Three studies reported resting HR, one of which reported a significantly higher resting HR among chronic cannabis users than non-users, opposing the findings of chronic cannabis use clinical trials (Benowitz and Jones 1975). The search and data abstraction were performed by AK, studies with potential relevance were reviewed by the other authors for inclusion. This systematic review aims to complement existing reviews, which primarily report on acute effects of cannabis use, by reviewing the available data on (1) the effects chronic cannabis use has on fitness measures; (2) any effects chronic cannabis use has on physical activity levels; (3) what effect chronic cannabis use has on actual sport performance. The establishment of the World Anti-Doping Agency (WADA) and subsequent penalisation of athletes for cannabis use has prompted greater scrutiny of the effects of cannabis effects on athletic performance (Hilderbrand 2011). A systematic review of the literature (cross-sectional, longitudinal, and intervention studies) concerning the effects of cannabis consumption on sports performance outcomes, e.g.
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.
CBD effects on anxiety seem to depend on dosage; 300 mg is THC flower in fitness and wellness discussions 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.
The purpose of this review is to critically evaluate the literature describing the effects of whole cannabis, THC, and CBD, on athletic performance and recovery. Amidst speculation of potential beneficial applications, the effects of cannabis and its two most abundant constituents, delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD), remain largely un-investigated. But it’s clear the scientific reasoning behind marijuana’s supposed performance-enhancing effect should be looked at more closely. The maximum length of suspension is two years but the minimum, if an athlete can show cannabis’ use was unrelated to the sport, is one month, which is what Richardson received. “But at the same time, we are seeing an increasing number of anecdotal reports of people using it in combination with everything from golfing and yoga to snowboarding and running.” While cannabis may offer therapeutic benefits for sleep, pain management, and anxiety reduction, its impact on cardiovascular health, cognitive function, and brain development warrants careful consideration.
Age related differences in cannabis use and subjective effects in a large population-based survey of adult athletes
The case supporting or opposing the use of cannabis to enhance athletic performance is still uncertain. To grasp the effects of cannabis and THC on athletes’ performance both in the short and long term, research tailored specifically for athletes is necessary, emphasizing applied performance outcomes. There is a lack of appropriate empirical evidence concerning cannabis use and its impact on sports performance.
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.
Cannabis and Athletic Performance
Three of the included studies measured participants’ performance on a treadmill with a breathing apparatus to determine VO2Max, while the 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.
Across the four included studies, no significant difference between cannabis users and non-users was observed for peak work capacity, cardiorespiratory fitness (VO2Max), other pulmonary measures (such as FEV1), strength and endurance measures (such as hand-grip strength), perceived exertion, or BP. Maksud and Baron (1980) graphically reported perceived exertion throughout testing, finding only that the tobacco smoking group differed from other groups. Lisano, Smith et al. expressed that an effect may be found with a larger sample size, suggesting cannabis users may demonstrate less endurance in later stages of Wingate analysis. Lisano et al. (2019b) and Maksud and Baron (1980) measured PWC using a bicycle ergometer.
While studies examining the combined cardiovascular stress of exercise with cannabis use in persons with identified CVD offer select insight into the human ability to perform aerobic work, their widespread acceptance as concrete evidence of the effects of cannabis or THC on general or high-level human performance is likely misplaced. Exercise is a commonly used tool for the identification and elicitation of signs and symptoms of underlying cardiovascular disease (CVD). Cannabis has been noted as the second most consumed recreational substance, next to alcohol , and with such ubiquity and increasing belief of potential for health benefit, the enticement for uptake and use by athletes is not surprising.
Although the potential negative health implications of cannabis use among elite athletes have not been directly examined, insights can be gained from existing literature on recreational cannabis. Recent reviews, including the latest systematic review, have reiterated the absence of performance-enhancing effects, suggesting that cannabis is banned mainly due to safety issues and because using an illicit substance contradicts the ethos of sports. Furthermore, studies indicate that athletes tend to have higher pain thresholds compared to non-athletes. While the findings regarding cannabis and quantitative sensory testing parameters are inconclusive, they indicate that cannabinoids might elevate punctate and pressure pain thresholds.
In 2015, UFC fighter Nick Diaz faced a five-year suspension from the commission for repeated cannabis violations, although this suspension was subsequently shortened to a year and a half. In May 2021, he was awarded the first exemption of this kind in the United States, which was sanctioned by the Colorado Combative Sports Commission. According to the new policy, fighters will face no penalties for cannabis usage unless there is additional proof showing the substance was consumed for performance-enhancing reasons, such as to relieve pain or anxiety. In 2018, he mentioned that several players have informed him that cannabis assists in managing their anxiety. In 2019, business partners Johnson and Sims declared a collaboration with Harvard University to investigate the effects of cannabis on chronic traumatic encephalopathy (CTE) and its role in pain management. In 2013, WADA eased its cannabis policy by raising the permissible level of THC metabolite in urine from 15 ng/mL to 150 ng/mL before an athlete is deemed to have failed a drug test.
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.
