Menthol as an Ergogenic Aid for the Tokyo 2021 Olympic Games: An Expert-Led Consensus Statement Using the Modified Delph
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CONSENSUS STATEMENT
Menthol as an Ergogenic Aid for the Tokyo 2021 Olympic Games: An Expert‑Led Consensus Statement Using the Modified Delphi Method M. J. Barwood1 · O. R. Gibson2 · D. J. Gillis3 · O. Jeffries4 · N. B. Morris5 · J. Pearce6 · M. L. Ross7,8 · C. Stevens9 · K. Rinaldi10,11 · S. N. Kounalakis12 · F. Riera13,14 · T. Mündel15 · M. Waldron16,17 · R. Best18,19
© The Author(s) 2020
Abstract Introduction Menthol topical application and mouth rinsing are ergogenic in hot environments, improving performance and perception, with differing effects on body temperature regulation. Consequently, athletes and federations are beginning to explore the possible benefits to elite sport performance for the Tokyo 2021 Olympics, which will take place in hot (~ 31 °C), humid (70% RH) conditions. There is no clear consensus on safe and effective menthol use for athletes, practitioners, or researchers. The present study addressed this shortfall by producing expert-led consensus recommendations. Method Fourteen contributors were recruited following ethical approval. A three-step modified Delphi method was used for voting on 96 statements generated following literature consultation; 192 statements total (96/96 topical application/mouth rinsing). Round 1 contributors voted to “agree” or “disagree” with statements; 80% agreement was required to accept statements. In round 2, contributors voted to “support” or “change” their round 1 unaccepted statements, with knowledge of the extant voting from round 1. Round 3 contributors met to discuss voting against key remaining statements. Results Forty-seven statements reached consensus in round 1 (30/17 topical application/rinsing); 14 proved redundant. Six statements reached consensus in round 2 (2/4 topical application/rinsing); 116 statements proved redundant. Nine further statements were agreed in round 3 (6/3 topical application/rinsing) with caveats. Discussion Consensus was reached on 62 statements in total (38/24 topical application/rinsing), enabling the development of guidance on safe menthol administration, with a view to enhancing performance and perception in the heat without impairing body temperature regulation.
1 Introduction Menthol is a naturally occurring cyclic terpene alcohol that is extracted from plants of the Mentha genus, e.g., peppermint and corn mint [25]. Presenting in eight forms, the (-) isomer is responsible for menthol’s characteristically fresh aroma, taste, and cooling sensation when applied to mucous membranes or the skin, with its effects inversely proportional to the thickness of the membrane to which it is applied [66, 72]. Menthol elicits these sensations by primarily stimulating the membrane bound ion channel transient receptor potential melastatin 8 (TRPM-8), mirroring temperature change within the range of 8–28 °C [58]. Stimulation of these receptors during periods of heat stress has consistently
* M. J. Barwood [email protected]
been shown to improve thermal comfort and decrease thermal sensation [38, 66]. Further downstrea
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