Sports recovery
The goal is faster recovery from physical exercise, reduced delayed-onset muscle soreness (DOMS) and overtraining prevention. ACSM/AND/DC Position Stand on Nutrition and Athletic Performance (2016) and the IOC Consensus Statement on Dietary Supplements (2018) emphasise adequate sleep, sufficient protein and carbohydrate intake and hydration. Routine high-dose antioxidant supplements (NAC, vitamin C ≥1000 mg/day, vitamin E 400 IU/day) are not recommended – they blunt the adaptive response to training and suppress mitochondrial biogenesis (Mason 2020 meta-analysis, Free Radic Biol Med).
8 drugs
Also known as: post-exercise recovery, training recovery, DOMS prevention, overtraining prevention
Marketing claims without evidence base
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
- DAstaxanthinNot recommended · Dietary supplements, carotenoids (local classification)Astaxanthin is a carotenoid antioxidant from the Haematococcus alga, marketed as a supplement to speed up post-workout recovery and ease muscle soreness. Studies have not shown a convincing benefit for this use, and the evidence on recovery or performance is lacking. Sleep, enough protein and a gradual increase in training load do more to help you recover.
- DBeta-hydroxy beta-methylbutyrate (HMB)Not recommended · Leucine metabolite, sport supplement and for sarcopenia. AEMPS does not register as medicineHMB is sold as a «post-workout recovery» product on the muscle damage inhibition hypothesis. ISSN 2013 position stand notes moderate reductions in muscle damage markers (CK, LDH) with HMB 3 g/day in resistance training beginners and extreme exercise (marathon, ultra-endurance); in trained athletes the effect is minimal. IOC consensus statement 2018 classified HMB as «evidence inconclusive». For recovery IOC 2018 lists adequate protein and calories, hydration, 7–9 hours of sleep; HMB is an additional option.
- DBromelain (pineapple enzyme)Not recommended · Proteolytic enzyme from Ananas comosus pineapple stem and fruit. EU registered NexoBrid (concentrate of proteolytic enzymes enriched in bromelain, EMA 2012) for enzymatic deep burn excision topical. Oral – supplement. AEMPS registered NexoBrid for specialised burn centre useBromelain is sold in the sports segment as a «natural muscle recovery aid», «delayed onset muscle soreness (DOMS) reducer» and «exercise recovery accelerator». Rondanelli 2018 systematic review analysed DOMS, postoperative and post-traumatic oedema data: effect small and inconsistent, RCT methodological quality low, samples small. IOC consensus statement 2018 (Maughan, Br J Sports Med) for endurance and recovery approves creatine, caffeine, beta-alanine, sodium bicarbonate, nitrates; bromelain is not on the approved list. In athletes on warfarin, apixaban, rivaroxaban, aspirin, bromelain raises bleeding and haematoma risk. If bromelain was recommended as a substitute for a supervised recovery protocol (sleep 7–9 h, active recovery, stretching, protein 1.4–2.0 g/kg body weight), consider seeking a second opinion from a sports physician.
- DL-citrulline (free form and L-citrulline malate for sports formulas)Not recommended · Non-essential amino acid and urea-cycle intermediate. Normally produced in liver and gut from glutamine and converted in plasma to L-arginine and then nitric oxide (NO). Supplements market it as a «natural Viagra alternative», a «pump» agent for bodybuilders (vasodilation and muscle blood flow), and a remedy for blood pressure and cardiovascular health. Neither AEMPS nor EMA register it as a medicine; a specialty product (citrulline malate) exists for mitochondrial disorders and urea-cycle defects, but it is a specialised drug, not a supplement. AESAN classifies regular L-citrulline supplements as complementos alimenticios. FDA has issued no supplement approval.L-citrulline and L-citrulline malate are among the best-selling pre-workout supplements; bodybuilders take them for «pump» (vasodilation and muscle blood flow), reduced muscle fatigue, and improved anaerobic tolerance. The evidence is moderate and heterogeneous. Meta-analyses of 10–15 RCTs describe a 6–9% increase in repetitions with 60–80% 1RM loads on 6–8 g citrulline malate taken 60 minutes pre-workout, reduced next-day muscle soreness, and a small increase in peak cycling power. Effects on VO2max and aerobic endurance are inconsistent. The Australian Institute of Sport places L-citrulline in Group B – «supplements with evidence of performance effect that need more research». The ergogenic effect is clinically modest for most amateur athletes; gains in the gym come from training programme, calorie balance, and sleep. In professional sport, citrulline in third-party certified forms (Informed Sport, NSF Certified for Sport) is considered safe and is not on the WADA prohibited list. Unverified supplements carry risk of contamination with stimulants and steroids.
- DL-glutamine (free amino acid)Not recommended · Conditionally essential amino acid; the main nitrogen source for nucleotide synthesis and fuel for enterocytes and immune cells. Normally supplied by dietary protein (meat, fish, eggs, dairy, legumes) and synthesised in skeletal muscle. Supplements market it as a remedy for «leaky gut», post-workout recovery, immune support in cancer patients, and a sugar-craving reducer. Neither AEMPS nor EMA registers it for supplement indications; a specialty drug exists (Endari, L-glutamine, FDA-approved) for sickle-cell disease to reduce pain-crisis frequency – this is a specialised clinical niche, not a supplement. AESAN classifies general L-glutamine supplements as complementos alimenticios.L-glutamine has been marketed to bodybuilders for years as a «post-workout recovery agent» and «muscle catabolism shield». The idea rested on falling plasma glutamine after prolonged exercise and a theoretical immune protection against colds in athletes. Real data in healthy trainees are disappointing. Large meta-analyses and reviews by the American College of Sports Medicine, Australian Institute of Sport, and the IOC consensus statement on dietary supplements 2018 place L-glutamine in the «non-effective» or «unclear evidence» category: muscle hypertrophy, strength, VO2max, and upper respiratory infection rates in athletes do not change. Strength recovery and reduced muscle soreness after eccentric exercise come from adequate protein (1.6–2.0 g/kg/day for trainees), post-exercise carbohydrate, and 8–9 hours of sleep, not from a packet of glutamine. In critically ill patients (burns, polytrauma, ICU ventilation), parenteral glutamine was tested in large RCTs (REDOXS, Heyland 2013, NEJM): adding glutamine to standard parenteral nutrition increased hospital mortality in severely ill patients with renal failure. This is not a supplement indication – ICU glutamine is prescribed by intensive care.
- DProteolytic enzyme complex (bromelain, papain, pancreatin, trypsin, chymotrypsin, rutoside)Not recommended · Combined enzyme preparations, systemic enzyme therapy (local classification)Proteolytic enzyme blends (bromelain, papain, pancreatin, trypsin, chymotrypsin and rutoside) are marketed to athletes as a way to speed recovery and ease muscle soreness after training. Studies have not shown a clear benefit for this use, and there is no solid evidence base behind enzyme blends for sports recovery. What actually helps sore muscles after hard training is well established: enough sleep, adequate protein, and building load up gradually.
- DTongkat ali (Eurycoma longifolia)Not recommended · Botanical supplement, Eurycoma longifolia root, traditional Malaysian and Indonesian medicine; sold on iHerb and Amazon as a «natural testosterone booster», adaptogen and aphrodisiac. NOTE: in 2016-2019 the FDA recalled tongkat ali products for lead contamination and adulteration with synthetic PDE-5 inhibitorsTongkat ali is marketed as an «adaptogen for athletic endurance and anabolism». The Talbott RCT (J Int Soc Sports Nutr 2013) in 63 moderately stressed adults used Physta 200 mg/day for 4 weeks: salivary cortisol dropped 16%, testosterone rose 37% and questionnaire-based stress decreased. The sample is small, the duration short and the study sponsored by Biotropics Malaysia. Leisegang's systematic review 2022 found heterogeneity and low methodological quality in sports-related RCTs. No large independent RCTs on endurance measures (VO2max, time to exhaustion), strength (1RM) or muscle mass (DEXA) in trained athletes exist. EFSA did not approve the 2021 novel-food application. WADA does not list tongkat ali as prohibited, but adulterated batches may contain banned substances (anabolic steroids have been detected in tongkat ali products in Malaysian and Taiwanese studies). If tongkat ali is being considered as a «sports booster», discuss with a sports medicine physician – efficacy is unproven and contamination risk is high. For competing athletes choose products with Informed-Sport or NSF Certified for Sport certification.
- FKetoprofenNot recommended · Non-steroidal anti-inflammatory drug, propionic acid derivativeSports forums suggest taking ketoprofen before training or a race to get ahead of pain and recover faster. No such indication exists in the AEMPS Fastum label or in the Russian registration, and the research shows the other side. In a randomised trial of 89 ultramarathon runners, ibuprofen 400 mg every 4 hours produced acute kidney injury in 52% of runners against 34% on placebo, with a number needed to harm of 5.5. In a crossover study of nine trained men, ibuprofen before cycling raised the small-bowel injury marker I-FABP to 875 pg/mL against 474 pg/mL without the drug and increased intestinal permeability. Ketoprofen shares the mechanism, and dehydration plus muscular work add their own load on the kidney. If an NSAID has been suggested as part of a recovery plan, consider seeking a second opinion.
How to read tiers A–F
Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.
- AStrong evidence – first or second line in international guidelines
- BRecommended in selected cases
- CStudy data contradict each other
- DBenefit not proven, no documented harm
- FDocumented harm, or risk without benefit