Introduction
Regular physical exercise is proven to increase endurance. Adequate nutrition accompanied by an optimal recovery phase can keep the body healthy and avoid sustained physical injury. Physical exercise has been shown to closely manage oxidative stress, a process that involves an rise in reactive nitrogen species (RNS) and reactive oxygen species (ROS). Exercise intensity, duration, and state of health of these individuals influence the level of oxidative stress induced by exercise, and can even have a positive or negative impact on human survival. The increase of ROS during exercise is widely studied and reportedly appears to be interrelated with the pathology of several illnesses, including alzheimer's disease, atherosclerosis, and metabolic syndrome. Furthermore, oxidative stress levels have the ability to precipitate a number of chronic illnesses, including infections, cancer, neurological illnesses, and cardiovascular illnesses. Overproduction of ROS can result in changes in cell structure and function causing chronic degenerative diseases and aging disease pathology.
We already know from research reports that antioxidants can help reduce oxidative stress and can improve health, especially in the heart. Increasing antioxidants has demonstrated the ability to lessen the negative consequences of oxidative stress. During aerobic exercise, increased contractile activity raises oxygen consumption. This can lead to electron leakage from mitochondria, which in turn increases ROS production. In this case, if free radical production outpaces the body's antioxidant capacity, it can be detrimental, leading to cellular damage and muscle dysfunction. Although ROS are known to be bad and can damage cells, the presence of ROS also contributes significantly to the improvement of other cellular defense processes including the antioxidant defense system.
Vitamin C, sometimes referred to as ascorbic acid, is a popular and powerful antioxidant that scavenges free radicals. In addition, ascorbic acid can also protect cell membranes and DNA from oxidative stress damage. Ascorbic acid has protective characteristics that allow it to interact with free oxygen ions, superoxide ions, and hydroxyl ions while inhibiting inflammation. The results of the research report prove that antioxidant levels in the body have increased after 1000 mg ascorbic acid supplementation and cycling physical exercise intervention, in addition to preventing and reducing muscle damage triggered by sports training. Likewise, other studies have shown a decrease in malondialdehyde levels in research subjects given 1000 mg ascorbic acid intervention and aerobic physical exercise intervention.
However, there is very little discussion about ascorbic acid during physical exercise, and a detailed explanation of how ascorbic acid reduces malondialdehyde levels is still confusing among researchers. There is other evidence that ascorbic acid can not only reduce MDA levels during exercise, but can also boost the immune system in healthy individuals. Therefore, the objective of this review is to discuss how the effect of ascorbic acid in lowering malondialdehyde levels, one of the oxidative stress biomarkers, during physical activity.
Materials and methods
Study Design
A systematic review, which evaluates scientific papers according to criteria set by the researchers, was the strategy employed in this investigation. To choose articles about how ascorbic acid lowers MDA levels following physical activity, the scientific literature was examined. The search engines Web of Science, Pubmed, Science Direct, and Scopus were used to locate the scientific literature. MDA levels, physical activity, and ascorbic acid were the search phrases used. Publications were chosen based on the following inclusion criteria: year of publication, experimental investigations, and human and animal-related literature.
Eligibility criteria
Study inclusion criteria were established by examining current databases for information released between 2015 and 2025. An experimental research of the impact of ascorbic acid supplementation following physical activity on MDA levels was part of this study. MDA levels, physical activity, and ascorbic acid were among the search phrases used. Additionally, papers that did not fit the criteria for scientific validity or that were not listed in reputable search engines such as Scopus, Web of Science, PubMed, or Science Direct were not included in our analysis. As a result, we used our predetermined inclusion criteria to screen the chosen papers.
Procedure
Each publication's complete text, abstract, and title were added to the Mendeley database following review and verification. Using Scopus, Science Direct, Pubmed, and Web of Science, 127 papers were found during the initial screening stage. 76 appropriate papers were chosen for the second screening stage after duplicate articles were found and the reasons behind title mismatches were addressed. 43 papers were selected for the next stage based on the concordance of the title, abstract, and keywords analyzed. After going over each paper, we come to the following conclusions: the study had to be experimental, the parameter had to be the MDA biomarker, the intervention had to be physical exercise, and both human and animal samples had to be used. This was the last phase of the process. We carried out a screening procedure to find papers that satisfied our predefined inclusion criteria. Following a rigorous review and scrutiny procedure, eight papers that satisfied the inclusion criteria were chosen for study. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria were adhered to in this study. This study looked at earlier studies that met bioethical and ethical standards.
Results
Discussion
Physical exercise increases ROS (reactive oxygen species)
Cell damage is triggered by an increase in ROS levels in the body. ROS increases one of which is caused by exercise. It is evident that the pathophysiology of diabetes mellitus, cancer, cardiovascular disease, hypertension, and a number of neurological illnesses is linked to persistent oxidative damage. Other reports suggest that regular exercise provides significant health benefits through blood sugar regulation and cardiovascular health in the general population. It is evident that regular physical exercise proves to have a lower risk of cardiovascular disease. ROS during exercise is a physiological response caused by exercise. However, if high ROS exceeds the antioxidant capacity, it will also adversely affect health. The adverse effects of high ROS include alterations to lipids, proteins, and nucleic acids.
When the level of oxidative stress surpasses the protective capacity in the body, it will result in cell damage and lipid peroxidation. Additionally, redox imbalance has a strong correlation with a number of illnesses, including aging and cancer. There is an increase in oxygen during activity demand by active muscles due to acute exercise causing an increase in oxygen consumption concentration and mitochondrial activity, which consequently increases the synthesis of reactive oxygen species (ROS), including superoxide radicals (O2-), which causes oxidative stress. Recent research reports have shown that low- or moderate-intensity exercise can cause oxidative stress, the failure of the antioxidant defense system is the main mediator of exercise-induced oxidative stress. The findings of 25 Wistar rats were studied who were given a high-intensity physical exercise intervention with swimming 1 hour per day, 5x a week for 8 weeks said that MDA levels increased after physical exercise The results of other studies also prove that there is an increase in MDA levels when subjects are given a physical exercise intervention of 2400 m for 12 minutes. It is evident that MDA increases during physical exercise.
Ascorbic Acid During Physical Training Lowers Malondialdehyde Levels
The results prove that ascorbic acid 1000 mg supplementation supplied to 19 women with moderate level of intensity physical exercise intervention for 30 minutes is proven to reduce MDA levels as one of the markers of oxidative damage. The outcomes of further studies are also the same that 1000 mg ascorbic acid supplementation is proven to reduce MDA levels after physical exercise using an ergocycle. The results of another study comparing supplementing with 1000 mg of ascorbic acid and a dose of 500 mg during physical exercise showed that a dose of 1000 mg lowered MDA levels than 500 mg. The results of various studies prove that by exercising it will make the body healthier by improving physical fitness, cardiorespiratory, heart health, muscle and bone strength, cardiometabolic health. Furthermore, a research revealed that ascorbic acid administration effectively decreased exercise-induced lipid peroxidation and that MDA levels increased considerably immediately following physical activity. These outcomes also support earlier research showing ascorbic acid may be used as a treatment to reduce ROS production and boost the body's antioxidant capacity.
Increasing the antioxidant capacity in the body is essential for protection against lipid damage. It is known that lipid damage can lead to serious health problems related to increased chronic inflammation and cardiovascular disease. If the body's antioxidant reserves aren't enough to combat free radicals, exogenous antioxidants are needed in an effort to reduce the adverse effects of free radicals. Ascorbic acid is an important cellular antioxidant that is responsible for detoxifying free radicals and scavenging ROS. The results of various studies show that ascorbic acid contains antioxidants and provides a protective impact against oxidative stress-related diseases. When the human body performs heavy physical exercise, it will also have an adverse effect on the body and will also increase physical fatigue if not balanced with a good recovery process. Research has shown that supplementation with ascorbic acid protects the body and alleviates fatigue. Furthermore, ascorbic acid is listed as an effective and essential medicine published by the World Health Organization. Its main function is to protect cellular cells from oxidative stress triggered by ROS.
The results of the study in rats given 500 mg ascorbic acid intervention and given physical exercise for 60 minutes on a treadmill demonstrated that there a significant reduction in MDA concentrations. The results of other studies in rats given ascorbic acid intervention and physical exercise also prove the same thing, namely a decrease in MDA levels after physical exercise. So, it can be proven that ascorbic acid supplementation during physical exercise has a protective effort and can reduce MDA levels as one of the signs of oxidative stress brought on by physical activity. A significant reduction in MDA levels also occurred in athletes who had been given ascorbic acid intervention and physical exercise until they experienced fatigue. There is confusion and it is still unclear how protective ascorbic acid is in reducing MDA levels during exercise and what the underlying theory is. For future research, the topic of ascorbic acid is an interesting one to discuss as it has been shown to have strong antioxidant properties. This could be a recommendation especially for athletes to consume ascorbic acid supplements for muscle recovery.
Results Other studies also support the data that supplementation of ascorbic acid supplementation of 1,000 mg/day consistently for several weeks proved to be able to result in rehabilitation of muscular strength and a decrease in discomfort in males who are not trained who performed 90 minutes of running physical exercise. Ascorbic acid in its efforts to counteract free radicals is by donating electrons, so that ROS become more neutral and unreactive which can trigger lipid peroxidation and cell damage. But, of course in this systematic review there are still limitations in the analysis, namely only looking at how ascorbic acid as an endogenous antioxidant has a remarkable effect in reducing MDA levels during exercise. During physical exercise, it is known that ROS increases and this can have an impact on lipid peroxidation. However, it should also be noted that the increase in MDA levels during physical exercise is also a physiological response caused by physical training. For further research, it is necessary to study in depth how the molecular response of ascorbic acid in reducing MDA after physical exercise so that it can provide understanding to the public and academics related to the importance of ascorbic acid supplementation as an effort to protect cells from oxidative stress during exercise.
Conclusions
Ascorbic acid supplementation has been shown to reduce malondialdehyde levels after exercise in both humans and animals. However, further testing with specific human subjects and experimental studies are needed to confirm the potential effect of ascorbic acid in reducing MDA levels, a marker of oxidative stress.
References
[1]
de Lira CAB. Maximizing Endurance: Exercise Physiology’s Role in Elevating Athletic Performance. Health Nexus. 2023;1(3):1-6. https://doi.org/10.61838/kman.hn.1.3.1
[2]
Meng Q, Su C-H. The Impact of Physical Exercise on Oxidative and Nitrosative Stress: Balancing the Benefits and Risks. Antioxidants. 2024; 13(5):573. https://doi.org/10.3390/antiox13050573
[3]
Lu Z, Xu Y, Song Y, Bíró I, Gu Y. A Mixed Comparisons of Different Intensities and Types of Physical Exercise in Patients With Diseases Related to Oxidative Stress: A Systematic Review and Network Meta-Analysis. Frontiers in physiology. 2021;12:700055. https://doi.org/10.3389/fphys.2021.700055
[4]
Kıran T, Otlu O, Karabulut A. Oxidative stress and antioxidants in health and disease. Journal of Laboratory Medicine. 2023;47(1):1-11. https://doi.org/10.1515/labmed-2022-0108
[5]
Verhaegen D, Smits K, Osório N, Caseiro A. Oxidative Stress in Relation to Aging and Exercise. Encyclopedia. 2022; 2(3):1545-1558. https://doi.org/10.3390/encyclopedia2030105
[6]
Leyane TS, Jere SW, Houreld NN. Oxidative Stress in Ageing and Chronic Degenerative Pathologies: Molecular Mechanisms Involved in Counteracting Oxidative Stress and Chronic Inflammation. International Journal of Molecular Sciences. 2022;23(13):7273. https://doi.org/10.3390/ijms23137273
[7]
Islam M. The Significance of Nitrosative Pressure in Underlying Pathophysiology and The Pharmacologic Therapy of Non-Communicable Disease with Fessional and Antioxidant Potential. Advances in Neurology and Neuroscience. 2022;5(1):17-34. https://doi.org/10.33140/an.05.01.04
[8]
Panda P, Verma HK, Lakkakula S, et al. Biomarkers of Oxidative Stress Tethered to Cardiovascular Diseases. Oxidative Medicine and Cellular Longevity. 2022;2022:9154295. https://doi.org/10.1155/2022/9154295
[9]
Espinosa A, Casas M, Jaimovich E. Energy (and Reactive Oxygen Species Generation) Saving Distribution of Mitochondria for the Activation of ATP Production in Skeletal Muscle. Antioxidants. 2023; 12(8):1624. https://doi.org/10.3390/antiox12081624
[10]
Zhou Z, Chen C, Teo E-C, Zhang Y, Huang J, Xu Y, Gu Y. Intracellular Oxidative Stress Induced by Physical Exercise in Adults: Systematic Review and Meta-Analysis. Antioxidants. 2022; 11(9):1751. https://doi.org/10.3390/antiox11091751
[11]
Zulfahmidah Z, and Safei I. The Role of Reactive Oxygen Species in Muscle: Beneficial/Harmful. Green Medical Journal. 2022;4(3):84–92. https://doi.org/10.33096/gmj.v4i3.129
[12]
Ali, A. et al. Potential of ascorbic acid in human health against different diseases: an updated narrative review. International Journal of Food Properties. 2024.27(1);493–515. https://doi.org/10.1080/10942912.2024.2327335
[13]
Kaźmierczak-Barańska J, Boguszewska K, Adamus-Grabicka A, Karwowski BT. Two Faces of Vitamin C—Antioxidative and Pro-Oxidative Agent. Nutrients. 2020;12(5):1501. https://doi.org/10.3390/nu12051501
[14]
Yimcharoen M, Kittikunnathum S, Suknikorn C, et al. Effects of ascorbic acid supplementation on oxidative stress markers in healthy women following a single bout of exercise. Journal of the International Society of Sports Nutrition. 2019;16(1):2. https://doi.org/10.1186/s12970-019-0269-8
[15]
Wibawa JC, Arifin ZM, Herawati L. Ascorbic Acid Drink after Submaximal Physical Activity can Maintain the Superoxide Dismutase Levels in East Java Student Regiment. Indian Journal of Forensic Medicine & Toxicology. 2021;15(3):3383–3392. https://doi.org/10.37506/ijfmt.v15i3.15824
[16]
Bozonet SM, Carr AC. The Role of Physiological Vitamin C Concentrations on Key Functions of Neutrophils Isolated from Healthy Individuals. Nutrients. 2019; 11(6):1363. https://doi.org/10.3390/nu11061363
[17]
Bunpo P, Chatarurk A, Intawong K, Naosuk K, Klangsinsirikul P. Effects of ascorbic acid supplementation on immune status in healthy women following a single bout of exercise. Sport Sciences for Health. 2021;17(3);1-17. https://doi.org/10.1007/s11332-020-00726-3
[18]
Bunpo P, Sirirungsee V, Puangin A. Ascorbic Acid Supplementation and Immune Response in Healthy Women during High-intensity Exercise. The Open Sports Sciences Journal. 2024;17(1);1–11. https://doi.org/10.2174/011875399x302175240427094350
[19]
Boonthongkaew C, Tong-Un T, Kanpetta Y, Chaungchot N, Leelayuwat C, Leelayuwat N. Vitamin C supplementation improves blood pressure and oxidative stress after acute exercise in patients with poorly controlled type 2 diabetes mellitus: A randomized, placebo-controlled, cross-over study. The Chinese Journal of Physiology. 2021;64(1):16-23. https://doi.org/10.4103/cjp.cjp_95_20
[20]
Chaoqun L, Yuqi Z, Shi Z, Zhenghui Y, Li W. A Comparison of the Antioxidant Effects Between Hydrogen Gas Inhalation and Vitamin C Supplementation in Response to a 60-Min Treadmill Exercise in Rat Gastrocnemius Muscle. Frontiers in Physiology. 2021;12:745194. https://doi.org/10.3389/fphys.2021.745194
[21]
Eatemadyboroujeni A, Kargarfard M, Alaei H. Can vitamin C supplementation reverse the effects of exercise training in polluted air on oxidative stress markers? A randomized controlled trial. ARYA Atheroscler. 2021;17(1):1-9. https://doi.org/10.22122/arya.v17i0.2101
[22]
Alves VJ, Barrientos G, Toro Román V, Robles Gil MC, Maynar Mariño M, Muñoz Marín D. Acute effect of a maximum incremental test until exhaustion on malondialdehyde and antioxidant vitamins in plasma and erythrocytes in athletes. Efecto agudo de un test incremental máximo hasta la extenuación sobre el malondialdehídoy las vitaminas antioxidantes en plasma y eritrocitos en atletas. Nutricion hospitalaria. 2021;38(2):374-382. https://doi.org/10.20960/nh.03400
[23]
de Oliveira DCX, Rosa FT, Simões-Ambrósio L, Jordao AA, Deminice R. Antioxidant vitamin supplementation prevents oxidative stress but does not enhance performance in young football athletes. Nutrition. 2019;63-64:29-35. https://doi.org/10.1016/j.nut.2019.01.007
[24]
Cordiano R, Di Gioacchino M, Mangifesta R, Panzera C, Gangemi S, Minciullo PL. Malondialdehyde as a Potential Oxidative Stress Marker for Allergy-Oriented Diseases: An Update. Molecules. 2023; 28(16):5979. https://doi.org/10.3390/molecules28165979
[25]
Kruk J, Aboul-Enein HY, Kładna A, Bowser JE. Oxidative stress in biological systems and its relation with pathophysiological functions: the effect of physical activity on cellular redox homeostasis. Free Radical Research. 2019;53(5):497-521. https://doi.org/10.1080/10715762.2019.1612059
[26]
Almuraikhy S, Doudin A, Domling A, Althani AAJF, Elrayess MA. Molecular regulators of exercise-mediated insulin sensitivity in non-obese individuals. Journal of Cellular and Molecular Medicine. 2024;28(1):e18015. https://doi.org/10.1111/jcmm.18015
[27]
Juan CA, Pérez de la Lastra JM, Plou FJ, Pérez-Lebeña E. The Chemistry of Reactive Oxygen Species (ROS) Revisited: Outlining Their Role in Biological Macromolecules (DNA, Lipids and Proteins) and Induced Pathologies. International Journal of Molecular Sciences. 2021;22(9):4642. https://doi.org/10.3390/ijms22094642
[28]
Forman HJ, Zhang H. Targeting oxidative stress in disease: promise and limitations of antioxidant therapy. Nature Reviews Drug Discovery. 2021;20(9):689-709. https://doi.org/10.1038/s41573-021-00233-1
[29]
Powers SK, Deminice R, Ozdemir M, Yoshihara T, Bomkamp MP, Hyatt H. Exercise-induced oxidative stress: Friend or foe?. Journal of Sport and Health Science. 2020;9(5):415-425. https://doi.org/10.1016/j.jshs.2020.04.001
[30]
Thirupathi A, Wang M, Lin JK, et al. Effect of Different Exercise Modalities on Oxidative Stress: A Systematic Review. BioMed Research International. 2021;2021:1947928. https://doi.org/10.1155/2021/1947928
[31]
Plasay M, Muslimin L. The Effect of Administration of Honey on Physical Activity in Malondialdehyde, Glutathione, and Superoxide Dismutase Blood Levels in Male Rat. Journal of Medicinal and Chemical Sciences. 2024:7(4);590–597. https://doi.org/10.26655/JMCHEMSCI.2024.4.3
[32]
Chaput JP, Willumsen J, Bull F, et al. 2020 WHO guidelines on physical activity and sedentary behaviour for children and adolescents aged 5-17 years: summary of the evidence. The International Journal of Behavioral Nutrition and Physical Activity. 2020;17(1):141. https://doi.org/10.1186/s12966-020-01037-z
[33]
Vona R, Pallotta L, Cappelletti M, Severi C, Matarrese P. The Impact of Oxidative Stress in Human Pathology: Focus on Gastrointestinal Disorders. Antioxidants. 2021; 10(2):201. https://doi.org/10.3390/antiox10020201
[34]
Meščić Macan A, Gazivoda Kraljević T, Raić-Malić S. Therapeutic Perspective of Vitamin C and Its Derivatives. Antioxidants. 2019; 8(8):247. https://doi.org/10.3390/antiox8080247
[35]
Waitzberg DL, Ravacci GR, Raslan M. Desnutrición hospitalaria. Nutr. Hosp. 2020:26(2);254–264. https://doi.org/10.3305/nh.2011.26.2.5070
[36]
Lee E, Park HY, Kim SW, Kim J, Lim K. Vitamin C and glutathione supplementation: a review of their additive effects on exercise performance. Physical Activity and Nutrition. 2023;27(3):36-43. https://doi.org/10.20463/pan.2023.0027
[37]
O’Connor E, Mündel T, Barnes MJ. Nutritional Compounds to Improve Post-Exercise Recovery. Nutrients. 2022; 14(23):5069. https://doi.org/10.3390/nu14235069
[38]
See XZ, Yeo WS, Saptoro A. A comprehensive review and recent advances of vitamin C: Overview, functions, sources, applications, market survey and processes. Chemical Engineering Research and Design. 2024:206(2);108–129. https://doi.org/10.1016/j.cherd.2024.04.048