The Changes in pH Levels, Blood Lactic Acid and Fatigue Index to

Mal J Med Health Sci 16(SUPP16): 50-56, Dec 2020

Malaysian Journal of Medicine and Health Sciences (eISSN 2636-9346)

ORIGINAL ARTICLE

The Changes in pH Levels, Blood Lactic Acid and

Fatigue Index to Anaerobic Exercise on Athlete After

NaHCO

Administration

Afif Rusdiawan

, Anindya Mar’atus Sholikhah

, Septyani Prihatiningsih

Department of Physical Education, Health, and Recreation, IKIP Budi Utomo Malang, Simpang Arjuno No.14B, Kauman,

Klojen, Malang, East Java 65119, Indonesia

Department of Education, Health, and Recreation Faculty of Sport Science, Universitas Negeri Surabaya, Rektorat Unesa,

Lidah Wetan, Lakarsantri, Surabaya, East Java 60213, Indonesia

Occupational Health and Safety, Department of Health, Faculty of Vocational Studies, Universitas Airlangga, Dharmawangsa

Dalam Selatan No. 68, Airlangga, Gubeng,Surabaya, East Java, 60286, Indonesia

ABSTRACT

Introduction: Previous studies have revealed that sodium bicarbonate consumption prior to physical activity

has a performance-enhancing effect on anaerobic activity. Methods: It was an experimental research using

retest and posttest design. 36 healthy professional athletes were randomly assigned to either NaHCO

group (SBC=18) or placebo group (PLA=18). Respondents in SBC were given sodium bicarbonate solution

at a dose of 0.4 gram/kg of bodyweight dissolved in 500 ml of aquades, while PLA group were given

mineral water. Sixty minutes after NaHCO3 administration, both groups were assigned to anaerobic

activity which was 300 m sprint test. pH level and lactic acid were measured 5 minutes after anaerobic activity,

while fatigue index was measured 30 minutes after anaerobic activity. Results: Significant differences between

SBC and PLA were found in pH level (p=0,000), blood lactic acid (p=0,000), and fatigue index (p=0,003).

Conclusion: The administration of NaHCO3 was able to prevent a decrease in pH and an excessive increase

of lactic acid and fatigue index as the result of anaerobic activity.

Keywords: Anaerobic activity, Blood lactic acid, Fatigue index, pH, Sodium bicarbonate

Corresponding Author:

Anindya Mar’atus Sholikhah, M.Kes.

Email: [email protected]

Tel: (+62)-8384-9865-215

INTRODUCTION

Aerobic and anaerobic exercise are two different type

of exercise classified based on the interval, intensity,

and muscle fibers involved (1). Anaerobic is a type of

sports activities that increases the concentration of lactic

acid in muscle cells. The increase of lactic acid causes a

decrease of pH cells, a decrease in pH causes a decrease

in reaction rate of catalyst and finally it decreases the

ability of metabolism and ATP production (2). Anaerobic

glycolysis exercise leads to excessive accumulation of

lactic acid in the blood which results in disruption of

muscle contraction (3). Accumulation of lactic acid and

carbon dioxide can lower the force or power, speed,

and cause fatigue (4). Previous study reported that the

increase in lactic acid would be followed by an increase

of fatigue index during an anaerobic (5).

In high intensity and short duration exercises, the

fulfillment of energy requirement increases almost 100

times (6). Oxidative phosphorylation is not able to

produce large amounts of energy in a short period of

time, therefore, the fulfillment of energy requirement of

this type of sport depends on the phosphagen system

and anaerobic glycolysis (7). The phosphagen system

can only provide energy for activities with a span

of 10-15 seconds, thus, anaerobic glycolysis is the

major metabolic pathway in high intensity exercise

(7). However, this anaerobic glycolysis metabolic

pathway produces by-product in the form of lactic

acid (8). Increased reliance energy causes lactic acid

accumulation. According to some researchers, lactic

acid accumulation causes muscle fatigue that arises

during the intense exercise (9).

Recovery from exercise or competition is an important

component of the overall sports paradigm. And the

most important thing from recovery is to support a

better performance in the next exercise or competition

(10). Recovery is useful for body adaptation after

Malaysian Journal of Medicine and Health Sciences (eISSN 2636-9346)

Mal J Med Health Sci 16(SUPP16): 50-56, Dec 2020

physical activity. Increased recovery time helps athletes

in maintaining health and performance in order to

increase opportunities to enter or undergo a competition

favorably (11).

Strategies for optimizing recovery from exercise or

physical activity depend on type of exercise, specific

exercise, duration, intensity, and time between exercise

sessions or competitions (12). Successful recovery

involves many physiological and metabolic processes

that act to prepare athletes for the next competition or

exercise (12). Adequate recovery has been proven to

result in the recovery of physiological and psychological

processes, so that athletes can compete or train again

at the appropriate level. Recovery from exercise and

competition is very complex and usually depends on

the nature of the exercise performed and other external

stressors (13).

There are a number of popular methods used by

athletes to improve recovery. Its use depends on the

type of activity carried out, and the period until the next

exercise session. Some popular recovery techniques for

athletes include stretching, active recovery, compression

sportswear, hydrotherapy, massage, good quality sleep,

and nutrition. Nutrition is one of the best ways for

athletes to do recovery, such as consuming balanced

diet and drinks containing sodium bicarbonate.

Consuming sodium bicarbonate has been proven to

increase exercise tolerance, but its effect on intermittent

sports with high intensity is obscure (14). Bicarbonate

is an alkaline neutralizer, naturally regulating acid-base

homeostasis in the body. Chemically, bicarbonate binds

with hydrogen lactate ions to form water and carbon

dioxide, and carbon dioxide dissolved in the blood will

be released through the respiratory system (15).

Anerobic glycolysis will generate lactic acid due to

incomplete breakdown of glucose (16). The higher

level of lactic acid in the blood will engage a decrease

in blood pH which then cause physical fatigue and

alter physical appearance. Moreover, prolonged

physical activity or high intensity exercise will trigger

the formation of lactic acid (9). When exercise occurs,

anaerobic fatigue may develop as a result of lactic acid

accumulation (17). Lactic acid in muscle cells causes

lactic acidosis so that the neuromuscular junction

stops the nerve stimulation to the muscle fibers,

consequently, the muscles are unable to contract (18).

Acidic status in the blood (low pH) can cause

interference with various cellular muscle mechanisms

such as decreased aerobic resistance due to inhibition

of aerobic enzymes, poor movement coordination due

to inhibition of creatin phosphate formation, decreased

fat oxidation rate due to increased urea levels (19). A

method that can be used to slow down the occurrence

of fatigue due to lactic acid that accumulates in the

body during physical activity is providing alkaline fluids

such as sodium bicarbonate drinks. Sodium bicarbonate

(NaHCO

) is an alkaline that has the ability to damage

and oxidize acids in food ingredients. This happens

because NaHCO

is the weakest sodium alkali and has

a pH of 8.3 in aqueous solution (19).

Some literatures also explain that drinks containing

sodium bicarbonate can neutralize low pH levels during

exercise or physical activity, thus it can alleviate the

lactic acid production during exercise (20). Sodium

bicarbonate is a strong base that quickly reacts with H

and NaOH quickly release acid molecules in solution.

Alkali is a molecule generated by the formation of one

or more alkali-sodium metals such as potassium and

lithium (19). The acid solution will be removed by this

alkaline molecule because it can react quickly with H

Normal pH level of the liquid in human body ranges

from 7,34 to 7,40 (21). If the pH is out of this range, the

mechanism of homeostasis will improve buffer process,

and consequently it will set a new pH level (19).

A pH level beyond 7.4 is categorized as alkaline, and

previous studies revealed that sodium bicarbonate drink

is one of the high alkaline-containing liquids that that

causes blood become more alkaline at a low pH or

acidic (3). Consuming sodium bicarbonate is an effort

to reduce the body acidity due to the physical activity,

especially in doing exercise, thus, the acidic condition

or decrease in pH can be reduced to postpone the

risk of fatigue as a result of lactate ions and H

ions

accumulation (3).

Therefore, the authors are interested to analyze the

effect of NaHCO

on pH levels, blood lactic acid, and

fatigue index after anaerobic activity. The aim of this

research is to investigate whether the administration

of NaHCO

can withstand the decrease in pH level and

fatigue index as well as an increase in blood lactic acid

due to anaerobic activity so that this treatment can delay

fatigue and improve athletic performance, especially

athletes in intermittent sports such as badminton (22)

MATERIALS AND METHODS

This research was an experimental research with

a pre and post control group design. A total of 36

PBSI Jombang (Badminton Association of Indonesia

in Jombang district) athletes were employed as the

research subject with inclusion criteria aged 16-20

years old, male, having normal weight and BMI, and

agreed to participate in this study and followed all

the protocols. All participants were informed about

the research purpose, procedures, and any potential

risks that may develop as side effects. The research

subjects were then randomly divided into two groups

(PLA and SBC) with a total of 18 people in each group

(See Fig. 1 below).

Mal J Med Health Sci 16(SUPP16): 50-56, Dec 2020

Remarks:

S : Sample

R : Randomization

PLA : Placebo group

SBC : Treatment group (with NaHCO3)

T1 : Mineral water

T2 : NaHCO3 with dose 0,4 gram/kg bodyweight in

500 ml mineral water

AA : Anaerobic activity

O1 : Pretest of PLA (pH levels, blood lactic acid, fatigue

index)

O2 : Pretest of SBC (pH levels, blood lactic acid,

fatigue index)

O3 : Post-test of PLA (pH levels, blood lactic acid,

fatigue index)

O4 : Post-test of SBC (pH levels, blood lactic acid,

fatigue index)

The research data were obtained from tests on blood

pH, blood lactic acid and anaerobic fatigue index

conducted 2 times (pretest and posttest). Blood pH

was measured with a pH meter 1-STAT tool and lactic

acid was measured using a lactate meter Roche Cobas

Accutrend Plus GCTL Meter. Blood pH and lactic acid

was employed by taking blood from the respondent’s

fingertips and then dripping on the instrument.

Whereas, the measurement of anaerobic fatigue index

used RAST-test (Running-based Anaerobic Sprint-test)

(23).

The procedure for carrying out the RAST-test was

done by asking the respondents to perform six 35-meter

sprint, with 10 seconds break for each sprint, then

the time was recorded. Next, speed (distance/time),

acceleration (speed/time), force (weight x acceleration)

and power (force x speed)were calculated (24). The

fatigue index is calculated using RAST calculator as

follows:

Fatigue index =

Before taking the pretest data, respondents were asked

to fast for 8 hours while still consuming mineral water

and checking their health condition both pulse and

blood pressure. Besides, respondents were also asked

questions about their medical history, eating habit and

physical activity carried out during the last 3 days.

30 minutes after the pretest, respondents consumed

sodium bicarbonate solution at a dose of 0.4 gram/

kg of bodyweight for the treatment group (SBC),

and drank mineral water for the placebo group (PLA)

(14). Sodium bicarbonate was dissolved in 500 ml of

aqua water (25). To avoid vomiting, sodium was given

in 3 stages: 60 minutes, 45 minutes and 30 minutes.

After 60 minutes of consuming sodium bicarbonate

or mineral water, the research subjects conducted

anaerobic activity by running 300 meters (26)(27).

Bloods were drawn after 5 minutes of conducting

anaerobic activity to re-measure pH and lactic acid

(posttest) (28). 30 minutes after anaerobic activity,

the subjects were measured their anaerobic fatigue

index by doing the RAST posttest.

Data were analyzed with statistical software and were

presented as mean values and standard deviation

(SD). Paired t-test was performed to compare pH level,

blood lactic acid, and fatigue index before and after

NaHCO

administration. Independent t-test was

performed to compare between groups. The tests were

all two-tailed and p<0,05 was considered statistically

significant.

RESULTS

Thirty-six healthy athletes were participated in this

study. The mean values and standard deviation of

physical characteristic (age, height, weight, and BMI) in

both groups are shown in Table I. For PLA group, the

mean value of age, height, weight, and BMI were 17,56

± 1,29, 168,89 ± 2,81 cm, 60,56 ± 3,85 kg, and 21,22

± 0,94, respectively. For SBC group, the mean value

of age, height, weight, and BMI were 18,44 ± 1,25,

167,00 ± 4,56 cm, 63,00 ± 3,85 kg, and 22,61 ± 1,40,

respectively.

Maximal Power - Minimal Power

Total time of 6 sprints

Fig. 1 : Research Design

Fig. 2 : The changes in pH levels (A), blood lactic acid (B); and fatigue

index (C) after anaerobic activity in control (PLA) and treatment

(SBC) group.

Mal J Med Health Sci 16(SUPP16): 50-56, Dec 2020

Malaysian Journal of Medicine and Health Sciences (eISSN 2636-9346)

DISCUSSION

The Effects of anaerobic exercise on pH levels, blood

lactic acid and fatigue index

Based on the results of the statistical tests in this study,

anaerobic exercise was able to influence the pH levels,

serum lactate and fatigue index (see Table II). These results

are in line with research conducted by Rashidi, Salehian,

& Vaezi (2013) that blood lactate levels increased after

5 minutes of anaerobic activity. Increased blood lactate

was caused by the active anaerobic glycolysis system

in the muscles during anaerobic activity resulting the

production of lactic acid (29). The lactic acid from

metabolism result in the muscle then was secreted into

the blood. It caused the decrease of blood pH and the

blood become acidic. The decreased blood pH would

disrupt the activity of glycolytic enzymes and muscle

contraction, consequently, it would cause fatigue and

decreased performance (30).

Anaerobic activity is a high intensity exercise with a

short duration and fueled by energy sources that are

Fig. 2 shows the changes in pH levels, blood lactic

acid, and fatigue index after respondents in both groups

performed running exercise. Both groups experienced

a significant decrease in pH levels, but the PLA group

decreased more sharply. A significant increase was

found in blood lactic acid and fatigue index, with PLA

group experience a sharper increase than SBC.

Table I : Baseline characteristic of respondents in both group

Group

Mean ± SD

Age Height (cm) Weight (kg) BMI

PLA 17,56 ± 1,29 168,89 ± 2,81 60,56 ± 3,85 21,22 ± 0,94

SBC 18,44 ± 1,25 167,00 ± 4,56 63,00 ± 3,85 22,61 ± 1,40

PLA = mineral water + anaerobic exercise

SBC = group of NaHCO

+ anaerobic exercise intervention

Table II shows the changes in pH levels, blood lactic

acid and fatigue index in the PLA and SBC groups.

Paired sample t-test results showed that data before

(pre) and after (post) intervention was significantly

different p<0,05. It can be concluded that anaerobic

exercise affected pH levels, serum lactate and fatigue

index in both PLA and SBC groups.

Table II : Effect of anaerobic exercise on the changes of pH levels, blood lactic acid and fatigue index

Group

pH levels

Mean ± SD

sig.

Blood lactic acid

(mg/dl)

Mean ± SD

sig.

Fatigue index (watt/s)

Mean ± SD

sig.

PLA

pre 7,41 ± 0,02

0,000*

1,20 ± 0,57

0,000*

3,89 ± 1,20

0,000*

post 7,12 ± 0,01 8,26 ± 1,16 7,55 ± 1,77

SBC

pre 7,40 ± 0,02

0,000*

1,21 ± 0,35

0,000*

4,38 ± 1,29

0,000*

post 7,22 ± 0,02 5,17 ± 1,19 6,17 ± 0,66

significant difference at α=0,05

PLA= mineral water + anaerobic exercise

SBC= NaHCO

+ anaerobic exercise

To find out the difference in the effect of NaHCO

administration on pH levels, blood lactic acid and

fatigue index, the difference between the pre and post

data in the PLA group and the SBC group was calculated

using an independent sample t-test.

The results of the independent sample t-test are

presented in Table III. The results of the independent

sample t-test showed the value of p <0,05 on the pH

level variable (p = 0,000), blood lactic acid (p = 0,000),

and fatigue index (p = 0,003). These results indicated

that there were significant differences between the

PLA group and the SBC group at pH levels, blood lactic

acid and fatigue index after anaerobic exercise. Thus, it

can be concluded that there was an influence of giving

NaHCO

on pH levels, blood lactic acid and fatigue

index after anaerobic exercise.

metabolized without oxygen (31). Energy in anaerobic

exercise is obtained from the ATP-PC system and

anaerobic glycolysis (32). ATP-PC system and anaerobic

glycolysis causing lactic acid production (27). The

examples of anaerobic exercises are sprint, bicycle

racing, weight-lifting (33). 300 meters run is anaerobic

activity because it is a high intensity in a short duration

exercise (34).

Anaerobic activity metabolism causes the production

of lactic acid in the working muscles (8). The part

of produced lactic acid is released into the blood,

consequently it reduce blood pH and disturb the

acid-base balance (35). Lactic acid is a three-carbon

biomolecule with a carboxyl group and a hydroxyl

group. It is the final product of the anaerobic glycolysis

process produced by red blood cells and active muscle

Table III : Differences in pH levels, blood lactic acid, and fatigue index after anaerobic exercise in the PLA group and SBC group

Group

Δ pH levels

Mean ± SD

sig.

Δ Blood lactic acid (mg/dl)

Mean ± SD

sig.

Δ Fatigue index (watt/s)

Mean ± SD

sig.

PLA 0,291 ± 0,03

0,000*

-7,061 ± 1,31

0,000*

-3,658 ± 1,87

0,003*

SBC 0,183 ± 0,02 -3,961 ± 1,17 -1,791 ± 1,65

significant difference at α=0,05

PLA= mineral water + anaerobic exercise

SBC= NaHCO

+ anaerobic exercise

Mal J Med Health Sci 16(SUPP16): 50-56, Dec 2020

However, the administration of sodium bicarbonate

70-90 minutes before competing does not improve

the performance of rowing athletes (41). Sodium

bicarbonate is the monosodium salt of carbonic acid

with alkalinizing and electrolyte replacement properties

(45). After dissociation, sodium bicarbonate forms

sodium ions and bicarbonate. This ion formation will

increase plasma bicarbonate levels and act as buffer

in excess concentrations of hydrogen ion, thereby

increasing blood pH (45). Sodium bicarbonate that

enters the body will cause metabolic alkalosis which is

good for buffering lactic acid. However, consumption

of sodium bicarbonate can cause discomfort in the

stomach as it emits a lot of carbon dioxide (46). The side

effect of sodium bicarbonate consumption is a decrease

in cardiac output and impaired lactate clearance by the

liver (47).

When someone does exercise, the body will produce

lactic acid (48), therefore, the body needs additional

sodium bicarbonate to buffer lactic acid. Continuous

training can cause mineral deficiency and sodium

bicarbonate deficiency (electrolytes lost through sweat

or urination) which can cause latent tissue acidosis, pain,

edema, hyponatremia and death (15). The administration

of alkaline sodium bicarbonate is a good treatment and

it is commonly used in overcoming the problem of

acidosis (49). Sodium bicarbonate increases hydroxyl

ions or electron levels through increased alkalinity to

cells that protect metabolic acids (15). Nanang et al.

(2018) in his research revealed that giving pH 9 alkaline

water could prevent fatigue due to high lactic acid and

low pH after submaximal exercise. Sodium bicarbonate

that is absorbed by the body immediately binds with

pyruvate molecules to form oxaloacetate and malate,

strong binding occurs by bicarbonate against hydrogen

ions, so that it leads to functioning bicarbonate, and

LDH enzyme does not work optimally (50).

Lactate level in the SBC group was lower because

bicarbonate was a buffer against lactic acid.

Biochemically the role of bicarbonate is a binding of

ions in intracellular fluid and extracellular fluid to

form carbonic acid (H

) Furthermore, carbonic acid

in the blood fluid will be brought to the respiratory

system into H2 O and CO2. Water and carbon dioxide

will then be excreted during the respiratory process.

Bicarbonate will combine with pyruvic acid in muscle

cells to form malate, then it will directly enter the Krebs’s

Cycle (50). The fatigue index of the SBC group was also

lower because the level of lactic acid was also low due

to the administration of sodium bicarbonate which was

buffered against lactic acid.

CONCLUSION

There was a decrease in pH level, as well as an increase

in lactic acid and fatigue index after anaerobic exercise.

The administration of NaHCO

was able to prevent a

cells (36). Lactic acid is a strong acid, and consequently

it will dissociate into lactic and H+. The increase of H

ions will decrease pH and cause acidosis (4).

The discussion of acidosis during the intense exercise

has been explained as a result of lactic acid production,

causing proton release and formation of sodium lactate.

This biochemical event is called as lactic acidosis (37).

Other theories reveal that acidosis is not the only way

to decreases the speed of observed contraction during

fatigue (38).

The pH change in the muscles that become acid will

inhibit the work of glycolysis enzymes, consequently,

it will disrupt the chemical reactions in the cell (39).

It causes the reduction of energy produced so that

the muscle contraction gets weaker and eventually,

and finally the muscles will experience fatigue. Low

pH levels will inhibit the performance of the enzyme

phosphofructokinase which plays an important role in

fulfilling muscle energy, so that it will cause muscle

fatigue (40).

From the above theories it can be concluded that

anaerobic exercise could increase the index of fatigue

due to the acid-base imbalance in the blood or it is called

as experiencing metabolic acidosis. Metabolic acidosis

was caused by an increase in lactic acid in the blood

that leads to decrease in blood pH and disruption the

performance of glycolytic enzymes to produce energy

used in muscle contraction.

The effect of NaHCO

administration on pH levels,

blood lactic acid and fatigue index

This study found that there was a significant difference

of pH levels as well as blood lactic acid with p-value

of zero and fatigue index (p = 0.003). The results of

this study indicated that the administration of NaHCO

affected the pH levels, serum lactate and fatigue index

after anaerobic exercise. In accordance with Hartono &

Sukadiono (2017) which stated that the administration

of sodium bicarbonate and sodium citrate at a dose of

300 mg/kg in 500 ml aqua was able to increase blood

pH and the time duration to fatigue after performing

anaerobic exercise (25). In line with research by Kupcis

et al. (2012) that there was an increase in blood pH and

a decrease in lactic acid after sodium bicarbonate was

given to the rowing athletes but there was no increase

in their performances (41). Krustrup in his study stated

that the administration of sodium bicarbonate at a dose

of 0,4 g•kg

−1

body weight could increase the results of

Yo-Yo IR2 performance by 14% higher than the placebo

group (14). These results indicated that administration

of sodium bicarbonate was able to increase fatigue

resistance.

Sodium bicarbonate has an ergogenic effect that can

improve performance in swimming, rowing, middle-

distance running, sprinting and boxing (42–44).

Mal J Med Health Sci 16(SUPP16): 50-56, Dec 2020

Malaysian Journal of Medicine and Health Sciences (eISSN 2636-9346)

decrease in pH and an excessive increase of lactic

acid that led to a decrease in the fatigue index values.

However, the dosage given should be considered for

sodium bicarbonate has side effects such as headache,

stomachache, and diarrhea.

ACKNOWLEDGEMENT

This work was supported by PBSI (Badminton

Association of Indonesia) Jombang. The author is

thankful to the organizations and the athletes who

have supported and participated in this study. Without

their contribution, the data collection process in this

study would not have been possible.

REFERENCES

1. Patel H, Alkhawam H, Madanieh R, Shah N,

Kosmas CE, Vittorio TJ, et al. Aerobic vs anaerobic

exercise training effects on the cardiovascular

system. World J Cardiol. 2017;9(2):134–8.

2. Hopkins ETSSS. Physiology , Acid Base Balance.

StatPearls Publishing LLC; 2018. p. 2–7.

3. Wan J-J, Qin Z, Wang P-Y, Sun Y, Liu X. Muscle

fatigue: general understanding and treatment. Exp

Mol Med. 2017;49(10):384.

4. Westerblad H, Allen DG, Lännergren J. Muscle

fatigue: Lactic acid or inorganic phosphate the

major cause? News Physiol Sci. 2002;17(1):17–21.

5. Andersen LW, Mackenhauer J, Roberts JC, Berg

KM, Cocchi MN, Donnino MW. Etiology and

Therapeutic Approach to Elevated Lactate Levels.

Mayo Clin Proc [Internet]. 2013;88(10):1127–

40. Available from: http://dx.doi.org/10.1016/j.

mayocp.2013.06.012

6. Miladiyah I, Trunogati P, Lestariana W. Perbandingan

Efektivitas Teofilin (1,3-Dimethylxanthine) dan

Kafein (1,3,7-Trimethylxanthine) dalam Menunda

Kelelahan Otot pada Tikus. Mutiara Med J Kedokt

dan Kesehat. 2017;17(2).

7. Baker JS, Mccormick MC, Robergs RA. Interaction

among skeletal muscle metabolic energy system

during intense exercise. J Nutr Metab. 2010;2010.

8. Plowman SA, Smith DL. Anaerobic Metabolism

during Exercise Exercise physiology for health,

fitness, and performance. In: Sports-Specific

Rehabilitation. Elsevier Inc.; 2007. p. 39–63.

9. Cairns S. Lactic Acid and Exercise Performance,

Culprit or Friend? Sport Med. 2006;36(4):279–91.

10. Dalleck L. Post-Exercise Recovery. Am Counsil

Exerc. 2014;(161):10–4.

11. Mujika I. Recovery for Performance in Sport.

Hausswirth C, editor. France: Human Kinetics Inc.;

2013. 296 p.

12. Williams C. Recovery from exercise: role of

carbohydrate nutrition. Malaysian J Movement,

Heal Exerc. 2014;3:1–13.

13. Halson SL. Recovery Techniques for Athletes. Sport

Sci Exch. 2013;26(120):1–6.

14. Krustrup P, Ermidis G, Mohr M. Sodium bicarbonate

intake improves high-intensity intermittent exercise

performance in trained young men. J Int Soc Sports

Nutr. 2015;12(1):1–7.

15. Young RO. Using Sodium and Potassium

Bicarbonates in the Prevention and Treatment of

all Sickness and Disease. Int J Complement Altern

Med. 2017;9(6).

16. Brooks GA, Gladden LB. The Metabolic

Systems: Anaerobic Metabolism (Glycolytic and

Phosphagen). In: Exercise Physiology. Springer

New York; 2003. p. 322–60.

17. Takeda K, Machida M, Kohara A, Omi N, Takemasa

T. Effects of citrulline supplementation on fatigue

and exercise performance in mice. J Nutr Sci

Vitaminol (Tokyo). 2011;57(3):246–50.

18. Wada M, Mishima T, Yamada T. The role of lactic

acid in muscle contraction. Taiikugaku kenkyu

(Japan J Phys Educ Heal Sport Sci. 2006;51(3):229–

39.

19. Nanang M, Fuad N, Didik R, Topo S, Panuwun J.

Effect of Alkaline Fluids to Blood pH and Lactic

Acid Changes on Sub Maximal Physical Exercise

Effect of Alkaline Fluids to Blood pH and Lactic

Acid Changes on Sub Maximal Physical Exercise.

IOP Conf Ser Earth Environ Sci. 2018;197:12049.

20. Hadzic M, Eckstein ML, Schugardt M. The impact

of sodium bicarbonate on performance in response

to exercise duration in athletes: A systematic

review. J Sport Sci Med. 2019;18(2):271–81.

21. Sandhya TTAAB. Internal Ph in Health and Disease.

Int J Curr Res. 2016;8(7):34315–20.

22. Aydoğmuş M, Arslanoğlu E, Özmen T. Effect of

Badminton Specific Training Versus Badminton

Match on Aerobic Fitness. Online J Recreat Sport.

2015;4(2):12–5.

23. Mackenzie B. Running-based Anaerobic Sprint

Test - RAST. 1998.

24. Nasuka, Santosa I, Setiowati A, Indrawati F. The

Running-based Anaerobic Sprint Test of different

Type of Sports. J Phys Conf Ser. 2019;1387(1).

25. Hartono S, Sukadiono. The effects of sodium

bicarbonate and sodium citrate on blood pH,

HCO3-, lactate metabolism and time to exhaustion.

Sport Mont. 2017;15(1):13–6.

26. R. Callister, A. Miller, E. Aguiar, B. Dascombe C,

Smith, L. Clark TR. Blood lactate levels support

classification of the 300 m shuttle run as an

anaerobic capacity field test. J Sci Med Sport.

2010;13:e29–30.

27. Vilmi N, Ayramo S, Nummela AT, Pullinen T.

Oxygen uptake, acid-base balance and anaerobic

energy system contribution in maximal 300-400 m

running in child, adolescent and adult athletes. J

Athl Enhanc. 2016;5(3).

28. Pennington C, Kinesiology MS. The Exercise Effect

on the Anaerobic Threshold in Response to Graded

Exercise. Int J Heal Sci. 2015;3(1):225–34.

29. Rashidi M, Salehian O, Vaezi G. The effect of

Mal J Med Health Sci 16(SUPP16): 50-56, Dec 2020

high intensity anaerobic training on the blood

lactate levels after active recovery. Eur J Exp Biol.

2013;3(6):346–50.

30. Sesboüé B, Guincestre JY. La fatigue musculaire.

Ann Readapt Med Phys. 2006;49(6):257–64.

31. Patel H, Alkhawam H, Madanieh R, Shah N,

Kosmas CE, Vittorio TJ. Aerobic vs anaerobic

exercise training effects on the cardiovascular

system . World J Cardiol. 2017;9(2):134.

32. Mancha-Triguero D, García-Rubio J, Antúnez

A, Ibáñez SJ. Physical and Physiological Profiles

of Aerobic and Anaerobic Capacities in Young

Basketball Players. Int J Environ Res Public Health.

2020;17(4):1409.

33. Manansang GR, Rumampuk JF, Moningka MEW.

Perbandingan Tekanan Darah Sebelum dan

Sesudah Olahraga Angkat Berat. J e-Biomedik.

2018;6(2).

34. Hecksteden A, Heinze T, Faude O, Kindermann

W, Meyer T. Validity of Lactate Thresholds in

Inline Speed Skating. J Strength Cond Res. 2015

Sep;29(9):2497–502.

35. Chycki J, Kurylas A, Maszczyk A, Golas A, Zajac

A. Alkaline water improves exercise-induced

metabolic acidosis and enhances anaerobic

exercise performance in combat sport athletes.

PLoS One. 2018;13(11):1–10.

36. Marshall W, Lapsley M, Day A, Ayling R.

Biochemical aspects of anaemia. In: Clinical

Biochemistry: Metabolic and Clinical Aspects. 3rd

Editio. Churchill Livingstone; 2014. p. 515–32.

37. Shalayel M, Ahmed S. Lactic acid – the innocent

culprit of muscle fatigue. Sudan J Med Sci.

2010;5(2).

38. Theofilidis G, Bogdanis G, Koutedakis Y,

Karatzaferi C. Monitoring Exercise-Induced Muscle

Fatigue and Adaptations: Making Sense of Popular

or Emerging Indices and Biomarkers. Sports.

2018;6(4):153.

39. Šimčíková D, Heneberg P. Identification of alkaline

pH optimum of human glucokinase because

of ATP-mediated bias correction in outcomes

of enzyme assays. Sci Rep. 2019;9(November

2018):1–6.

40. Bruton JD, Lännergren J, Westerblad H. Effects

of CO2-induced acidification on the fatigue

resistance of single mouse muscle fibers at 28°C. J

Appl Physiol. 1998;85(2):478–83.

41. Kupcis PD, Slater GJ, Pruscino CL, Kemp JG.

Influence of Sodium Bicarbonate on Performance

and Hydration in Lightweight Influence of Sodium

Bicarbonate on Performance and Hydration in

Lightweight Rowing. Int J Sports Physiol Perform.

2012;7:11–8.

42. MacNaughton LR. The effect of sodium bicarbonate

on rowing ergometer performance in elite rowers.

Aust J Sci Med Sport . 1991;23(3).

43. Zajac A, Cholewa J, Poprzecki S, Waśkiewicz Z,

Langfort J. Effects of sodium bicarbonate ingestion

on swim performance in youth athletes. J Sport Sci

Med. 2009;8(1):45–50.

44. Siegler JC. Sodium bicarbonate ingestion and

boxing performance. J strength Cond Res.

2010;24(1).

45. Carr AJ, Slater GJ, Gore CJ, Dawson B, Burke LM.

Effect of sodium bicarbonate on [HCO3-], pH, and

gastrointestinal symptoms. Int J Sport Nutr Exerc

Metab. 2011;21(3):189–94.

46. Ferreira CR, van Karnebeek CDM. Inborn errors of

metabolism. In: Handbook of Clinical Neurology.

Elsevier B.V.; 2019. p. 449–81.

47. Levraut J, Labib Y, Chave S, Payan P, Raucoules-

Aime M, Grimaud D. Effect of sodium bicarbonate

on intracellular pH under different buffering

conditions. Vol. 49, Kidney International. 1996.

48. Ishii H, Nishida Y. Effect of lactate accumulation

during exercise-induced muscle fatigue on

the sensorimotor cortex. J Phys Ther Sci.

2013;25(12):1637–42.

49. Forsythe SM, Schmidt GA. Sodium bicarbonate

for the treatment of lactic acidosis. Chest.

2000;117(1):260–7.

50. Wang Y, Huang Y, Yang J, Zhou F, Zhao L,

Zhou H. Pyruvate is a prospective alkalizer to

correct hypoxic lactic acidosis. Mil Med Res.

2018;5(13):1–9.