An Overview of the Risks and Impact of Pre-exercise Supplements for Exercise Performance, Recovery, and Cardiovascular Health

Purpose of the ReviewPre-workout supplements, usually referred to as dietary supplements, are very popular among consumers looking to improve their physical and athletic performance. Although use is broad, there is data lacking on the potential short- and long-term cardiac impact of these supplements. This review was undertaken to assess available information on the contemporary most used pre-workout supplement categories, their ergogenic effects to understand the rationale for use, their use in patients with CVD or those interested in CVD prevention or disease progression mitigation, and potential safety concerns in both younger and older people interested in augmentation of exercise performance and improved recovery times.Recent FindingsThe pre-workout supplement market in the USA is projected to increase to $26.8 billion by 2023 from its $14.2 billion value in 2022. It is important to note that the FDA does not currently regulate the safety, effectiveness, or labeling of these supplements; this puts the onus on the makers to provide accurate safety and use information, and this can lead to customer confusion. The effectiveness and safety of pre-workout supplement use amongst the CVD population or for CVD prevention are unclear despite the broad use and popularity of the most used products: antioxidants, caffeine, creatine, and nitrates. However, outside of antioxidant therapy, there are clear favorable differential impacts of these agents on exercise performance and potential heart health. There appears to be no benefit of use for exercise performance or CVD risk mitigation with antioxidants. Caffeine use can increase QTc intervals and exercise-related systolic and diastolic blood pressure that may augment risk in susceptible individuals; however, generalized use appears safe and improves exercise performance. Creatine use improves exercise performance and may have some disease-specific roles in the treatment of patients with CVD. To date, there are no significant harms identified with its use as a pre-workout supplement. Nitrate supplementation may exhibit cardioprotective effects, such as vasodilation and reduced oxidative stress, particularly when used for moderate-intensity exercise.SummaryThese mixed findings of benefits and risks with supplementation continue to support the need for adequately powered randomized prospective trials of pre-workout supplements to provide evidence of proper dosing, risks, and benefits in CVD patients and for CVD prevention and progression risk. Awareness needs to improve regarding the potential risks of exercise-induced QTc prolongation and blood pressure elevation that may put susceptible people at risk. However, the majority of the most common supplements do produce favorable ergogenic effects to support their use from an efficacy standpoint.