Oral carbohydrate sensing enhances prefrontal cortex oxygenation, reduces perceived exertion, and improves high-intensity cycling performance: A randomized crossover trial

Clinical Snapshot

Key Findings

• P Value: p < 0.05 for DLPFC oxygenation; p < 0.001 for Stroop performance; p ≤ 0.01 for RPE differences

• Effect Size: Faster completion times, greater mean power output, and higher mean speed with CHO-MR versus comparators

• Primary Outcome: Enhanced bilateral DLPFC oxygenation with CHO-MR compared to MUS and PLA post-intervention and post-time trial

• Nnt Or Sensitivity: Not calculable from available data; effect sizes not quantified numerically

• Confidence Interval: Not reported in abstract

Clinical Application

Highly feasible - simple, low-cost interventions requiring minimal equipment or training Relevant for Sports Medicine Australia guidelines and high-performance sport programs; no TGA or PBS implications as non-pharmaceutical intervention Trained endurance athletes, particularly cyclists engaged in high-intensity time trial events

Abstract

PURPOSE: Carbohydrate mouth rinsing (CHO-MR) and music listening (MUS) are non-metabolic interventions proposed to attenuate cognitive and perceptual fatigue during exercise. However, their comparative effects on prefrontal cortical oxygenation, executive function, and perceived exertion during high-intensity endurance performance remain unclear. This study examined the effects of CHO-MR and MUS on dorsolateral prefrontal cortex (DLPFC) oxygenation, cognitive performance, perceived exertion, and cycling performance during a 4-km time trial (TT). METHODS: Eleven trained cyclists (7 men, 4 women) completed a randomized, single-blind, crossover trial under three conditions: CHO-MR, MUS (120 beats/min), and placebo mouth rinse (PLA). Bilateral DLPFC oxygenation was assessed using functional near-infrared spectroscopy at rest, during Stroop testing, post-intervention, and post-TT. Stroop performance, rating of perceived exertion (RPE); every 500 m, completion time, power output, heart rate, and blood lactate were measured. Outcomes were analyzed using generalized estimating equations adjusted for period, sequence, and first-order carryover effects with robust standard errors. RESULTS: CHO-MR increased bilateral DLPFC oxygenation compared with MUS and PLA at post-intervention and post-TT time points (p < 0.05), with no differences at rest or baseline. Stroop performance was superior in CHO-MR relative to MUS and PLA following the TT (p < 0.001), without between-condition differences at earlier assessments. RPE was lower in CHO-MR than PLA across all intervals (p ≤ 0.01) and lower than MUS at mid-trial distances (p < 0.05). CHO-MR resulted in faster completion times, greater mean power output, and higher mean speed compared with MUS and/or PLA (p < 0.05), whereas peak power, heart rate, and blood lactate did not differ among conditions. Pooled change-score analyses demonstrated positive associations between bilateral ΔDLPFC oxygenation (p < 0.001) and between ΔDLPFC oxygenation and ΔStroop performance (p < 0.05). CONCLUSION: CHO-MR enhances bilateral DLPFC oxygenation, preserves executive function, and reduces perceived exertion during high-intensity endurance exercise, translating into improved performance without detectable peripheral metabolic alterations. These findings support a central neurocognitive mechanism underlying the ergogenic effects of oral carbohydrate sensing. TRIAL REGISTRATION: ClinicalTrials.gov NCT07099807.

References

1. 1.Park, S. B., Oh, K., Yang, G., Kim, T., Lee, J. W., Jeon, H. J., & Han, D. H. (2026). Oral carbohydrate sensing enhances prefrontal cortex oxygenation, reduces perceived exertion, and improves high-intensity cycling performance: A randomized crossover trial. PLoS One. https://doi.org/10.1371/journal.pone.0349067