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Robuvit® and endurance in triathlon:
improvements in training performance,
recovery and oxidative stress
COPYRIGHT© 2015 EDIZIONI MINERVA MEDICA
MINERVA CARDIOANGIOL 2015;63:403-9
Robuvit® and endurance in triathlon:
improvements in training performance,
recovery and oxidative stress
M. G. VINCIGUERRA 1, G. BELCARO 2, M. CACCHIO 2
Aim. The aim of this registry study was to
evaluate the effects of supplementation with
Robuvit® (Quercus robur wood extract, or
“QR”) on performance and endurance in triathlon by evaluating amateur athletes in a
period of 2 weeks of training. Supplementation with QR may improve training efficiency (by decreasing post-triathlon, muscular pain, cramps and by improving recovery
time). Robuvit® should decrease post-training plasma free radicals (PFR).
Methods. Sixty-one subjects (age range 3040) were included in the study. Subjects followed a free diet. An isotonic saline drink
was suggested to all subjects.
Results. After 2 weeks there were 27 subjects using the supplement and 27 without
supplementation. The groups were comparable. All subjects improved in training considering the 3 events (swim, biking, run).
The improvement was greater with Robuvit®
(P<0.05) for the swim and biking (P<0.05);
the running time decreased by 12.32% in
subjects using Robuvit® (3.6% in controls;
P<0.05). The improvement the total triathlon time was -10.56% with Robuvit® in comparison to -3.41% in controls. Safety: no side
effects or tolerance problems were reported; all QR capsules were used as indicated.
Conclusion. In conclusion, the -10.56% shorter total triathlon time was considered as a
very good improvement, considering that for
this type of athletes being almost at the top
of their form it is difficult to improve even
further without severe training. Training was
Corresponding author: M.G. Vinciguerra, Scienze Motorie
DISCAB, Università degli Studi di L’Aquila, Coppito II, Via
Vetoio, Coppito, L’Aquila, Italy.
E-Mail:
[email protected]
Vol. 63 - No. 5
1Scienze Motorie DISCAB
Università degli Studi di L’Aquila, Coppito II
Coppito, L’Aquila, Italy
2Irvine-Labs, Spoltore, Pescara, Italy
considered better (on an analogue scale) in
the QR group (P<0.05). Postrun muscular
pain, cramps, localized pain, straining and
the recovery time, were all considered better
with QR (P<0.05). Plasma free radical (PFR)
values 1 hour after the final run were, on
average,16.98% higher in controls (P<0.05),
indicating a higher level of oxidative stress.
Higher levels of PFR are associated with a
slower recovery. All routine blood tests were
normal at inclusion and after the final triathlon. After the final test run triathlon athletes using QR had a lower increase of UBR
and LDH (indicator of hemolysis). These two
tests were significantly increased in controls (P<0.05) but not in the Robuvit® group.
Robuvit® supplementation improved training, results and decreased hemolysis.
Key words: Robuvit® - Athletic performance Physical endurance - Oxidative stress.
E
ndurance 1 is the ability or strength to
continue or last, especially despite fatigue, stress, or other adverse conditions.
Endurance can be evaluated by strenuous exercises that require hard and repeated training. Triathlon 2 is an interesting model that can be used to evaluate
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improvements in endurance, including
training and performance of healthy subjects. The effects of repeated training are
often tiredness, that does not completely
disappear or improve with rest and posttraining diffuse pain, which has been also
associated to an increase in oxidative
stress with exercise.3
Recently a new extract from Quercus
Robur (QR) wood, produced in France, has
been used to improve chronic fatigue, particularly in otherwise healthy subjects with
chronic fatigue syndrome (CFS), moderate
hepatic failure (associated with increased
fatigue and decreased tolerance to exercise)
and increased oxidative stress associated
with these conditions.4-6
After strenuous exercise and a high level
of stress, a number of metabolites accumulate in the body and the liver has an essential function in clearing and metabolizing
these products. Hydration and hepatorenal
functions are very important in improving recovery, particularly after a triathlon.
The new French oak wood extract (Robuvit®, Horphag Research) has already shown
a significant protective effect in moderate
hepatic failure, due to drugs.6 The supplement is safe, it is very effective in controlling oxidative stress and it does not need to
be prescripted. It does not interfere with the
hormonal system.
The aim of this open registry study was to
evaluate the effects of QR supplementation
on training and on possible improvements
in endurance amongst healthy subjects who
train and perform in a triathlon. The study
included amateur athletes evaluated in a
2-week training period.
The effects of the supplementation are
an improvement in training efficiency (by
decreasing post-triathlon diffuse muscular
pain, but also decreasing localized cramps
and pain and by improving the post-exercise recovery time). QR was also considered
useful in decreasing post-training plasma
free radicals (PFR). The supplementation
registry study considered the main intermediate target of making training more effective, with the final target of improving
the triathlon performance (time).
404
Materials and methods
The study aimed to help training to a
higher level of fitness with the “100-min
triathlon” by evaluating the effects of supplementation with QR on training and performance. The registry study included nonprofessional triathlon athletes. The study
was approved by the committee on research
ethics at the institution in which the research
was conducted and any informed consent
from human subjects was obtained as required. Triathlon races may vary in distance.8
In our study, however, we have developed a
specific study-model of triathlon including:
—— a swim distance in open seawater of
750 meters (0.47 miles);
—— a cycling distance of 20 km (12 miles);
—— a 5 km run.
To keep conditions as standardized as
possible, the period of registry training was
between May 15 and June 20, when the average temperature at beachside in Pescara,
Italy at 2 pm is about 21-25 °C. The average
running times for these three events were,
respectively, around 12-15 minutes, 40 minutes and 25 minutes, with a total intended
average around 100 min. This time frame is
relatively easy to evaluate and can be performed by many non-professional athletes.
Transition areas/points between the
swim and bike part (T1) and between the
bike and the run parts (T2) were used to
switch from swimming to cycling, and then
from cycling to running. The time spent in
T1 and T2 was included in the overall time
of the race.
The nature of triathlon focuses on persistent and periodic training in each of the
three disciplines with general psychological
and physical strength leading to improvements in endurance. The evaluation of the
single distances and of the global time for
the triathlon were considered as the final
targets to improve in a 2-week period of
training and supplementation.
Subjects
Amateur athletes able to perform the triathlon in about 100 minutes (±15 minutes)
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ROBUVIT AND ENDURANCE IN TRIATHLON VINCIGUERRA
were considered. An analogue scale line
(range 0-10) was used to evaluate the subjective performance, post-training pain, cramps
and generally negative effects of training on
muscles. Also, oxidative stress was measured
by testing PFR (plasma free radical).
decided on the basis of the preliminary
briefing what group they would join. No
placebo was used. Patients were informed
about the supplement or the other possible
option. Possible placebo effect was also explained and considered.
Nutrition
QR dosage
Nutrition choice was completely left to
the participant. The only saline compound
suggested to all subjects was a reintegrating OTC complex (Polase) including potassium aspartate (450 mg), magnesium
aspartate (450 mg) and tetra-hydrated
magnesium (450 mg). The complex was
used 4 times a day in 400 mL of water. It
was not used in the initial and final measuring test-run.
In this study 300 mg/day (3 capsules)
were used.
Study training
The individual triathlon training included
repetition of the defined distances 8 times in
14 days in the same environment. A group
of athletes used QR (one 100 mg capsule,
three times a day with the meals, breakfast,
lunch and dinner). A control group did not
use any supplement but followed the same
training and nutritional plans.
Supplement studies
Supplement studies 9, 10 define the activity of supplements (preclinical, borderline
applications, management of risk conditions). Supplements are not generally used
for treatment of clinical conditions. Generally, supplement studies is to produce data
to be compared with background data (i.e.
based on the best management) or to other
management plans.
In this study, supplementation was used
according to the following rules: 1) supplementation was suggested as an option; 2)
supplementation was used in association
with what was considered at the time the
“best-management”; this non-clinical evaluation was a registry study; There was no defined group allocation and no randomization organized by the investigators. Subjects
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Oxidative stress measurements
Postexercise Plasma free radical (PFR)
levels (one hour after the end of triathlon) 2
were measured. PFRs were measured (FRAS
4: Diacron, Parma, Italy) with a photometric
system developed for the global assessment
of oxidative stress. The equipment measured PFR by measuring reactive oxygen
metabolites (using the d-ROMS test). The
method is validated and has been used in
several studies showing optimal reproducibility. PFRs are increased in clinical conditions and in risk conditions (i.e., hypertension, diabetes, hyperlipidemia). After
strenuous exercise PFRs increase in most
subjects:2 The persistence of higher levels
of PFR has been associated with delayed
recovery from fatigue.11-13
Statistical analysis
Ten subjects in each group (control or
supplement) were considered necessary to
evaluate differences after weeks of training
on the basis of observations from previous studies. The ANOVA test was used to
compare the differences in performance
prevalence in the two groups. A Sigma plot
(Systat Software Inc., San Jose, CA, USA)
program was used to perform all statistical
analyses.14 The total triathlon times in seconds was used as the final evaluation target. The non-decimal measurements (time
in minutes and seconds) are also shown. All
measurements were considered non-parametric and evaluated with non-parametric
tests (Mann-Whitney).
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Safety
Table I.—The groups completing the study.
Number
Age
Males
QR
Females
QR
Males
CON
Females
CON
16
34.5; 3
11
34.8; 4.7
15
34.2; 2.2
12
35.1; 2.5
Results
We selected 61 healthy subjects available
to follow the registry plan (age range 3040). No other clinical or risk condition, no
addictions were present and no drug were
used. Subjects followed a free diet. None
used “sport” supplements (i.e. aminoacids,
on anabolic products). The only admitted
beverage was Gatorade. The use of reintegrating drink (Polase) was suggested to all
subjects. At 2 weeks there were 27 subjects
using the supplement (4 subjects were lost
for logistical problems); 27 subjects did not
use the supplement and acted as controls
(3 were lost for logistical problems). The
two groups (Table I) resulted comparable
considering men and women performances
at inclusion and age distribution. Drinking
and training resulted comparable in the two
groups.
No side effects or tolerance problems
were reported; all QR capsules were used
as indicated.
The final “measurement” run was not
competitive (one athtlete against the other)
but chronometric. The start for each participant was given every 8 minutes and in
separate starting areas for men and women,
starting with the best performer (according
to previous time) and completing with the
lower performance subjects to avoid overlapping of subjects and measurements. All
subjects completed the test.
The events (swin, bike, run) variations
(time) are shown in Table II. All subjects
improved with training considering the 3
events. The improvement was greater with
QR (P<0.05) for the swim (-15.02% with QR
vs. 7.15% in controls). The improvement in
biking was also greater (P<0.05) with QR
(-9.3% vs. -1.2% in controls). The running
time was decreased by 12.32% with QR vs.
3.6% only in controls (P<0.05).
The final variation in time (expressed in seconds, including transitions) was -10.56% with
QR in comparison with a variation of -3.41%.
Table II.—Triathlon time variations in the 3 events.
Inclusion
Effort/Group
A) Swim
A) QR
A) CONT
B) Bike
A) QR
A) CONT
C) Run
A) QR
A) CONT
Transition time
A) QR
A) CONT
Totals
A) QR
A) CONT
2 weeks
Mean time;
SD
Mean time
(in seconds)
Mean time;
SD
Mean time
(in seconds)
14 min 32 s; 2.2
14 min 12 s; 2.5
872
852
12 min 21 s; 3*#
13 min 44 s; 3.2*#
741
791
37 min 33 s; 4.3
36 min 12 s; 4.2
2253
2172
34 min 3 s; 3.2*#
35 min 44 s; 5.3 NS
2043
2144
28 min 46 s; 4.2
25 min 34 s; 3.2
1606
1534
23 min 28 s; 5.2*#
24 min 38 s; 4*
1408
1478
23 min 12 s; 3.1
23 min 35 s; 2.4
1392
1385
21 min 24 s; 3.4*#
22 min 7 s; 5.2*#
1284
1327
102.5 min
4498.05 min
6123
5943
91.26 min
95.66 min
5476
5740
Total
% variation
-10.56
4-3.41
*Difference before - after; #Difference between groups.
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Table III.—The groups completing the study.
QR
A) Training (VASL score 0-10)
B) Postrun diffuse muscular pain (0-10) (within 24 hrs after the run)
C) Cramp (0-10) & localized pain (within 24 hrs after the run)
E) Postexercise recovery time (hours) (within 48 hrs after the run)
F) PFR (1 hr after the run)
18.6;
15.5;
13.4;
19.3;
418;
Controls
1.1*
1*,3
2.2*
2.2*
54*
17.8;
16.2;
14.1;
21.3;
489;
1.2
1.3
1.4
2.5
67
*p<0.05
Table IV.—Values indicative of hemolysis: variations of the main hematological parameters (before and after
the final test run triathlon) indicating hemolysis in the two groups (mean and SD).
Group 1 (QR)
UBR (mg/dL)
LDH (μ/mL)
Hb (g/L)
Ferritin (ng/mL)
Postrun
Prerun
Postrun
0.61±0.55
311±104
13.7±1.4
67.2±57.4
0.63±0.43
339±121
13.8±1.4
67.4±56.8
0.61±0.2
319±123
13.8±1.2
68±52
0.85±0.219 *
402±155 *
13.6±1.1 ns
68.3±51 ns
A 3-5% variation, in this competition may
be a significant value and allow subjects to
get i.e. from being in the 800th place (in a
run of 1000) subjects to around 700th. In an
international higher level competition (Pescara 2013) the winner ran in 30 minutes and
4 seconds. The runner at 800th place (center
of the pack) competed in 55 minutes and
44 seconds; the runner at 1011th place competed the triathlon in 60 minutes. In this
case less than 5 minutes means a difference
of about 200 positions.
Improving by 10.56% in the 100 minute
triathlon means an improvement of more
than 10 minutes in two weeks and a difference of 7.15% that may allow the athlete (considering different factors including
environmental elements) to move from the
slower 25% to the best 25% of the pack.
Occasional variations – when the full triatlon is repeated, in fully trained subjects are in the order of 2-3 minutes within same
conditions (including climatic parameters).
Shortly, for QR subjects a -10.56% result
was considered a very good improvement
considering that for this type of athletes ‑
almost at the top of their form ‑ it is difficult
to improve more even with severe training.
Table III shows the subjective parameters
and plasma free radicals. Training was considered better in the QR group (P<0.05).
Postrun muscular pain, cramps and local-
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Group 2 (Controls)
Prerun
ized pain and straining, and the postexercise recovery time, were all considered better with QR (P<0.05).
Lastly, PFR values 1 hour after the final run, were 16.98% higher in controls
(P<0.05), indicating a higher level of oxidative stress after the final test run. The higher
level of PFR may be associated to a slower
recovery time after training and after the
test run. The improvements were seen in
parallel both in men and women.
Routine blood tests were normal at inclusion and after the final triathlon. An interesting observation was the evaluation of
possible intravascular hemolysis during/after prolonged running, that was evaluated
by measuring unconjugated bilirubin (UBR)
(mg dL[-1]), lactate dehydrogenase (LDH)
(μ mL[-1]), hemoglobin and serum ferritin.
Variations in these parameters are significant indicators of hemolysis. After the final
test run there were no significant changes
in hemoglobin or serum ferritin in both
groups (Table IV). Athletes using QR had a
lower variation in UBR and LDH. These two
tests were significantly increased in controls
not using QR (P<0.05). This finding was not
expected, and more specific studies should
be carried out to evaluate hemolysis and
the connection between effective, strenuous training, oxidative stress and hemolysis.
These findings were considered an initial
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indication that QR may protect blood cells
from hemolysis.
Discussion
QR has already shown a significant protective effect on liver injury in rats with dietinduced cirrhosis and in moderate hepatic
failure in humans.6 Robuvit is produced
with a standardized process; it includes
hydrolysable tannins, namely ellagitannius. These compounds have demonstrated
a broad spectrum of bio pharmacological
properties in humans. Ellagitannins themselves are not physiologically active; they
need to be transformed by intestinal microbiota into urolithins A-C, i.e. active metabolites. Urolithin B inhibits the production
of the inflammatory interleukins Il-1β, IL-8
and the production of the matrix metalloprotease MMP-9, collagenase.15 Urolithin C
inhibits the release of another matrix metalloprotease, the elastase, whereas urolithin A
reduces the release of reactive oxygen species from activated neutrophils and blocks
TNFα.15 Furthermore, urolithin A inhibits the
activation of the key factor of inflammation,
NFκB.16 Consequently, QR also inhibits the
synthesis of prostaglandins and cyclooxygenase 2. This combined action of the metabolites of QR against several inflammatory molecules and the protein-destroying
matrix metalloproteases may explain the
fast relief from fatigue, muscular pain and
generally posteffort pain in most subjects
after triathlon. Also, the improved hepatic
function may play a significant role ‑ when
hydration is adequate ‑ in the clearance of
several posteffort metabolites accumulated
in the muscular system and in the body.
However, this aspect should be evaluated
in more specific, dedicated studies.
It is important to note that one of the satisfactory results of this type of strenuous efforts is not only based with measurements
of time and performance. A lower level of
fatigue, a better rest and easier effort and
improved quality of performance enable
better training and may be as important as
improvements in time. A subject may per-
408
form with the same final times but feeling
less exhausted and, basically, enjoying more
the triathlon, also recovering ludic aspects
of the competition, too often canceled by
the anxiety for absolute (time) performance.
The hepatoprotective effects of the constituents of oak wood may be also partly
due to its strong and effective antioxidant
activity. The metabolites of the ellagitannins counteract all the proinflammatory cytokines or adhesion molecules, the beneficial action of QR elements on the increased
oxidative stress is most probably associated
with its anti-inflammatory action.
Supplements, evaluated in open registry
studies, combined with the best present
management (i.e. for training, reintegration
and nutrition in this type of complex, multiple effort) could offer an important possible solution to postexercise fatigue not
relieved by simple rest. After a strenuous,
stressing exercise the inefficacy of rest is
possibly associated to both a permanent
increase in oxidative stress (as seen by the
persistent elevation in PFR) and to a the residual presence of several metabolites that
tend to be cleared slowly (within days).
Finally, the observation of a reduced hemolysis in subjects using QR may suggest
the need for a specific study to evaluate
the effects of Robuvit on blood cells in
stressing conditions.17, 18 The unexpected
observation of a reduced hemolysis after
exercise (that occur almost physiologically
in all triathlon and long-distance runners)
may adequately fit within the initial physiological profile of QR with a significant
cellular-protective action, also documented in the studies on hepatic failure 6 and
in the studies on CFS.
Conclusions
The observations from this study on
healthy individuals under a stressing physical effort may be translated into suggestions
and models for potential clinical conditions,
where a supplementation, improving the efficacy of recovery, may be important,22 particularly in older and weaker patients.
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Conflicts of interest.—The authors certify that there is
no conflict of interest with any financial organization regarding the material discussed in the manuscript.
Received on April 15, 2015.
Accepted for publication on May 7, 2015.
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