CHO Mouth Rinse Ameliorates Neuromuscular Response with Lower Endogenous CHO Stores

Carbohydrate Oral Rinsing, Cycling Performance and Individual Complex Carbohydrate Taste Sensitivity

The aim of this pilot study was to determine the effect of individual complex carbohydrate taste sensitivity on cycling performance with complex carbohydrate oral rinsing. Ten male participants completed five cycling time trials in a fasted state with a seven-day washout period between each trial. Participants completed a fixed amount of work (738.45 ± 150.74 kJ) as fast as possible on a cycle ergometer while rinsing with an oral rinse for 10 s every 12.5% of the trial. An oral rinse (maltodextrin, oligofructose, glucose, sucralose or water control) was given per visit in a randomised, crossover, blinded design. Afterwards, participants had their taste assessed with three stimuli, complex carbohydrate (maltodextrin), sweet (glucose) and sour (citric acid), using taste assessment protocol to determine individual taste sensitivity status. Participants were subsequently grouped according to their complex carbohydrate taste sensitivity and complex carbohydrate taste intensity. There were no significant effects of the oral rinses on cycling performance time (p = 0.173). Participants who did not have improvements in exercise performance with the maltodextrin rinse experienced a stronger taste intensity with complex carbohydrate stimuli at baseline (p = 0.047) and overall (p = 0.047) than those who did have improvements in performance. Overall, a carbohydrate oral rinse was ineffective in significantly improving cycling performance in comparison with a water control. However, when participants were grouped according to complex carbohydrate taste intensity, differences in exercise performance suggest that individual sensitivity status to complex carbohydrates could impact the efficacy of a carbohydrate-based oral rinse.

Central effects of mouth rinses on endurance and strength performance

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

Effects of carbohydrate drinks ingestion on executive function in athletes: a systematic review and meta-analysis

Background

Carbohydrates are often used as boosters for endurance and high-intensity exercise. However, it is unclear whether carbohydrate drinks intake before or during exercise can affect specific domains of cognitive function, such as Executive Function (EF).

Methods

Following the guidance of PRISMA 2020, we searched six major databases including PubMed, WOS, SPORTDiscus, Cochrane, Embase, and Scopus. Outcomes were presented in the form of Reaction Time (RT), Accuracy (ACC), and Scores (Score) for performing EF tests. Effect sizes were calculated from the test results of EF and expressed as standardized mean differences (SMDs). After analyzing the overall results, we performed subgroup analyses based on the athletes' program characteristics.

Results

After retrieving a total of 5,355 articles, ten randomized controlled trials (RCTs) were identified and included in this review. The overall results showed that the intake of carbohydrate drinks before or during exercise did not have a significant effect on the reduction of EF after exercise (ACC (-0.05 [-0.27, 0.18]); RT (-0.18 [-0.45, 0.09]); Score (0.24 [-0.20, 0.68])). The subgroup analyses based on open skill sports and close skill sports also showed invalid results, but the results of RT ended up with different preference (ACC of open skill sports athletes (-0.10 [-0.34, 0.14]); RT of open skill athletes (-0.27 [-0.60, 0.07]); RT of close skill athletes (0.29 [-0.24, 0.82])).

Conclusion

The intake of 6-12% of single or mixed carbohydrates before or during exercise was not significantly effective in reducing the decline in EF after exercise. Our findings may have been influenced by the type of intervention, dose, mode of administration, or individual variability of the included subjects.

Carbohydrate mouth rinse is no more effective than placebo on running endurance of dehydrated and heat acclimated athletes

PURPOSE

To determine whether carbohydrate mouth rinsing would improve endurance running performance of tropical natives in a warm-humid (30 °C and 70% relative humidity) environment.

METHOD

Twelve endurance male runners [age 25 ± 3 years; peak aerobic capacity ([Formula: see text]O_2peak) 57.6 ± 3.6 mL^.kg^-1.min^-1] completed three time-to-exhaustion (TTE) trials at ~ 70% [Formula: see text]O_2peak while swilling 25 ml of a 6% carbohydrate (CHO) or taste-matched placebo (PLA) as well as no mouth rinse performed in the control (CON) trial.

RESULTS

TTE performance was significantly longer in both CHO and PLA trials when compared with the CON trial (54.7 ± 5.4 and 53.6 ± 5.1 vs. 48.4 ± 3.6 min, respectively; p < 0.001 and p = 0.012, respectively), but was not significantly different between CHO and PLA trials (p = 1.000). The rating of perceived exertion was not different between the CHO and PLA trials, however, was significantly affected when compared to the CON trial (p < 0.001). A similar effect was observed for perceived arousal level between the CHO and PLA trials to the CON trial. Core temperature, mean skin temperature and skin blood flow were not significantly different between the three trials (all p > 0.05). Similarly, plasma lactate and glucose as well as exercise heart rate were not influenced by the trials.

CONCLUSIONS

The present study demonstrates that mouth rinsing, whether carbohydrate or placebo, provides an ergogenic benefit to running endurance when compared to CON in a heat stress environment. Nevertheless, the results do not support the notion that rinsing a carbohydrate solution provides a greater advantage as previously described among non-heat acclimated individuals within a temperate condition.

Mouth rinsing and ingesting salty or bitter solutions does not influence corticomotor excitability or neuromuscular function

PURPOSE

To explore the effect of tasting unpleasant salty or bitter solutions on lower limb corticomotor excitability and neuromuscular function.

METHODS

Nine females and eleven males participated (age: 27 ± 7 years, BMI: 25.3 ± 4.0 kg m^-2). Unpleasant salty (1 M) and bitter (2 mM quinine) solutions were compared to water, sweetened water, and no solution, which functioned as control conditions. In a non-blinded randomized cross-over order, each solution was mouth rinsed (10 s) and ingested before perceptual responses, instantaneous heart rate (a marker of autonomic nervous system activation), quadricep corticomotor excitability (motor-evoked potential amplitude) and neuromuscular function during a maximal voluntary contraction (maximum voluntary force, resting twitch force, voluntary activation, 0-50 ms impulse, 0-100 impulse, 100-200 ms impulse) were measured.

RESULTS

Hedonic value (water: 47 ± 8%, sweet: 23 ± 17%, salt: 71 ± 8%, bitter: 80 ± 10%), taste intensity, unpleasantness and increases in heart rate (no solution: 14 ± 5 bpm, water: 18 ± 5 bpm, sweet: 20 ± 5 bpm, salt: 24 ± 7 bpm, bitter: 23 ± 6 bpm) were significantly higher in the salty and bitter conditions compared to control conditions. Nausea was low in all conditions (< 15%) but was significantly higher in salty and bitter conditions compared to water (water: 3 ± 5%, sweet: 6 ± 13%, salt: 7 ± 9%, bitter: 14 ± 16%). There was no significant difference between conditions in neuromuscular function or corticomotor excitability variables.

CONCLUSION

At rest, unpleasant tastes appear to have no influence on quadricep corticomotor excitability or neuromuscular function. These data question the mechanisms via which unpleasant tastes are proposed to influence exercise performance.

Effect of carbohydrate mouth rinse on muscle strength and muscular endurance: A systematic review with meta-analysis

The present systematic review with meta-analysis summarized studies that investigated the effect of carbohydrate (CHO) mouth rinse on muscle strength and muscular endurance. The search was performed in six databases. Thirteen randomized clinical trials were selected and the standardized mean difference between CHO mouth rinse and placebo for maximal strength and muscular endurance was determined via a random-effects model using Review Manager 5.4 software. Meta-regression was also performed to explore the influence of load, number of sets, number of exercises, fasting time, CHO concentration, and number of mouth rinses on the main outcomes. There was no significant effect of CHO mouth rinse on maximal strength (mean difference= 0.25 kg, 95%CI - 1.81 to 2.32 kg, z = 0.24, p = 0.810). However, there was a significant positive effect of CHO mouth rinse on muscular endurance (mean difference = 1.24 repetitions, 95%CI 0.70 to 1.77 repetitions, z = 4.55, p < 0.001). Meta-regression identified that CHO mouth rinse has greater benefits on muscular endurance when using high workloads, multiple exercises, and a smaller number of mouth rinses (p = 0.001). In conclusion, CHO mouth rinse has no effect on maximal muscle strength but has a positive effect on muscular endurance and seems to optimize when fewer mouth rinses, high workloads and numbers of exercises are used.Supplemental data for this article is available online at https://doi.org/10.1080/10408398.2022.2057417.

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

Background

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

Objective

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

Methods

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

Results

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

Conclusion

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

Supplementary Information

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

Carbohydrate Mouth Rinse Increases High but Not Low Intensity Repetitions to Failure in Resistance-Trained Males

Carbohydrate mouth rinsing (CMR) has been shown to enhance exercise performance. However, the influence of CMR on repetitions to failure with different intensities (40% or 80% of 1 RM) is unknown. Therefore, the purpose of this study was to examine the effects of a 6% CMR solution on muscular endurance assessed at 40% and 80% of 1 RM in resistance-trained males. Sixteen resistance-trained males (age: 25 ± 3 years, height: 182 ± 6 cm, body mass: 86 ± 3 kg, body fat: 16 ± 3%, bench press 1 RM: 106 ± 16 kg, resistance training experience: 5 ± 1 years) completed four conditions in random order. The four conditions consisted of ten seconds of mouth rinsing with 25 mL solutions containing either maltodextrin or placebo (sweetened water) prior to performing a bench press muscular endurance test at either 40% of 1 RM or 80% of 1 RM. Total repetitions, heart rate (HR), ratings of perceived exertion (RPE), glucose (GLU) and felt arousal (FA) were recorded for each condition. There was a significant condition by intensity interaction (p = 0.02). CMR significantly increased total repetitions compared with placebo at the higher intensity (80% of 1 RM; p = 0.04), while there was no effect at the lower intensity (p = 0.20). In addition, HR, RPE, GLU and FA did not differ between conditions or across intensities (p > 0.05). In conclusion, CMR-enhanced muscular endurance performed at higher but not lower intensities.

Is caffeine mouth rinsing an effective strategy to improve physical and cognitive performance? A systematic review

The aim of this study was to perform a systematic review on the effects of caffeine mouth rinsing on physical and cognitive performance. Following a search through 4 databases, 18 studies were found meeting the inclusion criteria (15 for physical performance and 3 for cognitive performance). All selected studies found an improvement in cognitive performance with caffeine mouth rinse. Four studies found positive effects of caffeine mouthwash on physical performance when repeated during exercise, while one study detected a positive effect with a single mouthwash before exercise, but only in a fasted state. Among these studies that showed positive effects, however, three (2 for physical performance and 1 for cognitive performance) presented fair methodological quality. There was also a variety of methodological approaches in the studies that showed no improvement in physical performance with caffeine mouth rinse, which may have influenced the potential to detect the ergogenic effect of caffeine mouth rinse. Thus, the effects of caffeine mouth rinse on physical performance are mixed, but a potential ergogenic effect might be present in a fasted state and when mouthwash is repeated during exercise. Concerning cognitive performance, caffeine mouth rinse seems to be a beneficial strategy.

Carbohydrate mouth rinsing does not affect 6-min walk test performance and blood glucose responses in older adults

PURPOSE

Carbohydrate (CHO) mouth rinsing (MR) prior to exercise has been shown to elicit enhanced performance and energy availability in some studies. Previous literature has concentrated on examining CHO MR strategies for improving aerobic endurance performance in younger athletic adults. Knowledge of the impact of CHO MR on functional performance in older adults is scarce. The purpose of this investigation was to determine if CHO MR would improve 6-min walk test (6MWT) performance, perceived exertion, and blood glucose responses in older adults.

METHOD

Thirty-three individuals (16 males, 17 females), age ≥ 70 years performed two 6MWT trials, one of which utilized a 6.4% maltodextrin CHO MR and one of which utilized a placebo MR. Participants held the MR in their mouth for 20 s prior to the 6MWT, and trials occurred in a counterbalanced fashion. Total distance walked and rating of perceived exertion (RPE) were recorded upon completion of each 6MWT. Heart rate (HR), peripheral blood oxygen saturation (SpO₂), systolic and diastolic blood pressures (BP), blood glucose, and blood lactate were measured before and after each 6MWT.

RESULT

CHO MR did not alter the response of any study parameter compared to the placebo MR (p = 0.13-0.94). HR, systolic BP, and blood lactate increased and SpO₂ decreased across time (p < 0.01).

CONCLUSION

A 6.4% maltodextrin CHO MR did not alter total distance walked, perceived exertion, or other physiological responses elicited by the 6MWT in older adults.

Different Doses of Carbohydrate Mouth Rinse Have No Effect on Exercise Performance in Resistance Trained Women

Carbohydrate (CHO) mouth rinse has been shown to enhance aerobic endurance performance. However, the effects of CHO mouth rinse on muscular strength and endurance are mixed and may be dependent on dosage of CHO. The primary purpose was to examine the effects of different dosages of CHO rinse on strength (bench press 1 repetition maximum [1-RM]) and muscular endurance (40% of 1-RM repetitions to failure) in female athletes. Sixteen resistance-trained females (age: 20 ± 1 years; height: 167 ± 3 cm; body mass: 67 ± 4 kg; BMI: 17 ± 2 kg/m²; resistance training experience: 2 ± 1 years) completed four conditions in random order. The four conditions consisted of a mouth rinse with 25 mL solutions containing either 6% of CHO (Low dose of CHO: LCHO), 12% CHO (Moderate dose of CHO: MCHO), 18% CHO (High dose of CHO: HCHO) or water (Placebo: PLA) for 10 s prior to a bench press strength and muscular endurance test. Maximal strength (1-RM), muscular endurance (reps and total volume), heart rate (HR), ratings of perceived exertion (RPE) and glucose (GLU) were recorded each condition. There were no significant differences in strength (p = 0.95) or muscular endurance (total repetitions: p = 0.06; total volume: p = 0.20) between conditions. Similarly, HR (p = 0.69), RPE (p = 0.09) and GLU (p = 0.92) did not differ between conditions. In conclusion, various doses of CHO mouth rinse (6%, 12% and 18%) have no effect on upper body muscular strength or muscular endurance in female athletes.

Perceptual and Physiological Responses to Carbohydrate and Menthol Mouth-Swilling Solutions: A Repeated Measures Cross-Over Preliminary Trial

Carbohydrate and menthol mouth-swilling have been used to enhance exercise performance in the heat. However, these strategies differ in mechanism and subjective experience. Participants (n = 12) sat for 60 min in hot conditions (35 °C; 15 ± 2%) following a 15 min control period, during which the participants undertook three 15 min testing blocks. A randomised swill (carbohydrate; menthol; water) was administered per testing block (one swill every three minutes within each block). Heart rate, tympanic temperature, thermal comfort, thermal sensation and thirst were recorded every three minutes. Data were analysed by ANOVA, with carbohydrate intake controlled for via ANCOVA. Small elevations in heart rate were observed after carbohydrate (ES: 0.22 ± 90% CI: −0.09–0.52) and water swilling (0.26; −0.04–0.54). Menthol showed small improvements in thermal comfort relative to carbohydrate (−0.33; −0.63–0.03) and water (−0.40; from −0.70 to −0.10), and induced moderate reductions in thermal sensation (−0.71; from −1.01 to −0.40 and −0.66; from −0.97 to −0.35, respectively). Menthol reduced thirst by a small to moderate extent. These effects persisted when controlling for dietary carbohydrate intake. Carbohydrate and water may elevate heart rate, whereas menthol elicits small improvements in thermal comfort, moderately improves thermal sensation and may mitigate thirst; these effects persist when dietary carbohydrate intake is controlled for.

Adaptation to a low carbohydrate high fat diet is rapid but impairs endurance exercise metabolism and performance despite enhanced glycogen availability

KEY POINTS

Brief (5-6 days) adaptation to a low carbohydrate high fat diet in elite athletes increased exercise fat oxidation to rates previously observed with medium (3-4 weeks) or chronic (>12 months) adherence to this diet, with metabolic changes being washed out in a similar time frame. Increased fat utilisation during exercise was associated with a 5-8% increase in oxygen cost at speeds related to Olympic Programme races. Acute restoration of endogenous carbohydrate (CHO) availability (24 h high CHO diet, pre-race CHO) only partially restored substrate utilisation during a race warm-up. Fat oxidation continued to be elevated above baseline values although it was lower than achieved by 5-6 days' keto adaptation; CHO oxidation only reached 61% and 78% of values previously seen at exercise intensities related to race events. Acute restoration of CHO availability failed to overturn the impairment of high-intensity endurance performance previously associated with low carbohydrate high fat adaptation, potentially due to the blunted capacity for CHO oxidation.

ABSTRACT

We investigated substrate utilisation during exercise after brief (5-6 days) adaptation to a ketogenic low-carbohydrate (CHO), high-fat (LCHF) diet and similar washout period. Thirteen world-class male race walkers completed economy testing, 25 km training and a 10,000 m race (Baseline), with high CHO availability (HCHO), repeating this (Adaptation) after 5-6 days' LCHF (n = 7; CHO: <50 g day^-1 , protein: 2.2 g kg^-1 day^-1 ; 80% fat) or HCHO (n = 6; CHO: 9.7 g kg^-1 day^-1 ; protein: 2.2 g kg^-1 day^-1 ) diet. An Adaptation race was undertaken after 24 h HCHO and pre-race CHO (2 g kg^-1 ) diet, identical to the Baseline race. Substantial (>200%) increases in exercise fat oxidation occurred in the LCHF Adaptation economy and 25 km tests, reaching mean rates of ∼1.43 g min^-1 . However, relative V ̇ O 2 (ml min^-1  kg^-1 ) was higher (P < 0.0001), by ∼8% and 5% at speeds related to 50 km and 20 km events. During Adaptation race warm-up in the LCHF group, rates of fat and CHO oxidation at these speeds were decreased and increased, respectively (P < 0.001), compared with the previous day, but were not restored to Baseline values. Performance changes differed between groups (P = 0.009), with all HCHO athletes improving in the Adaptation race (5.7 (5.6)%), while 6/7 LCHF athletes were slower (2.2 (3.4)%). Substrate utilisation returned to Baseline values after 5-6 days of HCHO diet. In summary, robust changes in exercise substrate use occurred in 5-6 days of extreme changes in CHO intake. However, adaptation to a LCHF diet plus acute restoration of endogenous CHO availability failed to restore high-intensity endurance performance, with CHO oxidation rates remaining blunted.

Carbohydrate mouth rinse improves resistance exercise capacity in the glycogen-lowered state

The effect of carbohydrate mouth rinse (CHO MR) on resistance exercise performance is equivocal and may be moderated by carbohydrate availability. This study determined the effect of CHO MR on low-load resistance exercise capacity completed in a fed but glycogen-lowered state. Twelve resistance-trained men (age: 22 ± 4 years; height: 1.79 ± 0.05 m; mass: 78.7 ± 7.8 kg; bench press one-repetition maximum (1RM): 87 ± 21 kg; squat 1RM: 123 ± 19 kg) completed two fed-state resistance exercise bouts consisting of six sets of bench press and six sets of squat to failure at 40% 1RM. Each bout was preceded by glycogen-depleting cycling the evening before, with feeding controlled to create acute energy deficit and maintain low muscle glycogen. During resistance exercise, participants rinsed with either a 6% CHO MR solution or a taste-matched placebo (PLA) between sets. Total volume workload was greater with CHO MR (9354 ± 2051 vs. 8525 ± 1911 kg, p = 0.010). Total number of repetitions of squat were greater with CHO MR (107 ± 26 vs. 92 ± 16, p = 0.017); the number of repetitions of bench press were not significantly different (CHO MR: 120 ± 24 vs. PLA: 115 ± 22, p = 0.146). This was independent of differences in feeling or arousal. CHO MR may be an effective ergogenic aid for athletes completing resistance exercise when in energy deficit and with low carbohydrate availability. Novelty: CHO MR can increase low-load resistance exercise capacity undertaken in a glycogen-lowered but fed state. This effect was driven by a greater number of repetitions-to-failure in the squat - using muscles lowered in glycogen content with exhaustive cycling on the evening prior to resistance exercise - but not bench press.

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

BACKGROUND

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSION

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

Effect of Carbohydrate Mouth Rinse on Performance after Prolonged Submaximal Cycling

Previous studies have shown improved shorter duration (∼1 h) performance with carbohydrate (CHO) mouth rinsing (WASH), especially in overnight fasted/non-fuelled subjects.

PURPOSE

To determine the effect of WASH on cycling time trial (TT) performance and muscle activity (EMG) after 2 h of submaximal cycling while receiving CHO (FED).

METHODS

In a double-blind, placebo-controlled crossover design, 10 well-trained males cyclists (V˙O2max: 65 mL·kg·min) completed two experimental trials. Each trial consisted of a standardized pretrial snack (2 h prior) followed by 120 min of steady-state (SS) cycling (∼60% V˙O2max) followed by an approximately 30-min TT, randomized as follows: 1) 30 g CHO·h during SS + WASH during TT (every 20% of TT) (FEDWASH); 2) 30 g CHO·h during SS + placebo (PLA) wash during TT (FEDPLA).

RESULTS

Although FEDWASH was not significantly different than FEDPLA (P = 0.51), there was a 1.7% (90% confidence interval, +6.4% to -3.2%; ES, 0.21) decrease in TT time (35 s) for FEDWASH compared with FEDPLA, with qualitative probabilities of a 60% positive and 23% trivial outcome. For EMG, soleus showed significant increase, whereas medial gastrocnemius showed significant decrease in muscle recruitment from the beginning 20% TT segment to the last 20% only in the FEDPLA condition, which coincided with a slower (P = 0.01) last 20% of the TT in FEDPLA versus FEDWASH.

CONCLUSIONS

Contrary to previous studies, this investigation utilized conditions of high ecological validity including a pretrial snack and CHO during SS. Significant changes in muscle recruitment and time over the last 20% of the TT, along with an average 1.7% improvement in TT time, suggest CHO mouth rinse helps maintain power output late in TT compared with placebo. Although marginal gains were achieved with a CHO mouth rinse (35 s), small performance effects can have significant outcomes in real-world competitions.

Cycling time trial performance is improved by carbohydrate ingestion during exercise regardless of a fed or fasted state

PURPOSE

We tested the hypothesis that carbohydrate ingestion during exercise improves time trial (TT) performance and that this carbohydrate-induced improvement is greater when carbohydrates are ingested during exercise in a fasted rather than a fed state.

METHODS

Nine males performed 105 minutes of constant-load exercise (50% of the difference between the first and second lactate thresholds), followed by a 10-km cycling TT. Exercise started at 9 am, 3 hours after either breakfast (FED, 824 kcal, 67% carbohydrate) or a 15-hour overnight fast (FAST). Before exercise, after every 15 minutes of exercise and at 5 km of the TT, participants ingested 2 mL kg^-1 body mass of a non-caloric sweetened solution containing either carbohydrate (8% of maltodextrin, CHO) or placebo (0% carbohydrate, PLA).

RESULTS

Irrespective of the fasting state, when carbohydrate was ingested during exercise, the rating of perceived exertion (RPE) was lower throughout the constant-load exercise, while the plasma glucose concentration and carbohydrate oxidation were higher during the last stages of the constant-load exercise (P < 0.05). Consequently, TT performance was faster when carbohydrate was ingested during exercise (18.5 ± 0.3 and 18.7 ± 0.4 minutes for the FEDCHO and FASTCHO conditions, respectively) than when the placebo was ingested during exercise (20.2 ± 0.8 and 21.7 ± 1.4 minutes for the FEDPLA and FASTPLA conditions, respectively), regardless of fasting.

CONCLUSION

These findings indicate that even when breakfast is provided before exercise, carbohydrate ingestion during exercise is still beneficial for exercise performance. However, ingesting carbohydrate during exercise can overcome a lack of breakfast.

Repeated-sprints exercise in daylight fasting: carbohydrate mouth rinsing does not affect sprint and reaction time performance

To determine the effect of carbohydrate mouth rinsing (CHO-MR) on physical and cognitive performance during repeated-sprints (RS) after 3 days of intermittent fasting (abstaining from food and fluid 14 h per day). In a randomized and counter-balanced manner 15 active healthy males in a fasted state performed a RS-protocol [RSP; 2 sets (SET1 and SET2) of 5×5 s maximal sprints, with each sprint interspersed with 25 s rest and 3 min of recovery between SET1 and SET2] on an instrumented non-motorized treadmill with embedded force sensors under three conditions: i) Control (CON; no-MR), ii) Placebo-MR (PLA-MR; 0% maltodextrin) and iii) CHO-MR (10% maltodextrin). Participants rinsed their mouth with either 10 mL of PLA-MR or CHO-MR solution for 5 s before each sprint. Sprint kinetics were measured for each sprint and reaction time (RTI) tasks (simple and complex) were assessed pre-, during- and post-RSP. There was no statistical main effect of CHO-MR on mean power, mean speed, and vertical stiffness during the sprints between the PLA-MR and CON condition. Additionally, no statistical main effect for CHO-MR on accuracy, movement time and reaction time during the RTI tasks was seen. CHO-MR did not affect physical (RSP) or cognitive (RTI) performance in participants who had observed 3 days of intermittent fasting (abstaining from food and fluid 14 h per day).

Carbohydrate Mouth Rinse Fails to Improve Four-Kilometer Cycling Time Trial Performance

We investigated if a carbohydrate (CHO) mouth rinse may attenuate global fatigue and improve 4-km cycling time trial (TT_4km) performance. After a preliminary session, cyclists (n = 9) performed a TT_4km after a CHO or placebo (PLA) mouth rinse. Mean power output, time, and ratings of perceived exertion (RPE) were recorded throughout the TT_4km. Twitch interpolation responses (%VA; voluntary activation and ∆Tw; delta peak twitch torque) were compared pre and post TT_4km with traditional statistics and effect size (ES) analysis. Time-to-complete the 4 km and mean power output were comparable between CHO (386.4 ± 28.0 s) and PLA (385.4 ± 22.4 s). A lower central (p = 0.054) and peripheral (p = 0.02) fatigue in CHO than in PLA were suggested by an extremely-large ES in %VA (manipulation main effect: p = 0.052, d = 1.18; manipulation-by-time interaction effect: p = 0.08, d = 1.00) and an extremely, very-large ES in ∆Tw (manipulation main effect: p = 0.07, d = 0.97; time-by-manipulation interaction effect: p = 0.09, d = 0.89). The RPE increased slower in CHO than in PLA (p = 0.051; d = 0.7). The apparent reduction in global fatigue (central and peripheral) and RPE_SLOPE with only one CHO mouth rinse were not translated into improved TT_4km performance. Further tests may be required to verify if these likely differences in global fatigue might represent an edge in the short-lasting cycling time trial performance.

Impact of carbohydrate mouth rinsing on time to exhaustion during Ramadan: A randomized controlled trial in Jordanian men

Mouth rinsing using a carbohydrate (CHO) solution has been suggested to improve physical performance in fasting participants. This study examined the effects of CHO mouth rinsing during Ramadan fasting on running time to exhaustion and on peak treadmill speed (V_peak). In a counterbalanced crossover design, 18 sub-elite male runners (Age: 21 ± 2 years, Weight: 68.1 ± 5.7 kg, VO_2max: 55.4 ± 4.8 ml/kg/min) who observed Ramadan completed a familiarization trial and three experimental trials. The three trials included rinsing and expectorating a 25 mL bolus of either a 7.5% sucrose solution (CHO), a flavour and taste matched placebo solution (PLA) for 10 s, or no rinse (CON). The treatments were performed prior to an incremental treadmill test to exhaustion. Three-day dietary and exercise records were obtained on two occasions and analysed. Anthropometric characteristics were obtained and recorded for all participants. A main effect for mouth rinse on peak velocity (V_peak) (CHO: 17.6 ± 1.5 km/h; PLA: 17.1 ± 1.4 km/h; CON: 16.7 ± 1.2 km/h; P < .001, η_p² = 0.49) and time to exhaustion (CHO: 1282.0 ± 121.3 s; PLA: 1258.1 ± 113.4 s; CON: 1228.7 ± 98.5 s; P = .002, η_p² = 0.41) was detected, with CHO significantly higher than PLA (P < .05) and CON (P < .05). Oxygen consumption, heart rate, respiratory exchange ratio, and rating of perceived exertion were not significantly different between treatments or trials (P > .05). Energy availability from dietary analysis, body weight, and fat-free mass did not change during the last two weeks of Ramadan (P > .05). This study concludes that carbohydrate mouth rinsing improves running time to exhaustion and peak treadmill speed under Ramadan fasting conditions.

Carbohydrate mouth rinse does not affect performance during a 60-min running race in women

This study examined the effect of carbohydrate mouth rinsing on endurance running performance in women. Fifteen female recreational endurance runners, who used no oral contraceptives, ran two races of 1-h duration on an indoor track (216-m length) at 18:00 h after an 8-h fast with a 7-days interval between races, corresponding to the 3^rd-10th day of each premenopausal runner's menstrual cycle, or any day for the postmenopausal runners. In a double-blind random order, participants rinsed their mouth with 25 ml of either a 6.4% carbohydrate (RCHO) or a placebo solution (RP). No fluid was ingested during exercise. Serum 17β-Εstradiol (P = 0.59) and Progesterone (P = 0.35) did not differ between treatments. There was no difference in 1-hour running performance (RCHO: 10,621.88 ± 205.98 m vs. RP: 10,454.00 ± 206.64 m; t = 1.784, P = 0.096). Furthermore, the mean percentage effect (±99%CI) of RCHO relative to RP, 1.67% (-1.1% to 4.4%), and Cohen's effect size (d = 0.21) support a trivial outcome of RCHO for total distance covered. In conclusion, carbohydrate mouth rinsing did not improve 60-min track running performance in female recreational runners competing in a low ovarian hormone condition, after an 8-h fast and when no fluid was ingested during exercise.

Role of carbohydrate in central fatigue: a systematic review

Carbohydrate (CHO) depletion is linked to neuromuscular fatigue during exercise. While its role at peripheral level is relatively well understood, less is known about its impact centrally. The aim of this systematic review was to critically analyze the effects of CHO on central fatigue (CF) assessed by various neurophysiological techniques. Four databases were searched using PRISMA guidelines through February 2016. The inclusion criteria were: CHO as intervention against a placebo control, fatigue induced by prolonged exercise and assessed using neurophysiological measures [voluntary activation (VA), superimposed twitch (SIT), M-wave, electromyography], alongside maximal voluntary contraction (MVC). Seven papers were reviewed, where exercise duration lasted between 115 and 180 min. CHO improved exercise performance in three studies, whereby two of them attributed it to CF via attenuation of VA and SIT reductions, while the other indicated peripheral involvement via attenuation of M-wave reduction. Although a few studies suggest that CHO attenuates CF, data on its direct effects on neurophysiological outcome measures are limited and mixed. Generally, measures employed in these studies were inadequate to conclude central contribution to fatigue. Factors including the techniques used and the lack of controls render additional confounding factors to make definitive deductions. Future studies should employ consistent techniques and appropriate neurophysiological controls to distinguish CHO effect at central level. The use of pharmacological intervention should be incorporated to elucidate involvement of central mechanisms.

Carbohydrate Mouth Rinsing Enhances High Intensity Time Trial Performance Following Prolonged Cycling

There is good evidence that mouth rinsing with carbohydrate (CHO) solutions can enhance endurance performance (≥30 min). The impact of a CHO mouth rinse on sprint performance has been less consistent, suggesting that CHO may confer benefits in conditions of ‘metabolic strain’. To test this hypothesis, the current study examined the impact of late-exercise mouth rinsing on sprint performance. Secondly, we investigated the effects of a protein mouth rinse (PRO) on performance. Eight trained male cyclists participated in three trials consisting of 120 min of constant-load cycling (55% W_max) followed by a 30 km computer-simulated time trial, during which only water was provided. Following 15 min of muscle function assessment, 10 min of constant-load cycling (3 min at 35% W_max, 7 min at 55% W_max) was performed. This was immediately followed by a 2 km time trial. Subjects rinsed with 25 mL of CHO, PRO, or placebo (PLA) at min 5:00 and 14:30 of the 15 min muscle function phase, and min 8:00 of the 10-min constant-load cycling. Magnitude-based inferential statistics were used to analyze the effects of the mouth rinse on 2-km time trial performance and the following physiological parameters: Maximum Voluntary Contract (MVC), Rating of Perceived Exertion (RPE), Heart Rate (HR), and blood glucose levels. The primary finding was that CHO ‘likely’ enhanced performance vs. PLA (3.8%), whereas differences between PRO and PLA were unclear (0.4%). These data demonstrate that late-race performance is enhanced by a CHO rinse, but not PRO, under challenging metabolic conditions. More data should be acquired before this strategy is recommended for the later stages of cycling competition under more practical conditions, such as when carbohydrates are supplemented throughout the preceding minutes/hours of exercise.

Mouth rinsing with a sweet solution increases energy expenditure and decreases appetite during 60 min of self-regulated walking exercise

Carbohydrate mouth rinsing can improve endurance exercise performance and is most ergogenic when exercise is completed in the fasted state. This strategy may also be beneficial to increase exercise capacity and the energy deficit achieved during moderate-intensity exercise relevant to weight control when performed after an overnight fast. Eighteen healthy men (mean (SD); age, 23 (4) years; body mass index, 23.1 (2.4) kg·m^-2) completed a familiarisation trial and 3 experimental trials. After an overnight fast, participants performed 60 min of treadmill walking at a speed that equated to a rating of perceived exertion of 13 ("fairly hard"). Participants manually adjusted the treadmill speed to maintain this exertion. Mouth rinses for the experimental trials contained either a 6.4% maltodextrin solution with sweetener (CHO), a taste-matched placebo (PLA), or water (WAT). Appetite ratings were collected using visual analogue scales and exercise energy expenditure and substrate oxidation were calculated from online gas analysis. Increased walking distance during CHO and PLA induced greater energy expenditure compared with WAT (mean difference (90% confidence interval); 79 (60) kJ, P = 0.035, d = 0.24; and 90 (63) kJ, P = 0.024, d = 0.27, respectively). Appetite area under the curve was lower in CHO and PLA than WAT (8 (6) mm, P = 0.042, d = 0.43; and 6 (8) mm, P = 0.201, d = 0.32, respectively). Carbohydrate oxidation was higher in CHO than PLA and WAT (7.3 (6.7) g, P = 0.078, d = 0.47; and 10.1 (6.5) g, P = 0.015, d = 0.81, respectively). This study provides novel evidence that mouth rinsing with a sweetened solution may promote a greater energy deficit during moderate-exertion walking exercise by increasing energy expenditure and decreasing appetite. A placebo effect may have contributed to these benefits.