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Peer-reviewedCC BY 4.0Physiological Reports

Ketone monoester intake attenuates exercise performance decline in normobaric hypoxia: A post‐hoc subgroup analysis of 5 young male adults without acute mountain sickness

  • Myrthe Stalmans1,2
  • Domen Tominec3
  • Wout Lauriks1
  • Ruben Robberechts1,4
  • Monique Ramaekers1
  • Tadej Debevec3,5
  • Chiel Poffé1,4
5 affiliations
  1. 1Exercise Physiology Research Group, Department of Movement Sciences KU Leuven Leuven Belgium
  2. 2Department of Cellular and Physiological Sciences, Faculty of Medicine University of British Columbia Kelowna British Columbia Canada
  3. 3Faculty of Sport University of Ljubljana Ljubljana Slovenia
  4. 4REVAL—Rehabilitation Research Center, Faculty of Rehabilitation Sciences Hasselt University Diepenbeek Belgium
  5. 5Department of Automatics, Biocybernetics and Robotics Jožef Stefan Institute Ljubljana Slovenia
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Abstract

In hypoxia, endurance performance, sleep, and cognitive function are impaired. Ketone ester (KE) intake can elevate blood, brain, and skeletal muscle oxygenation, making it an interesting strategy to attenuate hypoxia‐induced impairments. Given that acute mountain sickness (AMS) influences these parameters, we evaluated the effects of KE intake in non‐AMS developing individuals. In a larger project, 14 young, healthy, male participants performed a 29‐h protocol at a simulated altitude of 4000–4500 m, involving regular KE or placebo intake. Five participants completed both sessions without developing severe AMS. They completed two maximal incremental cycling tests after 1.5 and 25 h (EXMAX1 and EXMAX2, resp.) and a combined maximal‐submaximal test after 26.5 h (EXCOMBO), while resting blood, brain, and skeletal muscle oxygenation and cognitive function were regularly (5‐6x) evaluated, and sleep was analyzed. KE did not alter peak power output (PPO) during EXMAX1 or EXMAX2, but increased PPO by 36 W during EXCOMBO. KE increased blood oxygenation before EXMAX1, EXMAX2, and EXCOMBO and increased muscle oxygenation only before EXCOMBO. Sleep and cognitive function were not affected by KE intake. In a non‐AMS developing subgroup, KE appears effective to attenuate high‐intensity endurance performance decline during subacute hypoxic exposure accompanied by repeated exercise until exhaustion.

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Cite

BibTeXRIS
BibTeX
@article{stalmans2026ketone,
  title = {{Ketone monoester intake attenuates exercise performance decline in normobaric hypoxia: A post‐hoc subgroup analysis of 5 young male adults without acute mountain sickness}},
  author = {Myrthe Stalmans and Domen Tominec and Wout Lauriks and Ruben Robberechts and Monique Ramaekers and Tadej Debevec and Chiel Poffé},
  journal = {Physiological Reports},
  year = {2026},
  month = oct,
  doi = {10.14814/phy2.71136},
  url = {https://doi.org/10.14814/phy2.71136},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Ketone monoester intake attenuates exercise performance decline in normobaric hypoxia: A post‐hoc subgroup analysis of 5 young male adults without acute mountain sickness
AU  - Myrthe Stalmans
AU  - Domen Tominec
AU  - Wout Lauriks
AU  - Ruben Robberechts
AU  - Monique Ramaekers
AU  - Tadej Debevec
AU  - Chiel Poffé
PY  - 2026
DA  - 2026/10/27
JO  - Physiological Reports
DO  - 10.14814/phy2.71136
UR  - https://doi.org/10.14814/phy2.71136
AB  - In hypoxia, endurance performance, sleep, and cognitive function are impaired. Ketone ester (KE) intake can elevate blood, brain, and skeletal muscle oxygenation, making it an interesting strategy to attenuate hypoxia‐induced impairments. Given that acute mountain sickness (AMS) influences these parameters, we evaluated the effects of KE intake in non‐AMS developing individuals. In a larger project, 14 young, healthy, male participants performed a 29‐h protocol at a simulated altitude of 4000–4500 m, involving regular KE or placebo intake. Five participants completed both sessions without developing severe AMS. They completed two maximal incremental cycling tests after 1.5 and 25 h (EXMAX1 and EXMAX2, resp.) and a combined maximal‐submaximal test after 26.5 h (EXCOMBO), while resting blood, brain, and skeletal muscle oxygenation and cognitive function were regularly (5‐6x) evaluated, and sleep was analyzed. KE did not alter peak power output (PPO) during EXMAX1 or EXMAX2, but increased PPO by 36 W during EXCOMBO. KE increased blood oxygenation before EXMAX1, EXMAX2, and EXCOMBO and increased muscle oxygenation only before EXCOMBO. Sleep and cognitive function were not affected by KE intake. In a non‐AMS developing subgroup, KE appears effective to attenuate high‐intensity endurance performance decline during subacute hypoxic exposure accompanied by repeated exercise until exhaustion.
SN  - 2051-817X
ER  -