Menthol routes show varied effects on exercise in hot environments

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Frontiers in Medicine Published May 18, 2026 Medically reviewed May 18, 2026 DOI ↗ By Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

Key Takeaway

Menthol ingestion may aid endurance, while mouth rinsing boosts power in heat, but no route shows definitive superiority.

A network meta-analysis of 15 randomized controlled trials evaluated menthol administration routes in hot environments (≥25 °C) for exercise performance. The primary outcome was endurance performance and mean power output, with secondary measures including core temperature and heart rate. Results indicated that ingestion (ING) showed a potential trend for improving endurance performance, while mouth rinsing (MR) tended to enhance mean power output.

Core temperature maintenance ranked higher with ingestion, whereas topical application exhibited the weakest potential for thermoregulation. Physiological responses, including core temperature and heart rate, showed modest impacts without statistically significant differences compared to control conditions.

Limitations include that most pairwise comparisons did not reach statistical significance, and current evidence does not establish definitive superiority among administration routes. Practice relevance suggests ingestion may be an exploratory option for long-duration events, with mouth rinsing considered for instantaneous power tasks, combined with objective monitoring.

The interventional efficacy of menthol in heat appears co-regulated by administration route and specific exercise task, though certainty is not reported. Adverse events were not reported, and funding or conflicts were not disclosed.

Study Details

Study typeMeta analysis

EvidenceLevel 1

PublishedMay 2026

View Original Abstract ↓

ObjectiveThis study employed a network meta-analysis (NMA) to systematically evaluate and compare the relative efficacy of three menthol administration routes—ingestion (ING), mouth rinsing (MR), and topical application (Top)—on exercise performance and physiological responses in the heat, aiming to explore potential task-oriented personalized supplementation strategies.MethodsDatabases including PubMed, Embase, Web of Science, and CNKI were searched for randomized controlled trials (RCTs) investigating menthol interventions on exercise performance in hot environments (T≥25 °C), with a search deadline of March 2, 2026. Two reviewers independently performed literature screening, data extraction, and risk of bias assessment using the Cochrane RoB 2.0 tool. Network meta-analysis was conducted using Stata 18.0 software.ResultsThe network meta-analysis of the 15 included randomized controlled trials revealed outcome-specific trends in exercise performance, although most pairwise comparisons did not reach statistical significance. Surface under the cumulative ranking curve (SUCRA) analysis indicated that ingestion (ING) demonstrated a potential trend for improving endurance performance (SUCRA = 76.1%), while mouth rinsing (MR) showed a tendency for enhancing mean power output (SUCRA = 66.9%). Regarding physiological responses, the impact of all administration routes on core temperature (Tc) and heart rate (HR) was modest and lacked statistically significant differences compared to control conditions. Specifically, ING ranked relatively higher in maintaining core temperature (SUCRA = 67.0%), whereas topical application (Top) exhibited the weakest potential for thermoregulation (SUCRA = 6.2%) and might even lead to a slight upward trend in temperature due to the physical obstruction of heat dissipation.ConclusionThe interventional efficacy of menthol in the heat appears to be co-regulated by the administration route and the specific exercise task. While the current evidence does not establish definitive superiority among the administration routes due to the lack of statistical significance, ingestion may serve as an exploratory option for long-duration endurance events, whereas mouth rinsing could be considered for tasks focusing on instantaneous power output. Given that menthol may mask actual subjective thermal perception without alleviating objective physiological heat strain, its application must be combined with objective physiological monitoring in practice to ensure exercise safety.Systematic Review Registrationwww.crd.york.ac.uk/prospero, identifier: CRD420261340546.