CoQ10 in Athletes: What the Evidence Actually Says About Supplementation, Recovery, and Performance
Table of Contents
Key Takeaways: CoQ10 in Athletes
- CoQ10 is biologically important, but it is not a classic vitamin deficiency issue in most athletes. The body synthesizes CoQ10 endogenously, and clinically obvious deficiency is not commonly encountered in otherwise healthy athletic patients.
- The strongest evidence for CoQ10 in athletes relates to blood biomarkers, especially oxidative stress and exercise-induced muscle-damage markers such as CK, LDH, myoglobin, and MDA.
- Lower biomarkers do not automatically mean better real-world recovery. CoQ10 may improve some recovery-related markers, but this does not prove that athletes recover faster, feel less sore, or perform better in the next session.
- CoQ10 does not appear to be a reliable performance-enhancing supplement. The evidence for endurance, strength, anaerobic performance, and overall athletic performance is inconsistent and low-certainty.
- Ubiquinol may have better bioavailability than ubiquinone, but whether this translates into clearly superior athletic outcomes remains uncertain.
- CoQ10 may be worth discussing in selected cases, such as athletes using statins, older athletes, or those with high training stress, but it should not be presented as a guaranteed recovery or performance tool.
- For most athletes, CoQ10 should be seen as a possible supportive supplement, not a foundation. Training load management, sleep, nutrition, adequate energy intake, and correction of true deficiencies remain much more important.
Introduction: CoQ10 in Athletes
Many athletes have heard of CoQ10. It appears in recovery stacks, pre-workout formulas, and supplement recommendations from coaches, practitioners, and health-conscious athletes who are trying to optimise performance, recovery, or general metabolic health. In the clinic, patients often do not refer to it as “CoQ10” at all, but instead talk about “ubiquinone,” especially if they have seen it listed on supplement labels. The marketing claims are often bold: better energy, faster recovery, improved endurance.
In my clinical experience, CoQ10 is not usually the first supplement athletes reach for. More often, I see it used by people who are already highly committed to supplementation and may be taking a broad range of products in an attempt to maximise performance. Part of its appeal is understandable: CoQ10 plays an important role in mitochondrial energy metabolism, which makes it easy to market as an “energy” supplement. But from a clinical perspective, that jump from mitochondrial biology to meaningful performance improvement needs to be made carefully.
True CoQ10 deficiency is not something I commonly see as a practical everyday explanation for fatigue or reduced performance in otherwise healthy athletic patients. The more relevant question is not whether CoQ10 is important biologically — it is — but whether supplementing it actually changes outcomes that matter to athletes.
So what does the peer-reviewed evidence say about CoQ10 in athletes? Does it improve performance, support recovery, reduce oxidative stress, or help with muscle-damage markers? And does the scientific picture match the promise?
What CoQ10 in Athletes Actually Involves: Physiology First
Coenzyme Q10 (CoQ10) is a fat-soluble, vitamin-like molecule synthesized endogenously in the human body. It exists in two primary forms: ubiquinone (the oxidized form) and ubiquinol (the reduced form) [5]. In eukaryotic cells, CoQ10 is present in three oxidation states: ubiquinol (Q10 H2), ubisemiquinone, and ubiquinone in its full oxidation state [1].
Its primary physiological role is as an electron carrier in oxidative phosphorylation — the process by which mitochondria produce ATP. CoQ10 acts directly as an electron carrier in oxidative phosphorylation that occurs in mitochondria, as well as assisting in the maintenance of the redox cycle by assisting in the antioxidant response [1].
For CoQ10 in athletes, both functions matter. Organs like the heart and muscles, which require consistent and robust bioenergetics, depend on a sufficient supply of CoQ10 and produce less energy and strength if they are deficient in CoQ10 [5].
There is one additional complicating factor that is underappreciated in athletic populations: intense training may deplete circulating CoQ10 levels. Heavy training and exercise leads to a decrease in plasma levels of athletes, and athletes had lower plasma levels during periods of heavy training than in training-free periods [5]. In one study of 21 male athletes, normalized coenzyme Q10 plasma content decreased significantly in all subjects following a single bout of intense exercise (40 min run at 85% maxHR) [4]. These data suggest that adequate CoQ10 status may be particularly relevant in active subjects, though the broader generalizability across athletic populations warrants further study [4].
From a clinical perspective, CoQ10 is different from the classic vitamins people often compare it with. We have well-known deficiency diseases for several vitamins: vitamin C deficiency can lead to scurvy, vitamin B1 deficiency can lead to beriberi, and vitamin D deficiency can lead to rickets or osteomalacia. CoQ10 does not fit into that same category in everyday clinical practice.
Strictly speaking, CoQ10 is not a vitamin in the traditional sense. Vitamins are nutrients the body cannot produce in adequate amounts and therefore must obtain from the diet. CoQ10, by contrast, is synthesized endogenously and is present in cells throughout the body. That is one reason why clinically obvious CoQ10 deficiency is not something I commonly encounter when assessing otherwise healthy patients or athletes with fatigue, reduced performance, or recovery concerns.
This does not mean CoQ10 biology is irrelevant. Rare primary CoQ10 deficiency syndromes, certain diseases, medications such as statins, and age-related changes may affect CoQ10 metabolism or levels [7]. In athletes, there is also some evidence that intense exercise may acutely lower circulating CoQ10 levels, but this should not be confused with a classic vitamin deficiency syndrome. In my view, this distinction is important, because it prevents us from framing CoQ10 supplementation as simply “correcting a deficiency” in the same way we might think about iron, vitamin D, vitamin B12, or vitamin C in clearly deficient patients.
A useful way to think about this is by comparison with iron, although the analogy has limits. In high-training-load athletes, iron status can become clinically relevant when training demand, losses, intake, and absorption no longer match the body’s needs. CoQ10 may have a superficially similar “demand versus availability” logic during heavy training, but this remains a clinical analogy rather than direct experimental evidence. For a detailed look at training-induced iron depletion, the ferritin levels for athletes guide covers that phenomenon in depth.
CoQ10 in Athletes and Oxidative Stress: Where the Evidence Is Most Consistent
This is where the evidence for CoQ10 in athletes is most consistent, though certainty remains low to very low across outcomes. A GRADE-assessed meta-analysis incorporating 28 RCTs and 830 subjects found that CoQ10 supplementation significantly decreased creatine kinase (CK) (WMD: −50.64 IU/L; 95% CI: −74.75, −26.53; P < 0.001), lactate dehydrogenase (LDH) (WMD: −52.10 IU/L; 95% CI: −74.01, −30.19; P < 0.001), myoglobin (Mb) (WMD: −21.77 ng/ml; 95% CI: −32.59, −10.94; P < 0.001), and malondialdehyde (MDA) (WMD: −0.73 μmol/l; 95% CI: −1.26, −0.20; P = 0.007) levels [3]. Using SMD analysis, “very large” effects on LDH and “moderate” effects on CK and MDA were noted [3].
These reductions suggest lower average muscle-damage biomarker levels with CoQ10 supplementation, though the clinical significance for an individual athlete remains uncertain given the low to very low GRADE certainty. CK, LDH, and myoglobin are commonly used research biomarkers of exercise-induced muscle damage. For context on how to interpret these markers in athletic blood work generally, see the guide on preparing for blood tests as an athlete.
A more recent 2025 meta-analysis — 17 trials, 440 participants — confirmed the direction of effect: CoQ10 significantly reduced MDA (MD = −0.61 μmol/L; 95% CI: −1.18, −0.03; p = 0.04), LDH (MD = −69.99 IU/L; 95% CI: −131.93, −8.05; p = 0.033) and CK (MD = −71.81 IU/L; 95% CI: −124.33, −19.3; p = 0.012) in athletes [2]. Subgroup analyses revealed dose-specific effects for CK at doses ≥300 mg/day, and LDH effects particularly at 14 days [2]. The authors noted that quality of evidence for all outcomes ranged from low to very low [2].
A 2023 systematic review of 16 athlete-specific studies found that after CoQ10 supplementation, there was a decrease in oxidative stress markers, followed by higher antioxidant activity. In some included studies, lower levels of liver enzyme markers were also identified, specifically ALT, AST, and γGT [1]. These liver enzyme findings may be relevant when interpreting elevated transaminases in athletes, but ALT and AST are nonspecific markers and should not be attributed to training load or CoQ10 status without full clinical context. For a practical framework on interpreting these markers, the liver enzymes in athletes article provides a detailed clinical approach.
This is an important distinction: most of the supportive evidence for CoQ10 in athletes relates to biomarkers, not hard recovery outcomes. Lower CK, LDH, myoglobin, or MDA may suggest less biochemical stress or a lower muscle-damage signal, but it does not automatically mean that an athlete recovers faster, feels less sore, trains better the next day, or performs better in the following session.
So, if an athlete asks whether CoQ10 truly improves recovery, my honest answer is cautious: we cannot say that with confidence. From a clinical perspective, this distinction matters because athletes are usually not supplementing to improve a laboratory value; they are supplementing because they want a real-world outcome.
For that reason, I would be careful about presenting CoQ10 as a powerful recovery supplement. It may have a role as a supportive intervention in selected cases, especially when the goal is to influence oxidative stress or muscle-damage markers, but in my view, the evidence is not strong enough to say that it reliably improves practical recovery outcomes in athletes.
CoQ10 in Athletes and Performance: A More Complicated Picture
The honest answer on CoQ10 in athletes and direct performance is nuanced, and the most recent data points toward measured expectations.
A 2025 systematic review and meta-analysis published in the British Journal of Nutrition — 24 studies, databases searched through November 2025 — found that supplementation consistently increased blood CoQ10, indicating robust biochemical responsiveness. In contrast, performance effects were small and inconsistent [6]. In primary analyses, chronic supplementation showed a small benefit, whereas acute supplementation showed no benefit. After excluding outliers, the chronic effect was no longer stable and the acute effect remained trivial [6]. No stable dose–response pattern emerged for supplementation dosage or duration, and heterogeneity and moderate-to-high risk of bias reduced certainty — with overall GRADE certainty rated as very low to low [6].
Importantly, ‘performance’ in this meta-analysis covered several different outcomes rather than one clear athletic endpoint. Aerobic endurance showed the most plausible signal, but it became less stable after sensitivity analysis. Anaerobic and strength outcomes showed little change, and subjective fatigue was only suggestive. Therefore, the review does not support presenting CoQ10 as a reliable performance-enhancing supplement for athletes [6].
This is consistent with the athlete-specific systematic review of 2023, which found that the protocol did not promote changes in body composition, kidney function, and aerobic performance [1]. Aerobic performance improvements were not consistently demonstrated across the majority of included studies [1].
However, within this broader picture, some included studies reported improvements in anaerobic-related outcomes. The 2023 review found significant changes in components of anaerobic performance including anaerobic threshold, muscle strength (number of repetitions), muscle power, and total work measured in Watts in some protocols after CoQ10 supplementation [1]. These findings do not establish a broad reliable performance effect, but they represent the most plausible domain of benefit.
Direct evidence comes from a double-blind, placebo-controlled study enrolling 100 young German Olympic athletes (53 male, 47 female, age 19.9 ± 2.3 years) who received either 300 mg ubiquinol or placebo for 6 weeks during Olympic preparation. The Ubiquinol group increased performance from 3.70 W/kg bw (±0.56) to 4.08 W/kg bw (±0.48), an increase of +0.38 ± 0.22 W/kg bw or +11.0% (±8.2). The absolute difference in the enhancement of the physical performance between the placebo and the Ubiquinol group of +0.08 W/kg bodyweight was significant (p < 0.03) [5]. This is a single study and should be interpreted in the context of the broader evidence base.
From a clinical perspective, I would not feel confident telling an athlete that CoQ10 supplementation is likely to improve sports performance in a reliable, evidence-based way. Some individuals may feel that they benefit from it, and it is possible that certain subgroups respond differently. But when we look at the evidence on average, CoQ10 does not appear to produce a consistent or dependable improvement in athletic performance.
This is why I would be cautious about presenting CoQ10 as a performance supplement. In my view, it belongs more in the category of biologically plausible but weakly supported interventions than in the category of supplements with a clear, practical performance benefit. The marketing around CoQ10 often sounds stronger than the evidence itself. Based on the current research, I would not describe it as an evidence-based choice for reliably improving athletic performance.
Conclusion: CoQ10 in Athletes
CoQ10 in athletes is best understood as a biologically plausible supplement with a stronger case for influencing blood biomarkers than for clearly improving real-world athletic outcomes. The most consistent evidence relates to oxidative stress and exercise-induced muscle-damage markers such as CK, LDH, myoglobin, and MDA. These findings are interesting, but they should not be overinterpreted: lower biomarkers do not automatically mean that an athlete recovers faster, feels less sore, trains better the next day, or performs better in competition.
The performance evidence is even more cautious. CoQ10 supplementation appears to raise blood CoQ10 levels reliably, but studies do not show a consistent or dependable improvement in endurance, strength, anaerobic performance, or overall athletic performance. Some individual studies and subgroups suggest possible benefit, but the broader evidence base remains inconsistent and limited by low to very low certainty.
From a clinical perspective, I would not present CoQ10 as a first-line or strongly evidence-based performance supplement for athletes. It may have a role as a supportive option in selected cases, particularly when the goal is to influence oxidative stress or muscle-damage biomarkers, but it should not be marketed as a reliable way to improve performance or guarantee better recovery. For most athletes, the practical foundation still remains training load management, sleep, nutrition, sufficient energy intake, and correcting true deficiencies when they exist. CoQ10 may be part of the discussion, but it should not be the centrepiece.
References
[1] https://doi.org/10.3390/nu15183990
[2] https://pubmed.ncbi.nlm.nih.gov/40367843/
[3] https://www.clinicalnutritionespen.com/article/S2405-4577(24)00018-4/abstract
[4] https://doi.org/10.1080/13510002.2018.1472924
[5] https://doi.org/10.1186/1550-2783-10-24
