Recovery on ADHD Meds: How to Press the Brake

Recovery advice wasn't built for stimulants

Most recovery advice was built for athletes who aren't taking ADHD medication. Let's fix that.

I'm not an exercise physiologist. But I dug into the recovery research to understand it, and I'm sharing what I found, along with how I think about it as a psychiatrist when stimulants are in the picture.

Three kinds of recovery

I like the framework from sport psychologist Michael Kellmann, which a 2018 international expert consensus statement on recovery and performance builds on. It breaks recovery into three types:

• Passive recovery: things done to your body, like massage, compression garments, and cold-water immersion (ice baths).
• Active recovery: easy movement, like a cool-down walk, jog, or light spin.
• Proactive recovery: things you choose for yourself, based on what you need. Time with friends, hobbies, calming routines.

What's been shown to work?

The honest answer: some things help, but the evidence is more mixed than social media suggests.

Passive recovery. A 2018 meta-analysis of 99 studies found that massage was the most effective technique for reducing muscle soreness and feelings of fatigue after exercise. Compression garments and cold-water immersion also helped, with smaller effects. But a 2024 review focused on endurance athletes found that no single strategy helped consistently, though compression and cold-water immersion looked promising for recovery between training sessions.

One caution on ice baths: regular cold-water immersion after strength training may blunt some of the muscle gains athletes are training for. If the goal of a session is getting stronger, think twice about routinely icing right after it.

Active recovery. Easy movement after exercise reduced muscle soreness in the 2018 meta-analysis and helps clear lactate. Researchers note some of the benefit may be psychological, and that's still a benefit.

Proactive recovery. This is the least studied category, but experts consider it important. The 2018 consensus statement calls sleep essential for both physical and psychological recovery, and notes that building recovery such as social connection into training may help buffer against burnout and depression.

What if you're taking stimulants?

When I did a quick review, I couldn't find recovery guidance specific to athletes on ADHD medication. So here's how I think about it.

Stimulants are sympathomimetics. They activate the sympathetic nervous system, both centrally in the brain and peripherally in the body.

The sympathetic nervous system is one half of the autonomic nervous system, the part of your nervous system that runs automatically. It's your "fight or flight" system. Think of it as the gas pedal.

Training already presses that pedal. Stimulants can press it harder:

• Heart rate goes up.
• Blood pressure goes up.
• Core temperature can rise, especially when training in the heat.
• Appetite and sleep can go down.

That's classic fight or flight.

The body's natural counterweight is the other half: the parasympathetic nervous system, your "rest and digest" system. Think of it as the brake.

We can't switch the medication off. But we can press the brake and help bring things back into balance.

Four ways to press the brake

1. Breathe to press the brake. Your vagus nerve is the main line of the parasympathetic system. Slow breathing, under about 10 breaths a minute, increases heart rate variability, a marker of parasympathetic activity. Try inhaling for 4 counts and exhaling for 6 to 8. Your heart naturally slows a little on each exhale, so a long exhale leans into the brake.

2. Fuel on the clock, not on hunger. Stimulants can mute appetite, so hunger isn't a reliable signal. Make eating part of recovery. Plan a real meal after training, even if you're not hungry. Research shows that carbohydrate after exercise supports performance in the next session. And under-fueling over time is how athletes end up with low energy availability, or REDs.

3. Protect sleep. Your parasympathetic system is most active during non-REM sleep, especially deep sleep. To help yourself get there:

• Take a warm shower or bath 1 to 2 hours before bed. A meta-analysis found that even 10 minutes of warm water at that time helped people fall asleep faster and rate their sleep as better.
• Try progressive muscle relaxation.
• Use slow breathing as you fall asleep.

4. Take your foot off any extra gas. Pre-workout supplements, energy drinks, and afternoon coffee press the same pedal on top of the medication. Many pre-workouts contain large amounts of caffeine and other stimulants. Cutting back on these can make it easier for your body to downshift after training and at bedtime.

Recovery is more than one tool

Recovery isn't one tool. It includes the body and the mind, and now you know, your nervous system too.

These four strategies are my clinical reasoning, based on how stimulants work. They haven't been tested as a package in athletes on ADHD medication. But each one is low-risk, and each one works with your body's brake instead of against it.

References

This post is for educational purposes only and is not medical advice. Talk with your physician before changing any medication or recovery routine.

1. Kellmann M, Bertollo M, Bosquet L, et al. Recovery and performance in sport: consensus statement. Int J Sports Physiol Perform. 2018;13(2):240–245. doi:10.1123/ijspp.2017-0759
2. Dupuy O, Douzi W, Theurot D, Bosquet L, Dugué B. An evidence-based approach for choosing post-exercise recovery techniques to reduce markers of muscle damage, soreness, fatigue, and inflammation: a systematic review with meta-analysis. Front Physiol. 2018;9:403. doi:10.3389/fphys.2018.00403
3. Li S, Kempe M, Brink M, Lemmink K. Effectiveness of recovery strategies after training and competition in endurance athletes: an umbrella review. Sports Med Open. 2024;10:55. doi:10.1186/s40798-024-00724-6
4. Zaccaro A, Piarulli A, Laurino M, et al. How breath-control can change your life: a systematic review on psycho-physiological correlates of slow breathing. Front Hum Neurosci. 2018;12:353. doi:10.3389/fnhum.2018.00353