Dados do Trabalho

Título

Does regular and acute use of non-steroidal anti-inflammatory drugs by exercising individuals effectively improve physical performance? A systematic review and meta-analysis.

Introdução e Objetivo

Several studies have explored the ergogenic effect of administering non-steroidal anti-inflammatory drugs (NSAIDs), however, the results are still conflicting. Thus, this systematic review and meta-analysis aims to exam the effects of ingesting NSAIDs on physical performance, muscle strength and creatine kinase (CK) in three different moments: immediately, 24 hours and 48 hours after resistance exercise.

Casuística e Método

The study was conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Relevant studies were searched in three databases (PubMed, Web of Science and SPORTDiscus) using the following keywords: non-steroidal anti-inflammatory drugs OR Paracetamol (Tylenol®) OR ibuprofen AND hypertrophy OR strength OR performance OR exercise OR satellite cells OR protein synthesis. The studies selected for the systematic review were divided into trials that evaluated the effects of NSAIDs ingestion on performance indices of: (I) resistance exercise, (II) endurance exercise, and (III) resistance training.

Resultados

The meta-analysis based only on resistance exercises revealed that both performance and muscle strength were similar between placebo or NSAID treatment 24 hours after resistance exercise. Interestingly, an ergolytic effect was found 48 hours after resistance exercise (mean effect size (ES) = -0.42; 95% confidence interval (CI): -0.71, -0.12; p = 0.132), as well as reduced strength level immediately (ES= -0.29; 95% CI: -0.58, 0.00; p = 0.418) and 48h after exercise (ES= -0.50; 95% CI: -0.83, -0.16; p = 0.072). Additionally, NSAID use did not prevent muscle waste as seen by the unchanged CK plasma concentration immediately after and also 24 and 48 hours after.

Discussão

Inflammatory processes take place from successive biochemical, vascular and cellular reactions and events. In this sense, NSAIDs are drugs which act on the inflammation cascade, mainly acting by inhibiting cyclooxygenases and consequently decreasing the production of inflammatory mediators such as prostaglandins, prostacyclin and thromboxanes. The effects of NSAIDs on exercise physiology are still unknown, but because of its anti-inflammatory effect associated with analgesia, the use of NSAIDs can eventually affect sports performance. In fact, their indiscriminate consumption as an ally in the prevention and recovery of musculoskeletal disorders is wide between athletes and physically active individuals as a way to avoid inflammation and pain while maintaining exercise performance. In the present study, no significant effect of NSAIDs on resistance-exercise performance and strength were seen during an exercise session immediately and 24 hours after exercise. On the contrary, resistance-exercise performance and strength decreased 48 hours after resistance exercise, and strength was reduced immediately after exercise. Moreover, the results support that NSAIDs seem to be ineffective in avoiding exercise-induced muscle wasting, since the increase in creatine kinase (CK) serum levels was similar to placebo. Taken together, these data indicate that the use of NSAIDs is actually deleterious to resistance exercise performance and muscle strength, being in contrast to what is commonly assumed.

Conclusão

In conclusion, resistance performance and muscle strength were negatively impacted by NSAID use, as seen by the performance results 48 hours after and strength immediately and 48h after resistance exercise, diverging from other previous reviews. Information about the applicability of NSAID on sports practice is constantly evolving and limited or contradictory information can lead to confusion for both prescribers and users. This meta-analysis brings valuable information about the existence of an ergolytic effect of NSAIDs on sport performance and strength, which can support future studies about the topic and the therapeutic application of these drugs.