Background: Analgesics are widely used in competitive sports, but their patterns of use and detection in anti-doping controls vary significantly across drug classes. This study examined a decade of Italian anti-doping reports with three aims: to describe trends involving non-steroidal anti-inflammatory drugs (NSAIDs), glucocorticoids, and narcotics; to characterize the distribution of specific active ingredients; and to analyze the relative contribution of these classes to anti-doping violations, placing the findings within the regulatory framework. Methods: Data from national anti-doping reporting systems were analyzed from 2013 to the first half of 2023. Yearly data included tested athletes, athlete declarations of NSAID use, and laboratory analytical findings for prohibited substances (glucocorticoids and narcotics). NSAID prevalence was calculated relative to tested athletes, while glucocorticoid and narcotic findings were assessed as absolute counts and proportions of total violations. Temporal trends were assessed using the Cochran–Armitage test. Results: NSAIDs consistently ranked as the most frequently reported medication, with nearly half of the tested athletes reporting their use and no significant linear trend in overall prevalence. However, a significant shift was observed within the NSAID class, with a marked decrease in declarations of COX-2 selective agents over time. Glucocorticoids accounted for a significant portion of prohibited substances, with fluctuating proportions (showing no significant linear trend), betamethasone being the most common active ingredient. Narcotics appeared only sporadically, although the use of non-prohibited opioids such as tramadol and codeine—absent from official reports—remains relevant for understanding analgesic practices. Conclusions: Analgesic use in Italian elite sports shows distinct patterns driven by therapeutic needs and anti-doping regulations. NSAIDs remain the primary choice for routine pain management, though the type of NSAID reported has shifted significantly. Glucocorticoids represent a notable share of prohibited findings with a fluctuating, rather than steadily increasing, pattern. Narcotics appear only sporadically in violation data. Ongoing monitoring will be crucial to understanding how evolving clinical practices and recent regulatory changes influence future detection trends and athlete health.

Background/Objectives: Physical activity is a cornerstone of preventive health, yet its practice often coexists with the consumption of alcoholic beverages like beer and wine. While these beverages contain bioactive compounds with potential health properties, alcohol itself carries significant risks. This systematic review aimed to synthesize and critically assess the evidence on physical activity and beer and wine consumption. Specifically, we examined their combined effects on metabolic syndrome components (body composition, blood pressure, lipids, glucose metabolism); inflammation and oxidative stress markers; mental health outcomes (cognitive function, mood, sleep); and physical performance, neuromuscular recovery, and fluid balance. Methods: Following a pre-registered protocol (PROSPERO: CRD420261281945), a systematic search of PubMed/MEDLINE, Scopus, and SPORTDiscus was conducted for studies published between 2000 and 2025. Included studies were randomized controlled trials or observational studies involving physically active adults (aged ≥ 18 years) who consumed beer or wine. Studies focusing solely on sedentary populations were excluded. Outcomes assessed included metabolic syndrome components, inflammation, oxidative stress, mental health, cognitive function, and physical performance. Risk of bias was evaluated using Cochrane RoB 2 for RCTs and ROBINS-I for non-randomized studies. Results: Eight studies were included. Moderate beer or wine consumption did not substantially negate the beneficial effects of exercise on cardiometabolic health, body composition, or cognitive function. Higher alcohol intake was associated with elevated blood pressure. Acute post-exercise consumption of alcoholic beer impaired rehydration and neuromuscular recovery, whereas non-alcoholic beer did not. Conclusions: Given the small number of studies and risk of bias, these findings should be interpreted with caution. In physically active populations, moderate beer or wine consumption does not clearly undermine the benefits of regular exercise on metabolic syndrome components (body composition, blood pressure, lipids, glucose metabolism). No additional benefits on inflammation or oxidative stress were observed, nor on mental health outcomes (cognitive function, mood, or sleep). However, acute post-exercise alcohol intake impairs rehydration and neuromuscular recovery, whereas non-alcoholic beer represents a safer alternative.