cakir et al., 2018;Lim et al., 2015;Tayman et al., 2012). ...
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Leukotrienes, free oxygen radicals, tumor necrosis factor‐alpha, and inflammatory mediators play major roles in the development of necrotizing enterocolitis (NEC). Rhus coriaria (RC: sumac) extracts may enhance cell viability by reinforcing defenses against free radical species in several progressive diseases as well as inflammatory diseases. The aim of the present study was to evaluate the effects of RC in a rat NEC model in terms of intestinal damage. Newborn pups were separated into three groups: control, NEC, and NEC treated with RC. Mortality and clinical sickness scores were evaluated. At the end of the study, ileum and proximal colon were obtained from all rats and histopathological and immunohistochemical studies were performed. In this study, the anti‐inflammatory, antioxidant, immunomodulatory, and anti‐apoptotic activities of RC were demonstrated in a rat NEC model, which suggests RC as a promising treatment option for preventing intestinal tissue damage. Practical applications Free oxygen radicals, tumor necrosis factor‐alpha, and inflammatory mediators play major roles in the development of NEC. Intestinal tissue damage is caused by necrosis and apoptosis as a result of intestinal inflammation and release of pro‐inflammatory cytokines. Anti‐inflammatory, antioxidant, immunomodulatory, and anti‐apoptotic activities of RC are especially due to its phenolic compounds. In this study, the anti‐inflammatory, antioxidant, immunomodulatory, and anti‐apoptotic activities of RC were demonstrated in a rat NEC model. RC can suggest as a new treatment option for preventing intestinal injury.
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Sumac (Rhus coriaria L.) is a commonly used spice in the Mediterranean region and considered as healthy food ingredients. The beneficial value of sumac is well documented in folk medicine. Accumulating data explored the phytochemical, nutritional and therapeutic proprieties suggesting sumac as a potential functional food. Here, we discuss the general and scientific aspects of sumac. Sumac is rich in different polyphenolic compounds such as flavonoids, tannins, and phenolic acids. The potential therapeutic effects of sumac have been studied in various cellular and animal models, as well as in human. These reports suggest that Sumac has potential effect against oxidative stress, inflammation, obesity, hyperglycemia, hypercholesterolemia, and hyperlipidemia, which represent key pathogenic mechanisms contributing to cardio-metabolic, liver, and cancer diseases. Clinical studies using sumac or its major compounds, suggest that this herbal product may represent a useful therapeutic tool in the management of metabolic-related conditions such as liver-atherosclerosis complications.
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Rhus coriaria L. (Anacardiaceae), commonly known as sumac, is a commonly used spice, condiment, and flavoring agent, especially in the Mediterranean region. Owing to its bountiful beneficial values, sumac has been used in traditional medicine for the management and treatment of many ailments including hemorrhoids, wound healing, diarrhea, ulcer, and eye inflammation. This plant is rich in various classes of phytochemicals including flavonoids, tannins, polyphenolic compounds, organic acids, and many others. By virtue of its bioactive, Rhus coriaria possesses powerful antioxidant capacities that have ameliorative and therapeutic benefits for many common diseases including cardiovascular disease, diabetes, and cancer. This review describes the phytochemical properties of R. coriaria and then focuses on the potent antioxidant capacities of sumac. We then dissect the cellular and molecular mechanisms of sumac’s action in modulating many pathophysiological instigators. We show how accumulating evidence supports the antibacterial, antinociceptive, antidiabetic, cardioprotective, neuroprotective, and anticancer effects of this plant, especially that toxicity studies show that sumac is very safe to consume by humans and has little toxicity. Taken together, the findings we summarize here support the utilization of this plant as an attractive target for drug discovery.
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Sumac is the common name for a genus (Rhus) that contains over 250 individual species of flowering plants in the family Anacardiaceae. These plants are found in temperate and tropical regions worldwide, often grow in areas of marginal agricultural capacity, and have a long history of use by indigenous people for medicinal and other uses. The research efforts on sumac extracts to date indicate a promising potential for this plant family to provide renewable bioproducts with the following reported desirable bioactivities: antifibrogenic, antifungal, antiinflamma-tory, antimalarial, antimicrobial, antimutagenic, antioxidant, antithrombin, antitumorigenic, antiviral, cytotoxic, hypo-glycaemic, and leukopenic. As well, the bioactive components can be extracted from the plant material using environmentally benign solvents that allow for both food and industrial end-uses. The favorable worldwide distribution of sumac also suggests that desirable bioproducts may be obtained at the source, with minimal transportation requirements from the source through processing to the end consumer. However, previous work has focussed in just a few members of this large plant family. In addition, not all of the species studied to date have been fully characterized for potential bioactive components and bioactivities. Thus, there remains a significant research gap spanning the range from lead chemical discovery through process development and optimization in order to better understand the full potential of the Rhus genus as part of global green technology based on bioproducts and bioprocesses research programs.
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Myocardial infarction (MI) is the acute condition of necrosis in myocardium which occurs as a result of imbalance between coronary blood supply and myocardial demand. The resultant oxidative stress excess leads to worsen the condition. The aim of this study was to investigate the effect of mebudipine, a new dihydropyridine calcium channel blocker, on lipid peroxidation and antioxidant enzymes in myocardial ischemia-reperfusion injury. Male Wistar rats (250-300 g) were randomly divided to Control-ischemic, mebudipine-ischemic and vehicle (ethanol-ischemic) groups. The hearts of anaesthetized rats were removed and mounted on Langendorff apparatus and perfused by Krebs-Henseleit solution under constant pressure of 75 mmHg at 37°C. Ischemic groups were received 30 min global ischemia and 120 min reperfusion and the mebudipine and vehicle groups received mebudipine (0.1 nM) or ethanol (0.01%)-enriched solution 25 min before global ischemia. Malondialdehyde (MDA), superoxide dismutase (SOD), glutathione peroxidase (GPX) and catalase levels of heart tissue samples were determined by commercial specific Kits. Mebudipine significantly reduced the MDA level (2.3 ± 0.07 nmol/mg protein) as the biochemical indicator of oxidative damage and lipid peroxidation product as compared with those of vehicle (4.6 ± 0.01 nmol/mg protein) and control groups (4.8 ± 0.09 nmol/mg protein). Furthermore, antioxidant enzymes SOD (0.1 ± 0.006 in drug vs. 0.037 ± 0.009 U/mg Protein in control), GPX (16 ± 0.009 in drug vs. 0.068 ± 0.01 U/mg Protein in control) and catalase activities (0.075 ± 0.006 in drug vs. 0.028 ± 0.002 U/mg Protein in control), activities of myocardium were significantly increased by mebudipine (P < 0.01). Our results showed that mebudipine may have antioxidant activity against myocardial ischemia-reperfusion injury since it decreased oxidative stress by enhancing the enzymatic antioxidant defense and inhibiting the lipid peroxidation. Thus, this drug can reduce the intensity of cardiac ischemic insults.
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Lactate and exercise : myths and realities This review is made of two parts ; each one is presented under the form of questions to which, by using only published scientific data, we try to give up-to-date answers and to highlight the limits of theories sometimes easily admitted concerning lactic acid effects. The first part of the review is mainly focused on the study of lactate synthesis and metabolism during and after exercise. This study would allow us to built our criticisms concerning : several a priori about lactate effects, about the concepts of « anaerobic lactic thresholds », and on the theories underlining these ones. The second part of the review is focused on possible consequences, but not proved, of lactate accumulation on the skeletal muscle function. How should we accept anymore to ear that lactic glycolysis has a poor energetic yield, or that lactate accumulation leads to cramps, fatigue, and other differed muscular pains ?
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Athletes fail to perform to the best of their ability if they become infected, stale, sore or malnourished. Excessive training with insufficient recovery can lead to a debilitating syndrome in which performance and well being can be affected for months. Eliminating or minimizing these problems by providing advice and guidelines on training loads, recovery times, nutrition or pharmacological intervention and regular monitoring of athletes using an appropriate battery of markers can help prevent the development of an overtraining syndrome in athletes. The potential usefulness of objective physiological, biochemical and immunological markers of overtraining has received much attention in recent years. Practical markers would be ones that could be measured routinely in the laboratory and offered to athletes as part of their sports science and medical support. The identification of common factors among overtrained athletes in comparison with well-trained athletes not suffering from underperformance could permit appropriate intervention to prevent athletes from progressing to a more serious stage of the overtraining syndrome. To date, no single reliable objective marker of impending overtraining has been identified. Some lines of research do, however, show promise and are based on findings that overtrained athletes appear to exhibit an altered hormonal response to stress. For example, in response to a standardized bout (or repeated bouts) of high intensity exercise, overtrained athletes show a lower heart rate, blood lactate and plasma cortisol response. Several immune measures that can be obtained from a resting blood sample (e.g. the expression of specific cell surface proteins such as CD45RO+ on T-lymphocytes) also seem to offer some hope of identifying impending overtraining. If an athlete is suspected of suffering from overtraining syndrome, other measures will also required, if only to exclude other possible causes of underperformance including post-viral fatigue, glandular fever, clinical depression, poor diet, anaemia, asthma, allergies, thyroid disorders, myocarditis and other medical problems interfering with recovery.
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Athletes use flavonoids as antioxidant to enhance endurance and physical performance. In vitro data indicate flavonoids have antioxidative and antiinflammatory functions but data in human studies are limited. The aim of this study was to determine the effects of a 2-month flavonoid quercetin supplementation on oxidative stress and inflammatory biomarkers in nonprofessional athletes with regular exercise. The randomized double-blind clinical trial was done among subjects with systematic and regular exercise for 8 weeks in four groups, each containing 15 individuals: 500 mg quercetin + 250 mg vitamin C as pro-oxidant (Q+C), 500 mg of quercetin alone (Q), 250 mg of vitamin C alone (C), and placebo (Control). IL-6, CRP, E-selectin and F2-isoprostane were measured before and after intervention. In 60 participants with mean (±SD) age of 21.0 ± 1.6 years, statistically significant within group differences were observed in IL-6 (P<0.1), CRP (P<0.01) and F2-isoprostane for group 1 and pre- and postchanges in E-selectin was marginally significant for all study groups (P<0.1). Group 1 had marginally smaller F2-isoprostane (P<0.1) and interleukin 6 than control group (P<0.05) and there were marginally differences in CRP between respondents in group 1 and 2 with the control group (P<0.1). Eight-week supplementation with quercein-vitamin C was effective in reducing oxidative stress and reducing inflammatory biomarkers including CRP and IL-6 with little effect on E-selectin in healthy subjects.
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Background The level of disability and endurance of back muscles have been investigated, but there is conflicting evidence following specific exercise interventions for participants with recurrent low back pain (LBP). The purpose of this study was to compare the level of disability and slope of median frequency (MF) of thoracic and lumbar erector spinae (ES) muscles following core stabilization exercise (CSE) and spinal flexibility exercise (SFE). Material/Methods In total, 46 individuals participated in this study. There were 25 participants in the CSE intervention group (average age of 47.7±8.9 years) and 21 participants in the SFE group (average age of 53.1±9.0 years). Each group participated in the specific exercise intervention program for 4 weeks while maintaining their current activity and/or exercise levels. The Oswestry Disability Index (ODI) was used to measure the level of disability changes. The fatigability of the ES back muscles was measured by the slope of MF, using a modified Sorensen test. Results The disability level decreased significantly following CSE intervention (t=2.23, p<0.05). However, there was no significant difference in muscle fatigability changes in the 4-week intervention period for either group. Conclusions The CSE intervention reduced disability level following the 4-week intervention period. Further studies are needed to investigate the effectiveness of specific back muscle exercises in longer intervention periods for back muscle fatigability.