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Of particular relevance to athletes are the metabolic actions of ketone bodies to alter substrate utilisation through attenuating glucose utilisation in peripheral tissues, anti-lipolytic effects on adipose tissue, and attenuation of proteolysis in skeletal muscle. There has been long-standing interest in the development of ingestible forms of ketone bodies that has recently resulted in the commercial availability of exogenous ketone supplements (EKS). These supplements in the form of ketone salts and ketone esters, in addition to ketogenic compounds such as 1,3-butanediol and medium chain triglycerides, facilitate an acute transient increase in circulating AcAc and \u03b2HB concentrations, which has been termed \u2018acute nutritional ketosis\u2019 or \u2018intermittent exogenous ketosis\u2019. Some studies have suggested beneficial effects of EKS to endurance performance, recovery, and overreaching, although many studies have failed to observe benefits of acute nutritional ketosis on performance or recovery. The present review explores the rationale and historical development of EKS, the mechanistic basis for their proposed effects, both positive and negative, and evidence to date for their effects on exercise performance and recovery outcomes before concluding with a discussion of methodological considerations and future directions in this field.<\/jats:p>","DOI":"10.1007\/s40279-022-01756-2","type":"journal-article","created":{"date-parts":[[2022,10,10]],"date-time":"2022-10-10T12:57:20Z","timestamp":1665406640000},"page":"25-67","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":68,"title":["Exogenous Ketone Supplements in Athletic Contexts: Past, Present, and Future"],"prefix":"10.1007","volume":"52","author":[{"given":"Mark","family":"Evans","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tyler S.","family":"McClure","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew P.","family":"Koutnik","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8327-9016","authenticated-orcid":false,"given":"Brendan","family":"Egan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,10,10]]},"reference":[{"key":"1756_CR1","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1152\/physrev.1980.60.1.143","volume":"60","author":"AM Robinson","year":"1980","unstructured":"Robinson AM, Williamson DH. 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An honorarium for participation in the meeting and preparation of this article was provided by the GSSI. No other sources of funding were used to assist in the preparation of this article. Studies from ME and BE cited in this review were funded in part by an Irish Research Council Enterprise Partnership Postgraduate Fellowship (EPSPG2016177). The Irish Research Council is an associated agency of the Department of Education and Skills and operates under the aegis of the Higher Education Authority of Ireland. Studies from AK and TM cited in this review were funded in part by the United States Department of Defense, and research funding from the Swezey Fund, and the Jewell, Moore and MacKenzie Fund.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Funding"}},{"value":"In the past 36\u00a0months, BE has received speaking honoraria from Pruvit Ventures, LLC, and Metabolic Health Initiative, LLC. In the past 36\u00a0months, APK has received honorarium from American College of Sports Medicine, Stanford University, and Metabolic Health Initiative, LLC, and provided consultation to Simply Good Foods Inc. APK is an inventor on pending patents \u201cCompositions and Methods for Weight Loss Maintenance\u201d and \u201cPrevention of Muscle Wasting with Ketone Supplementation\u201d. At the time of this publication, pending patents were still under review. Should patents become accepted, APK will receive a share under the patent terms prescribed by the University of South Florida. TSM and ME declare no conflicts of interest, and do not have any financial disclosures.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflicts of interest"}},{"value":"ME, TSM, APK, and BE conceptualised the review. ME and TSM developed and wrote the initial drafts of the manuscript with feedback from BE. ME, TSM, APK, and BE developed and wrote advanced drafts of the manuscript. All authors contributed to the article and approved the submitted version. All authors read and approved the final manuscript.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Author contributions"}},{"value":"Not applicable.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Availability of data and material"}},{"value":"Not applicable.","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Code availability"}},{"value":"Not applicable.","order":7,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Not applicable.","order":8,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}}]}}