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Table 3 Probiotic studies in an athletic population: performance, immune and GI health

From: International Society of Sports Nutrition Position Stand: Probiotics

ReferenceSubject groupSex and age
(M ± SD)
SupplementationTreatment durationExerciseDietPerformance BenefitImmune or GI Benefit
Clancy et al. (2006) [53]Healthy recreational athletes (n = 18),
Fatigued recreational athletes (n = 9)
11 M / 7 F
16–37 y
6 M / 3 F
17–40 y
L. acidophilus (LAFTI®L10), capsules, 2 × 1010 CFU
Daily
4 weeksNot reportedNot reportedNot assessedT cell deficit was reversed (increased secretion of IFNƴ from T cells) following probiotic supplementation
Moreira et al. (2007) [54]Non-elite Marathon runners (n = 141)62 M / 8 F in treatment group
39 ± 9 y
L. rhamnosus GG (LGG), milk-based drink, 4 × 1010 CFU
Daily
12 weeksRunning
During pollen season & 2003 Helsinki City Marathon
Subjects instructed to refrain from eating food containing probioticsNot assessedNo effects on symptoms of atopy or asthma
Kekkonen et al. (2007)* [55]
*Same subjects as Moreira et al (2007) [54]
Non-elite Marathon runners (n = 141)62 M / 8 F in treatment group
39 ± 9 y
L. rhamnosus GG (LGG), milk-based drink, 4 × 1010 CFU
Daily
12 weeksRunning
During pollen season & 2003 Helsinki City Marathon
Subjects instructed to refrain from eating food containing probioticsNot assessedNo effect on respiratory infections or GI episodes. Shortened GI stress post marathon
Tiollier et al. (2007) [56]French commando cadets (n = 47)47 M
21 ± 0.4 y
L. casei DN- 1 14 00 1, milk-based drink during training (dose not indicated)
Daily
3 weeksMilitary training for 3 weeks followed by a 5-day combat courseMilitary ration. No fermented dairy productsNot assessedNo effect on respiratory tract infections
Cox et al. (2010) [57]Elite male distance
runners (n = 20)
20 M
27.3 ± 6.4 y
1.2 × 1010 CFU L. fermentum VRI-003 (PCC)
Daily
16 weeksRunning (winter training)Not reportedNo changes in running performanceSignificant reduction in respiratory episodes and severity
Martarelli et al. (2011) [58]Amateur cyclists (n = 24)24 M
32.03 ± 6.12 y
L. rhamnosus IMC 501®, L. paracasei IMC 502® 1 × 109 CFU
Daily
4 weeksIntense physical activityDiets proportionally equivalent in macro and micronutrient quantity, containing 100% of the RDA for all nutrientsNot assessedReduced exercise induced oxidative stress
Gleeson et al. (2011) [59, 60]Recreationally active endurance athletes (n = 84)54 M / 30 F
27.0 ± 11.6 y
L. casei Shirota (LcS), 6.5 × 109 CFU
2x daily
16 weeksRunning (winter training, normal training load)Consumption of supplements, additional probiotics, or any fermented dairy products were not permitted during the study periodNot assessedSignificant reduction in frequency of URTI
West et al. (2011) [61]Competitive cyclists (n = 80)64 M / 35 F
35 ± 9 and 36 ± 9 y
L. fermentum (PCC®) 1 × 109 CFU
Daily
11 weeksCycling (winter training, normal training load)Subjects were asked to maintain a normal diet and refrain from eating probiotic or prebiotic enriched foods or supplementsNo effect on peak power or VO2 maxSignificant reduction in URTI (duration and severity) in males. No effect in females
Välimäki et al. (2012) [62]Marathon runners Placebo (n = 58), Probiotic (n = 61)105 M / 14 F
40 (23–69) y
40 (22–58) y
L. rhamnosus GG (LGG), 4 × 1010 CFU
Daily
12 weeksRunning training; marathon runInstructed to refrain from eating food containing probiotics and advised to follow normal dietary habitsNot assessedNo effects on serum LDL or antioxidant levels
Lamprecht et al. (2012) [63]Endurance trained men (triathletes, runners, cyclists) (n = 23)23 M
37.6 ± 4.7 y
Multispecies probiotic (B. bifidum W23, B. lactis W51, E. faecium W54, L. acidophilus W22, L. brevis W63, and L. lactis W58, 1 × 1010 CFU
Daily
14 weeksNormal training load7-dayfood record. Instructed to maintain their habitual dietNo effect on VO2 max, maximum performanceSignificant reduction in Zonulin (marker of gut permeability)
Gleeson et al. (2012) [64]Highly active individuals (n = 66)28 M / 38 W
23.9 ± 4.7 y
L. salivarious, 2 × 1010 CFU
Daily
16 weeksEndurance-based physical activities (spring training)Consumption of supplements, additional probiotics, or any fermented dairy products was not permittedNot assessedNo effect on frequency, severity and duration of upper respiratory tract infections
Grobbelaar et al. (2012) [65]Moderately active individuals (n = 50)50 M
18–30 y
Bifidobacterium and Lactobacillus strains (dose not indicated)
Daily
6 weeksModerately active as defined by ACSM and CDCNutritional supplementation prohibitedNot assessedNo significant increases in performance related blood markers
West et al. (2012) [66]Active individuals (n = 22)22 M
33.9 ± 6.5 y
Multi-strain probiotic (4.6 × 108 CFU L. paracasei subs paracasei (L. casei 431®), 6 × 108 CFU B. animalis ssp. lactis (BB-12®), 4.6 × 108 CFU L. acidophilus LA-5, 4.6 × 108 CFU L. rhamnosus GG
Daily
3 weeksRecreational cyclingNot reportedNot assessedNo effect on measures of systemic or mucosal immunity including gut permeability
Salarkia et al. (2013) [44]Adolescent endurance swimmer (n = 46)46 F
13.8 ± 1.8 y
Multi-strain probiotic yoghurt (L. acidophilus SPP, L. delbrueckii bulgaricus, B. bifidum, and S. salivarus thermnophilus) 4 × 1010 CFU
Daily
8 weeksSwimmingAdvised to refrain from other probiotic productsSignificant improvement in VO2 max. No effect on swim timesSignificant reduction in respiratory and ear infections. No effect on GI episodes
Charlesson et al. (2013)
Abstract of 2012 IJSNEM Confer.
Male athletes (n = 8) (travelling to high risk travelers’ diarrhea countries)8 M
Age not reported
L. acidophilus, B. lactis, L. rhamnosus (dose not indicated)
Daily
8 weeksNormal trainingNot reportedNot assessedNo effect on travelers’ diarrhea (TD). 50% of all athletes reported TD symptoms
Sashihara et al. (2013) [67]University-student athletes (n = 44)44 M
Grp-1: 19.8 ± 0.9 y
Grp-2: 19.9 ± 0.9 y
Grp-1: L. gasseri OLL2809 1 × 109 CFU.
Grp-2: alpha-lactalbumin 900 mg +: L. gasseri OLL2809 1 × 109 CFU
3x daily
4 weeksNormal training loadNot reportedNo improvement in 1 h of cycle ergometer exercise performancePrevented reduced natural killer cell activity due to strenuous exercise and elevated mood from a depressed state (POMS)
West et al. (2014) [68]Active individuals (n = 465)241 M / 224 F
35 ± 12 y / 36 ± 12 y
B. animalis subsp. lactis BI-04 2 × 1010 CFU, or L. acidophilus NCFM and B. animalis subsp. lactis BI-07 5 × 109 CFU
Daily
150 days (21.42 weeks)Normal activity load (approx. 6 h per week)Refrain from consumption of non-study probiotic or prebiotic supplements or foods during the study.Not assessedBI-04 reduced upper respiratory tract infection frequency. BI-07 + LA NCFM showed no effect. Probiotic treatments delayed URTI ~ 0.8 months
Haywood et al. (2014) [69]Highly-trained rugby union players (n = 30)30 M
24.7 ± 3.6 y
L. gasseri 2.6 × 109 CFU, B. bifidum 0.2 × 109, and B. longum 0.2 × 109 CFU
Daily
4 weeksNormal training load (during the winter months)Asked to maintain a normal diet and refrain from consuming probiotic and prebiotic enriched foods or supplementsNot assessedSignificant reduction in episodes of illness. No effect on illness severity
Shing et al. (2014) [46]Runners (n = 10)10 M
27 ± 2 y
Multispecies probiotic (L. acidophilus, L. rhamnosus, L. casei, L. plantarum, L. fermentum, B. lactis, B. breve, B. bifidum, and S. thermophilus) 4.5 × 1010 CFU
Daily
4 weeksNormal training loadProvided with a high glycemic index, low sucrose diet for the 26 h prior to each time to-fatigue run.Significant increase in run time to fatigue in the heatNo effects on inflammation or GI markers
Aghaee et al. (2014) [70]
Abstract
Athletes (n = 16)16 M
19–25 y
Probiotic (type and dose not indicated)
Daily
30 daysNormal training loadNot reportedNot assessedProbiotic treatment significantly increased monocyte levels in comparison to placebo control
Georges et al. (2014) PILOT [71]Resistance-trained individuals (n = 10)10 M
22.0 ± 2.4 y
B. coagulans GBI-30, 6086 (BC30), 5 × 108 CFU plus 20 g of casein
2x daily
8 weeksPeriodized resistance training (4x per week)Macronutrients were controlled to 50% carbohydrate, 25% protein, and 25% fat between groups.Trend to increase vertical jump power (not significant).Not assessed
Narimani-Rad et al. (2014) [72]Professional bodybuilding athletes (n = 14)14 M
20–55 y
Multi-strain probiotic (L. casei 5.1 × 109 CFU/g, L. acidophilus 2 × 109 CFU/g, L. C. 5.1 × 109 CFU/g, L. bulgaricus 2 × 108 CFU/g, B. breve 2 × 1010 CFU/g, B. longum 7 × 107 CFU/g, S. thermophilus 5.1 × 109 CFU/g)
Daily
30 daysNormal training loadNot reportedNot assessedStimulated thyroid activity. Significant increase in T4 and significant decrease TSH levels. No significant difference in T3 levels
Muhamad & Gleeson (2014) [73]Active University students (n = 11)11 (sex not reported)
22 ± 1 y
14 strain probiotic (L. acidophilus, L. delbrueckii ssp. bulgaricus, L. lactis ssp. lactis, L. casei, L. helveticus, L. plantarum, L. rhamnosus, L. salivarius ssp. salivarius, B. breve, B. bifidum, B. infantis, B. longum, B. subtilis, and S. thermophilus.) 6 × 109 CFU
Daily
30 daysNot reportedNot reportedNo significant change in rating of perceived exertion and HRNo significant change in salivary antimicrobial proteins (a measure of mucosal protection)
Salehzadeh (2015) [45]Endurance athletes (n = 30)30 M
21 y
200 ml of probiotic yogurt drink S. thermophilus or L. delbrueckii ssp. bulgaricus 1 × 105 CFU/g
Daily
30 daysIntense aerobic trainingNot reportedSignificant increase in VO2 MAX and aerobic powerSignificant decrease in serum CRP, significant increase in HDL
O’Brien et al. (2015) [74]Male and female runners
(n = 67)
Not reported
18–24 y
Kefir beverage (probiotic strain and amount not indicated)
2x week
15 weeksMarathon training programNot reportedNo effect on 1.5 mile run test timesAttenuated increase in inflammation (serum CRP)
Gill et al. (2016a) [75]Endurance-trained runners (n = 8)8 M
26 ± 6 y
L. casei 10 × 1010 CFU
Daily
7 daysRunning exercise in hot ambient temperatureRefrained from alcohol and caffeine for 72 h and exercise for 24 h before preliminary testing sessions and each experimental trialNo difference in exercise performance on a treadmill test and perception of effortNo improvement in salivary antimicrobial protein (mucosal immune protection) or cortisol status over placebo
Gill et al. (2016b) [76]Endurance-trained runners (n = 8)8 M
26 ± 6 y
L. casei 10 × 1010 CFU
Daily
7 daysRunning exercise in hot ambient temperatureConsumption of other probiotics was prohibited outside the study protocolNot reportedDid not prevent increases in external heat stress-induced circulatory endotoxin concentration or plasma cytokine profile compared with placebo
Jäger et al. (2016) [42]Recreationally-trained individuals
(n = 29)
29 M
21.5 ± 2.8 y
B. coagulans GBI-30, 6086 (BC30), 1 × 109 CFU plus 20 g of casein protein
Daily
2 weeksMuscle-damaging single leg training boutSubjects provided a standardized meal prior to exercise bout. Three-day dietary recalls were collectedSignificantly increased recovery and decreased soreness. Non-significant trend to increase powerNot assessed
Jäger et al. (2016) [43]Resistance-trained men (n = 15)15 M
25 ± 4 y
B. breve BR03 5 × 109 live cells (AFU) & S. thermophilus FP4 5 × 109 live cells (AFU)
Daily
3 weeksNormal training up until 72 h preceding muscle-damaging elbow flexor exercise challengeRefrain from any nutritional supplements or ergogenic aidsImproved isometric average peak torque production and range-of-motion during acute recoverySignificant decrease in marker of inflammation (IL-6)
Roberts et al. (2016) [77]Recreational triathletes (n = 30)25 M / 5 F
35 ± 1 y
Multi-strain pro/prebiotic/antioxidant 30 × 109 CFU per day containing 10 × 109 CFU L. acidophilus CUL-60 (NCIMB 30157), 10 × 109 CFU L. acidophillus CUL-21 (NCIMB 30156), 9.5 × 109 CFU B. bifidum CUL-20 (NCIMB 30172) and 0.5 × 109 CFU B. animalis subsp. lactis CUL-34 (NCIMB 30153)/55.8 mg fructooligosaccharides/ 400 mg alpha-lipoic acid, 600 mg N-acetyl-carnitine
Daily
12 weeksProgressive triathlon training programMaintained habitual dietary intake. Required not to consume any other nutritional supplementNo significant difference in race timesSignificant reduction in endotoxin levels
Strasser et al. (2016) [78]Trained athletes (n = 29)13 M / 16 F
26.7 ± 3.5 y
Multi-species probiotic (B. bifidum W23, B. lactis W51, E. faecium W54, L. acidophilus W22, L. brevis W63, and L. lactis W58) 1 × 1010 CFU/g
Daily
12 weeksWinter trainingMaintain normal diet and avoid anti-inflammatory drugs, antibiotics, additional probiotics and dietary supplementsDid not benefit athletic performanceLimited exercise-induced drops in tryptophan levels and reduced the incidence of URTI
Michalickova et al. (2016) [79]Elite athletes (badminton, triathlon, cycling, alpinism, karate, savate, kayak, judo, tennis and swimming)
(n = 39)
29 M / 10 F
23.15 ± 2.6 y
L. helveticus Lafti L10, 2 × 1010 CFU
Daily
14 weeksNormal training load (during winter)Subjects maintained normal diet and were asked to avoid fermented milk products and
immunomodulatory supplements
No significant differences in exercise performanceSignificant reduction in duration of URTI episodes and decreased symptoms in elite athletes
Gleeson et al. (2016) [80]College athletes
(n = 243)
142M / 101F
20.4 ± 0.2 y
Fermented milk beverage containing L. casei Shirota, 6.5 × 109 CFU
2x daily
20 weeksNormal training loadSupplements that might influence immune function and additional probiotics or fermented dairy were not permittedNot assessedSignificant reduction in cytomegalovirus and Epstein Barr virus antibody titres, benefiting immune status
Michalickova et al. (2017)Elite athletes (badminton, triathlon, bicycling, athletics, karate, kayaking, and judo)
(n = 30)
24 M / 6 F
23.6 ± 1.9 y
L. helveticus Lafti L10, 2 × 1010 CFU
Daily
14 weeksNormal training load (winter training)Subjects maintained normal diet and were asked to avoid fermented milk products and immunomodulatory supplementsNot assessedSupported humoral and mucosal immunity by preserving total salivary Immunoglobulin A level
Gepner et al. (2017)Soldiers from elite combat unit (n = 26)26 M
20.5 ± 0.8 y
B. coagulans GBI-30 (BC30) 1.0 × 109 CFU and HMB 3 g
Daily
40 daysStrenuous military training
40 days
No additional dietary supplements nor consumtion any androgens or other performance-enhancing drugsNot assessedCombined supplementation attenuated IL-6 and IL-10 response and maintained muscle integrity
Marshall et al. (2017) [81]Marathon competitors (n = 32)26 M / 6 F
23–53 y
PRO-grp: Multi-strain capsule; L. acidophilus CUL-60 10 × 109 CFU, and L. acidophillus CUL-21 (NCIMB 30156) 10 × 109 CFU), B. bifidum CUL-20 9.5 × 109 CFU and B. animalis subsp. lactis CUL-34 0.5 × 109 CFU, and 55.8 mg fructooligosaccharides.
PGLn-grp: L. acidophilus CUL-60 (NCIMB 30157) 2 × 109 CFU, L. acidophilus CUL-21 (NCIMB 30156) 2 × 109, B. bifidum CUL-20 (NCIMB 30172) 0.5 × 109 CFU, B. animalis subsp. lactis CUL-34 (NCIMB 30153) 0.95 × 109 CFU, L. salivarius CUL61 (NCIMB 30211) 5 × 109 CFU, and each 5-g dose also contained 0.9 g L-glutamine.
Daily
12 weeksMarathon training; Marathon raceNot permitted to consume any other commercial supplementation that conflicted with the study parametersNo difference in marathon time to completion compared to control groupNo change in immuno-stimulatory heat shock protein (eHsp72) concentrations
Toohey et al. (2018) [20]Soccer and volleyball Division I college athletes (n = 23)23 F
19.6 ± 1.0 y
B. subtilis (DE111) 5 × 109 CFU
Daily
10 weeksOffseason resistance training programNo dietary restrictions were placed on the athletes besides abstaining from other supplement useNo effect on physical performance parametersSignificant reduction in body fat percentage
Brennan et al. (2018) [82]
Abstract of 2018 ACSM Confer.
Endurance athletes
(n = 7)
(sex not reported)
31 ± 6.1 y
L. salivarius (UCC118) (dose not indicated)
Daily
4 weeksNot reportedNot reportedNot assessedExercise-induced intestinal hyperpermeability was attenuated
Townsend et al. (2018) [83]Division I Baseball Players (n = 25)25 M
20.1 ± 1.5 y
B. subtilis (DE111) 1 × 109 CFU
Daily
12 weeksOffseason trainingThree-day food logs collected on weeks 1, 9 and 12.No effect on physical performance or body compositionTNF-α concentrations were significantly lower compared to placebo
Antonio et al. (2018) [84]Active men and women (n = 20)6 M/ 14 F
30 ± 8 y
B. breve BR03 5 × 109 CFU and S. thermophilus FP4 5 × 109 CFU
Daily
6 weeksNormal training load (aerobic and/or resistance training)Subjects were instructed to not alter their dietNo effect on body compositionNot assessed
Huang et al. (2018) [85]Healthy adults without professional athletic training (n = 16)16 M
20–40 y
L. plantarum TWK10 1 × 1011 CFU
Daily
6 weeksNot reportedNormal diet maintained and no consumption of any other nutritional supplementsImproved endurance performance and blood glucose concentration in a maximal treadmill running testNot assessed
Carbuhn et al. (2018) [86]Division I collegiate female swimmers (n = 17)17 F
Age not reported
B. longum 35,624, 1 × 109 CFU
Daily
6 weeksOffseason trainingThree-day food logs collected at baseline and weeks 3 and 6.No effect on aerobic/anaerobic swim time trials and force plate vertical jumpNo effect on cytokine and gastrointestinal inflammatory markers and salivary IgA levels
Huang et al. (2019) [87]Healthy adult triathletes (n = 34)Study 1: 18 M, 20.2 ± 0.7 y
Study 2: 16 M, 22.3 ± 1.2 y
L. plantarum PS128 3 × 1010 CFU
Daily
Study 1: 4 weeks
Study 2: 3 weeks
Sprint triathlon (swimming 750 m, biking 20 km, running 5 km).Before race: 595 kcal (24 g PRO, 16 g FAT, 90 g CHO). In race: 30–40 g CHO and 500–1000 ml water per hour.Attenuated post-triathlon performance declines. No effect on body composition.Reduced post-race inflammatory cytokines, reduced oxidative stress, increased plasma BCAA levels.
Pugh et al. (2019) [88]Health adult marathon runners (ran marathon race quicker than 5 h within the previous 2 years; n = 24)20 M / 4 F
34.8 ± 6.9 y
L. acidophilus (CUL60 and CUL21), B. bifidum (CUL20), B. animalis subs p. Lactis (CUL34)
> 25 billion CFU daily in total, no information on individual strains
4 weeks (pre-race)Marathon raceBefore race: standardized high CHO, low fiber diet. In race: 60 mL CHO gel with 200 mL (15 min before start, 40 min post and every 20 min for the remainder of the race.No difference in race times.GI symptom severity during the final third was significantly lower.
Pumpa et al. (2019) [89]Elite rugby union athletes (n = 19)19 M
27.0 ± 3.2 y
L. rhamnosus, L. casei, L. acidophilus, L. plantarum, L. fermentum, B. lactis, B. bifidum, S. thermophilus
120 billion CFU daily in total, no information on individual strains
500 mg S. boulardi (added during stage 3)
17 weeks27-weeks, divided into three stages: 1) control period (10 weeks); 2) domestic competition (7 weeks); 3) international competition (10 weeks).A national training camp and 3 domestic games (stage one), 6-weeks of domestic competition (stage two), and 8-weeks of international competition (stage three).Not assessedNo effect on salivary Immunoglobulin A. Salivary cortisol increased. Increase in salivary alpha-amylase levels during stage 3.
Vaisberg et al. (2019) [90]Amateur marathon runners with previous history of post-race URTI (n = 42)42 M
39.5 ± 9.4 y
Fermented milk beverage containing L. casei Shirota, 4 × 1010 CFU
Daily
30 days (pre-race)Marathon raceUnknownNot assessedImproved airway and systemic immune and inflammatory responses post-marathon. No significant effect on URTI.