Metabolism of ketone bodies during exercise and training: physiological basis for exogenous supplementation

This review covers the physiology of ketone bodies during and after exercise and in response to training, as a basis for exogenous supplementation in athletes. It describes ketone bodies as oxidised during exercise, markedly elevated in post-exercise recovery, and better utilised in exercise-trained skeletal muscle, with actions that attenuate glucose utilisation, reduce lipolysis and attenuate muscle proteolysis, and with beta-hydroxybutyrate acting as a histone deacetylase inhibitor. It notes that initial reports suggest ketone esters alter the metabolic response to exercise and improve performance.