Comparative effects of plant-derived anthocyanin- and flavanol-rich supplements on recovery outcomes after exercise-induced muscle damage: a systematic review and network meta-analysis.
Level 1 - systematic review of randomized trials
Systematic review and network meta-analysis of randomized trials
PubMed 42666369 · doi:10.3389/fnut.2026.1857527
What was done
A systematic review and frequentist random-effects network meta-analysis was conducted across PubMed, Web of Science, CENTRAL, and Embase through January 2026. Included were randomized controlled trials in healthy adults with acute exercise-induced muscle damage comparing plant-derived anthocyanin- or flavanol-rich supplements against placebo or control. Thirty trials (595 participants) covering eight supplement types were analyzed. Primary outcomes were delayed onset muscle soreness (DOMS), muscle strength, creatine kinase (CK), and C-reactive protein (CRP) at 48 hours post-exercise; 24-hour and 72-hour outcomes were secondary. Certainty of evidence was evaluated with CINeMA and risk of bias with RoB 2.0.
What was found
The abstract reports no numerical effect sizes or confidence intervals. In the primary network meta-analysis, only pomegranate and tart cherry significantly reduced 48-hour DOMS compared with placebo, ranking first and second by SUCRA, respectively. No supplement demonstrated a clear advantage for muscle strength, CK, or CRP at 48 hours. For secondary outcomes, tart cherry was the only supplement significantly reducing DOMS at both 24 and 72 hours. No consistent benefits across supplements were observed for muscle strength, CK, or CRP at any time point. Overall certainty of evidence was rated as generally low.
Why it matters
Plant-derived polyphenols, particularly tart cherry and pomegranate, appear to provide targeted relief for subjective delayed-onset muscle soreness. They do not appear to enhance objective functional recovery or reduce physiological markers of muscle damage after acute exercise.
Limits
The abstract reports no numerical effect estimates, confidence intervals, or SUCRA values. The overall sample across 30 trials was small (595 total participants, averaging approximately 20 per trial). Certainty of evidence was low across outcomes, and estimates varied according to supplementation protocols, outcome definitions, and comparator characteristics.
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