Ashwagandha Supplementation in Healthy Aging and Musculoskeletal Health: Biological Rationale, Clinical Evidence, and Safety Considerations

Abstract

Aging is accompanied not only by molecular damage but also by progressive loss of sleep quality, stress tolerance, muscle strength, recovery capacity and mobility. These domains are closely connected: chronic stress and poor sleep can worsen fatigue, pain sensitivity, low-grade inflammation and physical inactivity, thereby contributing to musculoskeletal decline. Ashwagandha (Withania somnifera) is a botanical adaptogen increasingly used as a supplement for stress reduction, sleep support, vitality and physical performance. This narrative review summarizes the clinical and mechanistic evidence on ashwagandha supplementation in healthy aging, with particular attention to musculoskeletal health, muscle function, recovery and rehabilitation-relevant outcomes. The strongest human evidence supports modest benefits on perceived stress, anxiety and selected sleep outcomes. Preliminary evidence also suggests possible improvements in strength, recovery, VO2max and body-composition parameters, especially when supplementation is combined with resistance training or regular physical activity. However, current studies are generally small, short-term and heterogeneous in extract composition, dose and population. There is insufficient evidence to claim that ashwagandha reverses biological aging, prevents sarcopenia or treats osteoarthritis. Safety is generally favorable in short-term studies, but rare cases of liver injury and possible endocrine effects require caution. At present, ashwagandha is best considered as a supportive, not curative, intervention within a broader healthy-aging strategy that includes exercise, nutrition, sleep hygiene and medical supervision when appropriate.