270

Effect of milk-based carbohydrate-protein

supplement timing on the attenuation of exercise-
induced muscle damage
Emma Cockburn, Emma Stevenson, Philip R. Hayes, Paula Robson-Ansley, and
Glyn Howatson

Abstract: Exercise-induced muscle damage (EIMD) leads to decrements in muscle performance and increases in intramus-
cular enzymes measured in the plasma, and to delayed onset of muscle soreness (DOMS), partly due to the activation of
degradative pathways. It has been shown that milk-based carbohydrate-protein (CHO-P) can limit changes in markers of
EIMD, possibly by attenuating protein degradation and (or) increasing protein synthesis. However, the timing of supple-
mentation has received limited attention, and this may alter the response. This study examined the effects of acute milk-
based CHO-P supplementation timing on the attenuation of EIMD. Four independent matched groups of 8 healthy males
consumed milk-based CHO-P before (PRE), immediately after (POST), or 24 h after (TWENTY-FOUR) muscle-damaging
exercise. Active DOMS, isokinetic muscle performance, reactive strength index (RSI), and creatine kinase (CK) were as-
sessed immediately before and 24, 48, and 72 h after EIMD. POST and TWENTY-FOUR demonstrated a benefit in limit-
ing changes in active DOMS, peak torque, and RSI over 48 h, compared with PRE. PRE showed a possible benefit in
reducing increases in CK over 48 h and limiting changes in other variables over 72 h. Consuming milk-based CHO-P after
muscle-damaging exercise is more beneficial in attenuating decreases in muscle performance and increases in active
DOMS at 48 h than ingestion prior to exercise.
Key words: carbohydrate, protein, milk, muscle damage, DOMS, performance, creatine kinase.
Résumé : Les lésions musculaires suscitées par l’exercice physique (EIMD) sont la source des baisses de performance
musculaire et des augmentations d’enzymes intramusculaires mesurées dans le plasma ainsi que de la douleur musculaire
d’apparition retardée (DOMS) causée en partie par l’activation des voies de dégradation. Des études récentes révèlent que
des suppléments de protéines et de glucides lactés (CHO-P) peuvent limiter les modifications des marqueurs des EIMD
probablement par l’atténuation de la dégradation des protéines ou par l’augmentation de la synthèse des protéines. Néan-
moins, il y a peu d’études sur l’effet du moment de la supplémentation sur ces variables. Cette étude se propose donc
d’analyser les effets immédiats du moment de la supplémentation en CHO-P lactés sur l’atténuation des EIMD. Quatre
groupes indépendants mais appariés de 8 hommes en bonne santé consomment des CHO-P lactés avant (PRE), immédiate-
ment après (POST) et 24 h (TWENTY-FOUR) après l’effort causant des lésions musculaires. On évalue donc la DOMS
active, la performance musculaire isokinétique, l’indice de force réactive (RSI) et l’activité de la créatine kinase (CK) im-
médiatement avant et 24 h, 48 h et 72 h après l’EIMD. La consommation d’un supplément après la fin de l’exercice phy-
sique et 24 h plus tard suscite sur une période de 48 h des gains en matière de DOMS active, de moment de force de
pointe et de RSI comparativement aux valeurs observées avant le début de l’exercice physique. La consommation d’un
supplément avant le début de l’effort suscite un bienfait potentiel en matière de réduction de l’augmentation de l’activité
de la CK sur une période de 48 h et de l’atténuation des modifications des autres variables sur une période de 72 h.
Quarante-huit heures après la fin de l’EIMD, la consommation d’un supplément de CHO-P lactés après un exercice cau-
sant une lésion musculaire est plus profitable en ce qui concerne la diminution de la performance musculaire et l’augmen-
tation de la DOMS active comparativement à la consommation du même supplément avant le début de l’effort.
Mots-clés : sucres, protéines, lait, lésion musculaire, DOMS, performance, créatine kinase.
[Traduit par la Rédaction]

Introduction 2002a, 2002b; Byrne et al. 2004). EIMD is manifested as in-

creases in intramuscular enzyme release into the plasma
Exercise-induced muscle damage (EIMD) is caused by ac- (Sorichter et al. 2001) and the delayed onset of muscle sore-
tivities involving eccentric muscle actions (Byrne and Eston ness (DOMS) (Semark et al. 1999; MacIntyre et al. 2001).

Received 2 November 2009. Accepted 23 February 2010. Published on the NRC Research Press Web site at apnm.nrc.ca on 13 May
2010.
E. Cockburn,1 E. Stevenson, P.R. Hayes, P. Robson-Ansley, and G. Howatson. Department of Sport Sciences, Northumberland
Building, Northumbria University, Newcastle Upon Tyne, NE1 8ST, UK.
1Corresponding author (e-mail: e.cockburn@unn.ac.uk).

Appl. Physiol. Nutr. Metab. 35: 270–277 (2010) doi:10.1139/H10-017 Published by NRC Research Press
Cockburn et al.
Furthermore, there are decrements in muscle performance,
such as strength, peak power output, sprint times, and verti-
cal jump performance (Byrne and Eston 2002a, 2002b;
Twist and Eston 2005; Twist et al. 2008). These measures
decrease over a number of days, peaking between 24 and
72 h.
Many studies have investigated interventions to attenuate
the negative effects of EIMD, including pharmaceutical,
therapeutic, and nutritional methods; these have been exten-
sively reviewed elsewhere (Howatson and van Someren
2008). The use of carbohydrate and protein (CHO-P) con-
sumption has been thoroughly studied (Wojcik et al. 2001;
Saunders et al. 2004, 2007; Cockburn et al. 2008; Baty et
al. 2007; Luden et al. 2007; Green et al. 2008; Valentine et
al. 2008). The results are equivocal, with some studies re-
porting no benefit of CHO-P consumption (Wojcik et al.
2001; Green et al. 2008), and others demonstrating signifi-
cant reductions in markers of muscle damage (Saunders et
al. 2004, 2007; Romano-Ely et al. 2006; Baty et al. 2007;
Luden et al. 2007; Cockburn et al. 2008; Etheridge et al.
2008; Valentine et al. 2008). Many researchers reporting
benefits of CHO-P consumption have derived their conclu-
sions from measures of intramuscular enzymes in the plasma
(creatine kinase (CK) and myoglobin). However, changes in
DOMS and muscle performance are of greater importance to
the athlete. It has previously been shown that consuming
milk-based CHO-P supplements can attenuate decrements in
muscle performance and increases in CK and myoglobin
(Cockburn et al. 2008). EIMD may increase the degradation
of the protein and membrane structures, leading to myofi-
brillar and cytoskeleton disruption and the loss of both con-
tractile protein and cell membrane integrity (Armstrong et
al. 1991; Evans and Cannon 1991; Gissel 2005; Zhang et
al. 2008). The benefit derived from milk-based CHO-P may
come from altered protein balance, resulting from the addi-
tion of protein, which increases amino acid (AA) availability
(Tipton and Wolfe 2001), and CHO, which increases insulin
(Miller et al. 2003). Changes in protein balance may limit
the degradation of protein and membrane structures and, as
a consequence, limit changes in muscle performance and in-
tramuscular enzyme release.
Research demonstrating the beneficial effects of CHO-P
have provided the supplement at different times in muscle-
damaging exercise (before, during, and (or) after); hence,
there is very little consistency in ascertaining the optimal
timing of CHO-P ingestion. The effects of supplement tim-
ing before and following resistance exercise on muscle pro-
tein balance have been researched (Tipton et al. 2001,
2007); consuming essential AAs and CHO prior to exercise
results in greater AA uptake by the muscle, compared with
ingesting them following exercise (Tipton et al. 2001). How-
ever, the response to the timing of whey protein ingestion
was not different between pre- and postexercise consump-
tion (Tipton et al. 2007). The reason for the different find-
ings may be 2-fold. First, CHO increases insulin (Miller et
al. 2003), which has been shown to increase protein synthe-
sis, because of improved AA availability (Biolo et al. 1995),
and to limit myofibrillar breakdown (Roy et al. 1997), but
CHO was not consumed with whey protein (Tipton et al.
2007). Second, whey protein needs to be digested before
AAs are available for protein metabolism; therefore, the
271
time of AA availability may be responsible for the differ-
ence. It is plausible that timing of CHO-P ingestion affects
protein metabolism following muscle-damaging exercise
and, therefore, it may effect changes in intramuscular en-
zyme release, DOMS, and muscle performance.
To date, there has been only 1 study investigating the ef-
fect of timing of CHO-P supplementation (White et al.
2008) on indirect markers of muscle damage. White et al.
(2008) found no effect on the reduction of muscle-damage
indices when comparing a whey protein-CHO supplement
against a control in the 96 h following damaging exercise.
As a consequence, no effect of timing on response was
found, limiting any conclusions that can be drawn. There is
evidence that milk-based CHO-P has a positive impact on
EIMD (Cockburn et al. 2008). However, there are few data
concerning the optimal timing of milk-based CHO-P supple-
mentation in limiting changes in muscle-damage indices.
The aim of this investigation was to examine whether con-
suming milk-based CHO-P before muscle-damaging exer-
cise is more beneficial in attenuating EIMD than consuming
it after.
Materials and methods
Participants
Thirty-two healthy male participants (mean age, 20 ±
2 years; mean height, 180.3 ± 4.8 cm; mean body mass,
78.5 ± 9.0 kg) who regularly competed in a variety of sports
(team and individual) volunteered to take part in the study.
After institutional ethical approval, the experimental proce-
dures and the associated risks and benefits were explained;
the participants then gave their written informed consent.
Participants were fully familiarized with all testing proce-
dures prior to commencing the study, and had no prior expe-
rience in the bout of muscle-damaging exercise. Participants
were instructed to maintain their habitual diet throughout the
study and to record their food intake in the food diary pro-
vided. There were no differences between groups in total en-
ergy intake or macronutrient content of the diets.
Participants were required to arrive at the laboratory in a
rested state, having avoided strenuous physical activity for
at least 48 h and having not taken any nutritional supple-
ments, caffeine, alcohol, or anti-inflammatory drugs. Partici-
pants were tested in the morning to minimize diurnal
variation.
Procedures
Design
Participants were assigned to 1 of 4 independent groups,
which were single blinded. Participants in each group were
equally matched on the basis of concentric knee flexion
peak torque, recorded from 6 knee extension-flexions during
preliminary testing. The participants were allocated into 1 of
4 groups: milk-based CHO-P consumed before muscle-
damaging exercise and water consumed at all other time
points (PRE); milk-based CHO-P consumed immediately
after muscle-damaging exercise and water consumed at all
other time points (POST); milk-based CHO-P consumed
24 h after muscle-damaging exercise and water consumed at
all other time points (TWENTY-FOUR); and water con-
Published by NRC Research Press
272
sumed at all time points (CON). A 1-way analysis of var-
iance (ANOVA) revealed no group differences in baseline
subject characteristics (age, height, and body mass) (p >
0.05). There were no significant differences among groups
in the peak torque values used for group allocation (p >
0.05).
All participants were required to visit the laboratory on 4
consecutive days. Prior to baseline tests, height and body
mass were recorded. On each day prior to any exercise, a
venous blood sample was collected for analysis. Participants
completed a standardized warm-up, consisting of 5 min of
cycling at 60 W on a cycle ergometer (Monark 824 E,
Stockholm, Sweden), carried out isokinetic muscle perform-
ance measures and 3 drop jumps, and completed a visual
analogue scale for active muscle soreness when conducting
knee flexions. Following baseline testing, participants con-
sumed 1000 mL of their allocated supplement within
30 min, and then immediately completed a bout of exercise
designed to induce acute muscle damage. Upon completing
the exercise bout, they immediately consumed 1000 mL of
their allocated supplement within 30 min. At 24 h after
muscle-damaging exercise, participants consumed 1000 mL
of their allocated supplement. At 24, 48, and 72 h after
muscle-damaging exercise, participants repeated baseline
testing.
Nutritional supplement
The milk-based CHO-P supplement (For Goodness
Shakes, My Goodness Ltd, London, UK) had a nutritional
content, per 1000 mL, of 707 kcal, 33.4 g protein, 118.2 g
CHO, and 16.4 g fat. This supplement provided protein in
the form of semi-skimmed milk (casein and whey). Partici-
pants were provided with 1000 mL of this supplement be-
cause previous research has demonstrated that this
supplement and volume results in the significant attenuation
of decreases in isokinetic muscle performance and increases
in CK (Cockburn et al. 2008).
Muscle-damaging exercise
Muscle damage was induced in the hamstrings. Partici-
pants completed 6 sets of 10 repetitions, with 90 s rest be-
tween sets, of unilateral eccentric–concentric knee flexions,
at a speed of 1.05 rad
s–1, using an isokinetic dynamometer
(Cybex Norm, Cybex International, New York, N.Y.). This
was conducted on one side of the body and then repeated
on the contralateral leg. The process took approximately
30 min to complete. Participants were instructed to expend
maximal effort during the eccentric phase of each knee flex-
ion. During the concentric phase, participants were in-
structed to return their leg to the starting position with
minimal effort. This protocol has been previously used and
has been shown to induce significant increases in CK, myo-
globin, and DOMS, and decreases in peak torque and total
work of the set (Cockburn et al. 2008).
DOMS measurement
The degree of active DOMS experienced was measured
on a visual analogue scale. Participants were required to
rate the level of soreness that they perceived to have in their
hamstrings when conducting maximal knee flexions on the
isokinetic dynamometer, from 0 (no pain-soreness) to 10
Appl. Physiol. Nutr. Metab. Vol. 35, 2010
(pain-soreness as bad as it could be). This scale has been
previously used to determine significant increases in muscle
soreness following EIMD (Cockburn et al. 2008).
Measures of muscle performance
Peak torque
Peak torque of the best repetition for 6 concentric
maximal-effort knee flexion repetitions were measured se-
quentially on both legs, at a test speed of 1.05 rad
s–1, using
an isokinetic dynamometer (Cybex Norm, Cybex Interna-
tional). Participants were required to maximally extend and
flex their leg through their maximum range of motion for
6 repetitions. Coefficients of variation for this protocol are
reported to be 4.5% to 4.9%.
Reactive Strength Index
Each participant performed 3 separate drop jumps, from a
height of 43 cm, onto a force plate (AMTI, Watertown,
Mass.). Participants were instructed to drop from the box
and, upon landing, jump for maximum height with minimum
contact time (Young 1995). The reactive Strength Index
(RSI) was calculated as jump height (cm)/contact time (s)
(Young 1995), and the mean of the 3 jumps was used for
analysis. It has been reported that intraclass correlations for
the average RSI of 3 jumps is 0.989 (Flanagan et al. 2008).
Fast RSI is a measure of an athlete’s ability to utilize the
stretch-shortening cycle (Young 1995), and provides a meas-
ure of dynamic muscle actions that can be related to sports
involving running and jumping. Although this does not pro-
vide a measure in which the hamstrings are isolated, the au-
thors wanted to investigate a global picture of performance
that could be applied to a variety of athletes.
Blood sample collection and analysis
Serum CK concentration was determined from blood sam-
ples collected by venipuncture, from a forearm vein, into a
serum gel monovette (4.9 mL). The samples were centri-
fuged at 3000 r
min–1 for 10 min (Alegra X-22 Centrifuge,
Beckman Coulter, Bucks, UK). Of the resulting serum,
30 mL was alliquoted and used for the immediate analysis
of CK (Reflotron Plus System, Bio-Stat, Diagnostic Sys-
tems, Stockport, UK). Intra-assay and interassay coefficients
of variation for CK were 3.5% and 3.7%, respectively.
Data analysis
The current study used statistical analysis that reports un-
certainty of outcomes as 90% confidence intervals (CI),
making probabilistic magnitude-based inferences about the
true value of outcomes, using methods described by Batter-
ham and Hopkins (2006). This is in keeping with recent
trends in methods of inferential statistics (Sterne and Smith
2001; Batterham and Hopkins 2006). This method allows
the emphasis of effect magnitudes and estimate precision,
rather than the traditional null-hypothesis testing based on
an arbitrary p value, which focuses on absolute effect in-
stead of noneffect interpretation (Rowlands et al. 2008) and
does not deal with the real world significance of an outcome
(Batterham and Hopkins 2006). This method defines the
smallest biological or practical effect, allowing the re-
searcher to qualify the probability of a worthwhile effect
with inferential descriptors to aid interpretation (Rowlands
et al. 2008). Magnitude-based inferences recognise sample
Published by NRC Research Press
Cockburn et al. 273

variability (Rowlands et al. 2008), and provide scientists, Table 1. Effect of supplement timing on increases in active muscle
support staff, and athletes with an indication of the practical soreness following muscle-damaging exercise.
meaningfulness of the results. Traditional inferential statis-
tics do not allow for this and can be misleading, depending Mean effect± Qualitative
on the magnitude of statistic, error of measurement, and Comparison 90% CI inference
sample size (Batterham and Hopkins 2006). Change from baseline to 48 h
Each dependent variable was analysed, using a published PRE vs. CON –0.6±1.9 Decrease possible
spreadsheet (Hopkins 2003), to determine the effect of sup- POST vs. CON –1.4±2.4 Decrease likely
plement timing as the difference in the change between each TWENTY-FOUR vs. CON –0.6±2.3 Unclear
group. The analyses of most dependent variables were con- POST vs. PRE –0.8±2.3 Decrease possible
ducted on log-transformed values to overcome heteroscedas- TWENTY-FOUR vs. PRE 0.0±2.2 Unclear
tic error (Nevill and Lane 2007). Muscle soreness data were TWENTY-FOUR vs. POST 0.8±2.6 Unclear
not log-transformed; it is inappropriate because of interval Change from baseline to 72 h
scaling (Nevill and Lane 2007). Participant descriptive data PRE vs. CON –1.2±2.1 Decrease likely
and muscle soreness data are presented as absolute means ± POST vs. CON –0.8±2.7 Unclear
SD. Means derived from the analysis of log-transformed TWENTY-FOUR vs. CON –0.2±2.4 Unclear
variables are back transformed to provide mean percentage POST vs. PRE 0.4±2.2 Unclear
change and percentage SD, except CK values, which are re- TWENTY-FOUR vs. PRE 1.1±1.9 Increase likely
ported as factors because of the large percentage changes TWENTY-FOUR vs. POST 0.6±2.5 Unclear
(Hopkins 2003).
Note: Mean effect refers to the first named group minus the second
To calculate the chances of benefit and harm, the smallest named group. For ±90% CI, add and subtract this number to the mean ef-
worthwhile or important effect for each dependent variable fect to obtain the 90% confidence intervals for the true difference. CON,
was the smallest standardized (Cohen) change in the water consumed at all time points; PRE, milk-based carbohydrate-protein
mean — 0.2 times the between-subject SD for baseline val- (CHO-P) consumed before muscle-damaging exercise and water consumed
at all other time points; POST, milk-based CHO-P consumed immediately
ues of all participants (Batterham and Hopkins 2006) — after muscle-damaging exercise and water consumed at all other time
which has been used in a similar investigation (Rowlands et points; TWENTY-FOUR, milk-based CHO-P consumed 24 h after muscle-
al. 2008). Practical inferences were drawn using the ap- damaging exercise and water consumed at all other time points.
proach identified by Batterham and Hopkins (2006). Quanti-
tative chances of benefit and harm were assessed DOMS, compared with CON and TWENTY-FOUR. All
qualitatively: <1% indicated almost certainly none; 1% to other comparisons were unclear. The p value for the main
5% indicated very unlikely; 5% to 25% indicated unlikely; interaction effect was 0.827. A summary of the statistical
25% to 75% indicated possibly; 75% to 95% indicated analysis is shown in Table 1.
likely; 95% to 99% indicated very likely; and >99% indi-
cated almost certainly (Hopkins 2002). This method pro- Muscle performance
vides a way to qualify clear outcomes with a descriptor that A summary of the statistical analysis is shown in Table 2.
represents the likelihood that the true value will have the ob-
served magnitude (Batterham and Hopkins 2006). They are Peak torque
also free of the burden of type I and II errors because they There was a likely benefit of POST (–7% ± 30%) and
are probabilistic rather than definitive statements (Batterham TWENTY-FOUR (–12% ± 25%) in limiting decreases in
and Hopkins 2006). Because of the large number of compar- peak torque of the dominant leg between baseline and 48 h,
isons that could be reported, we only reported changes from compared with PRE (–22% ± 14%) and CON (–24% ±
baseline to 48 and 72 h. Previous research has shown that 39%). There were no clear effects of CON vs. PRE or
the point at which milk-based CHO-P supplements become POST vs. TWENTY-FOUR. For changes between baseline
beneficial is 48 h after muscle-damaging exercise (Cockburn and 72 h, there was a likely benefit of PRE (–10% ± 16%)
et al. 2008). As this statistical approach is relatively novel, and POST (–6% ± 20%), and a possible benefit of
p values for the main interaction effects (time  group), de- TWENTY-FOUR (–16% ± 24%), in limiting decreases in
termined using a factorial ANOVA with repeated measures peak torque, compared with CON (–27% ± 42%). There
on 1 factor (time), have also been stated. was also a possible benefit of POST, compared with
TWENTY-FOUR (Fig. 1). The p value for the main interac-
Results tion effect was 0.172.
DOMS Reactive Strength Index
All groups showed an increase in active DOMS for both Over the first 48 h, there was a likely benefit of POST
legs. Active muscle soreness peaked at 48 h for all groups (–11% ± 30%), compared with CON (–24% ± 24%) and
and, at 72 h, each group began to return to baseline levels. PRE (–30% ± 32%), in attenuating decreases in RSI.
For changes in active DOMS (dominant) from baseline to TWENTY-FOUR (–7% ± 18%) also demonstrated a likely
48 h, POST had a likely and possible benefit in reducing in- and very likely benefit in attenuating decreases in RSI, com-
creases in soreness, compared with CON and PRE. PRE also pared with CON and PRE, respectively. Again, there were
had a possible beneficial effect in reducing increases in no clear effects of PRE vs. CON or POST vs. TWENTY-
soreness, compared with CON. Between baseline and 72 h, FOUR. Decrements in RSI from baseline to 72 h were likely
PRE had a likely beneficial effect on recovery of active blunted by TWENTY-FOUR (–4% ± 16%), compared with

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274 Appl. Physiol. Nutr. Metab. Vol. 35, 2010

Table 2. Effect of supplement timing on decreases in muscle performance following muscle-damaging

exercise.

Muscle performance Comparison Mean effect±90% CI Qualitative inference

Change from baseline to 48 h
Peak torque (dom) PRE vs. CON 2.0±26 Unclear
POST vs. CON 22±30 Increase likely
TWENTY-FOUR vs. CON 16±28 Increase likely
POST vs. PRE 20±21 Increase likely
TWENTY-FOUR vs. PRE 14±18 Increase likely
TWENTY-FOUR vs. POST –5±24 Unclear
RSI PRE vs. CON –8±25 Unclear
POST vs. CON 17±24 Increase likely
TWENTY-FOUR vs. CON 22±19 Increase likely
POST vs. PRE 26±27 Increase likely
TWENTY-FOUR vs. PRE 32±23 Increase very likely
TWENTY-FOUR vs. POST 3±21 Unclear
Change from baseline to 72 h
Peak torque (dom) PRE vs. CON 24±28 Increase likely
POST vs. CON 29±29 Increase likely
TWENTY-FOUR vs. CON 16±30 Increase possible
POST vs. PRE 4±16 Unclear
TWENTY-FOUR vs. PRE –7±18 Unclear
TWENTY-FOUR vs. POST –11±19 Decrease possible
RSI PRE vs. CON –13±31 Decrease possible
POST vs. CON 8±27 Unclear
TWENTY-FOUR vs. CON 17±19 Increase likely
POST vs. PRE 25±35 Increase likely
TWENTY-FOUR vs. PRE 35±29 Increase likely
TWENTY-FOUR vs. POST 8±25 Unclear
Note: Mean effect refers to the first named group minus the second named group. For ± 90% CI, add and subtract
this number to the mean effect to obtain the 90% confidence intervals for the true difference. CON, water consumed
at all time points; dom, dominant limb; PRE, milk-based carbohydrate-protein (CHO-P) consumed before muscle-
damaging exercise and water consumed at all other time points; POST, milk-based CHO-P consumed immediately
after muscle-damaging exercise and water consumed at all other time points; RSI, reactive strength index;
TWENTY-FOUR, milk-based CHO-P consumed 24 h after muscle-damaging exercise and water consumed at all
other time points.

CON (–18% ± 25%) and PRE (–29% ± 43%), and by POST
(–11% ± 36%), compared with PRE. There was also a pos-
sible harmful effect of PRE, compared with CON (Fig. 2).
The p value for the main interaction effect was 0.218.
Creatine kinase
Mean baseline CK values for each group were 154 U
L–1,
307 U
L–1, 218 U
L–1, and 220 U
L–1 for CON, PRE, POST,
and TWENTY-FOUR, respectively. There was a likely ben-
efit of both POST (6.31 /7 3.06) and TWENTY-FOUR
(5.00 /7 7.62), compared with CON (16.48 /7 7.43),
in blunting increases in CK between baseline and 48 h.
There was also a possible benefit of PRE (7.54 /7 5.16)
in blunting increases in CK, compared with CON. All other
comparisons were unclear. Between baseline and 72 h, there
was a possible benefit of both POST (12.55 /7 3.59) and
PRE (9.89 /7 7.05) in recovery of CK, compared with
CON (21.49 /7 7.51). There was no clear benefit of
TWENTY-FOUR (14.64 /7 10.76) over CON (Table 3).
The p value for the main interaction effect was 0.832.
Only the results for the dominant leg have been presented
because, following analysis, similar responses in both legs
were evident.
Discussion
This study investigated whether consuming milk-based
CHO-P before muscle-damaging exercise is more beneficial
in limiting changes in indices of EIMD than consumption
immediately and (or) 24 h after. The primary finding of the
study was that consumption of a milk-based CHO-P supple-
ment following muscle-damaging exercise was beneficial in
blunting increases in active DOMS and decreases in muscle
performance over 48 h, compared with pre-exercise supple-
mentation. Over 72 h, pre-exercise supplementation was
more beneficial in limiting changes in active DOMS and
peak torque, compared with a control. Finally, consuming
milk-based CHO-P at any time point was beneficial in at-
tenuating increases in CK activity, compared with a control.
Previous studies (Saunders et al. 2004; Romano-Ely et al.
2006; Baty et al. 2007; Saunders et al. 2007; Cockburn et al.
2008; Etheridge et al. 2008; Valentine et al. 2008) have
shown that the consumption of a CHO-P supplement before,
during, and (or) after exercise, leading to changes in indices
of muscle damage, attenuates those markers. The current
study provides support for the use of CHO-P supplements
for the attenuation of EIMD. We speculate that the reason

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Cockburn et al. 275

Fig. 1. Relative peak torque of the dominant leg in response to Table 3. Effect of supplement timing on increases in creatine ki-
exercise-induced muscle damage in the CON (n = 8), PRE (n = 8), nase (CK) following muscle-damaging exercise.
POST (n = 8), and TWENTY-FOUR (n = 8) groups. Data are pre-
sented as means. PRE, milk-based carbohydrate-protein (CHO-P) SD as /7 Qualitative
consumed before muscle-damaging exercise and water consumed at Comparison factor inference
all other time points; POST, milk-based CHO-P consumed immedi- Change in CK from baseline to 48 h
ately after muscle-damaging exercise and water consumed at all PRE vs. CON –1.54/76.53 Possible decrease
other time points; TWENTY-FOUR, milk-based CHO-P consumed POST vs. CON –1.62/75.57 Likely decrease
24 h after muscle-damaging exercise and water consumed at all TWENTY-FOUR vs. CON –1.70/77.59 Likely decrease
other time points; CON, water consumed at all time points. POST vs. PRE –1.16/73.79 Unclear
TWENTY-FOUR vs. PRE –1.34/75.87 Unclear
TWENTY-FOUR vs. –1.21/74.87 Unclear
POST
Change in CK from baseline to 72 h
PRE vs. CON –1.54/77.39 Possible decrease
POST vs. CON –1.42/75.87 Possible decrease
TWENTY-FOUR vs. CON –1.32/79.05 Unclear
POST vs. PRE 1.30/74.80 Unclear
TWENTY-FOUR vs. PRE 1.48/78.04 Unclear
TWENTY-FOUR vs. 1.17/76.45 Unclear
POST
Note: CON, water consumed at all time points; PRE, milk-based
carbohydrate-protein (CHO-P) consumed before muscle-damaging exercise
and water consumed at all other time points; POST, milk-based CHO-P
consumed immediately after muscle-damaging exercise and water con-
sumed at all other time points; TWENTY-FOUR, milk-based CHO-P con-
sumed 24 h after muscle-damaging exercise and water consumed at all
other time points.

Fig. 2. Relative Reactive Strength Index in response to exercise-

induced muscle damage in the CON (n = 8), PRE (n = 8), POST
(n = 8), and TWENTY-FOUR (n = 7) groups. Data are presented as
means. PRE, milk-based carbohydrate-protein (CHO-P) consumed
before muscle-damaging exercise and water consumed at all other
time points; POST, milk-based CHO-P consumed immediately after
muscle-damaging exercise and water consumed at all other time
points; TWENTY-FOUR, milk-based CHO-P consumed 24 h after
muscle-damaging exercise and water consumed at all other time
points; CON, water consumed at all time points.
for this blunting is that the provision of CHO and protein im-
proves muscle protein balance by increasing synthesis and
(or) limiting increases in degradation. This may lead to better
maintenance of the cytoskeleton and blunting of contractile
protein loss, reducing changes in indices of muscle damage.
The current study demonstrated a benefit in consuming
milk-based CHO-P after muscle-damaging exercise on peak
torque, RSI, and active DOMS. Consuming milk-based
CHO-P after exercise reduced the impact of muscle damage,
possibly by replacing AAs lost to the increases in protein
degradation, as previously reported (Lowe et al. 1995). In
turn, this may limit ultrastructural damage and result in the
observed effect on the measured variables. Previous research
has demonstrated that milk ingestion after resistance exer-
cise results in a positive net muscle protein balance (Elliot
et al. 2006). It is possible that consuming milk-based
CHO-P 24 h after exercise has a positive effect, because
protein degradation rates start to increase at 24 h (Lowe et
al. 1995; Wojcik et al. 2001) and peak at 48 h (Lowe et al.
1995) following damaging exercise, and protein synthesis
rates remain below baseline (Lowe et al. 1995). Therefore,
consuming milk at a time point when the secondary phase
is responsible for changes in EIMD indices, rather than the
initial mechanical event, may allow the actions of CHO and
protein to coincide with changes in protein balance. How-
ever, this hypothesis has yet to be investigated.
Consuming CHO-P before muscle-damaging exercise was
not beneficial in reducing increases in active DOMS and de-
creases in muscle performance up to 48 h; responses were
similar to the control group. The reason for this may be
linked to the availability of nutrients when they are required.
To promote changes in protein metabolism within the
muscle, a change in the intracellular pool of AAs must oc-
cur. The process of whole protein intake to increased avail-
ability of AAs involves gastric emptying, which could
indirectly effect the rate of AA intestinal absorption (Gary

Published by NRC Research Press

276
1991), and thus the availability of AAs. The gastric empty-
ing half-time for a milk protein solution has been shown to
be 26 min (Calbet and MacLean 1997). Our muscle-
damaging exercise lasted approximately 30 min, which may
mean that pre-exercise ingestion provides AAs at a time
when mechanical factors influence changes in EIMD indi-
ces. By providing milk-based CHO-protein following exer-
cise, it is possible that AAs are available at a time when the
proteolytic pathways are activated; thus, the nutrients are
available at the time when they are required to influence
the response. It is acknowledged that the exercise bout may
have delayed gastric emptying. Previous research has dem-
onstrated an increase in gastric emptying half-time of a
CHO solution during intermittent high-intensity exercise,
compared with rest (Leiper et al. 2001). Over 72 h, pre-
exercise ingestion of milk-based CHO-P was possibly bene-
ficial in limiting changes in EIMD. However, values at this
time point remained below both the POST and TWENTY-
FOUR groups. It is not known why consumption before
exercise had this effect; this area needs to be researched fur-
ther. Last, over 48 h, milk-based CHO-P ingestion before
exercise had a possible benefit in blunting increases in CK.
The proteolytic pathways responsible for membrane damage
(hence, increased CK in serum), and contractile protein loss
and cytoskeletal disruption (decreased muscle performance)
are not the same, which may explain the different responses.
We have demonstrated that consuming milk-based CHO-P
immediately or 24 h after muscle-damaging exercise can
limit decreases in isokinetic peak torque and dynamic
muscle performance (RSI), which may be of practical bene-
fit to the athlete. Furthermore, increases in active DOMS
were reduced with the consumption of the supplement after
muscle-damaging exercise. We propose that athletes with
EIMD can, therefore, limit performance decrements in the
days following muscle-damaging exercise by consuming
milk-based CHO-P after exercise. Although pre-exercise in-
gestion may be beneficial over 72 h, this is of limited bene-
fit to athletes who train more frequently than every 3 days.
Therefore, we suggest that athletes consume milk-based
CHO-P immediately following training or competition to
limit the negative impact of EIMD on performance. This is
especially applicable to athletes starting a new training pro-
gram or increasing the intensity of training that involves a
high component of eccentric muscle actions. The benefits
would allow athletes to train at closer to optimal levels 48 h
after the damaging bout of exercise. This is important, as
athletes must maintain their ability to train frequently. This
is in agreement with previous findings (Cockburn et al.
2008), but the novel outcome of our study is the benefit to
stretch-shortening cycle exercise.
We conclude from our findings that milk-based CHO-P
consumed immediately or 24 h after muscle-damaging exer-
cise may hasten recovery at 72 h. The exact mechanisms are
unclear, but may be due to limiting increases in protein deg-
radation and stimulating protein synthesis; more research is
required to examine this theory. One limitation of this study
was the lack of a placebo with equicaloric content, making
it difficult to conclude that the benefits of milk-based
CHO-P were not due to additional calories. Therefore, future
studies should provide treatments matched for calories.
Appl. Physiol. Nutr. Metab. Vol. 35, 2010
Acknowledgements
My Goodness Ltd. provided the milk-based protein-CHO
product and contributed to consumable costs.
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