The effects of nicotine withdrawal on exercise-related physical ability and sports performance in nicotine addicts: a systematic review and meta-analysis.

Background: Previous research has established that nicotine withdrawal can ameliorate cardiovascular and pulmonary function in smokers. Nevertheless, the impact on physical fitness and athletic performance remains under-investigated.

Objective: To evaluating the impacts of nicotine withdrawal on both exercise performance and exercise-associated physical capabilities in nicotine-dependent individuals.

Study design: A comprehensive systematic review and meta-analysis.

Data sources: The data was compiled from databases such as PubMed, Scopus, Web of Science, Cochrane Central, and EBSCO.

Study selection: The selection criteria required studies to elucidate the effects of nicotine withdrawal on exercise performance or exercise-related physical abilities. Moreover, the selected studies needed to provide discernible experimental results.

Data synthesis and analysis: The random effects model was employed in data analysis, utilizing the standardized mean difference (SMD) and the 95% confidence intervals (95% CIs) to estimate participants' exercise performance and physical abilities, referencing the Mean ±SD during baseline and withdrawal states.

Results: Out of the selected studies, 10 trials were included, encompassing 13,538 participants aged 18 to 65 years. The findings suggest that nicotine withdrawal could potentially enhance sports performance (SMD = 0.45, 95% CI: 0.03 to 0.88; I^2 = 83%), particularly in terms of aerobic capacity. Short-term nicotine withdrawal (spanning 12 to 24 hours) might lead to a decline in participants' physical abilities in certain aspects like reaction time and sustained attention (SMD = -0.83, 95% CI: -1.91 to 0.25; I^2 = 79%), whereas long-term withdrawal (lasting 48 hours or more) demonstrated an opposing trend (SMD = 0.25, 95% CI: 0.12 to 0.39; I^2 = 81%). Overall, the results show that long-term nicotine withdrawal exhibited some positive impacts on sports performance and exercise-related physical ability, with the withdrawal duration being an indicator of subsequent physical performance.

Conclusions: Mid- to long-term (≥3 months) nicotine withdrawal significantly improved the exercisers' exercise-related physical ability and sports performance. Conversely, short-term (≤24 hours) nicotine withdrawal considerably hampered exercisers' performance and physical cognition. It is suggested that exercises avoid abrupt nicotine cessation prior to competitions, as long-term nicotine withdrawal has been shown to significantly enhance exercise-related physiological capacities and athletic performance. By referring to existing literatures we also found that athletes with existing nicotine addiction may could consume nicotine 15-30 minutes before competition to enhance athletic performance and physical function.PROSPERO registration number CRD42023411381.