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Smelling Salts or Smoke and Mirrors? Acute Ammonia Inhalation, Arousal, and Physical Performance: A Systematic Review
Shenghui Liu1, Xiaohan Fan1, Zhiyuan Tan2
1Faculty of Sports and Exercise Science, Universiti Malaya, Jalan Universiti, Kuala Lumpur 50603, Malaysia.
Background/Objectives:
Ammonia inhalants, commonly known as smelling salts, are widely used in sport as an acute arousal strategy, yet their ergogenic value remains uncertain. This systematic review and three-level meta-analysis examined the acute effects of ammonia inhalation on physical performance and selected psychophysiological outcomes.
Methods:
Controlled human studies involving healthy adults, physically active individuals, or athletes were included when they compared ammonia inhalation with placebo, sham, or no-inhalation control conditions. Physical performance was the primary outcome, with heart rate and selected subjective responses analyzed as exploratory secondary outcomes.
Results:
Ten studies were included. The primary analysis showed no statistically significant effect of ammonia inhalation on overall physical performance (k = 47, g = 0.11, 95% CI [-0.06, 0.28]). Heart rate and subjective exertion/fatigue were also not significantly affected. In contrast, subjective activation/arousal increased significantly (k = 9, g = 0.73, 95% CI [0.43, 1.04]), although this finding was based on only two studies. Moderator analyses did not show consistent subgroup differences for performance type, training status, or comparator type, whereas sex-based differences were exploratory and based on limited evidence. Sensitivity analyses suggested that physical performance became significantly improved after removal of influential effects, and power/explosive performance showed a possible benefit; however, these findings should be considered preliminary rather than confirmatory.
Conclusions:
Overall, ammonia inhalation appears to act primarily as a brief arousal stimulus rather than a consistent ergogenic aid. Potential benefits may depend on task demands, with explosive or repeated high-intensity tasks appearing more plausible targets than maximal strength or precision-based skills. Current evidence remains limited by small samples, heterogeneous protocols, and low certainty.
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