Effect Of Tart Cherry Concentrate On Endurance Exercise .
Journal of the American College of NutritionISSN: 0731-5724 (Print) 1541-1087 (Online) Journal homepage: https://www.tandfonline.com/loi/uacn20Effect of Tart Cherry Concentrate on EnduranceExercise Performance: A Meta-analysisRuirui Gao & Philip D. ChilibeckTo cite this article: Ruirui Gao & Philip D. Chilibeck (2020): Effect of Tart Cherry Concentrate onEndurance Exercise Performance: A Meta-analysis, Journal of the American College of Nutrition,DOI: 10.1080/07315724.2020.1713246To link to this article: shed online: 27 Jan 2020.Submit your article to this journalArticle views: 59View related articlesView Crossmark dataFull Terms & Conditions of access and use can be found ation?journalCode uacn20
JOURNAL OF THE AMERICAN COLLEGE OF 3246REVIEWEffect of Tart Cherry Concentrate on Endurance Exercise Performance:A Meta-analysisRuirui Gao and Philip D. ChilibeckCollege of Kinesiology, University of Saskatchewan, Saskatoon, CanadaABSTRACTARTICLE HISTORYObjective: Tart cherry concentrate has been shown to improve muscle function, and reducemuscle damage, oxidative stress/inflammation, and muscle soreness in athletes; however, evidencefor acute endurance performance benefits is scarce. The purpose of this review was to evaluatethe effect of tart cherry juice on endurance exercise performance with a meta-analysis.Method: Data sources included Medline, Embase, Web of Science, and Google Scholar. Eligibilitycriteria were randomized controlled trials with endurance exercise performance tests. Participantswere healthy individuals. Interventions included tart cherry supplementation and placebo ingestedbefore, and/or on the day of exercise. Ten studies were included (totaling 127 males and 20females). Standardized mean differences (SMD) with 95% confidence intervals were calculated foreach study and pooled effects were assessed.Results: Tart cherry concentrate in juice or powdered form, ingested for 7 days to 1.5 hoursbefore exercise performance testing significantly improved endurance exercise performance (SMD:0.36; 95% CI: 0.07 to 0.64; p ¼ 0.01; I2 ¼ 0%) upon pooling of the ten studies.Conclusions: Tart cherry concentrate has a significant benefit for endurance exercise performance.Received 3 September 2019Accepted 5 January 2020KEYWORDSTart cherry concentrate;endurance exercise;glycemic index; oxidativestress; inflammation;blood flowKEY TEACHING POINTS Tart cherry concentrate has a significant benefit for endurance exercise performance. Tart cherry concentrate may enhance endurance exercise performance via its low glycemicindex, anti-inflammatory and anti-oxidative capacity, and blood flow enhancing effects.IntroductionRecently, tart cherry concentrate has received growing attention for application in sport as it may be of benefit to performance by increasing muscle function (1–3), inhibitingoxidative stress/inflammation (2–4), and reducing musclesoreness (1,5). The improvement in these four aspects mightallow greater recovery from training sessions that lead up toan endurance exercise performance session, thus improvingendurance exercise performance. Tart cherry juice mightalso increase endurance performance by providing sustainedenergy and facilitating fat oxidation during exercise viaits low glycemic index (6), and increasing oxygen deliveryto working muscle via its blood flow enhancing effect (7) byincreasing nitric oxide (NO) bioavailability (8).Eccentric exercise-induced mechanical stress damagesmuscle (9) and impairs muscle function (10). Most studieshave shown that tart cherry concentrate consumptiondecreases the extent of this damage, attenuates strength lossand accelerates recovery after exercise (1–3, 11). Tart cherries might exert these beneficial effects via the prevention ofoxidative stress and inflammation (11). Exercise also produces excessive free radicals which disrupts re of bias was assessed by two reviewers using themodified Cochrane Collaboration tool which covers bias in
JOURNAL OF THE AMERICAN COLLEGE OF NUTRITIONsix domains: selection bias (source of bias: random sequencegeneration and allocation concealment), performance bias(source of bias: blinding of participants and personnel),detection bias (source of bias: blinding of outcome assessment), attrition bias (source of bias: incomplete outcomedata), reporting bias (source of bias: selective reporting), andother bias (other sources of bias specific to the study) (20).Data extractionData extracted included either performance change scoresor standard deviations after tart cherry concentrate (andplacebo) ingestion for nine studies (3, 7, 16, 18, 19, 21–24)or presupplementation and post-supplementation (cherryjuice and placebo) performance means and standard deviations for one study (17). When pre and postsupplementationmeans were extracted, change scores were calculated aspresupplementation mean subtracted from postsupplementation mean. Standard deviations (SD) for the change scoreswere estimated from pre and postsupplementation standarddeviations (SDpre and SDpost) using the following equationderived from the Cochrane Handbook for SystematicReviews of Interventions:SD change score ¼ ½ðSDpreÞ2 þ ðSDpostÞ2 – 2 ðcorrelation between pre and post scoresÞ SDpre SDpost 1 2In this equation we used 0.8 as the assumed correlationbetween pre and postscores.Data analysesA meta-analysis was run using RevMan 5 software.Heterogeneity was evaluated using v2 and I2 tests whereheterogeneity was indicated by either v2 p-value equal orless than 0.1 or I2 test value greater than 75%. Heterogeneitywas not present and therefore we used a fixed-effects modelfor our meta-analysis. As units of measurement differedacross studies we calculated standardized mean differencesand 95% confidence intervals. Measurements includedchange in distance on a shuttle swimming test (17), time toexhaustion on high-intensity cycling tests (16,24), total workperformed during cycling (21,22), time to complete a fullmarathon (3), a half marathon (18) and three cycling timetrials (10 km, 15 km and 20 km) (7,19,23). To ensure that allperformance changes were in a positive direction for beneficial effect, we converted the time to cover the full and halfmarathon and time to cover 10 km, 15 km and 20 km cyclingto velocity (i.e., km/min). A forest plot was generatedfor study-specific standardized mean differences along with95% confidence intervals and pooled effects. A p-value of0.05 or less was considered statistically significant. A funnelplot was generated to see if there is a publication bias. Thefunnel plot is used to visually assess publication bias viaits asymmetry. Each dot represents an individual study. Ifthe studies are unbiased, the plot would be symmetrical (i.e.,all the studies fall within the boundaries indicated by the3dashed lines representing the borders of an inverted funnel).If the studies are biased, the funnel plot would becomeasymmetrical (i.e., any studies that are biased fall outside theboundaries indicated by the dashed lines).ResultsSelection of studiesAfter exclusion by title and abstract, eight potential articleswere identified. A further three articles were included afterreading the full manuscript, as they included performancescores in the manuscript text, but not in the title or abstract(3,21,22). To be included, studies were required to assessaerobic endurance performance; this resulted in exclusion ofone additional article. Participant characteristics, supplementation protocols and exercise performance tests for eachstudy included are shown in Table 1. One study involvedonly the same-day supplementation while all the other studies involved chronic supplementation.Methodological qualityGeneration of the randomization sequence and allocationconcealment was adequate in only one study (19) andunclear in the remaining nine studies (Table 2). Only onestudy did not provide information for blinding of participants and researchers. The other nine studies used a doubleblind design (Table 2). In one study, attrition was higher inthe tart cherry arm than the placebo arm, resulting in imbalance in numbers between arms (18). Attrition was the samebetween arms in the remaining nine studies (Table 2).Results were fully reported in the ten studies, so these studies are at low risk of reporting bias (Table 2). The funnelplot (Figure 2) showed there is no publication bias.Meta-analysisSignificant endurance exercise performance-enhancingeffects were reported with tart cherry concentrate consumption in 2 of the 10 studies included (7,18). The pooled effectacross the 10 studies indicated a significant improvement inendurance performance with tart cherry concentrate supplementation (standardized mean difference: 0.36; 95% CI: 0.07to 0.64; p ¼ 0.01; I2¼0%; Figure 3).DiscussionThis is the first meta-analysis evaluating the effect of tartcherry concentrate on endurance performance. This reviewindicates significant ergogenic benefit of cherry consumption. The importance and practical application of this metaanalysis is that this will inform athletes of the use of tartcherry concentrate as an effective supplementation strategyto improve endurance exercise performance.Potential mechanisms for performance-enhancingeffectsTheoretically, tart cherry concentrate may enhance endurance exercise performance via its low glycemic index, anti-
Randomized, doubleblind, placebocontrolled, parallelStratified randomization(based on olled, parallelRandomized, doubleblind, placebocontrolled, parallelBell 2014Bell 2015Randomized, doubleblind, placebocontrolled, lacebocontrolled, lacebocontrolled, crossoverRandomized, counterbalanced, doubleblind, placebocontrolled, crossoverKeane 2018Gao 2018Davis 2019Morgan 2019Randomized, doubleblind, placebocontrolled, crossoverMcMormick 2016Levers d, crossoverClifford 2013Study designPseudorandomised,placebocontrolled, parallelHowatson 2010StudyPopulationWashout period1 week1 month3–7 days5 weeksNANANAAt least 5 daysNA8 highly trained maleAt least 2 weekscyclists, 19.7 1.6 years,VO2peak 62.3 10.1 mL/kg/min20 recreationally activemen, 27.83 22.62years, VO2peak40.95 2.87 ml/kg/min12 recreational cyclists, 8males, 4 females,34.6 15.8 years,VO2peak 38.2 7.4 ml/kg/min10 highly trained malecyclists, 28 7 years,VO2peak 59.0 7.0 mL/kg/min27 endurance-trainedrunners or triathletes,18 males, 9 females,21.8 3.9 years9 highly trained malewater polo athletes,18.6 1.4 years)16 well-trained malecyclists, 30 8 years,VO2peak 61.6 10.4 ml/kg/min9 male cyclists ortriathletes, 32.1 11.2years,80.2 8.6 kg,VO2max4.2 0.7 L/min,16 well-trained malecyclists, 30 8 years,VO2peak 61.6 10.4 ml/kg/min20 recreational marathonrunners, 13 males,7 femalesTable 1. Summary of the studies included.Tart cherry supplementPlacebo200 mg capsules per dayTwo servings of fruitflavored concentratedmixed with 8 oz ofwater per day6 Montmorency tart cherrypowder capsules daily(256.8 mg/day ofanthocyanin)Powdered tart cherries480 mg/day ( 66 mganthocyanins) incapsule form (n ¼ 11)90 mL tart cherry juiceconcentrate/day(9.117 mg/mL ofanthocyanins) dilutedwith water into 600mL60 mL of commerciallyavailable Montmorencytart cherry concentrate/day (73.50mg cyanidin3-glucoside/L) dilutedwith 100 mL water300mL tart cherry juice/day(9.2 mg/mlanthocyanins) for 4days before and 2 daysafter exercise; 1g/kgbody weightcarbohydrate in theform of tart cherry juice45min before exercise500 mg freeze dried tartcherry powder per dayTimingExercise performanceMean work performedover 3 cyclingtrials (kJ)20 km cycling timetrial (s)Marathon finishtime (h:min:s)8 consecutive days: 4 days Total work performedpre-exercise, on the dayduring cycling (kJ)of and 3 dayspostexercise7 consecutive days: 4 dayspre trials and on eachtrial day (3 trials)3 consecutive days: 2 daysbefore and on the dayof exercise5 days before, on the dayof and 2 days after aMarathon runChange scores6 Dextrose powdercapsules daily7 days in total: 3 pills inthe morning andevening for 6 daysbefore the testing day;on the testing day, 3pills 1 hour before tests500 mg powdered cellulose 8 consecutive days: 7 daysper daybefore and on the dayof exercise1506 86Time to exhaustion for 18.40 1.48cycling test (min)15-km cycling timetrial (s)118 9.72151.3 27.9142.292030.30 124.734:15:48 1:01:22Change 1580 10217.16 1.7817 2733 34YesNoNoNoPrescores Postscores Prescores Postscores No655 261 605 239 643 151 558 203103 9.28155.1 23.6146.492008.56 97.503:48:04 0:48:5860 ml commercially1.5 hour beforeTime to exhaustion for 772 34available fruit-flavoredperformance testscycling test (s)cordial mixed withmaltodextrin, wheyprotein isolate and100 mL water300mL sports drink /day7-day supplementation: 410-km cycling time17 3for 4 days before and 2days before, on the daytrial (min)days after exercise; 1g/of and 2 dayskg body weightafter exercisecarbohydrate in theform of sports drink45min before exercise10-day supplementation: 7 Half-marathon finishdays before, on the daytime (min)of and 2 days aftermarathon race120 mL cordials mixed with 6 consecutive days before Water Polo480 mL waterthe testing dayIntermittent ShuttleTest-distance (m)Rice flour 480mg/day incapsule form (n ¼ 10)30 mL concentrate30 mL cordial mixed with(9.117 mg/ml100 mL water andanthocyanins) mixedmaltodextrin, twicewith 100 mL water,per daytwice per day30 mL concentrate (9.2 mg/ 30 mL cordial mixed withml anthocyanins) mixed100 mL water andwith 100 mL water,maltodextrin, twicetwice per dayper dayTwo bottles of tart cherryjuice blend (8 oz foreach bottle, containingat least 40 mganthocyanins)200 mg capsules per daycontaining 216 mgpolyphenolsCherry juice4R. GAO AND P. D. CHILIBECK
JOURNAL OF THE AMERICAN COLLEGE OF NUTRITION5Table 2. Methodological quality of included studies.BiasStudyHowatson 2010Clifford 2013Bell 2014Bell 2015Levers 2016McCormick 2016Keane 2018Gao 2018Davis 2019Morgan 2019Randomsequencegeneration(selection learLow riskUnclearUnclearAllocationconcealment(selection bias)Blinding ofparticipants andresearchers(performancebias)Blinding ofoutcomeassessment(detection bias)Incompleteoutcome data(attrition learLow riskUnclearUnclearUnclearLow riskLow riskLow riskLow riskLow riskLow riskLow riskLow riskLow riskUnclearLow riskLow riskLow riskLow riskLow riskLow riskLow riskLow riskLow riskLow riskLow riskLow riskLow riskHigh riskLow riskLow riskLow riskLow riskLow riskSelectivereporting(reporting kriskriskriskriskriskriskOther riskriskriskriskriskriskFigure 2. Funnel plot indicating whether or not there is a publication bias.Figure 3. Forest plot showing the effects of tart cherry concentrate on endurance exercise performance. Diamond represents the pooled effect.inflammatory and anti-oxidative capacity, and blood flowenhancing effects. Tart cherry juice has a low glycemic index(GI ¼ 45) (6). Low glycemic index foods induce slower andsmaller increase in postprandial blood glucose and insulinlevels (25). Low glycemic index foods consumed before exercise may improve endurance performance by maintainingcarbohydrate availability during exercise (25). The sustainedrelease of glucose into blood after slow digestion of lowglycemic index foods provides sustained energy during exercise, which is important in the later stages of prolongedexercise. Also, insulin inhibits fat oxidation and promotesglucose utilization (26–28); therefore, the attenuation ofpost-prandial insulinemia may facilitate fat oxidation andreduce the depletion of muscle glycogen (29). This alteredfuel utilization may contribute to enhanced enduranceperformance.
6R. GAO AND P. D. CHILIBECKTart cherries contain many phytochemicals such asanthocyanins, flavonoids, flavanols, gallic acid equivalents,and phenolic acids. These anti-inflammatory and antioxidantcompounds have been shown to decrease muscle damage,reduce pain and improve recovery after intense exercise inathletes (14). Exercise-induced excess reactive oxygen speciesimpairs redox-sensitive calcium handling, damages musclemembrane, reduces muscle contractile force output andtherefore impairs exercise performance (30). Tart cherryjuice has the potential to improve exercise performance byreducing oxidative stress and rebalancing redox via its antioxidant capacity. This has been supported by many studieswhere blood markers of oxidative stress/inflammation weresignificantly attenuated after exercise with tart cherry juiceconsumption, compared with placebo (3, 4).Recent studies found that the tart cherry supplementationincreased muscle oxygenation during exercise (7) probablyvia: (1) the nitric oxide (NO) pathway by increasing NObioavailability through inhibiting nicotinamide adeninedinucleotide phosphate oxidase (8); and (2) cyanidin-3-glucoside (an anthocyanin high in tart cherries)-induceddecrease in the expression of inducible NO synthase (31)and increase in endothelial NO synthase expression (32).This altered balance between inducible NO synthase andendothelial NO synthase would further favor vasoactive NObioavailability (8), thus inducing vasodilation, increasingblood flow, and increasing oxygen delivery to the workingskeletal muscles, which is an important factor affecting exercise performance. The increased perfusion and blood flowwould also facilitate the efflux of exercise-induced metabolicwaste, thus further maintaining muscle function duringexercise and increasing exercise performance.Potential factors affecting resultsAmong the 10 studies included, only 2 studies reported significant performance-enhancing effects with tart cherry juicesupplementation (7,18), while the others were unable to findthis. Although most studies showed no effect, the pooledeffect from this meta-analysis showed significant benefits.Potential factors that might affect the study results are participant demographic, diet/exercise control, supplementationprotocol and measurements for exercise performance.Most of the studies used males only and 3 of 10 studiesin this meta-analysis included both males and females.Average ages ranged from 18.6 to 34.6 years old. Most ofthe studies involved endurance-trained individuals, i.e.,cyclists, runners or triathletes. Only one study employedWater Polo athletes and no differences were found for performance measures in this study. This could be due to theintermittent and un-weighted nature of the performancewhich was done in water. Water polo exercise might cause alower mechanical strain than that caused by cycling orendurance running efforts (17). This lower mechanical strainmight induce a smaller degree of inflammation (33), thuspotentially lessening the effects of a supplement that is supposed to offset inflammation. Land-based prolonged endurance exercise, such as running and cycling, might elicit agreater muscle damage and inflammation. Therefore, studieson cherry-based products might be of value to athletes inthese fields. Also, this study used a fruit juice as placebo,which may also contain beneficial anti-oxidants. Participantfitness level might be another important confounder.Performance
for acute endurance performance benefits is scarce. The purpose of this review was to evaluate the effect of tart cherry juice on endurance exercise performance with a meta-analysis. Method: Data sources included Medline
5. Tart cherry juice concentrate: End-of-period inventories of U.S. producers, 1988-90 . A-16 6. Average number of production and related workers producing tart cherry juice concentrate, hours worked, wages and total compensation paid to such employees, and hourly
Mix it up - look for cherry juice blends, like cherry apple juice. Or make your own blend and combine 100% ready to drink tart cherry juice with another juice. Juice on the Run - mix one or two tablespoons of tart cherry juice concentrate in a bottle of water, shake and go! Cooking/baking can be a fun family activity.
Available dried, frozen and in juice and concentrate, tart cherries contain a. unique package of antioxidants and beneficial phytonutrients, including anthocyanins — the pigments that give cherries . Cherry Juice Concentrate 3,622 (1unce) o 12,800. Antioxidant Levels of Tart Cherries and Other Common Fruits7,14 2500. 2000 1500. 1000 500. 0 .
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Montmorency tart cherry juice concentrate (MC). A washout period of at least 10 days between phases was administered, and counterbalancing participants eliminated order effects.The dosages used were 30 or 60 mL of the MC supplement (CherryActive, Hanworth, UK) mixed with 100 mL of water.Ac-cording to the manufacturer, a 30 mL dose was equivalent to
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