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.

Determination of Critical Power Using Different Possible Approaches among Endurance Athletes: A Review

Critical power represents an important parameter of aerobic function and is the highest average effort that can be sustained for a period of time without fatigue. Critical power is determined mainly in the laboratory. Many different approaches have been applied in testing methods, and it is a difficult task to determine which testing protocol it the most suitable. This review aims to evaluate all possible tests on bicycle ergometers or bicycles used to estimate critical power and to compare them. A literature search was conducted in four databases (PubMed, Scopus, SPORTDiscus, and Web of Science) published from 2012 to 2022 and followed the PRISMA guidelines to process the review. Twenty-one articles met the eligibility criteria: records with trained or experienced endurance athletes (adults > 18), bicycle ergometer, a description of the testing protocol, and comparison of the tests. We found that the most widely used tests were the 3-min all-out tests set in a linear mode and the traditional protocol time to exhaustion. Some other alternatives could have been used but were not as regular. To summarize, the testing methods offered two main approaches in the laboratory (time to exhaustion test andthe 3-min all-out test with different protocols) and approach in the field, which is not yet completely standardized.

Power profiling and the power-duration relationship in cycling: a narrative review

Emerging trends in technological innovations, data analysis and practical applications have facilitated the measurement of cycling power output in the field, leading to improvements in training prescription, performance testing and race analysis. This review aimed to critically reflect on power profiling strategies in association with the power-duration relationship in cycling, to provide an updated view for applied researchers and practitioners. The authors elaborate on measuring power output followed by an outline of the methodological approaches to power profiling. Moreover, the deriving a power-duration relationship section presents existing concepts of power-duration models alongside exercise intensity domains. Combining laboratory and field testing discusses how traditional laboratory and field testing can be combined to inform and individualize the power profiling approach. Deriving the parameters of power-duration modelling suggests how these measures can be obtained from laboratory and field testing, including criteria for ensuring a high ecological validity (e.g. rider specialization, race demands). It is recommended that field testing should always be conducted in accordance with pre-established guidelines from the existing literature (e.g. set number of prediction trials, inter-trial recovery, road gradient and data analysis). It is also recommended to avoid single effort prediction trials, such as functional threshold power. Power-duration parameter estimates can be derived from the 2 parameter linear or non-linear critical power model: P(t) = W'/t + CP (W'-work capacity above CP; t-time). Structured field testing should be included to obtain an accurate fingerprint of a cyclist's power profile.

Effect of High-Intensity Interval Training Versus Sprint Interval Training on Time-Trial Performance: A Systematic Review and Meta-analysis

BACKGROUND

Two forms of interval training commonly discussed in the literature are high-intensity interval training (HIIT) and sprint interval training (SIT). HIIT consists of repeated bouts of exercise that occur at a power output or velocity between the second ventilatory threshold and maximal oxygen consumption (VO_2max). SIT is performed at a power output or velocity above those associated with VO_2max.

OBJECTIVE

The primary objective of this study is to systematically review published randomized and pair-matched trials to determine which mode of interval training, HIIT versus SIT, leads to a greater improvement in TT performance in active and trained individuals. The second objective of this review is to perform a subgroup analysis to determine if there is a distinction between HIIT programs that differ in work-bout duration.

DATA SOURCES

SPORTDiscus (1800-present) and Medline with Full Text (1946-present) were used to conduct a systematic literature search.

STUDY SELECTION

Studies were selected for the review if they met the following criteria: (1) individuals (males and females) who were considered at least moderately trained (~ 3-h per week of activity) as specified by the authors of the included studies; (2) between the ages of 18 and 45 years; (3) randomized or pair-matched trials that included a HIIT and a SIT group; (4) provided detailed information about the interval training program; (5) were at least 2 weeks in duration; (6) included a TT test that required participants to complete a set distance.

RESULTS

A total of 6 articles met the inclusion criteria for the subjective and objective analysis. The pooled analysis was based on a random-effects model. There was no difference in the change in TT performance when comparing all HIIT versus SIT (0.9%; 90% CI - 1.2-1.9%, p = 0.18). However, subgroup analysis based on duration of work interval indicated a 2% greater improvement in TT performance following long-HIIT (≥ 4 min) when compared to SIT. There was no difference in change in VO_2max/_peak oxygen consumption (VO_2peak) between groups. There was a moderate effect (ES = 0.70) in favor of HIIT over SIT in maximal aerobic power (MAP) or maximal aerobic velocity (MAV).

CONCLUSION

The results of the meta-analysis indicate that long-HIIT may be the optimal form of interval training to augment TT performance. Additional research that directly compares HIIT exercise differing in work-bout duration would strengthen these results and provide further insight into the mechanisms behind the observed benefits of long-HIIT.

A non-linear analysis of running in the heavy and severe intensity domains

PURPOSE

Altered movement complexity, indicative of system dysfunction, has been demonstrated with increased running velocity and neuromuscular fatigue. The critical velocity (CV) denotes a metabolic and neuromuscular fatigue threshold. It remains unclear whether changes to complexity during running are coupled with the exercise intensity domain in which it is performed. The purpose of this study was to examine whether movement variability and complexity differ exclusively above the CV intensity during running.

METHODS

Ten endurance-trained participants ran at 95%, 100%, 105% and 115% CV for 20 min or to task failure, whichever occurred first. Movement at the hip, knee, and ankle were sampled throughout using 3D motion analysis. Complexity of kinematics in the first and last 30 s were quantified using sample entropy (SampEn) and detrended fluctuation analysis (DFA-α). Variability was determined using standard deviation (SD).

RESULTS

SampEn decreased during all trials in knee flexion/extension and it increased in hip internal/external rotation, whilst DFA-α increased in knee internal/external rotation. SD of ankle plantar/dorsiflexion and inversion/eversion, knee internal/external rotation, and hip flexion/extension and abduction/adduction increased during trials. Hip flexion/extension SampEn values were lowest below CV. DFA-α was lower at higher velocities compared to velocities below CV in ankle plantar/dorsiflexion, hip flexion/extension, hip adduction/abduction, hip internal/external rotation. In hip flexion/extension SD was highest at 115% CV.

CONCLUSIONS

Changes to kinematic complexity over time are consistent between heavy and severe intensity domains. The findings suggest running above CV results in increased movement complexity and variability, particularly at the hip, during treadmill running.

A 30-Min Rest Protocol Does Not Affect W', Critical Power, and Systemic Response

PURPOSE

This study aimed to assess and compare the systemic response of oxygen uptake kinetics and muscle deoxygenation between a 30-min rest protocol and a multivisit protocol on the parameters of the power-duration relationship (i.e., critical power [CP] and W').

METHODS

Nine endurance-trained triathletes reported to the laboratory on five occasions: a preliminary graded exercise test and a familiarization, a 30-min single-visit protocol (time trials of 10, 5, and 2 min in that order interspersed with 30 min rest), and a multivisit protocol (time trials of 10, 5, and 2 min in randomized order interspersed by >24 h rest). Heart rate (HR) was recorded continuously, respiratory gases were measured breath by breath, and deoxygenation was recorded at 10 Hz using near-infrared spectroscopy (NIRS) during all tests. Blood lactate (BLa-) concentration was measured before all time trials. Maximal HR (HRmax), oxygen uptake (V˙O2) during the first 2 min (V˙O2onset), mean response time, end-exercise V˙O2 (V˙O2peak), V˙O2 amplitude (amplV˙O2), O2 deficit, NIRS τ, amplitude (amplNIRS), and time delay were assessed. To compare the two protocols and to assess the differences in W' and CP, a paired sample t-test was used as well as a two-way ANOVA to assess the differences between trials and/or protocols, including trial-protocol interactions.

RESULTS

No significant differences, and trivial effect sizes, were found for W' and CP between protocols (P = 0.106-0.114, d < 0.01-0.08). Furthermore, no significant differences between protocols were found for all parameters, except for [BLa-]. Significant differences between trials were found for V˙O2ampl, V˙O2onset, NIRS τ, amplNIRS, [BLa-], and HRmax.

CONCLUSION

Results suggest that W' and CP can be determined using the 30-min rest protocol without confounding effects of previous severe exercise compared with the multivisit protocol.

Relationship Between the Critical Power Test and a 20-min Functional Threshold Power Test in Cycling

To investigate the agreement between critical power (CP) and functional threshold power (FTP), 17 trained cyclists and triathletes (mean ± SD: age 31 ± 9 years, body mass 80 ± 10 kg, maximal aerobic power 350 ± 56 W, peak oxygen consumption 51 ± 10 mL⋅min^-1⋅kg^-1) performed a maximal incremental ramp test, a single-visit CP test and a 20-min time trial (TT) test in randomized order on three different days. CP was determined using a time-trial (TT) protocol of three durations (12, 7, and 3 min) interspersed by 30 min passive rest. FTP was calculated as 95% of 20-min mean power achieved during the TT. Differences between means were examined using magnitude-based inferences and a paired-samples t-test. Effect sizes are reported as Cohen's d. Agreement between CP and FTP was assessed using the 95% limits of agreement (LoA) method and Pearson correlation coefficient. There was a 91.7% probability that CP (256 ± 50 W) was higher than FTP (249 ± 44 W). Indeed, CP was significantly higher compared to FTP (P = 0.041) which was associated with a trivial effect size (d = 0.04). The mean bias between CP and FTP was 7 ± 13 W and LoA were -19 to 33 W. Even though strong correlations exist between CP and FTP (r = 0.969; P < 0.001), the chance of meaningful differences in terms of performance (1% smallest worthwhile change), were greater than 90%. With relatively large ranges for LoA between variables, these values generally should not be used interchangeably. Caution should consequently be exercised when choosing between FTP and CP for the purposes of performance analysis.

Prediction of Simulated 1,000 m Kayak Ergometer Performance in Young Athletes

This study aimed to develop a predictive explanatory model for the 1,000-m time-trial (TT) performance in young national-level kayakers, from biomechanical and physiological parameters assessed in a maximal graded exercise test (GXT). Twelve young male flat-water kayakers (age 16.1 ± 1.1 years) participated in the study. The design consisted of 2 exercise protocols, separated by 48 h, on a kayak ergometer. The first protocol consisted of a GXT starting at 8 km.h⁻¹ with increments in speed of 1 km.h⁻¹ at each 2-min interval until exhaustion. The second protocol comprised the 1,000-m TT.

Results: In the GXT, they reached an absolute V∙O_2max of 3.5 ± 0.7 (L.min⁻¹), a maximum aerobic power (MAP) of 138.5 ± 24.5 watts (W) and a maximum aerobic speed (MAS) of 12.8 ± 0.5 km/h. The TT had a mean duration of 292.3 ± 15 s, a power output of 132.6 ± 22.0 W and a V∙O_2max of 3.5 ± 0.6 (L.min⁻¹). The regression model [TT (s) = 413.378–0.433 × (MAP)−0.554 × (stroke rate at MAP)] presented an R² = 84.5%.

Conclusion: It was found that V∙O_2max, stroke distance and stroke rate during the GXT were not different from the corresponding variables (V∙O_2peak, stroke distance and stroke rate) observed during the TT. The MAP and the corresponding stroke rate were strong predicting factors of 1,000 m TT performance. In conclusion, the TT can be useful for quantifying biomechanical parameters (stroke distance and stroke rate) and to monitor training induced changes in the cardiorespiratory fitness (V∙O_2max).

The Effect of Ingesting Carbohydrate and Proteins on Athletic Performance: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Endurance athletes participating in sporting events may be required to complete multiple training sessions a day or on successive days with a limited recovery time. Nutritional interventions that enhance the restoration of endogenous fuel stores (e.g., liver and muscle glycogen) and improve muscle damage repair have received a lot of attention. The purpose of this review is to investigate the effect of ingesting carbohydrate (CHO) and protein (PRO) on athletic performance. Studies were identified by searching the electronic databases PubMed and EMBASE. Random-effects meta-analyses were conducted to examine the intervention efficacy. A total of 30 randomized controlled trials (RCT), comprising 43 trials and 326 participants in total, were included in this review. The meta-analysis showed an overall significant effect in Time-To-Exhaustion (TTE) and Time-Trial (TT) performance, when ingesting carbohydrates and proteins (CHO-PRO) compared to CHO-only (p = 0.03 and p = 0.0007, respectively). A subgroup analysis demonstrated a significant effect in TTE by ingesting CHO-PRO compared to CHO, when supplements were provided during and/or following an exercise bout. CHO-PRO significantly improved TTE compared to CHO-only, when a long-term recovery (i.e., ≥8 h) was implemented (p = 0.001). However, no effect was found when the recovery time was short-term (i.e., ≤8 h). No significant effect was observed when CHO-PRO and CHO-only supplements were isocaloric. However, a significant improved TTE was evident with CHO-PRO compared to CHO-only, when the supplements were matched for carbohydrate content (p < 0.00001). In conclusion, co-ingesting carbohydrates and proteins appears to enhance TTE and TT performance compared to CHO-only and presents a compelling alternate feeding strategy for athletes.

Comparison of Critical Speed and D' Derived From 2 or 3 Maximal Tests

Purpose: The hyperbolic distance-time relationship can be used to profile running performance and establish critical speed (CS) and D' (the curvature constant of the speed-time relationship). Typically, to establish these parameters, multiple (3+) performance trials are required, which can be highly fatiguing and limit the usability of such protocols in a single training session. This study aimed to compare CS and D' calculated from a 2-trial (2-point model) and a 3-trial (3-point model) method. Methods: A total of 14 male distance runners completed 3 fixed-distance (3600, 2400, and 1200 m) time trials on a 400-m outdoor running track, separated by 30-min recoveries. Participants completed the protocol 9 times across a 12-mo period, with approximately 42 d between tests. CS and D' were calculated using all 3 distances (3-point model) and also using the 3600- and 1200-m distances only (2-point model). Results: Mean (SD) CS for both 3-point and 2-point models was 4.94 (0.32) m·s^-1, whereas the values for D' were 123.3 (57.70) and 127.4 (57.34) m for the 3-point and 2-point models, respectively. Overall bias for both CS and D' between 3-point and 2-point model was classed as trivial. Conclusion: A 2-point time-trial model can be used to calculate CS and D' as proficiently as a 3-point model, making it a less fatiguing, inexpensive, and applicable method for coaches, practitioners, and athletes for monitoring running performance in 1 training session.

From Paper to Podium: Quantifying the Translational Potential of Performance Nutrition Research

Sport nutrition is one of the fastest growing and evolving disciplines of sport and exercise science, demonstrated by a 4-fold increase in the number of research papers between 2012 and 2018. Indeed, the scope of contemporary nutrition-related research could range from discovery of novel nutrient-sensitive cell-signalling pathways to the assessment of the effects of sports drinks on exercise performance. For the sport nutrition practitioner, the goal is to translate innovations in research to develop and administer practical interventions that contribute to the delivery of winning performances. Accordingly, step one in the translation of research to practice should always be a well-structured critique of the translational potential of the existing scientific evidence. To this end, we present an operational framework (the "Paper-2-Podium Matrix") that provides a checklist of criteria for which to prompt the critical evaluation of performance nutrition-related research papers. In considering the (1) research context, (2) participant characteristics, (3) research design, (4) dietary and exercise controls, (5) validity and reliability of exercise performance tests, (6) data analytics, (7) feasibility of application, (8) risk/reward and (9) timing of the intervention, we aimed to provide a time-efficient framework to aid practitioners in their scientific appraisal of research. Ultimately, it is the combination of boldness of reform (i.e. innovations in research) and quality of execution (i.e. ease of administration of practical solutions) that is most likely to deliver the transition from paper to podium.

Different durations within the method of best practice affect the parameters of the speed-duration relationship

The aim of the study was to determine whether estimates of the speed-duration relationship are affected using different time-trial (TT) field-based testing protocols, where exhaustive times were located within the generally recommended durations of 2-15 min. Ten triathletes (mean ± SD age: 31.0 ± 5.7 years; height: 1.81 ± 0.05 m; body mass: 76.5 ± 6.8 kg) performed two randomly assigned field tests to determine critical speed (CS) and the total distance covered above CS (D́). CS and D́ were obtained using two different protocols comprising three TT that were interspersed by 60 min passive rest. The TTs were 12, 7, and 3 min in Protocol I and 10, 5, and 2 min in Protocol II. A linear relationship of speed vs. the inverse of time (s = D́ × 1/t + CS) was used to determine parameter estimates. Significant differences were found for CS (p = 0.026), but not for D́ (p = 0.123). The effect size for CS (d = 0.305) was considered small, while that for D́ was considered moderate (d = 0.742). CS was significantly correlated between protocols (r = 0.934; p < 0.001), however, no correlation was found for D́ (r = 0.053; p = 0.884). The 95% limits of agreement were ±0.28m s^-1 and ±73.9 m for CS and D́, respectively. These findings demonstrate that the choice of exhaustive times within commonly accepted durations results in different estimates of CS and D́, and thus protocols cannot be used interchangeably. The use of a consistent protocol is therefore recommended, when investigating or monitoring the speed-duration relationship estimates in well-trained athletes.

Reliability of the parameters of the power-duration relationship using maximal effort time-trials under laboratory conditions

The purpose of this study was to assess the reliability of critical power (CP) and the total amount of work accomplished above CP (W´) across repeated tests using ecologically valid maximal effort time-trials (TT) under laboratory conditions. After an initial incremental exercise test, ten well-trained male triathletes (age: 28.5 ± 4.7 years; body mass: 73.3 ± 7.9 kg; height: 1.80 ± 0.07 m; maximal aerobic power [MAP]: 329 ± 41 W) performed three testing sessions (Familiarization, Test I and Test II) each comprising three TT (12, 7, and 3 min with a passive recovery of 60 min between trials). CP and W´ were determined using a linear regression of power vs. the inverse of time (1/t) (P = W´ ∙ 1/t + CP). A repeated-measures ANOVA was used to detect differences in CP and W´ and reliability was assessed using the intra-class correlation coefficient (ICC) and the coefficient of variation (CoV). CP and W´ values were not significantly different between repeated tests (P = 0.171 and P = 0.078 for CP and W´, respectively). The ICC between Familiarization and Test I was r = 0.86 (CP) and r = 0.58 (W´) and between Tests I and II it was r = 0.94 (CP) and r = 0.95 (W´). The CoV notably decreased from 4.1% to 2.6% and from 25.3% to 8.2% for CP and W´, respectively. Despite the non-significant differences for both parameter estimates between Familiarization, Test I, and Test II, ICC and CoV values improved notably after the familiarization trial. Our novel findings indicate that for both, CP and W´ a familiarization trial increased reliability. It is therefore advisable to familiarize well-trained athletes when determining the power-duration relationship using TT under laboratory conditions.