All study participants were met during race registration for formal consenting, additional pre-race data collection, and review of expectations for participation. Subjects were then seen for further intervention before and during the race as outlined below.

Immediately after race completion, subjects were escorted 30 m to a tent adjacent to the finish line where post-race data collection and a blood draw were performed.

During the subsequent 10 days, the subjects recorded additional information that was then returned to the investigators electronically or by mail. They were sent an email the evening after the race reminding them of the post-race data collection and were provided an electronic copy of the data sheet at that time.

Subjects were asked to avoid any use of pain or nonsteroidal anti-inflammatory drugs NSAIDs during the race. Additionally, subjects were asked to avoid use of pain medications or NSAIDs, compression garments, massage, electrical stimulation, and thermal modalities in the 10 days following the race.

To check compliance, the post-race data form requested that they provide details about use of pain medications or NSAIDs during or after the race or any of the above interventions during the 10 days after the race.

Subjects were also asked which group they thought they were in and why. Subjects were assigned to the riboflavin or placebo group in an alternating fashion based on the order of arrival to meet with the research team at race registration, with the on-site researchers and subjects being blinded to the group assignment.

The subjects were told that they would receive either a placebo or an essential vitamin with flavonoid properties, but no other details of the supplement under study were provided until after data analysis had been completed. All subjects received a capsule 0. They were also provided and observed to take another capsule at the km aid station.

com, Henderson, NV. Because riboflavin can cause urine to appear bright or fluorescent yellow [ 37 ] and might allow subjects to suspect they were in the treatment group, the small amount of ß-carotene was added to the placebo, as done in a prior placebo-controlled trial of riboflavin [ 27 ], since it can also cause a similar urine color change.

The amount of ß-carotene in each capsule was approximately half of that in a single large raw baby carrot [ 38 ], so we recognize it was unlikely to cause marked urine discoloration, but it did allow us to legitimately tell the subjects that they might notice a discoloration of the urine regardless of their group assignment.

We also recognized that ß-carotene is an antioxidant but felt that it would have no recognizable antioxidant effect at such a low dose. The body weight of each subject was obtained at race registration and immediately after finishing the race using the same scale Sunbeam Products, Inc.

For each measurement, the runner was clothed in running attire and shoes but had no other items on their body or in their hands. Plasma creatine kinase CK concentration was determined immediately post-race from a blood sample taken from the antecubital vein, with subjects seated in the upright position.

The samples were centrifuged for 10 min at rpm within 10 min of collection and then stored in a cooler until transported to and analyzed by a clinical laboratory for plasma CK concentrations Siemens Aktiengesellschaft, Dimension EXL, Munich, Germany.

Runners were asked to rate their perceived lower-body muscle pain and soreness according to a point Likert scale with anchors of 1 no soreness , 2. This approach has been previously used at the WSER [ 2 — 7 ] and elsewhere [ 39 ], and the values have been found to correlate with plasma CK concentrations [ 3 — 5 ].

Ratings were provided at race registration, during the race at the , , and km checkpoints, at the finish prior to the blood draw, and each morning of the 10 days following the race after being up and moving around for approximately 30 min.

A m run at maximal speed was used as a functional measurement, which we have previously used successfully [ 2 , 3 ]. Those subjects enrolled in advance of race registration were asked to perform this test twice on separate days during the 21 days before the race, and all subjects were asked to perform the test on days 3, 5, and 10 after the race.

Subjects were sent an electronic reminder the night before each post-race m run. This test is functionally specific for running, but not overwhelmingly long and painful or so short and intense that it would be a high risk for inducing a strain injury.

After an adequate warm-up, subjects were instructed to self-time the run, starting from a standing start. Subjects were asked to use the inside lane of a running track, assuring an accurate distance. In the event they did not have access to a track, they were allowed to utilize a level section of road that had been measured to the correct distance.

They were asked to use the same site for all pre-race and post-race testing and under conditions without significant wind or other environmental variations. Comparison of treatment and control groups age, sex, finish time, percent change in body mass from registration to immediately post-race, post-race plasma CK concentration, pre-race m run time, average weekly running distance, highest weekly running distance, and longest training run were made using unpaired t tests and the chi-square test.

Main outcome variables muscle pain and soreness rating and m run time were compared between groups with two-way group × time repeated measure analysis of variance ANOVA and Bonferroni post-tests.

The m run time data were skewed and successfully normalized before analysis with the reciprocal function i. A priori sample size determination was performed based on muscle pain and soreness ratings from previous research at the WSER [ 2 — 4 ]. Of the race entries, 44 runners enrolled in the study 22 in each group and started the race.

Of this group, 37 Of the 32 completing data collection, 8 had enrolled in advance of race registration and completed both pre-race m run trials 5 in riboflavin group, 3 in placebo group.

Overall race finish rate was Selected characteristics of the subjects completing the study are shown in Table 1. None of the examined characteristics differed between groups, including the post-race plasma CK concentrations.

One subject in the placebo group failed to receive the capsule at 90 km, and two subjects in the riboflavin group reported emesis within an hour after taking the capsule at 90 km. All other subjects received both doses and were confirmed to not have had emesis during the hour after taking a capsule.

Post-race exercise behavior appeared comparable between groups, and during the first 2 days post-race, none of our subjects reported exercise more taxing than running less than 2 km or some walking. The findings relative to muscle pain and soreness ratings for those subjects completing the study are shown in Fig.

Post-race values were statistically similar to pre-race values by post-race day 5. The pre-race and race data for all subjects providing data through 90 km 21 and 20 in riboflavin and placebo groups, respectively were also analyzed.

This finding prompted further exploratory analysis of the data for those subjects completing the study with exclusion of the pre-race and post-race data i.

Mean lower-body muscle pain and soreness ratings for the 2 groups. Error bars represent 1 SD and are shown only in 1 direction for clarity. The post-race m run times are shown in Fig. Mean m run times for the 2 groups. There were 3 subjects in the riboflavin group and 1 subject in the placebo group who noted a yellow urine color.

This work is a preliminary examination of riboflavin for potential benefits of reducing muscle pain and soreness during and after strenuous exercise and at enhancing recovery from strenuous exercise. The findings suggest that the vitamin may have some benefits.

Indeed, riboflavin supplementation immediately before and midway during prolonged exercise appeared to be linked with reduced muscle pain and soreness during and at the completion of the exercise, and there was some evidence for enhanced functional performance during the initial several days after the exercise.

While the findings require cautious interpretation, they are adequately interesting to warrant further investigation. Given that post-race plasma CK concentrations were similar between groups, there is no evidence from this work that riboflavin acts by reducing muscle cell rupture.

Rather, it would seem that it must act by altering the physiological response to exercise in other manners. While the underlying mechanism of action cannot be established from this study, it seems conceivable that the antioxidant properties of riboflavin [ 17 — 23 ] could explain reduced muscle pain and soreness during exercise, although the lack of reduced muscle pain and soreness during recovery does not seem consistent with this mechanism.

On the other hand, the mitochondrial protective function of riboflavin [ 24 ] might be a plausible explanation for the riboflavin group demonstrating enhanced functional recovery without improvement in muscle pain and soreness during the recovery period.

Participants of the WSER are generally well-trained and experienced ultramarathon runners given that a recent qualifying ultramarathon is required to gain entry into the race.

In this regard, they were conditioned for this type of activity and were adapted for controlling and responding to significant muscle injury from prolonged running.

It is possible that an effect of riboflavin could be even greater in a group of subjects who are more naïve to strenuous exercise. We chose to provide two mg doses of riboflavin which were received immediately prior to exercise and around 11—16 h later during the approximately 20—30 h it took to complete the race.

This dose and schedule were chosen because we felt it would be feasible to achieve subject cooperation and that any effectiveness should still be evident even if this was not the optimal dose or dosing schedule. The doses we provided were well above the recommended dietary allowance for riboflavin of 1.

While the body absorbs little riboflavin from single doses beyond 27 mg [ 42 ], the vitamin appears safe at much higher doses [ 41 ] and riboflavin supplements are typically available in mg capsules with recommendations to take 1—2 per day.

Plasma concentrations of riboflavin and flavocoenzymes have been shown to peak around 2 and 3. Considering this information, it is possible that a lower dose at more frequent intervals might be more effective and would be recommended for future studies of this nature if feasible in the study environment.

The present findings indicate that muscle pain and soreness ratings of our subjects had returned to pre-race levels by 5 days after the race. Our prior work at the WSER had also demonstrated that muscle pain and soreness ratings had statistically returned to baseline by post-race day 5, but m run times were not examined in that study beyond post-race day 5 at which time pre-race performance had not been fully recovered [ 3 ].

In the present work, we extended the post-race time period of examination to 10 days and found that this appears to be close to the timeframe of m run recovery. This is not intended to suggest that athletes are fully recovered from a km ultramarathon within 10 days or shortly thereafter but rather that our subjective measure of resting muscle pain and soreness and our objective measure of m speed had nearly recovered during this relatively short time period.

The WSER serves as an excellent environment to induce muscle pain and damage as evident from prior work at the race [ 2 , 3 , 5 — 7 , 28 — 32 ].

However, subject recruitment is a challenge in performing research of this nature in a competition setting such as the WSER. This is reflected in the number of subjects we were able to recruit. In particular, it is unfortunate that the number of subjects completing the pre-race m runs was so low, which limits the robustness of our interpretation of the findings relative to functional recovery.

While the treatment and placebo groups appeared to be well matched and blinding appeared to be adequate in this study, we cannot be certain that the groups were well matched for baseline performance at the m run.

We acknowledge some other limitations with this study resulting largely from constraints related to the study being performed at a competition.

Interestingly, earlier work has demonstrated that NSAID use during the race was not effective at controlling post-race muscle soreness [ 4 ] though the effect of NSAIDs on muscle pain and soreness during the race has not been systematically examined.

Among the present subjects using pain medication during the race, the usual dosage was relatively low compared with the maximal recommended dose during 24 h. Not surprisingly, our separate comparison of muscle pain and soreness ratings between subjects who used pain medication during the race and those not using pain medication during the race revealed no suggestion of an effect of the pain medication on this variable.

Thus, given these considerations, it seems unlikely that the use of pain medication during the race confounded the present finding of lower muscle pain and soreness during and at the completion of the race among the riboflavin group compared with the placebo group.

Another potential study limitation is that, because we did not assess dietary practices of the subjects, it is conceivable that one group had a greater intake of anti-oxidants than the other. Additionally, the m runs were unsupervised and self-timed, but this was the most feasible approach and we believe this study population was capable of maximally exerting themselves during unsupervised trials and correctly recording the times.

Finally, we also recognize that some might consider it ideal to have measured pre-race plasma CK concentrations and to examine the pre-race to post-race change in plasma CK concentration rather than just the post-race value. But, since these runners would have reduced training prior to the race, we would expect pre-race plasma CK concentrations to have been very low relative to the post-race values, as previously demonstrated [ 4 — 7 ], so not using the pre-race to post-race change would not have altered our interpretation of the findings for this variable.

From this work, we conclude that there is some evidence that riboflavin supplementation immediately before and midway through prolonged running may reduce muscle pain and soreness during and at the completion of the exercise and that there is some suggestion that riboflavin might enhance functional recovery after the exercise.

We acknowledge that this study is a preliminary examination of riboflavin for this purpose and involved a small number of subjects in which the dose and dosing schedule might not have been optimal. As such, the findings appear intriguing and warrant additional investigation of riboflavin as a means to reduce muscle pain during exercise and to enhance post-exercise recovery.

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Dietary intake was assessed by 3-day dietary records as described previously [ 20 ]. Briefly, participants were asked to record the intake of 2 week days and one weekend day before each test day, based on standard household units. Statistical analysis was performed using IBM SPSS Statistics for Windows version Based on previous work [ 10 ], a sample size of 78 participants was required to reach sufficient statistical power.

Differences in outcomes between the intervention groups i. CFE and CFE and the placebo were assessed by unstructured linear mixed model analyses.

Intervention, time and intervention x time were included as fixed factors. This model accounts for the correlation between repeated measures and missing data.

Intention to treat analyses were performed for all outcomes. The effect size ES was determined by dividing the estimated mean difference by the square root of the estimated baseline residual variance obtained from the model. Within-group differences were not tested. In total, 93 healthy subjects were enrolled in the study.

Baseline characteristics of the study population are shown in Table 1. No significant differences in body weight were observed over time in the placebo and the two treatment groups. Therefore, the performance outcomes were not corrected for body weight.

Differences between the intervention groups and placebo group were compared with an unstructured linear mixed model with correction for baseline values. CFE: Citrus Flavonoid Extract. The intake of energy and macronutrients of the participants was assessed during the intervention period Table s1.

No significant differences in dietary intake not in total energy intake, nor in fat-, protein-, and carbohydrate intake between the intervention groups were observed throughout the study period.

This study determined the effects of 8-weeks CFE supplementation in different dosages on exercise performance under anaerobic conditions in moderately trained individuals. In the CFE group, but not in the CFE group, this was accompanied by a significant increase in peak power output, as indicated by the 5sPP.

The effect of polyphenols or antioxidants on endurance exercise performance has been investigated in previous studies, demonstrating that polyphenol supplementation can improve performance outcomes in study populations ranging from healthy but untrained individuals to trained athletes [ 10 , 21 , 22 , 23 , 24 ].

However, research into the effects of polyphenol supplementation on anaerobic capacity is less extensive. In the present study, we showed that daily supplementation with CFE increased anaerobic capacity in moderately trained individuals.

This increase did not result in a concomitant increase in maximum heart rate during the exercise. No significant improvements of this acute dose were observed for the average results [ 14 ].

In a study investigating supplementation of a polyphenol-rich extract, peak power was shown to be increased by 3. That study demonstrated that polyphenol supplementation did not affect heart workload despite the increased power outputs, probably due to a decreased blood pulse pressure, which is considered to be a biomarker for heart workload [ 2 , 25 ].

Despite the fact that blood pulse pressure was not measured in the current study, the same results in HR were observed. It might be possible that CFE supplementation decreased intravenous resistance as some studies showed that polyphenol supplementation is related to an increased endothelial NO production [ 12 , 13 ].

This finding was surprising, as we were expecting no difference in performance. As such, it is tempting to speculate on the possible explanation for these findings.

One potential explanation might be that the higher dosage may have reduced the ROS concentrations within the skeletal muscle to a larger extent, resulting in concentrations that were less optimal for muscle contractility [ 26 ].

We included healthy, moderately trained male and female subjects. Based on the result of the current study, strategic supplementation with CFE might be of interest for recreational athletes competing in sports that have a large anaerobic component, such as sprinters and track cyclists. Although the reported effects are small, these observed differences may be of high relevance and impact, if these results of this study in recreational athletes can be extrapolated to highly trained sports professionals.

In elite athletes, small differences may determine winning or losing a competition. Further research is needed to provide more insight into the effects of CFE supplementation in elite athletes, to substantiate CFE use as a nutritional ergogenic aid.

Although CFE supplementation increased anaerobic exercise performance in moderately trained subjects after supplementation with CFE, the underlying mechanism remains to be elucidated. A putative mechanism of action may be that CFE increases oxygen delivery to the muscles by upregulating NO with a subsequent vasodilation and increased blood flow response, thereby also increasing the removal of waste products, such as lactate.

For instance, hesperetin, a metabolite from the citrus flavonoid hesperidin, has been associated with an increased NO release from endothelial cells and hesperidin supplementation in human subjects has been associated with improved endothelial function [ 12 , 15 , 27 ]. Furthermore, previous studies have demonstrated that hesperidin reduces oxidative stress levels by scavenging ROS and improving antioxidative capacity, which is especially beneficial for high intensity anaerobic exercise as anaerobic functioning leads to increased production of muscle fatigue associated end-products such as lactate and high ROS levels [ 28 , 29 , 30 ].

Another potential mechanism of action might involve modulation of mitochondrial metabolism. Some potential limitation of the current study design should be mentioned.

Before the start of the study, a familiarization test was conducted to minimize learning effects of the WAnT exercise protocol. Nevertheless, a learning effect on the WAnT outcome cannot entirely be excluded, although the placebo arm did not show such learning effects over the consecutive tests, and the randomized design of the study will have minimized potential confounding of a potential learning effect.

Another limitation of this study is that participants were not randomized based on training level, mode of training, intensity of training or frequency of training. All participants were moderately trained, but some variation in the aforementioned factors may have been present, resulting in high standard deviations.

However, we did not observe significant differences in training hours per week or any of the baseline performance outcomes between groups.

Furthermore, this study did not investigate the mechanisms which underlie the observed differences in anaerobic exercise performance. Blood collection and muscle biopsies would have given more insight into the effect of hesperidin on oxidative stress levels, inflammation levels and mitochondrial function [ 31 ].

These tests were not included in the current study in order to limit the test burden for participants. This study shows that daily intake of CFE, a natural flavonoid containing supplement, resulted in increased anaerobic capacity and peak power output during high intensity exercise in moderately trained individuals without affecting the maximum heart rate.

Future research needs to be performed to identify the underlying mechanisms that are affected by CFE supplementation. Knapik JJ, Steelman RA, Hoedebecke SS, Austin KG, Farina EK, Lieberman HR.

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Sci Rep. Download references. The authors would like to thank Kevin H. Wolfs for his input during the conceptualization phase and Joris Kretzers for his input and help with the revisions.

BioActor BV, Gaetano Martinolaan 85, GS, Maastricht, The Netherlands. Division Gastroenterology-Hepatology, Department of Internal Medicine, School of Nutrition and Translational Research in Metabolism NUTRIM , Maastricht University, P.

Box , MD, Maastricht, The Netherlands. Yala R. This study set out to determine whether flavonoid supplementation improves cycling performance in trained male athletes. Participants were randomized into two control groups, receiving a different intervention between the groups.

The first group ingested a daily dose of mg of flavonoid extract over a period of 4 weeks. The second group was given a placebo over the same period. Both groups performed the same exercise intervention, which consisted of a 5-minute warm-up followed by a minute time trial on the cycle ergometer at max power output.

Power output and heart rate were measured post exercise, and athletes indicated their perceived exhaustion after each bout of exercise. Over the 4-week period of the study, the first group of participants who ingested a daily dose of mg of flavonoid extract significantly increased their peak power output.

Heart rate and oxygen consumption significantly decreased in the flavonoid extract supplementation group, while it did not significantly decrease in the placebo group. Flavonoids are one group of phytochemicals found primarily in red wine, tea, cocoa, soy, citrus fruits, berries, apples, onions, dried beans, peas and lentils.

Flavonoids act as a shield to protect against toxins and help repair damage to your cells, your muscles and your body. Through training, a diet that consists of flavonoids not only aids in repairing your body after exercise, but also enhances exercise performance.

Related Article: Athletes May Be Suffering From Vitamin D Deficiency. Overdevest, E. Flavonoid Supplementation Improves Exercise Performance in Trained Athletes. You must be logged in to post a comment. Citrus Flavonoid Supplementation May Improve Exercise Performance.

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