Extracellular Buffering Supplements to Improve Exercise Capacity and Performance: A Comprehensive Systematic Review and Meta-analysis.

BACKGROUND: Extracellular buffering supplements [sodium bicarbonate (SB), sodium citrate (SC), sodium/calcium lactate (SL/CL)] are ergogenic supplements, although questions remain about factors which may modify their effect. OBJECTIVE: To quantify the main effect of extracellular buffering agents on exercise outcomes, and to investigate the influence of potential moderators on this effect using a systematic review and meta-analytic approach. METHODS: This study was designed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Three databases were searched for articles that were screened according to inclusion/exclusion criteria. Bayesian hierarchical meta-analysis and meta-regression models were used to investigate pooled effects of supplementation and moderating effects of a range of factors on exercise and biomarker responses. RESULTS: 189 articles with 2019 participants were included, 158 involving SB supplementation, 30 with SC, and seven with CL/SL; four studies provided a combination of buffering supplements together. Supplementation led to a mean estimated increase in blood bicarbonate of + 5.2 mmol L-1 (95% credible interval (CrI) 4.7-5.7). The meta-analysis models identified a positive overall effect of supplementation on exercise capacity and performance compared to placebo [ES0.5 = 0.17 (95% CrI 0.12-0.21)] with potential moderating effects of exercise type and duration, training status and when the exercise test was performed following prior exercise. The greatest ergogenic effects were shown for exercise durations of 0.5-10 min [ES0.5 = 0.18 (0.13-0.24)] and > 10 min [ES0.5 = 0.22 (0.10-0.33)]. Evidence of greater effects on exercise were obtained when blood bicarbonate increases were medium (4-6 mmol L-1) and large (> 6 mmol L-1) compared with small (≤ 4 mmol L-1) [ßSmall:Medium = 0.16 (95% CrI 0.02-0.32), ßSmall:Large = 0.13 (95% CrI - 0.03 to 0.29)]. SB (192 outcomes) was more effective for performance compared to SC (39 outcomes) [ßSC:SB = 0.10 (95% CrI - 0.02 to 0.22)]. CONCLUSIONS: Extracellular buffering supplements generate large increases in blood bicarbonate concentration leading to positive overall effects on exercise, with sodium bicarbonate being most effective. Evidence for several group-level moderating factors were identified. These data can guide an athlete's decision as to whether supplementation with buffering agents might be beneficial for their specific aims.

Sodium bicarbonate supplementation and the female athlete: A brief commentary with small scale systematic review and meta-analysis.

ABSTRACTSodium bicarbonate (SB) is considered an effective ergogenic supplement for improving high-intensity exercise capacity and performance, although recent data suggests that women may be less amenable to its ergogenic effects than men. Currently, an apparent paucity of data on women means no consensus exists on whether women benefit from SB supplementation. The aim of the current study was to quantify the proportion of the published literature on SB supplementation that includes women, and to synthesise the evidence regarding its effects on blood bicarbonate and exercise performance in women by performing a systematic review and meta-analysis. Electronic searches of the literature were undertaken using three databases (MEDLINE, Embase, SPORTDiscus) to identify relevant articles. All meta-analyses were performed within a Bayesian framework. A total of 149 SB articles were identified, 11 of which contained individual group data for women. Results indicated a pooled blood bicarbonate increase of 7.4 [95%CrI: 4.2-10.4 mmol·L-1] following supplementation and a pooled standardised exercise effect size of 0.37 [95%CrI: -0.06-0.92]. The SB literature is skewed, with only 20% (30 studies) of studies employing female participants, of which only 11 studies (7.4%) provided group analyses exclusively in women. Despite the small amount of available data, results are consistent in showing that SB supplementation in women leads to large changes in blood bicarbonate and that there is strong evidence for a positive ergogenic effect on exercise performance that is likely to be small to medium in magnitude.HighlightsThis study aimed to quantify the proportion of the published literature on sodium bicarbonate supplementation that includes women and to synthesise the evidence regarding its ergogenic effect on women, using a systematic review and meta-analytic approach.The sodium bicarbonate literature is skewed, with only 30 studies (20%) employing female participants, of which only 11 studies (7.4%) provided group analyses exclusively in women.Despite the small amount of available data, results are consistent in showing that sodium bicarbonate supplementation in women leads to large changes in blood bicarbonate and that there is strong evidence for a positive ergogenic effect on exercise performance that is likely small to medium in magnitude.Based on these findings, we do not believe there is any evidence to support sex-specific sodium bicarbonate dosing recommendations and that current recommendations of 0.2-0.3 g·kg-1BM of SB taken 60-180 min prior to high-intensity exercise appear appropriate for the female athlete.