REF-955 · Lu et al., 2026 · 3 Biotech, Vol. · Paper · PubMed

The effects of coenzyme Q10 supplementation on exercise-induced oxidative stress and related physiological outcomes in athletes: a systematic review and meta-analysis

B+moderate evidenceMeasured on a mixed groupWritten before October 2026, being re-checked

A systematic review of randomized trials giving oral CoQ10 to athletes or to trained individuals relevant to athletes, with searches running from database inception to April 2026. Of the twenty-four included studies (613 participants), 15 (330 participants) fed into at least one quantitative synthesis.

The primary pooled outcome, malondialdehyde (MDA), did not reach statistical significance; a sensitivity analysis leaned towards CoQ10, but the authors call this signal fragile. Pooled VO₂max showed no effect, and neither did anaerobic threshold, tumor necrosis factor-α, total antioxidant capacity, interleukin-6, creatine kinase or blood pressure.

The authors conclude that current evidence does not back a robust overall benefit of CoQ10 supplementation for athletes, whether ergogenic or physiological.

Participants

Twenty-four studies (613 participants) in the systematic review; 15 studies (330 participants) in at least one quantitative synthesis. Athletes or athlete-relevant trained individuals; sex, sports and doses are not given in the abstract.

Protocol

Databases: PubMed, Web of Science, Embase and EBSCOhost, from inception to April 2026; prospectively registered in PROSPERO.
Eligible: randomized parallel-group and crossover trials evaluating oral CoQ10.
Random-effects models; the unit of quantitative reporting was the effect size/comparison, because several studies contributed more than one eligible estimate.

Key Results

MDA, primary pooled analysis (seven effect sizes/comparisons, five studies): no statistically significant effect — SMD = -0.96, with 95% CI -2.07 to 0.15 and I² = 73.0%.
MDA, sensitivity analysis: the pooled effect leaned towards CoQ10, SMD = -0.93 with 95% CI -1.65 to -0.22 and I² = 73.0% — a signal the authors describe as fragile.
VO₂max (eight effect sizes/comparisons from seven studies): neutral (SMD = 0.03, 95% CI -0.32 to 0.39; I² = 0.0%).
The supplementary pooled analyses were also neutral: anaerobic threshold, tumor necrosis factor-α, interleukin-6, creatine kinase, blood pressure and total antioxidant capacity.
Risk of bias: some concerns in 23 of 24 studies (95.8%), high risk in one study (4.2%).
In the narrative synthesis, signals looked more coherent, and dependent on context, in studies run under heavy oxidative or recovery stress.

Practical Application

"Should I take CoQ10 for performance or recovery?" Across randomized trials in athletes (24 studies, 613 participants; 15 studies pooled), CoQ10 did not change VO₂max (SMD = 0.03), anaerobic threshold, creatine kinase or inflammatory markers, and its effect on the oxidative-stress marker MDA was not significant in the primary analysis (SMD = -0.96, 95% CI -2.07 to 0.15; I² = 73.0%) — the authors' conclusion is no robust overall ergogenic or physiological benefit. Not a supplement to plan around.
The one favourable number (MDA in the sensitivity analysis) is a blood marker with high heterogeneity, from five studies; the authors themselves ask for caution.
Not from this paper: the same verdict for performance in healthy adults is in REF-216; the base's supplement framework lists CoQ10 under "not supported" (SYNTH-67).
Inference, not tested here: lowering an oxidative-stress marker is not the same as recovering or performing better.

Limitations

Each pooled outcome rests on few studies; total pooled sample 330 participants across 15 studies.
High heterogeneity for MDA (I² = 73.0%); the favourable result appears only in a sensitivity analysis.
Risk of bias: some concerns in 23 of 24 studies.
Doses, durations, sports and sex of participants are not given in the abstract; no time-trial or race outcome is named among the pooled outcomes.
Written from the abstract and record metadata only (full text not read).
How this entry was checked and changed
Why this level

graded on what was pooled: the two pooled outcomes with counts in the abstract rest on five and seven studies, the primary outcome is heterogeneous (I² = 73.0%), and risk of bias was "some concerns" in 23 of 24 studies

Content correction 2026-09-27
2026-10-01: independent check against the abstract — wording brought back to what the abstract states.