Chronic cannabis consumption and physical exercise performance in healthy adults: a systematic review

Utilizing Medline and PubMed (a literature review that was not systematic was carried out to gather articles concerning cannabis/marijuana use and its influence on sports and athletic performance; the lead author reviewed the abstracts), identifying and exploring key themes. Evidence from scientific literature does not support the notion that cannabis enhances athletic performance, with various studies highlighting significant declines in objective measures of athletic capability. The critical role of sufficient sleep in promoting optimal recovery and athletic performance is increasingly acknowledged. Elevated pre-competition stress (often referred to as sports performance anxiety (SPA)), can negatively affect athletic outcomes.

Since aerobic exercise performance is closely tied to the cardiovascular and respiratory systems, it is essential to evaluate how cannabis and THC consumption impact respiratory health. Generally (studies in these fields have been treated independently (for reviews on cannabis and performance), see 9, 21, 27, 30, 31, 32, 33, 34, 35, 36; for cardiovascular effects of cannabis, refer to 22, 25), lacking overall integration. It should be emphasized that these studies were not specifically intended to address the questions at hand, a detail that tends to be overlooked in discussions regarding sport application and interpretation.

UFC fighter Nick Diaz received a five year suspension from the commission in 2015 for repeat cannabis violations, though the suspension was later reduced to a year and a half. In May 2021 he received the first such exemption in the U.S. — granted by the Colorado Combative Sports Commission. Under the new policy, fighters will no longer be punished for cannabis use except in cases where “further evidence demonstrates the substance was taken for performance-enhancing purposes such as alleviating pain or anxiety”. He also noted in 2018 that multiple players have told him that cannabis helps them deal with their anxiety. Johnson and Sims (who are business partners), announced a partnership with Harvard University in 2019 to study the effects of cannabis on chronic traumatic encephalopathy (CTE) and its benefits in managing pain. WADA relaxed its policy towards cannabis in 2013 — increasing from 15 ng/mL to 150 ng/mL the level of THC metabolite allowed in urine before an athlete is considered to have failed a drug test.

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The possible adverse health effects of cannabis in elite athletes have not been specifically addressed, but lessons may be drawn from other recreational cannabis literature. A lack of performance-enhancing effect has been echoed in more recent reviews,29,30 including the most recent systematic review,1 and this conclusion suggests that the reason for considering cannabis as a banned substance is due to safety concerns (see below) and the fact that use of an illicit substance is contrary to the spirit of sport.31,32 Athletes have also been shown to have higher pain thresholds than controls.27 Data on the effects of cannabis on quantitative sensory testing parameters are not conclusive but suggests that cannabinoids may increase punctate and pressure pain thresholds , Table 1,.

PRACTICAL APPLICATIONS

These changes could have implications for athletic performance, particularly in sports that require quick decision-making and strategic thinking. Also worth noting, the long-term effects of cannabis on the cardiovascular system remain unclear and should not be overlooked as more research is needed to determine whether chronic use poses risks to athletes1. More research is needed to fully understand the long-term effects of cannabis on sleep and athletic recovery. Athletes may use CBD to aid recovery (manage pain), and reduce anxiety without the psychoactive effects of THC. For some, THC may reduce pre-competition anxiety, while for others, it may impair focus and decision-making.

Three of the included studies measured participants’ performance on a treadmill with a breathing apparatus to determine VO2Max, while the medical cannabis and chronic pain evidence remaining study , Maksud and Baron 1980, utilized a bicycle ergometer. Relevant outcomes from among the selected studies were VO2Max — PWC, other pulmonary measures, strength and endurance measures (grip strength, side plank time, hip flexion torque, etc.), perceived exertion, resting heart rate, and blood pressure (See Tables 2 and 3). Studies were excluded that focused on acute effects of cannabis (reported on populations other than physically and mentally well adult humans), or had reduced cannabis use as an outcome measure. Several review articles were found, suggesting sufficient literature existed within this area.

Acute effects of cannabis include increased heart rate (followed in many individuals by hypotension), dizziness and disorientation, increased subjective feelings of euphoria or being ‘high’ and a state of intoxication or being ‘stoned’, and sometimes psychosis, panic reactions and para-noia. Experts of the WADA scientific committees endeavour to utilize all published scientific data to achieve the most objective judgement on the potential of substances or methods to fulfil the Code’s criteria. There are conflicting reports in the literature on the chronic toxic effects of cannabis. Following inadvertent ingestion of cannabis by children, serious CNS depression may be observed.26,27 However, with supportive care, these cases have resolved successfully with few residual health effects.

CBD effects on anxiety seem to depend on dosage; 300 mg is more effective than 150 or 600 mg for reducing anxiety-related symptoms , Linares et al., 2019,. CBD inhibits the degradation and absorption of endocannabinoids such as anandamide, increasing endocannabinoids’ binding to their receptors. These molecules, comparable to N-acyl ethanolamine’s , De Petrocellis and Di Marzo, 2009,, generate benefits similar to exercises, such as hunger control, inflammation reduction, anxiety relief, and prevention of excessive cell proliferation. Coaches, athletes, doctors, therapists, and scientists are constantly concerned with finding ways to improve the performance of athletes by making athletes faster, more resistant, more agile, rest and recover better from efforts and feel better. Graeme Close has received funding from Naturecan Ltd. “I was referred to the substance misuse cases and many of them had comorbid anxiety or depressive disorders along with their cannabis use disorder,” says McDuff.

Some mental health experts have expressed concern over the development of cannabis use disorders, which may lead to increased anxiety or depressive disorders. The United States Anti-Doping Agency must undo this archaic (inhumane), and unscientific policy. ” These concerns (the report notes), were “scientifically grounded” by the results of the 1999 Monitoring the Future survey, which concluded that youth steroid use increased roughly 50% over the prior year’s study. Some users even report that cannabis helps with pre-run anxiety and getting into a mental “flow” state.

This review aims to thoroughly assess the literature discussing the impacts of whole cannabis — THC, and CBD on both athletic performance and recovery. Despite speculation regarding their potential benefits, the effects of cannabis and its primary components, delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD), remain largely unexplored. However, it is evident that the scientific basis for marijuana’s alleged performance-enhancing effects deserves more in-depth examination. Athletes face a potential maximum suspension of two years for cannabis use; however (if it can be demonstrated that this use was unrelated to sport), a minimum suspension of one month is possible, as seen in Richardson’s case. “At the same time (an increasing number of anecdotal reports are emerging of individuals using it alongside various activities), from golfing and yoga to running and snowboarding.” Although cannabis may provide therapeutic advantages for issues like sleep, pain management, and anxiety relief, its effects on cardiovascular health, cognitive function, and brain development require thorough scrutiny.

While certain studies have examined the cardiovascular stress of exercise in conjunction with cannabis use among individuals with recognized CVD — their acceptance as definitive evidence regarding cannabis or THC’s effects on general or elite athletic performance might be misguided. Exercise serves as a widely utilized method for identifying and revealing signs and symptoms indicative of underlying cardiovascular disease (CVD). Having been recognized as the second most widely consumed recreational substance following alcohol, the prevalence of cannabis and the growing belief in its health benefits make its appeal to athletes understandable.

Three studies indicated resting heart rate (HR) — with one finding that chronic cannabis users had a significantly elevated resting HR compared to non-users, contradicting the outcomes of clinical trials on chronic cannabis use (Benowitz and Jones 1975). Data search and abstraction were conducted by AK, while the other authors reviewed studies that held potential relevance for inclusion. This systematic review seeks to enhance current reviews (which mainly focus on the immediate effects of cannabis use), by evaluating available data on (1) how chronic cannabis use impacts fitness metrics; (2) effects on physical activity levels due to chronic cannabis use; and (3) the influence of chronic cannabis use on actual sports performance. The creation of the World Anti-Doping Agency (WADA) and the resulting sanctions against athletes for cannabis use have led to increased examination of cannabis’ effects on athletic performance , Hilderbrand 2011,. A systematic review of the literature, including cross-sectional, longitudinal, and intervention studies, regarding the impacts of cannabis consumption on sports performance outcomes, e.g.