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NCT Number: NCT06367413

Effects of Protein and NAC Co-ingestion on Skeletal Muscle Recovery

Previous evidence suggests that though N-acetylcysteine (NAC) supplementation following eccentric exercise-induced muscle damage disrupts the skeletal muscle's repair and remodelling process at 8 days of recovery, it attenuates substantially the decline of skeletal muscle performance during the first 48 hours of recovery. The enhanced performance capacity during the first phase of recovery in response to NAC supplementation might be attributed to the altered redox status in skeletal muscle as a consequence of the NAC-mediated elevation of reduced glutathione (GSH) levels. The rise in GSH results in a redox-dependent attenuation of immune cell mobilisation and reduction of oxidative stress response, leading to a blunted rise of muscle damage and inflammatory markers during the first 2-3 days of recovery. However, following exercise-induced muscle damage, protein synthesis increases in skeletal muscle over the next 24-48 hours to support its repair process, and thus protein supplementation might accelerate the recovery process by enhancing the protein synthetic response. Therefore, the present study aims at investigating for first time the combined effect of NAC and whey protein supplementation on the short-term (during the first 72 hours) recovery process of skeletal muscle following damaging exercise (eccentric exercise) and compared it with the well-documented efficacy of NAC supplementation. The results of this study might be particularly useful for athletes, such as those in soccer and basketball, that participate in 3 games or intense training sessions during the same macrocycle with only 48-72 hours of recovery in-between.

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Key information

Age range

18 year–27 year

Sex eligibility

Male

Study type

Interventional

Phase

Not applicable

Primary location

About this study

Participants will initially undergo baseline testing including assessment of their (i) anthropometrics, (ii) body composition via DXA, (iii) habitual physical activity level via accelerometry, (iv) resting metabolic rate via indirect calorimetry, (v) daily dietary intake via 7-day dietary recalls and (vi) cardiorespiratory fitness using a treadmill ramp test. After baseline testing, participants will be assigned to (a) a Placebo, (b) a N-acetylcysteine (NAC) or (c) a N-acetylcysteine + Whey protein (PRoNAC) group, in a randomized, double-blind, placebo-controlled, parallel group, repeated measures design. In all groups, participants will execute an eccentric exercise protocol on an isokinetic dynamometer consisted of 150 eccentric muscle contractions. Before exercise as well as at 1-, 2-, 3-, 24-, 48- and 72-hours post-exercise they will undergo assessment of their maximal voluntary isometric peal torque, maximal countermovement jump height and muscle soreness level. In addition, blood sample will be drawn before exercise and at 24-, 48- and 72-hours post-exercise for the determination of myoglobin concentration, reduced (GSH) and oxidized (GSSG) glutathione content, protein carbonyl formation and catalase activity.

Throughout the 4-day experimental period (Day 1: exercise day, Days 2, 3 and 4: 24-, 48- and 72-hours post-exercise, respectively) participants will receive daily, 3 doses from the respective supplement as follows: the 1st dose at mid-morning (between breakfast and lunch), the 2nd dose at mid-afternoon (post-exercise on day 1 and between lunch and dinner on days 2-4) and the 3rd dose before sleep. In Placebo group, participants will be supplemented with 0.31 gr of maltodextrin per kg of body weight in the first two servings (at mid-morning and mid-afternoon supplements) and with 0.49 gr of maltodextrin per kg of body weight in the pre-sleep serving (1.1 gr maltodextrin/kg BW/day). In NAC group, participants will be supplemented with 13.33 mg of N-acetylcysteine per kg of body weight per serving (40 mg NAC/kg BW/day). In PRoNAC group participants will be supplemented with 0.31 gr of whey protein and 13.33 mg of N-acetylcysteine per kg of body weight in the first two servings (at mid-morning and mid-afternoon supplements) and with 0.49 gr of whey protein and 13.33 mg of N-acetylcysteine per kg of body weight in the pre-sleep serving (1.1 gr Whey protein + 40 mg NAC /kg BW/day).

Who can participate

Healthy volunteers accepted: Yes

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • Free of asthma, kidney disease, bleeding disorders, peptic ulcers.
  • Free of musculoskeletal injuries and limitations.
  • Abstain from dietary energy restriction.
  • Do not use medication such as anti-inflammatory drugs, antibiotics, antihypertensive drugs or anticoagulants.
  • Do not use dietary supplements such as protein, carbohydrate, antioxidants, vitamins etc.
  • Free of N-acetylcysteine intolerance.
  • Non-smokers.
  • Abstain from alcohol throughout the study.

Exclusion criteria

  • Presence of asthma, kidney disease, bleeding disorders, peptic ulcers.
  • Musculoskeletal injuries and limitations.
  • Dietary energy restriction.
  • Use of anti-inflammatory drugs, antibiotics, antihypertensive drugs or anticoagulants.
  • Use of dietary supplements such as protein, carbohydrate, antioxidants, vitamins etc.
  • N-acetylcysteine intolerance.
  • Smoking.
  • Alcohol consumption during the study.

Treatment and study plan

Placebo

Dietary Supplement

Participants will receive three servings of carbohydrate per day during the 4-day experimental period. In specific, they will be supplemented with 0.31 gr of maltodextrin per kg of body weight in the first two servings (at mid-morning and mid-afternoon supplements) and with 0.49 gr of maltodextrin per kg of body weight in the pre-sleep serving (1.1 gr maltodextrin/kg BW/day).

NAC

Dietary Supplement

Participants will receive three servings of N-acetylcysteine per day during the 4-day experimental period. In specific, they will be supplemented with 13.33 mg of N-acetylcysteine per kg of body weight per serving (40 mg NAC/kg BW/day).

NAC + Whey Protein

Dietary Supplement

Participants will receive three servings of N-acetylcysteine + whey protein per day during the 4-day experimental period. In specific, they will be supplemented with 0.31 gr of whey protein and 13.33 mg of N-acetylcysteine per kg of body weight in the first two servings (at mid-morning and mid-afternoon supplements) and with 0.49 gr of whey protein and 13.33 mg of N-acetylcysteine per kg of body weight in the pre-sleep serving (1.1 gr Whey protein + 40 mg NAC /kg BW/day).

Primary outcomes

  1. Change in maximal voluntary isometric muscle contraction.

    Time frame: Before exercise and at 1-, 2-, 3-, 24-, 48- and 72-hours post-exercise.

    Maximal voluntary isometric muscle contraction will be assessed on an isokinetic dynamometer.

  2. Change in countermovement jump height.

    Time frame: Before exercise and at 1-, 2-, 3-, 24-, 48- and 72-hours post-exercise.

    Countermovement jump height will be assessed by using the Optojump Next system.

  3. Change in delayed onset of muscle soreness (DOMS)

    Time frame: Before exercise and at 1-, 2-, 3-, 24-, 48- and 72-hours post-exercise.

    DOMS of the knee extensors of the dominant limb will be evaluated by palpation of the relaxed muscle's belly and distal region with participants rating the perceived soreness on a visual analogue scale ranging from 1 to 10.

  4. Change in reduced glutathione content.

    Time frame: Before exercise and at 24-, 48- and 72-hours post-exercise.

    Reduced glutathione content in blood erythrocytes will be assessed using spectrophometric method.

  5. Change in oxidized glutathione content.

    Time frame: Before exercise and at 24-, 48- and 72-hours post-exercise.

    Oxidized glutathione content in blood erythrocytes will be assessed using spectrophometric method.

  6. Change in catalase activity.

    Time frame: Before exercise and at 24-, 48- and 72-hours post-exercise.

    Catalase activity will be measured spectrophotometrically in red blood cells.

  7. Change in protein carbonyl concentration

    Time frame: Before exercise and at 24-, 48- and 72-hours post-exercise.

    Protein carbonyl concentration will be measured spectrophotometrically in red blood cells.

  8. Change in myoglobin concentration in blood.

    Time frame: Before exercise and at 24-, 48- and 72-hours post-exercise.

    Myoglobin concentration in blood will be assessed using an automatic biochemistry analyzer and commercially available kits.

Secondary outcomes

  1. Participants' lean body mass

    Time frame: At baseline.

    Lean body mass (kg) will be assessed using dual-energy X-ray absorptiometry (DXA) instrumentation.

  2. Participants' daily physical activity-related energy expenditure.

    Time frame: At baseline.

    Physical activity-related energy expenditure (kcal/day) will be assessed using accelerometers.

  3. Participants daily dietary intake.

    Time frame: At baseline.

    Daily dietary intake composition (total kcal/day, gr of protein, gr of CHO and gr of fat intake/day, gr/mg of micronutrient intake/day) will be monitored using 24-h dietary recalls that will be analyzed by a trained dietitian using a dietary analysis software.

  4. Participants' resting metabolic rate.

    Time frame: At baseline.

    Resting metabolic rate will be assessed using indirect calorimetry.

  5. Participants' cardiorespiratory fitness status.

    Time frame: At baseline.

    Cardiorespiratory fitness will be assessed using a treadmill ramp test.

  6. Participants' fat free mass.

    Time frame: At baseline.

    Fat free mass will be assessed using dual-energy X-ray absorptiometry (DXA) instrumentation.

  7. Participants' fat mass.

    Time frame: At baseline.

    Fat mass will be assessed using dual-energy X-ray absorptiometry (DXA) instrumentation.

  8. Participants' body fat percent.

    Time frame: At baseline.

    Body fat percent (%) will be assessed using dual-energy X-ray absorptiometry (DXA) instrumentation.

Study contacts

Contact information is provided by the study sponsor or research team.

Dimitrios Draganidis, PhD

CONTACT

[email protected]

+30 2431047078

Ioannis G Fatouros, PhD

CONTACT

[email protected]

+302431047047

Sponsors and collaborators

Lead sponsor

University of Thessaly

Other

Registry information

Official study title

Effects of Whey Protein and N-acetylcysteine Co-ingestion on Skeletal Muscle Recovery Following Exercise-induced Muscle Damage.

Acronym: PRoNAC

Important dates

Study start
2024
Primary completion
2025
Study completion
2025
First posted
Apr 16, 2024
Registry last updated
Jun 4, 2025

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.