Nicotine: Sporting Friend or Foe? A Review of Athlete Use, Performance Consequences and Other Considerations

TL;DR

This narrative review examines nicotine use among athletes and the evidence for its effects on physical performance, noting that WADA only monitors nicotine and that use is high in several team, strength, and winter sports. Across ten performance studies yielding 16 measures, most showed no effect, with a small number ergogenic or ergolytic, and the evidence base is limited by methodological issues.

Key findings

• Nicotine is not prohibited by WADA; it was placed on WADA’s Monitoring Program in 2012. Active in-competition consumption of nicotine/nicotine-containing substances is reported in approximately 25–50% of athletes in professional team/strength sports (e.g., American football, ice hockey, wrestling, bobsleigh, gymnastics, rugby, skiing).
• Urine analyses: at the 2009 men’s World Ice-Hockey Championships (n = 72), traces of nicotine or its metabolites were present in every sample, with active use in at least 36% (metabolites in 53%). A 1-year Swiss laboratory monitoring study of 2185 samples across 43 sports found traces in 23% and active consumption in 15%; cumulative exposure >25% occurred in American football (56%), ice hockey (32%), wrestling (32%), bobsleigh (31%), gymnastics (29%), rugby (28%), and skiing (26%).
• Ten studies assessed performance with nicotine or smokeless tobacco, yielding 16 performance measures: 12 showed no significant effect, 2 an ergogenic effect, and 2 an ergolytic effect. At the study level, the abstract reports two ergogenic, one ergolytic, and seven no-change studies.
• Nicotine’s proposed modes of action include psychostimulatory effects via central reward pathways and sympathomimetic effects via catecholamine release; it is a nicotinic acetylcholine receptor agonist.

Methods

• Narrative review of quality-assured, peer-reviewed publications available through the end of June 2017, primarily using PubMed and Google Scholar, with manual checking of second- and third-order reference lists. Studies were excluded when interventions exclusively involved tobacco smoking or smokers.
• Ten included studies had performance outcomes using larger muscle mass/whole-body exercise; five used smokeless tobacco and five used nicotine (transdermal, sublingual tablet, chewing gum, vaporiser, lozenge). Average sample size was 17 (SD = 9, median = 16, range = 9–40); seven studies used males only, none exclusively females; participants were young (mean age ≤25 years), healthy, recreationally/competitively active but not (sub-)elite; seven studies included nicotine-naïve participants.
• Main analysis was a narrative synthesis subdivided into muscular strength and power, submaximal/maximal endurance, and high-intensity exercise/intermittent sprints.

Limitations

• Stated: the current evidence base is limited in both quantity and quality; notable limitations and confounders include participant tolerance to nicotine, interindividual responses, the nicotine delivery system used, and failure to adhere to rigorous experimental/scientific design.
• Stated: future research should address double-blind placebo-controlled designs with manipulation checks, criterion validity of performance tests, expert performers, female athletes, tolerant users (withdrawal/re-introduction), naïve users (desensitization), and environmental/diet interactions.
• Evident from the text: samples were small (average 17, range 9–40), mostly male, young, healthy, and not (sub-)elite; NRT studies used fixed doses; only five performance studies reported side effects; some studies did not explicitly report performance time/work; and cross-sectional prevalence data are self-reported and cannot distinguish nicotine sources.