A review of sarcopenia pathogenesis and therapeutic approaches: resistance exercise, nutrition, and monoterpenes

Article information

Phys Act Nutr. 2024;28(4):083-091

Publication date (electronic) : 2024 December 31

doi : https://doi.org/10.20463/pan.2024.0036

Sangmoon Lee ¹^,²^,^†, Suji Baek ³^,^†, Hangyul Park ³, Kang Han ³, Kang Pa Lee ⁴^,

, Sang Hyun Ahn ⁵^,

¹Department of Korean Medicine, graduate school of Korean medicine, Semyung University, Jecheon, Republic of Korea

²Yeongjusi Public Health Center, Yeongju, Republic of Korea

³Research and Development Center, UMUST R&D Corporation, Los Angeles, USA

⁴Research & Development Center, UMUST R&D Corporation, Seoul, Republic of Korea

⁵Department. of Anatomy, College of Korean Medicine, Semyung University, Jecheon, Republic of Korea

*Corresponding author : Kang Pa Lee, Ph.D. Research & Development Center, UMUST R&D corporation, 61, Madeul-ro 13-gil, Dobong-gu, Seoul, 01413, Republic of Korea. Tel: +82-2-998-5552 E-mail: umustrnd@naver.com

*Corresponding author : Sang Hyun Ahn, Professor Department of Anatomy, College of Korean Medicine, Semyung University, Semyung-ro 65, Jecheon, Chungchengbukdo, 27136, Republic of Korea. Tel: +82-43-649-1684 / Fax: +82-43-649-1702 E-mail: smkmana@semyung.ac.kr

†They are contributed equally to this study

Received 2024 November 23; Revised 2024 December 26; Accepted 2024 December 30.

Abstract

[Purpose]

Sarcopenia, characterized by the age-related loss of muscle mass and function, is a multifactorial condition influenced by oxidative stress, hormonal changes, and chronic inflammation. This study investigated the effects of resistance exercise and nutritional interventions, including antioxidants, such as monoterpenes, on sarcopenia prevention and treatment.

[Methods]

To identify relevant studies, a comprehensive literature search was conducted using electronic databases including PubMed and Google Scholar. Keywords such as “sarcopenia,” “resistance exercise,” “antioxidants,” “nutrition,” “muscle regeneration,” and related terms were utilized to gather evidence on the prevention and management of sarcopenia.

[Results]

This review focuses on the etiological factors of sarcopenia, particularly the decline in muscle function and acceleration of muscle protein degradation. This highlights the critical importance of the combined effects of exercise and nutrition in overcoming these challenges, with special emphasis on the potential of antioxidant intake as a promising solution for managing this condition

[Conclusion]

An integrated approach combining periodic resistance exercise with antioxidant-rich nutritional strategies is essential for the management of sarcopenia. By promoting muscle development and inhibiting protein breakdown, this dual strategy provides an effective framework for preventing and treating sarcopenia, and improving quality of life of the aging population. Further studies are warranted to explore the clinical potential of monoterpenes in the treatment of sarcopenia.

Keywords: sarcopenia; resistance exercise; monoterpenes; oxidative stress; nutrients; antioxidant

INTRODUCTION

Effective treatment and prevention of sarcopenia, an age-related decline in muscle mass and function, rely on understanding the various physiological mechanisms underlying this condition [1]. This knowledge empowers us to adopt an integrated approach to observation, which is a crucial step in fighting against this disease and preserving muscle function and quality of life in older adults.

Therefore, sarcopenia should be approached from the perspective of studying the relationship between aging and nutrition [2]. The pathology and main causes of sarcopenia are a decrease in muscle development and acceleration of muscle protein breakdown function [3]. In terms of muscle development and dysfunction, the main causes of sarcopenia are mitochondrial dysfunction, hormonal imbalance, chronic inflammation, and changes in nerve-muscle junction [4,5]. Next, in terms of promoting muscle protein breakdown, oxidative stress in vivo induces the expression of muscle degradation proteins, such as Muscle RING-finger Protein-1 (MURF-1) and Arogin-1 [6]. Chronic inflammatory diseases and disorders of energy metabolism can accelerate oxidative stress in the body [7]. Mitochondrial dysfunction, hormonal imbalances, chronic inflammation, and nerve-muscle junction changes are involved in the deterioration of muscle fiber function [8]. Mitochondria are the primary tissues responsible for supplying oxidative energy. Aging-induced oxidative stress reduces mitochondrial function and ATP production, thereby affecting energy supply and function of muscle cells [9].

Understanding the pathogenic mechanisms underlying sarcopenia will provide a foundation for the development of practical therapeutic approaches. Among the various strategies, exercise and nutrition are widely recognized as the most effective evidence-based methods for attenuating sarcopenia. Therefore, this study primarily focuses on the role of exercise and nutrition in the treatment and prevention of sarcopenia, while also exploring the potential benefits of antioxidant compounds, particularly monoterpenes, as highlighted in recent research.

Prevalence of Sarcopenia

Prevalence of sarcopenia, which was officially classified as a disease by the World Health Organization (WHO) in 2016 using the International Classification of Diseases (ICD-10) code M62.84, varies based on age, sex, race, and measurement method [10]. Understanding these pathogenic mechanisms will allow for the design of practical therapeutic approaches for sarcopenia. Therefore, this paper discusses treatment and prevention strategies for sarcopenia, focusing on three factors that recent research has emphasized on: exercise, nutrition, and antioxidant compounds (monoterpenes). It is estimated that approximately 10-20% of individuals over 60 years of age experience sarcopenia, with the prevalence increasing with age and affecting over 50% of people over 80 years of age [11]. In addition, men showed a higher prevalence compared to women [12]. The reported prevalence of sarcopenia can vary based on the country and research institution, and the exact prevalence may change over time owing to different research methods. In Europe, the prevalence ranges from approximately 11% to 20%. In the European Union, the social, health, and economic impacts of sarcopenia are significant owing to the large elderly population [13]. Japan, with its rapidly aging population, has a high prevalence of sarcopenia, with more than 20% of the elderly experiencing it [14]. Similarly, in Korea, prevalence is increasing with approximately 10-20% of people over 60 years of age being affected, although exact statistics are limited [15].

Pathogenesis of Sarcopenia

Sarcopenia occurs through various complex physiological processes. Major factors contributing to sarcopenia include hormonal changes, chronic inflammation, neuromuscular junction changes, mitochondrial dysfunction, and oxidative stress (Figure 1). The Forkhead box O3 (FOXO3) transcription factor is a significant signaling pathway that regulates muscle protein breakdown. Regulated by the insulin/IGF-1 pathway, FOXO3, when activated, induces the expression of genes that promote muscle protein breakdown upon activation. Insulin/IGF-1 activation leads to FOXO3 phosphorylation via the PI3K/AKT pathway, thereby maintaining FOXO3 inactivity in the cytoplasm. Reduced insulin/IGF-1 signaling suppresses AKT activation, causing FOXO3 dephosphorylation and nuclear translocation, and increasing MURF-1 and Atrogin-1 gene expression. Nuclear FOXO3 promotes the transcriptional activation of these ligases, enhancing muscle protein breakdown, and resulting in muscle atrophy. FOXO3 regulates autophagy in response to cellular stress and is crucial for removing damaged organelles and proteins.

Figure 1.

Mechanism of sarcopenia.

Accumulation of senescent cells in the muscles leads to increased secretion of inflammatory molecules [16]. Inflammatory cytokines such as interleukin (IL)-1α, IL-6, and tumor necrosis factor-α (TNF-α) activate the intracellular nuclear factor kappa-light-chain-enhancer of activated B cells (NF-kB) [17]. Activated NF-kB promotes skeletal muscle protein degradation by increasing the expression of MURF-1 and Atrogin-1 [18]. Additionally, it promotes the expression of inflammatory factors IL-6 and TNF-a, further activating inflammation and increasing the production of endogenous reactive oxygen species (ROS) [19].

Muscle cells have numerous mitochondria because of the high energy demand for contractile activity [20]. It generates a large amount of ROS within muscle cells and activates protein breakdown metabolism [21]. ROS damages mitochondrial DNA and proteins, which results in mitochondrial dysfunction [22]. Additionally, ROS phosphorylates MAPKs, which activate NF-κB. Activated proteins induce pro-cytokines or increase the expression of the protein degradation biomarkers, MURF-1 and Atrogin-1 [23].

Reduced muscle fiber synthesis due to inflammation, as well as decreased testosterone and estrogen hormone levels, inhibit muscle synthesis and cause muscular atrophy. Decreasing testosterone and estrogen levels also contribute to a reduction in muscle mass and function [24]. Inflammatory cytokines, such as TNF-α, IL-6, etc., accelerate the progression of sarcopenia by promoting muscle protein breakdown and interfering with muscle cell regeneration [25].

Latest knowledge on sarcopenia treatment

Exercise exerts mechanical stress on muscle cells, promotes muscle growth, and increases protein synthesis [26]. Resistance training, in particular, strengthens muscle fibers stronger and larger, improves mitochondrial function, and increases metabolic activity in muscle cells [27]. Exercise also regulates hormone secretion and promotes the production of growth hormones and IGF-1, aiding the recovery and regeneration of muscle cells [28].

Table 1 shows clinical results on the effects of exercise and nutrition on muscle growth. Monti et al. investigated the effects of exercise in 45 older adults with decreased muscle function [29]. The study was conducted over two years divided into a control group and an exercise group. The exercise was a combination of aerobic exercise and strength training and was trained three times a week for two years. The aerobic and strength exercises reduced the concentration of the C-terminal agrin fragment in the serum and were effective in maintaining neuromuscular junction stability and muscle structure, thereby improving physical performance in elderly people with sarcopenia. Similarly, Leuchtmann et al. investigated the effects of resistance exercise on skeletal muscle vascularization in older adults [30]. Healthy elderly men performed resistance training and high-intensity intermittent exercises for 12 weeks. The findings revealed enhanced capillary action and increased oxidase activity in the skeletal muscle, suggesting that exercise not only prevents muscle atrophy but also promotes vascular health, which is critical for sustaining muscle function.

Table 1.

List of clinical trials on the effectiveness of exercise in older adults and patients with sarcopenia.

Jhang et al. sought to determine the effects of lower extremity muscle exercises in middle-aged people [31]. The survey was conducted among residents aged 55 years or older. Fifty participants were randomly assigned to control and experimental groups. The experimental group exercised for 50 min three times a week for 12 weeks. These findings in middle-aged adults showed that lower-extremity exercises improved muscle functional fitness, physiological indices, sleep quality, and mental health. This holistic improvement highlights the systemic benefits of targeted muscle exercises.

Vikberg S et al. studied the effects of resistance exercise in sarcopenic patients over 70 years of age [32]. The participants were divided into a control group (n=34) and a physical training and diet control group (n=36). The diet was provided as a 250 mL supplement containing 19 g carbohydrates, 21 g protein, and 1.5 g fat. Resistance exercise was performed for 45 minutes three times a week for 10 weeks. Their results suggest that dietary protein supplementation synergizes with resistance training to maintain strength and increase muscle mass.

Hofmann M et al. investigated the effects of resistance training and nutritional supplementation on 91 women with an average age of 63.6 divided into resistance training, resistance training and nutritional supplementation, and control groups [33]. These results show that personalized approaches that integrate exercise and nutrition significantly improve muscle quality and physical performance in older women, emphasizing the need for tailored interventions.

These exercise protocols show a personalized approach in which each patient with sarcopenia is unique with their own health status, physiological characteristics, and exercise levels.

However, treatment of sarcopenia alone has some limitations. Exercise plays a crucial role in muscle growth and function; however, muscle cells may require proper nutrients [34]. Proteins, vitamin D, and omega-3 fatty acids are essential for muscle health [35]. Muscle recovery and growth are limited in the absence of these nutrients. Sarcopenia is caused by various physiological changes that occur with aging. These factors are challenging to address by using simple exercises alone. For instance, hormonal imbalance or chronic inflammation can significantly cause a decline in muscle cell function. Patients with sarcopenia who attempt exercise may experience a severe functional decline in their muscle cells. Representative resistance exercises and their effects on protein synthesis are summarized in Table 2.

Table 2.

List of clinical trials on the synergistic effects of diet and exercise in older adults and sarcopenia patients.

Choline is an essential nutrient for cell membrane metabolism and signaling, and is known to have antioxidant properties. Lee et al. studied the effects of choline intake and resistance exercise on the strength and muscle mass of elderly people [36]. Healthy adults were divided into three groups: low-, medium-, and high-choline intake groups. In all groups, resistance exercise was performed 3 times a week in 3 sets of 8-12 repetitions. Low choline intake did not increase muscle strength; however, high choline intake led to significant increases in strength after 12 weeks of training.

Kim et al. investigated the effects of combined exercise and nutrition in 26 elderly women with spinal sarcopenia patients [37]. A comparative analysis was conducted before and after the 13 weeks of exercise. All participants exercised for 50 min once every two weeks for 12 weeks. The diet consisted of liquid supplements and energy bars were consumed daily for 12 weeks. Physical and back performance, as measured using the Short Physical Performance Battery, significantly improved after exercise.

Leucine is an essential amino acid that decreases protein breakdown and increases protein synthesis [38]. Vitamin D is a potent antioxidant that reduces liposomal lipid peroxidation and regulates intracellular GSH and SOD [39]. Combining leucine and vitamin D intake with exercise increases muscle function and mass in elderly individuals and patients with muscular dystrophy. Rondanelli et al. analyzed the effects of nutrition and exercise in 161 sarcopenic older adult [40]. They were divided into two groups: a placebo group and a group wherein leucine and vitamin D-based whey protein food (150 kcal) was consumed. Additionally, all groups performed the exercise 20 minutes a day, 5 times a week, for 8 weeks. Consuming a whey protein-based diet rich in leucine and vitamin D improves physical performance and function and increases muscle mass. Nilsson et al. investigated the effects of five nutritional supplements containing vitamin D on muscle strength in older adult [41]. The participants were divided into two groups: an exercise-only group and an exercise and intake of the five nutritional supplements group. Nutritional supplements (proteins, micellar casein, creatine, vitamin D3, and omega-3) were administered in the mornings for 12 weeks. Additionally, all participants underwent home-based resistance training using elastic bands three times a week for 12 weeks. Muscle mass, strength, and tone improved in the group that received the five nutritional supplements. Finally, Molnár et al. investigated the effects of exercise and nutrition in 34 older adults [42]. They were divided into two groups: the resistance training group and the exercise and nutrition intake (containing 20 g protein, 10 g essential amino acids, 3 g leucine, 9 g carbohydrates, 3 g fat, vitamins, and minerals) group. Resistance exercises were performed twice a week for 3 months. In the resistance exercise group, skeletal muscle mass and strength did not improve, whereas exercise and intake significantly improved skeletal muscle mass and strength.

Monoterpene and Sarcopenia

Monoterpenes are abundant in oranges, lemons, grapefruits, rosemary, thyme, and mint [43]. Monoterpene is a substance that has anti-inflammatory, analgesic, antibacterial, antibacterial, antiviral, anticancer, antituberculous, and antioxidant effects [44]. Monoterpenes include thymol, p-cymene, linmonene, camphor, sabinene, and camphene. Table 3 lists the types and effects of monoterpenes. Thymol showed anti-inflammatory effects in acutely inflamed mice and in an acute periodontitis mouse model [45]. Additionally, P-cymene reduced the expression of inflammatory cytokines and increased the expression of superoxide dismutase in the serum of obese mice induced by a high-fat diet [46]. Monoterpenes are known to inhibit oxidative stress associated with mitochondrial dysfunction [47]. In addition, (R)-(+)-limonene regulates both glucose uptake and lipolysis [48]. Sarcopenia is caused by excessive generation of ROS, resulting in mitochondrial dysfunction and changes in lipid metabolism [49]. Recently, we reported that camphene alleviates muscular dystrophy by regulating mitochondrial dysfunction and MURF-1, and Atrogin-1 expression in muscular dystrophy cells and animal models [50]. Ryu et al. reported that sabinene was effective against muscular dystrophy in animal models of muscular dystrophy [51]. Therefore, monoterpenes, which have strong anti-inflammatory and antioxidant effects, may be potential candidates for clinical treatment of sarcopenia.

Table 3.

List of effects of monoterpenes.

DISCUSSION

In this study, we investigated the effects of resistance exercise and nutrient intake on sarcopenia. Sarcopenia should be studied in terms of the reduction in total musculoskeletal muscle mass. There is strong evidence that physical activity and nutritional approaches reduce the risk of sarcopenia. This inhibitory or protective effect of sarcopenia is achieved by the long-term control of various risk factors, such as ROS, hormonal changes, and inflammatory factors. In addition to muscle development through exercise and nutrition, suppression of the breakdown of muscle proteins through antioxidant action substantially changes whole-body homeostasis. Sarcopenia significantly affects the muscle cell breakdown induced by endogenous or exogenous ROS. The results showed that intake of nutrients combined with vitamin D has a significant impact on improving exercise capacity and muscle loss.

Natural compounds, such as monoterpenes and antioxidants, suppress oxidative stress caused by ROS, contributing to muscle cell protection and regeneration [38,50]. Monoterpenes have anti-inflammatory and antioxidant effects, which can help reduce muscle damage and inflammation, and prevent sarcopenia through cell protection [51]. The main mechanism for treating sarcopenia is muscle development through resistance exercise and nutrition [62]. Another important aspect is the inhibition of muscle protein breakdown, the key to which is removing ROS [63]. Monoterpenes are potent antioxidants that prevent sarcopenia by inhibiting muscle protein breakdown via ROS removal [64]. The key signaling pathways that regulate muscle protein breakdown include MURF-1, FOXO3, and Atrogin-1. MURF-1 and Atrogin-1 are E3 ubiquitin ligases that promote the degradation of muscle proteins, and FOXO3 is an important transcription factor that regulates the expression of these genes [65].

Exercise, nutrition, and antioxidants synergistically manage sarcopenia by regulating muscle protein degradation and promoting regeneration [66]. Resistance exercise activates the IGF-1/PI3K/Akt pathway, suppresses FOXO3, reduces MuRF-1 and Atrogin-1, and enhances muscle mass and function. Nutrients such as proteins, leucine, vitamin D, and omega-3 activate mTOR, reduce inflammation, and suppress protein degradation [37,40-42]. Antioxidants, such as monoterpenes and vitamins C and E, lower ROS levels, protect muscle cells, and support regeneration. This integrated approach effectively inhibits protein degradation while restoring muscle function.

Clinical studies on monoterpenes have demonstrated their potential therapeutic effects under various conditions, which may have implications in sarcopenia management. For instance, topical application of limonene and rosemary oil (1 ml, twice daily) significantly reduced pain and improved foot function in patients with plantar fasciitis [67]. Similarly, Chios mastic gum, containing α-pinene, β-myrcene, and β-pinene, was administered orally (200 mg/day) for three months to individuals with abdominal obesity and metabolic abnormalities, resulting in improved lipid profiles, anti-inflammatory markers, and antioxidant status [68]. Furthermore, carvacrol administered at a dose of 1.2 mg/kg/day (three times daily) for two months to patients with asthma significantly reduced oxidative stress markers and cytokine levels [69]. These findings highlight the potential of monoterpenes to address oxidative stress and inflammation, which are two critical contributors to the pathophysiology of sarcopenia. However, it is important to note that monoterpene-based therapies have not yet been formally approved as medications. Thus, further studies and clinical trials are urgently required to establish the recommended dosage, duration of use, safety profile, and long-term efficacy of monoterpenes in sarcopenia management. Future investigations will be crucial for determining the clinical applicability of monoterpenes as part of an integrated approach to combat sarcopenia.

Oxidative stress plays a critical role in accelerating muscle degradation and functional decline, and antioxidants are key factors in mitigating these effects [70]. By neutralizing ROS, reducing inflammatory responses, and enhancing mitochondrial efficiency, antioxidants protect muscle cells and support their regeneration [71]. Compounds such as monoterpenes have shown promising results in suppressing protein degradation pathways, such as MURF-1 and Atrogin-1, while promoting muscle repair and growth [50]. Furthermore, when combined with resistance exercise, antioxidants not only alleviate exercise-induced oxidative stress but also enhance muscle recovery and protein synthesis. These findings underscore the need for an integrated strategy that incorporates regular exercise and antioxidant-rich nutrition to effectively manage sarcopenia and improve the quality of life in aging populations.

Exercise regulates the muscle mass by activating or inhibiting these pathways [72]. Studies have shown that resistance training for 12 weeks or more significantly increases strength and muscle mass, and improves functional capacity in patients with sarcopenia [73]. Resistance exercises play an important role in promoting muscle protein synthesis and inhibiting muscle protein breakdown [74]. In particular, the MURF-1, FOXO3, and Atrogin-1 signaling systems play key roles in regulating muscle protein breakdown, and the activation of these molecules is directly linked to muscle loss [75].

Thus, this review suggests that combining resistance exercises (resistance bands, core strengthening exercises, and squats), nutritional interventions (choline, liquid protein, leucine, vitamin D, and amino acids), and especially the therapeutic potential of monoterpenes and antioxidants, may be a potential strategy to control and treat sarcopenia, focusing on addressing the pathophysiology of sarcopenia.

Acknowledgements

This research was supported by “Regional Innovation Strategy (RIS)” through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (MOE) (2021RIS-001(1345370811)) This thesis is submitted as a master’s degree thesis at Semyung University Graduate School by Sang Moon Lee.

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Participants	Exercise frequency	Exercise time	Types of exercise	Efficacy	Ref.
Mobility-limited older adults (age ≥ 85)	3 times a week for 10 weeks	30 min	Wall bar, squat, leg press, knee extension	Muscle fibers stronger	[29]
Older adults (age ≥ 60)	Every day for 12weeks	30 min	Leg extension, leg press, Squat	Improvement the skeletal muscle capillarization	[30]
Older adults (age ≥ 55)	3 times a week for 12 weeks	50 min	Lower extremity exercise	Improvement functional fitness, physiological index, sleep quality	[31]
Sarcopenia patients (age ≥ 70)	3 times a week for 10 weeks	45 min	Suspension bands	Increased the muscle mass and maintained functional strength	[32]
Woman older adults (age ≥ 65)	4 weeks for 10 months	60 min	Suspension bands	Improvement the muscle quality	[33]

Participants	Diet	Exercise frequency	Types of exercise	Efficacy	Ref.
Older adults (age ≥ 50)	Choline (egg yolk)	3 times a week for 12 weeks	Dynamic stretching, seated chest press, lat pull down, leg press, calf raises, seated leg curls, knee extension, biceps curls, and triceps extension exercises	Improved the lean mass	[36]
Spinal sarcopenia (age ≥ 70)	Liquid protein supplement and energy bar	1 time a 2 weeks for 12 weeks	McKenzie back extension, curl-up, side-bridge, and bird-dog, squat	Improved the physical and back performance	[37]
Sarcopenia (age ≥ 65)	Leucine and vitamin D	5 times a week for 8 weeks	Muscle strengthen exercise (toe and heel raises, knee lifts and extension, resistance band et.al)	Improved the physical performance and muscle mass.	[40]
Sarcopenia (age ≥ 65)	Leucine and vitamin D	5 times a week for 8 weeks	Balance and gait exercise (one-leg stands and tandem stand et.al)	Reduced the intensity and costa of care.	[40]
Older adults (age ≥ 65)	Protein, micellar casein creatine, vitamin D3, omega-3 and calcium.	3 times as week for 12 weeks	Whole-body elastic band	Improved the lean mass, strength and muscle quality	[41]
Sarcopenia (age ≥ 60)	Protein, essential amino acid, leucine, carbohydrate, vitamin D	2 times a week for 12 weeks	Resistance band, core strengthening exercise	Improved the muscle mass	[42]

Name	Organism	Biological effect	Ref
Thymol	Thymus vulgaris, Ocimum gratissimum, Satureja intermedia	Antibacterial, antifungal, anti-inflammatory, anticancer, antitumor, anti-HIV, antiviral, antipyretic, anticonvulsant, and antidepressant	[45]
A-Pinene	Oniferous trees, rosemary, lavender, and turpentine	Anti-inflammatory, antiviral, antitumor, cytotoxic, and antimicrobial activities	[46]
Limonene	Itrus rind oil, dill oil, cumin oil, neroli, bergamot, and caraway	Antitumor, antiviral, anti-inflammatory, and antibacterial	[48]
Camphene	Rosemary, turmeric, pine tree, and ginger	Antibacterial, antifungal, anticancer, antioxidant, antiparasitic, antidiabetic, anti-inflammatory, and hypolipidemic activities	[50]
Sabinene	Juniperus sabina and Juniperus foetidissima, Juniperus sabina	Anti-tumor, anti-inflammation, anti-angiogenesis	[51]
Geraniol	Essential oil	Antioxidant, anti-inflammation, anti-cancer, hepatoprotective, cardioprotective, and neuroprotective	[52]
Myrcene	Hops, cannabis, lemongrass, verbena and bay	Antidiabetic, antioxidant, anti-inflammatory, antibacterial, and anticancer effects	[53]
Linalool	Lavender, bergamot, orange, pepermint,	anti-depression, anti-inflammation	[54]
Citronellol	Lemongrass	Hypotensive, analgesic, vasorelaxant, anti-inflammatory and anti-diabetic	[55]
Neroli	Citrus aurantium L. blossoms	Antimicrobial, antioxidant, anti-inflammatory	[56]
Eugenol	Clovetree, Carrot, Turmeric, Chinese Ginger	Antioxidant, analgesic, antimutagenic, anti-platelet, antiallergic, anti-swelling, and anti-inflammatory	[57]
Terpinene	Tea Tree, Thyme, Oregano, Eucalyptus	Antibacterial, insecticide, antioxidant	[58]
Myrtenal	Cumin, pepper, mint, and eucalyptus	Antioxidant, anticancer, antidiabetic	[59]
Camphor	Camphor laurel tree	Analgesic, antipruritic, antispasmodic, anti-inflammatory rubefacient, anti-oxidant anti-sarcopenia	[60]
Borneol	Avandula, Thymus vulgaris and Rosmarinus officinalis Linnaeus	Anti-inflammation and antioxidant	[61]