Abstract
Background
Exercise-induced muscle damage (EIMD) is known to impair neuromuscular performance, provoke inflammation, and delay recovery. Tart cherry (TC) juice, a polyphenol-rich nutritional product, has been proposed as a strategy to support recovery in athletes; however, findings across studies remain inconsistent.
Objective
The aim was to conduct a systematic review combined with a meta-analysis and corroborate the certainty of evidence underpinning the effects of TC juice supplementation on physical, biochemical, and perceptual recovery markers following EIMD in trained athletes.
Methods
A systematic review and meta-analysis were conducted following PRISMA 2020 guidelines. PubMed, ScienceDirect, Web of Science and SPORTDiscus were searched from inception to 25 December 2025.
Results
Nineteen trials were included. Our results revealed TC juice supplementation significantly improved MVC recovery in the main analysis across all time points (post: ES = 0.63; 24 h: ES = 1.12; 48 h: ES = 1.29; 72 h: ES = 2.14; 96 h: ES = 4.82), with substantial heterogeneity (I² 69–93%). CMJ showed no significant effects post-exercise or at 24h but improved at 48 h (ES = 1.41; I² = 72%). TC juice significantly reduced CRP post-exercise and up to 48 h (post: ES = −0.46; 24 h: ES = −0.73; 48 h: ES = −0.68), whereas no significant pooled effects were found for muscle soreness, CK, IL-6, TNF-α, ROM, or most subgroup time points. Subgroup analyses suggested model-specific responses (e.g., MVC improvements at 24–48 h in whole-body protocols and at 72 h in isolated protocols). Sensitivity analyses indicated that statistical significance at selected time points (MVC post and 72 h; CMJ 48 h; CRP 24–48 h) was influenced by individual studies. Certainty of evidence ranged from very low to moderate.
Conclusions
TC juice supplementation may support recovery of selected functional and inflammatory markers following exercise-induced muscle damage in trained athletes; however, findings are heterogeneous and supported by low-to-moderate certainty of evidence, warranting cautious interpretation.
Supplementary Information
The online version contains supplementary material available at 10.1186/s40798-026-00993-3.
Keywords: Tart cherry juice, Recovery, Muscle damage, Polyphenols, Athletes, Inflammation, GRADE, Meta-analysis
Key Points
Tart cherry (TC) juice supplementation was associated with significantly improved MVC recovery across time points in the main analysis, although effects showed substantial heterogeneity and some time points were sensitive to single-study removal. TC significantly reduced C-reactive protein (CRP) levels post EIMD up to 48 h post EIMD, supporting a potential anti-inflammatory effect, but CRP effects at 24–48 h were sensitive to removal of an influential study.
TC showed a significant improvement in CMJ at 48 h only, with no significant effects post-exercise or at 24 h, and the 48 h effect was sensitive to study removal.
No consistent effects were observed on muscle soreness, creatine kinase (CK), interleukin-6 (IL6), tumor necrosis factor-alpha (TNFα), or range of motion (ROM), and subgroup analyses (whole-body vs isolated protocols) suggested model-specific responses without resolving heterogeneity.
Overall certainty of evidence ranged from very low to moderate supporting cautious interpretation and emphasizing the need for larger, well-controlled athlete trials with standardized dosing and outcomes.
Supplementary Information
The online version contains supplementary material available at 10.1186/s40798-026-00993-3.
Introduction
Exercise induced muscle damage (EIMD) is characterized by a range of physiological responses, that arise following exposure of a skeletal muscle to a high amount of eccentric contraction. EIMD is typically proposed to be associated with two phases: the first primary damage occurs from the mechanical stress during the exercise bout, while the loss of membrane integrity at the sarcoplasmic reticulum is the consequence of the subsequent secondary damage, involving, leakage of intramuscular proteins into the blood for several days following the damaging exercise. The secondary phase is accompanied by an inflammatory response that contributes to tissue repair and remodeling [1]. The consequences of EIMD are wide and could include prolonged impairment of the capacity to generate muscle force, as well as a decline in physical performance, reduction in the range of motion (ROM) and delayed onset of muscle soreness (DOMS) [2]. Accordingly, recovery from EIMD is commonly tracked using transient impairments in muscle function (e.g., MVC and jump performance), increased soreness, elevations in circulating muscle damage markers (e.g., CK), and inflammatory mediators (e.g., IL-6, CRP, TNFα), alongside reduced ROM.
While these responses are well recognized as recovery markers, it has been suggested that in team sport population, the structural disruption may be less pronounced, whereas neuromuscular impairment can still be meaningful [3]. Under these circumstances, adopting evidence-based strategies to mitigate the effects of EIMD is crucial for trained population who must recover rapidly between training sessions and competitions [4–6].
In the last decade, several strategies have been introduced to accelerate the recovery process and mitigate the effect of EIMD on the subsequent performance, including compression garments [7], cold water immersion [8], lower limb occlusion [9] and low-level laser therapy [10]. These strategies have shown trivial to small impact on the recovery process [11]. Nonetheless, it is evident that nutritional interventions hold significant potential for enhancing recovery from EIMD [6]. In fact, supplement ingestion aiming at enhancing performance is widespread in sport nutrition, with one of the primary goals being to promote muscle growth and repair. Recent survey data indicate that a high proportion of athletes regularly consume dietary supplements [12]. For instance, a recent study involving 600 athletes reported that 91.1% used at least one dietary supplement, with higher consumption observed among professional athletes compared to nonprofessionals (95.8% vs. 94.3%) [13]. Another cross-sectional study involving 433 fitness athletes found that 57.9% of them used dietary supplements, with whey protein and omega-3 fatty acids being the most frequently consumed [14]. Interestingly, 69.5% of participants in this study reported that the primary aim for supplement use was to accelerate the recovery process [14]. This widespread use underscores the relevance of investigating the effectiveness of dietary supplements in the context of recovery following EIMD. In this way, several supplements have been frequently introduced in athletes’ diets, and have demonstrated potential benefits in enhancing recovery from EIMD including creatine monohydrate [15], protein [16], branched-chain amino acid (BCAA) [17], Vitamin D [18] and Omega-3 Polyunsaturated Fatty Acids [19]. While these strategies are well established, bioactive compounds have recently attracted attention as an innovative addition to sports nutrition. Bioactive compounds are constituents in foods that exert biological effects when consumed at typical intake levels [20]. Plant-based bioactive compounds, particularly polyphenolic-rich foods, have been increasingly studied in the context of sports nutrition [21]. Montmorency tart cherries (TC), which can be consumed as a beverage made from powdered extract or liquid concentrate, are rich in flavonoids and anthocyanins [22]. These compounds have been reported to offer anti-inflammatory and antioxidant effects, potentially reducing inflammation and reactive oxygen and nitrogen species (RONS) through the inhibition of the cyclooxygenase (COX-1 and COX-2) pathways [23]. While these effects suggest that TC products could help attenuate inflammatory responses and enhance recovery process for muscle damage, it is important to acknowledge that most of these assumptions come from in vitro or animal studies [23].
Studies investigating the effects of TC on recovery in human have generally reported positive effects across several key indicators of EIMD. In this way, TC supplementation has been shown to accelerate the recovery of muscle function and strength [24, 25], attenuate the elevation of oxidative stress [26] and biomarkers of muscle damage and inflammation [24, 27–30] as well as reduce DOMS [30–32]. While a beneficial effect of TC on one or more parameters of EIMD has been reported in these studies, other investigations did not observe such an effect [33–36]. Several factors could explain these equivocal findings between studies including but not limited to (1) type of supplementation: TC was provided as a powder in some studies [30, 37] and as juice in others [24, 33], (2) type of exercise: most studies used aerobic exercises to induce muscle damage support TC supplementation for recovery by targeting inflammation [24, 29, 30] and oxidative stress [24, 28]. However, the response of some markers varies across studies; for instance, three studies reported a decrease in C-reactive protein (CRP) [24, 27, 29], while no effect was reported in two other studies [25, 28]. Resistance exercises, which primarily induce mechanical stress, also show conflicting findings on the effectiveness of TC, with some studies demonstrating beneficial effects on recovery [37, 38] and others showing no effect [33, 39]. This variability makes it challenging to determine the overall effects of TC on recovery processes. Furthermore, in the last few years, narrative reviews [40, 41], and systematic reviews with meta-analyses [42, 43] have attempted to identify the efficacy of TC in recovery process.
Although the available evidence remains informative, an important consideration is that many studies included in previous studies were conducted in patients or healthy active and sedentary individuals. This distinction is particularly relevant because trained individuals and athletes represent a physiologically distinct population. Compared with general or clinical populations, trained individuals exhibit training-induced adaptations, differences in baseline neuromuscular function, altered antioxidant capacity, and modified inflammatory responses. These factors collectively influence both the magnitude of EIMD and the subsequent recovery process.
Furthermore, athletes operate under unique performance constraints, including the need for rapid restoration of neuromuscular function and minimization of residual fatigue between training sessions and competitions. Such demands may modify the practical effectiveness and relevance of nutritional interventions. Consequently, findings derived from heterogeneous or non-athletic populations may not be directly transferable to trained individuals.
Therefore, a systematic review incorporating meta-analysis and certainty-of-evidence assessment focused exclusively on trained individuals and athletes is warranted to clarify the potential efficacy of TC juice supplementation on physical, biochemical, and perceptual markers of recovery following EIMD.
…The results will be discussed taking into consideration the practical significance of any potential beneficial effect of this nutritional supplementation. Moreover, given the relatively high cost of TC juice products compared to conventional recovery strategies, it is important to determine whether the physiological benefits observed justify their expense. This economic consideration is particularly relevant for athletes, coaches, and sports practitioners who must balance budgetary constraints with evidence-based recovery interventions. Therefore, a rigorous analysis is needed not only to evaluate the efficacy of TC juice on recovery but also to assess whether its use is a worthwhile investment.
The aim of this study, therefore, was to conduct a systematic review combined with a meta-analysis and employ the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to synthesize the evidence underscoring the effects of TC juice on recovery of physical, biochemical, and subjective markers following EIMD in well trained individuals and athletes. To address the variability across exercise protocols, supplement formats, and outcome assessments reported in the literature, outcomes were pooled using standardized effect sizes at comparable follow-up time points (≥ 24–96 h) and heterogeneity was quantified. We also explored potential sources of inconsistency using subgroup analyses (whole-body vs. isolated muscle-damage protocols) and tested the robustness of pooled estimates using sensitivity analyses.
Methods
For this review, we followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines [44]. The protocol of this systematic review was pre-registered at the Open Science Framework (https://osf.io/tgvd7).
Eligibility Criteria
Eligibility criteria were defined using The PICOS framework [45]:
Population (P): healthy, non-injured athletes from all competition level, with a mean age ≥ 18 years old including both sexes.
Intervention (I): TC juice supplementation administered before and/or after an exercise protocol designed to induce muscle damage.
Comparators (C): a control or placebo condition (e.g., no intervention, placebo or alternative supplement comparator).
Outcomes(O): Studies were eligible if they reported at least one marker of recovery following EIMD assessed at baseline and follow-up time points at least once after the EIMD. Outcomes were grouped as: performance/function markers (maximal voluntary contraction [MVC], countermovement jump [CMJ] height), perceptual markers (muscle soreness assessed using VAS or comparable scales), biochemical/inflammatory markers (creatine kinase [CK], interleukin-6 [IL-6], C-reactive protein [CRP], tumor necrosis factor-α [TNFα]), and functional markers (range of motion [ROM]). When available, outcomes were extracted across multiple follow-up time points (e.g., immediately post-exercise and 24–96 h).
Study design(S): Controlled trial designs (randomized or non-randomized), including parallel or crossover designs.
Other limits: Only studies published in English and in peer-reviewed journals were included.
Exclusion Criteria
Studies were excluded if: (i) they involved non-athletes, participants with a mean age < 18 years, injured or clinical populations, (ii) lacked a control or placebo group, (iii) did not administer TC juice, (iv) did not report eligible outcomes at baseline and did noy follow up at least once post-EIMD, (v) did not provide extractable data for analysis, (vi) were not full-text peer-reviewed original studies.
For the purposes of this review, exercise-induced muscle damage (EIMD) was operationally defined as a protocol expected to induce measurable functional impairment and/or soreness typically associated with substantial eccentric or impact-based loading (e.g., resistance exercise, downhill running, repeated sprint, or team-sport activity). Predominantly concentric exercise models without a well-established EIMD profile were not considered eligible. This operational definition was applied consistently during screening and is clarified here to improve transparency and reproducibility.
Search
The literature review was conducted by identifying articles using the databases PubMed, ScienceDirect, Web of Science and SPORTDiscus from the earliest available date to 25 December 2025.
The following keywords: “Tart Cherry Juice” and “recovery” were used in combination with “performance”, “fatigue”, “muscle damage”, “exercise”, “aerobic”, “anaerobic’’, “repeated sprint”, “VO2max”, “speed”, “endurance”, “sport”, “supplementation”, “athlete”, “muscle function”, “jump”, “sprint”, “strength” using the Boolean operators “OR” and “AND”.
Field tags, wildcard options (i.e., truncated words), and medical subject headings (MeSH) terms were incorporated where appropriate. The full research strategy and keywords are presented in Supplementary file 1: Table S1.
Text Screening, Data Extraction, Methodological Quality, and Publication BIas
Text Screening and Data Extraction
Screening of publications identified in the search was independently conducted by two authors WD and MAB, based on the inclusion and exclusion criteria mentioned above. Titles and abstracts were screened first to remove clearly irrelevant records. Full texts of potentially eligible studies were then retrieved and assessed for inclusion. Disagreements were resolved through discussion, and when necessary, a third author (A-E.A.) acted as a referee. In the case of any disagreement, the third author (referee) referred to the inclusion criteria in order to settle the dispute.
Screening decisions were guided by the operational definitions specified in the registered protocol; however, following peer-review feedback, these definitions are articulated more explicitly in the present manuscript to enhance interpretability and reproducibility.
Data extraction was performed independently by W.D and M.A.B. Extracted information included: (1) author(s), title, and year of publication; (2) participant characteristics (sample size, sex, age, and sport); (3) study characteristics (timing of tart cherry supplementation and time points of outcome assessment); (4) outcome measures used to assess performance/function, biochemical, and perceptual markers; and (5) pre- and post-exercise values required for analysis. Coding files were cross-checked between authors and discrepancies were resolved by consensus.
Methodological Quality and Publication Bias
Methodological quality (risk of bias) was assessed independently by two authors (W.D. and M.A.B.) using the Downs and Black checklist for both randomized and non-randomized studies. The checklist comprises 27 items, which are distributed over five sub-scales: reporting (item 1–10), external validity (item 11–13), bias (item 14–20), confounding (items 21–26) and power (item 27). Each item had to be answered in order to have a global score of methodological quality for each included study. The maximal score possible is 32. Studies were classified as being of ‘good quality’ if they scored 20–32 points, ‘moderate quality’ if they scored from 11 to 19 points, and ‘poor quality’ if they scored < 11 points on the checklist [46]. Disagreements were resolved by discussion, with a third author (A-E.A.) acting as referee when required. Two authors (W.D and M.A.B.) firstly analyzed each one separately the included articles. In the case of disagreement, the third author (A-E.A.) performed a specific analysis and discussed with the authors in order to reach a consensus on the decision to be made.
Outcome-level quality assessment was performed using the GRADE approach [47]. This approach allows to evaluate the overall evidence level in this review. Two authors (W.D. and M-A B.) assessed the outcome against each criterion, and contradictory results were resolved by a third author (A-E A.). The criteria used to make judgments were: (1) limitations (risk of bias), this domain evaluates the risk of bias arising from flaws in the design or implementation of individual studies, (2) inconsistency, this domain evaluates whether there are systematic differences across the study results included in an evidence synthesis, (3) indirectness, this domain covers concerns about applicability, generalizability, external validity, translatability and transferability of research results to a question of interest, (4) imprecision, this domain evaluates the risk of random error within a body of evidence and (5) publication bias, this domain evaluates whether the accessibility of study results is determined by the nature of their findings [47]. The primary method for assessing study limitations involves comparing studies with high risk and low of bias. As a consequence, outcomes were downgraded 1 level for limitations if the included studies scored less than 100% in methodological quality according to the Downs-Black checklist. Outcomes were downgraded 2 levels if the included studies scored less than 60% in methodological quality. As the inconsistency relies on heterogeneity, the certainty of the evidence should be rated down if a systematic difference exists between studies. Outcomes were downgraded 1 level for inconsistency if there was significant heterogeneity (i.e., I2 greater than 50%). It may be necessary to rate down the certainty of the evidence if there are differences in population, interventions, or outcome between studies. Outcomes were downgraded 1 level for indirectness if there were significant differences between the populations, interventions, or outcomes measured across studies. Indirectness is linked with the width of confidence intervals. Outcomes were downgraded 1 level for imprecision if the confidence intervals represented different conclusions. Outcomes were downgraded 1 level for publication bias if there was obvious industry involvement.
τ2 is the variance of the effect size parameters across the population of studies and it reflects the variance of the true effect sizes. The square root of this number is referred to as tau (T). τ2 represents the absolute value of the true variance (heterogeneity) and is the variance of the true effects. This is interpreted as systematic unexplained differences between the observed effects of the separate studies. It is not affected by the number of studies, but it is often hard to interpret how relevant the value is from a practical standpoint.
Publication bias was explored by visual inspection of funnel plots for outcomes with a sufficient number of studies. Funnel plot interpretation was performed cautiously, as asymmetry may reflect heterogeneity or small-study effects and is less informative when few studies contribute to an outcome. Funnel plots for the analyzed outcomes are provided in the Supplementary Materials.
Sensitivity Analysis
To assess the robustness of pooled estimates, we performed a leave-one-out sensitivity analysis for each outcome and time point where at least three studies were available. Each meta-analysis was repeated after removing the study(ies) detected as influential, and changes in pooled effect size (ES), statistical significance (p value), and heterogeneity (I²) were examined. Results are reported in the Supplementary Materials.
Meta Analysis
Effect sizes (ES) were calculated by dividing the mean difference between the TC and control/placebo conditions by the pooled standard deviation across participants at each post-exercise timepoint. Meta-analytic computations were conducted using the JASP software (JASP Team, 2024, Version 0.19.3). The pooled effect size was interpreted based on the following thresholds: Trivial (0–0.2), Small (0.21–0.6), Moderate (0.61–1.2), Large (1.21–2.0), Very Large (2.1–4.0), Nearly Perfect (> 4.0) [48]. Percent changes from baseline at various timepoints were calculated to provide a standardized measure of recovery across studies. Meta-analyses were conducted using between-group differences in raw outcome values (means and standard deviations) at each post-exercise time point (TC vs. control/placebo). Percent changes from baseline were calculated descriptively to aid interpretation of recovery trajectories but were not used for effect size computation. All outcomes were reported as effect sizes with 95% confidence intervals (ES ± 95% CI). A significance level of p < 0.05 was applied for all analyses. Statistical heterogeneity among studies was assessed using the I² statistic and Cochran’s Q test [49], with I² values interpreted as follows: Low (0–25%), Moderate (26–50%), substantial heterogeneity (51–75%), and considerable heterogeneity (> 75%) [50]. Due to expected variability in study protocols, exercise models, supplementation durations, and outcome measures, a random-effects model was employed for all pooled analyses to account for between-study heterogeneity.
A subgroup analysis was performed to investigate if the results were affected by the type of exercise. For this analysis, studies using a whole-body (running, team sport) or isolated muscle damage exercise were analyzed separately. Due to insufficient data for some parameters, the subgroup analysis was only performed on the following parameters: MVC, Soreness, CK, IL-6, and CRP.
Results
Literature Search
Figure 1 presents the flowchart of the search and selection process. A total of 1066 relevant articles were initially identified. A total of 215 duplicates were removed. After the screening, 851 articles remained based on the title and the abstract; of those 827 articles were excluded. After a careful review of 24 full-text articles, 19 articles were included in the systematic review and meta-analysis (Table 1).
Fig. 1.
Flow chart showing the study selection process
Table 1.
Description of the studies included in the systematic review
| Authors | Age (Mean± SD) | Participant details | Study design (parallel/crossover) | EIMD inducing exercise | Intervention | Dosage | Duration of ingestion (pre and post EIMD) | Outcome variables and time points (h) | Key findings |
|---|---|---|---|---|---|---|---|---|---|
| Abbott et al. [35] | 19 ± 1 years | Professional male soccer players from the reserve squad of an English Premier League team; sample size = 10 | Double-blind, placebo-controlled, crossover | 90-minute competitive soccer match | TC vs. isocaloric cherry-flavored control drink | 2 × 30-mL servings of TC or CON before and after the match, and 12 and 36 h after the match | Match day and up to 36 h post-match | Muscle function CMJ height, RSI, subjective well-being, and muscle soreness. - Time points: pre-match, 12-, 36-, and 60-hours post-match | No significant effect of TC on recovery of muscle function, muscle soreness, or subjective well-being compared to the control. |
| Beals et al. [39] | Tart cherry beverage: 25.9 ± 9.3 y; Placebo: 24.6 ± 2.8 y | recreationally active adults, men and women; total N = 29 (TCB: 15 [9 M/6F]; Placebo: 14 [10 M/4F]) | Randomized, double-blind, placebo-controlled parallel trial | Single-leg quadriceps eccentric fatigue protocol | Tart cherry beverage vs. placebo | 2 servings/day; total 60 g tart cherry powder/day | 12 days total: 4 days pre-EIMD, day of eccentric protocol, and 7 days post-EIMD (2 servings/day throughout) | Thigh circumference, quadriceps muscle tenderness (pressure dynamometer), knee ROM, muscle pain (VAS), quadriceps isokinetic strength (peak torque/body mass); blood markers: CK and cytokines (TNF-α, IFN-γ, IL-1β, IL-6, IL-8, IL-10, IL-12p70). Measured at baseline, immediately post-fatigue, and 24, 48, 96 h and 1 week (168 h) post-fatigue | Eccentric protocol produced modest DOMS, but no significant effects for any functional measure, CK or cytokines. Tart cherry beverage did not reduce muscle soreness, strength loss or systemic inflammation vs. placebo. |
| Bell et al. [28] | 25 ± 4 years | Semi-professional male soccer players (n = 16) | Double-blind, placebo-controlled independent groups design | LISTADAPT | TC vs. PLA | 30 mL twice daily for 8 consecutive days (4 days before and during the trial) | From 4 days pre-exercise to 3 days post-exercise | Functional Performance: MVIC, CMJ, 20 m Sprint Time, Agility Test. - Biochemical Variables: IL-6, IL-8, TNF-α, hsCRP, CK, LOOH. DOMS - Time points: Pre-exercise, immediately post-exercise,1 ,3 ,5 ,24, 48, and 72 h post-exercise. | TC supplementation improved recovery of MVIC, CMJ, 20 m sprint, and agility), reduced DOMS compared to PLA. IL-6 response was attenuated, while no significant effects were observed on oxidative stress (LOOH) and muscle damage markers (CK) |
| Bowtell et al. [26] | 27.8 ± 1.6 | Well-trained males engaged in high-intensity intermittent sports (rugby, football, taekwondo). (n = 10) | Double-blind, placebo-controlled crossover design. | 10 sets of 10 single-leg knee extensions at 80% 1RM with elongated eccentric phase. | TC vs. placebo. | 30 mL twice daily. | 7 days before and 2 days after the exercise session. | MVC, PC, CK, hsCRP, PPT - Time points: Pre-exercise, immediately post-exercise, 24 and 48 h post-exercise. | TC Improves MVC Recovery, Reduces Oxidative Damage (PC), No effect on Muscle damage, inflammation, and soreness |
| Brown et al. [52] | 19 ± 1 y | Physically active females from a university dance team; training in dance 13 ± 4 y, exercising 8.3 ± 5.0 h·wk⁻¹; N = 20 (Montmorency cherry, MC: n = 10; placebo, PL: n = 10) | Randomized, double-blind, placebo-controlled parallel trial | Repeated-sprint running protocol: 15 × 30 m maximal sprints with rapid 10 m deceleration, 60 s rest between sprints | Montmorency tart cherry concentrate vs. placebo | 30 mL MC concentrate diluted to 130 mL beverage, twice per day. | 8 days total: 4 days pre-EIMD, day of EIMD, and 3 days post-EIMD; 2 doses·day⁻¹ (only 1 dose on final day before last visit) | Muscle soreness (DOMS, VAS during 90° squat); pain pressure threshold (RF, VL, GM); limb girth (mid-thigh, calf); flexibility (sit-and-reach); muscle function: countermovement jump (CMJ), reactive strength index (drop jump), MVC knee extensors, 30 m sprint; blood markers: CK, hsCRP. Measured pre-exercise, immediately post (0 h), 24, 48, 72 h post-exercise | CMJ recovery was significantly better in MC vs. PL. Trend to lower DOMS and higher RF PPT with MC. No group differences for CK, hsCRP, limb girth, flexibility, MVC or sprint performance. |
| Connolly et al. [31] | 22 ± 4 years |
Male college students (n = 14) |
Randomized, placebo-controlled, crossover design | Two sets of 20 maximal eccentric contractions of the elbow flexors | TC or PLA | 12 fl. oz twice daily | Four days pre-exercise and four days post-exercise | Isometric elbow flexion strength,, pain, muscle tenderness, and relaxed elbow angle. - Time points: Baseline, 24, 48, 72, 96 h | Lower Strength loss, lower pain with TC, No significant difference in range of motion or muscle tenderness between groups |
| Difranco et al. 2022 |
PLA: 40.6 ± 7.2 years CWI: 41.3 ± 7.6 years TC: 37.6 ± 7.8 years Cocktail: 42.7 ± 4.7 years |
Trained male endurance runners (n = 39) Groups: PL (n = 10), CWI (n = 11), CJ (n = 10), CT (n = 8) |
Randomized placebo-controlled parallel-group design | Competitive trail marathon (42.2 km) |
TC or CWI or Cocktail (TC+ CWI) PLA |
Cherry Juice: 30 mL twice daily (5 days pre-run, day of run, 2 days post-run) Cold Water Immersion: 10 min at 8 °C immediately post-marathon |
TC: 7 days total (5 pre-run, day of run, and 2 post-run) CWI: Single treatment immediately post-marathon |
MVIC, CK, CRP, IL-6. - Time points: Baseline, immediately post-marathon, 24 h, and 48 h | No effect |
| Dimitriou et al. [53] |
TC: 37 ± 13 years PLA: 38 ± 5 years |
Recreational marathon runners (n = 20; CJ: 10, PL: 10) | Randomized placebo-controlled parallel design | Marathon race (42.2 km) | TC vs. PLA | 236 mL twice daily (5 days pre-marathon, on marathon day, and 48 h post-marathon) | 7 days (5 days pre-marathon, on marathon day, 2 days post-marathon) | CRP, URTS, sIgA. -Time points: Baseline, immediately post-marathon, 24 h, 48 h |
CRP: Significantly lower in TC group compared to PL at 24 h and 48 h post-marathon (P < 0.01). URTS: No reported symptoms in TC group, whereas 50% of the PL group reported URTS at 24 h and 48 h. Cortisol and sIgA: No significant differences between groups. |
| Drummer et al. [81] | 22.9 ± 4.1 years |
Resistance-trained males (n = 7) |
Single-blind, placebo-controlled, crossover design | High-intensity, unilateral resistance exercise protocol | TC vs. placebo | 30 mL twice daily for 10 days | 7 days pre-exercise, day of exercise, 2 days post-exercise |
IL-6, Monocyte Subsets (classical, intermediate, non-classical), PPT, VAS. -Time points: Baseline, immediately post-exercise, 24, 48, 72 h |
No significant differences in IL-6, monocyte subsets between TC and placebo. No significant effects on pressure pain threshold or muscle soreness. IL-6 levels and monocyte responses showed no effects for treatment. |
| Howatson et al. [24] | 37 ± 13 years (TC group), 38 ± 5 years (PLA group) | Recreational marathon runners (n = 20; 13 males, 7 females) | Randomized placebo-controlled parallel design | Marathon running (42.2 km) | TC vs. PLA | 236 mL (8 fl. oz) twice daily for 8 days (5 days pre-marathon, day of marathon, and 2 days post-marathon) | 8 days total (5 days pre-marathon, marathon day, 2 days post-marathon) |
IL-6,CRP, TBARS, TAS, MVIC, CK. -Time points: Pre-supplementation, Pre-race, Post-race, 24 h, 48 h |
Inflammation: IL-6 and CRP were significantly lower in the TC group post-race. Oxidative Stress: TBARS was lower in the TC group at 48 h post-race, and TAS was higher at all post-supplementation points . Muscle Strength Recovery: Faster recovery of MVIC in TC group compared to placebo . Muscle Damage: No significant differences in CK between groups. |
| Kuehl et al. [32] | 35.8 ± 9.6 years | Healthy recreational runners (n = 54; 36 male, 18 female) | Randomized, double-blind, placebo-controlled parallel design | Hood to Coast relay race: 26.3 ± 2.5 km running over a 24-hour period | TC vs. PLA | 355 mL (12 fl. oz) twice daily for 8 days | 7 days pre-race and the day of the race | VAS: Baseline (7 days pre-race), race start (0 h), race end (24 h) | Pain Reduction: The increase in pain was significantly smaller in the TC group compared to placebo at race end. |
| Kupusarevic et al. [80] | 28 ± 4 years | Elite male rugby union players (n = 10) | Randomized, double-blind, placebo-controlled crossover design | Competitive 80-minute rugby union match | TC vs. isocaloric cherry-flavored control gel | 30 mL twice daily for 5 days (2 days before the match, match day, and 2 days post-match) | 2 days before the rugby match, match day and 2 days post-match | Muscle Soreness, Daily Wellbeing. - Time points: Pre-match, Match Day +1 (M+1), Match Day +2 (M+2), Match Day +3 (M+3) |
Muscle Soreness: MS was elevated at M+1 and M+2 in both conditions but returned to baseline at M+3. No significant difference between TC and CON at any time point. Wellbeing: Scores were ~15% lower at M+1 in both conditions but did not differ between TC and CON. |
| Lamb et al. [33] | 24 years | Non-resistance-trained men (n = 36) | Randomized, double-blind, placebo-controlled parallel study with three treatment groups (Tart Cherry Juice, Pomegranate Juice, Placebo) | 5 × 10 sets of unilateral eccentric elbow flexions |
TC vs. POM vs. Placebo |
2 × 250 mL servings daily for 9 days | 4 days pre-exercise, day of exercise, and 4 days post-exercise | MIVC, DOMS, CK, ROM. - Time points: Pre-exercise, immediately post-exercise, 24 h, 48 h, 72 h, 96 h | No significant differences between groups. |
| Levers et al. [37] | 20.9 ± 2.6 y | Resistance-trained males, healthy; able to back-squat ≥1.5× body mass; N = 23 (Placebo, P: n = 12; Tart cherry, TC: n = 11) | Randomized, double-blind, placebo-controlled parallel trial | High-volume back-squat protocol on Smith machine: 10 × 10 reps at 70% 1-RM (after warm-up), 3 min rest between sets | Montmorency tart cherry powder vs. placebo | 480 mg/day powdered tart cherry or placebo, taken once daily with breakfast. | 10 days total: 7 days before exercise, day of exercise, and 2 days post-exercise (supplementation continued until 48 h post-lift) | Quadriceps muscle soreness, isokinetic MVC knee extension/flexion total work; blood markers: CK, AST, ALT, bilirubin, creatinine, BUN, uric acid, total protein; hormones (cortisol, testosterone); oxidative stress markers (SOD, TAS, TBARS, nitrotyrosine); inflammatory and anti-inflammatory cytokines (IL-1β, IL-2,4,5,6,7,8,10,12p70,13, TNF-α, IFN-γ, GM-CSF); CBC (WBC, lymphocytes, etc.). Measured at baseline, pre-lift, 60 min, 24 h, and 48 h post-lift | Tart cherry reduced muscle soreness compared with placebo, and attenuated increases in creatinine and total protein, with lower AST, ALT, and bilirubin at some time points. CK and cortisol responses tended to be lower with TC; oxidative stress and cytokine markers were not different between groups. |
| Levers et al. [30] | 21.8 ± 3.9 y | Endurance-trained runners/triathletes, healthy men and women; N = 27 (18 M/9F). Randomised to placebo (P, n = 16) or tart cherry (TC, n = 11). | Randomized, double-blind, placebo-controlled parallel trial | Outdoor half-marathon (21.1 km) race on road. | Montmorency tart cherry skin powder vs. placebo | 480 mg/day powdered tart cherry or placebo, taken once daily with breakfast. | 10 days total: once daily for 7 days pre-race, on race day, and 2 days post-race (up to 48 h post-run) | Serum markers of muscle catabolism & stress: creatinine, urea/BUN, BUN/Cr, total protein, CK, AST, ALT, bilirubin, uric acid; hormones: cortisol, testosterone; oxidative stress: TAS, SOD, TBARS, nitrotyrosine; inflammatory & anti-inflammatory cytokines: IL-1β,2,4,5,6,7,8,10,12p70,13, TNF-α, IFN-γ, GM-CSF; CBC (Hb, Hct, RBC, WBC, lymphocytes, granulocytes, etc.); quadriceps muscle soreness by algometer (VM 25%, VL 25%, VL 50%). Measured at baseline, pre-run, 60 min, 24 h, 48 h post-run. | TC attenuated increases in creatinine, urea/BUN, total protein and cortisol, showed higher total antioxidant status (TAS) during recovery, and had lower inflammatory responses (IL-6, IL-2, IL-13) vs. P. Medial quadriceps soreness was 34% lower pre-run in TC; changes in soreness over 48 h were smaller in P |
| McCormick et al. [34] | 18.6 ± 1.4 years | Highly trained male water polo players (n = 9) | Randomized, double-blind, repeated measures, crossover design | Simulated water polo team game activity | TC vs. PLA | 90 mL daily (30 mL TC concentrate diluted into two servings: 200 mL morning and 400 mL evening) | 5 days before the simulated water polo game (Day 1–Day 5), 1 day post-exercise (Day 6). |
IL-6, CRP, F2-IsoP, UA Performance Tests: VJ RST WIST Perceptual Measures: DOMS TQR - Time points: Pre, immediatley after and 24 h after |
IL-6 and CRP no significant differences between TC and PLA. F2-IsoP no significant condition effects. UA remained unchanged. No significant differences between TC and PLA for any performance measures. No significant differences between TC and PLA for DOMS or TQR. |
| Morehen et al. [66] | 18 ± 1 years | 11 male professional academy rugby league players (all starters; 5 forwards, 6 backs) | Randomized crossover, single-blind, placebo-controlled | Two live Rugby League matches (1 week apart) | TC vs. PLA | 2 × 30 mL daily (each diluted to 100 mL); total 320 mg anthocyanins/d | 7 days per condition: 5 days pre-match, match day, and 2 days post-match | IL-6, IL-8, IL-10 (48 h pre, HT, FT, 48 h post); CMJ, DJ, muscle soreness, fatigue, mood, sleep (24 h pre, 24 h and 48 h post) |
No significant differences between TC and placebo in recovery outcomes. Inflammation: IL-6, IL-8, and IL-10 increased significantly post-match, but with no group difference. Muscle soreness & function: Increased soreness and decreased CMJ in both conditions; no TC benefit. Subjective wellness: No effect of TC on fatigue, mood, stress, or sleep. |
| Quinlan and Hill, [25] | 26 ± 4 years | Team-sport athletes (football, netball, hockey); 20 participants (8 males, 12 females) | Parallel-group (randomized, single-blind, placebo-controlled) | LIST | TC vs. PLA | 2 × 30 mL servings per day (diluted to 100 mL each) | 8 days total: 5 days pre-exercise, day of exercise, and 2 days post-exercise | MVC, CMJ, 20-m sprint, muscle soreness, CK, CRP; measured at baseline, 1, 24, and 48 h post-exercise |
Significantly faster recovery of MVC, CMJ, and 20-m sprint in TC group at 24 and 48 h. Lower increase in DOMS at 24 h and 48 h in TC vs. PLA; CK & CRP: No significant between-group difference, but CK trended lower in TCJ group at 24 h CRP showed small ES, trend toward lower inflammation. |
| Wangdi et al. [61] | 23.4 ± 5.4 years | 10 active males | Crossover | Maximal unilateral eccentric knee extensions | TC vs. PLA | 2 × 30 mL/day | 7 days pre + 2 days post (10 days total) | MVC, jump height, soreness (VAS, PPT), IL-6, TNF-α, CK, phenolic acids, GPX3 protein, mRNA expression of antioxidant enzymes; Time: pre, 0 h, 24 h, 48 h | TC improves recovery of MVC, increases phenolic acids, GPX1,3,4,7 and SOD3 gene expression, and GPX3 protein expression |
TC Tart cherry juice, PLA placebo, CMJ countermovement jump, RSI reactive strength index, LISTADAPT Loughborough Intermittent Shuttle Test, MVIC maximal voluntary isometric contraction, IL-6 Interleukin-6, IL-8 Interleukin-8, TNF-α Tumor Necrosis Factor-alpha, hsCRP High-sensitivity C-Reactive Protein, CK Creatine Kinase, LOOH Lipid Hydroperoxides, DOMS Delayed Onset Muscle Soreness, PPT pressure pain threshold, PC Protein Carbonyls, CWI Cold water immersion, URTS Upper respiratory tract symptoms, sIgA Cortisol Secretory immunoglobulin A, VAS Muscle Soreness, TBARS Thiobarbituric Acid Reactive Substances, TAS Total Antioxidant Status. POM Pomegranate Juice, ROM range of motion, F2-IsoP F2-Isoprostane, UA Uric Acid, VJ Vertical Jump, RST Repeat Swim Test, WIST Water Polo Intermittent Shuttle Test, TQR Total Quality of Recovery, LIST Adapted Loughborough Intermittent Shuttle Test, DJ drop jump
Study Characteristics
The characteristics of the 19 studies included in this review are presented in Table 1. Studies were published between 2006 and 2022. The study design was crossover in 8 studies and parallel in 11 studies, with double-blinding reported in 11 studies, single-blinding in 3 studies.
A total of 385 participants were included across all studies (range 7–54 per study). Most studies recruited male-only cohorts (13 studies), while 1 study included females only and 5 studies included mixed-sex cohorts. Exercise models used to induce muscle damage were heterogeneous and included both whole-body protocols (e.g., running- and team-sport–based protocols) and isolated eccentric or resistance-based protocols targeting specific muscle groups. Outcomes most frequently assessed included muscle function and performance (e.g., MVC and CMJ), muscle soreness, biochemical/inflammatory markers (e.g., CK, IL-6, CRP, TNFα), and ROM, typically measured at baseline and at multiple follow-up time points between 24 and 96 h.
Across all studies, TC was administered primarily as concentrate (7 studies), juice (5 studies), or juice blend (4 studies), with fewer studies using powder (2 studies) or a TC beverage (1 study). Supplementation protocols generally involved one to two daily servings, most commonly around 30 mL per serving for concentrates or larger-volume juice protocols (236–355 mL twice daily), and supplementation duration varied from short protocols around the exercise bout (e.g., match day to 36 h post) to multi-day strategies typically including a pre-loading period ( 4–7 days) and post-exercise continuation ( 2–4 days).
Methodological Quality and GRADE Recommendations
The mean methodological quality score of the included studies was 22.3 ± 2.7 (range 19–26). Detailing each item showed that the mean score was 7.4 ± 0.8 (range 6–8) for “reporting”, 0.8 ± 0.5 (range 0–2) for “external validity”, 5.4 ± 1.3 (range 3–7) for “internal validity - bias”, 3.8 ± 1.4 (range 2–6) for “internal validity - confounding”. All the studies were quoted 5 for “Power”. Table 2 presents the details of the methodological quality score for each study.
Table 2.
Methodological quality of the included studies
| Study | Total score (/32) | Reporting (/11) | External Validity (/3) | Internal validity – bias (/7) | Internal validity – confounding (/6) | Power (/5) | Conflict of interest |
|---|---|---|---|---|---|---|---|
| Abbott et al. [35] | 26 (81.3%) | 7 | 2 | 7 | 5 | 5 | No |
| Beals et al. [39] | 26 (81.3%) | 8 | 0 | 7 | 6 | 5 | No |
| Bell et al. [28] | 21 (65.6%) | 7 | 0 | 6 | 3 | 5 | No |
| Bowtell et al. [26] | 20 (62.5%) | 6 | 1 | 6 | 2 | 5 | Yes |
| Brown et al. [52] | 27 (84.4%) | 8 | 1 | 7 | 6 | 5 | No |
| Connolly et al. 2019 | 19 (59.4%) | 7 | 1 | 3 | 3 | 5 | Yes |
| Difranco et al. [31] | 20 (62.5%) | 7 | 1 | 4 | 3 | 5 | No |
| Dimitriou et al. [53] | 19 (59.4%) | 7 | 1 | 4 | 2 | 5 | No |
| Drummer et al. [81] | 20 (62.5%) | 8 | 1 | 4 | 3 | 4 | No |
| Howatson et al. [24] | 21 (65.6%) | 8 | 1 | 4 | 3 | 5 | Unspecified |
| Kuehl et al. [32] | 22 (68.8%) | 6 | 1 | 6 | 4 | 5 | No |
| Kupusarevic et al. [80] | 22 (68.8%) | 7 | 1 | 5 | 4 | 5 | No |
| Lamb et al. [33] | 20 (62.5%) | 8 | 0 | 5 | 2 | 5 | No |
| Levers et al. [37] | 26 (81.3%) | 8 | 0 | 7 | 6 | 5 | No |
| Levers et al. [30] | 26 (81.3%) | 8 | 1 | 7 | 5 | 5 | No |
| McCormick et al. [34] | 23 (71.9%) | 6 | 1 | 7 | 4 | 5 | No |
| Morehen et al. [66] | 22 (68.8%) | 7 | 1 | 5 | 4 | 5 | No |
| Quinlan and Hill, [25] | 22 (%) | 8 | 1 | 4 | 2 | 5 | Unspecified |
| Wangdi et al. [61] | 24 (%) | 9 | 0 | 5 | 5 | 5 | Unspecified |
The strength of the evidence for all outcomes at each time point ranges from very low to moderate (Table 3 and Supplementary material 1). Each outcome was downgraded for limitations and for at least two out of the following three GRADE domains: inconsistency, indirectness, or imprecision.
Table 3.
GRADE recommendations for the parameters assessed at the different time points
| Parameter | Time point | ||||
|---|---|---|---|---|---|
| Post | 24 H | 48 H | 72 H | 96 H | |
| Maximal Voluntary contraction (n = 11) | Very Low | Very Low | Very low | Very low | Very low |
| CMJ (n = 6) | Very Low | Very Low | Very low | N/A | N/A |
| Range of motion (n = 3) | N/A | Very Low | Low | Very low | Very low |
| Soreness (n = 16) | Very Low | Very Low | Very low | Very low | N/A |
| CK (n = 9) | Very Low | Low | Low | N/A | N/A |
| IL-6 (n = 7) | Moderate | Low | Low | Very low | N/A |
| CRP (n = 8) | Very Low | Low | Low | N/A | N/A |
| TNF Alpha (n = 3) | Moderate | Moderate | Low | N/A | N/A |
N/A non-applicable, CMJ Countermovement Jump, CK creatine kinase, IL-6 Interleukine-6, CRP C-reactive protein
There were serious concerns with two or more GRADE domains (limitations, inconsistency, indirectness or imprecision), and the certainty of evidence for each parameter at each time point was considered low or very low except for IL-6 (post-exercise, moderate) and TNF-alpha (post and 24 H, moderate). Inconsistency in the findings suggests that further high-quality research may change the findings of this review. Moderate certainty of evidence suggests that we are quite confident that the effect is close to the true effect, but it is also possible it is substantially different [51].
Sensitivity Analysis
Leave-one-out analyses are summarized in Supplementary file 1 Table S2. Removing the influential studies had an impact on the results of the following outcomes by substantially changing the p value and/or the effect size: MVC (Post, 72 h), CMJ (48 h), and CRP (24 h and 48 h).For MVC, the pooled effect at post-exercise became small and non-significant when Lamb et al. [33] was removed (ES = 0.353, p = 0.055; I² = 62.3%), indicating some sensitivity at this time point. At 72 h, the pooled MVC effect was sensitive to removal of Brown et al. [52] (p = 0.074) and Connolly et al. [31] (p = 0.218); removing both also rendered the effect non-significant (p = 0.186) while reducing heterogeneity (I² = 68.5%), with no impact on the effect size.
The CMJ 48 h pooled estimate became non-significant when Brown et al. [52] was removed (p = 0.170) and the effect size kept being large.
However, pooled CRP effects at 24 h and 48 h became small and non-significant after removing Dimitriou et al. [53] (p = 0.061 and p = 0.115, respectively), suggesting sensitivity of these time points to a single study.
For the other parameters and/or timepoints, removing the influential studies could have changed heterogeneity, effect size, or both without changing the significance of the results (Supplementary file Table S1).
Effects of TC Juice on Performance and Recovery
The results of the Cochran’s Q test showed that the p-value was significant for the following parameters (p < 0.05): MVC (all time points), CMJ (24 h and 48 h), ROM (all time points) soreness (all time points), CK (all time points), IL-6 (24 h and 48 h), CRP (24 h and 48 h).
The results of the Cochran’s Q test showed that the p-value was non-significant for the following parameters (p > 0.05): CMJ (Post, p = 0.123), IL-6 (Post, p = 0.073), CRP (Post, p = 0.866).
Maximal Voluntary Contraction (MVC)
The meta-analysis revealed a significant effect of TC juice on MVC recovery across all evaluated time points (Fig. 2). A significant moderate effect was observed post-exercise (I² = 69.30%, ES = 0.63 [0.05 to 1.22], p = 0.034). The effect remained significant at 24 H (I² = 91.15%, ES = 1.12 [0.20 to 2.05], p = 0.017) and 48 H (I² = 92.67%, ES = 1.29 [0.25 to 2.34], p = 0.015). The magnitude of the effect increased at 72 H (I² = 92.38%, ES = 2.14 [0.34 to 3.94], p = 0.020) indicating a progressively greater benefit of TC juice on MVC recovery over time.
Fig. 2.
Effects of Tart Cherry Juice consumption on Maximal Voluntary Contraction (MVC). Effect sizes are expressed as follows: ES [95% Confidence Intervals]
Regarding the effects at 96 H, the number of studies available (n = 2) associated with a high heterogeneity (I² = 75.32%) did not allow to include the results in the meta-analysis.
Countermovement Jump (CMJ)
The meta-analysis indicated no significant effect of TC juice on CMJ height post-exercise (I² = 48.15%, ES = 0.40 [-0.19 to 0.98], p = 0.186) or at 24 H (I² = 74.75%, ES = 0.68 [-0.11 to 1.47], p = 0.091) (Fig. 3). A significant effect favoring TC juice was observed at 48 H (I² = 72.41%, ES = 1.41 [0.18 to 2.64], p = 0.025) during recovery.
Fig. 3.
Effects of Tart Cherry Juice consumption on Countermovement Jump height (CMJ). Effect sizes are expressed as follows: ES [95% Confidence Intervals]
Muscle Soreness
Non-significant results were observed for soreness across the evaluated time points (Fig. 5). Post-exercise perceived muscle soreness showed a small, non-significant effect (I² = 67.44%, ES = 0.14 [-0.33 to 0.61], p = 0.548). Similarly, non-significant effects were observed at 24 H (I² = 82.27%, ES = -0.24 [-0.75 to 0.26], p = 0.350), 48 H (I² = 90.37%, ES = -0.39 [-1.14 to 0.36], p = 0.305), and 72 H (I² = 93.28%, ES = -0.73 [-2.12 to 0.67], p = 0.307) during the recovery period.
Fig. 5.
Effects of Tart Cherry Juice consumption on muscle soreness. Effect sizes are expressed as follows: ES [95% Confidence Intervals]
Although data for soreness at 96 h and well-being outcomes were extracted for transparency, these outcomes were not meta-analyzed due to insufficient comparability of scales and/or inconsistent reporting across studies, precluding valid pooled effect size estimation. Extracted values are retained in the Supplementary Materials for completeness.
Creatine Kinase (CK)
Non-significant results were observed for CK across the evaluated time points (Fig. 6). TC juice supplementation showed a non-significant effect post-exercise (I² = 79.33%, ES = 0.29 [-0.43 to 1.01], p = 0.434), at 24 H (I² = 72.72%, ES = 0.16 [-0.39 to 0.71], p = 0.570), and at 48 H (I² = 56.50%, ES = -0.08 [-0.51 to 0.35], p = 0.716) during the recovery period.
Fig. 6.
Effects of Tart Cherry Juice consumption on Creatine Kinase (CK) blood concentrations. Effect sizes are expressed as follows: ES [95% Confidence Intervals]
Inflammatory Markers (IL-6, CRP, TNF-Alpha)
Non-significant results were observed for IL-6 across the evaluated time points (Fig. 7). A small, borderline non-significant effect was observed post-exercise (I² = 48.06%, ES = -0.42 [-0.88 to 0.04], p = 0.071). Non-significant effects were also found at 24 H (I² = 66.11%, ES = -0.18 [-0.79 to 0.44], p = 0.576), 48 H (I² = 65.43%, ES = -0.12 [-0.73 to 0.48], p = 0.685) during the recovery period.
Fig. 7.
Effects of Tart Cherry Juice consumption on Interleukine-6 (IL-6) blood concentrations. Effect sizes are expressed as follows: ES [95% Confidence Intervals]
Regarding the effects at 72 H, the number of studies available (n = 2) associated with a high heterogeneity (I² = 84.28%) did not allow to include the results in the meta-analysis.
The meta-analysis revealed a significant effect of TC juice on CRP across multiple time points (Fig. 8). A significant small effect size was observed post-exercise (I² = 0.00%, ES = -0.46 [-0.85 to -0.07], p = 0.020). Significant effects were also observed at 24 H (I² = 68.16%, ES = -0.73 [-1.31 to -0.15], p = 0.014) and 48 H (I² = 73.72%, ES = -0.68 [-1.32 to -0.05], p = 0.035) during the recovery period, indicating lower CRP levels following TC juice supplementation.
Fig. 8.
Figure 8: Effects of Tart Cherry Juice consumption on C-reactive protein (CRP) blood concentrations. Effect sizes are expressed as follows: ES [95% Confidence Intervals]
Non-significant results were observed for TNF-α across the evaluated time points (Fig. 9). Post-exercise TNF-α showed a non-significant effect (I² = 48.83%, ES = -0.51 [-1.15 to 0.13], p = 0.119). Similarly, non-significant effects were observed at 24 H (I² = 18.82%, ES = -0.29 [-0.79 to 0.20], p = 0.249) and 48 H (I² = 69.56%, ES = -0.16 [-0.99 to 0.67], p = 0.707) during recovery.
Fig. 9.
Figure 9: Effects of Tart Cherry Juice consumption on Tumor Necrosis Factor-Alpha(TNF-Alpha) blood concentrations. Effect sizes are expressed as follows: ES [95% Confidence Intervals]
ROM
The meta-analysis showed non-significant effects of TC juice on ROM across the evaluated time points (Fig. 4). Non-significant effects were observed at 24 H (I² = 92.67%, ES = -0.26 [-2.16 to 1.63], p = 0.787), 48 H (I² = 90.07%, ES = -0.59 [-2.18 to 0.99], p = 0.464), 72 H (I² = 95.10%, ES = -0.75 [-3.19 to 1.69], p = 0.549) during the recovery period.
Fig. 4.
Effects of Tart Cherry Juice consumption on Range of Motion (ROM). Effect sizes are expressed as follows: ES [95% Confidence Intervals]
Regarding the effects at 72 H, the number of studies available (n = 2) associated with a high heterogeneity (I² = 94.59%) did not allow to include the results in the meta-analysis.
A summary of the effects of TC consumption is shown on Figs. 10 and 11.
Fig. 10.
Figure 10: Time-course of standardized changes (effect sizes) in Maximal Voluntary Contraction (MVC), Countermovement Jump height (CMJ), Range of Motion (ROM), and muscle soreness. Time points: post-exercise to 96H post-exercise
Fig. 11.
Time-course of standardized changes (effect sizes) in Creatine Kinase (CK), Interleukine-6 (IL-6), C-Reactive Proteine (CRP), Tumor Necrosis Factor Alpha (TNF-Alpha) blood concentrations. Time points: post-exercise to 96 H post-exercise
Subgroup Analysis
The results of the Cochran’s Q test of the Whole-Body exercise group showed that the p-value was significant (p < 0.05) for the following parameters: MVC (24 h, 48 h and 72 h), IL-6 (24 h and 48 h), CRP (24 h and 48 h).
The results of the Cochran’s Q test of the Whole-Body exercise group showed that the p-value was non-significant (p > 0.05) for the following parameters: MVC (Post, p = 0.733), soreness (Post, p = 0.792; 24 h, p = 0.599; 48 h, p = 0.420; 72 h, p = 0.124), CK (Post, p = 0.397; 24 h, p = 0.185; 48 h, p = 0.179), IL-6 (Post, p = 0.051), CRP (Post, p = 0.600).
The results of the Cochran’s Q test of the Isolated exercise group showed that the p-value was significant (p < 0.05) for the following parameters: MVC (Post, 24 h, and 48 h), soreness (all time points), CK (all time points), CRP (24 h and 48 h).
The results of the Cochran’s Q test of the Isolated exercise group showed that the p-value was non-significant (p > 0.05) for the following parameters: MVC (72 h, p = 0.076), CMJ (Post, p = 0.123), IL-6 (Post, p = 0.569; 24 h, p = 0.182; 48 h, p = 0.360), CRP (Post, p = 0.921; 24 h, p = 0.612; 48 h, p = 0.490).
MVC
In the subgroup analysis restricted to whole-body EIMD protocols, TC juice showed no significant effect on MVC post-exercise (I² = 0.00%, ES = 0.15 [− 0.36 to 0.66], p = 0.564). Moderate and large significant effects were observed at 24 H (I² = 65.66%, ES = 0.92 [0.17 to 1.67], p = 0.016) and 48 H (I² = 80.86%, ES = 1.36 [0.29 to 2.43], p = 0.013), respectively. At 72 H, the effect was not significant (I² = 84.52%, ES = 0.79 [− 0.71 to 2.29], p = 0.302).
When restricted to isolated muscle-damage protocols, the meta-analysis showed a moderate significant effect on MVC post-exercise (I² = 78.18%, ES = 0.96 [0.06 to 1.86], p = 0.037). At 24 H, the effect was not significant (I² = 94.64%, ES = 1.30 [− 0.22 to 2.81], p = 0.094), and it remained non-significant at 48 H (I² = 95.44%, ES = 1.29 [− 0.36 to 2.95], p = 0.126). At 72 H, a large and significant effect was observed (I² = 92.38%, ES = 3.57 [2.04 to 5.09], p < 0.001)
Muscle Soreness
In the subgroup analysis restricted to whole-body EIMD protocols, TC juice showed no significant effect on perceived muscle soreness post-exercise (I² = 0.00%, ES = 0.03 [− 0.31 to 0.36], p = 0.881) or at 24 H (I² = 0.00%, ES = − 0.08 [− 0.34 to 0.18], p = 0.554). A small significant reduction in soreness was observed at 48 H (I² = 0.00%, ES = − 0.30 [− 0.60 to − 0.01], p = 0.045). At 72 H, the effect was not significant (I² = 47.84%, ES = − 0.57 [− 1.17 to 0.02], p = 0.058).
Regarding the isolated EIMD, TC juice showed no significant effect on perceived muscle soreness at any evaluated time point (Figure X). Post-exercise soreness was not significantly different between groups (I² = 82.27%, ES = 0.36 [− 0.64 to 1.36], p = 0.483). Similarly, non-significant effects were observed at 24 H (I² = 91.30%, ES = − 0.40 [− 1.59 to 0.79], p = 0.513), 48 H (I² = 95.41%, ES = − 0.51 [− 2.24 to 1.21], p = 0.558), and 72 H (I² = 96.73%, ES = − 0.88 [− 4.52 to 2.77], p = 0.638).
CK
The subgroup analysis showed no significant effect of TC juice consumption on CK at any time point for the two types of exercise.
In whole-body EIMD protocols, CK was not significantly different post-exercise (I² = 0.00%, ES = − 0.27 [− 0.73 to 0.20], p = 0.260), at 24 H (I² = 38.49%, ES = − 0.14 [− 0.67 to 0.40], p = 0.620), or at 48 H (I² = 40.54%, ES = − 0.24 [− 0.78 to 0.31], p = 0.393).
In isolated EIMD, CK was not significantly different post-exercise (I² = 88.30%, ES = 0.79 [− 0.54 to 2.11], p = 0.244), at 24 H (I² = 83.67%, ES = 0.46 [− 0.51 to 1.44], p = 0.349), or at 48 H (I² = 71.79%, ES = 0.08 [− 0.64 to 0.81], p = 0.826).
CRP
In the subgroup analysis restricted to whole-body EIMD protocols, TC juice consumption showed a non-significant effect on CRP post-exercise (I² = 0.00%, ES = − 0.39 [− 0.86 to 0.07], p = 0.099). A moderate significant reduction in CRP was observed at 24 H (I² = 77.43%, ES = − 0.85 [− 1.64 to − 0.07], p = 0.032). At 48 H, the effect was not significant (I² = 80.83%, ES = − 0.83 [− 1.68 to 0.02], p = 0.055).
In the subgroup analysis restricted to isolated EIMD, TC juice showed no significant effect on CRP at any evaluated time point. Post-exercise CRP showed a non-significant trend favoring TC juice (I² = 0.00%, ES = − 0.60 [− 1.29 to 0.09], p = 0.086). Non-significant effects were also observed at 24 H (I² = 0.00%, ES = − 0.41 [− 1.09 to 0.28], p = 0.243) and 48 H (I² = 0.00%, ES = − 0.30 [− 0.97 to 0.37], p = 0.384).
IL6
The subgroup analysis showed no significant effect of TC juice consumption on IL-6 at any time point for the two types of exercise.
In the subgroup analysis restricted to whole-body EIMD protocols, TC juice showed no significant effect on IL-6 at any evaluated time point. Specifically, IL-6 was not significantly different post-exercise (I² = 61.42%, ES = − 0.63 [− 1.32 to 0.05], p = 0.07), at 24 H (I² = 68.04%, ES = − 0.56 [− 1.42 to 0.30], p = 0.20), or at 48 H (I² = 81.15%, ES = − 0.33 [− 1.43 to 0.77], p = 0.560).
In the subgroup analysis restricted to isolated EIMD, TC juice showed no significant effect on IL-6 at any evaluated time point. IL-6 was not significantly different post-exercise (I² = 0.00%, ES = − 0.09 [− 0.61 to 0.42], p = 0.725), at 24 H (I² = 38.91%, ES = 0.23 [− 0.46 to 0.91], p = 0.517), or at 48 H (I² = 0.00%, ES = 0.09 [− 0.43 to 0.61], p = 0.722).
Discussion
The aim of this study was to determine the effect of TC juice consumption on recovery of physical, biochemical, and subjective markers following EIMD in athletes. To the best of our knowledge, this is the first time that a meta-analysis focuses on this topic in athletes. and these results can have an impact on their preparation. The main results showed that, compared with control, consuming TC juice significantly enhances MVC recovery across multiple time points during the 96 h post-EIMD window, and provides a limited benefit for CMJ (significant only at 48 h). TC juice was also associated with a reduction in CRP during the early recovery phase. Conversely, no clear effects were observed for muscle soreness, CK, IL-6, TNF-α, or ROM when outcomes were pooled across all studies, and heterogeneity was substantial for several endpoints.
Methodological Quality of the Included Studies and GRADE Recommendations
The methodological quality analysis showed a mean score of 69.7% (coefficient of variation inter-studies = 12.1%), which represents a good level of methodological quality. However, a more detailed analysis showed large differences in scores between the sub-scales. Considering the mean values, the included studies showed a high level of “reporting” and “internal-validity bias”, a low level of “external validity”, and a moderate level of “internal validity–confounding”.
Reporting is defined as “whether the information provided in the paper was sufficient to allow a reader to make an unbiased assessment of the findings of the study”. The mean score of 7.4 indicates that the information was sufficient to evaluate the degree of biases of the included studies in this meta-analysis.
Regarding “internal validity–bias”, this is defined by Downs and Black [24] as the “biases in the measurement of the intervention and the outcome”. This sub-scale involves the reliability and validity of the tools used in the study, the relevance of the statistical tests, the presence or absence of a double blinding process and the follow-up of the participants. In the present systematic review, the mean score of this item was 5.4 out of a possible 7 points, which can be considered as high. Such a high score allows the reader to be confident with the results obtained, and the accuracy of the materials used in the studies. In addition, a large majority of the included studies declared having blinded the participants during the protocol, which indicates a relevant practice to limit the bias.
“External validity” refers to “the extent to which the findings from the study could be generalized to the population from which the study subjects were derived”. The maximal score that can be obtained for this sub-scale was 3. In the present systematic review, the mean score obtained by the included studies was 0.8, and no study reached 3 points. Caution should be exercised when generalizing the results of these studies. This is mainly due to the fact that the individuals who participated in the studies were not representative of the entire population from which they were recruited. However, most studies used an ecological design.
The sub-scale “internal validity–confounding” has a maximum of 6 points, which was achieved by only 3 studies included in this systematic review. The mean score of the included studies was 3.8 which can be defined as moderate. This score should be analyzed in regards with the high between-studies variability for this item (coefficient of variation inter-studies = 36.9%). For the studies showing a low score of “internal validity–confounding”, the generalization of the results should be done with caution. As not controlled, confounding factors may have influenced some results described in the included studies.
Recovery Kinetics of Neuromuscular parameters
MVC
The present meta-analysis reveals that TC supplementation significantly improves recovery of MVC following EIMD in trained athletes. The beneficial effect of TC juice became increasingly evident over time, with a significant moderate effect observed post-exercise, and significant effects at 24 h. The magnitude of the pooled effect increased further at 72 h and reached its largest value at 96 h. This pattern suggests a progressive enhancement in neuromuscular recovery over time, which could be explained by the cumulative impact of TC juice’s bioactive compounds, particularly anthocyanins and their metabolites. These compounds exhibit time-dependent pharmacokinetics, with some evidence indicating peak plasma concentrations occurring several hours after ingestion and potential sustained antioxidant and anti-inflammatory activity over time [54, 55]. Additionally, the total dose ingested across repeated administrations could enhance tissue saturation and magnify recovery benefits over longer durations [40, 56].
These findings suggest a progressive enhancement in neuromuscular recovery, particularly between 48 h and 96 h post-exercise, supporting the effectiveness of TC polyphenols in attenuating strength loss. However, this interpretation should be made cautiously, as the certainty of the evidence according to the GRADE framework was rated low to moderate, primarily due to heterogeneity among studies and imprecision in effect estimates.
Neuromuscular reduction after EIMD is largely attributable to both central and peripheral factors [57, 58]. Central fatigue involves reduced voluntary activation of motor units, while peripheral components include sarcomere disruption, excitation-contraction uncoupling, and oxidative stress-induced impairment of calcium handling. The polyphenol-rich content of tart cherry, particularly anthocyanins, has been shown to attenuate oxidative stress and inflammatory signaling, thereby limiting secondary muscle damage, and preserving neuromuscular function [59, 60]. The present meta-analysis revealed significant reductions in CRP levels during early recovery, whereas no clear effects were observed for IL-6, TNF-α, or muscle soreness, suggesting that systemic anti-inflammatory activity may contribute to but does not fully explain the observed improvements in MVC recovery. In line with these observations, Wangdi et al. [61] demonstrated that 10 days of TC supplementation administered as two 30 mL doses per day (morning and evening), delivering approximately 1210 mg of total polyphenols daily enhanced MVC recovery alongside upregulation of endogenous antioxidant-related gene/protein expression and increased circulating phenolic metabolites, supporting a potential role for antioxidant response pathways in mediating recovery outcomes [52].
To further explore the heterogeneity, we conducted subgroup analyses based on the EIMD model (whole-body vs. isolated muscle-damage protocols). For MVC, the time course of benefit differed across exercise models. In whole-body protocols, TC showed significant benefits at 24–48 h but not immediately post-exercise, whereas in isolated protocols a significant effect was observed post-exercise and again at 72 h, with non-significant effects at intermediate time points. These findings suggest that the exercise model may influence the timing of the MVC recovery response, potentially contributing to the variability in pooled effects.
Four studies from our meta-analysis [24, 26, 28, 61] reported significant benefits of tart cherry juice on MVC recovery. The efficacity of the supplement seems to not be influenced by the type of exercise, since different muscle groups or approaches in each of these studies were used to induce muscle damage including; intensive knee extensor resistance exercise [26], maximal unilateral eccentric knee extension [61], marathon running [24] or 90 min repeated high-intensity shuttle running [28]. The TC juice in these studies was consumed morning and evening for at least 3 days before the damaging exercise, with at least 1200 mg of polyphenols ingested per day. On the other hand, in studies where TC juice supplementation did not enhance the recovery of MVC [34, 35, 62] athletes either consumed a lower (and preassembly insufficient) dose (in a single dose or/ and in a separate dose) [35] or the supplementation period was not long enough to maximize the benefits of TC juice supplementation [63].
Despite the observed heterogeneity across studies (I² = 75–94%), the cumulative evidence indicates that TC supplementation is effective in promoting MVC recovery in athletes, particularly when consumed before and after EIMD.
CMJ
The present meta-analysis indicates that tart cherry supplementation exerts a limited and time-dependent effect on countermovement jump (CMJ) performance following EIMD. The pooled analysis showed no significant effect post-exercise. In contrast, a significant benefit was observed at 48 h post-exercise (ES = 1.41 [0.18 to 2.64], p = 0.025), suggesting that TC may contribute to the restoration of explosive lower-limb power primarily during the later phase of short-term recovery. Given that CMJ performance is a widely recognized measure of neuromuscular power and fatigue [64], especially relevant in high-intensity intermittent sports [65], improvements in this metric carry practical significance for athletes requiring rapid recovery between training sessions or competitions.
However, findings across the six included studies assessing CMJ were not consistent. Notably, studies reporting a beneficial effect, for instance Bell et al. [28], Wangdi et al. [61], and Quinlan et al. [25] involved semi-professional soccer players, recreationally active individuals, and team sport athletes of mixed sex, respectively. In contrast, those studies that found no effect, including Abbott et al. [35], Morehen et al. [66], and McCormick et al. [34], investigated either professional football and rugby players or highly trained individuals. This divergence highlights the potential influence of training status on TC juice supplement efficacy. Highly trained and elite athletes typically possess superior antioxidant capacity [67], more efficient recovery systems, and greater neuromuscular resilience, factors that may attenuate the potential beneficial effect of polyphenol supplementation. On the other side, recreationally and moderately trained individuals may experience a greater benefit due to a relatively lower baseline level of antioxidant defense and recovery capacity [68].
In addition to the training status, methodological factors may also contribute to the heterogeneity in outcomes. Bell et al. [28] and Wangdi et al. [61] used supplementation protocols lasting ≥ 7 days, with a clear pre-loading phase and appropriate dietary controls. Conversely, Abbott et al. [35] and Morehen et al. [66] employed shorter protocols and lacked comprehensive dietary monitoring, potentially reducing the bioavailability and systemic activity of polyphenol metabolites [69]. Furthermore, the context in which CMJ was assessed (e.g., post-laboratory-based exercise vs. post-match) introduces variability; field-based assessments may be confounded by uncontrolled match loads, hydration status, and psychological stress. Post-harvest processing can alter the polyphenolic profile, potentially affecting the efficacy of the supplement [70]. As such, discrepancies between studies using different formulations may arise not only from differences in the dose and frequency but also from compositional variations introduced during manufacturing of the supplement [71].
Taken together, these findings suggest that the efficacy of tart cherry supplementation on CMJ is not consistently present across all studies and may depend on the supplementation strategy (duration, dosage, timing), but also by overall dietary control (i.e., ensuring participants avoid other sources of polyphenols or antioxidant-rich foods that may confound results), testing environment, and the specific formulation of the cherry product. Based on the present results, TC supplementation appears to provide a small-to-moderate advantage primarily at 48 h, while earlier time points show no clear benefit. However, according to the GRADE synthesis, the overall certainty of evidence for this outcome is rated as low to moderate, primarily due to study heterogeneity, small sample sizes, and potential risk of bias. Therefore, these results should be interpreted with caution. Further research is warranted to refine the optimal dose, frequency, and duration for various athlete populations and exercise contexts.
ROM
ROM is a clinically relevant indicator of functional recovery following EIMD, as it reflects joint flexibility, muscle stiffness, inflammation, and neuromuscular control all of which influence the ability to resume normal activity [72]. Contrary to the expected benefits of TC supplementation, the present meta-analysis revealed no significant effect of TC on ROM recovery at any assessed time point. with lower ROM values observed at multiple post-exercise time points compared to control. Specifically, pooled effects were non-significant at 24 h, 48 h, 72 h, and 96 h. Although the point estimates tended to favor the control condition (negative ES), the confidence intervals were wide and crossed zero, and the results were characterized by very high heterogeneity, limiting confidence in the direction and magnitude of any effect. This lack of a clear ROM benefit may reflect several sources of variability across studies, including differences in the exercise models used to induce damage, the joint and movement assessed, and the timing and methodology of ROM measurement (e.g., passive vs. active ROM, assessor standardization, and familiarization). Importantly, improvements in MVC observed in the present analysis may reflect enhanced recovery of active force-generating capacity, which does not necessarily translate to improvements in passive flexibility or reductions in muscle–tendon stiffness. Furthermore, while TC supplementation was associated with reductions in CRP during early recovery, no consistent effects were observed for IL-6, TNF-α, or muscle soreness, suggesting that any anti-inflammatory activity may be marker- and time-specific and not sufficient to meaningfully influence ROM restoration. From a mechanistic perspective, polyphenols such as anthocyanins may modulate oxidative stress and inflammation via antioxidant response pathways (e.g., Nrf2-related signaling) and suppression of NF-κB signaling [73]. However, these mechanisms may not directly target connective tissue remodeling edema-related stiffness, or neuromuscular control, which are key contributors to ROM impairment after EIMD [74]. Therefore, current evidence does not support a consistent role for TC supplementation in improving ROM recovery in athletes. According to the GRADE assessment, the certainty of the evidence for ROM outcomes is low, due to high inconsistency, imprecision, and potential bias across studies. Future research should prioritize standardized ROM assessment protocols, report joint-specific outcomes with reliability metrics, and explore whether exercise model, dosing strategy, and timing of supplementation modify the effects of TC on passive functional recovery.
Performance Parameters and Clinical Significance
The impact of tart cherry juice consumption on post-exercise recovery may be analyzed in the light of practical significance. This is expressed by comparing the difference in recovery kinetics between conditions with a minimal threshold value, usually the minimal difference (MD) or the smallest worthwhile change (SWC) [75, 76]. In the case of our study, one issue is to know if TC juice is “clinically” efficient to accelerate recovery. As the MD and the SWC are context-dependent, it would be more relevant to compare the results according to the general context. For instance, a study showed that a strength test has a MD between 8 and 10%, which means that a difference of more than 8 to 10% may be considered as clinically significant [77]. Our results showed that the difference between the experimental and control condition ranged between 7.4% (24 H post-exercise) and 15.8% (post-exercise), indicating a possible clinically significant effect of TC juice consumption on recovery in comparison with a control condition.
Regarding countermovement jump height, a study found the SWC to be equal to 3.5% [78]. The results of the present meta-analysis show that the difference between the experimental and control condition ranged between no difference (0%, 24 h post-exercise) and 1.6% (48 h post-exercise), indicating an incapacity to reach the SWC. In this case, the difference observed 48 H post-exercise cannot be considered as clinically significant.
Practical significance may also be applied to ROM. Considering a previously measured MD of 10° [79], it appears that the difference between the control and the experimental condition never reach this threshold, leading to the conclusion that the changes were not clinically meaningful.
Recovery Kinetics of Muscle Soreness
The current meta-analysis examined the effect of TC supplementation on perceived muscle soreness across several post-exercise recovery time points. Overall, no significant effects were observed at any time point, including post-exercise, 48 h, and 72 h. These pooled estimates were accompanied by substantial heterogeneity at 24–72 h, indicating considerable between-study variability in soreness responses. According to the GRADE assessment, the certainty of evidence for soreness outcomes remained low to moderate due to inconsistency and imprecision; therefore, the overall findings do not support a consistent analgesic effect of TC supplementation in athletes following EIMD. The effect of TC supplementation on muscle soreness following EIMD has been investigated across trials in professional [35, 66, 80], semiprofessional [28], highly trained [24, 34] or active population [25, 26, 31–33, 61, 81]. Soreness was typically assessed using visual analogue scales or subjective pain ratings. Despite the proposed anti-inflammatory and antioxidative mechanisms of polyphenols, only a subset of studies reported meaningful reduction in perceived soreness, most commonly in protocols involving eccentric loading with substantial perceived discomfort and where supplementation was administered for multiple days with adequate dosing (e.g.,7 to 8 days and involved doses of approximately 480–720 mg polyphenols per day, commonly administered as 2 × 30 mL TC concentrate) [40, 41].
To further explore heterogeneity, we conducted subgroup analyses based on the EIMD model (whole-body vs. isolated muscle-damage protocols). In whole-body protocols, TC supplementation produced a small but significant reduction in soreness at 48 h (ES = − 0.30, p = 0.045), whereas effects were not significant post-exercise or at 24 h, and at 72 h. In contrast, isolated protocols showed no significant effects at any time point, with wide confidence intervals and very high heterogeneity. These findings suggest that any perceptual benefit may be more detectable after systemic, whole-body exercise stress than after isolated muscle-damage models; however, subgroup estimates were based on relatively few studies and should be interpreted cautiously.
Several studies also reported a dissociation between muscle function recovery and soreness perception, which complicates mechanistic interpretation. For example, Bowtell et al. [26] observed improvements in strength recovery but no significant attenuation of soreness. Conversely, studies such as Connolly et al. [31] and Kuehl et al. [32] reported reductions in soreness without assessing muscle function, limiting insight into whether perceptual improvements reflect reduced damage, altered nociception, or placebo/context effects. Inflammation suppression is commonly proposed as a mechanism through which polyphenols attenuate muscle soreness [82]; however, the current evidence remains inconclusive. Reductions in serum inflammatory cytokines (e.g., IL-6, CRP) were not consistently aligned with perceptual outcomes. Howatson et al. [24] observed lower IL-6 and CRP without a corresponding analgesic effect. Bell et al. [28] was the only study to report concurrent reductions in both IL-6 and soreness, although other inflammatory markers remained unaffected. While the present meta-analysis showed reductions in CRP, no consistent effects were observed for IL-6, and soreness remained largely unchanged when pooled across studies. This supports the view that soreness is multifactorial and may be weakly coupled to systemic inflammatory signals, particularly in trained athletes where repeated-bout adaptations and contextual factors may blunt soreness responses. Collectively, the evidence suggests that TC supplementation does not produce a consistent reduction in muscle soreness in athletic populations following EIMD, although a small effect at 48 h in whole-body protocols may be possible. Future studies should standardize soreness assessment, quantify local tissue responses where feasible, and report concurrent functional outcomes to better understand whether changes in soreness reflect true physiological recovery or alterations in symptom perception.
Recovery Kinetics of Biochemical Parameters
Creatine Kinase (CK)
Creatine kinase (CK) is a well-established biomarker of muscle membrane disruption and EIMD, with elevated levels indicating structural compromise and delayed recovery [83]. In the present meta-analysis, TC juice supplementation showed no significant effect on CK at any evaluated time point. Although the pooled estimates tended to favor TC supplementation, effects were small and not statistically significant post-exercise (ES = 0.29, p = 0.434), at 24 h (ES = 0.16, p = 0.570), and at 48 h (ES = − 0.08, p = 0.716). Substantial heterogeneity was observed across time points, indicating considerable variability between studies. To explore potential sources of heterogeneity, subgroup analyses were performed based on the EIMD model (whole-body vs. isolated muscle-damage protocols). These analyses did not materially change the interpretation: CK responses remained non-significant in both whole-body protocols and isolated protocols post-exercise, 24 h and 48 h. These findings suggest that TC supplementation does not consistently attenuate CK release following EIMD in athletic populations, and that the exercise model alone is unlikely to explain the lack of a clear pooled effect.
Among the included studies, findings were inconsistent. Bell et al. [28], Howatson et al. [24], Difranco et al. [62], Lamb et al. [33], Quinlan & Hill [25], and Wangdi et al. [61]reported no significant attenuation in CK levels following 4–5 days of TC supplementation, particularly in semi-professional or recreational athletes. In contrast, Bowtell et al. [26] reported a substantial reduction in CK concentrations following a 5-day supplementation protocol in trained males. This inconsistency may reflect several limitations of CK as an outcome in athletes. First, CK demonstrates pronounced inter-individual variability and can be influenced by training status, repeated-bout adaptations, muscle mass engaged, and prior exposure to eccentric loading [84]. Second, CK does not always align closely with functional impairment or recovery of performance, which may explain why the present analysis showed clearer benefits for MVC recovery while CK remained unchanged. Third, differences in exercise protocols (endurance vs. resistance), magnitude of muscle damage, and supplementation regimens (dose, timing, duration, and product composition) likely contribute to variability in CK responses. Mechanistically, polyphenols in TC (including anthocyanins) have been proposed to modulate oxidative stress and inflammation pathways, potentially reducing secondary damage processes. However, the absence of consistent CK effects in this meta-analysis suggests that either (i) the protective effect is not reliably captured by CK kinetics, (ii) CK is insufficiently sensitive/too variable in trained cohorts, or (iii) functional benefits may occur through mechanisms not directly reflected by circulating CK.When assessed against the GRADE criteria, the certainty of evidence for CK remains low due to inconsistency, imprecision, and risk of bias across studies. Future research should prioritize standardized damaging protocols and supplementation strategies and include CK as part of a broader recovery biomarker panel, ideally combined with objective functional and neuromuscular outcomes to improve mechanistic interpretation.
Inflammatory Markers (IL-6, CRP, TNF-Alpha)
This meta-analysis found no significant effect of tart cherry juice supplementation on interleukin-6 (IL-6) concentrations at any time point following exercise. While a small to moderate effect size was observed immediately post-exercise this did not reach statistical significance post-exercise. Effects remained trivial to small and were non-significant at 24 h, 48 h and 72 h. Confidence intervals were wide at several time points and heterogeneity ranged from moderate to high, indicating variability in study outcomes and limiting the reliability of any directional trend. These findings collectively indicate that TC juice supplementation does not appear to modulate IL-6 concentrations consistently or meaningfully in the post-EIMD period. The absence of a clear IL6 response may reflect methodological and biological differences across studies, including exercise modality, supplementation dosage, and small sample sizes. Although polyphenols in TC juice supplementation particularly anthocyanins have been mechanistically linked to anti-inflammatory effects, and have been shown to inhibit pro-inflammatory cytokine production and modulate oxidative stress pathways [85]. the current study evidence does not support a clear or reliable attenuation of IL-6 in response to supplementation.
In contrast, the current meta-analysis demonstrates that TC supplementation significantly reduce CRP levels during early recovery. Significant reductions were observed post-exercise, at 24 h, and at 48 h. These findings suggest that the anti-inflammatory effects of tart cherry may be more consistently reflected in systemic acute-phase markers such as CRP rather than in cytokines like IL-6. Subgroup analyses provided additional nuance: the CRP reduction was more clearly detectable in whole-body protocols (notably at 24 h), whereas isolated muscle-damage protocols showed non-significant trends. This may indicate that tart cherry’s effect on CRP is most evident in contexts that induce a stronger systemic inflammatory signal. At 24 h post-exercise, the effect size increased to -0.88, and a similar result was observed at 48 h (ES = -0.85), though heterogeneity range to moderate levels (I² 72%). These results suggest that the anti-inflammatory benefits of tart cherry juice may persist beyond the immediate post-exercise period, with the most pronounced effects occurring during the first 48 h of recovery.
The observed reductions in CRP are biologically plausible given that tart cherries are rich in polyphenols and anthocyanins, which possess potent antioxidant and anti-inflammatory properties [86]. CRP, as a marker of systemic inflammation, is often elevated following strenuous exercise and is associated with muscle damage and delayed recovery [87, 88]. The ability of cherry juice to blunt CRP responses suggests a meaningful reduction in exercise-induced systemic inflammation, which could translate to enhanced recovery and reduced soreness. However, the moderate heterogeneity at later time points highlights some variability in response may still depend on exercise type, dosing strategy, and participant characteristics.
Finally, the present meta-analysis showed no significant effect of TC supplementation on TNF-α at any time point. Pooled effects were non-significant post-exercise, at 24 h and at 48 h. Therefore, while CRP appears responsive, the evidence does not support a consistent effect of tart cherry on TNF-α in athletes after EIMD. This marker-specific pattern suggests that TC supplementation may influence selected inflammatory pathways (e.g., acute-phase response) without producing uniform changes across cytokines, or that available studies are underpowered to detect cytokine-level effects reliably.
Several outcomes exhibited substantial between-study heterogeneity, and the leave-one-out sensitivity analyses indicated that some pooled estimates were influenced by individual studies. In particular, the pooled effect for MVC at post-exercise became non-significant after removal of Lamb et al. [33], and MVC at 72 h was sensitive to removal of Brown et al. [52]and Connolly et al. [31] (Supplementary file Table S2). Similarly, the pooled CRP effects at 24 h and 48 h became non-significant after removal of Dimitriou et al. [53], suggesting that the CRP findings at these time points should be interpreted cautiously. In contrast, sensitivity analyses for several outcomes (e.g., CK and IL-6) generally reduced heterogeneity without changing the overall non-significant conclusions. Collectively, these observations, together with the low-to-moderate GRADE ratings and the limited number of studies per time point for some outcomes, indicate that the magnitude and stability of effects may vary across contexts (exercise model, athlete characteristics, and supplementation protocols). Additionally, the very large effect estimates observed at later MVC time points should be interpreted cautiously, as they may be influenced by small-sample imprecision and between-study variability. Further well-controlled trials are needed to confirm the robustness and practical relevance of these effects. Although sport-specific physiological demands may influence recovery trajectories, the available evidence base was insufficient to support statistically robust sport-stratified meta-analyses. Consequently, subgroup analyses were conducted according to the type of EIMD protocol (whole-body vs. isolated), which more directly reflects the underlying damage stimulus. Future trials should report outcomes in a manner that facilitates sport-specific synthesis. Several limitations of the present meta-analysis should be acknowledged. First, the number of included studies was limited for certain outcomes and recovery time points, which may reduce statistical power and affect the stability of pooled estimates.
Second, the absence of sex-specific analyses limits the generalizability of the findings. Potential differences between male and female participants in muscle damage responses, inflammatory processes, and recovery kinetics could not be examined due to inconsistent reporting across studies.
Third, although subgroup analyses were performed based on muscle-damage protocol characteristics (whole-body vs. isolated models), studies were not consistently classified according to other exercise-related factors such as contraction mode, exercise modality, or mechanical load. Given that EIMD responses vary depending on these variables, residual methodological variability may have contributed to the substantial heterogeneity observed.
Finally, differences in supplementation strategies, including timing of ingestion, dosage, and duration of TC juice administration, were not formally explored. These factors may influence physiological and functional recovery outcomes.
Therefore, the present findings should be interpreted with caution. Future studies employing standardized exercise protocols, clearly defined supplementation regimens, and sex-balanced cohorts are warranted to strengthen the certainty of evidence. These limitations highlight the need for more methodologically consistent trials in trained and athletic populations.
It should also be noted that definitions of EIMD vary across the literature, and no single exercise model uniformly captures all aspects of the EIMD response. Although the present review applied a priori operational criteria focusing on protocols with established eccentric or impact-related damage profiles, we acknowledge that alternative definitions could yield different study selections. This variability underscores the importance of transparent operational definitions in future systematic reviews.
Conclusion
The present systematic review with meta-analysis suggests that TC juice consumption may support selected aspects of recovery following EIMD in trained athletes, particularly the recovery of maximal voluntary contraction (MVC) and short-term reductions in systemic inflammation (CRP) during the early recovery phase (post-exercise to 48 h). For CMJ, the evidence suggests a limited and time-dependent effect, with a significant benefit observed at 48 h only, whereas effects were not consistently present immediately post-exercise or at 24 h. No clear or consistent effects were observed for muscle soreness, CK, IL-6, TNF-α, or ROM. According to the GRADE assessment, the certainty of evidence for key outcomes ranged from low to moderate, reflecting inconsistency, imprecision, and potential risk of bias across studies; therefore, these findings should be interpreted cautiously. Overall, only the MVC effect appears to have the strongest potential for practical/clinical relevance in athletic settings, although the magnitude and consistency of this effect remain uncertain.
Practical Applications
From a practical perspective, TC juice consumption before and after exercise may be considered as part of a recovery strategy, particularly when accelerated restoration of strength capacity is required (e.g., congested training or competition schedules). While an optimal dose is not yet established, studies reporting improvements in muscle performance recovery commonly employed split dosing (typically morning and evening) with servings ranging from ~ 30 mL of concentrate to larger volumes depending on product formulation, administered over 4 to 10 consecutive days including a pre-loading phase and continued intake after exercise (see Table 1). This variability highlights the absence of a standardized evidence-based dosing approach and may contribute to heterogeneity in outcomes. Notably, none of the included studies individualized dosage by body mass, which could influence bioavailability and efficacy.
Among available protocols, a frequently used and practical regimen was 30 mL twice daily across several days including a pre-loading period and continued intake after the damaging bout. This strategy appears promising for supporting strength recovery and attenuating selected inflammatory responses (CRP) during early recovery. Considering the relatively high cost of tart cherry products, implementation should be individualized (e.g., by body mass) and evidence informed. Future trials should establish dose–response relationships, compare formulations (concentrate vs. juice vs. powder/gel), and determine whether individualized dosing improves consistency of response across diverse athletic populations to allow clearer cost–benefit judgments (e.g., clinically meaningful thresholds and sport-specific performance relevance).
Supplementary Information
Below is the link to the electronic supplementary material.
Acknowledgements
Not applicable.
Abbreviations
- BCAA
Branched-chain amino acid
- CI
Confidence interval
- CK
Creatine kinase
- CMJ
Countermovement jump
- COX
Cyclooxygenase
- COX-1
Cyclooxygenase-1
- COX-2
Cyclooxygenase-2
- CRP
C-reactive protein
- DOMS
Delayed onset muscle soreness
- EIMD
Exercise-induced muscle damage
- ES
Effect size
- GRADE
Grading of recommendations, assessment, development and evaluation
- IL-6
Interleukin-6
- MD
Minimal difference
- MVC
Maximal voluntary contraction
- NF-κB
Nuclear factor kappa-light-chain-enhancer of activated B cells
- Nrf2
Nuclear factor erythroid 2–related factor 2
- ROM
Range of motion
- RONS
Reactive oxygen and nitrogen species
- SWC
Smallest worthwhile change
- TC
Tart cherry
- TNF-α
Tumor necrosis factor-alpha
- VAS
Visual analogue scale
- VO2max
Maximal oxygen uptake
Author Contributions
WD, MAB, and AEA contributed to the conception and design of the study. GPN and AS helped in the development of the search strategy. WD performed the literature search. MAB and AEA selected retrieved relevant papers, performed data extraction, and assessed study quality. WD performed the data analysis with the support of HP. AA, AS, and AEA assisted with the interpretation. The paper was drafted by WD and AEA and revised by GPN, AS, AA and HP. All authors read and approved the final manuscript.
Funding
No sources of funding were used to assist in the preparation of this article.
Data Availability
Not applicable.
Declarations
Ethics Approval and Consent to Participate
Not applicable.
Consent for Publication
Not applicable.
Competing Interests
The authors declare that they have no competing interests.
Footnotes
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
References
- 1.Tidball JG. Regulation of muscle growth and regeneration by the immune system. Nat Rev Immunol. 2017;17(3):165–78. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Markus I, et al. Exercise-induced muscle damage: Mechanism, assessment and nutritional factors to accelerate recovery. Eur J Appl Physiol. 2021;121:969–92. [DOI] [PubMed] [Google Scholar]
- 3.Thomas K, et al. Etiology and Recovery of Neuromuscular Fatigue after Simulated Soccer Match Play. Med Sci Sports Exerc. 2017;49(5):955–64. [DOI] [PubMed] [Google Scholar]
- 4.Heaton LE, et al. Selected in-season nutritional strategies to enhance recovery for team sport athletes: a practical overview. Sports Med. 2017;47:2201–18. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Silva JR, et al. Acute and residual soccer match-related fatigue: a systematic review and meta-analysis. Sports Med. 2018;48:539–83. [DOI] [PubMed] [Google Scholar]
- 6.Harty PS, et al. Nutritional and Supplementation Strategies to Prevent and Attenuate Exercise-Induced Muscle Damage: a Brief Review. Sports Med Open. 2019;5(1):1. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Hill J, et al. Compression garments and recovery from exercise-induced muscle damage: a meta-analysis. Br J Sports Med. 2014;48(18):1340–6. [DOI] [PubMed] [Google Scholar]
- 8.Leeder J, et al. Cold water immersion and recovery from strenuous exercise: a meta-analysis. Br J Sports Med. 2012;46(4):233–40. [DOI] [PubMed] [Google Scholar]
- 9.Oliva-Lozano JM, et al. Blood flow restriction as a post-exercise recovery strategy: A systematic review of the current status of the literature. Biol Sport. 2024;41(3):191–200. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10.Luo WT, et al. Effects of Low-Level Laser Therapy on Muscular Performance and Soreness Recovery in Athletes: A Meta-analysis of Randomized Controlled Trials. Sports Health. 2022;14(5):687–93. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11.Li S, et al. Effectiveness of Recovery Strategies After Training and Competition in Endurance Athletes: An Umbrella Review. Sports Med Open. 2024;10(1):55. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12.Jagim AR, et al. Prevalence of adulteration in dietary supplements and recommendations for safe supplement practices in sport. Front Sports Act Living. 2023;5:1239121. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 13.Broniecka A, et al. Dietary supplement use and knowledge among athletes: prevalence, compliance with AIS classification, and awareness of certification programs. J Int Soc Sports Nutr. 2025;22(1):2496450. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14.Moradi F, et al. Prevalence of supplement usage and related attitudes and reasons among fitness athletes in the gyms of Kashan and its relationship with feeding behavior: a cross-sectional study. BMC Sports Sci Med Rehabil. 2024;16(1):150. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15.Wax B et al. Creatine for Exercise and Sports Performance, with Recovery Considerations for Healthy Populations. Nutrients, 2021. 13(6). [DOI] [PMC free article] [PubMed]
- 16.Pasiakos SM, Lieberman HR, McLellan TM. Effects of protein supplements on muscle damage, soreness and recovery of muscle function and physical performance: a systematic review. Sports Med. 2014;44(5):655–70. [DOI] [PubMed] [Google Scholar]
- 17.Salem A, et al. Attenuating Muscle Damage Biomarkers and Muscle Soreness After an Exercise-Induced Muscle Damage with Branched-Chain Amino Acid (BCAA) Supplementation: A Systematic Review and Meta-analysis with Meta-regression. Sports Med Open. 2024;10(1):42. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 18.Caballero-Garcia A et al. Vitamin D, Its Role in Recovery after Muscular Damage Following Exercise. Nutrients, 2021. 13(7). [DOI] [PMC free article] [PubMed]
- 19.Fernandez-Lazaro D et al. Omega-3 Fatty Acid Supplementation on Post-Exercise Inflammation, Muscle Damage, Oxidative Response, and Sports Performance in Physically Healthy Adults-A Systematic Review of Randomized Controlled Trials. Nutrients, 2024. 16(13). [DOI] [PMC free article] [PubMed]
- 20.Frank J, et al. Terms and nomenclature used for plant-derived components in nutrition and related research: efforts toward harmonization. Nutr Rev. 2020;78(6):451–8. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 21.Cao G, et al. Polyphenol supplementation boosts aerobic endurance in athletes: systematic review. Front Physiol. 2024;15:1369174. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 22.Jawad M et al. A Comprehensive Polyphenolic Characterization of Five Montmorency Tart Cherry (Prunus cerasus L.) Product Formulations. Foods, 2025. 14(7). [DOI] [PMC free article] [PubMed]
- 23.Marzocchella L, et al. Dietary flavonoids: molecular mechanisms of action as anti- inflammatory agents. Recent Pat Inflamm Allergy Drug Discov. 2011;5(3):200–20. [DOI] [PubMed] [Google Scholar]
- 24.Howatson G, et al. Influence of tart cherry juice on indices of recovery following marathon running. Scand J Med Sci Sports. 2010;20(6):843–52. [DOI] [PubMed] [Google Scholar]
- 25.Quinlan R, Hill JA. The Efficacy of Tart Cherry Juice in Aiding Recovery After Intermittent Exercise. Int J Sports Physiol Perform. 2020;15(3):368–74. [DOI] [PubMed] [Google Scholar]
- 26.Bowtell JL, et al. Montmorency cherry juice reduces muscle damage caused by intensive strength exercise. Med Sci Sports Exerc. 2011;43(8):1544–51. [DOI] [PubMed] [Google Scholar]
- 27.Bell PG, et al. Recovery facilitation with Montmorency cherries following high-intensity, metabolically challenging exercise. Appl Physiol Nutr Metab. 2015;40(4):414–23. [DOI] [PubMed] [Google Scholar]
- 28.Bell PG et al. The Effects of Montmorency Tart Cherry Concentrate Supplementation on Recovery Following Prolonged, Intermittent Exercise. Nutrients, 2016. 8(7). [DOI] [PMC free article] [PubMed]
- 29.Bell PG, et al. Montmorency cherries reduce the oxidative stress and inflammatory responses to repeated days high-intensity stochastic cycling. Nutrients. 2014;6(2):829–43. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 30.Levers K, et al. Effects of powdered Montmorency tart cherry supplementation on acute endurance exercise performance in aerobically trained individuals. J Int Soc Sports Nutr. 2016;13:22. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 31.Connolly DA, et al. Efficacy of a tart cherry juice blend in preventing the symptoms of muscle damage. Br J Sports Med. 2006;40(8):679–83. discussion 683. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 32.Kuehl KS, et al. Efficacy of tart cherry juice in reducing muscle pain during running: a randomized controlled trial. J Int Soc Sports Nutr. 2010;7:17. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 33.Lamb KL et al. No Effect of Tart Cherry Juice or Pomegranate Juice on Recovery from Exercise-Induced Muscle Damage in Non-Resistance Trained Men. Nutrients, 2019. 11(7). [DOI] [PMC free article] [PubMed]
- 34.McCormick R, et al. Effect of tart cherry juice on recovery and next day performance in well-trained Water Polo players. J Int Soc Sports Nutr. 2016;13:41. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 35.Abbott W, et al. Tart Cherry Juice: No Effect on Muscle Function Loss or Muscle Soreness in Professional Soccer Players After a Match. Int J Sports Physiol Perform. 2020;15(2):249–54. [DOI] [PubMed] [Google Scholar]
- 36.Squires E et al. Acute Dosing Strategy with Vistula Tart Cherries for Recovery of Strenuous Exercise-A Feasibility Study. Nutrients, 2024. 16(16). [DOI] [PMC free article] [PubMed]
- 37.Levers K, et al. Effects of powdered Montmorency tart cherry supplementation on an acute bout of intense lower body strength exercise in resistance trained males. J Int Soc Sports Nutr. 2015;12:41. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 38.Hooper DR, et al. Broad Spectrum Polyphenol Supplementation from Tart Cherry Extract on Markers of Recovery from Intense Resistance Exercise. J Int Soc Sports Nutr. 2021;18(1):47. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 39.Beals K, et al. The effects of a tart cherry beverage on reducing exercise-induced muscle soreness. Isokinet Exerc Sci. 2017;25(1):53–63. [Google Scholar]
- 40.McHugh MP. Precovery versus recovery: Understanding the role of cherry juice in exercise recovery. Scand J Med Sci Sports. 2022;32(6):940–50. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 41.Vitale KC, Hueglin S, Broad E. Tart Cherry Juice in Athletes: A Literature Review and Commentary. Curr Sports Med Rep. 2017;16(4):230–9. [DOI] [PubMed] [Google Scholar]
- 42.Hill JA, et al. Tart Cherry Supplementation and Recovery From Strenuous Exercise: A Systematic Review and Meta-Analysis. Int J Sport Nutr Exerc Metab. 2021;31(2):154–67. [DOI] [PubMed] [Google Scholar]
- 43.Ortega DR, et al. Tart cherry and pomegranate supplementations enhance recovery from exercise-induced muscle damage: a systematic review. Biol Sport. 2021;38(1):97–111. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 44.Page MJ et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ, 2021. 372. [DOI] [PMC free article] [PubMed]
- 45.Liberati A, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009;339:b2700. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 46.Downs SH, Black N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol community health. 1998;52(6):377–84. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 47.Guyatt GH, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336(7650):924–6. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 48.Cohen J. Statistical power analysis for the behavioral sciences. Routledge; 2013.
- 49.Cumming G. Understanding the new statistics: Effect sizes, confidence intervals, and meta-analysis. Routledge; 2013.
- 50.Higgins J, Thompson S. Altman DG. Measuring inconsistency in meta-analyses. 2003. [DOI] [PMC free article] [PubMed]
- 51.Neumann I, Schünemann H. The GRADE Book version 1.0 (updated September 2024). The GRADE Working Group; 2024.
- 52.Brown MA, Stevenson EJ, Howatson G. Montmorency tart cherry (Prunus cerasus L.) supplementation accelerates recovery from exercise-induced muscle damage in females. Eur J Sport Sci. 2019;19(1):95–102. [DOI] [PubMed] [Google Scholar]
- 53.Dimitriou L, et al. Influence of a montmorency cherry juice blend on indices of exercise-induced stress and upper respiratory tract symptoms following marathon running–a pilot investigation. J Int Soc Sports Nutr. 2015;12:22. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 54.Bell PG, et al. The role of cherries in exercise and health. Scand J Med Sci Sports. 2014;24(3):477–90. [DOI] [PubMed] [Google Scholar]
- 55.Keane KM, et al. Effects of Montmorency tart cherry (Prunus Cerasus L.) consumption on vascular function in men with early hypertension. Am J Clin Nutr. 2016;103(6):1531–9. [DOI] [PubMed] [Google Scholar]
- 56.Kimble R, et al. The influence of tart cherry (Prunus cerasus, cv Montmorency) concentrate supplementation for 3 months on cardiometabolic risk factors in middle-aged adults: a randomised, placebo-controlled trial. Nutrients. 2021;13(5):1417. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 57.Daab W, et al. Effects of breathing a hyperoxic gas mixture on perceptual, biochemical and performance recovery following simulated soccer match play. Biology Sport. 2025;42(3):51–60. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 58.Daab W et al. Ischemic preconditioning delayed neuromuscular fatigue development during a simulated soccer match. J Sci Med Sport, 2025. [DOI] [PubMed]
- 59.Kimble R, Jones K, Howatson G. The effect of dietary anthocyanins on biochemical, physiological, and subjective exercise recovery: A systematic review and meta-analysis. Crit Rev Food Sci Nutr. 2023;63(9):1262–76. [DOI] [PubMed] [Google Scholar]
- 60.Lima LC, et al. Consumption of an anthocyanin-rich antioxidant juice accelerates recovery of running economy and indirect markers of exercise-induced muscle damage following downhill running. Nutrients. 2019;11(10):2274. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 61.Wangdi JT, et al. Tart Cherry Supplement Enhances Skeletal Muscle Glutathione Peroxidase Expression and Functional Recovery after Muscle Damage. Med Sci Sports Exerc. 2022;54(4):609–21. [DOI] [PubMed] [Google Scholar]
- 62.Difranco I, et al. A combination of cherry juice and cold water immersion does not enhance marathon recovery compared to either treatment in isolation: A randomized placebo-controlled trial. Front Sports Act Living. 2022;4:957950. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 63.Squires E, et al. Acute Dosing Strategy with Vistula Tart Cherries for Recovery of Strenuous Exercise—A Feasibility Study. Nutrients. 2024;16(16):2709. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 64.Claudino JG, et al. The countermovement jump to monitor neuromuscular status: A meta-analysis. J Sci Med Sport. 2017;20(4):397–402. [DOI] [PubMed] [Google Scholar]
- 65.Nedelec M, et al. Recovery in soccer: part I - post-match fatigue and time course of recovery. Sports Med. 2012;42(12):997–1015. [DOI] [PubMed] [Google Scholar]
- 66.Morehen JC, et al. Montmorency tart cherry juice does not reduce markers of muscle soreness, function and inflammation following professional male rugby League match-play. Eur J Sport Sci. 2021;21(7):1003–12. [DOI] [PubMed] [Google Scholar]
- 67.Clemente-Suarez VJ et al. Antioxidants and Sports Performance. Nutrients, 2023. 15(10). [DOI] [PMC free article] [PubMed]
- 68.Thirupathi A, et al. Effect of different exercise modalities on oxidative stress: a systematic review. Biomed Res Int. 2021;2021(1):1947928. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 69.Di Lorenzo C et al. Polyphenols and Human Health: The Role of Bioavailability. Nutrients, 2021. 13(1). [DOI] [PMC free article] [PubMed]
- 70.Jawad M, et al. A Comprehensive Polyphenolic Characterization of Five Montmorency Tart Cherry (Prunus cerasus L.) Product Formulations. Foods. 2025;14(7):1154. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 71.Alba C, Daya M-AM, Franck C. Tart Cherries and health: Current knowledge and need for a better understanding of the fate of phytochemicals in the human gastrointestinal tract. Crit Rev Food Sci Nutr. 2019;59(4):626–38. [DOI] [PubMed] [Google Scholar]
- 72.Larkin-Kaiser KA, et al. Range of motion as a predictor of clinical shoulder pain during recovery from delayed-onset muscle soreness. J Athl Train. 2015;50(3):289–94. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 73.Salehi B, et al. The therapeutic potential of anthocyanins: current approaches based on their molecular mechanism of action. Front Pharmacol. 2020;11:1300. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 74.Kitaoka Y. The role of Nrf2 in skeletal muscle on exercise capacity. Antioxidants. 2021;10(11):1712. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 75.Bloom DA, et al. The minimal clinically important difference: a review of clinical significance. Am J Sports Med. 2023;51(2):520–4. [DOI] [PubMed] [Google Scholar]
- 76.Hopkins WG, Hawley JA, Burke LM. Design and analysis of research on sport performance enhancement. Med Sci Sports Exerc. 1999;31(3):472–85. [DOI] [PubMed] [Google Scholar]
- 77.McCall A, et al. Reliability and sensitivity of a simple isometric posterior lower limb muscle test in professional football players. J Sports Sci. 2015;33(12):1298–304. [DOI] [PubMed] [Google Scholar]
- 78.Kennedy RA, Drake D. Improving the signal-to-noise ratio when monitoring countermovement jump performance. J Strength Conditioning Res. 2021;35(1):85–90. [DOI] [PubMed] [Google Scholar]
- 79.Bhalodiya HP, et al. A Prospective Multicenter Analysis of the Mid-term Outcomes of Component Size Variation in Simultaneous Bilateral Total Knee Arthroplasty: Does One-Size Difference Matter? Cureus. 2025;17(10):e94421. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 80.Kupusarevic J, McShane K, Clifford T. Cherry Gel Supplementation Does Not Attenuate Subjective Muscle Soreness or Alter Wellbeing Following a Match in a Team of Professional Rugby Union players: A Pilot Study. Sports (Basel), 2019. 7(4). [DOI] [PMC free article] [PubMed]
- 81.Drummer DJ, et al. Montmorency Cherry Juice Consumption does not Improve Muscle Soreness or Inhibit Pro-inflammatory Monocyte Responses Following an Acute Bout of Whole-body Resistance Training. Int J Exerc Sci. 2022;15(6):686–701. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 82.Dupuy O, et al. An evidence-based approach for choosing post-exercise recovery techniques to reduce markers of muscle damage, soreness, fatigue, and inflammation: a systematic review with meta-analysis. Front Physiol. 2018;9:312968. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 83.Baird MF, et al. Creatine-kinase‐and exercise‐related muscle damage implications for muscle performance and recovery. J Nutr metabolism. 2012;2012(1):960363. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 84.McHugh MP. Recent advances in the understanding of the repeated bout effect: the protective effect against muscle damage from a single bout of eccentric exercise. Scand J Med Sci Sports. 2003;13(2):88–97. [DOI] [PubMed] [Google Scholar]
- 85.Nemes A et al. Effect of anthocyanin-rich tart cherry extract on inflammatory mediators and adipokines involved in type 2 diabetes in a high fat diet induced obesity mouse model. Nutrients, 2019. 11(9): p. 1966. [DOI] [PMC free article] [PubMed]
- 86.Chai SC, et al. Effects of tart cherry juice on biomarkers of inflammation and oxidative stress in older adults. Nutrients. 2019;11(2):228. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 87.Peake JM et al. Muscle damage and inflammation during recovery from exercise. J Appl Physiol, 2017. [DOI] [PubMed]
- 88.Daab W, et al. Chronic beetroot juice supplementation accelerates recovery kinetics following simulated match play in soccer players. J Am Coll Nutr. 2021;40(1):61–9. [DOI] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Data Availability Statement
Not applicable.