Sports Medicine

, Volume 49, Issue 5, pp 707–718 | Cite as

Acute Effects of Citrulline Supplementation on High-Intensity Strength and Power Performance: A Systematic Review and Meta-Analysis

  • Eric T. Trexler
  • Adam M. Persky
  • Eric D. Ryan
  • Todd A. Schwartz
  • Lee Stoner
  • Abbie E. Smith-RyanEmail author
Systematic Review



Citrulline is an increasingly common dietary supplement that is thought to enhance exercise performance by increasing nitric oxide production. In the last 5 years, several studies have investigated the effects of citrulline supplements on strength and power outcomes, with mixed results reported. To date, the current authors are unaware of any attempts to systematically review this emerging body of literature.


The current study sought to conduct a systematic review and meta-analysis of the literature describing the effects of citrulline supplementation on strength and power outcomes.


A comprehensive, systematic search of three prominent research databases was performed to find peer-reviewed, English language, original research studies evaluating the effects of citrulline supplementation on indices of high-intensity exercise performance in healthy men and women. Outcomes included strength and power variables from performance tests involving multiple repetitive muscle actions of large muscle groups, consisting of either resistance training sets or sprints lasting 30 s or less. Tests involving isolated actions of small muscle groups or isolated attempts of single-jump tasks were not included for analysis due to differences in metabolic requirements. Studies were excluded from consideration if they lacked a placebo condition for comparison, were carried out in clinical populations, provided a citrulline dose of less than 3 g, provided the citrulline dose less than 30 min prior to exercise testing, or combined the citrulline ingredient with creatine, caffeine, nitrate, or other ergogenic ingredients.


Twelve studies, consisting of 13 total independent samples (n = 198 participants), met the inclusion criteria. Between-study variance, heterogeneity, and inconsistency across studies were low (Cochrane’s Q = 6.9, p = 0.86; τ2 = 0.0 [0.0, 0.08], I2 = 0.0 [0.0, 40.0]), and no funnel plot asymmetry was present. Results of the meta-analysis identified a significant benefit for citrulline compared to placebo treatments (p = 0.036), with a small pooled standardized mean difference (SMD; Hedges’ G) of 0.20 (95% confidence interval 0.01–0.39).


The effect size was small (0.20), and confidence intervals for each individual study crossed the line of null effect. However, the results may be relevant to high-level athletes, in which competitive outcomes are decided by small margins. Further research is encouraged to fully elucidate the effects of potential moderating study characteristics, such as the form of citrulline supplement, citrulline dose, sex, age, and strength versus power tasks.



The authors would like to thank Dr. Charles Poole for his constructive feedback on the manuscript.

Compliance with Ethical Standards

Ethical Standards

The current project was conducted and reported in accordance with PRISMA guidelines.


No funding was obtained to support the current manuscript.

Conflict of Interest

Eric T. Trexler, Adam M. Persky, Eric D. Ryan, Todd A. Schwartz, Lee Stoner, and Abbie E. Smith-Ryan declare no conflicts of interest.

Data Availability Statement

Data for the current analysis are available upon request, and can be obtained by contacting the corresponding author.


  1. 1.
    Joyner MJ, Casey DP. Regulation of increased blood flow (hyperemia) to muscles during exercise: a hierarchy of competing physiological needs. Physiol Rev. 2015;95(2):549–601.CrossRefGoogle Scholar
  2. 2.
    Bailey SJ, Vanhatalo A, Winyard PG, Jones AM. The nitrate-nitrite-nitric oxide pathway: its role in human exercise physiology. Eur J Sport Sci. 2011;12(4):309–20.CrossRefGoogle Scholar
  3. 3.
    Chappell AJ, Allwood DM, Johns R, Brown S, Sultana K, Anand A, et al. Citrulline malate supplementation does not improve German Volume Training performance or reduce muscle soreness in moderately trained males and females. J Int Soc Sports Nutr. 2018;15(1):42.CrossRefGoogle Scholar
  4. 4.
    Cunniffe B, Papageorgiou M, O’Brien B, Davies NA, Grimble GK, Cardinale M. Acute citrulline-malate supplementation and high-intensity cycling performance. J Strength Cond Res. 2016;30(9):2638–47.CrossRefGoogle Scholar
  5. 5.
    Cutrufello PT, Gadomski SJ, Zavorsky GS. The effect of l-citrulline and watermelon juice supplementation on anaerobic and aerobic exercise performance. J Sports Sci. 2015;33(14):1459–66.CrossRefGoogle Scholar
  6. 6.
    Farney TM, Bliss MV, Hearon CM, Salazar DA. The effect of citrulline malate supplementation on muscle fatigue among healthy participants. J Strength Cond Res. 2017. (ePub ahead of print).Google Scholar
  7. 7.
    Gonzalez AM, Spitz RW, Ghigiarelli JJ, Sell KM, Mangine GT. Acute effect of citrulline malate supplementation on upper-body resistance exercise performance in recreationally resistance-trained men. J Strength Cond Res. 2017. (ePub ahead of print).Google Scholar
  8. 8.
    Glenn JM, Gray M, Jensen A, Stone MS, Vincenzo JL. Acute citrulline-malate supplementation improves maximal strength and anaerobic power in female, masters athletes tennis players. Eur J Sport Sci. 2016;16(8):1095–103.CrossRefGoogle Scholar
  9. 9.
    Glenn JM, Gray M, Wethington LN, Stone MS, Stewart RW Jr, Moyen NE. Acute citrulline malate supplementation improves upper- and lower-body submaximal weightlifting exercise performance in resistance-trained females. Eur J Nutr. 2017;56(2):775–84.CrossRefGoogle Scholar
  10. 10.
    Perez-Guisado J, Jakeman PM. Citrulline malate enhances athletic anaerobic performance and relieves muscle soreness. J Strength Cond Res. 2010;24(5):1215–22.CrossRefGoogle Scholar
  11. 11.
    Wax B, Kavazis AN, Luckett W. Effects of supplemental citrulline-malate ingestion on blood lactate, cardiovascular dynamics, and resistance exercise performance in trained males. J Diet Suppl. 2016;13(3):269–82.CrossRefGoogle Scholar
  12. 12.
    Wax B, Kavazis AN, Weldon K, Sperlak J. Effects of supplemental citrulline malate ingestion during repeated bouts of lower-body exercise in advanced weightlifters. J Strength Cond Res. 2015;29(3):786–92.CrossRefGoogle Scholar
  13. 13.
    Dickinson A, Blatman J, El-Dash N, Franco JC. Consumer usage and reasons for using dietary supplements: report of a series of surveys. J Am Coll Nutr. 2014;33(2):176–82.CrossRefGoogle Scholar
  14. 14.
    Bloomer RJ. Nitric oxide supplements for sports. Strength Cond J. 2010;32(2):14–20.CrossRefGoogle Scholar
  15. 15.
    Bloomer RJ, Farney TM, Trepanowski JF, McCarthy CG, Canale RE, Schilling BK. Comparison of pre-workout nitric oxide stimulating dietary supplements on skeletal muscle oxygen saturation, blood nitrate/nitrite, lipid peroxidation, and upper body exercise performance in resistance trained men. J Int Soc Sports Nutr. 2010;7:16.CrossRefGoogle Scholar
  16. 16.
    Bescos R, Sureda A, Tur JA, Pons A. The effect of nitric-oxide-related supplements on human performance. Sports Med. 2012;42(2):99–117.CrossRefGoogle Scholar
  17. 17.
    Liu TH, Wu CL, Chiang CW, Lo YW, Tseng HF, Chang CK. No effect of short-term arginine supplementation on nitric oxide production, metabolism and performance in intermittent exercise in athletes. J Nutr Biochem. 2009;20(6):462–8.CrossRefGoogle Scholar
  18. 18.
    Sunderland KL, Greer F, Morales J. VO2max and ventilatory threshold of trained cyclists are not affected by 28-day l-arginine supplementation. J Strength Cond Res. 2011;25(3):833–7.CrossRefGoogle Scholar
  19. 19.
    Bescos R, Gonzalez-Haro C, Pujol P, Drobnic F, Alonso E, Santolaria ML, et al. Effects of dietary l-arginine intake on cardiorespiratory and metabolic adaptation in athletes. Int J Sport Nutr Exerc Metab. 2009;19(4):355–65.CrossRefGoogle Scholar
  20. 20.
    Tsai PH, Tang TK, Juang CL, Chen KW, Chi CA, Hsu MC. Effects of arginine supplementation on post-exercise metabolic responses. Chin J Physiol. 2009;52(3):136–42.CrossRefGoogle Scholar
  21. 21.
    Schwedhelm E, Maas R, Freese R, Jung D, Lukacs Z, Jambrecina A, et al. Pharmacokinetic and pharmacodynamic properties of oral l-citrulline and l-arginine: impact on nitric oxide metabolism. Br J Clin Pharmacol. 2008;65(1):51–9.CrossRefGoogle Scholar
  22. 22.
    Bendahan D, Mattei JP, Ghattas B, Confort-Gouny S, Le Guern ME, Cozzone PJ. Citrulline/malate promotes aerobic energy production in human exercising muscle. Br J Sports Med. 2002;36(4):282–9.CrossRefGoogle Scholar
  23. 23.
    Sureda A, Cordova A, Ferrer MD, Perez G, Tur JA, Pons A. l-citrulline-malate influence over branched chain amino acid utilization during exercise. Eur J Appl Physiol. 2010;110(2):341–51.CrossRefGoogle Scholar
  24. 24.
    Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097.CrossRefGoogle Scholar
  25. 25.
    Borenstein M, Hedges LV, Higgins JPT, Rothstein HR. Introduction to meta-analysis. Chichester: Wiley; 2009.CrossRefGoogle Scholar
  26. 26.
    Borenstein M, Hedges LV, Higgins JP, Rothstein HR. A basic introduction to fixed-effect and random-effects models for meta-analysis. Res Synth Methods. 2010;1(2):97–111.CrossRefGoogle Scholar
  27. 27.
    Cohen J. A power primer. Psychol Bull. 1992;112(1):155–9.CrossRefGoogle Scholar
  28. 28.
    Borenstein M. Effect sizes for continuous data. In: Cooper H, Hedges LV, Valentine JC, editors. The handbook of research synthesis and meta analysis. 2nd ed. New York: Russell Sage Foundation; 2009. p. 279–93.Google Scholar
  29. 29.
    Baker D, Nance S. The relation between strength and power in professional rugby league players. J Strength Cond Res. 1999;13(3):224–9.Google Scholar
  30. 30.
    Higgins JP, Altman DG, Gotzsche PC, Juni P, Moher D, Oxman AD, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011;343:d5928.CrossRefGoogle Scholar
  31. 31.
    Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557–60.CrossRefGoogle Scholar
  32. 32.
    Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315(7109):629–34.CrossRefGoogle Scholar
  33. 33.
    Duval S, Tweedie R. Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics. 2000;56(2):455–63.CrossRefGoogle Scholar
  34. 34.
    Branch JD. Effect of creatine supplementation on body composition and performance: a meta-analysis. Int J Sport Nutr Exerc Metab. 2003;13(2):198–226.CrossRefGoogle Scholar
  35. 35.
    Grgic J, Trexler ET, Lazinica B, Pedisic Z. Effects of caffeine intake on muscle strength and power: a systematic review and meta-analysis. J Int Soc Sports Nutr. 2018;15:11.CrossRefGoogle Scholar
  36. 36.
    Christensen PM, Shirai Y, Ritz C, Nordsborg NB. Caffeine and bicarbonate for speed. A meta-analysis of legal supplements potential for improving intense endurance exercise performance. Front Physiol. 2017;8:240.CrossRefGoogle Scholar
  37. 37.
    DeWeese BH, Hornsby G, Stone M, Stone MH. The training process: Planning for strength–power training in track and field. Part 1: theoretical aspects. J Sport Health Sci. 2015;4(4):308–17.CrossRefGoogle Scholar
  38. 38.
    Rodgers AL, Webber D, de Charmoy R, Jackson GE, Ravenscroft N. Malic acid supplementation increases urinary citrate excretion and urinary pH: implications for the potential treatment of calcium oxalate stone disease. J Endourol. 2014;28(2):229–36.CrossRefGoogle Scholar
  39. 39.
    Martinez-Sanchez A, Alacid F, Rubio-Arias JA, Fernandez-Lobato B, Ramos-Campo DJ, Aguayo E. Consumption of watermelon juice enriched in l-citrulline and pomegranate ellagitannins enhanced metabolism during physical exercise. J Agric Food Chem. 2017;65(22):4395–404.CrossRefGoogle Scholar
  40. 40.
    Wu JL, Wu QP, Huang JM, Chen R, Cai M, Tan JB. Effects of l-malate on physical stamina and activities of enzymes related to the malate-aspartate shuttle in liver of mice. Physiol Res. 2007;56(2):213–20.Google Scholar
  41. 41.
    Brown AC, Macrae HS, Turner NS. Tricarboxylic-acid-cycle intermediates and cycle endurance capacity. Int J Sport Nutr Exerc Metab. 2004;14(6):720–9.CrossRefGoogle Scholar
  42. 42.
    da Silva DK, Jacinto JL, de Andrade WB, Roveratti MC, Estoche JM, Balvedi MCW, et al. Citrulline malate does not improve muscle recovery after resistance exercise in untrained young adult men. Nutrients. 2017;9(10):E1132.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Eric T. Trexler
    • 1
    • 2
  • Adam M. Persky
    • 3
  • Eric D. Ryan
    • 1
    • 2
  • Todd A. Schwartz
    • 4
  • Lee Stoner
    • 1
    • 2
  • Abbie E. Smith-Ryan
    • 1
    • 2
    Email author
  1. 1.Human Movement Science Curriculum, Department of Allied Health SciencesUniversity of North CarolinaChapel HillUSA
  2. 2.Applied Physiology Laboratory, Department of Exercise and Sport ScienceUniversity of North Carolina-Chapel HillChapel HillUSA
  3. 3.Eshelman School of PharmacyUniversity of North CarolinaChapel HillUSA
  4. 4.Department of Biostatistics, Gillings School of Global Public HealthUniversity of North CarolinaChapel HillUSA

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