Acute citrulline-malate supplementation is ineffective during aerobic cycling and subsequent anaerobic performance in recreationally active males

Overview of mechanisms related to citrulline malate supplementation and different methods of high-intensity interval training on sports performance: A narrative review

Regular exercise is a practical non-pharmacological approach to maintaining physical and mental health through rehabilitation and prevention of chronic diseases due to its cardiovascular, cardiorespiratory, neurological, and neuromuscular benefits. Despite awareness of the benefits of exercise, a "lack of time" has proven to be the most common impediment to regular activity. Thus, a time-efficient and potentially enjoyable training modality with growing popularity is high-intensity interval training (HIIT). HIIT incorporates intermittent bouts of work and recovery intervals performed at an intensity close to maximal oxygen consumption (VO2max). HIIT is considered to have equivalent or superior benefits compared to moderate-intensity continuous training (MICT). This narrative review focuses on the mechanisms of Citrulline Malate (CM) supplementation and various modes of HIIT on exercise performance. CM serves as a nitric-oxide enhancer leading to improved aerobic and anaerobic exercise performance by increasing muscle adenosine triphosphate (ATP) production, vasodilation, and blood flow to the active musculature and boosting work capacity. This article reviews the mechanisms related to CM supplementation and different modes of HIIT on exercise performance. Even though a single, acute 8 g dose of CM has been recommended, its mechanism of action remains to be seen due to the synergistic impact of both components (citrulline and malate). Moreover, the limited evidence for the standard level of supplement use and source of purchase results in athletes' self-prescription of supplements. Therefore, to reduce the risk of accidental doping or toxicity, further studies should continue to investigate the optimal dose, timing, mechanism of action, as well as reliable sources of purchase for CM consumption.

Acute antioxidant supplementation and performance - Should this be considered

It is well known that a training intervention leads to mitochondrial adaptations with increased skeletal muscle mitochondrial biogenesis and function. Studies have recently indicated that skeletal muscle mitochondrial function is important for athletic performance. During exercise reactive oxygen species are released from skeletal muscle potentially leading to adaptations but maybe also to fatigue. Focus has been on how chronic antioxidant supplementation affects a training adaptation, where some studies are reporting an abolished adaptation. Whether acute antioxidant supplementation could have a positive effect on fatigue and performance is interesting and highly relevant in sports where athletes are competing over several consecutive days or on the same day, with preliminary competitions in the morning and finals in the afternoon, where it is important for the athletes to recover fast. This review provides an overview of the effects of acute antioxidant supplementation and whether it leads to improved performance and/or faster recovery in humans.

Effects of Acute Citrulline Malate Supplementation on CrossFit® Exercise Performance: A Randomized, Double-Blind, Placebo-Controlled, Cross-Over Study

Given the increasing popularity of CrossFit® as a high-intensity functional training program and the potential benefits of citrulline malate (CM) in enhancing exercise performance through its role as a precursor to L-arginine and nitric oxide production, this study aimed to investigate the acute effects of CM supplementation on CrossFit® performance and cardiovascular function. Using a randomized, double-blind, placebo-controlled, cross-over design, 21 recreationally active participants (mean age 22.2 ± 2.6 years, mean body weight 75.9 ± 10.4 kg) with CrossFit® experience completed the "Cindy" workout under CM and placebo conditions. Participants consumed 4.4 g of CM or a placebo 60 min before the workout, and the performance was measured by the number of rounds completed. Secondary outcomes included heart rate response, time spent in different heart rate intensity zones, and post-exercise recovery time. The results indicated no significant difference in the number of rounds completed between the CM and placebo conditions (13.5 ± 5.2 vs. 13.8 ± 6.7 rounds, respectively; p = 0.587). However, the time spent in zone 4 (80-90% of HR max) was significantly increased in the CM condition (527 ± 395 s vs. 453 ± 334 s; p = 0.017), suggesting a potential benefit for aerobic capacity and anaerobic threshold. No significant differences in post-exercise recovery time were observed (6.6 ± 4.7 h vs. 6.9 ± 4.7 h; p = 0.475). This study highlights the need for further research with larger sample sizes, both genders, and different CM dosages to clarify these findings and better understand CM's role in enhancing athletic performance.

Effects of citrulline on endurance performance in young healthy adults: a systematic review and meta-analysis

BACKGROUND

Citrulline is a popular dietary supplement, primarily thought to exert ergogenic effects on exercise performance through the enhancement of nitric oxide (NO) synthesis and ammonia buffering. However, recent findings surrounding citrulline's effect on endurance performance have been inconsistent. A systematic review and meta-analysis of the relevant literature have yet to be undertaken.

AIM

To determine if acute ingestion of citrulline has an ergogenic effect on endurance performance in young healthy adults.

METHODS

A systematic search of three databases was undertaken to find peer-reviewed randomized controlled trials (RCTs) published in English investigating the effects of citrulline supplementation on endurance performance in young healthy adults. Two independent investigators completed a three-phased screening procedure against pre-determined eligibility criteria. Included studies evaluated loading or bolus dosage regimes of citrulline in participants aged 18 or over that were at least recreationally active. Outcome measures focused on time-to-completion (TTC) or time-to-exhaustion (TTE) in continuous submaximal intensity exercise. Cochrane's Risk of Bias 2 (RoB 2) tool was used to assess the risk of bias in individual studies. Meta-analysis was conducted using a fixed-effects model to pool the weighted estimate of standardized mean differences (SMD) across studies. A chi-squared test assessed heterogeneity between studies. This review was conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

RESULTS

Nine studies (n = 158 participants) met the eligibility criteria; five reported TTE outcomes (I² = 0%, χ² = 0.37, df = 4, P = 0.99) and four reported TTC outcomes (I² = 0%, χ² = 0.46, df = 3, P = 0.93), both with a low between-study heterogeneity. The results of the meta-analyses showed no significant difference in the endurance performance measures, TTE (pooled SMD = 0.03 [-0.27, 0.33]) and TTC (pooled SMD = -0.07 [-0.50, 0.15]), after acute ingestion of citrulline supplementation or a control in young healthy adults.

DISCUSSION

The current evidence suggests no significant benefit of citrulline supplementation for endurance performance. However, the small evidence base requires further research to fully evaluate this topic. Recommendations include a focus on female populations; higher continuous doses of citrulline over seven days; and TTC outcome measures over longer distances to simulate competition.

The Effect of Acute Pre-Workout Supplement Ingestion on Basketball-Specific Performance of Well-Trained Athletes

A pre-workout supplement's (PWS; 200 mg caffeine, 3.3 g creatine monohydrate, 3.2 g β-alanine, 6 g citrulline malate and 5 g branched chained amino acid (BCAA) per dose) acute effects on the alactic (jumping, sprinting, agility), lactic (Running-Based Anaerobic Sprint Test, RAST) and aerobic performance (Yo-Yo Intermittent Recovery Test Level 1, Yo-Yo IRL1 VO_2max) of well-trained basketball players was investigated in this double-blind placebo-controlled study. Thirty players (age 18-31 years, height 166-195 cm, weight 70.2-116.7 kg, body fat 10.6-26.4%) were allocated to pre-workout (PWS, n = 15) or placebo (PL, n = 15) groups. Half of the participants in each group performed the evaluations without PWS or PL, while the rest consumed PWS or PL 30 min before the assessments (1st trial) and vice versa (2nd trial). Significant improvements in counter-movement jump (CMJ) (PWS: 4.3 ± 2.1%; PL: 1.2 ± 1.0%), agility (PWS: -2.9 ± 1.8%; PL: 1.8 ± 1.7%), RAST average (PWS: 18.3 ± 9.1%; PL: -2.2 ± 2.0%), minimum power (PWS: 13.7 ± 8.9%; PL: -7.5 ± 5.9%), and fatigue index (PWS: -25.0 ± 0.9%; PL: -4.6 ± 0.6%) were observed in the PWS group vs. the PL group (p < 0.05). No differences were found regarding sprinting, aerobic performance, and blood lactate concentrations. Thus, although players' alactic and lactic anaerobic performance could be improved, peak power, sprinting and aerobic performance are not.

ENHANCEMENT BY DIET AND AEROBIC EXERCISE IN PROFESSIONAL ATHLETES

ABSTRACT Introduction: Body weight regulation in sports competitions is an essential factor affecting the physical capacity of athletes. Especially in high-level events, the role of weight loss is significant in improving the competitive status. Weightlifters have high anaerobic capacity, high aerobic capacity, high flexibility, and less body fat. In all regular competitions, weightlifters compete against competitors of the same weight class. Objective: This paper investigates the effect of moderate aerobic exercise on weight loss in athletes and the effects of related biochemical parameters. Methods: Twenty weightlifters were randomly selected to conduct a questionnaire survey. The athletes performed aerobic exercises for eight weeks. The collection method and mathematical statistics were used to study body shape and constitution, blood indices, and other relevant data about weightlifters in China. Results: The effect of aerobic exercise on improving the athletes' physical fitness is discussed. The results showed that body weight, waist circumference, hip circumference, and body mass index decreased the most (P<0.05). Waist-to-hip ratio, waist-to-height ratio, hip-to-height ratio, and BMI significantly decreased (P<0.05). There was no significant change in height and fat index (P>0.05). Conclusion: 8 weeks of aerobic exercise and an appropriate diet can significantly improve the body shape index, physical index, and biochemical index of athletes. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

Effects of Citrulline Supplementation on Different Aerobic Exercise Performance Outcomes: A Systematic Review and Meta-Analysis

Supplementation with Citrulline (Cit) has been shown to have a positive impact on aerobic exercise performance and related outcomes such as lactate, oxygen uptake (VO₂) kinetics, and the rate of perceived exertion (RPE), probably due to its relationship to endogenous nitric oxide production. However, current research has shown this to be controversial. The main objective of this systematic review and meta-analysis was to analyze and assess the effects of Cit supplementation on aerobic exercise performance and related outcomes, as well as to show the most suitable doses and timing of ingestion. A structured literature search was carried out by the PRISMA^® (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and PICOS guidelines in the following databases: Pubmed/Medline, Scopus, and Web of Science (WOS). A total of 10 studies were included in the analysis, all of which exclusively compared the effects of Cit supplementation with those of a placebo group on aerobic performance, lactate, VO₂, and the RPE. Those articles that used other supplements and measured other outcomes were excluded. The meta-analysis was carried out using Hedges’ g random effects model and pooled standardized mean differences (SMD). The results showed no positive effects of Cit supplementation on aerobic performance (pooled SMD = 0.15; 95% CI (−0.02 to 0.32); I², 0%; p = 0.08), the RPE (pooled SMD = −0.03; 95% CI (−0.43 to 0.38); I², 49%; p = 0.9), VO₂ kinetics (pooled SMD = 0.01; 95% CI (−0.16 to 0.17); I², 0%; p = 0.94), and lactate (pooled SMD = 0.25; 95% CI (−0.10 to 0.59); I², 0%; p = 0.16). In conclusion, Cit supplementation did not prove to have any benefits for aerobic exercise performance and related outcomes. Where chronic protocols seemed to show a positive tendency, more studies in the field are needed to better understand the effects.

A critical review of citrulline malate supplementation and exercise performance

As a nitric oxide (NO) enhancer, citrulline malate (CM) has recently been touted as a potential ergogenic aid to both resistance and high-intensity exercise performance, as well as the recovery of muscular performance. The mechanism has been associated with enhanced blood flow to active musculature, however, it might be more far-reaching as either ammonia homeostasis could be improved, or ATP production could be increased via greater availability of malate. Moreover, CM might improve muscle recovery via increased nutrient delivery and/or removal of waste products. To date, a single acute 8 g dose of CM on either resistance exercise performance or cycling has been the most common approach, which has produced equivocal results. This makes the effectiveness of CM to improve exercise performance difficult to determine. Reasons for the disparity in conclusions seem to be due to methodological discrepancies such as the testing protocols and the associated test–retest reliability, dosing strategy (i.e., amount and timing), and the recent discovery of quality control issues with some manufacturers stated (i.e., citrulline:malate ratios). Further exploration of the optimal dose is therefore required including quantification of the bioavailability of NO, citrulline, and malate following ingestion of a range of CM doses. Similarly, further well-controlled studies using highly repeatable exercise protocols with a large aerobic component are required to assess the mechanisms associated with this supplement appropriately. Until such studies are completed, the efficacy of CM supplementation to improve exercise performance remains ambiguous.

Citrulline, Biomarker of Enterocyte Functional Mass and Dietary Supplement. Metabolism, Transport, and Current Evidence for Clinical Use

L-Citrulline is a non-essential but still important amino acid that is released from enterocytes. Because plasma levels are reduced in case of impaired intestinal function, it has become a biomarker to monitor intestinal integrity. Moreover, oxidative stress induces protein citrullination, and antibodies against anti-citrullinated proteins are useful to monitor rheumatoid diseases. Citrullinated histones, however, may even predict a worse outcome in cancer patients. Supplementation of citrulline is better tolerated compared to arginine and might be useful to slightly improve muscle strength or protein balance. The following article shall provide an overview of L-citrulline properties and functions, as well as the current evidence for its use as a biomarker or as a therapeutic supplement.