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REPORT: Smoking and Exercise

Inhaling hot smoke is obviously harmful, but newer options have increased the use of both tobacco and marijuana in athletes.

You’re at the starting line waiting for the gun to sound. Glancing around at the other athletes, you may ask yourself how many arrived here ready to race after having a quick smoke. You may be surprised — unless you’re one of them.

A surprising number of people who exercise regularly, many of whom are also competitive athletes, use tobacco and or marijuana. Clinicians who properly perform extensive health histories on their athletic patients are aware of this frequency. While those who exercise have a relatively low prevalence of at-risk use of cigarettes and cannabis, the numbers appear to be rising rapidly with the implementation of smokeless products, and the legalization of both medical and recreational marijuana in some states.

Along with caffeine and alcohol, tobacco and cannabis use is not only common in the general population, but in the athletic population as well. In some cases, these drugs may be used because of their purported performance-enhancing potential. Only one of the drugs (caffeine) has enough scientific evidence indicating an ergogenic effect. There is some preliminary evidence for nicotine as an ergogenic aid, but further study is required; cannabis and alcohol can exhibit ergogenic potential under specific circumstances but are in general believed to be ergolytic, or impairing, to sports performance. These drugs are either currently (as in the case of cannabis and ethanol) or have been (caffeine) on the prohibited list of the World Anti-Doping Agency (WADA) or are being monitored (nicotine) due to their potential ergogenic or ergolytic effects.


Due to worldwide smoking restrictions, the tobacco industry has developed a number of smokeless alternatives, often containing much higher nicotine concentrations than regular cigarettes. Even certified organic tobacco is available. These represent an alternative for some athletes, and are becoming quite popular as they do not pose a risk of adversely affecting the respiratory system and some of these products do not contain additional harmful chemicals.

In addition to the opiate effects in the brain, nicotine stimulates the sympathetic nervous system increasing the heart rate and blood pressure, and can increase pain tolerance, some of the reasons why it might be used by athletes. Of course, being addicted to nicotine is another reason, and traditional cigarette smoking is not uncommon in athletes.

In a recent study designed to assess running and mortality (Dose of jogging and long-term mortality, J Am Coll Cardiol, 2015), test subjects and sedentary controls were asked about tobacco smoking. While 24 percent of sedentary individuals smoked, nearly 12 percent of the 1,098 runners did too. This included all three subgroups of runners, low, moderate and high-intensity training, with diminishing numbers of smokers seen as training intensity increased. (This could be 128 runners in your local 10K or half marathon.)

While exercise is a well-know therapy for tobacco cessation, the use of tobacco still has adverse effects on health, including its addictive property, which has been compared to heroin and cocaine.

The WADA has included nicotine, categorized as a stimulant and ‘in-competition only’ in its 2013 monitoring program stating they will “establish a monitoring program regarding substances which are not on the Prohibited List, but which WADA wishes to monitor in order to detect patterns of misuse in sport.”

In addition, another trend in tobacco use is smoking it in a mixture with marijuana (cannabis).


In 1999, a U.S. Institute of Medicine report supported the use of marijuana in medicine. And with medical, decriminalization and legalization occurring in half of U.S. States, including the District of Columbia, in various European and Latin American countries, Australia and elsewhere around the world, marijuana use is rising. With increased marijuana marketing and availability — Colorado has more cannabis dispensaries than Starbucks — the number of athletes using it will probably continue rising too.

Not all those using cannabis smoke it, with many opting for safer options available, including consuming it in food and drink.

If runner’s high is not enough, why do people exercise on THC, the active ingredient in cannabis? It is not unusual for athletes, like other social groups that follow common routines, to combine popular lifestyle activities like alcohol (beer after racing) and food consumption (pre-race pasta parties), with others in the clan. The same appears true of cannabis use, enhancing leisure and social activities such as getting together for a run or race.

Last summer, the 420 Games Road Race attracted 500 runners to promote a more active image among cannabis users. About half the entrants got high for the event in San Francisco’s Golden Gate Park.

While we don’t have good data on how many athletes use cannabis, the numbers in the general population, no doubt a good guide, are getting higher — in the U.S., for example, it’s nearly 20 percent of those 18 years and older in states where cannabis is legal (while a Gallup poll shows almost 60 percent of adult Americans favor legalization).

Researchers at Cornell University in New York and San Diego State University in California reviewed 12 years of data from the U.S. Centers for Disease Control and Prevention to examine the effects of medical marijuana laws on exercise, body weight and physical wellness. The results showed a reduction in the rates of obesity due to increased physical activity in those users 35 years and older, and reduced use of alcohol in younger users. Published in the journal Health Economics, the authors estimate that medical marijuana laws have induced a $58 to $115 per-person annual reduction in obesity-related medical costs. Other studies report many other health benefits of cannabis use, but no one knows whether this is why athletes use it.

Other reasons athletes claim to use cannabis include:

  • It may improve relaxation.
  • It may improve sleep quality, with the rationale that adequate sleep is important for better recovery and performance.
  • It may reduce an athlete’s feelings of pre-race stress and anxiety.
  • It is a mild sympathetic stimulant (less than that of a cup of regular coffee) and may help performance.
  • Some athletes may use cannabis for pain relief. The use of aspirin and other non-steroidal anti-inflammatory drugs is high in those who work out, and cannabis may offer a healthier alternative.
  • Research shows significant benefits in pain relief, and the analgesic effects of cannabis may be the most common reason for adding it to medical marijuana programs.

Studies on the use of cannabis on exercise performance has had mixed results, with some showing decreased and other increased performance. One published case report demonstrated improvement in asthmatic symptoms (much like that of caffeine) after smoking marijuana prior to exercise testing, because it led to bronchodilation and was without pulmonary dysfunction. As THC is a mild stimulant, those training by heart rate, such as the 180 Formula, may find they must go slower to keep their heart rate down, though I’ve been told by some that it helps them go faster.

Since 2004 WADA has prohibited cannabis use for all sports competition, partly because it is believed to enhance sports performance. While this may turn out to be untrue, athletes generally don’t use cannabis for performance effects — most just appear to enjoy being high during exercise.

Without proof of performance enhancement, its maintenance on the WADA’s banned list is likely a function of its illicitness. However, numerous prescription and over-the-counter drugs are allowed under the “therapeutic use exemptions,” which is for athletes with health conditions requiring medications. If the medication is on the Prohibited List, the exemption may give that athlete the authorization to take the needed medicine. With medical cannabis prescriptions by physicians for health conditions increasing, the use of a cannabis exemption will have to be addressed by WADA. (Whether athletes truly have the conditions they claim, and whether this medical exemption is for legal doping is a separate problem for WADA.)

With medical and legal use of cannabis increasing worldwide, it’s possible that the restrictions will change like those of caffeine. From 1962-1972 and again from 1984-2003 caffeine was on the WADA banned list. Since 2004, it has been removed, however, it is still part of WADA’s monitoring program in order to assess the potential misuse in sport. One of the reasons caffeine was removed from the prohibited list was that many experts believe it to be ubiquitous in beverages and food and that having a threshold might lead to athletes being sanctioned for social or dietary consumption of caffeine. One could now say the same about cannabis.

Certainly smoking anything is unhealthy because of very hot smoke entering the bronchial passageways and the lungs. Smokeless tobacco still has harmful side-effects because of nicotine, while the dramatic rise in cannabis research has resulted in its use in medicine and decriminalization/legalization because harmful side-effects are minimal, especially when not smoked (the use of no-heat edible consumption has increased, which also preserves some of the heat-labile therapeutic ingredients).

For nicotine, WADA may need to move tobacco from the monitoring program to the Prohibited List in order to curtail widespread use of smokeless tobacco in sports. Apart from the ergogenic effect of nicotine, this would underscore WADA’s effort following the ban of THC to promote a drug-free sport if that is one of their goals. While athletes won’t obtain prescriptions for tobacco use, look for medical cannabis to accomplish this soon by being a potential exemption.

The use of nicotine and cannabis in sports is a very complex and emotional issue, sure to remain a long-running topic of much controversy in the future.

The smoky history of the Pikes Peak Marathon

By Hal Walter

Most active people grew up in an era when smoking was known to be dangerous to health and well-being. Some of us still remember the uproar over the U.S. Surgeon General’s warning on tobacco labels, and even later the changing of the wording on cigarette packs from “may cause” to simply “causes.”

Two-pack-a-day smoker Lou Wille won the Pikes Peak Vertical Mile in 1936, and finished top-10 in the third Pikes Peak Marathon. (Photo courtesy Pikes Peak Marathon)

Two-pack-a-day smoker Lou Wille won the Pikes Peak Vertical Mile in 1936, and finished top-10 in the third Pikes Peak Marathon. (Photo courtesy Pikes Peak Marathon)

But it wasn’t always so.

Consider the origination of the Pikes Peak Marathon in Colorado. The race up and down “America’s Mountain” — named after explorer Zebulon Pike — was founded in 1956 as a challenge between smokers and non-smokers. Today more than 800 runners annually get their literal “runner’s high” in this marathon, and an additional 1,800 compete in the half-marathon ascent race the day prior.

The backstory on Pikes Peak Marathon began 20 years prior with the “Pikes Peak Vertical Mile” race to the summit of the 14,115-foot peak. It was held to celebrate the completion of the Pikes Peak Highway that brought auto access to the mountain. The race was not held on the new highway but rather on the rugged and historic Barr Trail.

With the start at 6.300 feet elevation, the vertical gain of the race is a whopping 7,815 feet, much more than an actual vertical mile.

The winner of this race was Lou Wille, a 24-year-old state-highway employee — and two pack-a-day smoker. Wille’s time for the then 12-mile ascent up the peak was about 3 hours, which would still be considered a respectable time today, though the record is just over 2 hours and race organizers have moved the start back about 1.1 mile.

But what’s even more remarkable is what happened a full two decades later, when the Pikes Peak Marathon was officially formed as a race up and back down the mountain.

This first race was organized by a Florida doctor who billed it as a challenge between smokers and non-smokers. At this point in time some people still believed smoking was not only harmless, but that it also boosted athletic performance. And guess who the favored smoker was.

The hype had the race as a duel between Wille, by then 44, and 28-year-old non-smoker and Mr. America competitor Monty Wolford. It was widely rumored that the American Tobacco Association had offered an under-the-table prize of $20,000, a hefty sum in those days, to any smoker who won the race.

Wolford ended up winning the first Pikes Peak Marathon, but surprisingly Wille — after another 20 years of baking his lungs with hot smoke and nicotine — was in third place at the summit. Instead of finishing the round trip, he opted for a smoke and a car ride back down the mountain.

Wille was not alone. In fact three of the 13 starters were smokers, and none of them finished the race. However, Wille did return in 1959 and finished the round-trip marathon in 6:30, good for a top-10 finish. He also ran the ascent race again in 1973, at the age of 61, finishing in 3:37 and first place in his age group.