There has been much consideration over whether exogenous ketone bodies have the capacity to enhance exercise performance through mechanisms such as altered substrate metabolism, accelerated recovery, or neurocognitive improvements. This systematic review aimed to determine the effects of both ketone precursors and monoesters on endurance exercise performance. A systematic search was conducted in PubMed, SPORTDiscus, and CINAHL for randomized controlled trials investigating endurance performance outcomes in response to ingestion of a ketone supplement compared to a nutritive or nonnutritive control in humans. A meta-analysis was performed to determine the standardized mean difference between interventions using a random-effects model. Hedge’s g and 95% confidence intervals (CI) were reported. The search yielded 569 articles, of which eight were included in this review (80 participants; 77 men and three women). When comparing endurance performance among all studies, no significant differences were found between ketone and control trials (Hedges g = 0.136; 95% CI [−0.195, 0.467]; p = .419). Subanalyses based on type of endurance tests showed no significant differences in time to exhaustion (Hedge’s g = −0.002; 95% CI [−0.312, 0.308]; p = .989) or time trial (Hedge’s g = 0.057; 95% CI [−0.282, 0.395]; p = .744) values. Based on these findings, exogenous ketone precursors and monoesters do not exert significant improvements on endurance exercise performance. While all studies reported an increase in blood ketone concentrations after ingestion, ketone monoesters appear to be more effective at raising concentrations than precursors.

对于外源性酮体是否有能力通过改变底物代谢、加速恢复或神经认知改善等机制来提高运动表现，已经有很多考虑。本系统评价旨在确定酮前体和单酯对耐力运动表现的影响。在 PubMed、SPORTDiscus 和 CINAHL 中对随机对照试验进行了系统搜索，以调查与人类营养或非营养对照相比，摄入酮补充剂后的耐力表现结果。使用随机效应模型进行荟萃分析以确定干预措施之间的标准化平均差异。对冲的g报告了 95% 的置信区间 (CI)。搜索产生了 569 篇文章，其中 8 篇被纳入本综述（80 名参与者；77 名男性和 3 名女性）。在比较所有研究中的耐力表现时，酮试验和对照试验之间没有发现显着差异（Hedges g  = 0.136；95% CI [-0.195, 0.467]；p  = .419）。基于耐力测试类型的子分析显示力竭时间（Hedge's g  = -0.002; 95% CI [-0.312, 0.308]; p  = .989）或计时赛（Hedge's g  = 0.057; 95% CI [ -0.282, 0.395]；p = .744) 值。基于这些发现，外源酮前体和单酯不会显着改善耐力运动表现。虽然所有研究都报告摄入后血酮浓度增加，但酮单酯似乎比前体更有效地提高浓度。