Effects of various concentrations of carbohydrate mouth rinse on cycling performance in a fed state

Carbohydrate mouth rinse failed to reduce central fatigue, lower perceived exertion, and improve performance during incremental exercise

We examined if carbohydrate (CHO) mouth rinse may reduce central fatigue and perceived exertion, thus improving maximal incremental test (MIT) performance. Nine recreational cyclists warmed up for 6 min before rinsing a carbohydrate (CHO) or placebo (PLA) solution in their mouth for 10 s in a double-blind, counterbalanced manner. Thereafter, they performed the MIT (25 W·min-1 increases until exhaustion) while cardiopulmonary and ratings of perceived exertion (RPE) responses were obtained. Pre- to post-MIT alterations in voluntary activation (VA) and peak twitch torque (Tw) were determined. Time-to-exhaustion (p = 0.24), peak power output (PPO; p = 0.45), and V̇O2MAX (p = 0.60) were comparable between conditions. Neither treatment main effect nor time-treatment interaction effect were observed in the first and second ventilatory threshold when expressed as absolute or relative V̇O2 (p = 0.78 and p = 0.96, respectively) and power output (p = 0.28 and p = 0.45, respectively) values, although with moderate-to-large effect sizes. RPE increased similarly throughout the tests and was comparable at the ventilatory thresholds (p = 0.56). Despite the time main effect revealing an MIT-induced central and peripheral fatigue as indicated by the reduced VA and Tw, CHO mouth rinse was ineffective in attenuating both fatigues. Hence, rinsing the mouth with CHO was ineffective in reducing central fatigue, lowering RPE, and improving MIT performance expressed as PPO and time-to-exhaustion. However, moderate-to-large effect sizes in power output values at VT1 and VT2 may suggest some beneficial CHO mouth rinse effects on these MIT outcomes.

Central effects of mouth rinses on endurance and strength performance

Rinsing the mouth with a carbohydrate (CHO) solution has been shown to enhance exercise performance while reducing neuromuscular fatigue. This effect is thought to be mediated through the stimulation of oral receptors, which activate brain areas associated with reward, motivation, and motor control. Consequently, corticomotor responsiveness is increased, leading to sustained levels of neuromuscular activity prior to fatigue. In the context of endurance performance, the evidence regarding the central involvement of mouth rinse (MR) in performance improvement is not conclusive. Peripheral mechanisms should not be disregarded, particularly considering factors such as low exercise volume, the participant's fasting state, and the frequency of rinsing. These factors may influence central activations. On the other hand, for strength-related activities, changes in motor evoked potential (MEP) and electromyography (EMG) have been observed, indicating increased corticospinal responsiveness and neuromuscular drive during isometric and isokinetic contractions in both fresh and fatigued muscles. However, it is important to note that in many studies, MEP data were not normalised, making it difficult to exclude peripheral contributions. Voluntary activation (VA), another central measure, often exhibits a lack of changes, mainly due to its high variability, particularly in fatigued muscles. Based on the evidence, MR can attenuate neuromuscular fatigue and improve endurance and strength performance via similar underlying mechanisms. However, the evidence supporting central contribution is weak due to the lack of neurophysiological measures, inaccurate data treatment (normalisation), limited generalisation between exercise modes, methodological biases (ignoring peripheral contribution), and high measurement variability.Trial registration: PROSPERO ID: CRD42021261714.

Food for thought: Physiological considerations for nutritional ergogenic efficacy

Top-class athletes have optimized their athletic performance largely through adequate training, nutrition, recovery, and sleep. A key component of sports nutrition is the utilization of nutritional ergogenic aids, which may provide a small but significant increase in athletic performance. Over the last decade, there has been an exponential increase in the consumption of nutritional ergogenic aids, where over 80% of young athletes report using at least one nutritional ergogenic aid for training and/or competition. Accordingly, due to their extensive use, there is a growing need for strong scientific investigations validating or invalidating the efficacy of novel nutritional ergogenic aids. Notably, an overview of the physiological considerations that play key roles in determining ergogenic efficacy is currently lacking. Therefore, in this brief review, we discuss important physiological considerations that contribute to ergogenic efficacy for nutritional ergogenic aids that are orally ingested including (1) the impact of first pass metabolism, (2) rises in systemic concentrations, and (3) interactions with the target tissue. In addition, we explore mouth rinsing as an alternate route of ergogenic efficacy that bypasses the physiological hurdles of first pass metabolism via direct stimulation of the central nervous system. Moreover, we provide real-world examples and discuss several practical factors that can alter the efficacy of nutritional ergogenic aids including human variability, dosing protocols, training status, sex differences, and the placebo effect. Taking these physiological considerations into account will strengthen the quality and impact of the literature regarding the efficacy of potential ergogenic aids for top-class athletes.

Carbohydrate Rinse Fails to Enhance Cycling Performance or Alter Metabolic and Autonomic Recovery in Recreational Cyclists

The purpose of the study was to examine the effects of carbohydrate (CHO) mouth rinsing on autonomic and metabolic recovery as well as cycling performance. Ten male recreational cyclists (age = 30 ± 6 years, VO_2peak = 54.5 ± 8.1 mL·kg^-1·min^-1) completed a randomized, double-blind, placebo-controlled, crossover designed study. A CHO or a placebo (PLA) rinse was administered every 12.5% of a work to completion trial (75%W_max). Heart rate variability (lnRMSSD), the respiratory exchange ratio, and plasma epinephrine, norepinephrine, insulin, glucose, free fatty acids (FFA), and lactate were measured pre- and post-exercise. The CHO rinse did not improve time to completion of the test trial (CHO: 4108 ± 307 s, PLA: 4176 ± 374 s, p = 0.545). Further, the CHO rinse did not impact autonomic recovery, as measured by lnRMSSD (p = 0.787) and epinephrine (p = 0.132). Metabolic biomarkers were also unaffected by the CHO rinse, with no differences observed in responses of FFA (p = 0.064), lactate (p = 0.302), glucose (p = 0.113) or insulin (p = 0.408). Therefore, the CHO mouth rinse does not reduce the acute sympathetic response following strenuous exercise and does not result in improvements in cycling time to completion.

A Narrative Review of Current Concerns and Future Perspectives of the Carbohydrate Mouth Rinse Effects on Exercise Performance

Previous systematic reviews have confirmed that carbohydrate (CHO) mouth rinse may boost physical exercise performance, despite some methodological aspects likely affecting its ergogenic effect. In this review, we discussed if the exercise mode, pre-exercise fasting status, CHO solutions concentration, CHO solutions temperature, mouth rinse duration, and CHO placebo effects may potentially reduce the CHO mouth rinse ergogenic effect, suggesting possible solutions to manage these potential confounders. The effectiveness of CHO mouth rinse as a performance booster is apparently related to the origin of the exercise-induced neuromuscular fatigue, as CHO mouth rinse unequivocally potentiates endurance rather than sprint and strength exercises performance. Furthermore, ergogenic effects have been greater in fasting than fed state, somehow explaining the varied magnitude of the CHO mouth rinse effects in exercise performance. In this regard, the CHO solution concentration and temperature, as well as the mouth rinse duration, may have increased the variability observed in CHO mouth rinse effects in fasting and fed state. Finally, placebo effects have challenged the potential of the CHO mouth rinse as an ergogenic aid. Therefore, we suggest that future studies should consider methodological controls such as sample size and sample homogeneity, proper familiarization with experimental procedures, and the use of alternative placebo designs to provide unbiased evidence regarding the potential of the CHO mouth rinse as an ergogenic aid.

Maltodextrin-Based Carbohydrate Oral Rinsing and Exercise Performance: Systematic Review and Meta-Analysis

Background

Carbohydrates are an important fuel for optimal exercise performance during moderate- and high-intensity exercise; however, carbohydrate ingestion during high-intensity exercise may cause gastrointestinal upset. A carbohydrate oral rinse is an alternative method to improve exercise performance in moderate- to high-intensity exercise with a duration of 30–75 min. This is the first systematic review and meta-analysis to comprehensively examine the isolated effect of maltodextrin-based rinsing on exercise performance.

Objective

The objective of this review was to establish the effect of a maltodextrin-based carbohydrate oral rinse on exercise performance across various modes of exercise. Furthermore, a secondary objective was to determine the effects of moderators [(1) participant characteristics; (2) oral rinse protocols; (3) exercise protocol (i.e. cycling, running etc.) and (4) fasting] on exercise performance while using a maltodextrin-based, carbohydrate oral rinse.

Methods

Five databases (MEDLINE, PsycINFO, Embase, SPORTDiscus and Global Health) were systematically searched for articles up to March 2021 and screened using Covidence (a systematic review management tool). A random effects robust meta-analysis and subgroup analyses were performed using Stata Statistical Software: Release 16.

Results

Thirty-five articles met the inclusion criteria and were included in the systematic review; 34 of these articles were included in the meta-analysis. When using a conventional meta-analytic approach, overall, a carbohydrate oral rinse improved exercise performance in comparison with a placebo (SMD = 0.15, 95% CI 0.04, 0.27; p = 0.01). Furthermore, when implementing an adjusted, conservative, random effects meta-regression model using robust variance estimation, overall, compared with placebo, a carbohydrate oral rinse demonstrated evidence of improving exercise performance with a small effect size (SMD = 0.17, 95% CI − 0.01, 0.34; p = 0.051).

Conclusion

This systematic review and meta-analysis demonstrates that a maltodextrin-based carbohydrate oral rinse can improve exercise performance. When comparing the two meta-analytic approaches, although non-significant, the more robust, adjusted, random effects meta-regression model demonstrated some evidence of a maltodextrin-based carbohydrate oral rinse improving exercise performance overall.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40279-022-01658-3.

Ingestion of Carbohydrate Solutions and Mouth Rinse on Mood and Perceptual Responses during Exercise in Triathletes

Triathlons are endurance events that include swimming, running, and cycling. Triathletes need to eat optimally during training and competitions to maximize their potential for success. The presence of carbohydrates in the mouth could activate regions in the brain to enhance athletic performance in exercise. Methods: This study examined the effects of glucose and mouthwash in ten male triathletes (age: 26.0 ± 8.7 years, height: 173.6 ± 10.4 cm, BMI 22.0 ± 1.7 kg/m2). The four oral test solutions included (A) Rinse with placebo, (B) Water + gel with placebo, (C) Rinse with 15% CH concentration, and (D) Water + gel with 15% CH concentration (25 g gel in 165 mL water). The Rate of Perceived Exertion (RPE), Sensation Scale (FS), Felt Arousal Scale (FAS), Profile of Mood States (POMS), blood glucose, sprints, and dietary habits were assessed in each subject. All preceded ingestion of the oral-based test solution during workouts. Results: RPE showed no significant differences for subjective perceptions. The same was observed for FS and sprints. FAS scores increased over time (p = 0.039) in all groups. POMS score increased significantly in group D (p = 0.041). There was no effect of time on plasma glucose levels (p = 0.737). As for correlations, positive correlations were observed between sprint and FAS variables (p = 0.011). Conclusions: It appears that CH intake correlates positively with mood, but in all other variables, there are no differences depending on the product.

Carbohydrate Mouth Rinsing Does Not Alter Central or Peripheral Fatigue After High-Intensity and Low-Intensity Exercise in Men

ABSTRACT

Black, CD, Haskins, KR, Bemben, MG, and Larson, RD. Carbohydrate mouth rinsing does not alter central or peripheral fatigue after high-intensity and low-intensity exercise in men. J Strength Cond Res 36(1): 142-148, 2022-Carbohydrate (CHO) mouth rinsing improves performance during endurance exercise. However, its ability to attenuate fatigue during strength-based exercise is less certain. This study sought to determine the effects of a CHO mouth rinse on torque production and voluntary activation (VA%) after high-intensity and low-intensity isometric exercise. Twelve male subjects (22.5 ± 2.3 years; 183.5 ± 6.5 cm; 82.2 ± 13.9 kg) completed 4 testing sessions in a double-blind crossover fashion. Knee extension maximal voluntary isometric strength (MVC) was assessed before(Pre), immediately (iPost-Ex), and 5 minutes (5-min Post Ex) after isometric exercise performed at 80% or 20% of MVC. An 8% CHO solution or placebo (PLA) was rinsed for 20 seconds after exercise. VA% was determined by twitch interpolation. A 2 condition (CHO vs. PLA) × 2 contraction intensity (20 vs. 80%) × 3 time (Pre, iPost Ex, and 5-min Post Ex) completely within subject-repeated measured analysis of variance was performed; statistical significance was set at p ≤ 0.05. Greater reductions in MVC were found at iPost-Ex after exercise at 20% compared with 80% of MVC (-25 ± 14% vs. -11 ± 8%; p < 0.001) as well as for VA% (-17 ± 14% vs. -8 ± 14%; p < 0.004). No differences were observed in the CHO vs. PLA condition (p ≥ 0.34). We were successful in eliciting differing levels of central and peripheral fatigue by exercising at a low and high intensity. Despite significantly larger declines in VA% after exercise at 20% of MVC, CHO mouth rinsing had no effects compared with placebo on any measured variable.

The Performance Effect of Scheduled Carbohydrate and Caffeine Intake during Simulated Team Sport Match-Play

The aim of the current investigation was to identify the effects of scheduled carbohydrate (CHO) and caffeine (CAF) supplementation on simulated team sport match-play performance. Ten male hurling players completed three hurling match-play simulation protocols (HSP) performed 7 days apart in a double-blind, randomized design. Supplementation included CHO, CHO + CAF, and placebo (PLA). In a randomized order, participants ingested either a 6% CHO solution, a PLA solution of similar taste, or a combined intake of 6% CHO solution + 200 mg CAF capsule. At specific time points (Pre-0 min; half time (HT)-30 min; full time (FT)-60 min), participants completed a repeated sprint protocol (RAST; 12 × 20 m). Physiological [% maximal oxygen uptake (%VO_2max), % mean oxygen uptake (%VO_2mean), % maximal heart rate (%HR_max), % mean heart rate (%HR_mean), respiratory exchange ratio (RER), and blood lactate (BLa)] and performance [(best sprint time (RSA_best), mean sprint time (RSA_mean), and rate of perceived exertion (RPE)] variables were monitored throughout each simulation. Non-significant differences were observed between supplement trials (CHO, CHO + CAF, and PLA) for BLa (η² = 0.001, small), %VO_2max (η² = 0.001, small), %VO_2mean (η² = 0.004, small), %HR_max (η² = 0.007, small), %HR_mean (η² = 0.018, small), RER (η² = 0.007, small), RPE (η² = 0.007, small), and RSA_best (η² = 0.050, small). RSA_mean performance significantly improved in CHO + CAF trials compared to PLA, with sprint times significantly improved from Pre to FT also (η² = 0.135, medium). A significant difference was observed in BLa between time points (Pre, HT, and FT) (η² = 0.884, large) in % HRmax (η² = 0.202, medium), %HR_mean (η² = 0.477, large), and RER (η² = 0.554, large) across halves and in RPE across time points (η² = 0.670, large). Our data provide novel data regarding the effects of CHO and CAF supplementation on team sport performance, with co-ingestion of CHO + CAF reducing the decrement in repeated sprint performance compared to PLA.

Effects of Carbohydrate Mouth Rinse on Cycling Time Trial Performance: A Systematic Review and Meta-Analysis

BACKGROUND

Despite the growing number of studies reporting carbohydrate mouth rinse effects on endurance performance, no systematic and meta-analysis review has been conducted to elucidate the level of evidence of carbohydrate mouth rinse effects on cycling trial performance such as time-, work-, and distance-based trials.

OBJECTIVES

The objective of this study were to establish the effect of a carbohydrate mouth rinse on cycling performance outcomes such as mean power output and time to complete a trial, together with the risk of bias in the cycling-carbohydrate mouth rinse literature.

METHODS

We systematically reviewed randomized placebo-controlled trials that assessed carbohydrate mouth rinse effects on mean power output and time to complete the trial. A random-effects meta-analysis assessed the standardized mean difference between carbohydrate and placebo mouth rinses.

RESULTS

Thirteen studies (16 trials) were qualitatively (systematic review) and quantitatively (meta-analysis) analyzed with regard to mean power output (n = 175) and time to complete the trial (n = 151). Overall, the reviewed studies showed a low risk of bias and homogeneous results for mean power output (I² = 0%) and time to complete the trial (I² = 0%). When compared with placebo, the carbohydrate mouth rinse improved mean power output (standardized mean difference = 0.25; 95% confidence interval 0.04-0.46; p = 0.02), but not the time to complete the trial (standardized mean difference = - 0.13; 95% confidence interval - 0.36 to 0.10; p = 0.25).

CONCLUSION

The present systematic and meta-analytic review supports the notion that a carbohydrate mouth rinse has the potential to increase mean power output in cycling trials, despite showing no superiority over placebo in improving time to complete the trials.

Impact of a Carbohydrate Mouth Rinse on Quadriceps Muscle Function and Corticomotor Excitability

PURPOSE

The purpose of this investigation is to determine the effects of different forms of a CHO MR on quadriceps muscle performance and corticospinal motor excitability.

METHODS

Ten subjects (5 females, 5 males; 25±1 years; 1.71±0.03 m 73±5 kg) completed 4 trials. A different MR condition was applied during each trial (Placebo (PLA), 6.4% glucose (GLU), 6.4% maltose (MAL), 6.4% maltodextrin (MDX)). Maximal voluntary contraction (MVIC) of the right quadriceps and motor-evoked potential (MEP) of the right rectus femoris was determined pre (10 min), immediately after, and post (10 min) MR. MEP was precipitated by transcranial magnetic stimulation (TMS) during muscle contraction (50% of MVIC). MR was held in the mouth for 20 s and treatments were applied using a Latin square design. The relative change in MEP from pre-measures was different across treatments (p=0.025) but was not different across time (p=0.357).

RESULTS

Relative change in MEP was greater for all CHO conditions immediately after (GLU=2.58±5.33%; MAL=3.92±3.90%; MDX=18.28±5.57%) and 10 min after (GLU=14.09±13.96%; MAL=8.64±8.67%; MDX=31.54±12.77%) MR compared to PLA (Immediately after=-2.19±4.25%, 10 min=-13.41±7.46%). The relative change in MVC was greater for CHO conditions immediately (GLU=3.98±2.49%; MAL=5.89±2.29.90%; MDX=7.66±1.93%) and 10 min after (GLU=7.22±2.77%; MAL=10.26±4.22%; MDX=10.18±1.50%) MR compared to PLA (Immediately after=-3.24±1.50%, 10 min=-6.46±2.22%).

CONCLUSIONS

CHO MR increased corticospinal motor excitability and quadriceps muscle performance immediately and 10 min after application; however, the form of CHO used did not influence this response.

Carbohydrate Mouth Rinsing Does Not Prevent the Decline in Maximal Strength After Fatiguing Exercise

Black, CD, Schubert, DJ, Szczyglowski, MK, and Wren, JD. Carbohydrate mouth rinsing does not prevent the decline in maximal strength after fatiguing exercise. J Strength Cond Res 32(9): 2466-2473, 2018-Carbohydrate (CHO) rinsing has been shown to attenuate the decline of maximal voluntary contractions (MVCs) after fatiguing exercise-perhaps through a central mechanism. This study sought to determine the effect of a CHO rinse on MVC, voluntary activation, and contractile properties after fatiguing exercise. Thirteen adults participated in a double-blind, cross-over study. Maximal voluntary contraction of the dominant knee extensors was assessed, and voluntary activation (%VA) was determined using twitch interpolation. Participants then held 50% of MVC until volitional fatigue followed by a 20-second rinse with a solution of 8% maltodextrin (CHO) or placebo (PLA). Maximal voluntary contraction and %VA were reassessed immediately and 5 minutes after exercise. Maximal voluntary contraction did not differ between the CHO and PLA conditions initially (230 ± 90 vs. 232 ± 90 N·m; p = 0.69). Maximal voluntary contraction declined after exercise (p ≤ 0.01), but no differences were found between the CHO and PLA conditions (p ≥ 0.59). %VA did not differ between conditions (91.9 ± 2.9% vs. 91.5 ± 3.8%; p ≥ 0.11) nor did it change after exercise (p = 0.57). Twitch torque, rate of torque development, and rate of torque relaxation were reduced after exercise (p ≤ 0.05) but were unaffected by CHO rinsing (p > 0.05). Unlike a previous study, a CHO rinse did not preserve MVC after fatiguing exercise. This was likely due to a lack of central fatigue induced by the exercise protocol (as %VA was unaffected) as the CHO rinse is thought to work through a central mechanism.

Effects of carbohydrate mouth rinse and caffeine on high-intensity interval running in a fed state

The current study aims to identify if mouth rinsing with a 6% carbohydrate mouth-rinse (CMR) solution and mouth rinsing and ingestion of caffeine (CMR+CAFF) can affect exercise performance during steady-state (SS) running and high-intensity intervals (HIIT) in comparison with a 0% control solution (PLA) when in a fed state. Eight recreationally trained males completed 3 trials (CMR, CMR+CAFF, and PLA) of 45 min SS running and an HIIT protocol (90% peak treadmill velocity) until fatigue in a double blinded, repeated-measures study. Participants ingested a capsule of either CAFF or PLA before and after SS. Participants received a 25-mL bolus of carbohydrate solution (CMR and CMR+CAFF trials) or taste-matched PLA (PLA trial) prior to HIIT protocol and after every second effort. Heart rate and lactate responses were recorded throughout the SS and HIIT protocol. CMR+CAFF was significantly different when compared with PLA (p = 0.001; Cohens d = 1.34) and CMR (p = 0.031; Cohens d = 0.87) in relation to distance covered before fatigue. Although there was no significant difference between CMR and PLA, there was a small benefit for CMR (p = 0.218; Cohens d = 0.46). Results indicate that CMR and ingestion of CAFF leads to improvements in performance during interval sessions while participants were in a fed state. These findings indicate that the regular use of CMR can decrease the risk of gastrointestinal distress reported by athletes, which can be applicable to athletes in a real-world setting.

Quantifying the Effect of Carbohydrate Mouth Rinsing on Exercise Performance

The purpose of this study was to review the existing literature investigating carbohydrate mouth rinsing as an ergogenic aid using the effect sizes (ES) and percentage change in performance of the respective studies as outcome measures. A trivial-small average overall ES was present for the 25 studies included in the review (0.18, 95% confidence interval [CI] = 0.10-0.27). Effect sizes for the subgroups were ≥25 minutes (0.25, 95% CI = 0.14-0.36), ≤180 seconds (0.06, 95% CI = -0.03 to 0.15), resistance exercise (-0.09, 95% CI = -0.20 to 0.03) but the ES is still small. A subanalysis of ∼1-h cycling time trial performance resulted in an overall ES of 0.20 (95% CI = 0.02-0.38), and ES for performance time and power output of 0.31 (95% CI = -0.02 to 0.64) and 0.19 (95% CI = -0.09 to 0.46), respectively. Although ES were small, the average percentage change in performance in ∼1-hour trials was 2.48%, which may have implications for elite performers as this is greater than the 1.30% smallest worthwhile change recommended in the past research.

Cognitive Performance Enhancement Induced by Caffeine, Carbohydrate and Guarana Mouth Rinsing during Submaximal Exercise

The aim of this study was to investigate the influence of serial mouth rinsing (MR) with nutritional supplements on cognitive performance (i.e., cognitive control and time perception) during a 40-min submaximal exercise. Twenty-four participants completed 4 counterbalanced experimental sessions, during which they performed MR with either placebo (PL), carbohydrate (CHO: 1.6 g/25 mL), guarana complex (GUAc: 0.4 g/25 mL) or caffeine (CAF: 67 mg/25 mL) before and twice during exercise. The present study provided some important new insights regarding the specific changes in cognitive performance induced by nutritional supplements. The main results were: (1) CHO, CAF and GUA MR likely led participants to improve temporal performance; (2) CAF MR likely improved cognitive control; and (3) CHO MR led to a likely decrease in subjective perception of effort at the end of the exercise compared to PL, GUA and CAF. Moreover, results have shown that performing 40-min submaximal exercise enhances information processing in terms of both speed and accuracy, improves temporal performance and does not alter cognitive control. The present study opens up new perspectives regarding the use of MR to optimize cognitive performance during physical exercise.