Multienzyme-complex for the management of delayed onset musclesoreness after eccentric exercise a randomized double blind placebo controlled study

Abstract

Background: Delayed onset muscle soreness (DOMS) results from muscle overload or strenuous exercise that goes beyond the intensity or duration for which the muscle is accustomed to performing. It is accompanied with the sensation of pain, tenderness, deep ache, and stiffness in muscles that usually begins several hours after the unaccustomed exercise. The aim of this study was to compare the efficacy of multi enzyme complex with a matching placebo in reducing pain associated with DOMS induced by standardized eccentric exercise.
Methods: Twenty healthy males (10 pairs) were randomized in this double blind, placebo controlled trial to receive a placebo or multi enzyme complex capsule (50 mg) thrice a day for a period of 3 days. Mean differences within the group and between groups were assessed at each data collection time-point using Analysis of Covariance (ANCOVA) and Wilcox on signed rank sum test for all outcome measures.
Results: In this controlled clinical study, intake of multi enzyme complex for 3 days resulted in no statistically significant changes in the descriptive statistics and efficacy analysis in muscle power and grip strength measured by hand held dynamometer. Algometer readings of thigh muscle, showed statistical significance (p<0.043). Decrements were observed in McGill Pain Questionnaire showing high statistical significance. Reducing trend was observed in bio markers of muscle damage (creatine kinase and lactate dehydrogenase) as well.
Conclusion: The study results suggest that compared to placebo, Multi enzyme complex supplementation improves the outcome measures related to DOMS induced by standardized eccentric exercise.

Full text

Volume 1 • Issue 3 • 1000113Sports Nutr Ther, an open access journal
ISSN: 2473-6449
OMICS International
Research Article
Majeed et al., Sports Nutr Ther 2016, 1:3
DOI: 10.4172/2473-6449.1000113
Sports Nutrition and Therapy
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ISSN: 2473-6449
Keywords: Delayed onset muscle soreness (DOMS); Muscle soreness
questionnaire (MSQ); Pressure pain threshold (PPT); Hand held
dynamometer; Illinois agility run test; Multi-enzyme complex
Introduction
Delayed onset muscle soreness is related to muscle damage
occurring several hours aer unaccustomed exercise, particularly
when eccentric muscle activity is involved [1,2]. Contracting muscles
are forcibly lengthened with eccentric exercise like downhill running
which limits physical function for several days [3,4]. is triggers an
inammatory response and the production of reactive oxygen species
(ROS) that sustain inammation and oxidative stress by promoting
the activation of transcription factors like the nuclear factor-κβ (NF—
κβ), a pro-inammatory master switch that controls the production of
inammatory markers and mediators [5]. e inammatory response
ensures musculoskeletal injury; uncontrolled inammation may
prolong skeletal muscle recovery [4].
Delayed onset muscle soreness (DOMS) is a well-documented
phenomenon, oen occurring as the result of the unaccustomed or
high intensity eccentric exercise. Associated symptoms include muscle
shortening, increased passive stiness, swelling, decreases in strength
and power, localized soreness and disturbed proprioception. Symptoms
will oen occur within 24 h post-exercise and typically subside aer 3-4
days. e severity of damage and soreness varies as a function of several
factors [6].
Considerable amount of research on the treatment of DOMS has
been carried out till date but no single treatment has been proven
successful in consistently preventing or treating DOMS. Treatment
strategies have oen integrated multiple therapeutic approaches such
as cryo therapy, ultrasound, compression therapy, stretching and deep
tissue massage [7-11]. ere is some evidence that ibuprofen, naproxen,
and massage may accelerate the resolution of DOMS [12]. In addition,
several dietary supplements have been tested in the treatment of DOMS
including protein, vitamin C, proteases (enzymes), phosphatidylserine,
chondroitin sulphate, and sh oil, all with variable success [4,12-18].
Non-steroidal anti-inammatory drugs (NSAIDs) like ibuprofen
are used widely as anti-DOMS recourse. NSAIDs are known to
interfere with chemo taxis of monocytes as well as inhibit neutrophil
aggregation [19]. Monocytes produce cytokines, which are responsible
for most of the physiological responses accompanying injury, and
neutrophils produce elastase and collagenase, which increase vascular
permeability via degradation of the vasculature and healthy tissue near
the injury site [20]. It is possible that the use of NSAIDs may impair
and lengthen the healing process.
In spite of inconsistencies, dose and timing of various NSAIDs also
in dierent studies there are side eects such as gastrointestinal distress
and hypertension. Hence NSAIDs are not an optimal choice for treating
DOMS [12]. Using enzymes to combat DOMS is also well established.
*Corresponding author: Vuppala KK, M.Ph, ClinWorld Private Limited, Peenya
Industrial Area, Bangalore, Karnataka, Tel: +917760956367; E-mail: kiran@clinworld.org
Received September 24, 2016; Accepted October 25, 2016; Published
November 11, 2016
Citation: Majeed M, Siva KA,Shaheen M,Priti V and Kiran KV (2016) Multi-Enzyme
Complex for the Management of Delayed Onset Muscle Soreness after Eccentric
Exercise: A Randomized, Double Blind, Placebo Controlled Study. Sports Nutr
Ther 1: 113. doi: 10.4172/2473-6449.1000113
Copyright: © 2016 Majeed et al. This is an open-access article distributed under
the terms of the Creative Commons Attribution License, which permits unrestricted
use, distribution, and reproduction in any medium, provided the original author and
source are credited.
Abstract
Background: Delayed onset muscle soreness (DOMS) results from muscle overload or strenuous exercise
that goes beyond the intensity or duration for which the muscle is accustomed to perform. It is accompanied with
the sensation of pain, tenderness, deep ache, and stiffness in muscles that usually begins several hours after the
unaccustomed exercise. The aim of this study was to compare the efcacy of multi enzyme complex with a matching
placebo in reducing pain associated with DOMS induced by standardized eccentric exercise.
Methods: Twenty healthy males (10 pairs) were randomized in this double blind, placebo controlled trial to
receive a placebo or multi enzyme complex capsule (50 mg) thrice a day for a period of 3 days. Mean differences
within the group and between groups were assessed at each data collection time-point using Analysis of Covariance
(ANCOVA) and Wilcoxon signed rank sum test for all outcome measures.
Results: In this controlled clinical study, intake of multi enzyme complex for 3 days resulted in no statistically
signicant changes in the descriptive statistics and efcacy analysis in muscle power and grip strength measured by
hand held dynamometer. Algometer readings of thigh muscle showed statistical signicance (p<0.043). Decrements
were observed in McGill Pain Questionnaire showing high statistical signicance. Reducing trend was observed in
bio markers of muscle damage (creatine kinase and lactate dehydrogenase) as well.
Conclusion: The study results suggest that compared to placebo, Multi enzyme complex supplementation
improves the outcome measures related to DOMS induced by standardized eccentric exercise.
Multi−Enzyme Complex for the Management of Delayed Onset Muscle
Soreness after Eccentric Exercise: A Randomized, Double Blind, Placebo
Controlled Study
Majeed M, Siva KA,Shaheen M,Priti V and Kiran KV*
ClinWorld Private Limited, Peenya Industrial Area, Bangalore, Karnataka

Citation: Majeed M, Siva KA,Shaheen M,Priti V and Kiran KV (2016) Multi-Enzyme Complex for the Management of Delayed Onset Muscle Soreness
after Eccentric Exercise: A Randomized, Double Blind, Placebo Controlled Study. Sports Nutr Ther 1: 113. doi: 10.4172/2473-6449.1000113
Page 2 of 7
Volume 1 • Issue 3 • 1000113Sports Nutr Ther, an open access journal
ISSN: 2473-6449
Advanced Surgeries, #146, Infantry Road, Bangalore prior to the
initiation of the study. e study documents reviewed were (protocol,
informed consent form, investigator brochure, and case record form).
e aforesaid Ethics Committee was registered under central drugs
standard control organization as per the gazette notication number
F.28-10/45-H(1), dated 21 Dec 1945 and last amended vide notication
number G.S.R. 76(E) dated 08 FEB 2012.
Informed consent
is study included a total of 20 healthy volunteers. An initial
screening visit was scheduled during which all subjects rst signed
written informed consent. Before the signing of the informed consent
adequate oral and written information concerning the study was
provided to the subjects and subjects were provided with ample
opportunity to consider their participation in the study. Aer obtaining
a signed informed consent subjects were screened for the study.
Study design
For the DOMS model under study, we selected the following
design features: prospective, double blind, randomized, and placebo
controlled. e analgesic ecacy of DigeZyme® was compared with a
matching placebo. e pre specied ecacy end points of the study
were assessed on Day 0 (pre exercise) and 72 hours post exercise.
Participants
Twenty healthy males with no known musculoskeletal pathology
participated in the study. Subjects were excluded if they met one
or more of the following exclusion criteria: treatment with anti-
inammatory/analgesic/antioxidant drugs in the previous month,
abnormal liver or renal function tests, laboratory ndings suggestive
of an active inammatory or infectious process and presence of any
known disease.
e participants also completed a health history questionnaire
designed to identify the degree of risk for cardiovascular or orthopaedic
complications during exercise.
Supplementation with multi enzyme complex
All participants in the experimental group received multi enzyme
complex supplementation over a 3 day period. During this period,
they consumed one capsule of multi enzyme complex thrice a day.
e participants in the placebo group received capsules of similar
size and colour. ey were given identical instructions on dosage of
study supplement to be followed. Study supplements were prepared
and provided by Sami Labs Limited, Bangalore. e administration of
treatment and placebo was blinded for both the participants and the
investigator. ere were no side eects reported by the participants as
a result of the supplementation.
Data collection protocol
Subjects visited the clinic on day 0 (baseline visit) and subsequent
visits on day 1, day 2 and day 3. Aer recording vital signs (blood
pressure, pulse rate, heart rate and respiratory rate), medical and
medication history, physical examination was conducted.
Randomisation and allocation concealment
e randomisation sequence was prepared by an independent
statistician, independent of the sponsoring organization and not
involved in conduct or reporting of the study. An alpha numeric
code was generated for both the active and placebo to improve the
A study by inner eld in 1957 examined the anti-inammatory
eects of protease enzyme therapy and showed that protease enzyme
supplementation may have anti-inammatory eects [21].
Commercially, digestive enzymes are isolated from various
sources such as the pancreas of higher animals (swine and cattle),
higher vegetables (barley), and microorganisms including bacteria and
fungi. e multi enzyme complex (DigeZyme®) consists of MO free
broad acting enzymes obtained from the fermentation process with
Aspergillusoryzae, including amylase, protease and lipase; this group
of enzymes breaks carbohydrates, proteins and fats and all three groups
of enzymes are resistant to the action of gastric juices, while retaining
their digestive activity. DigeZyme® was also clinically evaluated for
enhanced absorption of minerals and vitamins.
Absorption issues and the destruction of enzymes in the gut have
severely limited the eectiveness of traditional anti-DOMS enzyme
therapy. Sitosterols -- plant sterols and protease enzymes can help
reduce the inammation associated with DOMS. Earlier research has
suggested protease oral supplementation to shorten recovery time
post injury through the inhibition of arachidonic cascade. Protease is
also believed to inhibit the biosynthesis of pro-inammatory agents
[22], increase tissue permeability, facilitate resorption of oedema and
accelerate the restructuring of damaged tissue [23]. Protease utilization
is generally considered safe.
e current clinical study aims at investigating the ecacy of multi-
enzyme complex, a multi-enzyme complex which is a combination of ve
digestive enzymes (alpha-amylase, neutral protease, cellulase, lactase
and lipase), as a dietary supplement in the management of DOMS.
erefore, the current randomized, double blind placebo
controlled trial was conducted to evaluate the eect of multi-enzyme
complex (amylase, lipase, lactase, cellulose and neutral protease) for the
management of delayed onset muscle soreness aer eccentric exercise.
Materials and Methods
Product description
DigeZyme® is an “o - white to creamy white powder of multi-
enzyme complex”. is multi-enzyme complex consists of amylase,
protease, lipase, cellulase and lactase. Placebo capsules containing
equivalent weight of maltodextrin. No dierences in colour, taste,
texture or packaging were detectable between the two products. Capsules
were sealed in identically-appearing, high-density polyethylene bottles
with desiccant. e enzyme activity of multi-enzyme complex was
determined by following standard methods as per Food Chemicals
Codex guidelines (Table 1).
Enzyme units were dened as per Food Chemical Codex (FCC), 5th
ed. 2004. e National Academy Press Washington DC.
Ethics approval
Ethics approval was obtained through the Sparsh Hospital for
S. No. Enzyme Enzyme activity (Units/g)
1 Alpha-amylase 24000 DU/g (Dextrinizing Unit/gram)
2 Cellulase 1100 CU/g (Cellulase Unit/gram)
3 Lipase 200 FIP/g
(FédérationInternationalePharmaceutiqueUnit/gram)
4 Lactase 4000 ALU/g (Acid Lactase Unit/gram)
5 Neutral
Protease
6000 PC/g (Protease Unit on L-tyrosine basis/gram)
Table 1: Composition detail of multi-enzyme complex (DigeZyme) formulation.

Citation: Majeed M, Siva KA,Shaheen M,Priti V and Kiran KV (2016) Multi-Enzyme Complex for the Management of Delayed Onset Muscle Soreness
after Eccentric Exercise: A Randomized, Double Blind, Placebo Controlled Study. Sports Nutr Ther 1: 113. doi: 10.4172/2473-6449.1000113
Page 3 of 7
Volume 1 • Issue 3 • 1000113Sports Nutr Ther, an open access journal
ISSN: 2473-6449
blindness of the study and concealment of allocations. Computer
generated random allocation soware (version 2.0) was used for the
allocation of concealment. Block randomization (only one block) was
followed wherein the subjects were randomized to receive either active
or placebo. e randomization codes were kept strictly condential
and were accessible only to authorized persons on an emergency basis
as per the Sponsor standard operating procedures until the time of
unblinding.
Blinding
e study was double blinded wherein neither the Investigator nor
the trial participants knew whether they would receive the active or
the placebo. e investigational products were provided in pre labelled
containers to avoid bias.
Procedures Followed
Protocol for inducing DOMS
Subjects were instructed to ingest the study supplement and report
to the site aer 24-hours for the baseline readings. Aer 10 hours
fasting, heart rate and ratings of perceived exertion were monitored at
rest, every 5 minutes during exercise and 10 minutes into recovery. e
participants mounted a level motorized treadmill and warmed up for
5 minutes at a self-selected pace. Post 5-min warm up, treadmill speed
was increased until a heart rate of 80% of predicted maximal heart rate
was achieved and were instructed to maintain this pace for 5 min. e
treadmill grade at this time was adjusted to 10% and was maintained
for 30 minutes. Subjects then completed a 5 minutes active cool-down
at a self-selected pace and a 5 minutes seated passive recovery period.
Subjects were restricted from indulging in any other physical activity
24 hours prior and 72 hours aer the exercise session [24].
Quantifying muscle soreness using algometer
e Muscle Soreness Questionnaires (MSQ) required participants
to rate their general soreness on a scale of 1 (normal) to 10 (very, very
sore) for the right front thigh and right back thigh. An algometer was
used to quantify muscle pain by applying direct pressure over the
muscle. It involves documenting the threshold at which the applied
pressure over the muscle is perceived as a sensation of pain rather than
a pressure; this is referred to as the pressure pain threshold (PPT). e
PPT has been demonstrated to be reliable for measuring pain threshold.
e algometer standard is to increase pressure linearly to 5 kg/cm2 over
5 seconds according to the method recommended by Fischer. e
instrument has a 1cm2 rubber footplate and a scale marked from 2 to 20
kg/cm2, in increments of 0.2 kg/cm2. Subjects were instructed to report
as soon as the sensation of pressure changes to pain by saying ‘pain’,
and ‘I will stop’. e footplate of the algometer was held perpendicular
to the muscle belly with the gauge turned away from the subject and
the examiner. Pressure was increased at a rate of approximately 1 kg/
cm2/s until the subject reported ‘pain’. e examiner then released
the pressure and lied the algometer o the muscle to read the gauge
and record the measurement. e needle on the gauge was returned
to baseline before each trial using the pressure release button on the
algometer [24].
For muscular strength and power using hand held
dynamometer
A Hand-Held Dynamometer (HHD) was used to quantify changes
in muscle strength by measuring strength during maximal voluntary
isometric contraction (MVC) of the muscle. Each participant was
asked to perform three repetitions of maximal knee extension and
exion contractions (MVC) at three dierent positions of knee range
of motion (0 degrees, 90 degrees, 120 degrees). e test angles were
chosen to account for changes in muscle strength that could occur due
to alteration in the length of the muscle at dierent positions of the
knee [25].
Illinois agility run test
Agility was measured using Illinois agility run test. e tests were
conducted on a course 10 meters in length and 5 meters in width.
Agility time was recorded using a stopwatch. e start, nish and the
two turning points were marked with four cones and another four
cones were placed down the center equal distance spaced 3.3 meters
apart. Subjects were made to lie on their front (head to the start line)
and hands by their shoulders. e run started from a standing start on
the command ‘Go’ the stopwatch was started, and the subjects were
instructed to get up as quickly as possible and run around the course in
the direction indicated, without knocking the cones over, to the nish
line, at which the timer was stopped [26].
Outcome measures
McGill pain questionnaire comprising of 10 subscales from 0 (no
pain) to 10 (worst possible pain) was used to assess pain [27,28]. An
algometer was used to experimentally induce pain on a predened
point on the patellar tendon ve centimetres above the center of the
patella, tenderness was assessed.
Subjects ranked their pain perception on a scale from 0 to 10. On
day 3, assessments were taken at baseline (pre-exercise), post-exercise
and further at 24, 48 and 72 hours post-exercise for each arm of the
study. Secondary outcomes included assessments of inammation,
muscle damage, exibility, and the amount of energy expended prior
to exercise.
Biomarkers creatine kinase and lactate dehydrogenase were
monitored pre exercise and 72 hours post exercise.
Safety prole of the supplement was assessed by routine
haematology, kidney and liver function tests. Adverse events were
monitored throughout the study.
Statistical analysis
All testing was done using Statistical Analysis Soware (SAS)
having version 9.2. All analyses was conducted using the intent-to-treat
population. Patients with no data recorded for a particular parameter
were automatically excluded from the analyses of that parameter. For
all the data set variables analysis of covariance (ANCOVA) and Wilcox
on signed rank sum test were used and the level of signicance was set
as P<0.05.
Results
Subject disposition
A total of 20 subjects were enrolled into the study. ere were no
subject withdrawals or dropouts in this study.
Physical characteristics
e population was essentially healthy without signicant
concomitant disease or medication intake. Screening characteristics
of participants are presented in (Table2). ere were no statistically
signicant dierences between subjects in the placebo (n=10) and the
DigeZyme® (n=10) group. On the day of screening, the mean weight of

Citation: Majeed M, Siva KA,Shaheen M,Priti V and Kiran KV (2016) Multi-Enzyme Complex for the Management of Delayed Onset Muscle Soreness
after Eccentric Exercise: A Randomized, Double Blind, Placebo Controlled Study. Sports Nutr Ther 1: 113. doi: 10.4172/2473-6449.1000113
Page 4 of 7
Volume 1 • Issue 3 • 1000113Sports Nutr Ther, an open access journal
ISSN: 2473-6449
all the enrolled subjects was 59.3 ± 4.64 kgs; mean height was 163.8 ±
4.99 cm and the mean BMI was 22.2 ± 1.50 kg/m2.
Ecacy evaluation
Delayed Onset Muscle Soreness-quality of life was analyzed
throughout the study period as primary ecacy measure. e ‘p’
value suggests that there was a statistically signicant change in these
symptoms from baseline to nal visits, between the placebo and active
arms. Statistical analysis using Analysis of Co-Variance (ANCOVA)
showed the primary ecacy parameters were statistically signicant
(p<0.05) between the multienzyme complex and placebo groups (Table
3). Furthermore, comparative mean values of ecacy assessments
between Multi enzyme complex and placebo groups across various
visits (baseline, day 1, day 2 and day 3) are presented for ecacy
parameters (Figures 1-8). Patients who were on Multi enzyme complex
had statistically signicant dierence for the ecacy parameters on day
3 when compared with placebo.
Pain assessment
McGill pain questionnaire is a multidimensional pain instrument;
the nal score is a sum of all the ten individual pain questions. e
rst nine McGill pain questionnaires were based on assessment of pain
(current pain, least pain, and worst pain) while the tenth on the degree
of numbness and its interference with function.
When dierences between multi enzyme complex and placebo
were compared, the pain score showed high statistical signicance
(p=0.0061).
Demographics Values
Height (cm)
N 20
Mean(SD) 163.8 (4.99)
Median 164.5
Min, Max 154, 172
Weight (kg)
N 20
Mean(SD) 59.3 (4.64)
Median 59.2
Min, Max 51, 67
Body Mass Index (kg/m2)
N 20
Mean(SD) 22.2(1.50)
Median 22.3
Min, Max 20, 25
Race
Central American 0
East Asian 0
South Asian 20
South American 0
South East Asian 0
Western European 0
White 0
Table 2: Subject demographics characteristics.
Subjective Parameters
Measure Investigational Products Signicance
Hand held Dynamometer readings
result [grip strength] kg
DigeZyme®
Baseline 72 hours
Post
Exercise
Placebo
Baseline 72 hours
Post
Exercise
0.4956
36.2 (7.86) 37.6 (8.32) 35.2 (6.84) 36.2 (5.26)
Thigh muscle
(point of pain)
Algometer Reading’s kg/cm2
9.5 (0.58) 5.3 (1.18) 9.3 (1.03) 3.9 (1.45) 0.0436*
Calf muscle
(point of pain)
Algometer Reading’s kg/cm2
9.1 (1.09) 3.9 (1.20) 9.4 (1.11) 3.3 (1.03) 0.1397
Total Time Taken
Illinois Agility Run test (Seconds)
25.6 (3.43) 24.6 (4.11) 25.2 (1.69) 23.8 (2.91) 0.7246
The McGill pain questionnaire
(total pain score) 29.5 (2.55) 48.7 (8.86) 28.1 (1.45) 61.3 (7.07) 0.0061*
Objective Parameters (Serum markers (U/L)
Serum Creatine Kinase 42.4 (11.69) 45.8 (10.49) 36.7 (4.30) 40.5 (5.42) 0.5735
Serum Lactate De-hydrogenase 161.1 (35.56) 164.2 (31.17) 162.6 (28.40) 161.4 (25.44) 0.2556
Table 3: Efcacy analysis.
Figure 1: Flow chart.

Citation: Majeed M, Siva KA,Shaheen M,Priti V and Kiran KV (2016) Multi-Enzyme Complex for the Management of Delayed Onset Muscle Soreness
after Eccentric Exercise: A Randomized, Double Blind, Placebo Controlled Study. Sports Nutr Ther 1: 113. doi: 10.4172/2473-6449.1000113
Page 5 of 7
Volume 1 • Issue 3 • 1000113Sports Nutr Ther, an open access journal
ISSN: 2473-6449
Tenderness assessment
On the tenderness quotient, subjects taking multi enzyme complex
demonstrated signicantly less tenderness, 72 hours aer exercise
(p=0.042).
Muscle damage assessments
Liberation of biochemical substances such as creatine kinase,
lactate dehydrogenase, protein metabolites and myoglobin occurs
from muscle cells approximately 24 hours post exercise and have
been found in plasma up to 48 hours [29]. Creatine kinase being a
surrogate index of muscle damages more indicative of damage or gaps
in the sarcolemma [30]. e CK response was less in the multi enzyme
complex group suggesting the membrane integrity was maintained to
greater extent than the placebo group.
24 hours post exercise, subjects on the placebo group showed trend
towards a higher level of CK than the multi enzyme complex group.
is trend continued through the 72 hour assessment. Dierence
between the multi enzyme complex group and placebo in CK values
was not statistically signicant. Lactate dehydrogenase also showed a
similar phenomenon, which trended higher at 24 and 72 hours post-
exercise in the placebo group (Figures 7-8).
Flexion and extension measurements
On analysing the pre exercise leg exion measurements, they were
found to be equal between the groups for the le leg. Whereas the
exion measurement was found to be signicantly greater (p=0.049)
for the right leg in the placebo group.
When the post exercise exion measurements were analysed, only
the 24-hour right leg exion measurement was found to be signicant
(p=0.004) in the multi enzyme complex group.
Safety evaluations
Vital signs such as Blood Pressure, Respiratory Rate, Pulse Rate
and any abnormal laboratory parameters were considered for safety
evaluations. No clinically signicant changes were recorded for
descriptive physical examination in both the groups (Multi enzyme
complex and placebo). e safety of multi enzyme complex was assessed
using adverse event data (occurrence, intensity, and relationship to
study drug). No adverse events were noticed in the study.
Discussion
Multi enzyme complex capsules contain alpha-amylase, neutral
protease, lipase, lactase and cellulase. e capsule containsfree
broad acting enzymes obtained from the fermentation process
Figure 2: Hand-held dynamometer (HHD) readings of maximal voluntary
isometric contraction (MVC) at three different positions of knee range of motion
(0 degrees, 90 degrees, 120 degrees) of both active and placebo.
Figure 3: Aglometer readings to quantify pressure pain threshold (ppt) of thigh
muscle. P<0.05 between the treatment groups.
Figure 4: Aglometer readings to quantify pressure pain threshold (ppt) calf
muscle.
Figure 5: Illinois agility run test on length of 10 meters and the width (distance
between star and nish points) 5 meters.
Figure 6: The muscle soreness questionnaires (MSQ) on scale of 1 to 10 of
both active and placebo. p<0.05 between the treatments groups.

Citation: Majeed M, Siva KA,Shaheen M,Priti V and Kiran KV (2016) Multi-Enzyme Complex for the Management of Delayed Onset Muscle Soreness
after Eccentric Exercise: A Randomized, Double Blind, Placebo Controlled Study. Sports Nutr Ther 1: 113. doi: 10.4172/2473-6449.1000113
Page 6 of 7
Volume 1 • Issue 3 • 1000113Sports Nutr Ther, an open access journal
ISSN: 2473-6449
with Aspergillusoryzae, including amylase, protease and lipase. is
manufacturing technique ensures that the gastric enzymes from
Aspergillusoryzae are delivered at distinct sites, the stomach and the
small intestine, respectively. Various studies have shown protease
supplementation may attenuate muscle soreness aer downhill
running [31].
A subsequent series of four studies have evaluated papain, in
combination with other proteases, in small samples of male athletes,
especially with regard to its eectiveness in attenuating DOMS post
eccentric exercise. Two of the studies were able to show better exion
in the tested limb post eccentric load which was hypothesised to be
mediated by regulation of leukocyte activity and inammation. Two
further studies showed an improvement in contractile function and
subjective pain and tenderness ratings but not in biochemical measures
of DOMS. Further interpretation of these studies is dicult as all four
used a combination of papain with other proteolytic enzymes (e.g.
bromelain, amylase, lysozyme, and trypsin) [8].
In the present study we sought to investigate the eects of multi
enzyme complex on delayed onset muscle soreness induced by
eccentric exercise.
Delayed onset muscle soreness (DOMS) due to eccentric muscle
activity is associated with inammatory responses and production of
reactive oxygen species (ROS) that sustain both inammation and oxidative
stress. Aer eccentric exercise, damage to the contractile element of the
muscle leads to the occurrence of DOMS. e results of this study suggest
that supplementation with Multi enzyme complex supplementation helps
in the recovery of this contractile fraction of the muscles.
In the present study multi-enzyme complex capsules demonstrated
signicant improvement in subjective pain and tenderness, with no
signicant improvement in levels of markers of inammation, muscle
damage or muscle exion. Multi-enzyme complex contains a multiple
enzymes that are indicated for relieving the symptoms of DOMS.
e ndings of this study suggest that multi enzyme complex can
have several potential clinical applications. Protease supplementation
when coupled with a well-managed training programme can result in
more rapid recovery of the damage caused to contractile mechanism
by DOMS.
Registration
e trial was registered on the Clinical Trial Registry of India with
the registration number CTRI/2015/09/006148.
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Citation: Majeed M, Siva KA,Shaheen M,Priti V and Kiran KV (2016) Multi-Enzyme Complex for the Management of Delayed Onset Muscle Soreness
after Eccentric Exercise: A Randomized, Double Blind, Placebo Controlled Study. Sports Nutr Ther 1: 113. doi: 10.4172/2473-6449.1000113
Page 7 of 7
Volume 1 • Issue 3 • 1000113Sports Nutr Ther, an open access journal
ISSN: 2473-6449
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Citation: Vuppala KK, Majeed M, Kumar AS, Majeed S, Vaidyanathan P
(2016) Multi-Enzyme Complex for the Management of Delayed Onset Muscle
Soreness after Eccentric Exercise: A Randomized, Double Blind, Placebo
Controlled Study. Sports Nutr Ther 1: 113. doi: 10.4172/2473-6449.1000113
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