The Effects of Dietary Protein Supplementation on Acute Changes in Muscle Protein Synthesis and Longer-Term Changes in Muscle Mass, Strength, and Aerobic Capacity in Response to Concurrent Resistance and Endurance Exercise in Healthy Adults: A Systematic Review

Background Engaging in both resistance and endurance exercise within the same training program, termed 'concurrent exercise training,' is common practice in many athletic disciplines that require a combination of strength and endurance and is recommended by a number of organizations to improve muscular and cardiovascular health and reduce the risk of chronic metabolic disease. Dietary protein ingestion supports skeletal muscle remodeling after exercise by stimulating the synthesis of muscle proteins and can optimize resistance exercise-training mediated increases in skeletal muscle size and strength; however, the effects of protein supplementation on acute and longer-term adaptive responses to concurrent resistance and endurance exercise are unclear. Objectives The purpose of this systematic review is to evaluate the effects of dietary protein supplementation on acute changes in muscle protein synthesis and longer-term changes in muscle mass, strength, and aerobic capacity in responses to concurrent resistance and endurance exercise in healthy adults. Methods A systematic search was conducted in five databases: Scopus, Embase, Medline, PubMed, and Web of Science. Acute and longer-term controlled trials involving concurrent exercise and protein supplementation in healthy adults (ages 18-65 years) were included in this systematic review. Main outcomes of interest were changes in skeletal muscle protein synthesis rates, muscle mass, muscle strength, and whole-body aerobic capacity (i.e., maximal/peak aerobic capacity [VO2max/peak]). The quality of studies was assessed using the National Institute of Health Quality Assessment for Controlled Intervention Studies. Results Four acute studies including 84 trained young males and ten longer-term studies including 167 trained and 391 untrained participants fulfilled the eligibility criteria. All included acute studies demonstrated that protein ingestion enhanced myofibrillar protein synthesis rates, but not mitochondrial protein synthesis rates during post-exercise recovery after an acute bout of concurrent exercise. Of the included longer-term training studies, five out of nine reported that protein supplementation enhanced concurrent training-mediated increases in muscle mass, while five out of nine studies reported that protein supplementation enhanced concurrent training-mediated increases in muscle strength and/or power. In terms of aerobic adaptations, all six included studies reported no effect of protein supplementation on concurrent training-mediated increases in VO2max/peak. Conclusion Protein ingestion after an acute bout of concurrent exercise further increases myofibrillar, but not mitochondrial, protein synthesis rates during post-exercise recovery. There is some evidence that protein supplementation during longer-term training further enhances concurrent training-mediated increases in skeletal muscle mass and strength/power, but not whole-body aerobic capacity (i.e., VO2max/peak).