Objectives We aimed to examine the effect of ß2-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 ß2-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 ß2-agonists comprising 323 participants in crossover trials, and 149 participants in parallel trials. In the overall analyses, ß2-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 ß2-agonists and 0.46 (95% CI 0.24 to 0.68) for prohibited ß2-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 ß2-agonists. Conclusion/implication: Our study shows that non-asthmatic subjects can improve sprint and strength performance by using ß2-agonists. It is uncertain, however, whether World Anti-Doping Agency (WADA)-approved doses of ß2-agonists improve performance. Our results support that the use of ß2-agonists should be controlled and restricted to athletes with documented asthma.
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