A critical review of citrulline malate supplementation and exercise performance

Multi-Ingredient Preworkout Supplementation Compared With Caffeine and a Placebo Does Not Improve Repetitions to Failure in Resistance-Trained Women

There has been an increase in the use of commercially available multi-ingredient preworkout supplements (MIPS); however, there are inconsistencies regarding the efficacy of MIPS in resistance-trained women.

PURPOSE

To determine the effect of varying doses of MIPS compared with caffeine only (C) and a placebo (PL) on resistance-training performance in trained women.

METHODS

Ten women (21.5 [2.3] y) completed 1-repetition-maximum tests at baseline for leg press and bench press. A within-group, double-blind, and randomized design was used to assign supplement drinks (ie, PL, C, MIPS half scoop [MIPS-H], and MIPS full scoop [MIPS-F]). Repetitions to failure were assessed at 75% and 80% to 85% of 1-repetition maximum for bench and leg press, respectively. Total performance volume was calculated as load × sets × repetitions for each session. Data were analyzed using a 1-way repeated-measures analysis of variance and reported as means and SDs.

RESULTS

There were no differences in repetitions to failure for bench press (PL: 14.4 [3.2] repetitions, C: 14.4 [2.9] repetitions, MIPS-H: 14.2 [2.6] repetitions, MIPS-F: 15.1 [3.1] repetitions; P = .54) or leg press (PL: 13.9 [7.8] repetitions, C: 10.8 [5.9] repetitions, MIPS-H: 13.1 [7.1] repetitions, MIPS-F: 12.4 [10.7] repetitions; P = .44). Furthermore, there were no differences in total performance volume across supplements for bench press (PL: 911.2 [212.8] kg, C: 910.7 [205.5] kg, MIPS-H: 913.6 [249.3] kg, MIPS-F: 951.6 [289.6] kg; P = .39) or leg press (PL: 4318.4 [1633.6] kg, C: 3730.0 [1032.5] kg, MIPS-H: 4223.0 [1630.0] kg, MIPS-F: 4085.5 [2098.3] kg; P = .34).

CONCLUSIONS

Overall, our findings suggest that caffeine and MIPS do not provide ergogenic benefits for resistance-trained women in delaying muscular failure.

Advances in Understanding the Interplay between Dietary Practices, Body Composition, and Sports Performance in Athletes

The dietary practices of athletes play a crucial role in shaping their body composition, influencing sports performance, training adaptations, and overall health. However, despite the widely acknowledged significance of dietary intake in athletic success, there exists a gap in our understanding of the intricate relationships between nutrition, body composition, and performance. Furthermore, emerging evidence suggests that many athletes fail to adopt optimal nutritional practices, which can impede their potential achievements. In response, this Special Issue seeks to gather research papers that delve into athletes' dietary practices and their potential impacts on body composition and sports performance. Additionally, studies focusing on interventions aimed at optimizing dietary habits are encouraged. This paper outlines the key aspects and points that will be developed in the ensuing articles of this Special Issue.

Signaling pathways regulated by natural active ingredients in the fight against exercise fatigue-a review

Exercise fatigue is a normal protective mechanism of the body. However, long-term fatigue hinders normal metabolism and exercise capacity. The generation and recovery from exercise fatigue involves alterations in multiple signaling pathways, mainly AMPK, PI3K/Akt, Nrf2/ARE, NF-κB, PINK1/Parkin, and BDNF/TrkB, as well as MAPK signaling pathways that mediate energy supply, reduction of metabolites, oxidative stress homeostasis, muscle fiber type switching, and central protective effects. In recent studies, a rich variety of natural active ingredients have been identified in traditional Chinese medicines and plant extracts with anti-fatigue effects, opening up the field of research in new anti-fatigue drugs. In this review we give an overview of the signaling pathways associated with the activity of natural food active ingredients against exercise fatigue. Such a comprehensive review is necessary to understand the potential of these materials as preventive measures and treatments of exercise fatigue. We expect the findings highlighted and discussed here will help guide the development of new health products and provide a theoretical and scientific basis for future research on exercise fatigue.

Acute Effect of L-Citrulline Supplementation on Resistance Exercise Performance and Muscle Oxygenation in Recreationally Resistance Trained Men and Women

L-citrulline serves as a nitric oxide precursor with the potential to increase blood flow and improve resistance exercise performance, yet more research is needed to examine its ergogenic potential. To examine the effect of L-citrulline supplementation on resistance exercise performance, muscle oxygenation, and the subjective perception of effort, energy, focus, fatigue, and muscle pump, eighteen resistance-trained men (n = 11) and women (n = 7) (21.4 ± 1.8 years; 172.3 ± 7.5 cm; 76.9 ± 10.8 kg) were randomly assigned for supplementation with 8 g of L-citrulline (CIT) or a placebo (PL) in a cross-over fashion one hour prior to testing. Participants completed an isometric mid-thigh pull test (IMTP), a ballistic bench press protocol [two sets of two repetitions at 75% 1-repetition maximum (1 RM) with maximum ballistic intent], and a strength-endurance bench press protocol [five repetition-maximum sets at 75% 1RM]. Barbell velocity and power were measured via a linear position transducer during the ballistic protocol, while the repetitions completed, volume load and muscle oxygenation were quantified during the strength-endurance protocol. Subjective measures were assessed at the baseline and immediately pre- and post-exercise. Repeated measures of the analysis of variance and Bayesian equivalents revealed no significant interactions, providing evidence favoring the null hypothesis (BF10 < 1) for IMTP (PL 497.5 ± 133.6 vs. CIT 492.5 ± 129.4 N), barbell velocity, and power, and repetitions completed (PL 36.7 ± 7.2 vs. CIT 36.9 ± 8.1 repetitions). There were also no significant interactions for muscle oxygenation parameters or subjective measures except perceived fatigue. Women reported greater fatigue across all time points compared to men (~1.88 au, p = 0.045, BF10 = 0.2). The results indicate that a single 8 g dose of L-citrulline did not enhance isometric force production, muscle endurance, or muscle oxygenation parameters during the protocol implemented in this study.

Different Approaches to Ergogenic, Pre-, and Probiotic Supplementation in Sports with Different Metabolism Characteristics: A Mini Review

Sport disciplines with different metabolic characteristics require different dietary approaches. Bodybuilders or sprinters ("anaerobic" athletes) need a high-protein diet (HPD) in order to activate muscle protein synthesis after exercise-induced muscle damage and use nitric oxide enhancers (such as citrulline and nitrates) to increase vasodilatation, whereas endurance athletes, such as runners or cyclists ("aerobic" athletes), prefer a high-carbohydrate diet (HCHD), which aims to restore the intramuscular glycogen, and supplements containing buffering agents (such as sodium bicarbonate and beta-alanine). In both cases, nutrient absorption, neurotransmitter and immune cell production and muscle recovery depend on gut bacteria and their metabolites. However, there is still insufficient data on the impact of an HPD or HCHD in addition to supplements on "anaerobic" and "aerobic" athletes' gut microbiota and how this impact could be affected by nutritional interventions such as pre- and probiotic therapy. Additionally, little is known about the role of probiotics in the ergogenic effects of supplements. Based on the results of our previous research on an HPD in amateur bodybuilders and an HCHD in amateur cyclists, we reviewed human and animal studies on the effects of popular supplements on gut homeostasis and sport performance.

Dietary Arginine and Citrulline Supplements for Cardiovascular Health and Athletic Performance: A Narrative Review

The global market for nutritional supplements (NS) is growing rapidly, and the use of L-arginine (Arg), L-citrulline (Cit), and citrulline malate (CitMal) supplements has been shown to enhance cardiovascular health and athletic performance. Over the past decade, Arg, Cit, and CitMal supplements have received considerable attention from researchers in the field of exercise nutrition, who have investigated their potential effects on hemodynamic function, endothelial function, aerobic and anaerobic capacity, strength, power, and endurance. Previous studies were reviewed to determine the potential impact of Arg, Cit, and CitMal supplements on cardiovascular health and exercise performance. By synthesizing the existing literature, the study aimed to provide insight into the possible uses and limitations of these supplements for these purposes. The results showed that both recreational and trained athletes did not see improved physical performance or increased nitric oxide (NO) synthesis with 0.075 g or 6 g doses of Arg supplement per body weight. However, 2.4 to 6 g of Cit per day for 7 to 16 days of various NSs had a positive impact, increasing NO synthesis, enhancing athletic performance indicators, and reducing feelings of exertion. The effects of an 8 g acute dose of CitMal supplement were inconsistent, and more research is needed to determine its impact on muscle endurance performance. Based on the positive effects reported in previous studies, further testing is warranted in various populations that may benefit from nutritional supplements, including aerobic and anaerobic athletes, resistance-trained individuals, elderly people, and clinical populations, to determine the impact of different doses, timing of ingestion, and long-term and acute effects of Arg, Cit, and CitMal supplements on cardiovascular health and athletic performance.

Supplementation with Nitric Oxide Precursors for Strength Performance: A Review of the Current Literature

Nitric-oxide-stimulating dietary supplements are widely available and marketed to strength athletes and weightlifters seeking to increase muscle performance and augment training adaptations. These supplements contain ingredients classified as nitric oxide (NO) precursors (i.e., "NO boosters"). Endogenous NO is generated via a nitric oxide synthase (NOS)-dependent pathway and a NOS-independent pathway that rely on precursors including L-arginine and nitrates, with L-citrulline serving as an effective precursor of L-arginine. Nitric oxide plays a critical role in endothelial function, promoting relaxation of vascular smooth muscle and subsequent dilation which may favorably impact blood flow and augment mechanisms contributing to skeletal muscle performance, hypertrophy, and strength adaptations. The aim of this review is to describe the NO production pathways and summarize the current literature on the effects of supplementation with NO precursors for strength and power performance. The information will allow for an informed decision when considering the use of L-arginine, L-citrulline, and nitrates to improve muscular function by increasing NO bioavailability.

Remote ischemic preconditioning enhances aerobic performance by accelerating regional oxygenation and improving cardiac function during acute hypobaric hypoxia exposure

Remote ischemic preconditioning (RIPC) may improve exercise performance. However, the influence of RIPC on aerobic performance and underlying physiological mechanisms during hypobaric hypoxia (HH) exposure remains relatively uncertain. Here, we systematically evaluated the potential performance benefits and underlying mechanisms of RIPC during HH exposure. Seventy-nine healthy participants were randomly assigned to receive sham intervention or RIPC (4 × 5 min occlusion 180 mm Hg/reperfusion 0 mm Hg, bilaterally on the upper arms) for 8 consecutive days in phases 1 (24 participants) and phase 2 (55 participants). In the phases 1, we measured the change in maximal oxygen uptake capacity (VO₂max) and muscle oxygenation (SmO₂) on the leg during a graded exercise test. We also measured regional cerebral oxygenation (rSO₂) on the forehead. These measures and physiological variables, such as cardiovascular hemodynamic parameters and heart rate variability index, were used to evaluate the intervention effect of RIPC on the changes in bodily functions caused by HH exposure. In the phase 2, plasma protein mass spectrometry was then performed after RIPC intervention, and the results were further evaluated using ELISA tests to assess possible mechanisms. The results suggested that RIPC intervention improved VO₂max (11.29%) and accelerated both the maximum (18.13%) and minimum (53%) values of SmO₂ and rSO₂ (6.88%) compared to sham intervention in hypobaric hypoxia exposure. Cardiovascular hemodynamic parameters (SV, SVRI, PPV% and SpMet%) and the heart rate variability index (Mean RR, Mean HR, RMSSD, pNN50, Lfnu, Hfnu, SD1, SD2/SD1, ApEn, SampEn, DFA1and DFA2) were evaluated. Protein sequence analysis showed 42 unregulated and six downregulated proteins in the plasma of the RIPC group compared to the sham group after HH exposure. Three proteins, thymosin β4 (Tβ4), heat shock protein-70 (HSP70), and heat shock protein-90 (HSP90), were significantly altered in the plasma of the RIPC group before and after HH exposure. Our data demonstrated that in acute HH exposure, RIPC mitigates the decline in VO₂max and regional oxygenation, as well as physiological variables, such as cardiovascular hemodynamic parameters and the heart rate variability index, by influencing plasma Tβ4, HSP70, and HSP90. These data suggest that RIPC may be beneficial for acute HH exposure.

The use of traditional Chinese medicines in relieving exercise-induced fatigue

Exercise-induced fatigue is a non-pathological fatigue and indicated by a reduction of muscle performance that is caused by excessive physical activity. It seriously affects the daily lives of people, in particular athletes, military personnel, and manual laborers. In recent years, increasing attention has been paid to improving the adverse effect of exercise-induced fatigue on people’s daily activities. Thus, studies and applications of traditional Chinese medicines (TCMs) in relieving exercise-induced fatigue have become the focus because of their good curative effects with fewer side effects. This review aims to document and summarize the critical and comprehensive information about the biological processes of exercise-induced fatigue, and to know the types of TCMs, their active components, and possible molecular mechanisms in alleviating exercise-induced fatigue. The peripheral and central mechanisms that cause exercise-induced fatigue have been summarized. A total of 47 exercise-induced fatigue relief TCMs have been collected, mostly including the types of visceral function regulation and emotional adjustment TCMs. Polysaccharides, terpenes, flavonoids/polyphenols are demonstrated to be the major bioactive components. The underlying molecular mechanisms are mainly related to the improvement of energy metabolism, elimination of excess metabolites, inhibition of oxidative stress and inflammatory response, regulation of HPA axis and neurotransmitters. Although current results are obtained mostly from animal models, the clinic trials are still insufficient, and a very few TCMs have been reported to possess potential hepatotoxicity. These findings still offer great reference value, and the significant efficacy in relieving exercise-induced fatigue is impossible to ignore. This review is expected to give insights into the research and development of new TCMs-derived drugs and health care products in relieving exercise-induced fatigue.

The influence of caffeinated and non-caffeinated multi-ingredient pre-workout supplements on resistance exercise performance and subjective outcomes

Background

There is substantial consumer and practitioner interest in an emerging supplement class known as multi-ingredient pre-workout supplements (MIPS), largely due to their prevalence in resistance training communities as well as research findings demonstrating the ergogenic impact of caffeine on muscular performance. However, limited research has examined the potential efficacy of non-caffeinated MIPS, despite their growing popularity among those who are caffeine-sensitive or who train later in the day.

Methods

Twenty-four resistance-trained college-aged males (n = 12) and females (n = 12) completed three visits in which they ingested either a caffeinated MIPS (C), an otherwise identical non-caffeinated MIPS (NC), or placebo in a double-blind, counterbalanced, crossover fashion. Squat isometric peak force (PF_iso), rate of force development (RFD), and isokinetic performance were assessed. Upper and lower body maximal muscular strength and endurance were evaluated using the bench press and leg press, respectively. Visual analog scales for energy, focus, and fatigue were completed five times throughout the testing protocol. The effects of supplementation and biological sex on all variables were examined using linear mixed effects models.

Results

Significantly greater PF_iso was observed in both C (b: 0.36 transformed units [0.09, 0.62]) and NC (b: 0.32 transformed units [95% CI: 0.05, 0.58]) conditions, relative to placebo. Early RFD (RFD₅₀) may have been higher with supplementation, particularly in females, with no effects for late RFD (RFD₂₀₀) or peak RFD. In addition, increases in subjective energy after supplement ingestion were noted for C, but not NC. No effects of supplementation on traditional resistance exercise performance or isokinetic squat performance were observed, other than a lower leg press one-repetition maximum for males in the NC condition.

Conclusions

These data indicate that acute ingestion of either a caffeinated or non-caffeinated pre-workout formulation improved maximal force production during an isometric squat test but did not provide additional benefit to leg press, bench press, or isokinetic squat performance over placebo, within the context of a laboratory environment. The consumption of a caffeinated, but not non-caffeinated, MIPS increased subjective ratings of energy over placebo when assessed as part of a testing battery.

Dietary Supplements for Athletic Performance in Women: Beta-Alanine, Caffeine, and Nitrate

Beta-alanine, caffeine, and nitrate are dietary supplements generally recognized by the sport and exercise science community as evidence-based ergogenic performance aids. Evidence supporting the efficacy of these supplements, however, is greatly skewed due to research being conducted primarily in men. The physiological differences between men and women, most notably in sex hormones and menstrual cycle fluctuations, make generalizing male data to the female athlete inappropriate, and potentially harmful to women. This narrative review outlines the studies conducted in women regarding the efficacy of beta-alanine, caffeine, and nitrate supplementation for performance enhancement. Only nine studies on beta-alanine, 15 on caffeine, and 10 on nitrate in healthy women under the age of 40 years conducted in normoxia conditions were identified as relevant to this research question. Evidence suggests that beta-alanine may lower the rate of perceived exertion and extend training bouts in women, leading to greater functional adaptations. Studies of caffeine in women suggest the physiological responder status and caffeine habituation may contribute to caffeine's efficacy, with a potential plateau in the dose-response relationship of performance enhancement. Nitrate appears to vary in influence based on activity type and primary muscle group examined. However, the results summarized in the limited literature for each of these three supplements provide no consensus on dosage, timing, or efficacy for women. Furthermore, the literature lacks considerations for hormonal status and its role in metabolism. This gap in sex-based knowledge necessitates further research on these ergogenic supplements in women with greater considerations for the effects of hormonal status.