Efeitos da Punica granatum L. (romã) na saúde cardiovascular e cardiorrespiratória de indivíduos saudáveis praticantes de exercício físico aeróbico: revisão sistemática de estudos controlados aleatorizados e não aleatorizados

Abstract

Introduction: Punica granatum L. (PG) has been investigated in practitioners of various types of exercise due to its polyphenolic content with antioxidant capacity, promoting improved aerobic fitness and suggesting an ergogenic effect on performance. Objective: To investigate the effects of PG consumption on cardiovascular and cardiorespiratory health in healthy adults practicing aerobic exercise. Methods: A systematic review of randomized and non-randomized controlled trials was conducted in five databases (Cochrane (Central), PubMed, Scopus, SPORTDiscus, Web of Science) and a manual search for studies by May 10, 2020. Studies were included where subjects were 18 years or older, received pomegranate juice or capsule (pulp) intervention, and performed aerobic exercise testing. Studies were excluded when the population had pathologies of any kind, were sedentary, received intervention from parts of the fruit other than the pulp, and met the inclusion criteria, but had other outcomes investigated The primary outcomes encompassed oxygen consumption (O2); maximum oxygen consumption (VO2max), blood pressure (BP) and heart rate (HR). There were no language or date restrictions. Evidence was synthesized by means of mean difference. The risk of bias was assessed by ROB 2 and ROBINS-I tools. This systematic review was registered on the PROSPERO platform - CRD42020173612. Results: Of 10,094 records, 5 met the eligibility criteria. The total sample resulted in 73 participants (59 men and 14 women) with a mean age between 17.5 and 37 (27,25 ± 11) years, most being amateur or elite cyclists. PG was administered orally in capsule or juice, in doses ranging from 750 to 1350mg and 20 to 1000 mL, respectively, and the exercise protocol ranged from progressive testing (up to 100% of VO2max) to blocks of 5- to 6-second repeated sprints. Only VO2 (three interventions, 46 participants) had a significant result, and in only one study (-2.1 ml-min-1 - kg-1 , CI = 95% [-2.8 -0.23]; p < 0.04). Discussion: The studies had a high risk of bias and small sample size, and the treatment time was acute, factors that probably contributed to the lack of significant results. Conclusion: There were no significant effects for improvement of cardiovascular and cardiorespiratory outcomes in healthy adults practicing aerobic exercise supplemented with PG extract. The clinical evidence to date is insufficient and future studies with more robust designs, low risk of bias, and larger sample sizes are needed to clarify the role of PG as an ergogenic resource in aerobic exercisers.