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Can β2-agonists have an ergogenic effect on strength, sprint or power performance? Systematic review and meta-analysis of RCTs
  1. Amund Riiser1,
  2. Trine Stensrud2,
  3. Julie Stang2,
  4. Lars Bo Andersen1
  1. 1 Faculty of Teacher Education, Art and Sport, Western Norway University of Applied Sciences, Sogndal, Vestlandet, Norway
  2. 2 Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
  1. Correspondence to Dr Amund Riiser, Faculty of Teacher Education, Art and Sport, Western Norway University of Applied Sciences, Sogndal, Vestlandet, Norway; amund.riiser{at}


Objectives We aimed to examine the effect of β2-agonists on anaerobic performance in healthy non-asthmatic subjects.

Design Systematic review and meta-analysis.

Eligibility criteria We searched four databases (PubMed, Embase, SPORTDiscus and Web of Science) for randomised controlled trials, published until December 2019, examining the effect of β2-agonists on maximal physical performance lasting 1 min or shorter. Data are presented as standardised difference in mean (SDM) with 95% confidence intervals (95% CI).

Results 34 studies were included in the present meta-analysis. The studies include 44 different randomised and placebo-controlled comparisons with β2-agonists comprising 323 participants in crossover trials, and 149 participants in parallel trials. In the overall analyses, β2-agonists improved anaerobic performance by 5% (SDM 0.29, 95% CI 0.16 to 0.42), but the effect was related to dose and administration route. In a stratified analysis, the SDM was 0.14 (95% CI 0.00 to 0.28) for approved β2-agonists and 0.46 (95% CI 0.24 to 0.68) for prohibited β2-agonists, respectively. Furthermore, SDM was 0.16 (95% CI 0.02 to 0.30) for inhaled administration and 0.51 (95% CI 0.25 to 0.77) for oral administration, respectively, and 0.20 (95% CI 0.07 to 0.33) for acute treatment and 0.50 (95% CI 0.20 to 0.80) for treatment for multiple weeks. Analyses stratified for the type of performance showed that strength (0.35, 95% CI 0.15 to 0.55) and sprint (0.17, 95% CI 0.06 to 0.29) performance were improved by β2-agonists.

Conclusion/implication Our study shows that non-asthmatic subjects can improve sprint and strength performance by using β2-agonists. It is uncertain, however, whether World Anti-Doping Agency (WADA)-approved doses of β2-agonists improve performance. Our results support that the use of β2-agonists should be controlled and restricted to athletes with documented asthma.

Systematic review registration PROSPERO CRD42018109223.

  • doping
  • respiratory
  • elite performance

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  • Correction notice This article has been corrected since it published Online First. The second affiliation has been corrected.

  • Contributors All authors reviewed the report. AR generated the hypotheses, did the literature search, analysed the data and wrote the first draft of the manuscript. AR, TS, JS and LBA revised the manuscript critically for important intellectual content. All authors, external and internal, had full access to all of the data (including statistical reports and tables) in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis. AR and TS extracted the data. JS and AR assessed bias. AR and LBA evaluated studies for inclusion.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.