Effect of ingesting caffeine and ephedrine on 10-km run performance

Acute caffeine supplementation offsets the impairment in 10-km running performance following one night of partial sleep deprivation: a randomized controlled crossover trial

INTRODUCTION

Whether acute caffeine supplementation can offset the negative effects of one-night of partial sleep deprivation (PSD) on endurance exercise performance is currently unknown.

METHODS

Ten healthy recreational male runners (age: 27 ± 6 years;V ˙ O 2 max : 61 ± 9 mL/kg/min) completed 4 trials in a balanced Latin square design, which were PSD + caffeine (PSD-Caf), PSD + placebo (PSD-Pla), normal sleep (NS) + caffeine (NS-Caf) and NS + placebo (NS-Pla). 3 and 8 h sleep windows were scheduled in PSD and NS, respectively. 10-km treadmill time trial (TT) performance was assessed 45 min after caffeine (6 mg/kg/body mass)/placebo supplementation in the morning following PSD/NS. Blood glucose, lactate, free fatty acid and glycerol were measured at pre-supplementation, pre-exercise and after exercise.

RESULTS

PSD resulted in compromised TT performance compared to NS in the placebo conditions by 5% (51.9 ± 7.7 vs. 49.4 ± 6.9 min, p = 0.001). Caffeine improved TT performance compared to placebo following both PSD by 7.7% (PSD-Caf: 47.9 ± 7.3 min vs. PSD-Pla: 51.9 ± 7.7 min, p = 0.007) and NS by 2.8% (NS-Caf: 48.0 ± 6.4 min vs. NS-Pla: 49.4 ± 6.9 min, p = 0.049). TT performance following PSD-Caf was not different from either NS-Pla or NS-Caf (p = 0.185 and p = 0.891, respectively). Blood glucose, lactate, and glycerol concentrations at post-exercise, as well as heart rate and the speed/RPE ratio during TT, were higher in caffeine trials compared to placebo.

CONCLUSIONS

Caffeine supplementation offsets the negative effects of one-night PSD on 10-km running performance.

Effects of Caffeine Intake on Endurance Running Performance and Time to Exhaustion: A Systematic Review and Meta-Analysis

Caffeine (1,3,7-trimethylxanthine) is one of the most widely consumed performance-enhancing substances in sport due to its well-established ergogenic effects. The use of caffeine is more common in aerobic-based sports due to the ample evidence endorsing the benefits of caffeine supplementation on endurance exercise. However, most of this evidence was established with cycling trials in the laboratory, while the effects of the acute intake of caffeine on endurance running performance have not been properly reviewed and meta-analyzed. The purpose of this study was to perform a systematic review and meta-analysis of the existing literature on the effects of caffeine intake on endurance running performance. A systematic review of published studies was performed in four different scientific databases (Medline, Scopus, Web of Science, and SportDiscus) up until 5 October 2022 (with no year restriction applied to the search strategy). The selected studies were crossover experimental trials in which the ingestion of caffeine was compared to a placebo situation in a single- or double-blind randomized manner. The effect of caffeine on endurance running was measured by time to exhaustion or time trials. We assessed the methodological quality of each study using Cochrane’s risk-of-bias (RoB 2) tool. A subsequent meta-analysis was performed using the random effects model to calculate the standardized mean difference (SMD) estimated by Hedges’ g and 95% confidence intervals (CI). Results: A total of 21 randomized controlled trials were included in the analysis, with caffeine doses ranging between 3 and 9 mg/kg. A total of 21 studies were included in the systematic review, with a total sample of 254 participants (220 men, 19 women and 15 participants with no information about gender; 167 were categorized as recreational and 87 were categorized as trained runners.). The overall methodological quality of studies was rated as unclear-to-low risk of bias. The meta-analysis revealed that the time to exhaustion in running tests was improved with caffeine (g = 0.392; 95% CI = 0.214 to 0.571; p < 0.001, magnitude = medium). Subgroup analysis revealed that caffeine was ergogenic for time to exhaustion trials in both recreational runners (g = 0.469; 95% CI = 0.185 to 0.754; p = 0.001, magnitude = medium) and trained runners (g = 0.344; 95% CI = 0.122 to 0.566; p = 0.002, magnitude = medium). The meta-analysis also showed that the time to complete endurance running time trials was reduced with caffeine in comparison to placebo (g = −0.101; 95% CI = −0.190 to −0.012, p = 0.026, magnitude = small). In summary, caffeine intake showed a meaningful ergogenic effect in increasing the time to exhaustion in running trials and improving performance in running time trials. Hence, caffeine may have utility as an ergogenic aid for endurance running events. More evidence is needed to establish the ergogenic effect of caffeine on endurance running in women or the best dose to maximize the ergogenic benefits of caffeine supplementation.

Cannabis and Athletic Performance

Cannabis is widely used for both recreational and medicinal purposes on a global scale. There is accumulating interest in the use of cannabis and its constituents for athletic recovery, and in some instances, performance. Amidst speculation of potential beneficial applications, the effects of cannabis and its two most abundant constituents, delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD), remain largely un-investigated. The purpose of this review is to critically evaluate the literature describing the effects of whole cannabis, THC, and CBD, on athletic performance and recovery. While investigations of whole cannabis and THC have generally shown either null or detrimental effects on exercise performance in strength and aerobic-type activities, studies of sufficient rigor and validity to conclusively declare ergogenic or ergolytic potential in athletes are lacking. The ability of cannabis and THC to perturb cardiovascular homeostasis warrants further investigation regarding mechanisms by which performance may be affected across different exercise modalities and energetic demands. In contrast to cannabis and THC, CBD has largely been scrutinized for its potential to aid in recovery. The beneficial effects of CBD on sleep quality, pain, and mild traumatic brain injury may be of particular interest to certain athletes. However, research in each of these respective areas has yet to be thoroughly investigated in athletic populations. Elucidating the effects of whole cannabis, THC, and CBD is pertinent for both researchers and practitioners given the widespread use of these products, and their potential to interact with athletes' performance and recovery.

Four Days of Blueberry Powder Supplementation Lowers the Blood Lactate Response to Running But Has No Effect on Time-Trial Performance

Blueberries are abundant with anthocyanins possessing antioxidant and anti-inflammatory properties. As these properties combat fatigue and promote recovery, blueberry supplementation may enhance performance and recovery. Thus, the objectives were to examine the effects of two blueberry supplementation protocols on running performance, physiological responses, and short-term recovery. Using a randomized, double-blind, placebo (PLA)-controlled crossover design, 14 runners completed an 8-km time trial (TT) after supplementation with 4 days of blueberries (4DAY), 4 days of a PLA, or 2 days of placebo followed by 2 days of blueberries (2DAY). Heart rate and ratings of perceived exertion were monitored during the TT. Blood lactate, vertical jump, reactive strength index, and salivary markers were assessed before and after. No significant differences were observed for time to complete the TT (PLA: 3,010 ± 459 s; 2DAY: 3,014 ± 488 s; 4DAY: 3,011 ± 423 s), heart rate, ratings of perceived exertion, or any of the salivary markers. An interaction effect (p = .027) was observed for blood lactate, with lower post-TT concentrations in 4DAY (5.4 ± 2.0 mmol/L) than PLA (6.6 ± 2.5 mmol/L; p = .038) and 2DAY (7.4 ± 3.4 mmol/L; p = .034). Post-TT decreases in vertical jump height were not different, whereas the decline in reactive strength index was less following 4DAY (-6.1% ± 13.5%) than the other conditions (PLA: -12.6% ± 10.1%; 2DAY: -11.6% ± 11.5%; p = .038). Two days of supplementation did not influence performance or physiological stress. Although 4 days of supplementation did not alter performance, it blunted the increase in blood lactate, perhaps reflecting altered lactate production and/or clearance, and offset the decrease in dynamic muscle function post-TT, as indicated by the reactive strength index differences.

Caffeine and Doping-What Have We Learned since 2004

Caffeine is a naturally occurring plant alkaloid and is found in plant constituents such as coffee and cocoa beans, tea leaves, guarana berries and the kola nut [...].

Caffeine added to coffee does not alter the acute testosterone response to exercise in resistance trained males

BACKGROUND

This study investigated the effects of coffee ingestion with supplemental caffeine (CAF) on serum testosterone (T) responses to exercise in recreationally strength-trained males.

METHODS

Subjects ingested 6 mg/kg body weight of caffeine via 12 ounces of coffee (CAF) supplemented with anhydrous caffeine or decaffeinated (DEC) coffee prior to exercise in a randomized, within-subject, crossover design. The exercise session consisted of 21 minutes of high-intensity interval cycling (alternating intensities at power outputs associated with 2.0 mmol/L lactate for two minutes and 4.0 mmol/L lactate for one minute) followed by resistance exercise (seven exercises, three sets of ten repetitions, 65% 1RM, one-minute rest periods). Subjects also completed repetitions to fatigue tests and soreness scales to determine muscle recovery 24 hours following the exercise.

RESULTS

T was elevated immediately and 30-minutes post-exercise by 20.5% and 14.3% respectively (P<0.05). There was no main effect for treatment and no exercise x treatment interaction. There were no differences in repetitions to fatigue or soreness between treatments (P>0.05). No relationships were observed between T and any proxy of recovery.

CONCLUSIONS

While past literature suggests caffeine may enhance T post-exercise, data from the current study suggest that augmented T response is not evident following anhydrous caffeine added to coffee. The duration of T elevation indicates that this protocol is beneficial to creating long-lasting increases in serum testosterone.

The Effect of Acute Caffeine Ingestion on Endurance Performance: A Systematic Review and Meta-Analysis

BACKGROUND

Caffeine is a widely used ergogenic aid with most research suggesting it confers the greatest effects during endurance activities. Despite the growing body of literature around the use of caffeine as an ergogenic aid, there are few recent meta-analyses that quantitatively assess the effect of caffeine on endurance exercise.

OBJECTIVES

To summarise studies that have investigated the ergogenic effects of caffeine on endurance time-trial performance and to quantitatively analyse the results of these studies to gain a better understanding of the magnitude of the ergogenic effect of caffeine on endurance time-trial performance.

METHODS

A systematic review was carried out on randomised placebo-controlled studies investigating the effects of caffeine on endurance performance and a meta-analysis was conducted to determine the ergogenic effect of caffeine on endurance time-trial performance.

RESULTS

Forty-six studies met the inclusion criteria and were included in the meta-analysis. Caffeine has a small but evident effect on endurance performance when taken in moderate doses (3-6 mg/kg) as well as an overall improvement following caffeine compared to placebo in mean power output (3.03 ± 3.07%; effect size = 0.23 ± 0.15) and time-trial completion time (2.22 ± 2.59%; effect size = 0.41 ± 0.2). However, differences in responses to caffeine ingestion have been shown, with two studies reporting slower time-trial performance, while five studies reported lower mean power output during the time-trial.

CONCLUSION

Caffeine can be used effectively as an ergogenic aid when taken in moderate doses, such as during sports when a small increase in endurance performance can lead to significant differences in placements as athletes are often separated by small margins.

Establishing a relationship between the effect of caffeine and duration of endurance athletic time trial events: A systematic review and meta-analysis

OBJECTIVES

Caffeine has well-documented benefits on endurance athletic performance. Because of caffeine's ergogenic effects of reducing perceived fatigue, it is hypothesized that as duration of athletic event increases, so will the effect size of caffeine upon performance. This study aims to examine the relationship between duration of endurance athletic event and the effect size of caffeine compared to placebo for athletic performance.

DESIGN

A systematic review and meta-analysis of placebo-controlled trials assessing the effects of caffeine in adults performing endurance athletic events.

METHODS

We searched MedLine, Web of Science, and review article references published through March 2016. We performed meta-analyses on placebo-controlled trials to determine the effect of the duration of an endurance athletic event on the standardized mean difference (Cohen's d) between the caffeine and placebo groups for athletic performance.

RESULTS

Forty articles including 56 unique comparison groups were included. Pooled results showed a Cohen's d of 0.33 (95% CI=0.21, 0.45; p=1.00; I²=0%). The effect of the duration of athletic event was significantly associated with Cohen's d (Relative Risk: 0.005; 95% CI=0.001, 0.009; p=0.024). For a 30min increase in duration of the athletic event, Cohen's d will increase by 0.150.

CONCLUSIONS

This study is the first to report on the statistical finding that the effect size of caffeine increases along with the increasing duration of the time trial event. Endurance athletes may especially benefit from caffeine for performance enhancement.

The Critical Power Model as a Potential Tool for Anti-doping

Existing doping detection strategies rely on direct and indirect biochemical measurement methods focused on detecting banned substances, their metabolites, or biomarkers related to their use. However, the goal of doping is to improve performance, and yet evidence from performance data is not considered by these strategies. The emergence of portable sensors for measuring exercise intensities and of player tracking technologies may enable the widespread collection of performance data. How these data should be used for doping detection is an open question. Herein, we review the basis by which performance models could be used for doping detection, followed by critically reviewing the potential of the critical power (CP) model as a prototypical performance model that could be used in this regard. Performance models are mathematical representations of performance data specific to the athlete. Some models feature parameters with physiological interpretations, changes to which may provide clues regarding the specific doping method. The CP model is a simple model of the power-duration curve and features two physiologically interpretable parameters, CP and W′. We argue that the CP model could be useful for doping detection mainly based on the predictable sensitivities of its parameters to ergogenic aids and other performance-enhancing interventions. However, our argument is counterbalanced by the existence of important limitations and unresolved questions that need to be addressed before the model is used for doping detection. We conclude by providing a simple worked example showing how it could be used and propose recommendations for its implementation.

Acute Ingestion of Caffeinated Chewing Gum Improves Repeated Sprint Performance of Team Sport Athletes With Low Habitual Caffeine Consumption

The effects of acute ingestion of caffeine on short-duration high-intensity performance are equivocal, while studies of novel modes of delivery and the efficacy of low doses of caffeine are warranted. The aims of the present study were to investigate the effect of acute ingestion of caffeinated chewing gum on repeated sprint performance (RSP) in team sport athletes, and whether habitual caffeine consumption alters the ergogenic effect, if any, on RSP. A total of 18 male team sport athletes undertook four RSP trials using a 40-m maximum shuttle run test, which incorporates 10 × 40-m sprints with 30 s between the start of each sprint. Each participant completed two familiarization sessions, followed by caffeine (CAF; caffeinated chewing gum; 200 mg caffeine) and placebo (PLA; noncaffeinated chewing gum) trials in a randomized, double-blind manner. RSP, assessed by sprint performance decrement (%), did not differ (p = .209; effect size = 0.16; N = 18) between CAF (5.00 ± 2.84%) and PLA (5.43 ± 2.68%). Secondary analysis revealed that low habitual caffeine consumers (<40 mg/day, n = 10) experienced an attenuation of sprint performance decrement during CAF relative to PLA (5.53 ± 3.12% vs. 6.53 ± 2.91%, respectively; p = .049; effect size =0.33); an effect not observed in moderate/high habitual caffeine consumers (>130 mg/day, n = 6; 3.98 ± 2.57% vs. 3.80 ± 1.79%, respectively; p = .684; effect size = 0.08). The data suggest that a low dose of caffeine in the form of caffeinated chewing gum attenuates the sprint performance decrement during RSP by team sport athletes with low, but not moderate-to-high, habitual consumption of caffeine.

Muscle fatigue: general understanding and treatment

Muscle fatigue is a common complaint in clinical practice. In humans, muscle fatigue can be defined as exercise-induced decrease in the ability to produce force. Here, to provide a general understanding and describe potential therapies for muscle fatigue, we summarize studies on muscle fatigue, including topics such as the sequence of events observed during force production, in vivo fatigue-site evaluation techniques, diagnostic markers and non-specific but effective treatments.

Performance effects and metabolic consequences of caffeine and caffeinated energy drink consumption on glucose disposal

This review documents two opposing effects of caffeine and caffeine-containing energy drinks, i.e., their positive effects on athletic performance and their negative impacts on glucose tolerance in the sedentary state. Analysis of studies examining caffeine administration prior to performance-based exercise showed caffeine improved completion time by 3.6%. Similar analyses following consumption of caffeine-containing energy drinks yielded positive, but more varied, benefits, which were likely due to the diverse nature of the studies performed, the highly variable composition of the beverages consumed, and the range of caffeine doses administered. Conversely, analyses of studies administering caffeine prior to either an oral glucose tolerance test or insulin clamp showed a decline in whole-body glucose disposal of ~30%. The consequences of this resistance are unknown, but there may be implications for the development of a number of chronic diseases. Both caffeine-induced performance enhancement and insulin resistance converge with the primary actions of caffeine on skeletal muscle.

The Parkinson's disease death rate: carbidopa and vitamin B6

The only indication for carbidopa and benserazide is the management of L-3,4-dihydroxyphenylalanine (L-dopa)-induced nausea. Both drugs irreversibly bind to and permanently deactivate pyridoxal 5'-phosphate (PLP), the active form of vitamin B6, and PLP-dependent enzymes. PLP is required for the function of over 300 enzymes and proteins. Virtually every major system in the body is impacted directly or indirectly by PLP. The administration of carbidopa and benserazide potentially induces a nutritional catastrophe. During the first 15 years of prescribing L-dopa, a decreasing Parkinson's disease death rate was observed. Then, in 1976, 1 year after US Food and Drug Administration approved the original L-dopa/carbidopa combination drug, the Parkinson's disease death rate started increasing. This trend has continued to the present, for 38 years and counting. The previous literature documents this increasing death rate, but no hypothesis has been offered concerning this trend. Carbidopa is postulated to contribute to the increasing Parkinson's disease death rate and to the classification of Parkinson's as a progressive neurodegenerative disease. It may contribute to L-dopa tachyphylaxis.

A systematic review of the efficacy of ergogenic aids for improving running performance

Running is a common form of activity worldwide, and participants range from "weekend warriors" to Olympians. Unfortunately, few studies have examined efficacy of various ergogenic aids in runners because the majority of the literature consists of cycling-based protocols, which do not relate to running performance. The majority of running studies conducted markedly vary in regards to specific distance completed, subject fitness level, and effectiveness of the ergogenic aid examined. The aim of this article was to systematically examine the literature concerning utility of several ergogenic aids on middle-distance running (400-5,000 m) and long-distance running (10,000 meters marathon = 42.2 km) performance. In addition, this article highlights the dearth of running-specific studies in the literature and addresses recommendations for future research to optimize running performance through nutritional intervention. Results revealed 23 studies examining effects of various ergogenic aids on running performance, with a mean Physiotherapy Evidence Database score equal to 7.85 ± 0.70. Of these studies, 71% (n = 15) demonstrated improved running performance with ergogenic aid ingestion when compared with a placebo trial. The most effective ergogenic aids for distances from 400 m to 40 km included sodium bicarbonate (4 studies; 1.5 ± 1.1% improvement), sodium citrate (6 studies; 0.3 ± 1.7% improvement), caffeine (CAFF) (7 studies; 1.1 ± 0.4% improvement), and carbohydrate (CHO) (6 studies; 4.1 ± 4.4% improvement). Therefore, runners may benefit from ingestion of sodium bicarbonate to enhance middle distance performance and caffeine and carbohydrate to enhance performance at multiple distances.

Ephedra increases VO2, impairs thermoregulation and cardiovascular function, but does not enhance exercise performance

The dietary supplement ephedra is a potent sympathomimetic that was banned by the US Food and Drug Administration in 2003 because of its deleterious effects on cardiovascular function and thermoregulation during exercise. Unfortunately, extracts of ephedra can still be obtained via the internet and are in use worldwide. The horse is the only athletic species other than humans that sweats to thermoregulate and it controls cardiovascular function in a similar fashion. The purpose of this study was to use the horse to examine the acute effects of ephedra (Ma Huang) to investigate on markers of performance as well as effects on cardiovascular function and thermoregulation during acute exercise. Six Standardbred mares (~450 kg; 6-12 years of age) were used in a crossover design consisting of a ephedra (Ma Huang containing 8% ephedra alkaloid) and control (applesauce) group. All horses performed an incremental graded exercise test (GXT) at a 6% fixed grade to measure oxygen uptake (VO2), run time, velocity at VO2max, maximal velocity, recovery time, haematocrit, total plasma protein concentration, heart rate, right ventricular pressure (RVP), pulmonary arterial pressure (PAP), rectal temperature and recovery. Measurements were recorded at rest, during exercise and post 2 and 5 min recovery. There was a difference (P<0.05) in pre-exercise haematocrit but not in any other haematocrit or plasma protein sampling intervals. VO2 was greater (P<0.05) for the ephedra group before exercise, at each step of the GXT, at VO2max, and during recovery compared to the control group. Recovery time was significantly different, but run time was not (P≯0.05). Heart rate was elevated (P<0.05) at 2 and 5 min recovery in horses administered ephedra. Significant differences were observed for RVP and PAP and rectal temperature during recovery. Recovery score (sweating response, respiration rate, behaviour) was altered (P<0.05) by ephedra administration. These data suggests an increase in energy expenditure and thermogenesis when horses consume ephedra. However, markers of performance (run time, velocity at VO2max, and maximal velocity completed) were not altered by ephedra administration.

Herbs in exercise and sports

The use of herbs as ergogenic aids in exercise and sport is not novel. Ginseng, caffeine, ma huang (also called 'Chinese ephedra'), ephedrine and a combination of both caffeine and ephedrine are the most popular herbs used in exercise and sports. It is believed that these herbs have an ergogenic effect and thus help to improve physical performance. Numerous studies have been conducted to investigate the effects of these herbs on exercise performance. Recently, researchers have also investigated the effects of Eurycoma longifolia Jack on endurance cycling and running performance. These investigators have reported no significant improvement in either cycling or running endurance after supplementation with this herb. As the number of studies in this area is still small, more studies should be conducted to evaluate and substantiate the effects of this herb on sports and exercise performance. For instance, future research on any herbs should take the following factors into consideration: dosage, supplementation period and a larger sample size.

Validity of urinary monoamine assay sales under the "spot baseline urinary neurotransmitter testing marketing model"

Spot baseline urinary monoamine assays have been used in medicine for over 50 years as a screening test for monoamine-secreting tumors, such as pheochromocytoma and carcinoid syndrome. In these disease states, when the result of a spot baseline monoamine assay is above the specific value set by the laboratory, it is an indication to obtain a 24-hour urine sample to make a definitive diagnosis. There are no defined applications where spot baseline urinary monoamine assays can be used to diagnose disease or other states directly. No peer-reviewed published original research exists which demonstrates that these assays are valid in the treatment of individual patients in the clinical setting. Since 2001, urinary monoamine assay sales have been promoted for numerous applications under the "spot baseline urinary neurotransmitter testing marketing model". There is no published peer-reviewed original research that defines the scientific foundation upon which the claims for these assays are made. On the contrary, several articles have been published that discredit various aspects of the model. To fill the void, this manuscript is a comprehensive review of the scientific foundation and claims put forth by laboratories selling urinary monoamine assays under the spot baseline urinary neurotransmitter testing marketing model.

The influence of nutritional ergogenic aids on exercise heat tolerance and hydration status

Exercise in the heat may predispose an athlete to an exertional heat illness. It is imperative to be knowledgeable on the influence of various nutritional supplements on exercise tolerance and hydration status. Because of the variety of nutritional ergogenic aids that are easily accessible to athletes, medical and health professionals must rely on empirical evidence when making conclusions about the efficacy of a supplement while not ignoring significant anecdotal reports that may resemble real-life situations more closely.

Effect of caffeine on sport-specific endurance performance: a systematic review

Endurance athletes often ingest caffeine because of its reported ergogenic properties. Although there are a vast number of studies quantifying caffeine's effects, many research studies measure endurance performance using a time-to-exhaustion test (subjects exercise at a fixed intensity to volitional exhaustion). Time-to-exhaustion as a performance measure is not ideal because of the high degree of measurement variability between and within subjects. Also, we are unaware of any endurance sports in which individuals win by going a longer distance or for a longer amount of time than their competitors. Measuring performance with a time-trial test (set distance or time with best effort) has high reproducibility and is more applicable to sport. Therefore, the purpose of this review was to critically and objectively evaluate studies that have examined the effect of caffeine on time-trial endurance (>5 minutes) performance. A literature search revealed 21 studies with a total of 33 identifiable caffeine treatments that measured endurance performance with a time-trial component. Each study was objectively analyzed with the Physiotherapy Evidence Database (PEDro) scale. The mean PEDro rating was 9.3 out of 10, indicating a high quality of research in this topic area. The mean improvement in performance with caffeine ingestion was 3.2 +/- 4.3%; however, this improvement was highly variable between studies (-0.3 to 17.3%). The high degree of variability may be dependent on a number of factors including ingestion timing, ingestion mode/vehicle, and subject habituation. Further research should seek to identify individual factors that mediate the large range of improvements observed with caffeine ingestion. In conclusion, caffeine ingestion can be an effective ergogenic aid for endurance athletes when taken before and/or during exercise in moderate quantities (3-6 mg.kg body mass). Abstaining from caffeine at least 7 days before use will give the greatest chance of optimizing the ergogenic effect.

The effect of ephedra and caffeine on maximal strength and power in resistance-trained athletes

Caffeine and ephedrine-related alkaloids recently have been removed from International Olympic Committee banned substances lists, whereas ephedrine itself is now permissible at urinary concentrations less than 10 mug.mL. The changes to the list may contribute to an increased use of caffeine and ephedra as ergogenic aids by athletes. Consequently, we sought to investigate the effects of ingesting caffeine (C) or a combination of ephedra and caffeine (C + E) on muscular strength and anaerobic power using a double-blind, crossover design. Forty-five minutes after ingesting a glucose placebo (P: 300 mg), C (300 mg) or C + E (300 mg + 60 mg), 9 resistance-trained male participants were tested for maximal strength by bench press [BP; 1 repetition maximum (1RM)] and latissimus dorsi pull down (LP; 1RM). Subjects also performed repeated repetitions at 80% of 1RM on both BP and LP until exhaustion. After this test, subjects underwent a 30-second Wingate test to determine peak anaerobic cycling power, mean power, and fatigue index. Although subjects reported increased alertness and enhanced mood after supplementation with caffeine and ephedra, there were no significant differences between any of the treatments in muscle strength, muscle endurance, or peak anaerobic power. Our results do not support the contention that supplementation with ephedra or caffeine will enhance either muscle strength or anaerobic exercise performance.

Human pharmacology of a performance-enhancing dietary supplement under resting and exercise conditions

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT

Performance-enhancing dietary supplements have not been clinically tested for safety or efficacy. In clinical trials performed under resting conditions, performance-enhancing supplements raise blood pressure and affect glucose homeostasis. The effect of exercise on the pharmacokinetics and pharmacodynamics of stimulant herbals is unknown.

WHAT THIS STUDY ADDS

Supplement-induced effects on blood pressure and glucose levels are not ameliorated by exercise. Exercise does not affect the kinetics of stimulant ingredients, caffeine and synephrine. Performance-enhancing supplement use modestly improves exercise tolerance. AIMS Dietary supplements (DS) promoted to enhance athletic performance often contain herbal sympathomimetics such as Citrus aurantium (synephrine) and caffeine. We aimed to characterize the pharmacology of a performance-enhancing DS in the setting of exercise.

METHODS

Ten healthy adults (three women) aged 20-31 years participated in a three-arm, double-blind, placebo-controlled, crossover study. Subjects ingested one dose of DS (Ripped Fuel Extreme Cut(R) with 21 mg synephrine and 304 mg caffeine by analysis) under resting conditions and 1 h prior to moderately intense exercise (30 min on cycle ergometer at 75-80% HR(max)), with a placebo (PLC)/exercise control. Plasma synephrine and caffeine concentrations were measured over 12 h, and vital signs, serum electrolytes, oxygen consumption and perceived exercise exertion were monitored.

RESULTS

No significant adverse events occurred. Synephrine and caffeine pharmacokinetics were unaffected by exercise. Post-exercise diastolic blood pressure was higher after DS (peak mean 71.7 +/- 8.7 mmHg) than PLC (63.0 +/- 4.9 mmHg) (p = 0.007). There were no substantial treatment-related differences in post-exercise HR, systolic blood pressure, or temperature. Postprandial plasma glucose increased to 121.0 +/- 31.6 mg dl(-1) with DS and exercise vs. 103.7 +/- 25.5 mg dl(-1) with PLC and exercise (P = 0.004). No treatment differences in exercise-related oxygen consumption, serum lactate, or insulin were observed. Exercise was rated less difficult with DS than PLC (P = 0.001).

CONCLUSIONS

Blood pressure and plasma glucose increased post-exercise with DS use, which could be detrimental in some people. Exercise was perceived as less strenuous after DS, presumably due to the stimulant effects of caffeine.

Caffeine and other sympathomimetic stimulants: modes of action and effects on sports performance

Stimulants, illegal and legal, continue to be used in competitive sport. The evidence for the ergogenic properties of the most potent stimulants, amphetamines, cocaine and ephedrine, is mostly insubstantial. Low doses of amphetamines may aid performance where effects of fatigue adversely affect higher psychomotor activity. Pseudoephedrine, at high doses, has been suggested to improve high intensity and endurance exercise but phenylpropanolamine has not been proven to be ergogenic. Only caffeine has substantial experimental backing for being ergogenic in exercise. The mode of action of these stimulants centres on their ability to cause persistence of catecholamine neurotransmitters, with the exception of caffeine which is an adenosine receptor antagonist. By these actions, the stimulants are able to influence the activity of neuronal control pathways in the central (and peripheral) nervous system. Rodent models suggest that amphetamines and cocaine interact with different pathways to that affected by caffeine. Caffeine has a variety of pharmacological effects but its affinity for adenosine receptors is comparable with the levels expected to exist in the body after moderate caffeine intake, thus making adenosine receptor blockade the favoured mode of ergogenic action. However, alternative modes of action to account for the ergogenic properties of caffeine have been supported in the literature. Biochemical mechanisms that are consistent with more recent research findings, involving proteins such as DARPP-32 (dopamine and cAMP-regulated phosphoprotein), are helping to rationalize the molecular details of stimulant action in the central nervous system.

Caffeine As an Ergogenic Aid

Caffeine is a naturally occurring substance that is widely consumed in a variety of forms. It produces multiple physiologic effects throughout the body. It is thought that this is mediated mainly through action at centrally located adenosine receptors. Caffeine has been studied for its potential use as an ergogenic aid. Several studies have demonstrated an improvement in exercise performance in submaximal endurance activities. Its potential ergogenic effect in acute, high-intensity exercise is less clear. Because of its potential use as an ergogenic aid, it use in sports is regulated by most sanctioning bodies.

Central nervous system stimulants and sport practice

BACKGROUND AND OBJECTIVES

Central nervous system (CNS) stimulants may be used to reduce tiredness and increase alertness, competitiveness, and aggression. They are more likely to be used in competition but may be used during training to increase the intensity of the training session. There are several potential dangers involving their misuse in contact sports. This paper reviews the three main CNS stimulants, ephedrine, amfetamine, and cocaine, in relation to misuse in sport.

METHODS

Description of the pharmacology, actions, and side effects of amfetamine, cocaine, and ephedrine.

RESULTS

CNS stimulants have psychotropic effects that may be perceived to be ergogenic. Some are prescription drugs, such as Ephedra alkaloids, and there are issues regarding their appropriate therapeutic use. Recently attention has been given to their widespread use by athletes, despite the lack of evidence regarding any ergogenic or real performance benefit, and their potentially serious side effects. Recreational drugs, some of which are illegal (cocaine, amfetamines), are commonly used by athletes and cause potential ergolytic effects. Overall, these drugs are important for their frequent use and mention in anti-doping laboratories statistics and the media, and their potentially serious adverse effects.

CONCLUSIONS

Doping with CNS stimulants is a real public health problem and all sports authorities should participate in its prevention. Dissemination of information is essential to prevent doping in sport and to provide alternatives. Adequate training and education in this domain should be introduced.

Medication and supplement use by athletes

Athletes are affected in various ways by medications and supplements. Physicians caring for athletes need to be aware of medicines that athletes are taking and how they may interact with performance, exercise, environment, and other medicines. Athletes may attempt to gain a performance advantage with the use of a variety of dietary supplements and performance enhancers. Physicians must be knowledgeable of these so that athletes are properly educated about potential benefits and risks and physical effects. This article first reviews common medicines that athletes use and their potential efficacy and interactions with exercise and environment, then reviews dietary supplements and the data on their efficacy for performance enhancement. Finally, current and future doping issues are discussed.

The effect of caffeine ingestion on 8 km run performance in a field setting

The aim of this study was to assess the effect of caffeine ingestion on 8 km run performance using an ecologically valid test protocol. A randomized double-blind crossover study was conducted involving eight male distance runners. The participants ran an 8 km race 1 h after ingesting a placebo capsule, a caffeine capsule (3 mg x kg(-1) body mass) or no supplement. Heart rate was recorded at 5 s intervals throughout the race. Blood lactate concentration and ratings of perceived exertion were recorded after exercise. A repeated-measures analysis of variance (ANOVA) identified a significant treatment effect for 8 km performance time (P < 0.05); caffeine resulted in a mean improvement of 23.8 s (95% confidence interval [CI] = 13.1 to 34.5 s) in 8 km performance time (1.2% improvement, 95% CI = 0.7 to 1.8%). In addition, a two-way (time x condition) repeated-measures ANOVA identified a significantly higher blood lactate concentration 3 min after exercise during the caffeine trial (P < 0.05). We conclude that ingestion of 3 mg . kg(-1) body mass of caffeine can improve absolute 8 km run performance in an ecologically valid race setting.

Popular ergogenic drugs and supplements in young athletes

Ergogenic drugs are substances that are used to enhance athletic performance. These drugs include illicit substances as well as compounds that are marketed as nutritional supplements. Many such drugs have been used widely by professional and elite athletes for several decades. However, in recent years, research indicates that younger athletes are increasingly experimenting with these drugs to improve both appearance and athletic abilities. Ergogenic drugs that are commonly used by youths today include anabolic-androgenic steroids, steroid precursors (androstenedione and dehydroepiandrosterone), growth hormone, creatine, and ephedra alkaloids. Reviewing the literature to date, it is clear that children are exposed to these substances at younger ages than in years past, with use starting as early as middle school. Anabolic steroids and creatine do offer potential gains in body mass and strength but risk adverse effects to multiple organ systems. Steroid precursors, growth hormone, and ephedra alkaloids have not been proven to enhance any athletic measures, whereas they do impart many risks to their users. To combat this drug abuse, there have been recent changes in the legal status of several substances, changes in the rules of youth athletics including drug testing of high school students, and educational initiatives designed for the young athlete. This article summarizes the current literature regarding these ergogenic substances and details their use, effects, risks, and legal standing.

Caffeine lowers perceptual response and increases power output during high-intensity cycling

The aim of this study was to determine the effects of caffeine ingestion on a 'preloaded' protocol that involved cycling for 2 min at a constant rate of 100% maximal power output immediately followed by a 1-min 'all-out' effort. Eleven male cyclists completed a ramp test to measure maximal power output. On two other occasions, the participants ingested caffeine (5 mg. kg(-1)) or placebo in a randomized, double-blind procedure. All tests were conducted on the participants' own bicycles using a Kingcycle test rig. Ratings of perceived exertion (RPE; 6-20 Borg scale) were lower in the caffeine trial by approximately 1 RPE point at 30, 60 and 120 s during the constant rate phase of the preloaded test (P <0.05). The mean power output during the all-out effort was increased following caffeine ingestion compared with placebo (794+/-164 vs 750+/-163 W; P=0.05). Blood lactate concentration 4, 5 and 6 min after exercise was also significantly higher by approximately 1 mmol. l(-1) in the caffeine trial (P <0.05). These results suggest that high-intensity cycling performance can be increased following moderate caffeine ingestion and that this improvement may be related to a reduction in RPE and an elevation in blood lactate concentration.

Ergogenic aids: a review of basic science, performance, side effects, and status in sports

The use of drugs and supplements to enhance performance has become a part of mainstream athletics. Many team physicians and sports medicine practitioners are unfamiliar with the benefits and risks of these products and thus are unable to educate young athletes on this topic. In spite of numerous reports on the health risks of anabolic steroid use, 1 to 3 million Americans have used them. Human growth hormone has been tried by up to 5% of 10th graders, although no scientific study has shown that it is an effective performance-enhancing drug. Amphetamines and similar compounds may be the most widely abused drug in baseball; recently, they have come under increased scrutiny in sport. Erythropoietin is a highly effective aerobic enhancer that has been linked to multiple deaths in cyclists and other endurance athletes. The neutraceutical industry, led by supplements such as creatine, ephedra, and androstenedione, remains unregulated by the Food and Drug Administration and has serious issues with quality and side effects. An understanding of these products is essential for the sports medicine practitioner to provide sound, safe advice to the athlete.

ISSN Exercise & Sport Nutrition Review: Research & Recommendations

Sport nutrition is a constantly evolving field with literally thousands of research papers published annually. For this reason, keeping up to date with the literature is often difficult. This paper presents a well-referenced overview of the current state of the science related to how to optimize training through nutrition. More specifically, this article discusses: 1.) how to evaluate the scientific merit of nutritional supplements; 2.) general nutritional strategies to optimize performance and enhance recovery; and, 3.) our current understanding of the available science behind weight gain, weight loss, and performance enhancement supplements. Our hope is that ISSN members find this review useful in their daily practice and consultation with their clients.

Popular sports supplements and ergogenic aids

This article reviews the evidence-based ergogenic potential and adverse effects of 14 of the most common products in use by recreational and elite athletes today. Both legal and prohibited products are discussed. This is an aggressively marketed and controversial area of sports medicine worldwide. It is therefore prudent for the clinician to be well versed in the more popular supplements and drugs reputed to be ergogenic in order to distinguish fact from fiction.Antioxidants, proteins and amino acids are essential components of diet, but additional oral supplementation does not increase endurance or strength. Caffeine is ergogenic in certain aerobic activities. Creatine is ergogenic in repetitive anaerobic cycling sprints but not running or swimming. Ephedrine and pseudoephedrine may be ergogenic but have detrimental cardiovascular effects. Erythropoietin is ergogenic but increases the risk of thromboembolic events. beta-Hydroxy-beta-methylbutyrate has ergogenic potential in untrained individuals, but studies are needed on trained individuals. Human growth hormone and insulin growth factor-I decrease body fat and may increase lean muscle mass when given subcutaneously. Pyruvate is not ergogenic. The androgenic precursors androstenedione and dehydroepiandrosterone have not been shown to increase any parameters of strength and have potentially significant adverse effects. Anabolic steroids increase protein synthesis and muscle mass but with many adverse effects, some irreversible. Supplement claims on labels of product content and efficacy can be inaccurate and misleading.

Caffeine and Ephedrine

Preparations containing caffeine and ephedrine have become increasingly popular among sportspersons in recent years as a means to enhance athletic performance. This is due to a slowly accumulating body of evidence suggesting that combination of the two drugs may be more efficacious than each one alone. Caffeine is a compound with documented ergogenicity in various exercise modalities, while ephedrine and related alkaloids have not been shown, as yet, to result in any significant performance improvements. Caffeine-ephedrine mixtures, however, have been reported in several instances to confer a greater ergogenic benefit than either drug by itself. Although data are limited and heterogeneous in nature to allow for reaching consensus, the increase in performance is a rather uniform finding as it has been observed during submaximal steady-state aerobic exercise, short- and long-distance running, maximal and supramaximal anaerobic cycling, as well as weight lifting. From the metabolic point of view, combined ingestion of caffeine and ephedrine has been observed to increase blood glucose and lactate concentrations during exercise, wheareas qualitatively similar effects on lipid fuels (free fatty acids and glycerol) are less pronounced. In parallel, epinephrine and dopamine concentrations are significantly increased, wheareas the effects on norepinephrine are less clear. With respect to pulmonary gas exchange during short-term intense exercise, no physiologically significant effects have been reported following ingestion of caffeine, ephedrine or their combination. Yet, during longer and/or more demanding efforts, some sporadic enhancements have indeed been shown. On the other hand, a relatively consistent cardiovascular manifestation of the latter preparation is an increase in heart rate, in addition to that caused by exercise alone. Finally, evidence to date strongly suggests that caffeine and ephedrine combined are quite effective in decreasing the rating of perceived exertion and this seems to be independent of the type of activity being performed. In general, our knowledge and understanding of the physiological, metabolic and performance-enhancing effects of caffeine-ephedrine mixtures are still in their infancy. Research in this field is probably hampered by sound ethical concerns that preclude administration of potentially hazardous substances to human volunteers. In contrast, while it is certainly true that caffeine and especially ephedrine have been associated with several acute adverse effects on health, athletes do not seem to be concerned with these, as long as they perceive that their performance will improve. In light of the fact that caffeine and ephedra alkaloids, but not ephedrine itself, have been removed from the list of banned substances, their use in sports can be expected to rise considerably in the foreseeable future. Caffeine-ephedra mixtures may thus become one of most popular ergogenic aids in the years to come and while they may indeed prove to be one of the most effective ones, and probably one of the few legal ones, whether they also turn out to be one of the most dangerous ones awaits to be witnessed.

β-Phenylethylamines and the isoquinoline alkaloids

This review covers beta-phenylethylamines and isoquinoline alkaloids derived from them, including further products of oxidation. condensation with formaldehyde and rearrangement, some of which do not contain an isoquinoline system, together with naphthylisoquinoline alkaloids, which have a different biogenetic origin. The occurrence of the alkaloids, with the structures of new bases, together with their reactions, syntheses and biological activities are reported. The literature from July 2002 to June 2003 is reviewed, with 568 references cited.

Effects of pseudoephedrine on maximal cycling power and submaximal cycling efficiency

PURPOSE

To study the effects of a therapeutic dose of pseudoephedrine on anaerobic cycling power and aerobic cycling efficiency.

METHODS

Eleven healthy moderately trained males (VO (2peak) 4.4 +/- 0.8 L x min(-1) participated in a double-blinded crossover design. Subjects underwent baseline (B) tests for anaerobic (Wingate test) and aerobic (VO (2peak) test) cycling power. Subjects ingested either 60 mg of pseudoephedrine hydrochloride (D) or a placebo (P) and, after 90 min of rest, a Wingate and a cycling efficiency test were performed. During the cycling efficiency test, heart rate (HR) and VO(2) were averaged for the last 5 min of a 10-min cycle at 40% and 60% of the peak power achieved during the VO (2peak) test.

RESULTS

There were no significant differences in peak power (B = 860 +/- 154, D = 926 +/- 124, P = 908 +/- 118 W), total work (B = 20 +/- 3, D = 21 +/- 3, P = 21 +/- 3 kJ), or fatigue index (B = 39 +/- 8, D = 45 +/- 5, P = 43 +/- 5%). There were no significant differences in HR at 40% power (D = 138 +/- 10, P = 137 +/- 10 beats.min-1) or 60% power (D = 161 +/- 11, P = 160 +/- 11 beats x min(-1). There were no significant differences in cycling efficiency at 40% power (D = 18.8 +/- 1.8, P = 18.5 +/- 1.8%) or 60% power (D = 20.3 +/- 2.0, P = 20.1 +/- 2.1%).

CONCLUSION

A therapeutic dose of pseudoephedrine hydrochloride does not affect anaerobic cycling performance or aerobic cycling efficiency.

Effects of ephedrine, caffeine, and their combination on muscular endurance

PURPOSE

The purpose of this study was to investigate the effects of ingesting caffeine (C), ephedrine (E), and their combination on muscular endurance, using a double-blind, repeated measures design.

METHODS

Ninety minutes after ingesting either C (4 mg x kg-1), E (0.8 mg x kg-1), a combination of C+E, or a placebo (P), 13 male subjects performed a weight-training circuit consisting of three supersets (SS), each SS consisting of leg press (at 80% of 1 RM to exhaustion) followed by bench press (at 70% 1-RM to exhaustion); 2 min of rest intervened between SS.

RESULTS

The trials involving ephedrine ingestion (C+E and E), when compared with the nonephedrine trials (C and P), caused significant increases (P < 0.05) in the mean number of repetitions completed for both the leg-press and bench-press exercises but only during the first SS. During that first set, the mean number (+/-SD) of repetitions for leg press was 19 +/- 8, 16 +/- 7, 14 +/- 6, and 13 +/- 5 for the C+E, E, C, and P trials, respectively. The mean numbers of repetitions for the first set of bench-press exercise were 14 +/- 3, 13 +/- 3, 12 +/- 3, and 12 +/- 3 for the C+E, E, C, and P trials, respectively. As a result, the total weight lifted during all three sets was greater for the trials involving ephedrine ingestion. Systolic blood pressure before exercise was significantly increased with both ephedrine treatment trials when compared with the other trials (C+E = 156 +/- 29 mm Hg; E = 150 +/- 14; C = 141 +/- 16; P = 138 +/- 14).

CONCLUSION

It was concluded that acute ingestion of C+E and E increases muscular endurance during the first set of traditional resistance-training exercise. The performance enhancement was attributed primarily to the effects of E; there was no additive effect of C.

Informed decision-making on sympathomimetic use in sport and health

The International Olympic Committee, the World Anti-Doping Agency, and International Sport Federations have banned and restricted the use of many stimulants including prescription and over-the-counter medications and dietary supplements. In addition to elite athletes, people of all ages use stimulants in attempts to improve athletic performance, alter body composition, and increase levels of energy. Here we introduce a seven-stage model designed to facilitate informed decision-making by individuals taking or thinking of taking stimulants for sport, health, and/or appearance reasons. We review for amphetamines, over-the counter sympathomimetics, and caffeine their performance-enhancing and performance-degrading effects, health benefits and mechanisms of action, medical side effects, and legal, ethical, safety, and financial implications.