Sports Medicine

, Volume 49, Issue 1, pp 57–66 | Cite as

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

  • Cayque Brietzke
  • Paulo Estevão Franco-Alvarenga
  • Hélio José Coelho-Júnior
  • Rodrigo Silveira
  • Ricardo Yukio Asano
  • Flávio Oliveira PiresEmail author
Systematic Review



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.


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.


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.


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).


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.



Flávio Oliveira Pires is grateful to the National Council for Scientific and Technological Development (CNPq-Brazil) for his researcher scholarship (#307072/2016-9). The authors thank ES Chambers, TN Kulaksız, and RM James for providing the requested data.

Compliance with Ethical Standards


This analysis is part of a carbohydrate mouth rinse project supported by the São Paulo Research Foundation (FAPESP-Brazil) (#2016/16496-3). This study was financed in part by the Coordination of Improvement of Higher Education Personnel (CAPES-Brazil), Finance Code 001 (Cayque Brietzke, Hélio José Coelho-Júnior, Paulo Estevão Franco-Alvarenga and Rodrigo Silveira).

Conflict of interest

Cayque Brietzke, Paulo Estevão Franco-Alvarenga, Hélio José Coelho-Júnior, Rodrigo Silveira Silva, Ricardo Yukio Asano, and Flávio Oliveira Pires have no conflicts of interest that are directly relevant to the contents of this review.

Supplementary material

40279_2018_1029_MOESM1_ESM.pdf (12 kb)
Supplementary material 1 (PDF 11 kb)
40279_2018_1029_MOESM2_ESM.pdf (95 kb)
Supplementary material 2 (PDF 95 kb)
40279_2018_1029_MOESM3_ESM.tif (109 kb)
Funnel plots: (A) mean power output and (B) time to complete the trial. SE standard error, SMD standardized mean difference (TIFF 109 kb)
40279_2018_1029_MOESM4_ESM.xlsx (13 kb)
Supplementary material 4 (XLSX 12 kb)
40279_2018_1029_MOESM5_ESM.tiff (17.2 mb)
Forest plot comparing the mean power output between carbohydrate and placebo mouth rinses excluding high risk of bias studies; ‘a’ and ‘b’ denote different experiments within the same study. CI confidence interval, IV inverse variance, SD standard deviation, Std standardized (TIFF 17589 kb)
40279_2018_1029_MOESM6_ESM.tiff (17.2 mb)
Forest plot comparing time to complete the cycling trial (minutes) between carbohydrate and placebo mouth rinses excluding high risk of bias studies; ‘a’ and ‘b’ denote different experiments within the same study. CI confidence interval, IV inverse variance, SD standard deviation, Std standardized (TIFF 17589 kb)


  1. 1.
    Carter JM, Jeukendrup AE, Jones DA. The effect of carbohydrate mouth rinse on 1-h cycle time trial performance. Med Sci Sports Exerc. 2004;36:2107–11.CrossRefPubMedGoogle Scholar
  2. 2.
    Thomas DT, Erdman KA, Burke LM. Position of the Academy of Nutrition and Dietetics, Dietitians of Canada, and the American College of Sports Medicine: nutrition and athletic performance. J Acad Nutr Diet. 2016;116:501–28.CrossRefPubMedGoogle Scholar
  3. 3.
    Chambers ES, Bridge MW, Jones DA. Carbohydrate sensing in the human mouth: effects on exercise performance and brain activity. J Physiol. 2009;587:1779–94.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Devenney S, Collins K, Shortall M. Effects of various concentrations of carbohydrate mouth rinse on cycling performance in a fed state. Eur J Sport Sci. 2016;16:1073–8.CrossRefPubMedGoogle Scholar
  5. 5.
    James RM, Ritchie S, Rollo I, James LJ. No dose response effect of carbohydrate mouth rinse on cycling time-trial performance. Int J Sport Nutr Exerc Metab. 2017;27:25–31.CrossRefPubMedGoogle Scholar
  6. 6.
    Tsintzas OK, Williams C, Boobis L, Greenhaff P. Carbohydrate ingestion and glycogen utilization in different muscle fibre types in man. J Physiol. 1995;489:243–50.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Coyle EF, Coggan AR, Hemmert MK, Ivy JL. Muscle glycogen utilization during prolonged strenuous exercise when fed carbohydrate. J Appl Physiol. 1986;61:165–72.CrossRefPubMedGoogle Scholar
  8. 8.
    Hargreaves M, Costill DL, Coggan A, Fink WJ, Nishibata I. Effect of carbohydrate feedings on muscle glycogen utilization and exercise performance. Med Sci Sport Exerc. 1984;16:219–22.Google Scholar
  9. 9.
    Robertson CV, Marino FE. A role for the prefrontal cortex in exercise tolerance and termination. J Appl Physiol. 2016;120:464–6.CrossRefPubMedGoogle Scholar
  10. 10.
    Turner CE, Byblow WD, Gant N. Creatine supplementation enhances corticomotor excitability and cognitive performance during oxygen deprivation. J Neurosci. 2015;35:1773–80.CrossRefPubMedGoogle Scholar
  11. 11.
    Ataide-Silva T, Ghiarone T, Bertuzzi R, Stathis CG, Leandro CG, Lima-Silva AE. CHO mouth rinse ameliorates neuromuscular response with lower endogenous CHO stores. Med Sci Sports Exerc. 2016;48:1810–20.CrossRefPubMedGoogle Scholar
  12. 12.
    Bastos-Silva VJ, Melo Ade A, Lima-Silva AE, Moura FA, Bertuzzi R, de Araujo GG. Carbohydrate mouth rinse maintains muscle electromyographic activity and increases time to exhaustion during moderate but not high-intensity cycling exercise. Nutrients. 2016;8:49.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Rollo IAN, Williams C, Nevill M. Influence of ingesting versus mouth rinsing a carbohydrate solution during a 1-h run. Med Sci Sport Exerc. 2011;43:468–75.CrossRefGoogle Scholar
  14. 14.
    Lane SC, Bird SR, Burke LM, Hawley JA. Effect of a carbohydrate mouth rinse on simulated cycling time-trial performance commenced in a fed or fasted state. Appl Physiol Nutr Metab. 2013;38:134–9.CrossRefPubMedGoogle Scholar
  15. 15.
    Pottier A, Bouckaert J, Gilis W, Roels T, Derave W. Mouth rinse but not ingestion of a carbohydrate solution improves 1-h cycle time trial performance. Scand J Med Sci Sport. 2010;20:105–11.CrossRefGoogle Scholar
  16. 16.
    Beelen M, Berghuis J, Bonaparte B, Ballak SB, Jeukendrup AE, van Loon LJC. Carbohydrate mouth rinsing in the fed state: lack of enhancement of time-trial performance. Int J Sport Nutr Exerc Metab. 2009;19:400–9.CrossRefPubMedGoogle Scholar
  17. 17.
    Trommelen J, Beelen M, Mullers M, Gibala MJ, van Loon LJC, Cermak NM. A sucrose mouth rinse does not improve 1-hr cycle time trial performance when performed in the fasted or fed state. Int J Sport Nutr Exerc Metab. 2015;25:576–83.CrossRefPubMedGoogle Scholar
  18. 18.
    Kulaksız TN, Koşar ŞN, Bulut S, Güzel Y, Willems MET, Hazir T, et al. Mouth rinsing with maltodextrin solutions fails to improve time trial endurance cycling performance in recreational athletes. Nutrients. 2016;8:2–15.CrossRefGoogle Scholar
  19. 19.
    Pires FO, Brietzke C, Pinheiro FA, Veras K, de Mattos ECT, Rodacki ALF, et al. Carbohydrate mouth rinse fails to improve four-kilometer cycling time trial performance. Nutrients. 2018;10:342.CrossRefGoogle Scholar
  20. 20.
    Fraga C, Velasques B, Koch AJ, Machado M, Paulucio D, Ribeiro P, et al. Carbohydrate mouth rinse enhances time to exhaustion during treadmill exercise. Clin Physiol Funct Imaging. 2017;37:17–22.CrossRefPubMedGoogle Scholar
  21. 21.
    Bavaresco BG, Gomes YDSBL, Dos Pinheiro Anjos ER, Antonelli BA, Gomes DGESC, de Pires Mélo MIH, et al. Carbohydrate mouth rinse improves cycling performance carried out until the volitional exhaustion. J Sports Med Phys Fit. 2017. (Epub ahead of print).CrossRefGoogle Scholar
  22. 22.
    Ispoglou T, OʼKelly D, Angelopoulou A, Bargh M, OʼHara JP, Duckworth LC. Mouth rinsing with carbohydrate solutions at the postprandial state fail to improve performance during simulated cycling time trials. J Strength Cond Res. 2015;29:2316–25.CrossRefPubMedGoogle Scholar
  23. 23.
    Rollo I, Williams C. Effect of mouth-rinsing carbohydrate solutions on endurance performance. Sports Med. 2011;41:449–61.CrossRefPubMedGoogle Scholar
  24. 24.
    Jeukendrup AE. Oral carbohydrate rinse: placebo or beneficial? Curr Sports Med Rep. 2013;12:222–7.CrossRefPubMedGoogle Scholar
  25. 25.
    Jeukendrup AE, Chambers ES. Oral carbohydrate sensing and exercise performance. Curr Opin Clin Nutr Metab Care. 2010;13:447–51.CrossRefPubMedGoogle Scholar
  26. 26.
    Jeukendrup AE, Rollo I, Carter JM. Carbohydrate mouth rinse: performance effects and mechanisms. Sport Sci Exch. 2013;26:1–8.Google Scholar
  27. 27.
    de Ataide e Silva TA, Di Calvalcanti Alves de Souza ME, de Amorim JF, Stathis CG, Leandro CGG, Lima-Silva AE. Can carbohydrate mouth rinse improve performance during exercise? A systematic review. Nutrients. 2013;6:1–10.CrossRefPubMedGoogle Scholar
  28. 28.
    Peart DJ. Quantifying the effect of carbohydrate mouth rinsing on exercise performance. J Strength Cond Res. 2017;31:1737–43.CrossRefPubMedGoogle Scholar
  29. 29.
    Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011;343:d5928.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Stewart B, Outram S, Smith ACT. Doing supplements to improve performance in club cycling: a life-course analysis. Scand J Med Sci Sports. 2013;23:e361–72.CrossRefPubMedGoogle Scholar
  31. 31.
    Pires FO, Dos Anjos CA, Covolan RJ, Pinheiro FA, St Clair Gibson A, Noakes TD, et al. Cerebral regulation in different maximal aerobic exercise modes. Front Physiol. 2016;7:253.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Silva RAS, Silva-Júnior FL, Pinheiro FA, Souza PFM, Boullosa DA, Pires FO. Acute prior heavy strength exercise bouts improve the 20-km cycling time trial performance. J Strength Cond Res. 2014;28:2513–20.CrossRefPubMedGoogle Scholar
  33. 33.
    Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Ann Intern Med. 2009;151:W65–94.CrossRefPubMedGoogle Scholar
  34. 34.
    Higgins JPT, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327:557–60.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Sedgwick P. Meta-analyses: what is heterogeneity? BMJ. 2015;350:h1435.CrossRefPubMedGoogle Scholar
  36. 36.
    Murray KO, Paris HL, Fly AD, Chapman RF, Mickleborough TD. Carbohydrate mouth rinse improves cycling time-trial performance without altering plasma insulin concentration. J Sports Sci Med. 2018;17:145–52.PubMedPubMedCentralGoogle Scholar
  37. 37.
    Ferreira AMJ, Farias-Junior LF, Mota TAA, Elsangedy HM, Marcadenti A, Lemos TMAM, et al. Carbohydrate mouth rinse and hydration strategies on cycling performance in 30 km time trial: a randomized, crossover, controlled trial. J Sport Sci Med. 2018;17:181–7.Google Scholar
  38. 38.
    Pöchmüller M, Schwingshackl L, Colombani PC, Hoffmann G. A systematic review and meta-analysis of carbohydrate benefits associated with randomized controlled competition-based performance trials. J Int Soc Sports Nutr. 2016;13:27.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Gant N, Stinear CM, Byblow WD. Carbohydrate in the mouth immediately facilitates motor output. Brain Res. 2010;1350:151–8.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.Exercise Psychophysiology Research Group, School of Arts, Sciences and HumanitiesUniversity of São PauloSão PauloBrazil
  2. 2.Applied Kinesiology LaboratoryUniversity of CampinasCampinasBrazil

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