***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: PURPOSE Dietary supplementation with polyphenols , particularly ellagitannins , may attenuate the muscular damage experienced after eccentric exercise , producing delayed-onset muscle soreness . The purpose of this study was to determine whether ellagitannin supplementation from Wonderful variety pomegranate extract ( POMx ) improved recovery of skeletal muscle strength after eccentric exercise . METHODS Recreationally active males were r and omized into a crossover design with either pomegranate extract ( POMx ) or placebo ( PLA ) , each given during a period of 9 d . To produce delayed-onset muscle soreness , subjects performed two sets of 20 maximal eccentric elbow flexion exercises with one arm . Maximal isometric elbow flexion strength and muscle soreness as well as serum measures of creatine kinase , myoglobin , interleukin 6 , and C-reactive protein were made at baseline and 2 , 24 , 48 , 72 , and 96 h after exercise . RESULTS With both treatments , strength was similarly reduced 2 h after exercise ( i.e. , 72 % of baseline ) , and recovery of strength was incomplete after 96 h ( i.e. , 91 % of baseline).However , strength was significantly higher in POMx compared with that in PLA at 48 h ( 85.4 % + /- 2.5 % and 78.3 % + /- 2.6 % , P = 0.01 ) and 72 h ( 88.9 % + /- 2.0 % and 84.0 % + /- 2.0 % , P = 0.009 ) after exercise . Serum markers of inflammation and muscle damage did not provide insight regarding possible mechanisms . CONCLUSIONS Supplementation with ellagitannins from pomegranate extract significantly improves recovery of isometric strength 2 - 3 d after a damaging eccentric exercise The aims of the present study were to : ( 1 ) investigate the effect of a weightlifting training session and time-of-day ( TOD ) upon biological parameters ( i.e. , oral temperature , hematological , C-reactive protein ( CRP ) , and oxidative stress ) and ( 2 ) assess their possible link with muscle damage responses . Nine weightlifters ( 21 ± 0.5 years ) performed , in a r and omized order ,  three Olympic-Weightlifting sessions  ( i.e. , at 08:00 , 14:00 , and 18:00 ) . Blood sample s were collected at rest , 3 min and 48 h after each training session . Between pre- and post-training session , ANOVA showed significant increases in oxidative stress markers at the three TODs ( p < 0.01 ) and significant increases for creatine kinase ( CK ) and lactate dehydrogenase ( LDH ) only at 08:00 and 18:00 ( p < 0.05 ) . At rest , the results showed a significant diurnal variation for the majority of the selected parameters except for malondialdehyde ( MDA ) , total bilirubin , and CRP with higher values observed at 18:00 ( p < 0.05 ) . After the training session , given the higher rate of increase during the morning session , these diurnal variations persisted for temperature and WBC ( p < 0.01 ) and were suppressed for CK , LDH , uric acid ( UA ) , catalase , and glutathione peroxidase . The main significant correlations ( p < 0.001 ) were observed between : ( 1 ) CK and MDA ( r = 0.6 ) and CK and UA ( r = 0.66 and r = 0.82 ) during the morning and evening training sessions ; ( 2 ) CK and CRP only during the morning session ( r = 0.5 ) ; and ( 3 ) CRP and WBC during the three training sessions ( r = 0.8 ) . In conclusion , the present findings : ( 1 ) confirm that the muscle damage responses could be induced by a high level of oxidative stress and ( 2 ) suggest to avoid scheduling training sessions in the morning given the higher muscle damage , inflammatory , and oxidative responses at this TOD Recent research has shown that dietary nitrate has favorable effects on blood flow and exercise performance . The purpose of this r and omized , double-blind , placebo-controlled crossover study was to investigate the acute effects of pomegranate extract on blood flow , vessel diameter , and exercise performance in active individuals . Nineteen men and women ( mean ± SD : age , 22.2 ± 2.2 years ; height , 174.8 ± 10.7 cm ; body mass , 71.9 ± 13.5 kg ) were r and omly assigned to a placebo ( PL ) or pomegranate extract ( PE ) group . Participants performed a maximal oxygen consumption treadmill test to determine peak velocity ( PV ) . Participants returned after 24 - 48 h and ingested either PL or PE . Brachial artery blood flow was assessed using ultrasound at baseline and 30 min post-ingestion ( 30minPI ) . Three treadmill runs to exhaustion were performed at 90 % , 100 % , and 110 % PV . Blood flow was assessed immediately after each exercise bout and 30 min postexercise ( 30minPEx ) . After a 7 - 10 day washout , participants repeated the same procedures , ingesting the opposite supplement . Separate repeated measures ANOVAs were performed for blood flow , vessel diameter , and time to exhaustion ( TTE ) . Blood flow was significantly augmented ( p = 0.033 ) 30minPI with PE in comparison with PL . Vessel diameter was significantly larger ( p = 0.036 ) 30minPEx with PE . Ingestion of PE was found to significantly augment TTE at 90 % ( p = 0.009 ) and 100 % PV ( p = 0.027 ) . Acute ingestion of PE 30 min before exercise may enhance vessel diameter and blood flow and delay fatigue during exercise . Results of the current study indicate that PE is ergogenic for intermittent running , eliciting beneficial effects on blood flow Ageing is thought to be associated with decreased vascular function partly due to oxidative stress . Resveratrol is a polyphenol , which in animal studies has been shown to decrease atherosclerosis , and improve cardiovascular health and physical capacity , in part through its effects on Sirtuin 1 signalling and through an improved antioxidant capacity . We tested the hypothesis that resveratrol supplementation enhances training-induced improvements in cardiovascular health parameters in aged men . Twenty-seven healthy physically inactive aged men ( age : 65 ± 1 years ; body mass index : 25.4 ± 0.7 kg m(-2 ) ; mean arterial pressure ( MAP ) : 95.8 ± 2.2 mmHg ; maximal oxygen uptake : 2488 ± 72 ml O2 min(-1 ) ) were r and omized into 8 weeks of either daily intake of either 250 mg trans-resveratrol ( n = 14 ) or of placebo ( n = 13 ) concomitant with high-intensity exercise training . Exercise training led to a 45 % greater ( P < 0.05 ) increase in maximal oxygen uptake in the placebo group than in the resveratrol group and to a decrease in MAP in the placebo group only ( -4.8 ± 1.7 mmHg ; P < 0.05 ) . The interstitial level of vasodilator prostacyclin was lower in the resveratrol than in the placebo group after training ( 980 ± 90 vs. 1174 ± 121 pg ml(-1 ) ; P < 0.02 ) and muscle thromboxane synthase was higher in the resveratrol group after training ( P < 0.05 ) . Resveratrol administration also abolished the positive effects of exercise on low-density lipoprotein , total cholesterol/high-density lipoprotein ratio and triglyceride concentrations in blood ( P < 0.05 ) . Resveratrol did not alter the effect of exercise training on the atherosclerosis marker vascular cell adhesion molecule 1 ( VCAM-1 ) . Sirtuin 1 protein levels were not affected by resveratrol supplementation . These findings indicate that , whereas exercise training effectively improves several cardiovascular health parameters in aged men , concomitant resveratrol supplementation can blunt these effects Eccentrically biased exercise results in skeletal muscle damage and stimulates adaptations in muscle , whereby indexes of damage are attenuated when the exercise is repeated . We hypothesized that changes in ultrastructural damage , inflammatory cell infiltration , and markers of proteolysis in skeletal muscle would come about as a result of repeated eccentric exercise and that gender may affect this adaptive response . Untrained male ( n = 8) and female ( n = 8) subjects performed two bouts ( bout 1 and bout 2 ) , separated by 5.5 wk , of 36 repetitions of unilateral , eccentric leg press and 100 repetitions of unilateral , eccentric knee extension exercises ( at 120 % of their concentric single repetition maximum ) , the subjects ' contralateral nonexercised leg served as a control ( rest ) . Biopsies were taken from the vastus lateralis from each leg 24 h postexercise . After bout 2 , the postexercise force deficit and the rise in serum creatine kinase ( CK ) activity were attenuated . Women had lower serum CK activity compared with men at all times ( P < 0.05 ) , but there were no gender differences in the relative magnitude of the force deficit . Muscle Z-disk streaming , quantified by using light microscopy , was elevated vs. rest only after bout 1 ( P < 0.05 ) , with no gender difference . Muscle neutrophil counts were significantly greater in women 24 h after bout 2 vs. rest and bout 1 ( P < 0.05 ) but were unchanged in men . Muscle macrophages were elevated in men and women after bout 1 and bout 2 ( P < 0.05 ) . Muscle protein content of the regulatory calpain subunit remained unchanged whereas ubiquitin-conjugated protein content was increased after both bouts ( P < 0.05 ) , with a greater increase after bout 2 . We conclude that adaptations to eccentric exercise are associated with attenuated serum CK activity and , potentially , an increase in the activity of the ubiquitin proteosome proteolytic pathway PURPOSE Vitamin E supplementation may confer a protective effect against eccentrically biased exercise-induced muscle damage through stabilization of the cell membrane and possibly via inhibition of free radical formation . Evidence supporting a protective role of vitamin E after contraction-induced muscle injury in humans is , however , inconsistent . The present study sought to determine the effect of vitamin E supplementation on indices of exercise-induced muscle damage and the postexercise inflammatory response after performance of repeated eccentric muscle contractions . METHODS Young healthy men performed a bout of 240 maximal isokinetic eccentric muscle contractions ( 0.52 rad.s-1 ) after being supplemented for 30 d with either vitamin E ( N = 9 ; 1200 IU.d-1 ) or placebo ( N = 7 ; safflower oil ) . RESULTS Measurements of torque ( isometric and concentric ) decreased ( P < 0.05 ) below preexercise values immediately post- and at 48 h post-exercise . Biopsies taken 24 h postexercise showed a significant increase in the amount of extensive Z-b and disruption ( P < 0.01 ) ; however , neither the torque deficit nor the extent of Z-b and disruption were affected by vitamin E. Exercise result ed in increased macrophage cell infiltration ( P = 0.05 ) into muscle , which was also unaffected by vitamin E.  Serum CK also increased as a result of the exercise ( P < 0.05 ) with no effect of vitamin E. CONCLUSION We conclude that vitamin E supplementation ( 30 d at 1200 IU.d-1 ) , which result ed in a 2.8-fold higher serum vitamin E concentration ( P < 0.01 ) , had no affect on indices of contraction-induced muscle damage nor inflammation ( macrophage infiltration ) as a result of eccentrically biased muscle contractions PURPOSE This study investigated the effects of a dietary supplement on exercise-induced markers of cell damage and the inflammatory mediators C-reactive protein ( CRP ) and interleukin-6 ( IL-6 ) . METHODS The supplement contained mixed tocopherols , flavonoids , and docosahexaenoate .  Forty healthy , nonsmoking , untrained males ( aged 18 - 35 yr ) were r and omly assigned to receive either the supplement ( N = 20 ) or placebo ( N = 20 ) during the 14-d experimental protocol . Blood sample s were collected on day 0 ( baseline ) , day 7 ( eccentric exercise-induced injury ) , day 10 , and day 14 . OBJECTIVE Markers of cell damage ( creatine kinase ( CK ) and lactate dehydrogenase ( LDH ) ) and inflammation IL-6 and CRP were assessed at these time points in conjunction with subjective range of motion ( ROM ) and perceived pain measurements . Statistical analyses were conducted using nonparametric methods ( P < 0.05 ) . RESULTS Eccentric arm curl exercise was used to induce an acute phase injury response as evidence d by significant ( P < 0. 
    Output:
    
However , the beneficial effects of POM supplementation appeared to be less likely when ( i ) unilateral eccentric exercise was employed , ( ii ) the POM administered was not rich in polyphenols ( < 1·69 g/l ) and ( iii ) insufficient time was provided between POM-ingestion and the assessment of physiological responses/performance ( ≤1 h ) .
The review indicates that POM has the potential to enhance exercise performance and to expedite recovery from intensive exercise .
The findings and recommendations from this review may help to optimise POM-supplementation practice in athletes and coaches to potentially improve exercise-performance and post-exercise recovery