Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Effects of Acute Alkalosis and Acidosis on Performance

A Meta-Analysis


Ingestion of agents that modify blood buffering action may affect high-intensity performance. Here we present a meta-analysis of the effects of acute ingestion of three such agents — sodium bicarbonate, sodium citrate and ammonium chloride — on performance and related physiological variables (blood bicarbonate, pH and lactate). A literature search yielded 59 useable studies with 188 observations of performance effects. To perform the mixed-model meta-analysis, all performance effects were converted into a percentage change in mean power and were weighted using standard errors derived from exact p-values, confidence limits (CLs) or estimated errors of measurement. The fixed effects in the meta-analytic model included the number of performance-test bouts (linear), test duration (log linear), blinding (yes/no), competitive status (athlete/nonathlete) and sex (male/female). Dose expressed as buffering mmoL/kg/body mass (BM) was included as a strictly proportional linear effect interacted with all effects except blinding. Probabilistic inferences were derived with reference to thresholds for small and moderate effects on performance of 0.5% and 1.5%, respectively. Publication bias was reduced by excluding study estimates with a standard error >2.7%. The remaining 38 studies and 137 estimates for sodium bicarbonate produced a possibly moderate performance enhancement of 1.7% (90% CL± 2.0%) with a typical dose of 3.5mmoL/kg/BM (~0.3 g/kg/BM) in a single 1-minute sprint, following blinded consumption by male athletes. In the 16 studies and 45 estimates for sodium citrate, a typical dose of 1.5mmoL/kg/BM (~0.5 g/kg/BM) had an unclear effect on performance of 0.0% (±1.3%), while the five studies and six estimates for ammonium chloride produced a possibly moderate impairment of 1.6% (±1.9%) with a typical dose of 5.5mmoL/kg/BM (~0.3 g/kg/BM). Study and subject characteristics had the following modifying small effects on the enhancement of performance with sodium bicarbonate: an increase of 0.5% (±0.6%) with a 1mmoL/kg/BM increase in dose; an increase of 0.6% (±0.4%) with five extra sprint bouts; a reduction of 0.6% (±0.9%) for each 10-fold increase in test duration (e.g. 1–10 minutes); reductions of 1.1%(±1.1%) with nonathletes and 0.7% (±1.4%) with females. Unexplained variation in effects between research settings was typically ±1.2%. The only noteworthy effects involving physiological variables were a small correlation between performance and pre-exercise increase in blood bicarbonate with sodium bicarbonate ingestion, and a very large correlation between the increase in blood bicarbonate and time between sodium citrate ingestion and exercise. The approximate equal and opposite effects of sodium bicarbonate and ammonium chloride are consistent with direct performance effects of pH, but sodium citrate appears to have some additional metabolic inhibitory effect. Important future research includes studies of sodium citrate ingestion several hours before exercise and quantification of gastrointestinal symptoms with sodium bicarbonate and citrate. Although individual responses may vary, we recommend ingestion of 0.3–0.5 g/kg/BM sodium bicarbonate to improve mean power by 1.7% (±2.0%) in high-intensity races of short duration.

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

Fig. 1
Table I
Table II
Fig. 2
Fig. 3
Fig. 4


  1. 1.

    Gledhill N. Bicarbonate ingestion and anaerobic performance. Sports Med 1984; 1: 177–80

  2. 2.

    Dennig H, Talbott JH, Edwards HT, et al. Effects of acidosis and alkalosis upon capacity for work. J Clin Invest 1931; 9: 601–13

  3. 3.

    Dill DB, Edwards HT, Talbott JH. Alkalosis and the capacity for work. J Biol Chem 1931; 97: 58–9

  4. 4.

    Matson LG, Tran ZV. Effects of sodium bicarbonate ingestion on anaerobic performance: a meta-analytic review. Int J Sport Nutr 1993; 3 (1): 2–28

  5. 5.

    Cohen J. Statistical power analysis for the behavioural sciences. Hillsdale (NJ): Lawrence Erlbaum Associates, 1988

  6. 6.

    Burke LM, Pyne DB. Bicarbonate loading to enhance training and competitive performance. Int J Sports Physiol Perform 2007; 2: 93–7

  7. 7.

    Requena B, Zabala M, Padial P, et al. Sodium bicarbonate and sodium citrate: ergogenic aids? J Strength Cond Res 2005; 19 (1): 213–24

  8. 8.

    McNaughton L, Siegler J, Midgley A. Ergogenic effects of sodium bicarbonate. Curr Sports Med Rep 2008; 7 (4): 230–6

  9. 9.

    Hopkins WG, Schabort EJ, Hawley JA. Reliability of power in physical performance tests. Sports Med 2001; 31 (3): 211–34

  10. 10.

    Léger L, Mercier D. Gross energy cost of horizontal treadmill and track running. Sports Med 1984; 1: 270–7

  11. 11.

    Hopkins WG, Marshall SW, Batterham AM, et al. Progressive statistics for studies in sports medicine and exercise science. Med Sci Sports Exerc 2009; 41 (1): 3–12

  12. 12.

    McNaughton L, Cedaro R. The effect of sodium bicarbonate on rowing ergometer performance in elite rowers. Aust J Sci Med Sport 1991; 23 (3): 66–9

  13. 13.

    Artioli GG, Gualano B, Coelho DF, et al. Does sodiumbicarbonate ingestion improve simulated judo performance? Int J Sport Nutr Exerc Metab 2007; 17: 206–20

  14. 14.

    Bishop D, Edge J, Davis C, et al. Induced metabolic acidosis affects muscle metabolism and repeated-sprint ability. Med Sci Sports Exerc 2004; 36 (5): 807–13

  15. 15.

    Zajac A, Cholewa J, Poprzecki S, et al. Effects of sodium bicarbonate ingestion on swim performance in youth athletes. J Sports Sci Med 2009; 8: 45–50

  16. 16.

    Gao J, Costill DL, Horswill CA, et al. Sodium bicarbonate ingestion improves performance in interval swimming. Eur J Appl Physiol 1988; 58: 171–4

  17. 17.

    Balberman SE, Roby FB. The effects of induced alkalosis and acidosis on the work capacity of the quadriceps and hamstrings muscle groups [abstract]. Int J Sports Med 1983; 4: 143

  18. 18.

    Lindh AM, Peyrebrune MC, Ingham SA, et al. Sodium bicarbonate improves swimming performance. Int J Sports Med 2008; 29: 519–23

  19. 19.

    Goldfinch J, McNaugton L, Davies P. Induced metabolic acidosis and its effects on 400-m racing time. Eur J Appl Physiol 1988; 57: 45–8

  20. 20.

    George KP, MacLaren DPM. The effect of induced alkalosis and acidosis on endurance running at an intensity corresponding to 4 mM blood lactate. Ergonomics 1988; 31 (11): 1639–45

  21. 21.

    Van Montfoort MCE, Van Dieren L, Hopkins WG, et al. Effects of ingestion of bicarbonate, citrate, lactate and chloride on sprint running. Med Sci Sports Exerc 2004; 36 (7): 1239–43

  22. 22.

    Pruscino CL, Ross MLR, Gregory JR, et al. Effects of sodium bicarbonate, caffeine and their combination on repeated 200-m freestyle performance. Int J Sport Nutr Exerc Metab 2008; 18: 116–30

  23. 23.

    Wilkes D, Gledhill N, Smyth R. Effect of acute induced metabolic akalosis on 800-m racing time. Med Sci Sports Exerc 1983; 15 (4): 277–80

  24. 24.

    McCartney N, Heigenhauser GJF, Jones NL. Effects of pH on maximal output and fatigue during short-term dynamic exercise. J Appl Physiol 1983; 55: 225–9

  25. 25.

    Lavender G, Bird SR. Effect of sodium bicarbonate ingestion upon repeated sprints. Br J Sports Med 1989; 23 (1): 41–5

  26. 26.

    Kozac-Collins K, Burke ER, Schoene R. Sodium bicarbonate ingestion does not improve performance in women cyclists. Med Sci Sports Exerc 1994; 26 (12): 1510–5

  27. 27.

    Pierce EF, Eastman NW, Hammer WH, et al. Effect of induced alkalosis on swimming time trials. J Sports Sci 1992; 10: 255–9

  28. 28.

    Bird SR, Wiles J, Robbins J. The effect of sodium bicarbonate ingestion on 1500-m racing time. J Sports Sci 1995; 13: 399–403

  29. 29.

    Klein L. The effect of bicarbonate ingestion on upper body power in trained athletes [abstract]. Med Sci Sports Exerc 1987; 19: 567

  30. 30.

    Siegler JC, Keatley S, Keatley S, et al. Pre-exercise alkalosis and acid-base recovery. Int J Sports Med 2008; 29: 545–51

  31. 31.

    Katz A, Costill DL, King DS, et al. Maximal exercise tolerance after induced alkalosis. Int J Sports Med 1984; 5: 107–10

  32. 32.

    Linderman JK, Kirk L, Musselman J, et al. The effects of sodium bicarbonate and pyridoxine-alpha-ketoglutarate on short-term maximal exercise capacity. J Sports Sci 1992; 10: 243–53

  33. 33.

    Stephens TJ, McKenna MJ, Canny BJ, et al. Effect of sodium bicarbonate on muscle metabolism during intense endurance cycling. Med Sci Sports Exerc 2002; 43 (4): 614–21

  34. 34.

    Kowalchuk JM, Heigenhauser GJF, Jones NL. Effect of pH on metabolic and cardiorespiratory responses during progressive exercise. J Appl Physiol 1984; 57 (5): 1558–63

  35. 35.

    Brien DM, McKenzie DC. The effect of induced alkalosis and acidosis on plasma lactate and work output in elite oarsmen. Eur J Appl Physiol 1989; 58: 797–802

  36. 36.

    Marx JO, Gordon SE, Vos NH, et al. Effect of alkalosis on plasma epinephrine responses to high intensity cycle exercise in humans. Eur J Appl Physiol 2002; 87: 72–7

  37. 37.

    Tiryaki GR, Atterbom HA. The effects of sodium bicarbonate and sodium citrate on 600m running time of trained females. J Sports Med Phys Fit 1995; 35: 194–8

  38. 38.

    Cox G, Jenkins DG. The physiological and ventilatory responses to repeated 60 s sprints following sodium citrate ingestion. J Sports Sci 1994; 12: 469–75

  39. 39.

    Schabort E, Wilson G, Noakes TD. Dose-related elevations in venous pH with citrate ingestion do not alter 40-km cycling time-trial performance. Eur J Appl Physiol 2000; 83: 320–7

  40. 40.

    Potteiger JA, Nickel GL, Webster MJ, et al. Sodium citrate enhances 30 km cycling performance. Int J Sports Med 1996; 17: 7–11

  41. 41.

    Linossier MT, Dormois D, Brégère P, et al. Effect of sodium citrate on performance and metabolism of human skeletal muscle during supramaximal cycling exercise. Eur J Appl Physiol 1997; 76: 48–54

  42. 42.

    Oopik V, Saaremets I, Medijainen L, et al. Effects of sodium citrate ingestion before exercise on endurance performance in well trained college runners. Br J Sports Med 2003; 37: 485–9

  43. 43.

    Shave R, Whyte G, Siemann A, et al. The effects of sodium citrate ingestion on 3,000-meter time-trial performance. J Strength Cond Res 2001; 15 (2): 230–4

  44. 44.

    Feriche Fernández-Castanys B, Delgado-Fernández M, Alvarez Garcia J. The effect of sodium citrate intake on anaerobic performance in normoxia and after sudden ascent to moderate altitude. J Sports Med Phys Fitness 2002; 42 (2): 179–85

  45. 45.

    Ibanez J, Pullinen T, Gorostiaga E, et al. Blood lactate and ammonia in short-term anaerobic work following induced alkalosis. J Sports Med Phys Fit 1995; 35: 187–93

  46. 46.

    Ball D, Maughan RJ. The effect of sodium citrate ingestion on metabolic response to intense exercise following diet manipulation in man. Exp Physiol 1997; 82: 1041–56

  47. 47.

    Oopik VT, Timpmann S, Timpmann S, et al. The effects of sodium citrate ingestion on metabolism and 1500-m racing time in trained female runners. J Sports Sci Med 2008; 7: 125–31

  48. 48.

    Oopik V, Saaremets I, Timpmann S, et al. Effects of acute ingestion of sodium citrate on metabolism and 5-km running performance: a field study. Can J Appl Physiol 2004; 29 (6): 691–703

  49. 49.

    Robergs R, Hutchinson K, Hendee S, et al. Influence of preexercise acidosis and alkalosis on the kinetics of acid-base recovery following intense exercise. Int J Sport Nutr Exerc Metab 2005; 14: 59–74

  50. 50.

    Sostaric S, Skinner SL, Brown MJ, et al. Alkalosis increases muscle K+ release, but lowers plasma [K+] and delays fatigue during dynamic forearm exercise. J Physiol 2005; 570 (1): 185–205

  51. 51.

    Kowalchuk JM, Maltais SA, Yamaji K, et al. The effect of citrate loading on exercise performance, acid-base balance and metabolism. Eur J Appl Physiol 1989; 58: 858–64

  52. 52.

    Horswill CA. Effects of bicarbonate, citrate and phosphate loading on performance. Int J Sport Nutr 1995; 5: 111–9

  53. 53.

    Newsholme EA, Leech AR. Biochemistry for the Medical Sciences. Chichester, London: John Wiley & Sons Ltd, 1983

  54. 54.

    Potteiger JA, Webster MJ, Nickel GL, et al. The effects of buffer ingestion on metabolic factors related to distance running performance. Eur J Appl Physiol 1996; 72: 365–71

  55. 55.

    McNaughton L. Sodiumcitrate and anaerobic performance: implications of dosage. Eur J Appl Physiol 1990; 61: 392–7

  56. 56.

    Price MJ, Singh M. Time course of blood bicarbonate and pH three hours after sodium bicarbonate ingestion. Int J Sports Physiol Perform 2008; 3: 240–2

  57. 57.

    Renfree A. The time course for changes in plasma [H+] after sodium bicarbonate ingestion. Int J Sports Physiol Perform 2007; 2: 323–6

  58. 58.

    McNaughton L, Cedaro R. Sodium citrate ingestion and its effects on maximal anaerobic exercise of different durations. Eur J Appl Physiol 1992; 64: 36–41

  59. 59.

    McNaughton L, Strange N, Backx K. The effects of chronic sodium bicarbonate ingestion on multiple bouts of anaerobic work and power output. J Hum Move Stud 2000; 38: 307–22

  60. 60.

    McNaughton L, Dalton B, Palmer G. Sodium bicarbonate can be used as an ergogenic aid in high-intensity, competitive cycle ergometry of 1 h duration. Eur J Appl Physiol 1999; 80: 64–9

  61. 61.

    Tan F, Polglaze T, Cox G, et al. Effects of induced alkalosis on simulated match performance in elite female water polo players. Int J Sport Nutr Exerc Metab 2010; 20 (3): 198–205

  62. 62.

    Cameron SL, McLay-Cooke RT, Brown RC, et al. Increased blood pH but not performance with sodium bicarbonate supplementation in elite rugby union players. Int J Sport Nutr Exerc Metab 2010; 20 (4): 307–21

Download references


No funding has been received for the preparation of this manuscript. The authors declare that there are no conflicts of interest that are directly relevant to the content of this review.

Author information

Correspondence to Dr Amelia J. Carr.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Carr, A.J., Hopkins, W.G. & Gore, C.J. Effects of Acute Alkalosis and Acidosis on Performance. Sports Med 41, 801–814 (2011). https://doi.org/10.2165/11591440-000000000-00000

Download citation


  • HCO3
  • Sodium Bicarbonate
  • Ammonium Chloride
  • Sodium Citrate
  • Performance Effect