Skip to main content
Log in

β2-Agonists and Physical Performance

A Systematic Review and Meta-Analysis of Randomized Controlled Trials

  • Review Article
  • Published:
Sports Medicine Aims and scope Submit manuscript

Abstract

Inhaled β2-agonists are commonly used as bronchodilators in the treatment of asthma. Their use in athletes, however, is restricted by anti-doping regulations. Controversies remain as to whether healthy elite athletes who use bronchodilators may gain a competitive advantage.

The aim of this systematic review and meta-analysis is to assess the effects of inhaled and systemic β2-agonists on physical performance in healthy, nonasthmatic subjects. To this end, MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched up to August 2009. Reference lists were searched for additional relevant studies. The search criteria were for randomized controlled trials examining the effect of inhaled or systemic β2-agonists on physical performance in healthy, nonasthmatic subjects. Two authors independently performed the selection of studies, data extraction and risk of bias assessment. Parallel-group and crossover trials were analysed separately. Mean difference (MD) and 95% confidence intervals were calculated for continuous data and, where possible, data were pooled using a fixed effects model.

Twenty-six studies involving 403 participants (age range 7–30 years) compared inhaled β2-agonists with placebo. No significant effect could be detected for inhaled β2-agonists on maximal oxygen consumption (V̇O2max) [MD −0.14mL•kg−1•min−1; 95% CI −1.07, 0.78; 16 studies], endurance time to exhaustion at 105–110% V̇O2max (MD −1.5 s; 95% CI −15.6, 12.6; four studies), 20-km time trial duration (MD −4.4 s; 95% CI −23.5, 14.7; two studies), peak power (MD −0.14 W•kg−1; 95% CI −0.54, 0.27; four studies) and total work during a 30-second Wingate test (MD 0.80 J•kg−1; 95% CI −2.44, 4.05; five studies). Thirteen studies involving 172 participants (age range 7–22 years) compared systemic β2-agonists with placebo, with 12 studies involving oral and one study involving intravenous salbutamol. A significant effect was detected for systemic β2-agonists on endurance time to exhaustion at 80–85% V̇O2max (MD 402 s; 95% CI 34, 770; two studies), but not for V̇O2max (placebo 42.5–1.7mL•kg−1•min−1, salbutamol 42.1±2.9mL•kg−1•min−1, one study), endurance time to exhaustion at 70% V̇O2max (MD 400 s; 95%CI −408, 1208; one study) or power output at 90% V̇O2max (placebo 234.9±16 W, salbutamol 235.5±18.1 W, one study). Asignificant effect was shown for systemic β2-agonists on peak power (MD 0.91 W•kg−1; 95% CI 0.25, 1.57; four studies), but not on total work (MD 7.8 J•kg−1; 95% CI −3.3, 18.9; four studies) during a 30-second Wingate test. There were no randomized controlled trials assessing the effects of systemic formoterol, salmeterol or terbutaline on physical performance.

In conclusion, no significant effects were detected for inhaled β2-agonists on endurance, strength or sprint performance in healthy athletes. There is some evidence indicating that systemic β2-agonists may have a positive effect on physical performance in healthy subjects, but the evidence base is weak.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Table I
Fig 1
Table II
Table III
Table IV
Fig. 2
Table V
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Carlsen KH, Anderson SD, Bjermer L, et al. Treatment of exercise-induced asthma, respiratory and allergic disordersin sports and the relationship to doping: part II of the reportfrom the Joint Task Force of European RespiratorySociety (ERS) and European Academy of Allergy andClinical Immunology (EAACI) in cooperation with GA(2) LEN. Allergy 2008 May; 63 (5): 492–505

    Google Scholar 

  2. Larsson K, Ohlsen P, Larsson L, et al. High prevalence of asthma in cross country skiers. BMJ 1993 Nov 20; 307 (6915): 1326–9

    Google Scholar 

  3. Leuppi JD, Kuhn M, Comminot C, et al. High prevalence of bronchial hyperresponsiveness and asthma in ice hockeyplayers. Eur Respir J 1998 Jul; 12 (1): 13–6

    Google Scholar 

  4. Knopfli BH, Luke-Zeitoun M, von Duvillard SP, et al. High incidence of exercise-induced bronchoconstriction intriathletes of the Swiss national team. Br J Sports Med 2007 Aug; 41 (8): 486–91

    Article  PubMed  Google Scholar 

  5. Parsons JP, Kaeding C, Phillips G, et al. Prevalence of exercise-induced bronchospasm in a cohort of varsity collegeathletes. Med Sci Sports Exerc 2007 Sep; 39 (9): 1487–92

    Google Scholar 

  6. Maiolo C, Fuso L, Todaro A, et al. Prevalence of asthma and atopy in Italian Olympic athletes. Int J Sports Med 2004 Feb; 25 (2): 139–44

    Google Scholar 

  7. Weiler JM, Layton T, Hunt M. Asthma in United States athletes who participated in the 1996 summer games. J Allergy Clin Immunol 1998 Nov; 102 (5): 722–6

    Google Scholar 

  8. Weiler JM, Ryan 3rd EJ. Asthma in United States olympic athletes who participated in the 1998 Olympic wintergames. J Allergy Clin Immunol 2000 Aug; 106 (2): 267–71

    Google Scholar 

  9. Wilber RL, Rundell KW, Szmedra L, et al. Incidence of exercise-induced bronchospasm in Olympic winter sportsathletes. Med Sci Sports Exerc 2000 Apr; 32 (4): 732–7

    Google Scholar 

  10. Rundell KW. Exercise-induced bronchospasm in the elite athlete. Sports Med 2002 Sep; 32 (9): 583–600

    Google Scholar 

  11. Langdeau JB, Boulet LP. Prevalence and mechanism of development of asthma and airway hyperresponsiveness inathletes. Sports Med 2001 Aug; 31 (8): 601–16

    Google Scholar 

  12. Fitch KD. b2-Agonists at the Olympic Games. Clin Rev Allergy Immunol 2006 Oct-Dec; 31 (2-3): 259–68

    Google Scholar 

  13. WADA. Medical Information to support the decisions of TUECs. Asthma. World Ant-Doping Agency, wada-ama.org [online]. Available from URL: http://www.wada-ama.org/Documents/Science_Medicine/Medical_info_to_support_TUECs/WADA_Medical_info_Asthma_v2.3_EN.pdf [Accessed2010 Mar 18]

  14. WADA. The World Anti-Doping Code. The 2011 Prohibited list. World Ant-Doping Agency, wada-ama.org[online]. Available from URL: http://www.wada-ama.org/Documents/World_Anti-Doping_Program/WADP-Prohibited-list/To_be_effective/WADA_Prohibited_List_2011_EN.pdf [Accessed 2010 Nov 14]

  15. Kindermann W. Do inhaled b2-agonists have an ergogenic potential in non-asthmatic competitive athletes? Sports Med 2007 Feb; 37 (2): 95–102

    Article  PubMed  Google Scholar 

  16. Backer V, Lund T, Pedersen L. Pharmaceutical treatment of asthma symptoms in elite athletes: doping or therapy? Scand J Med Sci Sports 2007 Dec; 17 (6): 615–22

    Google Scholar 

  17. Fitch KD, Sue-Chu M, Anderson SD, et al. Asthma and the elite athlete: summary of the International Olympic Committee’sconsensus conference, Lausanne, Switzerland,January 22-24, 2008. J Allergy Clin Immunol 2008 Aug; 122 (2): 254–60, 60E1-7

    Google Scholar 

  18. Arts FJ, Kuipers H. The relation between power output, oxygen uptake and heart rate in male athletes. Int J Sports Med 1994 Jul; 15 (5): 228–31

    Google Scholar 

  19. Higgins JPT, Green S, editors. Cochrane handbook for systematic reviews of Interventions version 5.0.1 [updated2008 Sep]. The Cochrane Collaboration, 2008 [online].Available from URL: http://www.cochrane.org/resources/handbook/index.htm [Accessed 2009 Oct 4]

  20. Review Manager (RevMan) [computer program]. Version 5.0. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2008

  21. Hodges AN, Lynn BM, Koehle MS, et al. Effects of inhaled bronchodilators and corticosteroids on exercise inducedarterial hypoxaemia in trained male athletes. Br J Sports Med 2005 Dec; 39 (12): 917–20

    Google Scholar 

  22. Caruso J, Hamill J, Yamauchi M, et al. Albuterol aids resistance exercise in reducing unloading-induced ankle extensorstrength losses. J Appl Physiol 2005 May; 98 (5): 1705–11

    Google Scholar 

  23. Caruso JF, Hamill JL, Yamauchi M, et al. Can albuterol help resistance exercise attenuate unloading-induced boneloss? J Strength Cond Res 2004 Nov; 18 (4): 753–9

    Google Scholar 

  24. Caruso JF, Hamill JL, Yamauchi M, et al. Albuterol and exercise effects on ankle extensor strength during 40 days ofunloading. Aviat Space Environ Med 2008 Jun; 79 (6): 577–84

    Google Scholar 

  25. Caruso JF, Hamill JL, Yamauchi M, et al. Albuterol helps resistance exercise attenuate unloading-induced knee extensorlosses. Aviat Space Environ Med 2004 Jun; 75 (6): 505–11

    Google Scholar 

  26. Caruso JF, Hamill JL, Yamauchi M, et al. Temporal strength changes from resistance exercise and albuterol on unloadedmuscle. J Strength Cond Res 2008 Jul; 22 (4): 1156–63

    Google Scholar 

  27. Schiffelers SL, Brouwer EM, Saris WH, et al. Inhibition of lipolysis reduces beta1-adrenoceptor-mediated thermogenesisin man. Metabolism 1998 Dec; 47 (12): 1462–7

    Google Scholar 

  28. Schiffelers SL, Saris WH, Boomsma F, et al. Beta(1)- and beta(2)-adrenoceptor-mediated thermogenesis and lipidutilization in obese and lean men. J Clin Endocrinol Metab 2001 May; 86 (5): 2191–9

    Google Scholar 

  29. Suzuki J, Suzuki S, Okubo T. Effects of fenoterol on inspiratory effort sensation and fatigue during inspiratorythreshold loading. J Appl Physiol 1996 Mar; 80 (3): 727–33

    Google Scholar 

  30. Amoroso P, Wilson SR, Moxham J, et al. Acute effects of inhaled salbutamol on the metabolic rate of normal subjects. Thorax 1993 Sep; 48 (9): 882–5

    Google Scholar 

  31. Wilson SR, Amoroso P, Moxham J, et al. Modification of the thermogenic effect of acutely inhaled salbutamol by chronicinhalation in normal subjects. Thorax 1993 Sep; 48 (9): 886–9

    Google Scholar 

  32. Lanigan C, Howes TQ, Borzone G, et al. The effects of beta 2-agonists and caffeine on respiratory and limb muscleperformance. Eur Respir J 1993 Sep; 6 (8): 1192–6

    Google Scholar 

  33. Musch W, Vincken W, Noppen M, et al. Metabolic effects of inhaled fenoterol in normal subjects. Chest 1992 Oct; 102 (4): 1099–103

    Google Scholar 

  34. Rolett EL, Strange S, Sjogaard G, et al. Beta 2-adrenergic stimulation does not prevent potassium loss from exercisingquadriceps muscle. Am J Physiol 1990 May; 258 (5Pt2): R1192–200

    Google Scholar 

  35. Javaheri S, Smith JT, Thomas JP, et al. Albuterol has no effect on diaphragmatic fatigue in humans. Am Rev Respir Dis 1988 Jan; 137 (1): 197–201

    Google Scholar 

  36. Bedi JF, Gong Jr H, Horvath SM, et al. Enhancement of exercise performance with inhaled albuterol. Can J Sport Sci 1988 Jun; 13 (2): 144–8

    Google Scholar 

  37. Phillips PJ, Vedig AE, Jones PL, et al. Metabolic and cardiovascular side effects of the beta 2-adrenoceptoragonists salbutamol and rimiterol. Br J Clin Pharmacol 1980 May; 9 (5): 483–91

    Google Scholar 

  38. Arlettaz A, Le Panse B, Portier H, et al. Salbutamol intake and substrate oxidation during submaximal exercise. Eur JAppl Physiol 2009 Jan; 105 (2): 207–13

    Google Scholar 

  39. Decorte N, Verges S, Flore P, et al. Effects of acute salbutamol inhalation on quadriceps force and fatigability. Med Sci Sports Exerc 2008 Jul; 40 (7): 1220–7

    Google Scholar 

  40. Sporer BC, Sheel AW, McKenzie DC. Dose response of inhaled salbutamol on exercise performance and urine concentrations. Med Sci Sports Exerc 2008 Jan; 40 (1): 149–57

    Google Scholar 

  41. Tjorhom A, Riiser A, Carlsen KH. Effects of formoterol on endurance performance in athletes at an ambient temperatureof -20 degrees C. Scand J Med Sci Sports 2007 Dec; 17 (6): 628–35

    Google Scholar 

  42. Riiser A, Tjorhom A, Carlsen KH. The effect of formoterol inhalation on endurance performance in hypobaric conditions. Med Sci Sports Exerc 2006 Dec; 38 (12): 2132–7

    Google Scholar 

  43. van Baak MA, de Hon OM, Hartgens F, et al. Inhaled salbutamol and endurance cycling performance in nonasthmatic athletes. Int J Sports Med 2004 Oct; 25 (7): 533–8

    Google Scholar 

  44. Stewart IB, Labreche JM, McKenzie DC. Acute formoterol administration has no ergogenic effect in nonasthmaticathletes. Med Sci Sports Exerc 2002 Feb; 34 (2): 213–7

    Google Scholar 

  45. Goubault C, Perault MC, Leleu E, et al. Effects of inhaled salbutamol in exercising non-asthmatic athletes. Thorax 2001 Sep; 56 (9): 675–9

    Google Scholar 

  46. Carlsen KH, Hem E, Stensrud T, et al. Can asthma treatment in sports be doping? The effect of the rapid onset,long-acting inhaled b2-agonist formoterol upon enduranceperformance in healthy well-trained athletes. Respir Med 2001 Jul; 95 (7): 571–6

    Google Scholar 

  47. Sue-Chu M, Sandsund M, Helgerud J, et al. Salmeterol and physical performance at -15 degrees C in highly trainednonasthmatic cross-country skiers. Scand J Med Sci Sports 1999; Feb: 9 (1): 48–52

    Google Scholar 

  48. Sandsund M, Sue-Chu M, Helgerud J, et al. Effect of cold exposure (-15 degrees C) and salbutamol treatment onphysical performance in elite nonasthmatic cross-countryskiers. Eur J Appl Physiol Occup Physiol 1998 Mar; 77 (4): 297–304

    Google Scholar 

  49. Larsson K, Gavhed D, Larsson L, et al. Influence of a b2- agonist on physical performance at low temperature in eliteathletes. Med Sci Sports Exerc 1997 Dec; 29 (12): 1631–6

    Google Scholar 

  50. Carlsen KH, Ingjer F, Kirkegaard H, et al. The effect of inhaled salbutamol and salmeterol on lung function andendurance performance in healthy well-trained athletes. Scand J Med Sci Sports 1997 Jun; 7 (3): 160–5

    Google Scholar 

  51. McDowell SL, Fleck SJ, Storms WW. The effects of salmeterol on power output in nonasthmatic athletes. J Allergy Clin Immunol 1997 Apr; 99 (4): 443–9

    Google Scholar 

  52. Norris SR, Petersen SR, Jones RL. The effect of salbutamol on performance in endurance cyclists. Eur J Appl Physiol Occup Physiol 1996; 73 (3-4): 364–8

    Article  PubMed  CAS  Google Scholar 

  53. Morton AR, Joyce K, Papalia SM, et al. Is salmeterol ergogenic? Clin J Sport Med 1996 Oct; 6 (4): 220–5

    Google Scholar 

  54. Lemmer JT, Fleck SJ, Wallach JM, et al. The effects of albuterol on power output in non-asthmatic athletes. Int JSports Med 1995 May; 16 (4): 243–9

    Google Scholar 

  55. Heir T, Stemshaug H. Salbutamol and high-intensity treadmill running in nonasthmatic highly conditioned athletes. Scand J Med Sci Sports 1995 Aug; 5 (4): 231–6

    Google Scholar 

  56. Unnithan VB, Thomson KJ, Aitchison TC, et al. Beta 2- agonists and running economy in prepubertal boys. Pediatr Pulmonol 1994 Jun; 17 (6): 378–82

    Google Scholar 

  57. Fleck SJ, Lucia A, Storms WW, et al. Effects of acute inhalation of albuterol on submaximal and maximal V̇O2 and blood lactate. Int J Sports Med 1993 Jul; 14 (5): 239–43

    Google Scholar 

  58. Morton AR, Papalia SM, Fitch KD. Changes in anaerobic power and strength performance after inhalation of salbutamolin nonasthmatic athletes. Clin J Sport Med 1993 Jul; 3: 14–9

    Google Scholar 

  59. Signorile JF, Kaplan TA, Applegate B, et al. Effects of acute inhalation of the bronchodilator, albuterol, on power output. Med Sci Sports Exerc 1992 Jun; 24 (6): 638–42

    Google Scholar 

  60. Meeuwisse WH, McKenzie DC, Hopkins SR, et al. The effect of salbutamol on performance in elite nonasthmaticathletes. Med Sci Sports Exerc 1992 Oct; 24 (10): 1161–6

    Google Scholar 

  61. Morton AR, Papalia SM, Fitch KD. Is salbutamol ergogenic? The effects of salbutamol on physical performancein high-performance nonasthmatic athletes. Clin J Sport Med 1992 Apr; 2 (2): 93–7

    Google Scholar 

  62. Gong Jr H, Bedi JF, Horvath SM. Inhaled albuterol does not protect against ozone toxicity in nonasthmatic athletes. Arch Environ Health 1988 Jan-Feb; 43 (1): 46–53

    Google Scholar 

  63. Booth M, Bogan T, Binns J. The effect of ventolin on a maximal work capacity test in trained female cyclists. NZ JPhysiother 1988 Nov; 16 (3): 17–8

    Google Scholar 

  64. McKenzie DC, Rhodes EC, Stirling DR, et al. Salbutamol and treadmill performance in non-atopic athletes. Med Sci Sports Exerc 1983 Jun; 15 (6): 520–2

    Google Scholar 

  65. Le Panse B, Arlettaz A, Portier H, et al. Effects of acute salbutamol intake during supramaximal exercise inwomen. Br J Sports Med 2007 Jul; 41 (7): 430–4

    Google Scholar 

  66. Le Panse B, Arlettaz A, Portier H, et al. Short term salbutamol ingestion and supramaximal exercise in healthywomen. Br J Sports Med 2006a Jul; 40 (7): 627–31

    Google Scholar 

  67. Le Panse B, Arlettaz A, Portier H, et al. Effect of chronic therapeutical b2-agonist intake during maximal exercise. Sci Sports 2006b Jun; 21 (5): 163–5

    Google Scholar 

  68. Le Panse B, Collomp K, Portier H, et al. Effects of shortterm salbutamol ingestion during a Wingate test. Int JSports Med 2005 Sep; 26 (7): 518–23

    Google Scholar 

  69. Collomp K, Le Panse B, Portier H, et al. Effects of acute salbutamol intake during a Wingate test. Int J Sports Med 2005 Sep; 26 (7): 513–7

    Article  PubMed  CAS  Google Scholar 

  70. Caruso JF, Hamill JL, De Garmo N. Oral albuterol dosing during the latter stages of a resistance exercise program. J Strength Cond Res 2005 Feb; 19 (1): 102–7

    Google Scholar 

  71. Collomp K, Candau R, Millet G, et al. Effects of salbutamol and caffeine ingestion on exercise metabolism and performance. Int J Sports Med 2002 Nov; 23 (8): 549–54

    Google Scholar 

  72. Collomp K, Candau R, Collomp R, et al. Effects of acute ingestion of salbutamol during submaximal exercise. Int JSports Med 2006a Oct; 21 (7): 480–4

    Google Scholar 

  73. Collomp K, Candau R, Lasne F, et al. Effects of short-term oral salbutamol administration on exercise endurance andmetabolism. J Appl Physiol 2006b Aug; 89 (2): 430–6

    Google Scholar 

  74. van Baak MA, Mayer LH, Kempinski RE, et al. Effect of salbutamol on muscle strength and endurance performancein nonasthmatic men. Med Sci Sports Exerc 2000 Jul; 32 (7): 1300–6

    Google Scholar 

  75. Caruso JF, Signorile JF, Perry AC, et al. The effects of albuterol and isokinetic exercise on the quadriceps musclegroup. Med Sci Sports Exerc 1995 Nov; 27 (11): 1471–6

    Google Scholar 

  76. Martineau L, Horan MA, Rothwell NJ, et al. Salbutamol, a beta 2-adrenoceptor agonist, increases skeletal musclestrength in young men. Clin Sci (Lond) 1992 Nov; 83 (5): 615–21

    Google Scholar 

  77. Violante B, Pellegrino R, Vinay C, et al. Failure of aminophylline and salbutamol to improve respiratory musclefunction and exercise tolerance in healthy humans. Respiration 1989; 55 (4): 227–36

    Article  PubMed  CAS  Google Scholar 

  78. Dickersin K, Berlin JA. Meta-analysis: state-of-the-science. Epidemiologic Reviews 1992 Jan; 14 (1): 154–76

    Google Scholar 

  79. Currell K, Jeukendrup AE. Validity, reliability and sensitivity of measures of sporting performance. Sports Med 2008 Apr; 28 (4): 297–316

    Google Scholar 

  80. Butler J, O’Brien M, O’Malley K, et al. Relationship of betaadrenoreceptor density to fitness in athletes. Nature 1982 Jul 1; 298 (5869): 60–2

    Google Scholar 

Download references

Acknowledgements

The authors would like to acknowledge Marijke A.E. Mol, PhD, for her assistance in the literature search strategy and Michael Turner, MD, for his general assistance. No funding was used to assist in the preparation of this review. The authors have no conflicts of interest that are directly relevant to the content of this review.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Babette M. Pluim.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Pluim, B.M., de Hon, O., Staal, J.B. et al. β2-Agonists and Physical Performance. Sports Med 41, 39–57 (2011). https://doi.org/10.2165/11537540-000000000-00000

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/11537540-000000000-00000

Keywords

Navigation