Cerebrovascular, cardiovascular and strength responses to acute ammonia inhalation



Ammonia is used as a stimulant in strength based sports to increase arousal and offset fatigue however little is known about its physiological and performance effects. The purpose of this study was twofold (1) establish the physiological response to acute ammonia inhalation (2) determine whether the timing of the physiological response corresponds with a performance enhancement, if any.


Fifteen healthy males completed two trials. Trial one investigated the beat-to-beat middle cerebral artery blood flow velocity (MCAv), heart rate (HR) and mean arterial pressure (MAP) response to ammonia inhalation. During trial two, participants performed a maximal single mid-thigh pull (MTP) at various time points following ammonia inhalation in a randomised order: MTPs were conducted immediately, 15, 30 and 60 s following ammonia inhalation. A MTP with no ammonia inhalation served as the control. During this trial maximal MTP force, rate of force development (RFD) and electromyography (EMG) activity were recorded.


MCAvmean increased and peaked on average by 6 cm s−1 (P < 0.001), 9.4 ± 5.5 s following ammonia inhalation. Similarly, HR was increased by 6 ± 11 beats per minute 15 s following ammonia inhalation (P < 0.001). MAP remained unchanged following inhalation (P = 0.51). The use and timing of ammonia inhalation had no effect on maximal force, RFD or EMG (all P > 0.2) compared to control.


MCAv was elevated despite no increase in MAP occurring; this is indicative of a cerebrovascular vasodilation. Despite the marked cerebrovascular and cardiovascular response to ammonia inhalation no ergogenic effect was observed during the MTP, irrespective of the timing of administration.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2



Cerebral vascular conductance index




International Powerlifting Federation


Mean arterial pressure


Middle cerebral artery blood flow velocity


Mid-thigh pull


Maximum voluntary isometric contraction


Normalised EMG

P ETCo2 :

Partial pressure of end tidal Co2


Peak rate of force development

\( \dot{Q} \) :

Cardiac output


Rate of force development


Repetition maximum


  1. Aaslid R, Markwalder TM, Nornes H (1982) Noninvasive transcranial Doppler ultrasound recording of flow velocity in basal cerebral arteries. J Neurosurg 57:769–774

    Article  CAS  PubMed  Google Scholar 

  2. Aaslid R, Lindegaard KF, Sorteberg W, Nornes H (1989) Cerebral autoregulation dynamics in humans. Stroke 20:45–52

    Article  CAS  PubMed  Google Scholar 

  3. Compton D, Hill P, Sinclair J (1973) Weight-lifters’ blackout. Lancet 302:1234–1237

    Article  Google Scholar 

  4. Coverdale NS, Gati JS, Opalevych O, Perrotta A, Shoemaker JK (2014) Cerebral blood flow velocity underestimates cerebral blood flow during modest hypercapnia and hypocapnia. J Appl Physiol 117:1090–1096

    Article  PubMed  Google Scholar 

  5. Del Coso J, Muñoz G, Muñoz-Guerra J (2011) Prevalence of caffeine use in elite athletes following its removal from the World Anti-Doping Agency list of banned substances. Appl Physiol Nutr Metab 36:555–561

    Article  PubMed  Google Scholar 

  6. Dynarex Corporation (2012) Ammonia inhalation solution: material safety data sheet. Dynarex Corporation. http://www.dynarex.com/MSDS/MSDS_Ampules-Sting_Pads_(1401).pdf. Accessed 25 Apr 2015

  7. Ebben W, Feldmann C, Dayne A, Mitsche D, Alexander P, Knetzger K (2009) Muscle activation during lower body resistance training. Int J Sports Med 30:1–8

    Article  CAS  PubMed  Google Scholar 

  8. Escamilla RF, Francisco AC, Kayes AV, Speer KP, Moorman C 3rd (2002) An electromyographic analysis of sumo and conventional style deadlifts. Med Sci Sports Exerc 34:682–688

    Article  PubMed  Google Scholar 

  9. Giller CA, Bowman G, Dyer H, Mootz L, Krippner W (1993) Cerebral arterial diameters during changes in blood pressure and carbon dioxide during craniotomy. Neurosurgery 32:737–742

    Article  CAS  PubMed  Google Scholar 

  10. Gonzalez AM, Walsh AL, Ratamess NA, Kang J, Hoffman JR (2011) Effect of a pre-workout energy supplement on acute multi-joint resistance exercise. J Sports Sci Med 10:261

    PubMed Central  PubMed  Google Scholar 

  11. Haff GG, Ruben RP, Lider J, Twine C, Cormie P (2015) A comparison of methods for determining the rate of force development during isometric mid-thigh clean pulls. J Strength Cond Res 29:386–395

    Article  PubMed  Google Scholar 

  12. Hermens HJ, Freriks B, Disselhorst-Klug C, Rau G (2000) Development of recommendations for SEMG sensors and sensor placement procedures. J Electromyogr Kinesiol 10:361–374

    Article  CAS  PubMed  Google Scholar 

  13. Ide K, Eliasziw M, Poulin MJ (2003) Relationship between middle cerebral artery blood velocity and end-tidal PCO2 in the hypocapnic-hypercapnic range in humans. J Appl Physiol 95:129–137

    Article  PubMed  Google Scholar 

  14. International Powerlifting Federation (2012) Technical rules book. International Powerlifting Federation, Luxembourg

  15. International Weightlifting Federation (2015) Technical and competition rules and regulations. The International Weightlifting Federation, Budapest, Hungary

  16. Julu P, Cooper V, Hansen S, Hainsworth R (2003) Cardiovascular regulation in the period preceding vasovagal syncope in conscious humans. J Physiol 549:299–311

    PubMed Central  Article  CAS  PubMed  Google Scholar 

  17. Kawamori N, Rossi SJ, Justice BD, Haff EE, Pistilli EE, O’Bryant HS, Stone MH, Haff GG (2006) Peak force and rate of force development during isometric and dynamic mid-thigh clean pulls performed at various intensities. J Strength Cond Res 20:483–491

    PubMed  Google Scholar 

  18. Keogh JWL, Hume PA, Pearson SN, Mellow PJ (2009) Can absolute and proportional anthropometric characteristics distinguish stronger and weaker powerlifters? J Strength Cond Res 23:2256–2265

    Article  PubMed  Google Scholar 

  19. Konrad P (2012) The ABC of EMG: a practical introduction to kinesiological electromyography. Noraxon USA Inc., Scottsdale, Arizona

  20. Maughan RJ, Depiesse F, Geyer H (2007) The use of dietary supplements by athletes. J Sports Sci 25:S103–S113

    Article  PubMed  Google Scholar 

  21. McCrory P (2006) Smelling salts. Br J Sports Med 40:659

    PubMed Central  Article  CAS  PubMed  Google Scholar 

  22. Ogoh S, Brothers RM, Barnes Q, Eubank WL, Hawkins MN, Purkayastha S (2005) The effect of changes in cardiac output on middle cerebral artery mean blood velocity at rest and during exercise. J Physiol 569:697–704

    PubMed Central  Article  CAS  PubMed  Google Scholar 

  23. Ott P, Vilstrup H (2014) Cerebral effects of ammonia in liver disease: current hypotheses. Metab Brain Dis 29:901–911

    Article  CAS  PubMed  Google Scholar 

  24. Perry BG, Schlader ZJ, Barnes MJ, Cochrane DJ, Lucas S, Mündel T (2013) Hemodynamic response to upright resistance exercise: effect of load and repetition. Med Sci Sports Exerc 46:479–487

    Article  Google Scholar 

  25. Prentice C, Stannard SR, Barnes MJ (2013) The effects of binge drinking behaviour on recovery and performance after a rugby match. J Sport Health Sci 17:244–248

    Google Scholar 

  26. Pritchard HJ, Stannard SR, Barnes MJ (2014) Ammonia inhalant and stimulant use among powerlifters: results from an international survey. J Aus Strength Cond 22:52–54

    Google Scholar 

  27. Richmond SR, Potts AC, Sherman JR (2014) The impact of ammonia inhalants on strength performance in resistance trained males. J Exerc Physiol Online 17:60–66

    Google Scholar 

  28. Slater G, Phillips SM (2011) Nutrition guidelines for strength sports: sprinting, weightlifting, throwing events, and bodybuilding. J Sports Sci 29:S67–S77

    Article  PubMed  Google Scholar 

  29. Sørensen M (2013) Update on cerebral uptake of blood ammonia. Metab Brain Dis 28:155–159

    Article  PubMed  Google Scholar 

  30. Tod D, Iredale F, Gill N (2003) ‘Psyching-up’ and muscular force production. Sports Med 33:47–58

    Article  PubMed  Google Scholar 

  31. Tofteng F, Larsen FS (2004) The effect of indomethacin on intracranial pressure, cerebral perfusion and extracellular lactate and glutamate concentrations in patients with fulminant hepatic failure. J Cereb Blood Flow Metab 24:798–804

    Article  CAS  PubMed  Google Scholar 

  32. Valdueza JM, Balzer JO, Villringer A, Vogl TJ, Kutter R, Einh K (1997) Changes in blood flow velocity and diameter of the middle cerebral artery during hyperventilation: assessment with MR and transcranial Doppler sonography. Am J Neuroradiol 18:1929–1934

    CAS  PubMed  Google Scholar 

  33. Vaquero J, Chung C, Blei AT (2004) Cerebral blood flow in acute liver failure: a finding in search of a mechanism. Metab Brain Dis 19:177–194

    Article  PubMed  Google Scholar 

  34. Velasquez JR (2011) The use of ammonia inhalants among athletes. Strength Cond J 33:33–35

    Article  Google Scholar 

  35. Warren GL, Park ND, Maresca RD, McKibans KI, Millard-Stafford ML (2010) Effect of caffeine ingestion on muscular strength and endurance: a meta-analysis. Med Sci Sports Exerc 42:1375–1387

    Article  CAS  PubMed  Google Scholar 

  36. Widdicombe J, Lee L-Y (2001) Airway reflexes, autonomic function, and cardiovascular responses. Environ Health Perspec 109:579

    Article  CAS  Google Scholar 

  37. Willie C, Colino F, Bailey D, Tzeng Y, Binsted G, Jones L, Haykowsky M, Bellapart J, Ogoh S, Smith K (2011) Utility of transcranial Doppler ultrasound for the integrative assessment of cerebrovascular function. J Neurosci Methods 196:221–237

    Article  CAS  PubMed  Google Scholar 

  38. World Anti-Doping Agency (2014) The World Anti-doping code: the 2014 prohibited list. World Anti-Doping Agency. https://wada-main.s3.amazonaws.com/?files/WADA-Revised-2014-Prohibited-List_EN.PDF. Accessed 24 Apr 2015

  39. Zhang R, Zuckerman JH, Giller CA, Levine BD (1998) Transfer function analysis of dynamic cerebral autoregulation in humans. Am J Physiol Heart Circ Physiol 274:233–241

    Google Scholar 

Download references


The authors would like to thank the participants for their time and effort.

Author information



Corresponding author

Correspondence to Matthew J. Barnes.

Ethics declarations

Conflict of interest

No conflicts of interest.

Additional information

Communicated by William J. Kraemer.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Perry, B.G., Pritchard, H.J. & Barnes, M.J. Cerebrovascular, cardiovascular and strength responses to acute ammonia inhalation. Eur J Appl Physiol 116, 583–592 (2016). https://doi.org/10.1007/s00421-015-3313-7

Download citation


  • Ammonia inhalation
  • Rate of force development
  • Mid-thigh pull
  • Ergogenic aids