Stimulant Medication and Endurance Running: What Athletes and Coaches Need to Know

Questions about stimulant medication are coming up more often in my coaching practice and in conversations with coaches I mentor.

An athlete starts medication for attention-deficit/hyperactivity disorder (ADHD), then notices something different on a run. Their heart rate may seem higher than usual. Their appetite disappears during the day. A familiar pace feels unexpectedly easy, or unexpectedly difficult, and the coach is then asked to interpret what is happening.

Medication decisions are outside a coach’s scope, but changes in training response are not. We need to know which effects are biologically plausible, which ones have actually been measured, and when an observation should be taken back to the prescribing clinician.

The research does not give us clear answers for every athlete. It does give us enough information to take the question seriously.

This article is educational and is not a substitute for medical advice. It does not recommend starting, stopping, skipping, delaying, or changing medication. Those decisions should be made with the prescribing clinician.

Most stimulant research does not look like real endurance training

A 2022 systematic review found only nine studies examining ADHD prescription medications and athletic performance. Those studies included 157 participants in total, most of whom were male. Only two studies involved participants with ADHD who were already taking medication. Much of the research consisted of small laboratory experiments in which medication-naive participants received a single dose before exercising (Berezanskaya et al., 2022).

That is a very different situation from a runner taking prescribed medication every day while training through months of changing volume, intensity, weather, sleep, work stress, and recovery.

Six of the nine studies found an improvement in at least one performance outcome, but only two studies were similar enough to combine in a meta-analysis. The pooled findings were inconclusive.

A newer crossover study followed 35 physically active college students with ADHD as they completed physical tests with and without their prescribed methylphenidate. Researchers found no significant differences in heart rate, blood pressure, core temperature, perceived exertion, agility, or balance (Tsuk et al., 2026). That adds useful evidence from people who actually had ADHD, but the tests focused on short motor tasks rather than prolonged running or cycling.

Researchers have studied pieces of this question. They have not studied the full reality of an endurance athlete using prescribed stimulant medication through a training cycle.

Exercise heart rate may change, but the direction is not predictable

In clinical trials, stimulant medications tend to produce small average increases in resting pulse and blood pressure.

A 2025 network meta-analysis of 102 randomized trials found modest average increases in adult pulse and blood pressure across several ADHD medications compared with placebo. For commonly prescribed stimulants, the average differences were generally a few beats per minute for pulse and a few millimetres of mercury for blood pressure. Most of the studies were short, and the confidence in several of the adult estimates was very low (Farhat et al., 2025).

Those averages are useful for clinical monitoring. They do not tell a runner what will happen during an easy run, interval workout, or race.

Exercise studies have produced mixed results. Heart rate was higher during a hot cycling trial after participants took methylphenidate (Roelands et al., 2008). In a separate treadmill study, 245 current stimulant users reached a slightly lower peak heart rate than matched nonusers. The stimulant users were also more likely to meet the study’s definition of chronotropic incompetence, meaning they did not reach the expected percentage of their predicted maximum heart rate (Westover et al., 2015).

The treadmill study could not account for medication dose, timing, duration, or adherence. Its authors also cautioned that the clinical significance of the finding was unknown.

Automatic heart-rate zone changes are difficult to justify from this evidence. Some athletes may see higher numbers, some may see little change, and others may experience a different peak response.

For coaching purposes, the useful information is the relationship among heart rate, pace, perceived effort, and conditions. If that relationship changes repeatedly after medication is started or adjusted, the pattern is worth documenting and discussing with the prescriber.

One unusual watch reading is not enough, but a series of comparable runs can tell us much more. That said, athletes should not skip or delay medication to create an “off-medication” comparison unless their clinician has specifically directed them to do so.

Heat and effort perception deserve particular attention

The study I find most relevant for endurance coaches involved only eight trained male cyclists, so its limitations are obvious. Its findings are still difficult to ignore.

Participants received either 20 mg of methylphenidate or a placebo before cycling in temperate and hot laboratory conditions. Methylphenidate did not improve performance in the temperate environment. In the heat, participants completed the time trial 16 percent faster. Their heart rates were higher, and core temperatures reached above 40°C. Their perception of effort and thermal stress did not increase in proportion to the physiological strain (Roelands et al., 2008).

Another small study asked cyclists to exercise at a fixed rating of perceived exertion. After taking methylphenidate, they exercised approximately 32 percent longer. At the point when they had stopped during the placebo condition, they were producing more power and had higher oxygen consumption, heart rate, ventilation, and lactate while taking methylphenidate (Swart et al., 2009).

These studies do not show that stimulant medication causes heat illness. They do raise a question about internal feedback. In some circumstances, an athlete may be able to produce more work before the effort feels proportionally harder.

That matters in endurance sports because pacing depends heavily on perception. It may matter even more in hot weather, when an athlete needs to respond to both effort and accumulating thermal strain.

A runner who has recently started medication or changed a dose should pay attention to early hot-weather sessions. The goal is not to become anxious about every heart-rate change. It is to notice whether pace, effort, heart rate, and thermal sensation still line up in the usual way.

This is also why the concern should not be reduced to dehydration. There is not good evidence that prescribed stimulant medication directly causes dehydration. Normal heat preparation still applies: appropriate acclimation, sensible pacing, cooling when available, and a hydration plan based on the environment, session duration, and the athlete’s usual sweat losses.

Appetite may be the most practical day-to-day concern

Decreased appetite and weight loss are documented adverse effects of medications such as lisdexamfetamine and methylphenidate (Novartis Pharmaceuticals Canada Inc., 2020; Takeda Canada Inc., 2024).

There is no good evidence showing that stimulant medication directly causes Relative Energy Deficiency in Sport (RED-S), menstrual dysfunction, or bone-stress injuries in runners. The potential connection is indirect and still important.

An athlete whose appetite is suppressed may delay breakfast, eat very little at lunch, miss recovery nutrition, or simply underestimate how little they have eaten. If this happens regularly, total energy intake may no longer support training and basic physiological function.

Problematic low energy availability can affect bone health, menstrual and reproductive function, immunity, recovery, training adaptation, and performance (Mountjoy et al., 2023). Medication does not need to be the sole cause of underfueling to make appetite changes relevant.

I would not wait for a stress fracture or a major performance decline before asking about this.

When hunger cues become unreliable, a more structured eating schedule may help. Breakfast, lunch, pre-run fuel, and recovery nutrition may need to happen because they are part of the training plan, not because the athlete feels hungry at the time.

Unintended weight loss, persistent fatigue, menstrual-cycle changes, recurrent illness, declining performance, or repeated bone pain should be taken seriously. None of these signs identifies medication as the cause. They are reasons to involve the prescribing clinician and, when appropriate, a sports dietitian or sports-medicine physician.

Sleep changes can become training changes

Insomnia and difficulty sleeping are also recognized possible effects of stimulant medication (Novartis Pharmaceuticals Canada Inc., 2020; Takeda Canada Inc., 2024).

We do not have strong runner-specific evidence showing that prescribed stimulants directly impair endurance adaptation. We do know that reduced sleep can affect recovery, mood, training tolerance, and performance.

The relevant question is whether the athlete’s sleep changed after medication was started or adjusted. If it did, the coach can respond to the athlete’s current recovery capacity and the prescriber can assess whether the medication is contributing.

Changing the dose, formulation, or timing remains a clinical decision. A coach should not advise an athlete to move or withhold medication to make a workout easier.

Cardiovascular risk requires context

Average increases in pulse and blood pressure are usually modest, but averages can hide larger individual responses.

Canadian product monographs for methylphenidate and lisdexamfetamine recommend cardiovascular history, physical assessment, and ongoing monitoring of blood pressure and pulse. They also advise caution when sympathomimetic ADHD medications are prescribed to people involved in strenuous exercise, particularly when cardiovascular risk factors are present (Novartis Pharmaceuticals Canada Inc., 2020; Takeda Canada Inc., 2024).

A small open-label study of adults with ADHD found no clinically meaningful changes in peak cardiopulmonary measurements or cardiac structure after six months of lisdexamfetamine treatment. The study was too small and uncontrolled to settle questions about long-term safety (Hammerness et al., 2013).

A much larger Swedish observational study found that longer cumulative use of ADHD medication was associated with an increased risk of cardiovascular disease, particularly hypertension and arterial disease (Zhang et al., 2024).

That finding deserves attention, but it does not show that ADHD medication caused cardiovascular disease. Observational studies cannot fully separate medication exposure from other health, behavioural, and clinical factors. The study was not specific to athletes and did not examine whether endurance exercise changed the association.

It would be inaccurate to turn those results into a headline claiming that prescribed stimulants damage runners’ hearts. They support routine monitoring and an informed medical history.

A prescribing clinician should know about:

• The athlete’s weekly training volume and typical workout intensity

• Long races, ultramarathons, or frequent training in extreme heat

• Caffeine, pre-workout products, nicotine, and decongestant use

• Previous fainting, chest pain, palpitations, or high blood pressure

• A family history of sudden cardiac death or serious cardiovascular disease

Exertional chest pain, unexplained fainting, new sustained palpitations, or severe and unusual shortness of breath warrant prompt medical assessment.

Stimulants do not reliably improve endurance

Some acute studies suggest that stimulant medication can improve certain exercise outcomes. The systematic review found improvements in measures such as time to exhaustion and time-trial performance in several studies, but the overall evidence was inconsistent (Berezanskaya et al., 2022).

The strongest positive findings came from very small laboratory studies. Participants often received a single dose before a controlled exercise test. That cannot tell us whether a runner taking a prescribed dose over months or years will become faster.

Appropriate ADHD treatment may help an athlete function better and train more consistently (Pujalte et al., 2023). That is a meaningful treatment benefit. It is different from demonstrating a direct improvement in aerobic capacity or endurance performance.

Runner accounts are inconsistent for a reason

Online accounts cannot establish whether medication caused a particular response, but they show the questions athletes are already trying to answer.

In a 2019 LetsRun forum thread titled “Vyvanse effects on runners,” some contributors described heart rates 15 to 25 beats per minute higher at familiar paces. Others reported little or no heart-rate change. A few felt that treatment improved their ability to train consistently (LetsRun.com, 2019).

We cannot verify the contributors’ diagnoses, medications, doses, training, health, or environmental conditions. The thread tells us nothing about how common these experiences are.

What it does show is substantial individual variation. It also shows how easily athletes can be left trying to make medical sense of training data on their own.

What athletes can bring to the conversation

A useful record does not need to become a second training log. It needs enough context to show whether a pattern is developing.

After starting medication or following a medication change, an athlete might track:

• Typical easy-run pace, heart rate, and perceived effort

• Workout conditions, particularly temperature and humidity

• Appetite and ability to complete regular meals and recovery nutrition

• Sleep duration and quality

• General training tolerance and recovery

• Menstrual-cycle changes, when applicable

• Unintended changes in body weight

• Caffeine, pre-workout products, nicotine, or decongestant use

• Medication timing relative to training, for discussion with the prescriber rather than self-adjustment

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The coach can help determine when a change began, whether it has persisted, and what else changed at the same time. Training can then be adjusted to the response the athlete is actually having.

The prescriber needs the same information for a different reason. They can assess whether the pattern may be medication-related, whether additional monitoring is needed, and whether treatment should change.

Medication management is not a coaching decision.

Competitive athletes also need to check anti-doping rules

As of 2026, several prescription stimulants, including methylphenidate, amphetamine, and lisdexamfetamine, are prohibited in competition under the World Anti-Doping Agency’s Prohibited List (World Anti-Doping Agency, 2025).

These medications are not necessarily prohibited at all times. The correct classification is important because “banned substance” can create unnecessary fear and stigma around legitimate treatment.

A prescription does not automatically satisfy anti-doping requirements. Depending on the athlete’s competition level and testing status, a Therapeutic Use Exemption may be required.

Athletes should check their medication through Global DRO and consult Sport Integrity Canada, or the relevant anti-doping organization in their country, well before competition (Sport Integrity Canada, 2026).

Where this leaves athletes and coaches

The useful question is not whether stimulant medication is good or bad for runners. It is whether this athlete’s training response has changed, whether that change is persistent enough to matter, and who is qualified to act on it.

A coach can help with the first two questions. The prescribing clinician handles the third.

No athlete should alter a prescription because of one watch reading or a coach’s hunch. At the same time, a repeated change in heart rate, heat tolerance, appetite, sleep, recovery, or exercise capacity should not be dismissed simply because the research is incomplete.

Better endurance-specific research is overdue.

References

Berezanskaya, J., Cade, W., Best, T. M., Paultre, K., & Kienstra, C. (2022). ADHD prescription medications and their effect on athletic performance: A systematic review and meta-analysis. Sports Medicine - Open, 8(1), Article 5. https://doi.org/10.1186/s40798-021-00374-y

Farhat, L. C., Lannes, A., Del Giovane, C., Parlatini, V., Garcia-Argibay, M., Ostinelli, E. G., Tomlinson, A., Chang, Z., Larsson, H., Fava, C., Montastruc, F., Cipriani, A., Revet, A., & Cortese, S. (2025). Comparative cardiovascular safety of medications for attention-deficit hyperactivity disorder in children, adolescents, and adults: A systematic review and network meta-analysis. The Lancet Psychiatry, 12(5), 355-365. https://doi.org/10.1016/S2215-0366(25)00062-8

Hammerness, P., Zusman, R., Systrom, D., Surman, C., Baggish, A., Schillinger, M., Shelley-Abrahamson, R., & Wilens, T. E. (2013). A cardiopulmonary study of lisdexamfetamine in adults with attention-deficit/hyperactivity disorder. World Journal of Biological Psychiatry, 14(4), 299-306. https://doi.org/10.3109/15622975.2012.678884

LetsRun.com. (2019, September 25). Vyvanse effects on runners [Online forum thread]. https://www.letsrun.com/forum/flat_read.php?thread=9609742

Mountjoy, M., Ackerman, K. E., Bailey, D. M., Burke, L. M., Constantini, N., Hackney, A. C., Heikura, I. A., Melin, A., Pensgaard, A. M., Stellingwerff, T., Sundgot-Borgen, J. K., Torstveit, M. K., Jacobsen, A. U., Verhagen, E., Budgett, R., Engebretsen, L., & Erdener, U. (2023). 2023 International Olympic Committee’s consensus statement on Relative Energy Deficiency in Sport (REDs). British Journal of Sports Medicine, 57(17), 1073-1098. https://doi.org/10.1136/bjsports-2023-106994

Novartis Pharmaceuticals Canada Inc. (2020, June 19). Ritalin and Ritalin SR (methylphenidate hydrochloride) product monograph. https://pdf.hres.ca/dpd_pm/00056977.PDF

Pujalte, G. G. A., Narducci, D. M., Smith, M. S., King, R., Logan, K., Callender, S. S., Liebman, C. A., Kane, S. F., Israel, M. P., Wolf, S. F., Nuti, R., & Khodaee, M. (2023). Athletes with attention-deficit/hyperactivity disorder: Position statement of the American Medical Society for Sports Medicine. Clinical Journal of Sport Medicine, 33(3), 195-208. https://doi.org/10.1097/JSM.0000000000001152

Roelands, B., Hasegawa, H., Watson, P., Piacentini, M. F., Buyse, L., De Schutter, G., & Meeusen, R. (2008). The effects of acute dopamine reuptake inhibition on performance. Medicine & Science in Sports & Exercise, 40(5), 879-885. https://doi.org/10.1249/MSS.0b013e3181659c4d

Sport Integrity Canada. (2026, April). Therapeutic use exemption checklist: ADHD. https://sportintegrity.ca/media/521

Swart, J., Lamberts, R. P., Lambert, M. I., St Clair Gibson, A., Lambert, E. V., Skowno, J., & Noakes, T. D. (2009). Exercising with reserve: Evidence that the central nervous system regulates prolonged exercise performance. British Journal of Sports Medicine, 43(10), 782-788. https://doi.org/10.1136/bjsm.2008.055889

Takeda Canada Inc. (2024, March 20). Vyvanse (lisdexamfetamine dimesylate) product monograph. https://pdf.hres.ca/dpd_pm/00075011.PDF

Tsuk, S., Zeevi, Y., & Mimouni-Bloch, A. (2026). Effects of single-dose methylphenidate on motor performance in physically active college students with attention-deficit/hyperactivity disorder: A randomized crossover trial. Frontiers in Sports and Active Living, 8, Article 1869057. https://doi.org/10.3389/fspor.2026.1869057

Westover, A. N., Nakonezny, P. A., Barlow, C. E., Vongpatanasin, W., Adinoff, B., Brown, E. S., Mortensen, E. M., Halm, E. A., & DeFina, L. F. (2015). Exercise outcomes in prevalent users of stimulant medications. Journal of Psychiatric Research, 64, 32-39. https://doi.org/10.1016/j.jpsychires.2015.03.011

World Anti-Doping Agency. (2025). The 2026 prohibited list: International standard. https://www.wada-ama.org/sites/default/files/2025-09/2026list_en_final_clean_september_2025.pdf

Zhang, L., Li, L., Andell, P., Garcia-Argibay, M., Quinn, P. D., D’Onofrio, B. M., Brikell, I., Kuja-Halkola, R., Lichtenstein, P., Johnell, K., Larsson, H., & Chang, Z. (2024). Attention-deficit/hyperactivity disorder medications and long-term risk of cardiovascular diseases. JAMA Psychiatry, 81(2), 178-187. https://doi.org/10.1001/jamapsychiatry.2023.4294