Journal of Functional Morphology and Kinesiology Review Review EffectsEffects of Ashwagandha of Ashwagandha (Withania (Withania somnifera somnifera) on Physical) on Physical Performance:Performance: Systematic Systematic Review Review and Bayesian and Bayesian Meta-Analysis Meta-Analysis Diego A.Diego Bonilla A.1,2,3,4, Bonilla* ,1,2,3,4, Yurany*, Yurany Moreno Moreno1,2, Camila 1,2, Camila Gho 1Gho, Jorge 1, Jorge L. PetroL. Petro1,3 1,3, Adrián Odriozola-Martínez 4,5,6 4,5,6 7 Adrián Odriozola-Martand Richard B.ínez Kreider 7 and Richard B. Kreider 1 Research1 Division,Research Dynamical Division, Dynamical Business & Business ScienceSociety—DBSS & Science Society—DBSS International International SAS, SAS, Bogotá 110861,Bogotá Colombia; 110861, Colombia; [email protected] [email protected] (Y.M.); [email protected] (Y.M.); [email protected] (C.G.); (C.G.); [email protected]@dbss.pro (J.L.P.) (J.L.P.) 2 Research2 GroupResearch in Biochemistry Group in Biochemistry and Molecular and Biology,Molecular Universidad Biology, Universidad Distrital Francisco Distrital Jos Franciscoé de Caldas, José de Caldas, Bogotá 110311,Bogotá Colombia 110311, Colombia 3 Research3 GroupResearch in Physical Group in Activity, Physical Sports Activity, and Sports Health and Sciences Health (GICAFS), Sciences Universidad(GICAFS), Universidad de Córdoba, de Córdoba, Montería 230002,Montería Colombia 230002, Colombia 4 kDNA Genomics,4 kDNA Genomics, Joxe Mari KortaJoxe Mari Research Korta Center, Research University Center, University of the Basque of the Country Basque UPV/EHU, Country UPV/EHU, 20018 Donostia,20018 SanDonostia, Sebasti Sanán, Spain;Sebastián, [email protected] Spain; [email protected] 5 Sport Genomics5 Sport ResearchGenomics Group, Research Department Group, Department of Genetics, of Physical Genetics, Anthropology Physical Anthropology and Animal and Physiology, Animal Physiology, Faculty of ScienceFaculty andof Science Technology, and Technology, University ofUniversity the Basque of the Country Basque (UPV/EHU), Country (UPV/EHU), 48940 Leioa, 48940 Spain Leioa, Spain 6 Phymo Lab,6 Phymo Physiology Lab, Physiology and Molecular and Laboratory,Molecular Laboratory, 08028 Barcelona, 08028 SpainBarcelona, Spain 7 Exercise7 &Exercise Sport Nutrition & SportLaboratory, Nutrition Labo Humanratory, Clinical Human Research Clinical Facility, Research Texas Facility, A&M Texas University, A&M University, College Station,College TX Station, 77843, USA;TX 77843, [email protected] USA; [email protected] * Correspondence:* Correspondence: [email protected]; [email protected]; Tel.: +57-320-335-2050 Tel.: +57-320-335-2050 Abstract: AshwagandhaAbstract: Ashwagandha (Withania somnifera(Withania) issomnifera considered) is considered a potent adaptogen a potent adaptogen and anti-stress and anti-stress agent agent that couldthat have could some have potential some potential to improve to improve physical physical performance. performance. This preferred This preferred reporting reporting items items for Citation: Bonilla, D.A.; Moreno,for Y.; systematic systematic reviews reviews and meta-analyses and meta-analyses (PRISMA)-based (PRISMA)-based comprehensive comprehensive systematic systematic review and review and Citation: Bonilla,Gho, D.A.;C.; Petro, Moreno, J.L.; Y.;Odriozola-Bayesian meta-analysisBayesian meta-analysis aimed to aimed evaluate to evaluate clinical trials clinical up trials to 2020 up to from 2020 PubMed, from PubMed, ScienceDirect, ScienceDirect, and Gho, C.; Petro,Martínez, J.L.; A.; Kreider, R.B. Effectsand of Google Google Scholar Scholar databases databases regarding regarding the effect the ofeffect Ashwagandha of Ashwagandha supplementation supplementation on physical on physical per- Odriozola-Martínez, A.; Kreider, R.B. Ashwagandha (Withania somniferaperformance) on formance in healthy in healthy individuals. individuals. Besides Besides implementing implementing estimation estimation statistics statistics analysis, analysis, we devel- we developed Effects of Ashwagandha (Withania Physical Performance: Systematicoped BayesianBayesian hierarchical hierarchical models models for a for pre-specified a pre-specified subgroup subgroup meta-analysis meta-analysis on strength/power, on strength/power, cardi- somnifera) on Physical Performance: Review and Bayesian Meta-Analysis.cardiorespiratory J. orespiratory fitness fitness and fatigue/recoveryand fatigue/recovery variables. variable As. totalA total of 13of 13 studies studies met met the the require- requirements of Systematic ReviewFunct. andMorphol. Bayesian Kinesiol. 2021, 6, 20. J. Funct. Morphol. ments of thisthissystematic systematic review,review, althoughalthough only 12 were were included included in in the the quan quantitativetitative analysis. analysis. A low-to-mod- A Meta-Analysis.https://doi.org/10.3390/jfmk6010020 Kinesiol. 2021, 6, 20. https:// low-to-moderateerate overall overall risk risk of of bias bias of of the the trials trials included included in in this this study study was was detected. detected. All All Bayesian Bayesian hierarchical doi.org/10.3390/jfmk6010020 hierarchicalmodels models converged converged to to a a target target distribution distribution ( Ȓ = 1) for both meta-analytic effecteffect sizesize( (µμ)) and and between- Received: 1 January 2021 study standard deviationτ (τ). The meta-analytic approaches of the included studies revealed that Accepted: 9 February 2021 between-study standard deviation ( ). The meta-analytic approaches of the included studies revealed Received: 1 January 2021 Published: 11 February 2021 that AshwagandhaAshwagandha supplementation supplementation was morewas more efficacious efficaciou thans than placebo placebo for improvingfor improving variables variables related Accepted: 9 February 2021 related to physicalto physical performance performance in healthy in health meny men and and female. female. In fact, In fact, the Bayesianthe Bayesian models models showed showed that that future Published: 11 February 2021 Publisher’s Note: MDPI staysfuture interventionsinterventions might might be at be least at least in some in some way beneficialway bene onficial the on analyzed the analyzed outcomes outcomes considering considering the neutral with regard to jurisdictionalthe 95% credible95% credible intervals intervals for the meta-analyticfor the meta-analytic effect size. effect Several size. practical Several applicationspractical applications and future and future Publisher’s Note:claimsMDPI in published stays neutral maps anddirections directions are discussed, are discussed, although morealthough comparable more comparab studies arele studies needed are in needed exercise in training, exercise and training, and with regard toinstitutional jurisdictional affiliations. claims in athletic populationsathletic populations are needed are to deriveneeded a to more derive stable a more estimate stable of estimate the true underlyingof the true underlying effect. effect. published maps and institutional affil- iations. Keywords:Keywords:herbal supplements; herbal supplements; muscle strength; muscle cardiorespiratory strength; cardiorespiratory fitness; exercise fitness; tolerance; exercise quality tolerance; qual- of life; sleepity latency of life; sleep latency Copyright: © 2021 by the authors. Licensee MDPI, Basel, Switzerland. Copyright: ©This 2021 article by is the an authors.open access article Licensee MDPI,distributed Basel, under Switzerland. the terms and1. Introduction1. Introduction This article isconditions an open accessof the Creative article Commons Traditional botanical knowledge is characteristic of cultural contexts with long ex- distributed underAttribution the (CC terms BY) andlicense Traditional botanical knowledge is characteristic of cultural contexts with long expe- conditions of(http://creativecommons.org/licenses the Creative Commons perience inrience the naturalin the natural environment; environment; however, however, as it as is it transmitted is transmitted from from generation generation to to gener- Attribution (CC/by/4.0/). BY) license (https:// generation,ation, it adapts it adapts and and transforms transforms through through scientific scientific experimentation. experimentation. Within Within the tradi-the traditional creativecommons.org/licenses/by/ tional medicine of India (Ayurveda), the Rasavatam¯ provides nutritional and behavioral 4.0/). recommendations for all phases of life, which may delay the onset of aging processes [1]. J. Funct. Morphol. Kinesiol. 2021, 6, 20. https://doi.org/10.3390/jfmk6010020 www.mdpi.com/journal/jfmk J. Funct. Morphol. Kinesiol. 2021, 6, 20. https://doi.org/10.3390/jfmk6010020 https://www.mdpi.com/journal/jfmk J. Funct. Morphol. Kinesiol. 2021, 6, 20 2 of 31 Thus, there is a wide range of Rasavatam¯ preventive or therapeutic strategies with various health objectives (e.g., improvement of the libido). One of the most popular plants in Ayurveda is Ashwagandha (Withania somnifera), which is considered a potent adaptogen and anti-stress agent [2]. Brekhman and Dardymov [3] proposed in 1969 the term adap- togen as an innocuous agent that increases in a nonspecific way the resistance against harmful factors or physical, chemical, biological and psychological “stressors”, normalizing the homeostasis of individuals. Ashwagandha, commonly known as Indian ginseng or poison gooseberry, belongs to the Solanaceae family (NCBI:txid126910). In addition to its adaptogenic properties, several authors have attributed