Acute topical menthol application and exercise performance: A systematic review and meta-analysis of perceptual and...

Topical menthol is increasingly used as a perceptual cooling strategy during exercise, yet its ergogenic potential and underlying mechanisms remain unclear. Unlike previous route-mixed meta-analyses, this systematic review and three-level meta-analysis specifically examined the effects of acute topical menthol application on exercise performance alongside perceptual and physiological responses.

Meta-analysis.

Six databases were searched from inception to March 2026. Randomized or controlled trials examining acute topical menthol application during exercise were included. Risk of bias was assessed using RoB-2. Three-level meta-analyses accounted for dependence among multiple outcomes. Prespecified moderators included sex, training status, environmental condition, application method, application site, and exercise modality. Sensitivity analyses addressed outliers and influential cases.

Sixteen studies involving 191 participants were included. Topical menthol produced a small but significant improvement in exercise performance (g = 0.27, p = 0.02). Thermal sensation (g = -0.74) and perceived exertion (g = -0.35) were reduced, with a small improvement in thermal comfort (g = 0.34), whereas core body temperature was unchanged. Performance benefits were most evident in aerobic endurance tasks, following rub-on application methods, and under temperate conditions, whereas effects in hot environments (≥30 °C) were smaller and not statistically significant. Several subgroup findings were sensitive to influential observations and should be interpreted cautiously.

Acute topical menthol may provide a small ergogenic benefit primarily through perceptual cooling rather than physiological heat strain. Effects appear context dependent and most relevant for endurance exercise. Further well-controlled studies are needed to clarify optimal application strategies and environmental conditions.