Oxidative stress, a state characterized by an imbalance between the production of reactive oxygen species (ROS) and the antioxidant capacity, plays a critical role in cellular damage and fatigue during intense physical activity [1]. Oxidative stress and inflammation play an important role in the pathogenesis of various diseases as well as sports injuries [2,3]. While regular exercise is well-documented to improve overall antioxidant capacity, excessive or high-intensity exercise may transiently increase oxidative stress, leading to potential muscle damage and impaired recovery [4]. Among athletes, mitigating oxidative stress and reducing muscle damage are essential for optimizing performance and recovery [5].

Coenzyme Q10 (CoQ10 or ubiquinone), a lipophilic antioxidant naturally present in the mitochondria, is an essential component of the electron transport chain, playing a pivotal role in cellular energy production [6]. Beyond its metabolic functions, reduced form of CoQ10, ubiquinol, exhibits potent antioxidant properties, scavenging free radicals and regenerating other antioxidants such as vitamin E [7]. At the molecular level, CoQ10 stabilizes mitochondrial membranes and prevents lipid peroxidation by neutralizing ROS at their source within the inner mitochondrial membrane [7]. Additionally, it modulates redox-sensitive signaling pathways, including those regulating the expression of antioxidant enzymes such as superoxide dismutase (SOD) and catalase [8]. Given its dual role in energy metabolism and oxidative stress mitigation, CoQ10 has gained increasing attention as a dietary supplement in athletes.

Incorporating CoQ10 supplementation into sports nutrition regimens may offer practical benefits for high-performance athletes by enhancing recovery and reducing fatigue [9]. In a study involving elite German Olympic athletes, daily supplementation of 300 mg of ubiquinol (the active form of CoQ10) over six weeks resulted in significant improvements in peak power production. This enhancement, though modest in numerical terms, holds substantial significance for elite athletes where even slight performance gains are critical [10]. Furthermore, research involving top-level cross-country skiers demonstrated that CoQ10 supplementation (90 mg/day) led to significant improvements in various performance metrics, including anaerobic threshold and VO2Max. Notably, 94 % of athletes reported perceived benefits in performance and recovery during the supplementation period [11].

Numerous clinical trials have investigated the effects of CoQ10 supplementation on oxidative stress biomarkers and muscle damage indicators, such as malondialdehyde (MDA), creatine kinase (CK), lactate dehydrogenase (LDH), and total antioxidant capacity (TAC) [[12], [13], [14], [15]]. While some studies suggest that CoQ10 supplementation can attenuate exercise-induced oxidative damage [16] and improve recovery [17], others report inconsistent or negligible effects [18,19]. These discrepancies may arise from variations in study design, population characteristics, exercise protocols, supplementation doses, and durations.

Several meta-analyses have investigated the effects of CoQ10 on biomarkers of oxidative stress and muscle damage [[20], [21], [22], [23]]. However, none of them have focused on trained athletes. This represents a critical gap in the current literature, as the needs and responses of high-performance athletes may differ from those of the general population. This study provides critical insights into the role of CoQ10 supplementation in supporting the recovery of high-performance athletes. By examining its effects on oxidative stress and muscle damage, the research contributes to the growing body of evidence supporting the use of CoQ10 in sports nutrition. Specifically, the study adds to guidelines by highlighting potential of CoQ10 to improve muscle recovery in trained athletes. This study aims to address this gap by conducting a systematic review and meta-analysis of clinical trials evaluating the effect of CoQ10 supplementation on oxidative stress and muscle damage biomarkers in athletes.