NSAIDs and Exercise

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NSAIDs are now starting to be used as an ergogenic aid to enhance performance especially before and during long endurance races and longer training sessions. Is this safe?

By Anna L. Waterbrook, M.D.
Member AMSSM

Non-steroidal anti-inflammatories (NSAIDs) are a class of over-the-counter (OTC) and prescription medications that include Ibuprofen (Advil and Motrin), Naproxen (Aleve), Aspirin and others. They work by inhibiting the production of prostaglandins, natural substances produced by the body that control a number of different processes including pain and inflammation. They also help to keep the blood vessels of the kidneys open and protect the stomach lining. They are commonly used for the treatment of various causes of pain and inflammation.

NSAIDs are used by athletes to treat many conditions including acute musculoskeletal injuries, such as a sprained ankle or muscle soreness after an intense workout. However, they are now starting to be used as an ergogenic aid to enhance performance especially before and during long endurance races and longer training sessions. 30-50% of participants in Ironman races and marathons are reported to take NSAIDs. The theory behind this practice is that the prophylactic inhibition of the production of inflammatory mediators will lead to decreased muscle soreness, fatigue, and ultimately shorter recovery times and improved performance.

Do NSAIDs enhance athletic performance?

Currently there is no convincing evidence that NSAIDs enhance performance or recovery time.

David Nieman, Dr. PH., of Appalachian State University, studied the effects of two different doses of ibuprofen and a control group during a 100-mile trail running race. He found that “…ibuprofen use compared to nonuse by athletes competing in a 160-km race did not alter muscle damage or soreness, and was related to elevated indicators of endotoxemia and inflammation.” In addition, he found no difference in race times or rate of perceived exertion between the three groups.

McAnulty, et al, studied the effects of inflammatory markers in a group of ultramarathon ibuprofen “users” versus “non-users”. He found that some inflammatory markers were actually increased in the ibuprofen user vs. the non-user group.

Donnelly, et al, studied the effects of ibuprofen and exercise to prevent delayed-onset muscle soreness and its effect on known markers of muscle breakdown, which can be seen in the blood and urine. He found no change in either of these parameters in the ibuprofen vs. no ibuprofen groups.

However, these are all relatively small studies with several limitations in the way their research was conducted. More research still needs to be done until any final conclusions can be made.

What are the side effects of NSAID use?

There are several side effects to NSAID use. The most dangerous is bleeding from the gastrointestinal tract. This is usually associated with chronic use, but can also be seen acutely. Prolonged use can also lead to kidney damage.

NSAIDs have further been shown to increase gastrointestinal permeability and contribute to the development of hyponatremia when taken by endurance athletes during long races.

Safe uses and indications for NSAID use

So, with all of these possible side effects and lack of scientific evidence that they help to enhance athletic performance, should one ever take NSAIDs? In general, moderate use after exercise to treat acute musculoskeletal injuries or muscle soreness for a short period of time is usually safe. People who have a history of gastrointestinal bleeding or kidney problems should check with their physicians before taking any NSAIDs.

Bottom Line

Take care of your body including proper training, rest, nutrition, hydration and recovery. Occasional NSAID use AFTER exercise is probably helpful and safe if used for a short time period for an acute injury. It is probably safer to avoid taking it as an ergogenic aid to improve athletic performance before or during races. Always seek physician recommendations and expertise if you are ever in doubt about what is best for you.

Anna L. Waterbrook, M.D.
Board Certified in Sports and Emergency Medicine
University of Arizona
Arizona Institute for Sports Medicine
Tucson, AZ
 

Resources:

Nieman DC, Henson DA, Dumke CL, et al. Ibuprofen use, endotoxemia, inflammation, and plasma cytokines during ultramarathon competition. Brain Behaviour and Immunity. 2006 Nov;20(6):578-84.

McAnulty SR, Owens JT, McAnulty LS, et al. Ibuprofen use during extreme exercise. Medicine and Science in Sports and Exercise. 2007 July;39(7):1075-9.

Donnelly AE, Maughan RJ, Whiting PH. Effects of ibuprofen on exercise-induced muscle soreness and indices of muscle damage. British Journal of Sports Medicine. 1990 Sep; 24(3): 191-5.

Wharam PC, Speedy DB, Noakes TD, Thompson JM, Reid SA, Holtzhausen LM. NSAID use increases the risk of developing hyponatremia during an Ironman triathlon. Medicine and Science Sports and Exercise. 2006 Apr; 38(4): 618-22.

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date: October 9, 2009