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Effects of different antioxidants on exercise-induced oxidative stress and muscle damage in athletes: a systematic review and meta-analysis

Jingfeng Chen,Jiahao Ding,Chunlong Han,Qi Liu,Li Wang,Wenlong Ma,Zeyu Liang,Yang Li

Published 2025 in BMC Sports Science, Medicine and Rehabilitation

ABSTRACT

Exercise-induced oxidative stress and muscle damage are key factors affecting athletes’ performance and recovery. This meta-analysis aims to assess the effects of different antioxidants on post-exercise muscle damage and oxidative stress in athletes, providing evidence-based support for the development of effective exercise nutrition strategies. This meta-analysis strictly followed the PRISMA guidelines. It systematically retrieved the Web of Science, PubMed, Cochrane Library, Embase, and Scopus databases for randomized controlled trials (RCTs) investigating the effects of antioxidants on post-exercise muscle damage and oxidative stress in athletes. Primary outcomes encompassed total antioxidant status (TAS), glutathione peroxidase (GPx), superoxide dismutase (SOD), thiobarbituric acid reactive substances (TBARS), and lactate (LA). Secondary outcomes were interleukin-6 (IL-6), malondialdehyde (MDA), creatine kinase (CK), and nitrates (NOx). Effect sizes were combined via standardized mean difference (SMD). Heterogeneity tests, sensitivity analyses, and subgroup analyses were performed, as well as publication bias evaluations. Twenty-six RCTs involving 505 athletes were incorporated. The overall analysis indicated that antioxidant supplementation significantly decreased post-exercise LA (SMD: -1.25; 95% CI: -2.06, -0.43; I²=81.7%, p < 0.001) and CK (SMD: -1.88; 95% CI: -2.98, -0.78; I²=86.2%, p < 0.001) levels in athletes. However, the overall effects for TAS, TBARS, SOD, GPx, NOx, IL-6, and MDA exhibited no statistical significance. All outcomes, whether showing significant or nonsignificant effects, demonstrated varying degrees of heterogeneity. Subgroup analyses revealed that region, sex distribution, study type, and athletes’ professional level were important sources of heterogeneity for indicators like LA and SOD. Funnel plot analysis for publication bias revealed no significant asymmetry. Sensitivity analyses confirmed the robustness of major results. The current study suggests that antioxidant supplementation can effectively reduce post-exercise LA and CK levels in athletes. This reduction may help promote fatigue recovery and alleviate muscle damage. However, the overall effects of antioxidant supplementation on inflammatory biomarkers and other oxidative stress are unclear and are modulated by factors such as region, sex, professional level, and study design. Future research should concentrate on individual differences and more refined intervention regimens to optimize antioxidant use in exercise. PROSPERO, CRD42023460244.

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