Received: 6 December 2019

| Revised: 28 June 2020

| Accepted: 9 July 2020

DOI: 10.1111/sms.13776

ORIGINAL ARTICLE

Caffeine increases strength and power performance in resistance-

trained females during early follicular phase

Martin Norum1 | Linn Christin Risvang1,2 | Thomas Bjørnsen3,4 |

Lygeri Dimitriou1,5 | Per Ola Rønning2 | Morten Bjørgen | Truls Raastad7
6

1
School of Science and Technology,
London Sport Institute, Middlesex
The effects of 4 mg·kg−1caffeine ingestion on strength and power were investigated
University, London, UK for the first time, in resistance-trained females during the early follicular phase utiliz-
2
Department of Mechanical, Electronics ing a randomized, double-blind, placebo-controlled, crossover design. Fifteen females
and Chemical Engineering, Faculty
(29.8 ± 4.0 years, 63.8 ± 5.5 kg [mean ± SD]) ingested caffeine or placebo 60 min-
of Technology, Art and Design, Oslo
Metropolitan University, Oslo, Norway utes before completing a test battery separated by 72 hours. One-repetition maximum
3
Department of Sport Science and (1RM), repetitions to failure (RTF) at 60% of 1RM, was assessed in the squat and
Physical Education, Faculty of Health bench press. Maximal voluntary contraction torque (MVC) and rate of force devel-
and Sport Sciences, University of Agder,
Kristiansand, Norway
opment (RFD) were measured during isometric knee extensions, while utilizing in-
4
Norwegian Olympic and Paralympic terpolated twitch technique to measure voluntary muscle activation. Maximal power
Committee and Confederation of Sports, and jump height were assessed during countermovement jumps (CMJ). Caffeine me-
Oslo, Norway
tabolites were measured in plasma. Adverse effects were registered after each trial.
5
Department of Natural Sciences, School
Caffeine significantly improved squat (4.5 ± 1.9%, effect size [ES]: 0.25) and bench
of Science and Technology, Middlesex
University, London, UK press 1RM (3.3 ± 1.4%, ES: 0.20), and squat (15.9 ± 17.9%, ES: 0.31) and bench
6
Department of Life Sciences and press RTF (9.8 ± 13.6%, ES: 0.31), compared to placebo. MVC torque (4.6 ± 7.3%,
Health, Faculty of Health Sciences, Oslo ES: 0.26), CMJ height (7.6 ± 4.0%, ES: 0.50), and power (3.8 ± 2.2%, ES: 0.24) were
Metropolitan University, Oslo, Norway
7
also significantly increased with caffeine. There were no differences in RFD or mus-
Department of Physical Performance,
Norwegian School of Sport Sciences, Oslo, cle activation. Plasma [caffeine] was significantly increased throughout the protocol,
Norway and mild side effects of caffeine were experienced by only 3 participants. This study
demonstrated that 4 mg·kg−1 caffeine ingestion enhanced maximal strength, power,
Correspondence
Linn Christin Risvang, Department of and muscular endurance in resistance-trained and caffeine-habituated females dur-
Mechanical, Electronics and Chemical ing the early follicular phase, with few adverse effects. Female strength and power
Engineering, Faculty of Technology, Art
and Design, Oslo Metropolitan University,
athletes may consider using this dose pre-competition and -training as an effective
Oslo, Norway. ergogenic aid.
Email: [email protected]
KEYWORDS
caffeine supplementation, female athletes, muscular activation level, muscular endurance, strength
and power performance

Martin Norum and Linn Christin Risvang should be considered joint first authors.

This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original
work is properly cited.
© 2020 The Authors. Scandinavian Journal of Medicine & Science In Sports published by John Wiley & Sons Ltd

2116 | 
wileyonlinelibrary.com/journal/sms Scand J Med Sci Sports. 2020;30:2116–2129.
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NORUM et al.    2117

1 | IN T RO D U C T IO N controlled for potential metabolic alterations across the

menstrual cycle, making it difficult to conclude on the ef-
Caffeine (1,3,7-trimethylxanthine) is the most widely used fects of caffeine on power in females. Moreover, a recent
legal drug in the world, by the general as well as athletic pop- study found differences in the effect of caffeine on power
ulations,1 and researchers’ interest in the effects of caffeine performance between the phases in the menstrual cycle.17
on exercise performance is apparent in light of multiple re- It, therefore, seems important to control for stages in the
views of the literature published in the recent years.2-5 These menstrual cycle to further establish clear recommendations
reviews currently agree that caffeine is a potent ergogenic aid for the use of caffeine in females. The early follicular phase
for a variety of exercise performances; however, the effects of of the menstrual cycle has shown the lowest variability in
caffeine on maximal strength and power performance are less oestradiol and progesterone concentration,18 and the sex
clear. Meta-analyses by Warren et al6 and Polito et al7 showed hormone levels in this phase are similar to the levels in
that caffeine ingestion can increase isometric strength and females using hormone contraceptives.19 Furthermore, a
muscular endurance performance. However, Polito et al7 recent study found that the fluctuations in sex hormones
could not observe improved dynamic strength with caffeine throughout the menstrual cycle affect neuromuscular func-
supplementation, and a recent meta-analysis by Grgic et al4 tion.20 Hence, conducting caffeine research on females
only found increased performance in upper but not lower would benefit from being performed at the same stage of
body dynamic strength. On the other hand, increased mus- the menstrual cycle and can reliably be performed during
cular endurance has been demonstrated with larger effect the early follicular phase.
sizes in lower body rather than upper body exercises.7 The The underlying mechanisms by which caffeine may aid
conflicting results could be due to varying effect of caffeine maximal strength and power are likely increased motor unit
on different types of contractions, as the contribution of cor- recruitment and voluntary muscle activation of the involved
tical and spinal centers to the neural drive changes with the muscles.6,21,22 However, there seem to be discrepancies in
contraction type.8 Hence, further research is warranted to in- the caffeine effect on strength and power that corresponds
vestigate the effect of caffeine on maximal isometric versus to varying degree of baseline voluntary activation. Larger
dynamic strength, power, and muscular endurance, as well as lower body muscles such as knee extensors seem to have a
comparing lower and upper body muscle groups. relatively low (85%-95%) muscle activation level compared
A recent review of the caffeine literature found that only to the small upper body muscles (90%-99%),6 such as elbow
~13% of the total sample in research on the ergogenic effect flexors.23 These differences in baseline muscle activation
of caffeine between 1978 and 2018 were women and that may influence the magnitude of the caffeine effect. As
the number of women in studies investigating caffeine ef- Warren et al6 discuss in their meta-analysis, logically there
fects on speed and muscle power is very low.9 A likely ex- will be more to improve with lower baseline muscle activa-
planation for this difference in representation of the sexes tion levels, that is, larger lower body muscles might have
is that females can be a slightly more challenging cohort a greater effect of caffeine. Correspondingly, strength and
to conduct caffeine research on. The use of oral contracep- power improvements with caffeine have been reported in
tives10 and the large variations in hormone concentrations this pattern.6 However, one study in females shows the quite
between phases of the menstrual cycles11 can alter caffeine opposite pattern, that is, caffeine-induced improvements of
metabolization speeds,12 which in turn may alter the ergo- upper body but not lower body maximal strength, although
genic effects of caffeine. Indeed, significant sex differences this needs further investigation.16 Perceived pain and exer-
have been reported in caffeine concentrations post-exercise tion during exhaustive resistance work have been thought
with ingestion of 3 mg/kg caffeine, with females having a to be reduced, and thereby improving performance, through
greater amount. This suggests that females do not metab- caffeine's inhibitory binding to adenosine receptors.21
olize caffeine as rapidly as males. Furthermore, variations However, caffeine's effect on intra-set ratings of perceived
in strength and power have been demonstrated through- exertion seems under-investigated compared to post-fatigue
out the menstrual cycle,13 which can cause noise in per- ratings, although Doherty et al's meta-analysis24 observed
formance data and affect overall results. Taken together, that a ~5% reduction in intra-set ratings of perceived ex-
although there are a number of studies demonstrating that ertion (RPE) explained about a third of the variance in
caffeine clearly has an ergogenic effect in females,9,14-16 the exhaustive work between caffeine and placebo. Moreover,
information about the effect of caffeine on muscle perfor- the contribution of muscle activation to increased strength
mance in women is uncertain, especially in strength and and power, comparison of upper and lower body maximal
power performance. As an example, a recent meta-sub- strength and effects on RPE and pain has to the authors’
group analysis examined the effects of caffeine on muscle knowledge, not been investigated specifically with moder-
power in females for the first time.4 However, only three ate caffeine doses in resistance-trained females while con-
studies examining vertical jumps were included and neither trolling for menstrual cycle.
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2118    NORUM et al.

Only three studies have investigated the effects of caf- 2.2 | Study design
feine doses <6 mg·kg−1 on strength performance in fe-
males.16,25,26 Goldstein et al27 and others4 have specifically A randomized, double-blind, placebo-controlled crossover
proposed that future research should examine the ergogenic design was used to investigate the effects of 4 mg·kg−1 caf-
effects of lower doses of caffeine. Several studies have feine on strength and power performance. The participants
reported severe side effects such as “intense emotional attended four sessions; two familiarizations to all procedures
responses,” tremor, heart palpitations, and tachycardia (except blood sampling) and to the test battery, and two tri-
when supplementing with relatively high doses of caffeine als. However, three familiarization sessions were performed
(6-11 mg·kg−1).27-29 A lower caffeine dose could induce when the variation between the two first familiarization ses-
similar performance enhancements but with fewer adverse sions exceeded a coefficient of variation (CV) of 10% (total
events, which would be an advantage, especially to compet- number of participants completing three familiarizations for
ing strength and power athletes. one of the tests, n = 8). Participants were instructed to re-
Thus, the main purpose of the present study was to in- frain from alcohol, caffeine, and vigorous physical activity
vestigate, for the first time, the effects of 4 mg·kg−1 caffeine 48 hours prior to the trials and were provided with a detailed
on various strength and power measures in resistance-trained list of items containing caffeine, such as coffee, chocolate,
females during the early follicular phase. We hypothesized tea, soda, and energy drinks. All participants recorded their
a caffeine-induced increase in maximal strength and muscu- weekly intake of these products using a caffeine frequency
lar activation levels, vertical jump height, as well as in mus- questionnaire to calculate their habitual caffeine intake
cular endurance, compared to placebo ingestion. Secondary (Table 1), and were classified as low, medium, or high caf-
outcomes of the study were intra-set ratings of perceived feine consumers based on habitual intakes (<1.5, 1.5-5.0 and
exertion, perceived pain, plasma caffeine concentration, ha- >5.0 mg·kg−1·d−1, respectively).30 They also completed a 24-
bituation, and adverse effects. hour food diary (MyFitnessPal®, MyFitnessPal, Inc) prior to
the first trial and replicated the food intake prior to the second
trial to ensure minimal variation in hydration level and en-
2 | METHODS ergy intake. Body composition was assessed by bioelectrical

2.1 | Participants TABLE 1 Participant characteristics.

Mean ± SD Range
Fifteen caucasian female volunteers (age: 29.8 ± 5.5 years;
a
stature: 165.8 ± 4.8 cm; body mass: 63.8 ± 5.5 kg Fat-free mass (kg) 52.3 ± 5.2 44.4-63.2
a
[mean ± SD]) completed this study (Table 1). Nine of the Fat mass (kg) 11.3 ± 4.0 4.9-21.2
25 recruited participants dropped out after randomization due Fat mass (%)a 17.7 ± 5.8 8.1-32.3
to logistical issues, and one was excluded due to intake of a Hormone contraceptive use (n - %) 10 66.7
source of caffeine unknown to participant and researchers. RE experience (y) 7±5 2-16
Resistance-trained participants (recreational lifters, personal
RE frequency (sessions·wk−1) 4±1 2-5
trainers, and functional fitness athletes) were recruited fol-
Squat 1RM (kg)b 97 ± 13 75-115
lowing these inclusion criteria: (a) 18-45 years old; (b) resist-
Squat 1RM (kg·bw−1) 1.5 ± 0.2 1.2-1.8
ance-trained for minimum 12 months, 2-3 sessions/week and
currently resistance training; (c) ability to perform squat and Bench press 1RM (kg)b 66 ± 10 50-82
−1
bench press with a load corresponding to 110% and 80% of Bench press 1RM (kg·bw ) 1.0 ± 0.2 0.8-1.3
their current body mass, respectively, and (d) familiar with Energy (kcal)c 2208 ± 509 1473-
the bench press and back squat exercises (performed at least 3497
one time/wk). Participants were excluded if they were smok- Protein (g·d−1)c 143 ± 37 67-210
ers, pregnant, or lactating, were adversely affected by caf- Carbohydrate (g·d−1)c 209 ± 54 130-301
feine, used medicines and/or other ergogenic supplements, Fat (g·d−1)c 84 ± 39 40-182
had history of recent injury, illness or other diseases that Caffeine (mg·d−1)d 341 ± 184 54-692
could affect measurements. Participants signed a written in-
Note: Range: min-max.
formed consent and completed a Physical Activity Readiness
Abbreviations: 1RM, one-repetition maximum; RE, resistance exercise.
Questionnaire (PAR-Q). Ethical approval was obtained from a
Measured with InBody720.
the research ethics committee of London Sports Institute, b
Based on the maximal 1RM across the two familiarizations.
Middlesex University (London, UK) and the Norwegian c
Mean habitual intakes from a 24-h food diary prior to each test day.
School of Sport Science (Oslo, Norway). The project was ap- d
Habitual caffeine intake questionnaire.
proved by the Norwegian Centre for Research Data.
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NORUM et al.    2119

impedance analysis (InBody 720, InBody Co., Ltd) follow- 1.5 g·kg−1 banana (0.35 g·kg−1 carbohydrate). All participants
ing (a) 24 hours without vigorous exercise, (b) minimum performed a standardized warm-up for 10 minutes by cycling
2 hours fasting, and (c) emptying the bladder. on a stationary bicycle at ~100 W at 80-90 RPM (Monark,
Both trials were performed at the same time of day, ap- Ergomedic 828E), followed by a standardized 5 minutes rest,
proximately 1 week after familiarization. The participants and were equally verbally encouraged to perform to the best
performed the caffeine and placebo trials at individually of their abilities during all tests. The participants completed
standardized test times, which was self-selected to corre- questionnaires about their preparation adherence, withdrawal
spond with the participant's habitual training schedule. The symptoms, and the Brunel Mood score (BRUMS) 24-item
trials were interspersed by 72 hours to ensure treatment wash- questionnaire31 prior to the protocol and an end-of-trial ques-
out, allow for recovery and for both trials to be completed tionnaire about adverse effects and blinding, where the par-
within the early follicular phase of the menstruation cycle ticipants were asked to state if they believed they had received
as previously used by Chen et al15 This is when the concen- caffeine, placebo or were unsure, after completion of the test
tration and variation in estrogen and progesterone are low- battery and final blood sampling.
est as compared to other the phases of the menstrual cycle.18
Participants using hormone contraceptives were included, as
these show very similar levels of estrogen and progesterone 2.4 | Supplementation
to the levels during the early follicular phase.19 Confirmation
of a new menstruation cycle was obtained from each partici- Treatment was given 60 minutes prior to testing, allowing
pant prior to confirming trial day 1. peak plasma levels of caffeine to coincide with testing.1 The
treatments were administered as 150 mL non-caloric Fun
Light© cordial concentrate from an opaque bottle. To pre-
2.3 | Experimental protocol pare the caffeine treatment, 4 mg·kg−1 anhydrous caffeine
(Caffeine, ReagentPlus®, Sigma-Aldrich) was dissolved in
All participants performed the test battery in the same order the cordial concentrate with heat to ensure complete disso-
each day within the set amount of time of 210 minutes, in- lution of the caffeine. Both treatments were equal in color,
cluding rest intervals and breaks, estimated from pilot testing taste, and volume due to not diluting the cordial. The drink
(Figure 1). Upon arrival, participants provided a urine sample was rapidly ingested immediately followed by another 150-
for visual assessment of hydration status (The Urine Colour mL cordial from a separate cup to conceal any potential
Chart®, Human Hydration, LLC). If the urine color chart in- bitter taste and rinse the mouth of caffeine residues. An inde-
dicated a score of 5 or below, the participants were provided pendent researcher randomized treatment order, mixed, and
250-500 mL of water to improve hydration levels prior to con- administered the treatments and held the key to the randomi-
tinuing the protocol. In addition, 4 mL blood was collected zation until the end of the study.
from the cubital fossa veins (Vacuette® Multiple use draw-
ing needle; Vacuette® tube, 4 mL K2EDTA, Greiner Bio-One
GmbH). Blood was further collected at 60 and 270 minutes 2.5 | Measurements
following treatment ingestion. Subsequently, height and body
mass were measured (SECA stadiometer, Model 213; SECA 2.5.1 | Countermovement jump
weight scale 876, respectively). All participants received a
standardized meal 45 minutes prior to testing, consisting of Participants performed the countermovement jump (CMJ)
0.4 g·kg−1 whey protein powder (0.36 g·kg−1 protein) and to assess jump height (cm), maximal power (W) and

F I G U R E 1 Experimental protocol
timeline. Overview of the experimental
protocol. In addition, urine was observed at
arrival for visual hydration status estimation
with the urine color chart. 1RM, one-
repetition maximum; BP, bench press; CMJ,
countermovement jump; ITT, interpolated
twitch technique; MVC, maximal voluntary
isometric contraction; SQ, squat; RTF,
repetitions to failure
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2120    NORUM et al.

maximal force (N). Participants were instructed to stand beginning and ending with an un-evoked contraction. The
on a force plate (FP4, HUR Labs OY, Hur AB) with hands maximal voluntary activation level across the two attempts
kept on their hips with legs shoulder width apart while ex- is presented. The peak torque of un-evoked MVCs controlled
ecuting a maximal vertical jump, from an upright position whether the evoked were in fact maximal contractions and
to a self-selected depth immediately prior to jumping. To contractions with torque prior to stimulus below 80% of peak
warm-up, three submaximal CMJ trials with approximately torque were defined as submaximal and excluded from fur-
50%, 75%, and 90% intensity were performed with 1-min- ther calculation of activation level (n = 6). Two self-adhesive
ute breaks. After another 2 minutes rest, maximal effort surface electrodes (Veinoplus, 8 × 13 cm, Oval shape, Ad
CMJ trials with 2 minutes rest between each trial were Rem Technology) were positioned over the quadriceps of the
performed for at least 3 sets. If the third set resulted in right leg, one proximally and one distally, in a medial-lateral
an improved jump height compared to the second, the par- position to target as many muscle bellies as possible. An in-
ticipants were allowed to continue until a set resulted in a tensity test was performed in rested state after the warm-up,
decline in performance. Jump height was determined as the to determine the stimulus output level for the ITT. The stim-
center of mass displacement, calculated from take-off force uli were given as 200 µs, 400 V single-imposed signals from
development and force plate-measured body mass with the a digitimer (Digitimer DS7AH HV Constant current stimu-
provided software (Force Platform Software Suite, Version lator, Digitimer Ltd.), with successive increments until the
2.6.51). The single best result was noted and used for sta- evoked force amplitude was no larger than the previous. To
tistical analysis. Test-retest measurements revealed a CV ensure maximal evoked force, a 10% increase was added to
of 9.7%, 5%, and 6% for jump height, maximal power, and the stimulus output, equating totally to 660-990 mA. Four
maximal force, respectively. “singlet” stimulations about 5 seconds apart and one dou-
ble-imposed stimulus at this output were given as familiar-
ization with the stimuli. The “doublet” was given as a 10 ms,
2.5.2 | Maximal isometric strength, 100 Hz-stimulus (Digitimer DG2A Train/Delay Generator,
muscular activation level, and RFD Digitimer Ltd.) and was used during the evoked MVC.
The MVC was evoked at the peak of contraction, about
Peak torque, muscular activation level, and RFD were 0.5 seconds after initiation, and again as the quadriceps had
measured by maximal voluntary isometric contractions relaxed and the force curve had returned to baseline. The
(MVC) of the right knee extensor muscles, while seated percentage muscle activation level was determined with the
in a knee extension machine (Knee extension, Gym2000; following equation32:
Software: Acq Knowledge 4.4, Biopac systems Inc) in-
strumented with a load cell (U2A, Hottinger Baldwin ⎛
� Mean force
MVC pre − stimulus
�
⎞
Messtechnik GmbH). The seat was adjusted to 100- and ⎜D× ⎟
(1)
Peak forceMVC
Muscle activation % = 100 − ⎜ ⎟ × 100
90- degrees hip and knee flection, respectively, the mo- ⎜ Peak force Evoked at rest ⎟
⎝ ⎠
ment arm pad proximal to the ankle and the knee axis of
rotation coincided with that of the apparatus. The partici-
pants were strapped across the hip, chest, and ankle of the where D is the difference between the voluntary and evoked
right leg to minimize any joint movement. Adjustments force:
were recorded to ensure consistent positioning between tri-
als. All participants were instructed to contract as hard and D = Peak forceEvoked MVC − Mean forceMVC pre − stimulus
as rapidly as possible. After three submaximal warm-up
contractions (~50%, 75%, and 90%), five MVCs were per- If submaximal voluntary force was achieved during the
formed with 60 seconds rest intervals. Peak torque, defined evoked contractions, the calculated muscle activation % was
as the maximum voluntarily achieved value across the five corrected by replacing Peak forceMVC in Equation (1) with the
MVCs, was used in the data analyses. RFDmax, defined as peak force across the un-evoked contractions. Test-retest mea-
the maximum positive change of force over 10 ms intervals surements revealed a CV of 9.7%, 7.1%, and 18.3% for peak
from initiation of contraction, as well as torque at 100 ms torque, muscle activation level, and RFDmax, respectively.
(from initiation of contraction) was extracted from the soft-
ware. The recordings had a sampling frequency of 1000 Hz
and were smoothed with a moving average of 10 samplings 2.5.3 | 1-repetition maximum
before analyses.
Of the five MVCs, three were un-evoked and two were The participants completed 1-repetition maximum (1RM) in
evoked utilizing the interpolated twitch technique (ITT).32 the squat followed by bench press (T-100G, Eleiko Sport).
The MVCs were performed in an alternating fashion, A standardized warm-up was performed consisting of three
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NORUM et al.    2121

sets with gradually increasing load (50-75-90% of maximal Scientific, Thermo Electron LED GmbH) before transferring
familiarization 1RM) and declining number of repetitions (8- plasma to two 1.5 mL micro tubes (MCT-150-C, Axygen, Inc
4-1). After 2 minutes rest, the first attempt was performed at for storage at −80°C until further preparation and analyses.
95% of maximal familiarization 1RM. After each success- Samples were analyzed in duplicate with reverse phase
ful attempt and 3-minute rest periods, the load was increased LC-MS (Dionex Ultimate HPLC 3000 system; Agilent TOF
by 0.5%-5% (smallest increment 0.5 kg) until the participant 6230, positive electrospray ionization [ESI]), based on the
reached voluntary failure. If the lift was unsuccessful, the method used by Chen et al.33 We were not able to separate
load was decreased (0.5%-5%) for another attempt until 1RM paraxanthine and theophylline; hence, all paraxanthine anal-
was determined. The bench press 1RM test was performed yses included small contributions (~4% of total caffeine me-
in the same manner with a preceding 5-minute rest follow- tabolites concentration) from theophylline.34 Individually
ing the squat RTF test (Figure 1). A Smith rack was used to prepared quality control samples at three concentration levels
prevent substantial change in the technique during the squats. and a blank sample were included in each run of the plasma
Intra-individual control of equipment utilized (limited to analyses. Limit of detection (LOD) and limit of quantifica-
weight lifting shoes, belt, wrist support, and knee sleeves), tion (LOQ) were determined based on signal-noise ratio to
squat stance and bar position, bench press set up, and grip be <0.008 μg·mL−1 and <0.05 µg·mL−1, respectively. In all
distance that the participants were accustomed to were noted samples where the analytes were non-detected or estimated
and reproduced in the second trial. The CV for this test was <LOQ, values were substituted with worst case scenarios
2.3% for squats and 2.4% for bench press, and number of at- equal to LOD and LOQ, respectively, that is biased high,
tempts were 4-6 and 3-5, respectively. to enable statistical analyses comparing baseline to 60- and
270 minutes.

2.5.4 | Muscular endurance and perceived

exertion and pain 2.7 | Statistical analyses

Repetitions to failure (RTF) were performed with 60% of The sample size was calculated using a priori t tests for
maximal familiarization 1RM to ensure equal absolute load. paired samples to ensure sufficient statistical power in
The repetitions were counted out loud and a smart phone the main analyses (G*Power version 3.1, Heinrich-Heine
metronome application (Tap Metronome v1.2.1, Daniel University).35 With α-level set at 0.05 for the main outcomes
Soper) was set to 15 BPM/4-seconds intervals to standard- and a 1-β error probability of 0.8, we used the mean and
ize the repetitions. The technical requirements were (a) depth SD from Goldstein et al27 to calculate the sample size. Ten
equating to hips below parallel and maintaining an upright participants were needed to detect a true mean difference in
torso position, and (b) a controlled change of direction and 1RM strength of 0.8 kg (1.54% difference). Due to an ex-
fully extended arms in the top position, for squats and bench pected drop out of 25%, we aimed to recruit a minimum of 15
press, respectively. If unable to complete a repetition within subjects for the present study.
the two metronome signals, the following repetition had to All variables’ distributions were tested with the Shapiro-
be completed in time, otherwise the previous repetition was Wilks normality test and assessing skewness, kurtosis, and
counted as the last. Failure was otherwise defined as failure histograms. Paired sample t tests and Wilcoxon signed-rank
to complete the repetition at all. The CV for this test was tests were performed on paired differences with Gaussian
2.0% for squats and 2.4% for bench press. and non-Gaussian distribution, respectively, and P < .05
From pilot testing and previous studies at 60% of 1RM,25,27 was considered statistically significant. Values are given as
it was expected that the participants would complete over mean ± SD and median (confidence interval) for parametric
20 repetitions in both the squat and bench press RTF test. and non-parametric tests, respectively. To assess “practical”
Following repetition 10, the participants gave ratings of per- significance, Hedge's g values were calculated with weighted
ceived exertion from the 11-point Borg RPE C-10 scale (0 and pooled SD’s and adjustment for samples n < 50. Effect
[rest] to 10 [maximal exertion]). Perceived pain was rated size cutoffs were defined as <0.25, 0.25-0.5, 0.5-1.0, and
from the 11-point NRS perceived pain scale (0 [no pain] to >1.0 for trivial, small, moderate, and large effect sizes, re-
10 [worst imaginable pain]) immediately after the RTF tests. spectively.36 Values are given as mean ± SD and as median
(confidence interval) for parametric and non-parametric tests,
respectively. The ergogenic effects of caffeine dependent of
2.6 | Plasma analysis order of trials and caffeine identification were assessed with
unpaired t tests. Pearson r correlation was assessed between
All samples were centrifuged for 10 minutes at 3000 rpm, habitual caffeine intakes and delta caffeine effects. CV for the
1700 g, and 4°C (Heraeus Megafuge 16R, ThermoFisher main outcomes was calculated from the two familiarizations
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2122    NORUM et al.

and the last familiarization and the placebo trial, and the 3.1 | Countermovement jump
largest was consistently chosen throughout. Statistical anal-
yses were performed using GraphPad Prism 7.0 (GraphPad The mean CMJ jump height, maximal power, and maximal
Software, Inc). force across the two trials were 33 ± 2 cm, 2893 ± 74 W,
and 1570 ± 26 N, respectively. Jump height and peak power
increased by 2.3 ± 1.1 cm (7.6 ± 4.0%) and 105 ± 63 W
3 | R ES U LTS (3.8 ± 2.2%), respectively (Table 2; Figure 3). No difference
was observed in peak force.
There were no significant differences in the macronu-
trient intake prior to each of the trials (carbohydrate
[P = .39], fat [P = .62], protein [P = .59]) and overall 3.2 | Maximal isometric strength, rate of
energy intake (P = .77), or in withdrawal symptoms (all force development, and muscle activation level
P > .16) or BRUMS mood score on commencement of
either trials (all P > .42). On the post-trial question about The mean peak torque, RFDmax, and activation level across
which treatment the participants thought they received, the two trials were 177 ± 6 Nm, 19 ± 1 Nm·10 ms−1, and
seven participants (44%) correctly guessed the treatment 86 ± 1% muscle activation, respectively. Caffeine signifi-
order (ie, correctly guessed both conditions), stating rest- cantly increased peak torque of the knee extensors by 11 Nm
lessness, heart palpitations, and or increased energy and (CI: 2-18 Nm), corresponding to 4.6 ± 7.3%, compared to
motivation as reasons for guessing caffeine. However, placebo (Figure 2). No difference was observed with caf-
10 participants (66%) total correctly identified caffeine feine on muscle activation level (−2 ± 4%, n = 9, Figure 2),
independent of identifying placebo. No differences were RFDmax (1.1 ± 4.9 Nm·10 ms−1 [9.2 ± 26.5%], Figure 3), or
observed in the effects of caffeine between the identifiers torque at 100 ms (−2.9 ± 26.2 Nm, Table 2). Six participants,
and non-identifiers of the caffeine condition (all P > .20, in one or both of the trials, had a substantially lower force
see Appendix Table A1) or by the order of trials (all output during the evoked MVC than the unevoked MVC. The
P > .13, see Appendix Table A2). All performance and force output during the evoked MVC was 26%-78% of the
plasma caffeine concentration data are shown in Tables 2 peak torque contraction in these six participants, whom were
and 3, respectively. excluded from the statistical analyses.

TABLE 2 The effect of caffeine on performance outcomes

Mean of Effect
Performance outcomes Placebo Caffeine Δ ± SD 95% CI P-value size- Magnitude
CMJ jump height (cm) 32.0 ± 4.7 34.3 ± 4.5 2.3 ± 1.1 1.7, 2.9 <.001 0.44 - Small
CMJ peak power (W) 2840 ± 430 2946 ± 430 105 ± 63 71, 140 <.0001 0.21 - Trivial
CMJ peak force (N) 1550 ± 247 1588 ± 247 37 ± 96 −16, 91 .16 0.13 - Trivial
MVC peak torque (Nm) 173 ± 29 181 ± 31 11a 2, 18 .02 0.23 - Trivial
MVC activation level (%) [n = 9] 87 ± 5 85 ± 5 −2 ± 4 −5, 1 .16 −0.35 - Small
MVC RFDmax (Nm.10 ms−1) 15 ± 5 17 ± 6 2±5 −0.5, 4.5 .10 0.34 - Small
MVC Torque100ms (Nm) 75 ± 24 72 ± 29 −3 ± 26 −17, 12 .67 −0.09 - Trivial
1RM Squat (kg) 96 ± 14 100 ± 13 4±1 3, 5 <.001 0.27 - Small
RTF Squat (repetitions) 39 ± 17 45 ± 17 5.8 ± 6.2 2, 9 .003 0.27 - Small
a
RPE Squat rep 10 6±1 6±1 −1 −1, 1 .67 0.05 - Trivial
PP Post-squat 8±1 9±2 0a −1, 0 .60 0.07 - Trivial
1RM Bench press (kg) 66 ± 10 68 ± 11 2±1 2, 3 <.001 0.18 - Trivial
RTF Bench press (repetitions) 21 ± 6 23 ± 6 2±3 0, 3 .01 0.27 - Small
RPE Bench press rep 10 7±1 7±1 0a −1, 1 >.99 0.09 - Trivial
a
PP Post-bench press 8±2 7±1 0 −1, 0 .14 0.27 - Small
a
Note: Values are presented as mean ± SD or median and 95% confidence intervals.
Abbreviations: 1RM, one repletion maximum; CI, 95% confidence interval; CMJ, countermovement jump; Δ, difference between trials; MVC, maximal voluntary
contractions; PP, perceived pain; RPE, rating of perceived exertion; RTF, repetitions to failure.
a
Non-Gaussian distributed paired differences tested with Wilcoxon paired rank test.
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NORUM et al.    2123

TABLE 3 The effect of caffeine on plasma concentrations

Caffeine Placebo

Analyte Baseline 60 min 270 min Baseline 60 min 270 min

−1 a,c a,b,c
Caffeine (μg·mL ) 0.0 ± 0.1 3.6 ± 0.8 3.1 ± 0.9 0.1 ± 0.2 0.1 ± 0.1 0.0 ± 0.0
−1 a,c a,b,c
Paraxanthine (μg·mL ) 0.1 ± 0.1 0.8 ± 0.4 1.7 ± 0.8 0.1 ± 0.2 0.1 ± 0.1 0.2 ± 0.2
−1 a a,b c a
Theobromine (μg·mL ) 0.0 ± 0.0 0.5 ± 0.1 0.7 ± 0.1 0.2 ± 0.3 0.6 ± 0.4 0.8 ± 0.4a
−1 a,c a,b,c c
TC (μg·mL ) 0.2 ± 0.3 4.9 ± 0.9 5.6 ± 1.0 0.4 ± 0.6 0.8 ± 0.6 1.0 ± 0.6a
Note: All baseline and placebo mean values are based on several substituted values for non-detected and non-quantifiable measurements equal to limit of detection
and limit of quantification, respectively, and thus, should be interpreted with caution. Paraxanthine concentrations include a small contribution of the metabolite
theophylline.
Values are presented as mean ± SD.
Abbreviation: TC, total concentration of metabolites.
a
Different from within condition baseline (P < .05).
b
Different from within condition 60 min (P < .05).
c
Different from between condition corresponding time-point (P < .05).

F I G U R E 2 Effect of caffeine on
maximal strength and activation level.
Individual results (dotted lines) and
mean ± CI (solid lines) are presented for (A)
squats; and (B) bench press 1RM; (C) MVC
peak torque and (D) MVC activation level
of the knee extensors (n = 9). *Significantly
different from placebo (P < .05). CI,
95% confidence interval; MVC, maximal
isometric voluntary contraction

3.3 | 1-repetition maximum and bench press RTF by 1.8 ± 2.5 repetitions (9.8 ± 13.6%),
compared to placebo (Table 2; Figure 4). No differences be-
The mean absolute weight lifted across the two trials tween trials were found in intra-set RPE at repetition 10 or in
was 98.4 ± 2.4 kg and 66.6 ± 1.5 kg for squat and bench at-failure perceived pain (Table 2).
press, respectively. Compared to placebo, caffeine inges-
tion increased 1RM in the squat and in the bench press by
4.1 ± 1.4 kg (4.5 ± 1.9%) and by 2.2 ± 1.0 kg (3.3 ± 1.4%) 3.5 | Plasma caffeine concentration
(see Table 2 and Figure 2).
Upon arrival on both trial days, plasma caffeine concentra-
tions were negligible, that is, not detected or <LOQ in all
3.4 | Muscular endurance and perceived participants except two in the placebo trial and one in the
effort and pain caffeine trial (all 0.4 μg·mL−1). At baseline, theobromine
was significantly higher in the placebo compared to the
The mean absolute weight lifted during the RTF test (60% caffeine trial (P = .03); however, 8 and 9 of the individual
of familiarization 1RM) was 58 ± 8 kg and 39 ± 6 kg in values, respectively, were below LOQ. Due to the choco-
squats and bench press, respectively. Caffeine significantly late protein powder administered all participants, theobro-
increased squat RTF by 5.8 ± 6.2 repetitions (15.9 ± 17.9%) mine was significantly increased from baseline to 60 and
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2124    NORUM et al.

F I G U R E 3 Effect of caffeine on rate

of force development and countermovement
jumps. Individual results (dotted lines) and
mean ± CI (solid lines) are presented for
(A) RFD max during MVC of the knee
extensors; (B) CMJ jump height; (C) CMJ
Peak force; and (D) CMJ Peak power.
*Significantly different from placebo
(P < .05). CI, 95% confidence interval;
CMJ, countermovement jump; MVC,
maximal isometric voluntary contraction;
RFD, rate of force development

F I G U R E 4 Effect of caffeine on muscular endurance. Individual results (dotted lines) and mean ± CI (solid lines) are presented for (A) squats
and (B) bench press repetitions to failure at 60% of familiarization-1RM. *Significantly different from placebo (P < .05). CI, 95% confidence
interval

270 minutes during both trials (all P < .01) with no differ- 4 | DISCUSSION
ences between trials (P > .05). No other analyte increased
from baseline during the placebo trial (all P > .05). In the This study investigated the acute effects of 4 mg·kg−1 caf-
caffeine trial, plasma caffeine concentration increased to feine ingestion on maximal isometric and dynamic mus-
3.6 ± 0.8 (P < .001) and 3.1 ± 0.9 µg·mL−1 (P < .001) cle strength, power, activation level, RFD, and muscular
60 and 270 minutes following ingestion, respectively, endurance in resistance-trained females during the early
confirming intention to treat (Table 3). Paraxanthine and follicular phase. There were several notable findings in
total metabolite concentration significantly increased from the present study. Caffeine ingestion increased dynamic
baseline to 60 minutes and 270 minutes following caffeine strength measured as 1RM in squat and bench press and
ingestion (all P > .001, Table 3). isometric knee extension torque, leg muscle power and
jump height in CMJ, and improved both squat and bench
press muscular endurance measured as repetitions per-
3.6 | Habituation formed until failure at 60% of 1RM. However, no effect of
caffeine was observed on RFD, muscle activation, or affect
The habitual caffeine intake was 341 ± 184 mg·d−1, cor- perceived exertion and pain.
responding to 5.4 ± 2.9 mg·kg−1, while the administered In this study, caffeine increased maximal upper body
dose of 4 mg·kg−1 equated to 254 ± 20 mg. The partici- strength, which is in agreement with Grgic et al's recent me-
pants were moderate to high caffeine consumers (n catego- ta-analysis,4 as well as the study by Goldstein et al27 who found
rized as low, moderate, high: 2, 5, 8, respectively). Only increased bench press 1RM performance (1.5%) in 15 resis-
the effect of caffeine on muscular endurance was signifi- tance-trained females. It is suggested that smaller upper body
cantly correlated with the habitual intakes (Pearson r = .52, muscles are less affected by caffeine than larger lower body
P = .045 and r = .58, P = .024 for squat and bench press muscles,6 which has been implied by studies on for example
RTF, respectively). elbow flexors, not showing effects on maximal strength with
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NORUM et al.    2125

caffeine.23 Moreover, the positive associations seen between overall effect on lower body maximal strength. However,
strength and muscle activation with caffeine suggests that mus- very few studies have been conducted examining dynamic,
cles with high baseline activation level, such as upper body multi-joint maximal strength in females, indicated by only
muscles like the elbow flexors, would likely be less affected three included in the above meta-analysis from 2018.25,27,38
by caffeine, that is,there is less room to improve.6 However, Two of the three studies investigated lower body maximal
in studies examining multi-joint upper body exercises, there strength, in which one observed an effect of caffeine and the
seems to be an overall trend that caffeine has positive effects on other a trend of increased performance.25,38 Thus, one could
strength.4 This discrepancy might be explained by more mus- speculate whether females could have a greater effect of caf-
cle mass being recruited as compared to single joint arm exer- feine on lower body dynamic strength compared to males.
cises, including several muscles with varying activation levels, Furthermore, Grgic et al4 discuss that the included studies did
which might potentiate the effect of caffeine. The present re- not report the reliability of their strength tests. In the present
sults support that multi-joint upper body strength is indeed af- study, we report a low CV (2.3%) for the squat 1RM, which
fected by caffeine, although possibly still less than lower body could partly explain why we were able to detect an effect of
strength (3.3% [ES:0.20] vs 4.5% [ES: 0.25] increase in bench caffeine.
press and squat 1RM, respectively). Although no sex differences have been reported on the
A novel finding of this study was that a dose of only ergogenic effects of caffeine on exercise performance,2 only
4 mg·kg−1 caffeine induced a similar or even greater effect two studies,15,16 to our knowledge, have investigated caf-
on bench press 1RM than a dose of 6 mg·kg−1 in the study by feine's effects on sex differences with strength-power modal-
Goldstein et al27 (+3.3% vs +1.5%, respectively). The slight ities, showing similar effects (or lack of effects) of caffeine
difference in performance between our study and Goldstein in both males and females.15,16 As previously mentioned,
et al27 may partly be explained by severity of adverse events fluctuating hormone levels with the phases of the menstrual
occurring during the caffeine trial. Three participants felt cycles can alter caffeine metabolization speeds,12 as well as
“shaky” and the remaining participants reported no adverse neuromuscular function,20 and ultimately the ergogenic ef-
events in the present study, as opposed to three participants fects of caffeine. As an example, a recently published study
“exhibiting intense emotional responses” in the study by showed that half squat velocity was increased by 1.4%, 5%,
Goldstein et al,27 who reported habitual caffeine intakes of and 5.3% in the early follicular, late follicular, and mid-luteal
only 0-41 mg·d−1. The difference in side effects may be ex- phase, respectively.17 Thus, ensuring caffeine research in fe-
plained by the lower acute dose of caffeine (4 vs 6 mg·kg−1) males is conducted during the same menstrual cycle phase
and possibly due to higher habitual caffeine intakes in the is important and furthermore, which phase could potentially
present trial (341 ± 184 mg·d−1). affect the effect size. Moreover, only one15 of the two stud-
Even though habitual caffeine intake may influence the ies comparing effects of caffeine on strength performance
prevalence of adverse events, it might not affect exercise per- between the sexes controlled for menstruation cycle phase.
formance. A study,37 although on endurance performance, Therefore, further research is still warranted to establish
found that acutely ingesting 6 mg·kg−1 caffeine increased whether sex differences in ergogenic effect of caffeine on
performance irrespective of whether the daily habitual in- maximal strength occur.
take was low (0.8 mg·kg−1), moderate (1.9 mg·kg−1), or The effect of caffeine on maximal isometric strength ob-
high (4.6 mg·kg−1) and that habituation was not correlated served in this study is in agreement with Warren et al's me-
with performance. This is in line with the results of the ta-analysis findings,6 who found caffeine to have a moderate
present study, and in addition, and contrary to the above effect on isometric knee extensor strength. On the other hand,
study, we report the same for participants habitually con- Ali et al14 found no effects of 6 mg·kg−1 caffeine on knee ex-
suming more than the acute dose administered (4 mg·kg−1 tensor isometric strength in women. However, their protocol
vs 5.4 mg·kg−1·d−1, respectively). Importantly, habitual measured maximal muscle strength between fatiguing blocks
caffeine may be consumed in small doses over the day, so of sprints and consequently, might have masked a caffeine-in-
an acute dose of 4 mg·kg−1 may induce higher peak plasma duced effect on maximal strength.
concentration levels than many habitual consumers will No effect of caffeine on voluntary muscle activation
experience by administering 5.4 mg·kg−1·d−1 daily. This of the knee extensors was observed in the present study.
raises the question if the use of high doses is necessary to Previous studies such as Behrens et al22 demonstrated that
achieve an equally or potentially better ergogenic effect as strength enhancements by caffeine are associated with in-
seen in the example with Goldstein et al's study.27 Thus, creased voluntary activation, and the meta-analysis by
future research should explore optimal caffeine dosage in Warren et al6 showed that caffeine has an moderate effect
relation to habituation. on voluntary muscle activation. On the other hand, Meyers
Squat 1RM increased (+4.5%) significantly in this study, & Cafarelli39 found no effect of caffeine on muscle activa-
as opposed to Grgic et al's meta-analysis,4 who observed no tion level after ingesting 6 mg·kg−1 of caffeine. The initial
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2126    NORUM et al.

activation level in Meyers & Cafarelli's39 study was ~94% participants were not athletes, one could speculate that the
compared to 70%-80% in the study by Behrens et al,22 training status of our participants might have contributed to
which may suggest that baseline muscle activation level the positive effect of caffeine. Altogether, the evidence sug-
may affect the results, that is, the higher baseline level the gests that caffeine acutely improves power, which is in line
less room to improve. In the present study, the participants with our results.
had a muscle activation level of 85%-87%, which could Finally, 4 mg·kg−1 caffeine ingestion also significantly
partly explain why we did not detect any effects of caffeine. increased muscular endurance in both lower (~16%) and
Six participants (excluded from analysis of activation level) upper body (~10%,) exercises in this study. These results
found it especially difficult to maximally contract during are in agreement with Duncan et al,43 who found 5 mg·kg−1
the ITT compared to the un-evoked contractions, indepen- caffeine to increase the number of bench press repetitions to
dent of treatment. These participants’ maximal force output failure (60% of 1RM) in men. On the other hand, these results
when knowing they would be stimulated was ~25%-75% are in disagreement with other studies in females who did not
lower than the intra-trial peak force, although they reported find any effects on muscular endurance.16,25,27 However, hor-
that they felt they were contracting as forcefully as possi- mone concentration and hormone contraceptive use were not
ble. Thus, there may be a psychological factor (ie, being controlled for16,25,27 and one did not report familiarization,16
afraid of the electrical stimuli) inhibiting the voluntary con- while the other two only performed one familiarization ses-
traction when knowing electrical stimuli would be given. sion.25,27 In the present study, the participants who performed
Potentially, this might be overcome with further familiar- three familiarization sessions were mainly participants with
izations to increase the reliability of the test, that is, more CV > 9% in the muscular endurance tests. Hence, there could
than two as in the present study. However, this is a well- have been a masking of the caffeine effect in the studies with
known negative effect of stimulus anticipation in the ITT only one or no familiarization, due to continued learning ef-
method.40 fect in both trials.
The main mechanism by which caffeine induces ergo- Caffeine reducing pain perception and RPE is a possible
genic effects on muscular strength and power is thought to in- mechanism for increased performance,21 and, as mentioned
volve supra-spinally-driven increases in muscle activation.14 in the introduction, in a 2005 meta-analysis, Doherty et al,24
Surprisingly, we did not observe any difference between observed that a ~5% reduction in RPE during, as opposed
conditions in muscle activation level or RFDmax, despite to at-failure, explained about a third of the variance in ex-
demonstrating effects in 1RM strength, isometric strength, haustive work performance between caffeine and placebo.
and power. However, the high CV revealed especially for However, and albeit the analgesic effects might be easier to
RFDmax (18.3%) in the present study increases the risk of observe when assessed intra-set compared to at-failure (due
a type II error as the statistical power might have been too to an assumed greater relative difference in motor output be-
low to detect a possible effect. Nevertheless, this is a com- tween trials when caffeine increases number of repetitions
mon challenge and even higher CVs than demonstrated in performed), no difference in intra-set RPE was observed be-
this study are typically reported for RFD in the literature.41 tween the caffeine and placebo trials in the present study. The
Furthermore, RFD is closer associated to the rate of mus- fact that RPE was assessed only one time during the set and
cle activation (RMA) rather than just muscle activation per that a lower dose was used than most of the included studies
se, as demonstrated by a recent study showing that the pre- in the meta-analysis (4 vs 6 mg·kg−1) could explain why no
ceding effective motor neuron drive to the muscle influences difference in intra-set exertion was observed.
changes in RFD.42 Unfortunately, we did not measure RMA Total caffeine concentration and the individual metabo-
in the present study. It could be speculated that the influence lites were significantly higher at 270 minutes as compared
of caffeine on changes in RMA is not as profound as with to 60 minutes after ingestion, whereas caffeine tended to be
other strength-power measures. lower. Theophylline and paraxanthine can contribute to the
In parallel to the observed effect on muscle strength but pharmacological effect on the central nervous system as these
in contrast to the lacking effect on RFD, caffeine ingestion also inhibit the adenosine A1 and A2 receptors.44 Theophylline
improved performance and power measures in the CMJ; the is considered to be three to five times more potent than caf-
participants jumped 2.3 cm higher with caffeine than in the feine, and paraxanthine may be as potent as caffeine.44 Thus,
placebo trial. In line with previous divergent results of caf- we can expect that the participants in the present study had
feine effects on maximal strength, the acute effects of caf- similar effects of caffeine throughout the test protocol (60-
feine ingestion on strength-power performance and RFD are 270 minutes following ingestion), and we did indeed observe
inconsistent, but most studies show significant increased significant effects both on the first (CMJ), as well as the last
lower body power during countermovement jumps.4 In a (bench press RTF) test of the protocol.
subgroup meta-analysis,4 training status indicated a signifi- Controlling for hormone concentrations in the way which
cant effect for athletes, but not for non-athletes. Although our was used in the present study is cost- and time-efficient,
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NORUM et al.    2127

when assuming the participants are having no health is- placements in competition can be small. However, within-
sues that would affect their hormones around the menstrual individual differences in performance need to be taken into
cycle. To our knowledge, this is only the second study on account and the acute effects of caffeine may be smaller in a
the effects of caffeine on strength performance to control competitive context due to increased arousal. Performance
for oscillations in reproductive hormones in this way.15 effects of caffeine during the different menstrual cycle
However, we did not confirm the hormone concentrations phases should be investigated further. Establishing whether
in blood samples, which would be a strength of future stud- menstrual cycle phase affects the ergogenity of caffeine al-
ies. Recently, as mentioned, the first study on the effect lows optimization of personalized recommendations and
of caffeine on half squat velocity during three phases of will inform future caffeine research. Furthermore, further
menstrual cycle was published.17 Nevertheless, we recom- examination of the potential sex differences in the ergo-
mend that further studies compare the effects of caffeine on genic effect of caffeine on strength and power is warranted.
female strength and power performance between the men- At the time being, such research should take into account
strual cycle phases to establish the interaction of female the effects of menstrual cycle phase. Lastly, the long-term
reproductive hormones on the ergogenity of caffeine. This effects of chronic caffeine supplementation on resistance
is warranted to further optimize personalized recommen- exercise adaptations have not been investigated and are thus
dations for caffeine use in female athletes and will inform warranted.
future research on caffeine in females. Another strength of
this study is the blinding efficacy check, a potential bias ACKNOWLEDGEMENT
in the caffeine literature, as recently discussed by Painelli All authors declare no conflict of interest. No funding was
et al45 and Pickering and Grgic.46 Although 66% partici- received for this study. The authors would like to thank Dr
pants correctly guessed when they ingested caffeine, no Hans Kristian Stadheim for the preparation, blinding and ad-
difference in performance was observed between these and ministering of the treatments, and to all the research partici-
those that guessed incorrectly in the present study. Thus, pants for partaking in this study.
the performance increments observed in the caffeine trial
do not seem to be due to the placebo effect. AUTHOR CONTRIBUTIONS
A limitation of this study is a skewed counterbalance of MN, LCR, TB, LD, and TR involved in conception and de-
treatment order arising due to dropout after randomization. sign. MN, LCR, TB, POR, MB, and TR involved in acquisi-
Consequently, ten participants received placebo and five tion of data, and/or analysis and interpretation of data. MN
participants received caffeine in the first trial. However, we and LCR drafted the manuscript. MN, LCR, TB, LD, POR,
could not detect an effect of treatment order. All participants MB, and TR revised the manuscript.
had an effect of caffeine irrespective of order of trial on CMJ
jump height and power and on maximal strength, and fur- ORCID
thermore, 12 of the 15 participants performed better with Linn Christin Risvang https://orcid.
caffeine in the muscular endurance and isometric strength org/0000-0003-4532-2129
tests. Nevertheless, the low statistical power in the analyses Thomas Bjørnsen https://orcid.
of treatment order in the latter outcomes increases the risk of org/0000-0002-4010-8038
type II error. Lygeri Dimitriou https://orcid.
In conclusion, ingestion of 4 mg·kg−1 caffeine 60 minutes org/0000-0002-5093-558X
prior to tests improved maximal strength and power in highly Per Ola Rønning https://orcid.org/0000-0003-1341-3229
resistance-trained females during the early follicular phase of Truls Raastad https://orcid.org/0000-0002-2567-3004
menstruation. The caffeine supplementation also increased
muscular endurance in both upper and lower body exercises R E F E R E NC E S
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meta-analysis. Eur J Sport Sci. 2018;18(2):219-225. https://doi.
These findings of 3%-5% improvement on maximal org/10.1080/17461​391.2017.1394371
strength and power could potentially be relevant to female 4. Grgic J, Trexler ET, Lazinica B, Pedisic Z. Effects of caffeine
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