Influence of Exogenous Factors Related to Nutritional and Hydration Strategies and Environmental Conditions on Fatigue in Endurance Sports: A Systematic Review with Meta-Analysis.

The aim of this systematic review with meta-analysis was to examine the influence of exogenous factors related to nutritional and hydration strategies and environmental conditions, as modulators of fatigue, including factors associated with performance fatigability and perceived fatigability, in endurance tests lasting 45 min to 3 h. A search was carried out using four databases: PubMed, Web of Science, SPORTDiscus, and EBSCO. A total of 5103 articles were screened, with 34 included in the meta-analysis. The review was registered with PROSPERO (CRD42022327203) and adhered to the PRISMA guidelines. The study quality was evaluated according to the PEDro score and assessed using Rosenthal's fail-safe N. Carbohydrate (CHO) intake increased the time to exhaustion ( < 0.001) and decreased the heart rate (HR) during the test ( = 0.018). Carbohydrate with protein intake (CHO + PROT) increased lactate during the test ( = 0.039). With respect to hydration, dehydrated individuals showed a higher rate of perceived exertion (RPE) ( = 0.016) and had a higher body mass loss ( = 0.018). In hot conditions, athletes showed significant increases in RPE ( < 0.001), HR ( < 0.001), and skin temperature ( = 0.002), and a decrease in the temperature gradient ( < 0.001) after the test. No differences were found when athletes were subjected to altitude or cold conditions. In conclusion, the results revealed that exogenous factors, such as nutritional and hydration strategies, as well as environmental conditions, affected fatigue in endurance sports, including factors associated with performance fatigability and perceived fatigability.