Background: Pre-workout supplements, or “pre-workouts,” have skyrocketed in popularity in recent years. Taken before exercise, pre-workout is advertised to improve athletic performance and increase energy and focus. Typically, pre-workout is sold in powder form, intended to be combined with water and consumed as a drink. They often contain high concentrations of caffeine mixed with substances such as Beta-alanine, L-Citrulline, and BCAAs. Several pre-workouts have been banned for containing substances such as DMAA and Synephrine. “Dry scooping,” one particularly risky method of consumption, entails putting undiluted powder into one’s mouth followed by sips of liquid. The highly concentrated powder can lead to choking, accidental inhalation, overconsumption, injury, and death. Despite being labeled 18+, pre-workout has become increasingly popular among teens. This study investigates risky behavior associated with underage pre-workout use on the social media app, TikTok, a platform with millions of teenage users. Methods: TikTok videos under the hashtag “#preworkout” were collected. Video content was analyzed and the following data were collected: likes, method of ingestion, number of servings, and combination with other substances. Descriptive analysis was conducted to understand potential trends in the collected data. Results: Of the videos analyzed (n=100), the cumulative number of likes was 259,773,000 and ranged from 112,300-1,700,000 per video. 64% (n=64) of the videos featured males, 30% (n=30) females, 3% both, and 3% were ambiguous. 31% (n=31) of the videos featured dry scooping (totaling 8,201,900 likes), 11% (n=11) featured users improperly concentrating/mixing pre-workout (totaling 2,399,400 likes), and 7% featured users consuming pre-workout through other dangerous methods (totaling 1,721,200 likes). Only 8% (n=8) of videos depicted use according to instructions (totaling 2,030,200 likes) (Table 1). When excluding videos that do not show consumption, 86.0% (n=49) depicted improper pre-workout use while 14.0% (n=8) depicted use according to instructions (Figure 1). The most popular substances consumed alongside pre-workout were energy drinks (n=5, totaling 1,053,900 likes), creatine/protein powder (n=4, totaling 681,700), and alcohol (n=2, totaling 509,900 likes) (Table 1). Conclusion: Pre-workouts are supplements advertised to enhance athletic performance, but they often contain ingredients unsuitable for children. On TikTok, dangerous methods of consuming pre-workout were found to be extremely prevalent; videos featuring dry scooping amassed over 8 million likes. This may mislead millions of impressionable minors into improper use of pre-workout, which could lead to respiratory or cardiovascular distress and/or death. Physicians should be aware of the pervasiveness of pre-workout, dangerous methods of consumption, and the potential for accidental overconsumption, inhalation, and injury.
Usage According to Recommendations.
Of the videos which explicitly showed or described a specific instance of pre-workout ingestion (n=57), 86.0% (n=49) depicted improper use (e.g. dry scooping, multiple servings at once, mixing with energy drinks) compared to 14.0% (n=8) depicting use according to instructions (e.g. one serving, mixed with water if powdered).
Usage According to Recommendations.
Of the videos which explicitly showed or described a specific instance of pre-workout ingestion (n=57), 86.0% (n=49) depicted improper use (e.g. dry scooping, multiple servings at once, mixing with energy drinks) compared to 14.0% (n=8) depicting use according to instructions (e.g. one serving, mixed with water if powdered).
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