Pre-workout

In 1982, Dan Duchaine formulated the first pre-workout, called Ultimate Orange, in Venice, California. Ultimate Orange quickly became popular among bodybuilders.[4]

Between the late 1990s and early 2000s, consumers alleged that an active ingredient in Ultimate Orange, called ephedra, caused high blood pressure, strokes, seizures, cardiac arrhythmia, and heart attacks.[2]

In the early 2000s, supplement companies created more potent forms of pre-workout that caused the blood vessels to enlarge temporarily, giving lifters a better “pump."[2] These more potent supplements are called Arginine AKG, Arginine Malate, and Citrulline.[2]

In 2005, chemist Patrick Arnold formulated a pre-workout called Jack3d, which contained a new ingredient called DMAA (dimethylamylamine).[6] Jack3d quickly gained notoriety for its potency, but its high concentrations of DMAA were suspected of causing shortness of breath, chest pain, and an elevated risk of heart attacks.[2] Jack3d was banned in 2012 by the FDA.[2]

Pre-workout supplements are available in different forms including tablets, capsules, liquids, powders, and bars.[7] A number of common ingredients are used. There is considerable overlap between the ingredients used in pre-workout blends and other supplements intended for weight loss, improving mood, life extension, or as purported nootropics or aphrodisiacs, although certain ingredients tend to be found only in products intended to assist in bodybuilding or athletic training. Some ingredients such as caffeine, creatine and β-alanine are found in nearly all pre-workout blends, but each branded product is a "proprietary blend" with an average of 18 different ingredients, the exact composition and proportions of which can vary widely between different products.[8][9]

• Ephedrine (usually as Ephedra extract) was a common ingredient in many pre-workout supplements in the 1990s and early 2000s, sometimes in combination with caffeine and aspirin (the so-called ECA stack), however following many reports of serious side effects and some deaths, it was banned for use in supplements by the FDA in 2004 throughout the USA, and many other countries have enacted similar bans.
• Caffeine is now one of the most common ingredients, found in one study to be in 86% of the bestselling pre-workout supplements.[3] Caffeine is a popular ingredient in pre-workout because it increases alertness, mental concentration, and energy.[10] Related compounds such as theophylline or theobromine (sometimes as "cocoa extract") may also be used.[11]
• Methylhexanamine, also known as DMAA, is another stimulant which was widely used for some time as an alternative or supplement to caffeine.[12] The FDA has warned that DMAA "is known to narrow the blood vessels and arteries, which can elevate blood pressure and may lead to cardiovascular events ranging from shortness of breath and tightening in the chest to heart attack". DMAA is also considered a prohibited stimulant by the United States Anti-Doping Agency.[13] Following the widespread banning of DMAA, it has in some cases been replaced by similar compounds such as DMBA, octodrine, tuaminoheptane or DEPEA, which are associated with similar side effects.[14]
• Carbohydrates are usually present, often in a mix of simple sugars like glucose and more complex oligosaccharides such as maltodextrin which are supposed to provide more sustained energy. These are used both to provide a sweet taste and fuel for exercise, though evidence for whether they actually enhance exercise performance is mixed.[15][16]
• Protein supplements, usually in a palatable powdered form such as whey protein or rice protein, are also commonly used both for flavour and as a fuel for muscle growth and recovery.[17][18]
• Electrolytes providing sodium, potassium and magnesium (and often others such as zinc, calcium, iron etc in smaller amounts) are often included to replace those lost due to sweating during heavy exercise, generally as a mixture of different salts, sometimes including exotic forms such as zinc monomethionine aspartate or calcium fructoborate which are supposed to be better absorbed or have other special properties.
• Nitrate salts are commonly included (often as "beetroot extract") for their supposed benefits for endurance exercise. Sometimes this is achieved by using nitrate salts of other ingredients (e.g. arginine nitrate, creatine nitrate).[19]
• Creatine, a natural chemical created in the kidneys and liver, is another popular ingredient in pre-workout. Creatine has been proven to improve physical performance as well as increase strength, under some circumstances.[20][21]
• β-Alanine is another very common ingredient that was found to be present in 87% of leading pre-workout formulas. Beta-alanine has been found to decrease fatigue during high-intensity exercise by increasing the muscle carnosine concentration which creates a buffer against muscle fatigue.[22]
• Branched-chain amino acids, leucine, isoleucine and valine are commonly used for their muscle fueling properties and relief of post-workout soreness, often alongside other amino acids such as glutamine which are thought to have synergistic effects. Results from research have been mixed, and the dose contained in commercial pre-workout products is often less than an optimum effective dose.[23][24][25][26][27]
• β-hydroxy-β-methylbutyrate may sometimes be used as an ingredient in some high-end products,[28][29] though is prohibitively expensive for most commercial pre-workout blends.
• Arginine (sometimes as complexes like arginine alpha-ketoglutarate), is also commonly used as a nitric oxide precursor and supposed booster of growth hormone and IGF-1 release, though studies have shown limited benefits, and generally at higher doses than are present in typical pre-workout products.[30][31]
• Ornithine or L-Ornithine L-aspartate are sometimes used as an alternative or in addition to arginine, and have generally similar properties.[32]
• Citrulline (sometimes as "watermelon extract") is used as an alternative or supplement to arginine, and is claimed to reduce post-exercise soreness.[33]
• Agmatine is also often used as an alternative or supplement to arginine.[34]
• Taurine is also a common ingredient in pre-workout, and can be used as a supplement taken alone. It is similar to creatine in helping muscle hypertrophy that increases strength, endurance, reduced muscle damage, and helps with a faster recovery.[35][36]
• Tyrosine or its precursor N-Acetyl-L-tyrosine are commonly used to purportedly boost levels of dopamine and noradrenaline.[37] Some brands may contain L-Dopa (generally as Mucuna pruriens extract),[38] but this is classified as a prescription medicine in many countries.
• 5-HTP (often as Griffonia simplicifolia extract) is sometimes included to boost levels of serotonin.
• Choline is often used as an ingredient to boost levels of acetylcholine and S-adenosyl methionine, usually as choline bitartrate, or in complexed forms such as alpha-GPC, citicoline or phosphatidylcholine.
• Theanine is often used as an ingredient (sometimes as "green tea extract", though this may alternatively be used to refer to EGCG, which may also be present), to supposedly improve mental and physical performance, and reduce anxiety.[39][40]
• Piperine (often as "black pepper extract") is often included both to improve absorption of other ingredients, and for its supposed ability to improve muscle recovery.[41][42]
• B vitamins are another common ingredient, most commonly Vitamin B3 and Vitamin B12 in various forms, but also often thiamine (Vitamin B1, sometimes as sulbutiamine),[43] pantothenic acid (Vitamin B5) and folic acid (Vitamin B9). Other vitamins such as Vitamin C, Vitamin D3 or Vitamin E are also less commonly used.
• Carnitine or its precursor acetylcarnitine are sometimes added to the mix for their supposed ability to enhance exercise performance and aid recovery, though evidence for these benefits is weak.[44][45]
• Betaine (trimethylglycine) is often used as an ingredient, despite limited evidence for effectiveness in increasing athletic performance.[46][47]
• Phenethylamines such as β-phenethylamine, halostachine, N-methyltyramine, hordenine or synephrine (sometimes as "bitter orange extract") may be included as thermogenics to aid in weight loss.[48]
• Higenamine (norcoclaurine) is also often added for its weight loss and mild stimulant properties.[49]
• Resveratrol and related polyphenols (usually as "grape seed extract") are often included for their antioxidant and fat burning properties.[50]
• Yohimbine has also been used as an ingredient (often as Pausinystalia johimbe extract), as a supposed testosterone booster and fat-loss agent,[51][52][53] but it has been associated with dangerous side effects, and is also a prescription medicine in many countries.[54]
• Phenibut is occasionally found as an ingredient of pre-workout blends, to reduce anxiety and supposedly boost dopamine levels,[55] though it is now classified as a medicine or controlled drug in many countries.
• Phenylpiracetam is also sometimes used as an ingredient for its nootropic and stimulant effects.[56]
• Capsaicin is sometimes used as an ingredient in gelcap pre-workout formulations, both as a weight loss aid and for a supposed improvement of endurance.[57]
• Adaptogenic plant extracts such as Ginkgo biloba, Panax ginseng, Rhodiola rosea and Huperzine A (from Huperzia serrata) are sometimes included for their supposed ability to improve endurance and mental clarity, despite limited evidence for efficacy. Other plant extracts such as Tribulus terrestris and Lepidium meyenii (Maca) may also be included for their supposed ability to boost testosterone levels, though again evidence for effectiveness is lacking.
• Prohormones such as DHEA, CDMA, 1-androstenediol and 7α-methyl-19-norandrostenedione were widely used in pre-workout formulations prior to 2014 when they were formally banned. These compounds are not anabolic agents in their own right, but are metabolised into anabolic steroids of a type which at the time were not restricted. Despite most known prohormones having now been banned, novel compounds of this type or older compounds which are simply not listed as ingredients, are still sometimes found in over-the-counter pre-workout products, and are a frequent cause of inadvertent drug testing failures by athletes in competition.[58]
• Selective androgen receptor modulators (SARMs) such as enobosarm and ligandrol are also sometimes found as ingredients in pre-workout supplement blends, and again when present are often not accurately declared on the ingredients listing.[59]

Pre-workout supplements are sold in a variety of retailers. The top-selling brands of pre-workout supplements in 2019 included Pre JYM Pre Workout by JYM Supplemental Science, ENGN Shred Pre Workout by EVLUTION Nutrition, and C4 Original Pre Workout by Cellucor.[1] These brands were the top three in the overall bestseller category on leading bodybuilding informational website bodybuilding.com.[1] Some variations on common pre-workout products include sugar-free, creatine-free and stimulant-free options. The market size for pre-workout products was a $2.7 billion industry in 2008.[60]

Lack of regulation can mean that the ingredients used to prepare the product may not be of high quality and purity. This can mean the dose stated on the ingredients does not match the actual composition of the blend. Plant extracts in particular are often adulterated or of varying quality, but may be assumed by manufacturers to be pure and consistent. Also protein powders used to prepare the blend may sometimes be contaminated with melamine, a plastic precursor which is sometimes added to produce false positive results for nitrogen content. Up to 50% of pre-workout blends analysed in one study were found to be contaminated with melamine.[61][62]

Pre-workout supplements that contain between 91–227 mg of sodium bicarbonate per pound may also cause digestive issues.[71]

Those who have taken a pre-workout supplement containing beta-alanine may also feel tingling sensations. This sensation is called paresthesia. Supplements containing large concentrations of niacin may cause facial flushing and dizziness.[71]

Drawbacks of using pre-workout are:

• Unwanted over stimulation.
• Dehydration.
• Tachycardia (rapid heartbeat)
• Increased blood pressure (potentially leading to stroke or heart attack).
• Addiction.
• Insomnia.
• Adrenal fatigue.
• Drug test failure (depending on ingredients, and if a competing athlete in particular sports)
• Energy crash.[72]

The FDA has minimal control when regulating dietary supplements like pre-workout. Product manufacturers are responsible to verify that dietary supplements are safe for consumption.[73] Financial limitations prevent the FDA from testing dietary supplements before they enter the marketplace.[73] Once a supplement is available for sale, the FDA is responsible to document and monitor manufacturer reports of adverse effects.[5] Manufacturers are obligated to report documented adverse effects to the FDA.[5]

The FDA recommends speaking with a healthcare professional before using dietary supplements. Ingredients in pre-workout can have negative side effects or contraindications with other medications.[5] Taking dietary supplements may have life-threatening consequences if taken with pre-existing health conditions.[5] Federal laws state that a supplement does not have to be declared safe by FDA standards when labeled.[5] Most supplement businesses hire third-party companies to identify the contents of their supplement to ensure it enhances athletic performance. This also aids in assuring that a product’s labeled ingredients are free from illegal substances.[7]

• Doping in sport
• Patent medicine