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Review Not peer-reviewed version
Prospective Analysis of Cannabidiol's
Effectiveness in Post-Exercise
Recovery: An integrative Systematic
Review and Research Agenda
Carmen E. Villalobos-González , Carlos D. Gómez-Carmona , Braulio Sánchez-Ureña ,
Christian Azofeifa-Mora , Daniel Rojas-Valverde *
Posted Date: 8 May 2024
doi: 10.20944/preprints202405.0517.v1
Keywords: recovery; cannabidiol; anti-inflammatory; dietary supplements; sport
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Review
Prospective Analysis of Cannabidiol's Effectiveness in
Post-Exercise Recovery: An integrative Systematic
Review and Research Agenda
Carmen E. Villalobos-González 1,2, Carlos D. Gómez-Carmona 3,4, Braulio Sánchez-Ureña 1,5,
Christian Azofeifa-Mora 1,5 and Daniel Rojas-Valverde 1,2,*
1 Núcleo de Estudios en Alto Rendimiento y Salud (NARS), Escuela Ciencias del Movimiento Humano y
Calidad de Vida (CIEMHCAVI), Universidad Nacional, 86-3000 Heredia, Costa Rica;
cavg03@gmail.com (C.E.V.-G.); braulio.sanchez.urena@una.ac.cr (B.S.-U.);
cristian.azofeifa.mora@una.cr (C.A.-M.)
2 Centro de Investigación y Diagnóstico en Salud y Deporte (CIDISAD), Universidad Nacional, 86-3000
Heredia, Costa Rica. 2
3 Grupo de Optimización del Entrenamiento y Rendimiento Deportivo, Facultad de Ciencias del Deporte,
Universidad de Extremadura, 10071 Caceres, Spain. cdgomezcarmona@unex.es
4 Grupo de Investigación BIOVETMED & SPORTSCI. Campus de Excelencia Internacional “Mare Nostrum”.
Facultad de Ciencias del Deporte. Universidad de Murcia, 30720 Murcia, Spain
5 Programa de Ciencias del Ejercicio y la Salud (PROCESA), Universidad Nacional, Heredia, Costa Rica
* Correspondence: drojasv@una.cr
Abstract: Recovery between physical efforts is essential for optimal performance in sports. Dietary
supplements like cannabidiol (CBD) have been proposed to facilitate recovery and performance optimization.
This systematic review aimed to: a) systematize the scientific evidence on CBD for recovery, b) associate CBD's
biomedical properties with those required for optimal fatigue recovery, and c) recommend a future research
agenda. Searches across databases identified 70 relevant studies from 1990-2023, including 38.6% preclinical,
31.4% clinical trials, and 30.0% reviews/meta-analyses across various populations like mice, rats, epileptics,
and athletes. CBD demonstrated potentially beneficial properties for athlete recovery such as anti-
inflammatory, neuroprotective, anxiolytic, and analgesic effects with doses ranging from 5-600mg
administered orally, intravenously, and via other routes. However, rigorous confirmatory research specifically
in athlete populations is lacking. While CBD appears promising for facilitating recovery and performance
optimization, further randomized placebo-controlled trials are needed to test the acute and chronic effects of
different CBD dosing regimens in athletes. Future research should focus on elucidating CBD's physiological
mechanisms of action as they relate to post-exercise recovery, as well as its comparative effectiveness versus
conventional medications and therapies. Advancing our understanding of CBD's role in athlete recovery could
provide new therapeutic strategies to optimize recovery and performance.
Keywords: recovery; cannabidiol; anti-inflammatory; dietary supplements; sport
1. Introduction
Nowadays, recovery between physical efforts is essential to achieve optimal performance in
sports. The increase in the number, frequency, and intensity of competitions has resulted in relatively
little time between efforts[1], which increases the relevance of planning and implementing effective
and accessible recovery strategies.[2] Physical exertion causes a series of structural and functional
alterations that must be controlled, monitored, and counteracted to achieve a rapid return to
homeostasis.[3] In this sense, depending on the exercise dose, myositis occurs by releasing cytokines
(e.g., IL-1, IL-6, TNFα) that trigger inflammatory responses[4] and lead to an effective but relatively
slow recovery process. Sports practice can also cause drowsiness, swelling, pain, and weakness for
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© 2024 by the author(s). Distributed under a Creative Commons CC BY license.
2
hours or even days.[5] So, these aspects can be largely mitigated with the use of certain recovery
measures.
Thanks to scientific and technological advances, the level of performance among elite athletes is
very similar, which suggests the need to seek new alternatives to improve performance.[6] For
recovery effects to achieve optimal performance different ergogenic supplements have been used as
dietary supplements[7], antioxidants[8], and more recently, organic foods such as ginseng and
beetroot.[9] One of these proposed new aids is cannabidiol (CBD), a phytocannabinoid grouped
among the cannabinoids found in the cannabis sativa plant and also obtained from hemp.[10]
CBD can be administered in the form of oral solutions, oral capsules, buccal aerosol, and drops,
among other presentations, and the dose can vary depending on the desired effect.[11] Unlike Δ9-
tetrahydrocannabinol (THC) is one of the compounds in the cannabis sativa plant, CBD lacks
psychotomimetic and psychotropic effects, and there is no evidence of dependence or abuse, and it
has a fairly favorable safety and tolerability profile.[12] Although somnolence, diarrhea, and an
variances on body temperature are among the reported side effects, these are mild and infrequent.[13]
The common concentration of CBD in hemp oils is 12-18% (often higher due to enrichment
procedures) [14]; CBD has been administered for medical purposes at doses of 1-50 mg/kg/d[15], 200-
300 mg/d for six months[16] y 1200-1500 mg/d for four weeks[17] without significant adverse effects.
In all international sports leagues and organizations, tetrahydrocannabinol (THC) and its
metabolites, such as 11-COOH-THC, are prohibited both in and out of competition, with an
acceptable threshold of 11-COOH-THC in urine ranging from >15 to 150 ng/ml.[18] However, isolated
cannabidiol (CBD) is not included in the World Anti-Doping Agency's (WADA) Prohibited List, and
it was recently removed from the list.[18] This reflects a growing social acceptance of CBD and
cannabis use for recreational and medicinal purposes, although not all of its biological effects are
fully understood.[19] Nevertheless, it is important to note that CBD products may contain traces of
THC, so athletes should be cautious when consuming these products to avoid potential anti-doping
rule violations.[20] In this regard, a recent systematic review on cannabis use in sports suggested that
25% of athletes reported having consumed cannabis in the last 12 months.[18]
Preclinical and clinical evidence suggests that CBD could provide a positive effect on the
treatment of chronic pain, spasticity, and sleep quality[21], and has a potential role in managing mood
disorders.[22] CBD intake has presented multiple benefits at the immune level, including anti-
inflammatory and immunosuppressive effects[19], both crucial for the recovery of sports injuries and
the effects of fatigue caused by the daily physical load that athletes are exposed to.[23,24] The
supposed effects of CBD include, among others, analgesic, antioxidant, anxiolytic, anti-inflammatory,
cytotoxic, and anticonvulsant, which are mediated by signaling mechanisms that include
cannabinoid receptors, protein-coupled receptors, and serotonin receptors.[25]
The mechanism of action of CBD in the body could be explained by the endocannabinoid system,
among other body systems that participate in it. This endocannabinoid system participates globally
in maintaining homeostasis in the human body and is involved in a variety of regulatory functions
such as chronic inflammation and regulation of the immune system.[14] The body has its own
endogenous cannabinoids and there are strong hypotheses that endocannabinoids could mediate
some central and peripheral effects of exercise.[26] Previous research indicated that
endocannabinoids could have an influence on skeletal muscle, adipose tissue, liver, immune system
and redox state[27], increasing anti-inflammatory and immunosuppressive responses[27], reducing
pain[28] and improving sleep and anxiety scores when consuming CBD.[29]
The evidence regarding the use of cannabinoids and CBD in sports is relatively scarce due to a
gap in research that lasted for decades that led to a lack of research, reducing the potential benefits
of CBD.[30] With the recent legal opening for the medicinal prescription of cannabinoids, as well as
an allocation for recreational use with greater popular acceptance, studies have begun to emerge.
Although the publication rate on CBD worldwide is relatively low due to some administrative
processes regarding the local pharmaceutical institution[31], scientists' interest has increased
significantly, implying the need to direct efforts based on the evidence gathered to date.
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In sports, recently published narrative reviews on the effect of cannabidiol and its relationship
with performance[32] and recovery[33] suggest that CBD possesses anti-inflammatory,
neuroprotective, and analgesic effects, and also promotes the healing of traumatic skeletal injuries.
Additionally, early-stage clinical studies suggest that CBD may have anxiolytic effects, and some
evidence points to an improvement in sleep.[32,33] Based on this evidence, and understanding the
need to orient future research on CBD and sports recovery, this systematic review aims to: a)
systematize the first and second-level scientific evidence related to the study of CBD, b) associate the
biomedical properties attributed to CBD with those required for optimal fatigue recovery, and c)
recommend a future research agenda related to the role of CBD in recovery.
2. Materials and Methods
2.1. Study Design
This study followed an integrative systematic review methodology to synthesize and critically
analyze the diverse literature related to the use of cannabidiol (CBD) in sports recovery following the
Preferred Reporting Guidelines for Systematic Reviews and Meta-Analysis (PRISMA).[34]
Integrative systematic reviews facilitate the combination and synthesis of different types of evidence,
including empirical studies, theoretical literature, and methodological contributions.[35] The key
feature of this approach is the possibility of incorporating a wide range of relevant data to build a
comprehensive understanding of the research topic.[36]
This integrative systematic methodology was consider appropriate given the emergent and
multidisciplinary nature of the research topic, which spans domains such as sports science, exercise
physiology, pharmacology, and medicine.[37] The comprehensive and rigorous synthesis of diverse
evidence, including both empirical and non-empirical sources, aligns with the overarching purpose
of providing a holistic understanding of CBD's efficacy and mechanisms in the context of sports
recovery. The protocol for this integrative systematic review was registered in PROSPERO (ID:
479815) to ensure transparency and minimize potential bias.
2.2. Eligibility Criteria
To identify relevant studies in the use of cannabidiol (CBD) for sports recovery, this systematic
review used a structured set of eligibility criteria following the PICOS (Population, Intervention,
Comparator, Outcomes, Study design) framework.[34] Additionally, studies were excluded
following this criteria: (1) if the article was not written in English; (2) if the full-text was not available,
(3) if the type of document was doctoral thesis, books or book chapters, conference papers, patents
or low-quality articles with a severe lack of information (number and characteristics of participants,
design, methodology, CBD dose, etc.). The eligibility criteria were shown in Table 1.
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Table 1. Eligibility criteria.
PICOS
Inclusion criteria
Exclusion criteria
Population
Studies involving humans (e.g. athletes and healthy individuals), as
well as animal models (e.g. mice, rats).
Studies that not involve
humans or animals.
Intervention/
Exposure
Examining the use of CDB in any formulation (e.g. oral, topical) or
dosage as primary intervention.
Not examining the use of
CBD as primary intervention.
Comparator
Studies with a placebo or control group were included, as well as
those without a comparator.
None.
Outcomes
Studies reporting outcomes related to sports/exercise recovery,
physical performance, and/or physiological effects of CBD (e.g.
inflammation, pain, sleep, cognition).
Studies that report only the
psychoactive effects of CBD.
Study design
Scientific evidence classified as a first and second level were
incorporated
[38], that Included experimental (randomized trials, non
-
randomized trials), observational (cohort, case
-control), and
systematic reviews/meta-analyses.
Studies were non
-empirical
or lacked sufficient
methodological details.
2.3. Search Strategy and Article Management Process
The search strategy for this integrative systematic review was designed to capture a
comprehensive body of literature related to the use of cannabidiol (CBD) in sports recovery. An initial
exploratory search was conducted to identify relevant keywords, controlled vocabulary terms, and
subject headings across different disciplines related to the topics of CBD, sports, exercise, recovery,
fatigue, and performance. The search terms were selected or adapted based on the Medical Subject
Headings (MeSH) descriptor data from the National Library of Medicine. Once this initial
identification of relevant descriptors was made, the words chosen for the formal search were:
"(cannabidiol OR CBD) AND (sports OR exercise OR physical activity) AND (recovery of function
OR fatigue OR sports performance OR injury OR inflammation OR muscle fatigue)."
Then, the formal search was then performed on November 30th, 2023 by two independent
reviewers in three electronic databases: PubMed (MEDLINE), Scopus (EMBASE) and Web of Science
(Web of Science Core Collection, MEDLINE, Current Contents Connect, Derwent Innovations Index,
KCI-Korean Journal Database, Russian Science Citation Index and Scielo Citation Index).
Additionally, the reference lists of included studies were manually screened to identify any
potentially relevant publications that may have been missed in the initial search, All references were
extracted and imported into an open-source research tool (5.0.64, Zotero, CA, United States) to
subsequently systematize the studies (Excel, Microsoft, CA, United States). All duplicates found
among the databases were identified and eliminated.
2.4. Study Selection
The selection of studies for inclusion was guided by the predetermined eligibility criteria
outlined previously, considering empirical data, theoretical perspectives, or literature reviews related
to the use of CBD in the context of sports, exercise, recovery, fatigue, or performance. Firstly, the title
and abstract screening was conducted independently by two reviewers. Any disagreements that
arose during this initial screening phase were resolved through discussion between the two
reviewers.
The articles that passed the title and abstract screening then underwent a full-text assessment
for final eligibility. During this stage, the full manuscripts were reviewed to ensure the studies met
all of the inclusion criteria. Only those studies that were deemed eligible based on the full-text review
were selected for data extraction and synthesis. The PRISMA flow of the integrative review can be
analyzed in Figure 1.
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Figure 1. Flowchart of article identification, selection, and exclusion.
2.5. Study Quality Assessment
For assessing the preclinical animal studies, the ARRIVE guidelines have been used.[39] The
selected studies obtained moderate to high methodological quality. Most of them clearly report the
study objectives, animal characteristics, experimental procedures, and statistical analyses. However,
some studies not include important aspects such as randomization, blinding, and sample size
calculations, which are important to ensure internal validity and minimize bias. Additionally, most
of them recommended replicating and extending their findings in the future, suggesting more robust
preclinical evidence.
The clinical studies involving human participants were assessed using the Cochrane Risk of Bias
2 (RoB 2) tool.[40] The risk of bias across the studies was generally low to moderate. Most studies
demonstrated appropriate randomization, blinding, and handling of missing data. Instead, some
studies had concerns that could introduce potential sources of bias like the selection of the reported
results and the overall study design. It is necessary to conduct larger, well-designed, and adequately
powered clinical trials to further establish the efficacy and safety of cannabidiol (CBD) in various
medical conditions.
The studies under review and meta-analysis were assessed using the AMSTAR checklist.[41]
The methodological quality of these studies was found to be moderate to high. The authors of the
reviews provided a comprehensive search strategy, clearly defined the inclusion criteria and
conducted a thorough quality assessment of the included studies. However, certain reviews did not
mention details on the rationale for excluded studies, the evaluation of publication bias, and the
exploration of potential sources of heterogeneity. These areas should be improved in future review-
level evidence to enhance the reliability and robustness of the conclusions.
In summary, the analysis of the study methods across the preclinical, clinical, and review-level
evidence indicates that the overall quality is acceptable, with some opportunities for development.
Improving the methodological rigor, specifically in areas such as randomization, blinding, and
sample size calculations, will help enhance the validity and reproducibility of the findings. In
addition, more well-designed, large-scale clinical trials and comprehensive systematic reviews are
needed to elucidate the therapeutic potential of cannabidiol (CBD) and its fundamental mechanisms
of action.
2.6. Data Extraction
The data extraction process involved compiling key information from the included studies into
a standardized spreadsheet. Two independent reviewers extracted the following data elements:
a) Authors and year of publication: The full citation details, including the year the study was
published.
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b) Main aim: The primary objective or research question addressed by the study.
c) Methodology:
c.1) Subjects: The participant characteristics, such as species (human, animal), population (athletes,
healthy individuals), age, sex, etc.
c.2) Study design: The type of study design (e.g. randomized controlled trial, observational,
systematic review).
c.3) CBD supplement: Details on the CBD intervention, including the formulation (oral, topical,
etc.), dosage, and administration protocol (frequency, timing).
d) Main results (CBD effects): The key findings and conclusions related to the effects of CBD, such as
impact on recovery, performance, inflammation, pain, sleep, etc.
e) Recommendations for future research: Any suggestions or directions for further study proposed by
the authors.
The reviewers worked independently to extract this information, with any discrepancies
resolved through discussion and consensus. This systematic data collection process ensured
comprehensive and accurate extraction of the relevant study details.
3. Results
3.1. Search, Selection and Inclusion of Publications
1761 articles were identified from the Web of Science (n = 630), PubMed (n = 728) and Science
Direct (n = 403) database search. In the screening phase, 1322 articles were deleted due to the year of
publication, the title of the article or abstract. From the remaining 439 papers in the eligibility phase,
they were exported to a reference manager (Zotero), and any duplicates (76 articles) were eliminated
automatically. Finally, 363 articles arrived at the last phase, where 288 did not fulfill the inclusion
criteria and 5 had methodological doubts, so 293 articles were removed. At the end of the screening
procedure, 70 articles remained for the systematic review related to the study topic that were
included in Table 2, indicating authors and year of publication, main aim, methodology (subjects,
study design and CBD supplement, including periodization and dose characteristics), main results
(CBD effects) and recommendations for future research.
3.2. Type of Study, Subjects and Clinical Evidence of CBD
Regarding the type of study, preclinical studies represent 38.57% (n=27), clinical studies
represent 31.43% (n=22), and reviews and meta-analyses represent 30.00% (n=21). Various
populations were evaluated during the studies, such as mice (26%), rats (37%), epileptics (16%), men
(8%), women (9%), girls (2%), and rugby players (2%). Respect to clinical evidence, 22% of selected
studies reporting its beneficial effect during the pathology treatment, 17% on anxiety, 17% on anti-
inflammatory characteristics, 11% exploring its effects on sleep, and 6% on muscle recovery in
athletes.
3.3. Effects of CBD, doses and Administration Methods
The effects of CBD are varied, among which 39% refer to studies with anti-inflammatory effects,
22% on disorders (fibrosis, asthma, chronic pain), another 22% are studies on muscular recovery and
as a therapeutic agent and 17% on studies about the benefits as a neuroprotector. The doses used
were 5-10mg (21%), 20-30mg (43%), 300-600mg (36%), other doses used in a smaller percentage were
60mg, 0.005-5mg, 50mg, 150mg, and 120mg. Additionally, CBD was administered mixed in a medium
such as oil in 6%, orally in 33%, intravenously in 40%, aerosol, intracerebroventricular, subcutaneous,
and intraperitoneal in 7%, and with a plug in a single dose (n=1, 0.01%).
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Table 2. Summary of first and second-level scientific evidence related to the biomedical properties of cannabidiol.
#
Authors
Aim
Methodology
Main results (CBD effects)
Recommendations for future research
Preclinic research (animals) (n= 27)
1
Zieba et al. (2019)
[42]
Effect of CBD on anxiety-related
behavior
n = 72 mice with acute administration
of CBD at 5-20 mg/kg versus control
Better adaptation to the new anxiolytic
environment
Clarify the relationship between CBD
and pre-pulse inhibition.
2
Schleicher et al.
(2019) [43]
Effect of CBD on behavioral profile,
motor performance, anxiety, and
memory
Acute administration of CBD in mice
at 20 mg/kg for six months versus
control
Non-negative effects
Optimal treatment strategies.
3
Myers et al. (2019)
[44]
Effects of CBD on cognition
n = 335 mice
Acute CBD intake at 3-
10 mg/kg,
chronic at 5-20 mg/kg
Anxiolytic
More suitable animal models.
4
Iannotti et al. (2019)
[45]
Effect of cannabinoids (CBD) on
inflammation, functional autophagy,
and improvement of muscle function
Mice, muscular dystrophies
Chronic intake of CBD at 60 mg/kg,
three times per week for two weeks
Improved structural and functional
muscle enhancement and recovery
Replication and extension of findings.
5
Santiago et al.
(2019) [46]
Effects of CBD on neuroplasticity,
inflammation, and cognitive function
Diabetic rats
Chronic CBD at 10 mg/kg, once a day
for 30 days.
Reduction of blood glucose levels,
cognitive enhancer, reduction of
neurodegeneration and inflammation,
and attenuation of decreased levels of
BDNF (neuroprotective)
Effects of low-high dose ratio of THC
and CBD administration.
6
Casey et al. (2017)
[47]
Effects of cannabinoids on
neuropathic pain
Mice, chronic constriction injury
0.01-0.015 mg/g
Potential in the treatment of
neuropathic pain
Anti-allodynic properties
Confirm results.
7
Hayakawa et al.
(2007) [48]
Effects of CBD as a neuroprotective
agent.
Mouse, cerebral ischemia
Dissolved at 1%
Neuroprotection through an anti-
inflammatory mechanism of the CB1
receptor
Confirm chronic effects of CBD
administration on cerebral ischemia.
8
Mori et al. (2017)
[49]
Effects of CBD on functional recovery
after cerebral ischemic injury
Mice, bilateral common carotid artery
occlusion
Short-term 10 mg/kg CBD before and
after the event
Prevention of anxiety-like behavior,
memory impairments, and despair-like
behavior
Clarify the relationship between CBD
and pre-pulse inhibition.
9
Murillo-Rodríguez
et al. (2018) [50]
Effects of CBD on neurochemicals
related to wakefulness
Rats, microdialysis surgeries
Intravenous dose of 5-30 mg/kg
Increases acetylcholine levels in a brain
region related to wakefulness control.
Clarification of how CBD induces
improvement in neurobiological
processes involving acetylcholine.
10
García-Baños et al.
(2021)
[51]
Effects of CBD demonstrating that
Phytocannabinoid could attenuate
alcohol-induced cognitive deficits
n = 6 rats. CBD (20 mg/kg ip). 10 ml
alcohol or water
Counteract neuroinflammatory-
induced cognitive impairments with
PLAE treatment with CBD.
Further studies evaluating dose-
dependent positive or adverse effects of
CBD.
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#
Authors
Aim
Methodology
Main results (CBD effects)
Recommendations for future research
11
Mukhopadhyay et
al. (2011) [52]
Effects of cannabidiol (CBD) on
myocardial dysfunction,
inflammation, oxidative/nutrient
stress, cell death, and interrelated
signaling pathways
Mice. Dose of 50 mg/kg dissolved in
100 ml citrate buffer pH 4.5 for 5
consecutive days.
Did not alter glucose levels. Improved
myocardial dysfunction.
CBD as a potential therapeutic in the
treatment of diabetic cardiovascular
conditions and oxidative stress.
12
Gregorio et al.
(2019) [53]
Determining whether acute CBD
administration modulates DRN 5-HT
neuronal activity and effect of
repeated treatment with low doses of
CBD on mechanical allodynia
Rats. Acute increasing intravenous
doses of CBD (0.1-
1.0 mg/kg).
Repeated treatment with CBD (5
mg/kg/day, subcutaneously)
Repeated CBD treatment could
prevent mechanical allodynia and
anxiety-like behavior.
Repeating with low doses of CBD
induces analgesia and reduces anxiety.
13
Bis-Humbert et al.
(2021) [54]
Comparing the antidepressant-like
response induced by cannabidiol
Rats. 3, 10, and 30 mg/kg
Decreased body weight. Improved
despair-
like behavior. Did not
modulate anxiety-like behavior.
Support the idea that cannabidiol exerts
antidepressant and anxiolytic effects.
14
Borys et al. (1979)
[55]
Effects in mice of both acute and
subacute CBD treatment on sleep time
Rats. 120 mg/kg
Significant increases in sleep.
Inhibitory action of CBD is still
unknown.
15
Peres et al. (2016)
[56]
CBD treatment would attenuate
motor and cognitive impairments
Rats. 0.5 or 5 mg/kg
CBD improves motor and cognitive
impairments.
Include CBD in the pharmacotherapy of
Parkinson's disease.
16
Vuolo et al. (2015)
[57]
Effects of CBD on inflammatory
parameters (evaluated by cytokine
levels) in an asthma model.
Rats. Dose of 5 mg/kg.
Significantly reduced cytokine levels,
exhibiting anti-inflammatory effects.
Beneficial effect of CBD in an animal
model of asthma.
17
Wheal et al. (2014)
[58]
CBD effect decreases insulitis,
inflammation, neuropathic pain, and
myocardial dysfunction in preclinical
models
Rats. Dose of 10 mg.
Relaxing
Improves the ability of arteries to relax
through increased production of
vasodilatory products.
18
Hammell et al.
(2016) 5/8/2024
4:05:00 PM
Cannabidiol (CBD) attenuates
inflammation and pain without side
effects
Rats.
Reduced joint inflammation.
Effective doses for reduce inflammation.
19
Belardo et al. (2019)
[60]
Effects of CBD on neurological
dysfunctions associated with TBI
Dose of 0.6 to 6.2 mg/day.
Restored behavioral alterations and
partially normalized cortical
biochemical changes.
CBD as a pharmacological tool to
improve neurological dysfunctions
caused by trauma.
20
Ceprián et al.
(2017) [61]
Protective effect of CBD in a neonatal
rat model of AIS.
Dissolved in hemp seed oil and
tocopherol. CBD (30 μl, 10% oil).
Improved neurobehavioral function in
terms of strength, hemiparesis,
coordination, and sensorimotor
performance.
CBD administration following middle
cerebral artery occlusion (MCAO).
21
Costa et al. (2004a)
[62]
Anti-inflammatory and anti-
hyperalgesic effects of cannabidiol
Rats. Dose of 5 mg/kg
intraperitoneally.
Anti-hyperalgesic effect.
Beneficial effect on two inflammation
symptoms.
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#
Authors
Aim
Methodology
Main results (CBD effects)
Recommendations for future research
22
Costa et al. (2004b)
[63]
Anti-hyperalgesic effect of CBD
Rats. Oral dose (5-40 mg/kg).
Anti-hyperalgesic effect.
The potential involvement of transient
receptor potential vanilloid type 1
receptor.
Could be a molecular target of anti-
hyperalgesic action.
23
Costa et al. (2007)
[64]
Therapeutic potential in neuropathic
pain.
Rats. Oral dose of 10 mg kg-1 (5 ml kg-
1).
Anti-inflammatory and
immunomodulatory effects.
Therapeutic use for pain.
24
Ignatowska-
Jankowska et al.
(2011) [65]
Effects of repeated CBD
administration on body weight gain
in rats
Rats. at doses of 2.5 and 5 mg/kg/day
Ability to modulate weight gain.
Further investigation into the regulation
of body weight.
25
Murillo-Rodríguez,
et al. (2006) [66]
Effects of CBD on sleep
Rats. Doses of 10mg/5mg
intracerebroventricularly
Modulates wakefulness.
Addressing vanilloid receptors.
26
Schiavon et al.
(2014) [67]
Cannabidiol, one of the main non-
psychoactive components
Mice. Doses of 3, 10, and 30 mg/kg
Protective effect of CBD on neuronal
death.
The mechanisms underlying the
neuroprotective effects of CBD.
27
Wang et al. (2017)
[68]
Effects of CBD on alcohol-induced
chronic and compulsive feeding-
induced liver injury.
Mice. Doses: ethanol (5 g/kg body
weight) and 5 or 10 mg/kg/day of
CBD.
Antioxidant, cytoprotective, and anti-
inflammatory properties. Attenuates
chronic liver injury and ethanol-
induced steatosis.
Therapeutic potential in liver diseases
associated with inflammation, oxidative
stress, metabolic dysregulation, and
steatosis.
Clinical studies in humans (n=19)
28
Zuardi et al.
(1993a) [69]
Explore the effect of CBD and aspirin
in stressful situations.
n = 40 (
♂
= 18,
♀
= 22), CBD single
healthy doce at 300 mg dissolved in
corn oil (100 mg / ml)
Anxiolytic
Realize confirmatory analysis of results
29
Zuardi et al.
(1993b) [70]
Explore the effects of CBD on plasma
prolactin, growth hormone, and
cortisol.
n = 11, healthy
Single dose of CBD at 300 mg and 400
mg
Sedative and anti-inflammatory
Realize confirmatory analysis of results
30
Martin et al. (2019)
[71]
Long-term effects of CBD on cognitive
function.
n = 27, epilepsy
Annual CBD intake of 36,5 mg / kg /
día
No effects on cognitive function
Realize new studies with Randomized,
placebo-controlled, and larger samples.
31
Allendorfer et al.
(2019) [72]
Effects of CBD oral solution on
attention.
n = 22 epilepsy
25 mg / kg / d for at least 2 weeks
No effect on mood
Controlled trials and examination of
long-term effects, follow-
ups after
treatment.
32
Santos et al. (2021)
[73]
Reduce tremors in patients with ET.
n=19 ET patients. Oral dose of CBD
(300 mg).
A single dose had no effect on upper
limb tremors
Chronic treatment with CBD.
33
Kasper et al. (2020)
[74]
Prevalence of CBD use in professional
rugby league and union players.
n=517 rugby players. Survey.
CBD use showed improvement in
recovery/pain (80%) and sleep (78%),
and 68% of players reported a
perceived benefit
Need to explore claims regarding pain
and sleep.
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10
#
Authors
Aim
Methodology
Main results (CBD effects)
Recommendations for future research
34
Cochrane-Snyman
et al. (2021) [75]
Effect of CBD oil on perceived muscle
pain, inflammation, and strength
performance.
n=13 men
Dose: 150 mg.
They did not support that
supplementation with CBD oil would
have an effect on muscle damage and
inflammation after an ECC protocol.
Investigate broader ranges of CBD
dosage and scheduling in trained and
untrained men and women.
35
Neubauer et al.
(2018) [76]
Evaluate the effectiveness of
complementary therapy with CBD.
Patients with epilepsy. Dose of less
than 8 mg/kg/day.
Less intense seizures, shorter seizure
duration, shorter recovery time, and
other positive side effects of CB
treatment.
Potential benefits as adjunctive therapy.
36
Lopez et al. (2020)
[77]
Effects of a CBD oil extract on stress
resilience, perceived recovery, mood,
affect, and body composition.
65 men and women. Dose of 60 mg.
Improved HDL cholesterol, supported
psychometric measures of sleep, stress
response, and perceived vitality.
Supplementary use.
37
Hatchett et al.
(2020) [78]
Determine the influence of
cannabidiol oil in attenuating delayed
onset muscle soreness.
N=23. Dose of 16.67 mg.
Muscle recovery
Investigate the role of CBD dosage level,
nutrition, sleep, exercise type, and other
factors on CBD's ability to attenuate
exercise-induced muscle damage effects
and aid in the recovery process.
38
Sahinovic et al.
(2022) [79]
Effects of acute CBD treatment on
physiological and psychological
responses to aerobic exercise
n=9, trained males (57.4±4 ml/kg/min)
CBD (300 mg) vs Placebo 1.5h before
exercise
CBD appeared to increase VO
2
, ratings
of pleasure and blood lactate compared
to placebo.
Larger studies are required to confirm
and better understand these preliminary
findings.
39
Alhamoruni et al.
(2012) [80]
Determine if cannabinoids modulate
increased permeability associated
with inflammation in vitro.
Dose of 10 ng · mL -1.
Recovery of increased permeability
Locally produced endocannabinoids,
acting through CB1 receptors, play a role
in mediating changes in permeability
with inflammation.
40
Arndt and de Wit
(2017) [81]
Effects of CBD on responses to
negative emotional stimuli as a model
for its potential anxiety-reducing
effects.
n=38.
Oral CBD 300, 600, and 900 mg.
CBD did not produce detectable
subjective effects or alterations in
mood or anxiety.
Further research on the behavioral and
neural mechanisms of CBD and
41
Bergamaschi et al.
(2011) [82]
Effects of a simulated public speaking
test.
N=24
CBD dose of 600 mg
Reduced anxiety, cognitive
impairment, and discomfort in speech
performance, and decreased
anticipatory speech alertness.
More research to determine the precise
mechanisms of action of CBD in different
anxiety disorders.
42
Birnbaum et al.
(2019) [83]
Evaluate the pharmacokinetics of an
oral cannabidiol capsule with and
without food.
n=8. Dose of 99% pure CBD capsules
on an empty stomach as well as under
fed conditions.
More precise pharmacokinetic
parameters
Use of CBD capsules
43
Jadoon et al. (2017)
[84]
Investigate if CBD reduces blood
pressure in humans.
n=9. Dose of 600 mg.
Reduces resting blood pressure and
attenuates blood pressure increase
during stress
Research to establish if CBD has a role in
the treatment of cardiovascular
disorders.
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11
#
Authors
Aim
Methodology
Main results (CBD effects)
Recommendations for future research
44
Kraft et al. (2008)
[85]
Effects of oral cannabis extract in two
different human models of acute
inflammatory pain and hyperalgesia.
n=18 women. Oral capsule
administration.
Hyperalgesic
Future clinical studies in patients with
chronic pain
45
Linares et al. (2018)
[86]
Effect of a clinically anxiolytic dose of
CBD on the sleep-wake cycle.
n=27. Dose of 300 mg.
Does not interfere with the sleep cycle
Address the effects of CBD on the sleep-
wake cycle in patient populations
46
Masataka (2019)
[87]
Evaluate the efficacy of CBD
treatment for adolescents with social
anxiety disorder.
n=17. Dose of 300 mg.
Reduced anxiety
Useful option for treating social anxiety.
47
Shannon and
Opila-Lehman
(2016) [88]
Evidence that CBD is effective as a
safe alternative treatment to
traditional psychiatric medications for
reducing anxiety and insomnia.
n=1, 10-year-old girl.
CBD supplements (25 mg) at bedtime,
and 6 mg to 12 mg of sublingual CBD
spray administered during the day
Reduces anxiety and improves sleep
Study long-term effects.
48
Isenmann et al.
(2021) [89]
Effect of CBD after resistance training
on performance and muscle damage
n=21
CBD after exercise (60mg on 250 mL
water) vs Placebo
Small significant effects on muscle
damage and recovery after 72 h in CBD
group vs Placebo
More data are required for clearer
statements concerning potential pro-
regenerative effects of CBD
49
Crossland et al.
(2022) [90]
Determine that CBD is effective to
reduce inflammation and enhances
performance for strenuous eccentric
exercise
27 female (18-26 years-old)
Isolate CBD (5 mg/kg; 3 times -2h, 0h
and +10h) vs Placebo
No effect for inflammation, muscle
damage and subjective fatigue
Study of varying CBD supplements to
determine if other phytochemicals in
cannabis plant prove effective for
recovery
Reviews and meta-analysis (n=21)
50
McCartney et al.
(2020) [32]
Present preliminary preclinical
laboratory animal data in humans,
non-athletes.
Narrative review
Anti-inflammatory Neuroprotector
Analgesic
Anxyolitic
Rigorous and controlled studies in
humans
51
Burggren et al.
(2019) [91]
Review the effects of CBD on brain
structure, function, and cognition.
Literature review
Insufficient evidence
Short and long-term consequences
Effect in older adults
Efficacy and safety of existing products
52
Burstein (2015) [30]
Review the effects of CBD on
inflammation.
Literature review
Anti-inflammatory
Decrease of secondary inflammatory
effects
Human trials with clinical application
Advantages of CBD over other
cannabinoids
Synthetic analogs with greater potency
than CBD
53
Hill et al. (2012)
[92]
Effects of phyto-cannabinoids (CBD)
in preclinical models of central
nervous system disease.
Literature review
Neuroprotective anticonvulsant
(modulates immune cell activity and
limits oxidative stress)
Long-term, double-blind, placebo-
controlled trials are needed. Participants
with different affective disorders.
54
Booz (2011) [93]
Effects of CBD on inflammation and
oxidative stress.
Narrative review
Anti-inflammatory
Antioxidant
More details are needed on how CBD
targets inflammatory signaling.
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#
Authors
Aim
Methodology
Main results (CBD effects)
Recommendations for future research
Test studies on the therapeutic utility of
CBD.
55
Lorenzetti et al.
(2016) [94]
Recent findings from human
structural neuroimaging research.
Systematic review
CBD protects against these harmful
effects in the hippocampus, prefrontal
cortex, amygdala, and cerebellum.
Urgent development of consensus-based
guidelines to quantify cannabis
consumption and exposure in human
studies.
56
Rojas-Valverde
(2021) [33]
Explore the potential role of CBD in
sports recovery.
Narrative review
CBD has anti-inflammatory,
antioxidant, anxiolytic properties, and
improves sleep quality.
Specific investigations are required to
determine if cannabis can provide
indirect benefits to athletes.
57
Kramer et al. (2020)
[95]
Effects of chronic cannabis
consumption on physiological
parameters of sports performance.
Systematic review
It did not have a significant effect on
athletic performance. Resting heart
rate was the only physiological
measure that differed.
Specific investigations are required to
determine if cannabis can provide
indirect benefits to athletes.
58
Singh and Neary
(2020) [96]
Neuroprotective effects of
cannabinoids, specifically the
phytocannabinoid CBD, after a
traumatic brain injury (TBI).
Systematic review
Enhancing neuroprotection by
reducing inflammation.
Influence the blood-brain barrier, brain-
derived neurotrophic factors, cognitive
ability, brain vasculature, cardiovascular
physiology, and neurogenesis.
59
Reillo (2019) [97]
Examine sport-related traumatic brain
injury and the preventive and
therapeutic use of cannabidiol among
athletes.
Systematic review
Efficacy of preventive and therapeutic
administration of cannabidiol (CBD) in
head injuries.
Recommended as a preventive and
therapeutic intervention in the treatment
of traumatic brain injury.
60
Fine and Rosenfeld
(2013) [98]
Link the endocannabinoid system and
phytocannabinoids to their
potentially therapeutic role in chronic
pain management.
Systematic review
Analgesic for chronic pain.
Administered orally.
61
Sholler et al. (2020)
[99]
Synthesize the efficacy of CBD as a
therapeutic agent.
Systematic review
Efficacy of CBD as a therapeutic for
various medical conditions, including
epilepsy, anxiety, pain/inflammation,
schizophrenia, and substance use
disorders.
Rigorous and controlled evidence of the
therapeutic efficacy of CBD is lacking.
62
Lowin et al. (2019)
[100]
General effects of cannabinoids on
inflammation.
Systematic review
Anti-inflammatory effects.
Targeting the right receptors in the right
place.
63
Stanley et al. (2013)
[101]
Establish whether the cardiovascular
system is a potential therapeutic
target for CBD.
Systematic review
CBD reduces the cardiovascular
response to stress models.
More evidence of the positive role of
CBD in the heart.
64
Bruni et al. (2018)
[102]
Synergistic effect in pain treatment.
Systematic review
Therapeutic, anti-inflammatory.
Further assessment of nanotechnology
systems.
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13
#
Authors
Aim
Methodology
Main results (CBD effects)
Recommendations for future research
65
Zurier and Burstein
(2016) [103]
Ability to facilitate inflammation
resolution.
Systematic review
Anti-inflammatory
Reduction of fibrosis
Cannabinoids becoming safe and
effective anti-inflammatory medications.
66
Vuolo et al. (2019)
[104]
CBD in respiratory pathways
remodeling.
Systematic review
Anti-inflammatory
Reduction of asthma
More details on airway remodeling.
67
Crippa et al.(2011)
[105]
Investigate generalized social anxiety
disorder (GSAD) using functional
neuroimaging.
Preliminary report
Reduction of anxiety
Effects on activity in the limbic and
paralimbic areas of the brain.
68
Huestis et al. (2011)
[106]
Support the status of cannabis
regarding the Prohibited List.
Systematic review
Positive effect on performance
Further research on the development of
tolerance after long-
term frequent
exposure.
69
Lattanzi et al.
(2018) [107]
Efficacy and safety of CBD as an
adjunctive treatment in patients with
epilepsy.
Systematic review and metanalysis
Reduction of seizures frequency
Does not produce euphoric or intrusive
side effects.
70
Ware et al. (2018)
[108]
Identify and highlight challenges in
interpreting information regarding
elite athletic performance and identify
important areas of research that need
to be addressed.
Literature review
Promising effect for the treatment of
chronic pain.
There is no evidence that cannabis
consumption is a performance-
enhancing drug.
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4. Discussion
4.1. Preclinic Research (Animals)
Despite the relatively popular use of cannabinoids in humans, most of the actual evidence on
the effects of CBD on physiological and psychological effects focuses on animals, especially pigs,
mice, and rats. The lack of clinical trials could be due to national and international restrictions on
access to cannabinoids, including CBD, and strict control of their use for research purposes. Other
limitations are rigorous procedures for trial approval by government drug agencies. Therefore,
preclinical studies have been conducted to determine the safe initial dose and assess the potential
toxicity of CBD before testing it in humans.
Some preliminary studies have found some benefits of CBD consumption in both physiological
and cognitive functions. Recent evidence suggested a reduction in anxiety and better adaptation to
new environments when CBD is prescribed in mice.[42,44] In contrast, other studies suggest no
benefits on anxiety in response to CBD administration but not found negative effects.[43] Novel
studies have suggested a neuroprotective consequence of CBD administration leading to a decrease
in attenuation in BNDF levels related to the reduction of neuroinflammation[46], and some
neuroprotection after a stroke event[48], stimulating neurogenesis and promoting dendritic
restructuring in the hippocampus.[49] CBD also showed potential in the treatment of central and
peripheral neuropathic pain[47] and some increases in acetylcholine in the brain after its
administration were reported.[50] In addition, it was found to exert antidepressant and anxiolytic
effects at the cognitive level, with only positive and beneficial evidence for functional recovery and
anti-inflammatory symptoms.[50]
Regarding muscle function and anti-inflammatory effects of CBD administration in animals, a
revealing study found that CBD intake could lead to structural and functional improvement of
muscles, suggesting muscular recovery.[45] This study explained that CBD could promote the
differentiation of myoblast cells into myotubes by increasing Ca2+, preventing locomotor activity loss
related to the reduction of proinflammatory markers in tissue and plasma and restoration of
autophagy. The results of this main study on the anti-inflammatory effects of CBD are supported by
additional evidence, recognizing its use as a potential new treatment in the inflammatory response
and reduction of chronic pain.[46] Hammell et al.[59] and Vuolo et al.[57] also found a positive
relation of CBD with anti-inflammatory parameters (reduction of cytokine levels). Other studies have
found the benefits of CBD consumption regarding sleep disorders in animals, showing that it can
prolong sleep time and avoid excessive drowsiness.[46,55,66]
The notable physiological differences between animals and humans notwithstanding, these
results indicate promising potential for CBD to improve muscular recovery. The data suggest CBD
may modulate inflammation and thereby accelerate healing stages like inflammation, proliferation,
and regeneration following tissue damage. While extrapolation to healthy humans or athletes is
premature, the results merit further research on CBD's utility in recovery from muscular injury in
both animals and humans.
Exercise-induced fatigue and damage in humans trigger physiological and psychological
cascades. Extensive research, including studies, guidelines, reviews, and meta-analyses, has
examined exercise fatigue to elucidate the central and peripheral mechanisms disrupting bodily
function.[2] Common delayed-onset symptoms like sleepiness, swelling, pain, and weakness often
persist hours or days post-exertion.[5] This review synthesizes human evidence on CBD’s potential
to improve recovery. Elucidating CBD’s effects on inflammation, sleep, pain, and other cognitive and
psychological outcomes in healthy and pathological populations could inform future applied
research on CBD in sports science and medicine.
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4.2. Noninflammatory and Antioxidant Effects in Humans
Eccentric exercise can induce sarcolemma damage by altering muscle cell membrane
permeability and the basement membrane, enabling Ca++ influx that disrupts muscle fiber
electrochemical gradients. If sarcolemma damage is modest, ATPase pumps can restore Ca++
homeostasis and reverse the damage. However, Ca++ overload initiates degradation of structural and
contractile proteins, eliciting an inflammatory cascade involving macrophage and phagocyte
activation within 2-6 hours post-injury, persisting for days.[30,109]
A single 300mg CBD dose alters human glucocorticoid levels including the key inflammatory
regulator cortisol[70], that is considered as one of the main homeostatic regulators of the
inflammatory response to injury.[110] A recent narrative review proposed CBD's anti-inflammatory
effects in humans could benefit athletic performance[32], potentially by interacting with
inflammation-modulating receptors (e.g., CB1, CB2, A2A) and attenuating pro-inflammatory
cytokines including IL-1, TNFα, thus suppressing hyperactive immune responses and associated
tissue damage.[30,92,93] There is also evidence suggesting the potential of CBD to promote the
release of arachidonic acid, leading to greater healing capacity as a result of central regulation of
growth signals mediated by pro-resolving substances such as lipoxin A4 and 15d-PGJ2.[30]
CBD may confer neuroprotection by reducing inflammation, protecting the brain and heart, and
attenuating cardiovascular responses.[30] As CBD resolves chronic inflammation via
phytocannabinoids, it could have therapeutic efficacy in conditions like epilepsy and Parkinson's
disease.[30] It is also known that many human diseases due to tissue and organ damage are
underpinned by the interaction between inflammation and oxidative stress.[111] In this sense, in
sports, the hypothesis is raised that this CBD related to inhibitions of oxidative stress and
neuroinflammation could have some therapeutic potential in sports research.
4.3. Pain and Discomfort in Humans
In sports, changes in muscle structure in response to damage can cause pain. Maximum pain is
experienced 2-3 days after exercise as a result of prostaglandins produced by monocytes, which
sensitize afferent nerve endings in the muscles and cause a sensation of discomfort felt as fatigue and
tension (nociceptive pain). Swelling causes pain, and after intense exercise, maximum swelling
typically occurs five days after exertion due to increased muscle pressure as a result of inflammation
(inflammatory pain).[112] Both pain and swelling can cause a reduction in muscle shortening
capacity, limitations in mobility and range of motion, decreased sleep quality, reduced muscle
strength, and other reductions in neuromechanical function; that is why research on effective and
efficient recovery methods is crucial in sports.[113,114]
The delayed onset of muscle pain due to damage from physical activity, as well as the
management of chronic pain, are part of the therapeutic benefits of using CBD in sports performance,
also improving sleep and therefore mood.[113,114] They can also include the potential of reducing
resting blood pressure as a potential that improves athlete performance and regulation of body
weight by CB2 receptors.[113,114]
Currently, there is very limited evidence about the ingestion of CBD and its sedative effect. In
this sense, 300-400 mg of CBD seems to have sedative effects in humans due to apparently acting
directly on the central nervous system[70], supported by the idea that CBD has a beneficial action on
edema and hyperalgesia.[30,115] In this sense, in many countries, drugs such as Sativex, THC, and
CBD are approved for the treatment of both central and peripheral neuropathic pain, which is
associated with microglial activation and subsequent proinflammatory cytokine cascades such as IL-
6, IL-1β, and TNFα; this supports the idea of using CBD as an anti-nociceptive agent.[93] This effect,
along with other neuroprotective qualities, was also found in a recent systematic review of the
outcome of CBD ingestion concerning its potential use as a substance to enhance sports
performance.[32]
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4.4. Sleep Quality
Sleep disorders are relatively common among athletes when recovering from fatigue injuries.
Athletes are recommended to sleep for 7 to 10 hours per night, and the usual duration of sleep is less
than 8 hours per night, increasing the risk of injury. The duration of sleep, but not sleep quality,
appears to have an impact on performance.[116]
Sleep and pain have a reciprocal relationship, with greater pain resulting in greater sleep
disturbance, as well as poor sleep quality and higher levels of pain. Some strategies such as
mindfulness, self-hypnosis, meditation, and stress or anxiety reduction techniques show significant
potential for sleep improvement.[113] Additionally, other psychological factors may potentially
influence sleep, such as overtraining, which often occurs when intensified training and competition
are accompanied by insufficient recovery.[116]
Some natural alternatives have been proposed, such as infusions, hot showers, tea consumption,
and the use of oil as sleep and anxiety improvement strategies.[117] Based on these effective benefits,
some team sports athletes have widely used CBD for sleep, pain relief, and recovery, and its
consumption increases with age.[74] Endocannabinoid system stimulation may modulate sleep
disorders in aging, being very promising evidence for sports while some elements of this system
modulate the sleep-wake cycle.[118]
4.5. Cognitive and Psychological Effects
Regarding the effect on cognition and mood, there is evidence suggesting the absence of benefits
after prolonged use of CBD in humans.[71,72] On the other hand, a single administration of 300 mg
of CBD has been reported to have an anxiolytic effect in healthy humans.[69] Specifically in sports,
athletes, due to their competitive nature, tend to exhibit exaggerated behaviors. This can lead to states
of high anxiety and even in some situations can trigger states of depression. In this sense, CBD could
have anxiolytic and antidepressant actions through the activation of 5-HT1A receptors, but more
evidence is needed to consider these conclusions strong enough.[93]
Preliminary studies show that CBD protects against neuroanatomical alterations.[93] This is
significant as emotional stimuli can be determinants in sports performance, such as anxiety[93], and
they are reduced with the useful use of cannabidiol on the limbic and paralimbic areas of the
brain.[93] Finally, the potential use of CBD in sports performance as an anxiolytic substance has been
explored, with authors linking the possible effect on exercise with previous clinical and preclinical
studies in animals, healthy populations, and patients with underlying pathologies.[32]
4.6. Study Limitations
Due to the lack of research in sports medicine and science, the main limitation is the struggle to
extrapolate the benefits found in animals, healthy humans, and patients with pathologies to potential
applications in sports science. There is a need for new evidence in humans considering the lack of
available information, knowing an exact dosage, and relatively common methodological flaws in
accessible research.
The relatively low rate of publications analyzing the effects of CBD on variables related to
recovery led to a large amount of duplicated information among databases. The way some studies
approach the descriptors cannabinoids, CBD, cannabis, and THC generates confusion, due to some
flaws in the presentation of methodology, which make interpretation of results difficult. As a result
of the different approaches of studies and methodological differences, it was difficult to systematize
information.
Although CBD has been shown to have a series of properties that may suggest its potential use
in athletes, there are current conditions of sale and commercialization that require caution in its
consumption. Poor manufacturing, THC present in CBD products and lack of product labeling and
analytical reports could cause serious health problems and violations of doping regulations. In
addition, the large doses of CBD used in the reviewed studies are not readily available to athletes
without prescription.
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5. Conclusions
CBD appears to have anti-inflammatory, neuroprotective, analgesic, anxiolytic, and potentially
performance-enhancing properties in athletes, but further scientific evidence is necessary to confirm
these effects. Confirmatory analyses using randomized placebo-controlled trials to test the acute and
chronic effects of different dosing regimens are needed. These studies should consider fundamental
aspects of sports, such as the variety of biological and situational conditions that contribute to fatigue,
the characteristics of each discipline during training and competition, as well as individual athlete
peculiarities, tolerance and response to CBD intake, and the combined effect of CBD administration
with other physical and nutritional aids.
5.1. Practical Applications and Future Research
Given the relatively common use of cannabis and CBD among athletes, there is a clear need to
improve scientific understanding of the effects of CBD use on athlete recovery and performance.
More scientific advances are needed, mainly the execution of experimental trials, which allow for a
greater understanding of both positive and negative critical results for the ultimate benefit of athlete
recovery and performance.
New randomized placebo-controlled studies should consider different etiologies of fatigue and
damage, individualities and disciplines, needs and special characteristics. Other potential research
areas include: (1) optimal dosing based on physical and physiological load, (2) the efficacy concerning
the timing of CBD administration (before, during, or after training/competition), (3) the chronic
versus the acute effects of CBD, (4) the cumulative responses with other recovery strategies, or (5) the
differences in tolerance and efficacy by sex, professional level, fitness level, and other individual
conditions. More information is needed on understanding CBD's inflammatory signaling in recovery
process. Also, the effectiveness of CBD versus conventional medication should be evaluated.
The resulting evidence could provide new clinical guidance for prescribing CBD during the
athlete's recovery process and other potential applications. The possible therapeutic benefits of CBD
administration have been minimized for years, but the actual scenario could facilitate increased
knowledge about this natural compound and its effects. Moreover, a clearer and global policy for the
use of cannabis in sports should be considered.
Author Contributions: Conceptualization, C.E.V.-G. and D.R.-V.; methodology, B.S.-U. and C.A.-M.; software,
C.E.V.-G. and C.D.G.-C.; validation, C.D.G.-C., C.A.-M. and D.R.-V.; formal analysis, C.D.G.-C. and B.S.-U.;
investigation, C.E.V.-G. and D.R.-V.; resources, B.S.-U. and C.A.-M.; data curation, C.D.G.-C. and B.S.-U.;
writing—original draft preparation, C.E.V.-G. and C.D.G.-C.; writing—review and editing, B.S.-U., C.A.-M. and
D.R.-V.; visualization, B.S.-U. and C.A.-M.; supervision, D.R.-V.; project administration, B.S.-U. All authors have
read and agreed to the published version of the manuscript.
Funding: This research received no external funding.
Institutional Review Board Statement: Not applicable.
Informed Consent Statement: Not applicable.
Conflicts of Interest: The authors declare no conflicts of interest.
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