Effects of exogenous ketones on post-exercise recovery: A systematic review and meta-analysis

Exogenous ketone supplementation has gained attention as a potential strategy to enhance post-exercise recovery. This systematic review and exploratory meta-analysis evaluated its effects on recovery outcomes in adults. PubMed, Embase and Web of Science were searched for randomized controlled and cross-over trials investigating exogenous ketone supplementation. Sixteen studies met the inclusion criteria, of which seven were included in the meta-analysis. Meta-analyses showed no significant effects on muscle soreness (SMD = 0.39, 95% CI [-0.29 to 1.07], p = 0.26, I² = 0%) or muscle glycogen resynthesis (SMD = 18.21, 95% CI [-19.15 to 55.56], p = 0.34, I² = 30%). A small effect on post-exercise lactate concentrations (mmol/L) favored the control condition (MD = 0.34, 95% CI [0.02-0.66], p = 0.04, I² = 0%), although its clinical relevance appears limited. No consistent improvements were observed across physical recovery outcomes. Evidence for cognitive recovery was mixed, with isolated improvements in reaction time, while most outcomes remained unaffected. Creatine kinase concentrations were not significantly affected. Overall, current evidence suggests limited benefits of exogenous ketones for post-exercise recovery and is largely restricted to physically active male adults, limiting generalizability. Further well-powered studies in more diverse populations and recovery contexts are needed.