Vitaminas “C” e “E” na resposta inflamatória e na funcionalidade musculoesquelética após exercícios físicos: revisões sistemáticas

Abstract

Regular practice of physical exercises, when performed at high intensity, results in muscle damage, which leads to an inflammatory response and reduced functionality. Supplementation with exogenous antioxidants, such as vitamins “C” and “E” may be a strategy used to mitigate these exercise-induced damage. However, its effects on the inflammatory response and musculoskeletal functionality after physical exercises are still controversial. Therefore, this dissertation proposed to carry out two systematic reviews aimed at: 1) verifying the effects of isolated vitamin "E" supplementation and 2) associated with vitamin "C" on the inflammatory response and musculoskeletal functionality after physical exercises in volunteers. healthy and athletes. The search strategy was carried out in the MEDLINE (PubMed), Cochrane CENTRAL, EMBASE, Sport Discus and Web of Science databases, with the descriptors “Adult”, “Healthy volunteers”, “Athlete”, “Vitamin E”, “Tocopherols ”, “Alpha-tocopherol”, “Ascorbic acid” and “Exercise”. Randomized clinical trials (RCTs) and placebo-controlled studies were included that evaluated the effects of supplementation of vitamin “E” alone and combined with vitamin “C” on the inflammatory response and musculoskeletal functionality after physical exercise in healthy volunteers. Title, abstract and full text reading, as well as risk of bias analysis (RoB 2.0), data extraction from studies and certainty of evidence (GRADE) were performed by two independent reviewers. A random effect model was used to compare mean changes before and after exercise in subjects who received the vitamins or placebo. Data are presented by the standard mean difference (SMD) and the respective 95% confidence intervals (95% CI). Twenty RCTs were included, with 298 subjects in the vitamin “E” review, and eighteen RCTs, with 322 subjects in the vitamins (C and E) review. Vitamin E supplementation alone did not attenuate oxidative stress, inflammatory markers, muscle damage, muscle soreness, or improve muscle strength after a bout of exercise. The combination of vitamins (C+E) attenuated lipid peroxidation (SMD = -0.703; 95%CI = -1.035 to -0.372; p<0.001), interleukin-6 (IL-6) (SMD = -0.576; 95%CI = -1.036 to -0.117; p=0.014), cortisol (SMD = -0.918; 95%CI = -1.475 to -0.361; p=0.001) immediately, and 48h creatine kinase (CK) levels (SMD = -0.991 ; 95%CI = -1.611 to -0.372; p=0.002) after the exercises. However, they did not change protein carbonyls, reduced/oxidized glutathione ratio, catalase, interleukin-1 receptor, C-reactive protein, lactate dehydrogenase, pain and muscle strength. The results suggest that supplementation of the combination of vitamins (C+E) can be used in this context, as it attenuates oxidative stress (lipid peroxidation), inflammatory response (IL-6), cortisol levels and muscle damage (CK) after a physical exercise session in healthy volunteers. The certainty of the evidence is low or very low and the findings should be interpreted with caution.