β2‐adrenergic agonists do not improve physical performance in healthy individuals

Beta2‐adrenergic agonists can enhance intense performance and muscle strength in healthy individuals

“…The claims are unsupported by the approach utilized, wherein only performance measures related to V O 2max and otherwise aerobicdominated performances were assessed. 1 As we highlight below, there is compelling and consistent evidence for beta 2 -agonists to enhance 'physical performance' of predominantly anaerobic character, such as short intense exercise performance (<1 min) and muscle strength.…”

“…To the Editor, Cardoso et al 1 claim that beta 2 -agonists do not improve 'physical performance' in healthy individuals, as stated in both the title and the conclusion of their paper. Their claim is based on a systematic review revealing no effect of beta 2 -agonists on aerobic-dominated performances, including maximal oxygen uptake (VO 2max ) and time to exhaustion during endurance-based exercise.…”

“…4 A recent comprehensive meta-analysis that included 44 randomized and placebo-controlled comparisons of common beta 2 -agonists in 323 participants concluded exactly this for muscle strength and intense exercise performance measures (<1 min) with estimated effect sizes of ≈6% and ≈3%, respectively, regardless of administration route (inhaled or oral). 4 We also wish to rectify the introductory paragraph of the paper by Cardoso et al, 1 which incorrectly states that: 'All beta 2 -agonists are prohibited by the World Anti-Doping Agency. However, its use may be permitted in athletes who are granted a therapeutic use exemption (TUE)'.…”

“…2 And just as a lack of effect of erythropoietin (EPO) on sprint power or muscle strength cannot be used to draw inferences on its effects on aerobic performance, it is also inappropriate to preclude a performance-enhancing effect of beta 2 -agonists on anaerobic performance based on VO 2max or other aerobic-dominated performance measures. Hence, the approach by Cardoso et al 1 cannot be used to support the authors' overreaching title or conclusion as VO 2max and time-to-exhaustion tests are but one aspect of 'physical performance'.…”

β2‐adrenergic agonists and doping: Where do we stand?

“…To the Editor, Hostrup et al 1 kindly commented on our previous paper related to the enhancement of physical performance by β2-agonists. 2 First, we would like to thank the authors for their review and acknowledge that our title and conclusions may have been misleading because, in fact, they only refer to endurance/aerobic-dominated performances. However, we were very clear that our results were based on VO2max and time to exhaustion at this intensity.…”