Table 2.

Studies investigating the effect of smokeless tobacco on exercise performance

Study	Participants	Performance protocol	Tobacco intervention	Performance effect
Baldini et al. [3]	12 habitual smokeless tobacco users abstinent ≥10 h, and 6 non-users as controls	30-s Wingate test with a resistance of 7.5% bodyweight	20 min smokeless tobacco use whilst resting supine, then tobacco discarded and performed Wingate test. Four conditions: zero, 1/3 mean, mean, mean +2/3 where ‘mean’ refers to individual average of 10 dips	5-s peak and 30-s mean power output unaffected by dose and similar to controls
Van Duser and Raven [58]	15 habitual smokeless tobacco users abstinent ~12 h	Graded maximal treadmill test at 93.8 m min−1 with incline increasing 2.5% min−1 to volitional exhaustion	30 min smokeless tobacco use whilst resting seated, then tobacco discarded and performed maximal protocol. 2.5 g smokeless tobacco compared to placebo chew	Not reported but maximal O2 uptake and lactate unchanged
Escher et al. [21]	20 habitual smokeless tobacco users, and 20 non-users as controls	Maximum voluntary force and rate of force development using knee extension at 250° s−1 from 90° to 0° of flexion	2 conditions for habitual users: (1) abstinent ≥12 h and remained abstinent for testing, (2) one dip 2 h prior to and then again on arrival at the laboratory whilst testing	Maximal force (12%) and rate of force development (9–10%) reduced when using smokeless tobacco compared to abstinent
Morente-Sánchez et al. [45]	18 non-users/non-smokers	Maximum handgrip strength, maximum countermovement jump height, agility shuttle run, Yo-yo recovery intermittent shuttle test (level 1)	40 min smokeless tobacco use whilst resting supine, then handgrip strength, countermovement jump and agility shuttle run were performed before tobacco discarded after 70 min and the Yo-yo test was performed. 1.0 g smokeless tobacco compared to placebo chew	All performance tests were unaffected by smokeless tobacco
Zandonai et al. [62]	14 non-users/non-smokers	Cycle to volitional exhaustion at 65% maximal aerobic power	Smokeless tobacco use from start of exercise and throughout exhaustion trial. 1.0 g smokeless tobacco compared to placebo chew	Endurance time unaffected with smokeless tobacco