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Intermittent Running and Cognitive Performance after Ketone Ester Ingestion


Medicine & Science in Sports & Exercise: November 2018 - Volume 50 - Issue 11 - p 2330–2338
doi: 10.1249/MSS.0000000000001700

Purpose Ingestion of exogenous ketones alters the metabolic response to exercise and may improve exercise performance, but it has not been explored in variable-intensity team sport activity, or for effects on cognitive function.

Methods On two occasions in a double-blind, randomized crossover design, 11 male team sport athletes performed the Loughborough Intermittent Shuttle Test (part A, 5 × 15-min intermittent running; part B, shuttle run to exhaustion), with a cognitive test battery before and after. A 6.4% carbohydrate–electrolyte solution was consumed before and during exercise either alone (PLA) or with 750 mg·kg−1 of a ketone ester (KE) supplement. Heart rate, RPE, and 15-m sprint times were recorded throughout, and serial venous blood samples were assayed for plasma glucose, lactate, and β-hydroxybutyrate.

Results KE resulted in plasma β-hydroxybutyrate concentrations of ~1.5 to 2.6 mM during exercise (P < 0.001). Plasma glucose and lactate concentrations were lower during KE compared with PLA (moderate-to-large effect sizes). Heart rate, RPE, and 15-m sprint times did not differ between trials. Run time to exhaustion was not different (P = 0.126, d = 0.45) between PLA (mean = 268 s, 95% confidence interval [CI] = 199–336 s) and KE (mean = 229 s, 95% CI = 178–280 s). Incorrect responses in a multitasking test increased from pre- to postexercise in PLA (mean = 1.8, 95% CI = −0.6 to 4.1) but not in KE (mean = 0.0, 95% CI = −1.8 to 1.8) (P = 0.017, d = 0.70).

Conclusion Compared with carbohydrate alone, coingestion of a KE by team sport athletes attenuated the rise in plasma lactate concentrations but did not improve shuttle run time to exhaustion or 15-m sprint times during intermittent running. An attenuation of the decline in executive function after exhausting exercise suggests a cognitive benefit after KE ingestion.

1School of Health and Human Performance, Dublin City University, Dublin, IRELAND; and

2National Institute for Cellular Biotechnology, Dublin City University, Dublin, IRELAND

Address for correspondence: Brendan Egan, Ph.D., School of Health and Human Performance, Dublin City University, Glasnevin, Dublin 9, Ireland; E-mail:

Submitted for publication April 2018.

Accepted for publication June 2018.

© 2018 American College of Sports Medicine