Table 3.

Outcomes from all studies with directions of effect and commonly seen effects

Outcome	Total number of studies	Direction of effect*	Adjusted total	Effect
Cycle speed and avg work rate	3	↑	1	Inconclusive
		↔	0
		↓	1
Time trial and time to exhaustion	5	↑↑	2	Inconclusive
		↔↔	2
		↓	1
Respiratory exchange ratio	12		0	No change
		↔↔↔↔↔↔↔↔↔↔	8
		↓↓	2
Fat oxidation	11	↑↑	2	No change
		↔↔↔↔↔↔↔↔↔	7
			0
Carbohydrate oxidation	12		0	No change
		↔↔↔↔↔↔↔↔↔↔	8
		↓↓	2
Lactate concentration	9	↑	1	No change
		↔↔↔↔↔↔↔	6
		↓	1
Ketone concentration	10	↑↑↑↑↑↑↑↑↑↑	8	Increase
			0
			0
Glucose concentration	11		0	No change
		↔↔↔↔↔↔↔↔↔↔↔	9
			0

*Outcome symbol: ↔, no significant difference; ↑, a significant increase (P<0.05); ↓, a significant decrease (P<0.05). Each individual arrow reflects one study and the effect on that specific outcome; an adjusted total was created by excluding the high risk of bias studies from the risk of bias assessment. Effects were noted as commonly if the majority of studies (> 50%) favored a direction (increase, decrease, or no change); if there was no favored effect (≤ 1), no common effect was noted.

avg, average.