Table 5.
Results of clinical studies on humans involving effects of plant adaptogens on physical and mental performance related to fatigue.
| Plant name Intervention/ control/ Daily dose/ Duration | Study designa/ Total subjects | Primary endpoint and main resultsb | Quality level ofevidence* | Jadad score [183]* | Ref. |
|---|---|---|---|---|---|
|
Rhodiola rosea Extract SHR-5 (288 mg twice daily)/placebo for 4 weeks Rhodiola roseaExtract SHR-5 (170 mg once daily)/placebo for 2 weeks Rhodiola rosea Extract SHR-5 (50 mg twice daily)/placebo for 20 days Rhodiola rosea Extract SHR-5 (single dose of 370 mg or 555 mg) /placebo Rhodiola rosea Extract SHR-5 (170 mg or 340 mg twice daily)/placebo for 6 weeks |
R, PC, DB 2 parallel groups 60 volunteers with stress-induced fatigue, (30/30) [20–55 years] | Symptoms of fatigue, attention, depression, QOL, salivary cortisol. Symptoms of fatigue, attention and salivary cortisol significantly improved compared with control | Ib | 5 | [122] |
| R, PC, CO, DB 2 parallel groups 56 healthy subjects (?/?)c [24–35 years] | Mental fatigue, perceptive and cognitive functions such as associative thinking, short-term memory, calculation and ability of concentration, and speed of audio-visual perception Statistically significant improvement in the treatment group (SHR-5) during the first 2 week period | Ib | 4 | [143] | |
| R, PC, DB 2 parallel groups 40 healthy subjects (20/20) [17–19 years] | Mental fatigue, physical performance, general well-being Significant improvement in physical fitness, mental fatigue and neuromotor tests compared with control (p<0.01). General well-being was also significantly (p<0.05) better in the verum group. No significance was seen in the correction of text tests or a neuromuscular tapping test | Ib | 3 | [144] | |
| R, PC, DB 3 parallel treatments |
Capacity for mental work Significant difference in anti-fatigue effects in SHR-5 |
Ib | 3 | [145] | |
| groups 161 healthy subjects, (41/20/40 treated + 20 untreated) [19–21 years] |
groups compared with control (p<0.001), whilst no significant difference between the two dosage groups was observed. | ||||
| R, PC, DB 3 parallel treatment groups 91 patients with mild and moderate depression (31/30/30) [18–70 years] |
Depression in total HAMD and BDI scores Significant differences in HAMD and BDI scores and scores reflecting levels of insomnia, emotional instability, somatisation and self–esteem in SHR–5 groups compared to placebo (p<0.001) |
Ib | 5 | [134] | |
|
Eleutherococcus senticosus
Extract (2mg eleutherosides B and E equivalent to 2–4 g of herbal substance daily)/placebo for 2 months and 2 months of follow-up |
R, PC, DB 2 parallel treatment groups 96 patients with chronic fatigue syndrome (49/47) [21–65 years] |
RVI measurement of fatigue reduced Significant (p<0.05) improvement in RVI compared with control after 2 months treatment in the subgroups of patients with moderate fatigue at baseline (RVI value 8–12) and a history of fatigue <5 years. However, no significant difference was observed after 4 months treatment |
Ib | 5 | [142] |
| Chisan-fixed combination of Rhodiola-Schisandra-Eleutherococcus | R, PC, DB 2 parallel groups 60 patients suffering from acute non-specific pneumonia (30/30) [18–65 years] |
Duration of antibiotic therapy associated with the clinical manifestations of the acute phase of the disease, mental performance and self-evaluation by WHO-QOL brief questionnaires Adjuvant therapy with ADAPT-232 had a positive effect on the recovery of patients by decreasing the duration of the acute phase of the illness for 2 days, by increasing mental performance of patients in the rehabilitation period, and by improving their QOL |
Ib | 4 | [146] |
| ADAPT-232 capsules [fixed combination of standardised extracts of Rhodiola rosea (salidroside 3 mg), E. senticosus (syringin 3 mg), S. chinensis (schizandrin 4 mg)] 3 capsules acute |
PC, CO, DB 60 PC, CO, DB 5 cosmonauts |
Compared with placebo, ADAPT-232 significantly increased short-term memory, speed and reliability in the understanding of information, and precision and accuracy in the ability to reproduce the information in repeated highly sophisticated computer-based tests (Monotonic 2). ADAPT-232 was most effective against a background of pronounced fatigue induced by monotonous night work. The effect was most marked in complicated tests and under extreme conditions.ADAPT-232 significantly decreased the number of mistakes (cf. with placebo) in complicated psychometric tests 4 h after administration and increased working capacity 1.5 and 4 h after administration to Russian cosmonauts during their training in prolonged isolation (90 days) under conditions of long-term, monotonous work. No significant effects were observed in non-complicated tests. | IIa IIa |
1 | [147] [148] |
|
Eleutherococcus senticosus extract 0.25, 0.5, 1.0, 2.0, 4.0 and 8.0 mL acute |
PC, CO, OL 357 Sailors |
E. senticosus improved mental performance in correction test; increased activity of the adrenal cortex, the activity of the sympathetic adrenomedullar system, the intensity of metabolic processes, and the intensity of red-ox processes. In stress conditions E. senticosus decreased adrenal cortex activity and sympathetic nervous system; increased the tonus of the parasympathetic nervous system; moderately intensified excitation of the CNS and of energy metabolism; improved endurance to hypoxia. | IIa | 1 | [149] |
| Schisandra chinensis extract 0.25, 0.5, 1.0, 2.0, 4.0 and 8.0 mLacute | S. chinensis stimulated the activity of the CNS at night; increased tonus of the sympathetic part of the autonomic nervous system (having no effect on the parasympathetic part) after night duty; activated the adrenal cortex activity; increased the activity of the cardiovascular and respiratory systems; intensified oxidation-reduction and metabolic processes; improved working ability parameters; reduced parameters of non-specific resistance the organism. | ||||
|
Rhodiola rosea (extract) 10 drops or 3 x 10 drops/day Rhaponticum cartamoides (extract) 40 drops or 3 x 10 drops/day. Acute and 10 days |
PC, SB 80 healthy students (control group) and 70 patients with neurosis |
Single and repeated administration of adaptogens improved functional state of the CNS in patients with neurosis as characterised by normalisation of the speed and power of neural processes in Ivanov-Smolenski’s verbal test with speech-supported locomotor-conditioned reflex measurement. The memory improved and attention became more stable. | IIa | 1 | [150] |
| Rhodosin (R. rosea extract, 100 mg/ 20 days | PC, DB 60 |
Significant improvement in physical fitness, mental fatigue and neuromotor tests compared with control (p<0.01): general well-being was also significantly (p<0.05) better in the verum group. No significance was seen in the correction of text tests or a neuromuscular tapping test. | IIa | 1 | [151] |
| Rodelim tablets (fixed combination of the extracts of R. rosea,
E. senticosus and S. chinensis) 100 mg/acute |
PC, DB 60 | Rodelim improved mental working capacity in computer and correction tests against a background of fatigue. | IIa | 1 | [152] |
|
R. rosea (tincture 40% ethanol) 5-10 drops/acute |
PC/85 | Improved mental performance, reduced the number of errors in Anfimov’s correction test: the stimulating effect lasted 4 h or more | IIb | 1 | [153] |
|
Rhodiola rosea (40% ethanol tincture, 20 drops) E. senticosus (40% ethanol tincture, 20 drops) Extract of R. rosea rhizome, 0.3 g/ acute |
PC/254 | Improved mental performance; reduced the number of errors in Anfimov’s correction test; increased the accuracy, working capacity and speed of information perception. Stimulating effect lasted 4 h or more | IIa | 1 | [154] |
| Tyrosol (1, 5, 10 and 20 mg), R. rosea extract, 5 drops |
? / 82 patients |
Improved mental performance, reduced the number of errors in Anfimov’s correction test. | III | 0 | [155] |
| Salidroside, 2.5 mg/ acute |
PC, SB/ 46 |
Improved mental performance; reduced the number of errors in Anfimov’s correction test; stimulating effect lasting 4 h or more. | IIa | 1 | [39] |
| E. senticosus (dry extract), 120 mg/ Acute and 3 weeks | PC, DB/40 | Improved mental performance determined by a letter correction test | IIa | 1 | [156] |
|
E. senticosus (tincture) P. ginseng tincture/ 2 ml/ acute |
PC, SB,CO/ 13 |
Decreased errors in data sent by radio operators 1 h after drug uptake. Stimulating effect of E. senticosus was stronger and more stable than the effect of Ginseng, which was insignificant. | IIa | 1 | [157] |
| Eleutherococcus (extract 1250 mg) Ginkgo (extract, 28 mg flavonoids, 7 mg gingkolides) 3 months |
PC, CO /24 |
Selective memory significantly improved compared with placebo (p<0.02). | IIa | 1 | [158] |
|
S. chinensis (tincture) E. senticosus (tincture) Rhaponticum cartamoides (tincture) Oplopanax elatus (tincture), 0.5, 1.0 and 2.0 mL, acute |
PC, CO, OL 1327 healthy subjects |
Eleutherococcus and Rhaponticum treatment significantly increased precision in tremometric test compared with placebo. Significant differences compared with placebo were observed with various doses of all tested preparations in psychometric tests including assessment of attention and memory functions. | IIa | 1 | [159] |
|
S. chinensis (tincture) E. senticosus (tincture) Rhaponticum cartamoides (tincture) Oplopanax elatus (tincture, 0.5, 1.0 and 2.0 mL), 10 days |
PC, CO 665 healthy subjects |
Pilots were tested before a flight and again 5 –15 min later, and finally 1 and 3 h after landing Significant differences compared with placebo were observed for all tested preparations in tests including assessment of precision, dynamic tremometry, sensomotor response, and attention and memory functions | IIa | 1 | [160] |
|
S. chinensis (tincture, 2 ml) E. senticosus (tincture, 2 ml) Coffee, 200 ml Black tea, 200 ml (control) Acute and repeated |
OL, PC 200 sailors |
S. chinensis showed a tonic effect for 4–7 h in those on night duties. E. senticosus was inactive Repeated uptake (for more than 2 weeks) of coffee and S. chinensis produced similar negative effects (insomnia, excitability, etc.). |
IIb | 0 | [161] |
|
S. chinensis (seed powder, 2g) Panax ginseng (tincture, 2 ml), acute |
CO, PC, SB, 122 students |
Improved attention in text correction 2 h after drug administration. Both extracts increased quality and quantity of mental work performed. | IIa | 1 | [162] |
|
S. chinensis (seed tincture, 30 ml) P. ginseng (3% tincture, 30 ml) Phenamine(0.02 g) Glucose (0.5 g), acute |
CO, PC /20 |
P. ginseng and S. chinensis improved accuracy in the work of telegraph operators at exhaustion compared with control group (glucose) and those given phenamine. | IIa | 1 | [51] |
| S. chinensis (seed – 3 g, extract and fractions, tablets and capsules, 0.036–0.168 g), acute | OL,CO/20 | Improved accuracy in error correction test. Most active stimulating effect was revealed by a crystalline substance identified as the lignan schizandrin. | IIb | 0 | [50, 51] |
| Schizandrin (0.02, 0.01, 0.005 g), Phenamine (0.2 g) Glucose (0.5g) acute | PC/23 | Schizandrin improved accuracy in the work of telegraph operators at exhaustion compared with control group (glucose) and those given phenamine. | IIb | 1 | [29,51] |
| S. chinensis (seed powder, 0.25 and 0.5 g), 10 days | OL / 36 |
Beneficial effects on symptoms of astheno-depressive syndrome | IIIa | 0 | [163] |
| S. chinensis (fruit and seed tincture, 1:5, 90% ethanol, 1 ml), 16–40 days | OL/ 40 |
Stimulating effect-improve mood, increases physical and psychological vivacity, relief of tiredness and fatigue in asthenia and depressions. | III | 0 | [164] |
| S. chinensis (tincture, decoction and tablets), 2–10 weeks | OL/ 2000 |
Stimulating and tonic effct. | III | 0 | [165] |
| S. chinensis (tincture, decoction and tablets), 2–10 weeks | OL/ 250 |
Effective in the treatment of general asthenia, exhaustion and reduced physical and mental performance in group of patients with nervous disorders where an increase in general well-being and working capacity, as well as a decrease in sleepiness and exhaustion, were observed. | III | 0 | [166] |
|
S. chinensis (tincture 95% ) 45–120 drops S. chinensis (tablets, 0.25 g, 0.5 g), 10 days |
OL, observational study/ 30 |
Stimulating effect in astheno-depressive syndrome with relief of somnolence, limpness, tiredness, fatigue | III | 0 | [167] |
a R – Randomized, PC – placebo– controlled; DB – double– blind; SB – single blind, NC – not controlled; CO – crossover, UC – uncontrolled, OL – open label trial; b According to WHO, FDA and EMEA: Ia – meta– analyses of randomised and controlled studies; Ib – evidence from at least one randomised study with control ; IIa – evidence from at least one well– performed study with control group; IIb – evidence from at least one well– performed quasi– experimental study; III – evidence from well– performed non– experimental descriptive studies as well as comparative studies, correlation studies and case– studies; and IV – evidence from expert committee reports or appraisals and/or clinical experiences by prominent authorities; c ? – data not listed or unavailable.* –max 5.