Exercise is a stress on the body that causes positive adaptations including increased endurance and muscle mass.¹ The training that athletes (and active individuals) use to improve their performance is critical to their goals but also needs to be balanced with recovery strategies from sleep, to antioxidant-rich foods that contain phytonutrients and polyphenols and appropriate macronutrient distribution, rest days, and sometimes, herbal supplements that aid the body’s ability to adapt to the stress of training. Certain herbs, called adaptogens, help the body adapt to physical and mental stresses in ways that target common challenges athletes have including endurance, strength, hormone balance, and even cognition.^1-3 Health care providers may be asked about their opinion of adaptogen use for athletes and recreationally active clients as interest in these herbs has increased greatly over the past few years. The global market for adaptogens is booming and is projected to reach over $20 billion by 2031.^4,5 

The Science of Adaptogens
Adaptogens are a class of medicinal herbs considered pharmacotherapeutic – aiding in the body’s healing process.¹ Though they have been used in traditional medicine for centuries, interest in their use for athletic performance has been a focus for the past 50 years.^1,2 Adaptogenic herbs offer qualities that help the body ‘adapt’ to stress and maintain homeostasis, even under physically or psychologically stressful conditions.^3,6 Scientists have also referred to adaptogens as natural “bioregulators” indicating they help the body adapt to environmental factors and avoid damage that would normally occur.⁶ Some studies show that using adaptogens helps increase endurance during fatigue, improve physical stamina in endurance sports, muscle strength, energy levels, cognitive performance, and balance cortisol hormone levels.^1,3,6

The mechanism of action of adaptogens isn’t yet completely understood though there are studies suggesting that these plant compounds may affect the hypothalamic-pituitary-adrenal axes and stress mediators of the body. They may support athletic performance through increased nitric oxide levels in the body, helping balance blood glucose and cortisol hormone levels.²

Although adaptogens aren’t specifically listed on the banned substances list, groups like the (National Collegiate Athletic Association) NCAA warn that nutritional and dietary supplements may cause positive drug tests due to the lack of regulation in the industry. There have been instances of supplements contaminated with banned substances so athletes should use extreme caution.⁷ Third-party testing agencies help reduce risk by product testing for banned substances, inspecting both suppliers and facilities, and running label reviews.^8,9 The National Sanitation Foundation (NSF) has a “Certified for Sport®” certification indicating their testing and Informed Sport has a certified list and mobile app to aid in finding sports-safe supplements.^8,9 

Adaptogens Commonly Used in Athletic Performance

Ashwagandha
Commonly used for reducing stress, improving sleep, and enhancing muscle recovery, randomized controlled trials (RCTs), show that athletes benefit from ashwagandha. In particular, studies have shown a potential impact on VO2 max (a measure of aerobic capacity that can indicate improved cardiorespiratory endurance). A recent meta-analysis also showed that ashwagandha aids in reducing stress and fatigue, contributing to overall athletic performance and recovery.¹⁰ An older study by Shenoy et al. evaluated the effects of ashwagandha on the aerobic capacity of 40 elite Indian cyclists divided into a treatment or placebo group. The treatment group that received 0.5g capsules of ashwagandha twice daily for eight weeks showed increases in VO2 max, the metabolic equivalent of task (METS) which measures the amount of energy a person uses during physical activity compared to the amount used when resting, and time to exhaustion on the treadmill. The placebo group experienced no changes from their baseline values.¹¹

Ginseng (Panax/American and Eleuthero/Siberian Ginseng)
Ginseng is one of the best-known adaptogenic herbs. Panax and Eleuthero are different plants with completely different active ingredients, though both are considered adaptogens. Both plants contain compounds including steroidal saponins that are structured similarly to each other, in addition to plant phenolic compounds that act as antioxidants in the body.¹² Both Panax and Eleuthero are used to support energy levels, physical activity performance, and reduce muscle damage.^1,12 Panax ginseng is an antioxidant-rich compound that likely plays a role in regulatory centers in the brain, offering ergogenic effects (delaying fatigue and increasing work capacity). A double-blind placebo-controlled randomized control trial in 2020 study by Bhattacherjee et al. found that 200mg of Panax ginseng extract provided one hour before exercise (running until exhaustion) significantly increased endurance, lowered heart rate, and lowered rates of perceived exertion (RPE) at the time of exhaustion when compared to a control group in young, male, endurance athletes (n=12).¹³

Rhodiola Rosea
Studies show that Rhodiola may be effective at increasing stamina, reducing fatigue, and supporting mental performance through activating the cerebral cortex and increasing levels of serotonin, dopamine, acetylcholine, and norepinephrine.^2,12  Supplementing with Rhodiola has been used in traditional folk medicine to combat fatigue and balance mood, but recent studies have explored its use regarding hormonal modulation and central nervous system activity.² A small study (n=10) on resistance-trained male athletes found, in a double-blind, crossover, counterbalanced study that participants who supplemented with 1500mg per day of Rhodiola, vs a placebo, for three days in addition to a 500mg dose 30 minutes before exercise testing (bench press, one repetition maximum) found that the intervention group experienced increased mean bench press velocity (p = 0.049; d = 0.728) as well as higher blood norepinephrine hormone levels (p = 0.008).¹⁴  Rhodiola has also been used in a trial of recreationally fit women (n=18) at 3mg per kilogram body weight and was shown to decrease heart rate response to submaximal exercise (R. rosea =136 ± 17 beats per min^-1; placebo= 140 ± 17 beats per min^-1; mean ± SD; p = 0.001) and also lower the rate of perceived exertion during high-intensity endurance exercise (bicycle ergometer) (R. rosea = 6.0 ± 0.9; placebo = 6.6 ± 1.0; p = 0.04).¹⁵

Takeaways for Healthcare Providers

The foundation of sports performance should include rest and recovery for athletes, taking a holistic approach including sleep, rest days, hydration, and nutrition. Herbal supplements should be chosen with caution, and under the guidance of healthcare professionals who have it within their scope of practice to offer guidance on the evidence-based use of supplements for athletes or active people. Because market research shows that interest in adaptogens is increasing rapidly among consumers, healthcare providers will likely be approached with questions about their potential benefits and safety.⁴

Studies on adaptogens for sports performance are still in an exploratory phase and many of the results are based on animal studies, small human intervention studies, and almost always in male participants. Many studies also yield mixed results, with some RCTs showing that using adaptogens doesn’t significantly enhance physical activity. However, the adaptogenic class of herbs does not generally come with significant safety concerns, side effects, or medicine/herbal interactions. Healthcare practitioners should consider adding questions about the use of herbal supplements to their intake/medical history forms to encourage patients to honestly share the products they are using. Patients’ doctors should always be informed of their use of herbals. Adaptogens are a consideration for those interested in enhancing sports performance, helping the body adapt to stress and recovery.

References:

1. Amir M, Vohra M, Raj RG, Osoro I, Sharma A. Adaptogenic herbs: A natural way to improve athletic performance. Health Sciences Review. 2023;7:100092.
2. Todorova V, Ivanov K, Delattre C, Nalbantova V, Karcheva-Bahchevanska D, Ivanova S. Plant adaptogens—History and future perspectives. Nutrients. 2021;13(8):2861.
3. Lamoreau TW, Schneider C. Can Herbs Improve Endurance? Adaptogens and Athletic Performance. Integrative Medicine Alert. 2018;21(10).
4. Yahoo Finance. Adotpgen Drink Market to total US $2416.8 Million by 203 Amid Increasing Demand for Organic and Healthy Beverages among Millenials. https://finance.yahoo.com/news/adaptogen-drink-market-total-us-140500592.html?guccounter=1&guce_referrer=aHR0cHM6Ly93d3cuZ29vZ2xlLmNvbS8&guce_referrer_sig=AQAAAC2V1FaSEMy0A-Sf_aIy7_YOZc7CJqhBtaP4DMYjUn6jWF7GOsR744O9_BZd6QmGU_gHXOq1jPLjKFJ4iwr1aaWqhOhf9IUKNYMW0A5P6geGZElKX8LBLxbVqZ3-CBYLftyBMZmNQ_oqFNzBrm7b2HNMHwpUFJBcqGVdzTu9xcKJ. Published March 21, 2024. Accessed August 14, 2024. 
5. Verified Market Research. North America Adaptogens Market Size and Forecast. https://www.verifiedmarketresearch.com/product/north-america-adaptogens-market/. Accessed August 12, 2024.
6. Liao LY, He YF, Li L, et al. A preliminary review of studies on adaptogens: comparison of their bioactivity in TCM with that of ginseng-like herbs used worldwide. Chin Med. 2018;13:57. 
7. NCAA. https://www.ncaa.org/sports/2015/6/10/ncaa-banned-substances.aspx. Updated July 8, 2024. Accessed July 29, 2024. 
8. NSF’s Certified for Sport® Program. https://www.nsf.org/consumer-resources/articles/certified-for-sport-program. Accessed July 29, 2024. 
9. Informed Sport. About Informed Sport. https://sport.wetestyoutrust.com/about. Accessed August 12, 2024.
10. Pérez-Gómez J, Villafaina S, Adsuar JC, Merellano-Navarro E, Collado-Mateo D. Effects of Ashwagandha (Withania somnifera) on VO2max: a systematic review and meta-analysis. Nutrients. 2020;12(4):1119.
11. Shenoy S, Chaskar U, Sandhu JS, Paadhi MM. Effects of eight-week supplementation of Ashwagandha on cardiorespiratory endurance in elite Indian cyclists. Journal of Ayurveda and integrative medicine. 2012;3(4):209.
12. Sellami M, Slimeni O, Pokrywka A, et al. Herbal medicine for sports: a review. J Int Soc Sports Nutr. 2018;15:14.
13. Bhattacharjee I, Bandyopadhyay A. Effects of acute supplementation of panax ginseng on endurance performance in healthy adult males of Kolkata, India. Int. J. Clin. Exp. Physiol. 2020;7(2):63-8.
14. Williams TD, Langley HN, Roberson CC, Rogers RR, Ballmann CG. Effects of short-term golden root extract (Rhodiola rosea) supplementation on resistance exercise performance. International Journal of Environmental Research and Public Health. 2021;18(13):6953.
15. Noreen EE, Buckley JG, Lewis SL, Brandauer J, Stuempfle KJ. The effects of an acute dose of Rhodiola rosea on endurance exercise performance. J Strength Cond Res. 2013;27(3):839-47