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Protein supplementation augments the adaptive response of skeletal muscle to resistance-type exercise training: a meta-analysis
Open accessAbstract
Background Protein ingestion after a single bout of resistance-type exercise stimulates net muscle protein accretion during acute postexercise recovery. Consequently, it is generally accepted that protein supplementation is required to maximize the adaptive response of the skeletal muscle to prolonged resistance-type exercise training. However, there is much discrepancy in the literature regarding the proposed benefits of protein supplementation during prolonged resistance-type exercise training in younger and older populations.Objective The objective of the study was to define the efficacy of protein supplementation to augment the adaptive response of the skeletal muscle to prolonged resistance-type exercise training in younger and older populations.Design A systematic review of interventional evidence was performed through the use of a random-effects meta-analysis model. Data from the outcome variables fat-free mass (FFM), fat mass, type I and II muscle fiber cross-sectional area, and 1 repetition maximum (1-RM) leg press strength were collected from randomized controlled trials (RCTs) investigating the effect of dietary protein supplementation during prolonged (>6 wk) resistance-type exercise training.Results Data were included from 22 RCTs that included 680 subjects. Protein supplementation showed a positive effect for FFM (weighted mean difference: 0.69 kg; 95% CI: 0.47, 0.91 kg; P < 0.00001) and 1-RM leg press strength (weighted mean difference: 13.5 kg; 95% CI: 6.4, 20.7 kg; P < 0.005) compared with a placebo after prolonged resistance-type exercise training in younger and older subjects.Conclusion Protein supplementation increases muscle mass and strength gains during prolonged resistance-type exercise training in both younger and older subjects.
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“The insertion of clinical trials testing multi‐ingredient supplements, 106 including energy‐restricted weight‐loss diets, 13 or using different cut‐off points for age sub‐groups likely explain the differences in main effects and conclusions when comparing studies. 14 , 21 , 22 , 23”
From Systematic review and meta-analysis of protein intake to support muscle mass and function in healthy adults (2022) · cites this paper as [23]
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In the citing paper
“This question is relevant as protein supplementation rarely substantially affects strength outcomes, 14 , 21 , 22 , 23 which highlights that the extra LBM gain stimulated by protein supplementation may not be muscle, 111 or at least not sufficient muscle that is contributing to increases in strength.”
From Systematic review and meta-analysis of protein intake to support muscle mass and function in healthy adults (2022) · cites this paper as [23]
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Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“A growing body of literature is available that suggests higher amounts of protein are needed by exercising individuals to optimize exercise training adaptations [11, 83, 211, 226].”
From ISSN exercise & sports nutrition review update: research & recommendations (2018) · cites this paper as [211]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“The anabolic effects of insulin and amino acids on protein synthesis are enhanced by physical activity and some nutrients (omega-3 fatty acids, vitamin D) and are impaired by sedentary lifestyle, bed rest, or immobilization (Figure 2).53,120,121”
From Evidence-Based Recommendations for Optimal Dietary Protein Intake in Older People: A Position Paper From the PROT-AGE Study Group (2013) · cites this paper as [53]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Pooled results of multiple studies using meta-analytic and other systematic approaches consistently indicate that protein supplementation (15 to 25 g over 4 to 21 weeks) exerts a positive impact on performance.”
From International Society of Sports Nutrition Position Stand: protein and exercise (2017) · cites this paper as [35]
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In the citing paper
“This lack of agreement on the efficacy of protein supplementation6–12 is likely due to the use of divergent study inclusion criteria and inclusion of subjects with differing: ages, training statuses, total protein intakes, protein sources and protein doses.”
From A systematic review, meta-analysis and meta-regression of the effect of protein supplementation on resistance training-induced gains in muscle mass and strength in healthy adults (2018) · cites this paper as [7]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Previous data from our group 14 and Cermak et al. 23 showed very small but significant effect of additional protein ingestion on strength, mainly lower body strength data when selecting RE studies.”
From Systematic review and meta-analysis of protein intake to support muscle mass and function in healthy adults (2022) · cites this paper as [23]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“According to previous meta‐analyses from our group and others, the effects of increasing daily protein ingestion on muscle strength are highly variable. 14 , 21 , 22 , 23”
From Systematic review and meta-analysis of protein intake to support muscle mass and function in healthy adults (2022) · cites this paper as [23]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“On the other hand, amount of CAS supplementation used in this study is relatively low in comparison with those used in the previous studies (10–63 g/d or 0.3 g/kg/d) (10,11).”
From Modulation of Neural and Muscular Adaptation Processes During Resistance Training by Fish Protein Ingestions in Older Adults (2020) · cites this paper as [10]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Because protein supplementation mainly induces muscular adaptations such as muscle hypertrophy, contributions of neural and muscular factors to training-induced adaptation would not be coincidence between resistance training interventions with and without protein supplementation.”
From Modulation of Neural and Muscular Adaptation Processes During Resistance Training by Fish Protein Ingestions in Older Adults (2020) · cites this paper as [10]
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“Cermak 2012 53 Protein supplementation increases muscle mass and strength gains during prolonged resistance-type exercise training in both younger and older subjects”
From Evidence-Based Recommendations for Optimal Dietary Protein Intake in Older People: A Position Paper From the PROT-AGE Study Group (2013) · cites this paper as Cermak 2012 53
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In the citing paper
“The present meta-analysis includes more than double the number of studies and participants than the largest published comprehensive meta-analysis on protein supplementation during RET to date.7ST1”
The cited source says what the claim attributes to it.
In the citing paper
“Most meta‐analyses have reported consistently positive results regarding the effect of additional protein ingestion on RE training‐induced increases in LBM. 13 , 14 , 21 , 23”
From Systematic review and meta-analysis of protein intake to support muscle mass and function in healthy adults (2022) · cites this paper as [23]
The cited source says what the claim attributes to it.
In the citing paper
“An abundance of evidence is available, however, to indicate that ingestion of high-quality protein sources can heighten adaptations to resistance training [211].”
From ISSN exercise & sports nutrition review update: research & recommendations (2018) · cites this paper as [211]
The cited source says what the claim attributes to it.
In the citing paper
“Results of a meta-analysis of 22 RCTs involving 680 young and old subjects demonstrated that prolonged resistance training (>6 weeks) combined with cotemporal protein supplement consumption led to significant muscle mass gains, which were associated with significant strength gains. 53”
From Evidence-Based Recommendations for Optimal Dietary Protein Intake in Older People: A Position Paper From the PROT-AGE Study Group (2013) · cites this paper as [53]
The cited source says what the claim attributes to it.
In the citing paper
“a meta-analysis by Cermak and colleagues [35] reported a mean increase in fat-free mass of 0.69 kg (95% Confidence Interval: 0.47–0.91 kg) when protein supplementation was provided versus a placebo during a resistance-training program.”
From International Society of Sports Nutrition Position Stand: protein and exercise (2017) · cites this paper as [35]
The cited source says what the claim attributes to it.
In the citing paper
“Despite a large volume of work in this area, narrative reviews1–5 and even meta-analyses6–12 yield conflicting results as to the actual effectiveness of protein supplementation to enhance RET-mediated gains in muscle mass and strength.”
The cited source says what the claim attributes to it.
In the citing paper
“Cermak et al. 23 showed a significant main effect for protein supplementation in muscle mass in young and old subjects during resistance exercise‐like training.”
From Systematic review and meta-analysis of protein intake to support muscle mass and function in healthy adults (2022) · cites this paper as [23]
The cited source says what the claim attributes to it.
In the citing paper
“There has been growing recognition that increases in muscle mass and strength following resistance training is elicited by protein supplementation in older adults (10,11).”
From Modulation of Neural and Muscular Adaptation Processes During Resistance Training by Fish Protein Ingestions in Older Adults (2020) · cites this paper as [10]
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In the citing paper
“In most of the previous studies, casein, whey, and/or milk protein have been used as protein supplementations to test the effect of its combination with resistance training (10,11)”
From Modulation of Neural and Muscular Adaptation Processes During Resistance Training by Fish Protein Ingestions in Older Adults (2020) · cites this paper as [10]
The cited source says what the claim attributes to it.
In the citing paper
“Consuming supplemental protein during resistance training (RT) can result in an increased accretion of LBM (2).”
The check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“While interesting, the inability of the group that delayed supplementation but still completed the resistance training program to experience any measurable increase in muscle cross-sectional area has led some to question the outcomes resulting from this study [5, 123].”
From International society of sports nutrition position stand: nutrient timing (2017) · cites this paper as [5]
Experimental — accuracy not yet measuredIn the citing paper
“Nutrition and exercise interventions are the two of the most promising strategies in the management of sarcopenic obesity.17–19”
From Nutritional and exercise interventions in individuals with sarcopenic obesity around retirement age: a systematic review and meta-analysis (2023) · cites this paper as [19]
In the citing paper
“As with endurance exercise, nutrition can play a critical role in augmenting the adaptive stimulus that comes from resistance exercise [84].”
From New strategies in sport nutrition to increase exercise performance (2016) · cites this paper as [84]
In the citing paper
“Furthermore supplementation of protein during a program of resistance training is well proven to enhance lean mass/muscle gains [84].”
From New strategies in sport nutrition to increase exercise performance (2016) · cites this paper as [84]
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“Although meta-analysis has determined the existence of an additive effect of protein supplements for independently enhancing muscle size and strength (8), this effect is not universal (9, 10).”
BackgroundResultInfluentialInsulin Treatment Attenuates Decline of Muscle Mass in Japanese Patients with Type 2 Diabetes
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“As in healthy older people [19,20], it has been suggested that oral Whey Protein (WP) could maximize the effects of exercise and positively influence skeletal muscle anabolism in people with Sarcopenia [21].”
Background
Metadata
- Authors
- Cermak, N. M., Res, P. T., de Groot, L. C., Saris, W. H., & van Loon, L. J.
- Affiliations
- Maastricht University Medical Centre (NL)
- Venue
- The American Journal of Clinical Nutrition
- Publisher
- Elsevier BV
- Published
- 2012-12
- Volume
- 96
- Issue
- 6
- Pages
- 1454-1464
- ISSN
- 0002-9165 (ISSN-L)
- OpenAlex
- W2113082753
- Cited by
- 827
- References
- 70
- Citations by year
- 2026: 39 · 2025: 50 · 2024: 33 · 2023: 49 · 2022: 52 · 2021: 68 · 2020: 65 · 2019: 82 · 2018: 93 · 2017: 83 · 2016: 65 · 2015: 70 · 2014: 47 · 2013: 27 · 2012: 2
- FWCI
- 4.30
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- American Journal of Clinical Nutrition (publishedVersion)
- PubMed (publishedVersion)
- Research Publications (Maastricht University) (publishedVersion, other-oa)
- Socio-Environmental Systems Modeling (acceptedVersion)
- Research Bank (Australian Catholic University) (submittedVersion)
- VUBIR (Vrije Universiteit Brussel) (submittedVersion)
- Research Publications (Maastricht University) (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Funders
- Canadian Institutes of Health Research
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Muscle metabolism and nutrition
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Sports Performance and Training
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Muscle Physiology and Disorders
- Keywords
- protein supplementation, skeletal muscle adaptation, muscle protein accretion, fat-free mass, muscle strength, leg press strength, muscle fiber cross-sectional area, older adults, muscle hypertrophy
- MeSH terms
- Aging, Dietary Proteins, Humans, Randomized Controlled Trials as Topic, Muscle, Skeletal, Dietary Supplements, Muscle Development, Muscle Strength, Resistance Training
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