Intermittent Running and Cognitive Performance after Ketone Ester Ingestion

Med Sci Sports Exerc. 2018 Nov;50(11):2330-2338. doi: 10.1249/MSS.0000000000001700.


Purpose: Ingestion of exogenous ketones alters the metabolic response to exercise and may improve exercise performance, but it has not been explored in variable-intensity team sport activity, or for effects on cognitive function.

Methods: On two occasions in a double-blind, randomized crossover design, 11 male team sport athletes performed the Loughborough Intermittent Shuttle Test (part A, 5 × 15-min intermittent running; part B, shuttle run to exhaustion), with a cognitive test battery before and after. A 6.4% carbohydrate-electrolyte solution was consumed before and during exercise either alone (PLA) or with 750 mg·kg of a ketone ester (KE) supplement. Heart rate, RPE, and 15-m sprint times were recorded throughout, and serial venous blood samples were assayed for plasma glucose, lactate, and β-hydroxybutyrate.

Results: KE resulted in plasma β-hydroxybutyrate concentrations of ~1.5 to 2.6 mM during exercise (P < 0.001). Plasma glucose and lactate concentrations were lower during KE compared with PLA (moderate-to-large effect sizes). Heart rate, RPE, and 15-m sprint times did not differ between trials. Run time to exhaustion was not different (P = 0.126, d = 0.45) between PLA (mean = 268 s, 95% confidence interval [CI] = 199-336 s) and KE (mean = 229 s, 95% CI = 178-280 s). Incorrect responses in a multitasking test increased from pre- to postexercise in PLA (mean = 1.8, 95% CI = -0.6 to 4.1) but not in KE (mean = 0.0, 95% CI = -1.8 to 1.8) (P = 0.017, d = 0.70).

Conclusion: Compared with carbohydrate alone, coingestion of a KE by team sport athletes attenuated the rise in plasma lactate concentrations but did not improve shuttle run time to exhaustion or 15-m sprint times during intermittent running. An attenuation of the decline in executive function after exhausting exercise suggests a cognitive benefit after KE ingestion.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • 3-Hydroxybutyric Acid / blood
  • Administration, Oral
  • Athletic Performance / physiology*
  • Blood Glucose / metabolism
  • Cognition / physiology*
  • Cross-Over Studies
  • Dietary Supplements* / adverse effects
  • Double-Blind Method
  • Executive Function / physiology
  • Exercise Test
  • Gastrointestinal Diseases / chemically induced
  • Heart Rate
  • Humans
  • Ketones / administration & dosage*
  • Ketones / adverse effects
  • Lactic Acid / blood
  • Male
  • Perception
  • Physical Exertion
  • Running / physiology*
  • Soccer / physiology


  • Blood Glucose
  • Ketones
  • Lactic Acid
  • 3-Hydroxybutyric Acid