The use of drugs and nutritional supplements in top-level track and field athletes

A descriptive study of self-medication practices among Sri Lankan national level athletes

Background

Intake of medicines and supplements is widespread among the professional athletes in developed countries and there are reports to suggest inappropriate self-administration of medicine. Data from South Asia on this area is lacking. This study examined self-medication practices with regard to use of allopathic and herbal/traditional medicines among national -level Sri Lankan athletes.

Results

209 athletes from 15 national sport teams were assessed using an anonymous, interviewer administered questionnaire. Self-medication practices during the 3 months before data collection were evaluated. 60.8% athletes practiced self-medication. 58.3 and 9.4% consumed western and herbal/traditional medicines respectively, while a third used both. The most common symptom for which self-medication was practiced was musculoskeletal pain (73.2%). Oral non-steroidal anti-inflammatory drugs (NSAIDs) and antibiotics were used by 15.7 and 7.1% respectively. Musculoskeletal pain was the predominant symptom that prompted the use of allopathic medicines, while the majority of athletes with upper respiratory tract symptoms being the predominant symptoms, consumed herbal/traditional medicines. Two different commercially available preparations of herbal mixtures were consumed by 15.7 and 15%. Pain prophylaxis during or prior to a sport event was reported by 20.1%, mainly with topical medicines. Medicines were obtained by direct request from a pharmacy without an authorized prescription by a majority (77.2%), followed by using an old prescription in 12.6%.

Conclusions

This study finds that self-medication with both allopathic and herbal/traditional preparations among athletes in a Sri Lanka is high. The use of oral NSAIDs without an authorized prescription in a significant number of athletes is a potential health risk. Frequency of oral NSAID use is lower than that is reported in non-Asian studies from developed countries. The use of herbal/traditional medications increases the likelihood of inadvertent doping. Enhancing awareness regarding risk of such practices among athletes, trainers, pharmacists and prescribers is essential.

Diclofenac pretreatment modulates exercise-induced inflammation in skeletal muscle of rats through the TLR4/NF-κB pathway

Nonsteroidal anti-inflammatory drugs, such as diclofenac, are widely used to treat inflammation and pain in several conditions, including sports injuries. This study analyzes the influence of diclofenac on the toll-like receptor-nuclear factor kappa B (TLR-NF-κB) pathway in skeletal muscle of rats submitted to acute eccentric exercise. Twenty male Wistar rats were divided into 4 groups: control-saline, control-diclofenac, exercise-saline, and exercise-diclofenac. Diclofenac or saline were administered for 7 days prior to an acute eccentric exercise bout. The inflammatory status was evaluated through mRNA levels of cyclooxygenase-2 (COX-2), inducible nitric oxide synthase (iNOS), interleukin-6 (IL-6), IL-1β, and tumor necrosis factor alpha (TNF-α), and protein content of COX-2, IL-6, and TNF-α in vastus lateralis muscle. Data obtained showed that a single bout of eccentric exercise significantly increased COX-2 gene expression. Similarly, mRNA expression and protein content of other inflammation-related genes also increased after the acute exercise. However, these effects were attenuated in the exercise + diclofenac group. TLR4, myeloid differentiation primary response gene 88 (MyD88), and p65 were also upregulated after the acute eccentric bout and the effect was blunted by the anti-inflammatory drug. These findings suggest that pretreatment with diclofenac may represent an effective tool to ameliorate the pro-inflammatory status induced by acute exercise in rat skeletal muscle possibly through an attenuation of the TLR4-NF-κB signaling pathway.

The Effectiveness of a New School-Based Media Literacy Intervention on Adolescents' Doping Attitudes and Supplements Use

The aim of the study was to evaluate the effectiveness of a media literacy intervention targeting, for the first time, the specific topic of Performance and Appearance Enhancing Substances (PAESs) use in high-school students. Overall, 389 students (52% male) aged between 13 and 19 years (mean = 16.56 year; SD = 1.26) participated to a media literacy intervention (i.e., “intervention group”) while 103 students aged between 14 and 19 year (mean = 16.10 year; SD = 1.38) were considered as the control group (i.e., “control group”). In two separate occasions over the course of six consecutive months, students in both groups filled out a set of questionnaires which included measures of social-cognitive beliefs (i.e., attitudes, subjective norms, intentions) and a self-reported measure of retrospective use of doping (Yes/No) and supplements (Yes/No). Compared to students in the control group (Mean_(time1) = 1.96; SD_(time1) = 0.85; and Mean_(time2) = 2.09; SD_(time2) = 0.94), intervention students on average expressed relatively stronger attitudes against doping use over time (Mean_(time1) = 2.2; SD_(time1) = 0.85; and Mean_(time2) = 2.05; SD_(time2) = 0.82). Students in the latter group also showed a statistically significant decrease in self-reported supplement use (Use_(time1) = 6.7%; Use_(time2) = 3.8%; p = 0.05, McNemar Test). Interestingly, albeit marginally significant, students in the control group showed a relative increment in the self-reported use of supplements over time (Use_(time1) = 4.9%; Use_(time2) = 8.7%; p = 0.22, McNemar Test). Overall, the media literacy intervention investigated in the present study was effective in decreasing adolescent student’s positive attitudes toward doping use and in reducing the use of legal PAES. These findings supported the generalizability and the usefulness of a media literacy approach in the specific field of PAES.

Caffeine and Bicarbonate for Speed. A Meta-Analysis of Legal Supplements Potential for Improving Intense Endurance Exercise Performance

A 1% change in average speed is enough to affect medal rankings in intense Olympic endurance events lasting ~45 s to 8 min which for example includes 100 m swimming and 400 m running (~1 min), 1,500 m running and 4000 m track cycling (~4 min) and 2,000 m rowing (~6-8 min). To maximize the likelihood of winning, athletes utilizes legal supplements with or without scientifically documented beneficial effects on performance. Therefore, a continued systematic evidence based evaluation of the possible ergogenic effects is of high importance. A meta-analysis was conducted with a strict focus on closed-end performance tests in humans in the time domain from 45 s to 8 min. These test include time-trials or total work done in a given time. This selection criterion results in a high relevance for athletic performance. Only peer-reviewed placebo controlled studies were included. The often applied and potentially ergogenic supplements beta-alanine, bicarbonate, caffeine and nitrate were selected for analysis. Following a systematic search in Pubmed and SportsDiscuss combined with evaluation of cross references a total of 7 (beta-alanine), 25 (bicarbonate), 9 (caffeine), and 5 (nitrate) studies was included in the meta-analysis. For each study, performance was converted to an average speed (km/h) from which an effect size (ES; Cohens d with 95% confidence intervals) was calculated. A small effect and significant performance improvement relative to placebo was observed for caffeine (ES: 0.41 [0.15–0.68], P = 0.002) and bicarbonate (ES: 0.40 [0.27–0.54], P < 0.001). Trivial and non-significant effects on performance was observed for nitrate (ES: 0.19 [−0.03–0.40], P = 0.09) and beta-alanine (ES: 0.17 [−0.12–0.46], P = 0.24). Thus, caffeine's and bicarbonate's ergogenic effect is clearly documented for intense endurance performance. Importantly, for all supplements an individualized approach may improve the ergogenic effect on performance.

Use of Non-Steroidal Anti-Inflammatory Drugs among Participants in a Mountain Ultramarathon Event

The aim of this study was to evaluate and compare the prevalence of non-steroidal anti-inflammatory drugs (NSAID) consumption immediately before, during and immediately after three mountain ultra-endurance runs that differed in their course distance. This observational study took place at the Ultra Mallorca Serra de Tramuntana (Mallorca, Spain), an ultra-endurance mountain event with runners participating either in a 112-km (Ultra, n = 58), a 67-km (Trail, n = 118) or a 44-km (Marathon, n = 62) run competition. Participants in the study answered, within an hour after finishing the competition, a questionnaire focused mainly on NSAIDs consumption. Among study participants, 48.3% reported taking NSAIDs at least for one of the time-points considered: before, during and/or immediately after the competition, with more positive responses (having taken medication) found for the Ultra (60.3%) than for the Trail (49.2%) and the Marathon (35.5%). Among consumers, the Ultra participants reported the lowest intake before and the highest during the race, while participants in the Marathon reported similar consumption levels before and during the race. In conclusion, a high prevalence of NSAID consumption was found among athletes participating in an ultra-endurance mountain event. Competition duration seemed to determine both the prevalence and the chronological pattern of NSAID consumption.

Echinacea Supplementation: Does it Really Improve Aerobic Fitness?

PURPOSE

Echinacea is an herbal supplement used by endurance athletes for its performance boosting properties. It is thought that Echinacea improves the blood's oxygen carrying capacity by increasing production of erythropoietin (EPO), a glycoprotein that regulates red blood cell formation. Subsequently, these changes would lead to an overall improvement in maximal oxygen uptake (VO2max) and running economy (RE), two markers of aerobic fitness. The purpose of this review is to briefly discuss the physiological variables associated with distance running performance and how these variables are influenced by Echinacea supplementation.

METHODS

To determine Echinacea's ergogenic potential, human studies that used Echinacea in conjunction to analyzing the blood's oxygen carrying capacity and/or aerobic fitness were assessed.

RESULTS

Taken together, the majority of the published literature does not support the claim that Echinacea is a beneficial ergogenic aid. With the exception of one study, several independent groups have reported Echinacea supplementation does not increase EPO production, blood markers of oxygen transport, VO2max or RE in healthy untrained or trained subjects.

CONCLUSION

To date, the published literature does not support the use of Echinacea as an ergogenic aid to improve aerobic fitness in healthy untrained or trained subjects.

Injury and illness in aquatic sport: how high is the risk? A comparison of results from three FINA World Championships

BACKGROUND

Epidemiological information on injury/illness is required to develop effective injury prevention strategies.

AIM

To assess the frequency and characteristics of injuries/illnesses (1) in the 4 weeks prior to and (2) during the Fédération Internationale de Natation (FINA) World Championships 2015 compared with 2013 and 2009.

METHOD

(1) Athletes answered a retrospective questionnaire, and (2) the medical staff reported injuries/illnesses prospectively during the championships.

RESULTS

(1) A quarter of responding athletes reported symptoms in the 4 weeks prior to the championships. More than half of all affected athletes presented with substantial severity, 80% took medication, 70% had overuse injuries and 30% did not modify their training regime despite symptoms. At the start of the championships, 70% of affected participants were still symptomatic. (2) During the championships, injury and illness incidence was 12.9 per 100 athletes. The most common injuries were shoulder sprains (5.7%) and muscle cramps of the lower back (5.7%). The most common illnesses were infections of the respiratory (33.9%) and gastrointestinal tract (23.5%). Risk factors included discipline and age, but not gender. Incidence was highest in athletes competing in high diving (HD), water polo (WP) and diving (DIV) for injuries, and WP and swimming (SW) for illnesses. The significantly higher incidence of injuries and illnesses at the FINA World Championships 2015 compared with 2013 and 2009 was most probably due to a similarly improved response rate of the medical staff.

CONCLUSIONS

In aquatic sports, surveillance and health promotion should focus on prevention of out-of-competition overuse injuries and athlete education.

Creatine Supplementation and Lower Limb Strength Performance: A Systematic Review and Meta-Analyses

BACKGROUND

Creatine is the most widely used supplementation to increase strength performance. However, the few meta-analyses are more than 10 years old and suffer from inclusion bias such as the absence of randomization and placebo, the diversity of the inclusion criteria (aerobic/endurance, anaerobic/strength), no evaluation on specific muscles or group of muscles, and the considerable amount of conflicting results within the last decade.

OBJECTIVE

The objective of this systematic review was to evaluate meta-analyzed effects of creatine supplementation on lower limb strength performance.

METHODS

We conducted a systematic review and meta-analyses of all randomized controlled trials comparing creatine supplementation with a placebo, with strength performance of the lower limbs measured in exercises lasting less than 3 min. The search strategy used the keywords "creatine supplementation" and "performance". Dependent variables were creatine loading, total dose, duration, the time-intervals between baseline (T0) and the end of the supplementation (T1), as well as any training during supplementation. Independent variables were age, sex, and level of physical activity at baseline. We conducted meta-analyses at T1, and on changes between T0 and T1. Each meta-analysis was stratified within lower limb muscle groups and exercise tests.

RESULTS

We included 60 studies (646 individuals in the creatine supplementation group and 651 controls). At T1, the effect size (ES) among stratification for squat and leg press were, respectively, 0.336 (95 % CI 0.047-0.625, p = 0.023) and 0.297 (95 % CI 0.098-0.496, p = 0.003). Overall quadriceps ES was 0.266 (95 % CI 0.150-0.381, p < 0.001). Global lower limb ES was 0.235 (95 % CI 0.125-0.346, p < 0.001). Meta-analysis on changes between T0 and T1 gave similar results. The meta-regression showed no links with characteristics of population or of supplementation, demonstrating the creatine efficacy effects, independent of all listed conditions.

CONCLUSION

Creatine supplementation is effective in lower limb strength performance for exercise with a duration of less than 3 min, independent of population characteristic, training protocols, and supplementary doses and duration.

Use of nutritional supplements by Danish elite athletes and fitness customers

The nutritional supplement (NS) industry is one of the fastest growing in the world, and NS use in Denmark is among the highest in Europe. However, the exact use in elite athletes and fitness customers targeted for doping control is unknown. Information from 634 doping control forms obtained in 2014 was evaluated (elite athletes: n = 361; fitness customers: n = 273). The majority of female (92.6%) and male (85.0%) elite athletes and female (100.0%) and male (94.0%) fitness customers declared using one or more NS. The use of non-ergogenic NS was more prevalent in women than in men and in younger (15-34 years) compared with older (35-49 years) subjects, but it was less prevalent in intermittent compared with endurance and power/strength sports. Additionally, fitness customers who tested positive for doping also reported using more NS than subjects testing negative, indicating an association between NS and doping abuse. The present results demonstrate a very high prevalence of NS usage in both elite athletes and fitness customers. This highlights the importance of a strong national regulation of NS to avoid contamination of NS with doping substances.

Preparticipation Evaluation of the Young Athlete: What an Orthopaedic Surgeon Needs to Know

The preparticipation evaluation (PPE) is a widely used tool for detecting health conditions that may delay or disqualify athletic participation. The medical interview is the most valuable tool for identifying athletes who may be at increased risk for injury. Physical examination is tailored to identifying cardiac abnormalities or factors that may place an athlete at increased risk for injury. Although practiced in Europe, universal cardiac screening with electrocardiography is not currently recommended in the United States largely due to the high rate of false-positive results. Neuropsychological testing for management of concussion and laboratory testing for sickle cell trait may be indicated in select groups of athletes. Health care providers should view the PPE as a chance for anticipatory guidance and athlete-directed health counseling. Despite widespread acceptance of the PPE, the quality of such examinations varies significantly, which is an area for possible improvement and further research.

High prevalence of medication use in professional football tournaments including the World Cups between 2002 and 2014: a narrative review with a focus on NSAIDs

The use of medication in international football has been monitored since the 2002 FIFA World Cup. Team physicians were asked to provide information on prescribed medication 72 h prior to each match for every player. 69% of adult male players reported using medication, with more than half the players using non-steroidal anti-inflammatory drugs (NSAIDs). Up to one-third of all players used NSAIDs prior to every match, regardless of whether they took the field or not. The mean intake of medication was significantly higher during the FIFA Women's World Cup (0.85 vs 0.77 substances per player and per match in men, p<0.001), whereas the use of NSAIDs was similar to that for men. In the Under-20 and Under-17 male competitions, the use of medication was lower as 60% of players used some kind of medication and 43% of the players used NSAIDs during the tournaments. Despite the potential side effects of medication, especially of NSAIDs in the recovery process after a sports activity, there is no evidence of decreasing intake. The reported incidence is alarming, and moreover is most probably underestimated, since self-medication by the players or treatment already prescribed by club physicians is not included in the published reports. Future studies should focus on the daily dosage, time of treatment and especially the medical indication for painkilling agents to better understand the underlying factors.

Prevalence of Dietary Supplement Use by Athletes: Systematic Review and Meta-Analysis

BACKGROUND

Dietary supplements (DSs) are commercially available products consumed as an addition to the usual diet and are frequently ingested by athletes.

OBJECTIVE

Our objective was to examine the prevalence of DS use by athletes.

DATA SOURCES

PubMed, Ovid MEDLINE, OVID Healthstar, and Cumulative Index to Nursing and Allied Health were searched for original research articles published up to August 2014. Search terms included specific sports, specific DSs, and other terms.

STUDY SELECTION

Studies were selected if they were written in English, involved athletes, and provided a quantitative assessment of the proportion of athletes using specific DSs. Percent of athletes using specific DSs.

SYNTHESIS OF DATA

Methodological quality of studies was assessed by three reviewers using an 8-point scale that included evaluations for sampling methods, sampling frame, sample size, measurement tools, bias, response rate, statistical presentation, and description of the participant sample. Where there were at least two investigations, meta-analysis was performed to obtain summary (pooled) prevalence estimates (SPEs) on (1) DS use prevalence by sport and sex, (2) DS use prevalence by elite versus non-elite athletic status, and (3) specific DS prevalence for all athletic groups combined. Meta-analyses included evaluations of homogeneity and publication bias.

RESULTS

A total of 159 unique studies met the review criteria. Methodological quality was generally low with an average ± standard deviation of 43 ± 16% of available rating points. There was low homogeneity for SPEs when compiled by sport, athletic status, and/or specific DSs. Contributing to the lack of homogeneity were differences in studies' objectives and types of assessments used (e.g., dietary surveys, interviews, questionnaires). Despite these limitations, the data generally indicated that elite athletes used DSs much more than their non-elite counterparts. For most DSs, use prevalence was similar for men and women except that a larger proportion of women used iron while a larger proportion of men used vitamin E, protein, and creatine. No consistent change in use over time was observed because even the earliest investigations showed relatively high use prevalence.

CONCLUSION

It was difficult to generalize regarding DS use by athletes because of the lack of homogeneity among studies. Nonetheless, the data suggested that elite athletes used dietary supplements far more than their non-elite counterparts; use was similar for men and women with a few exceptions; use appeared to change little over time; and a larger proportion of athletes used DSs compared with the general US population. Improvements in study methodology should be considered in future studies especially (1) defining DSs for participants; (2) querying for very specific DSs; (3) using a variety of reporting timeframes (e.g., daily, 2-6 times/week, 1 time/week and <1 time/week); (4) reporting the sampling frame, number of individuals solicited, and number responding; (5) reporting characteristics of volunteers (and non-volunteers, if available); and (6) using similar methods on several occasions to examine possible temporal trends among athletes.

Why the war on drugs in sport will never be won

Recent exposes of drug use in sports suggest that doping might be more problematic than doping-control test results reveal. A zero-tolerance (ZT) model, which aims to eliminate the use, has dominated the thinking of sport's policy makers over the last 15 years. In light of the limitations associated with ZT-based policy, we propose an alternative policy, one based on controlled use and harm reduction principles. We argue that substance control policies underpinned by harm reduction (HR) principles of social utility and public value will deliver superior social outcomes. First, a harm reduction approach better accommodates the competitive realities of sports and the impact of elite sports' emphasis on performance at all costs. Second, HR prioritises athlete welfare over sport and brand reputation. Finally, while appreciating the regulatory and risk management responsibilities of sports' governing bodies, the HR model offers greater space to the athlete's right to privacy, and right to personal autonomy.

Medications and Nutritional Supplements in Athletes during the 2000, 2004, 2008, and 2012 FIFA Futsal World Cups

Objective. To examine the use of medications and nutritional supplements among top-level male futsal players during international tournaments. Materials and Methods. This retrospective survey of the four consecutive 2000 to 2012 FIFA (Fédération Internationale de Football Association) Futsal World Cup tournaments analyzes data about the use of medications and nutritional supplements by each player prior to every match. A total of 5264 reports on 1064 futsal players were collected from the 188 matches played. Results. A total of 4237 medications and 8494 nutritional supplements (0.8 and 1.6 per player per match, resp.) were prescribed, and 64% of the players used at least one type of medication over the four tournaments. The most frequently prescribed medication was nonsteroidal anti-inflammatory drugs (NSAIDs) (41.1%), whereby 45.7% of all players consumed at least one NSAID during the tournament and 27.4% did so prior to every match. Conclusions. The intake of medications, particularly of NSAIDs, is frequently high among top-level futsal players and follows a similar pattern to that found in FIFA Football World Cups. Campaigns should be instituted to understand this prescription practice by team physicians involving professional football players, with the aim to decrease its use and to prevent athletes from potential short- and long-term risks.

Use and abuse of medication during 2014 FIFA World Cup Brazil: a retrospective survey

OBJECTIVE

To examine the use of medication of top-level male players during the 2014 FIFA World Cup Brazil.

DESIGN

Retrospective survey.

PARTICIPANTS/INFORMATION

736 top level players.

SETTING

The teams' physicians disclosed a list of the medications used by each player within 72 h before each match of the 2014 FIFA World Cup Brazil.

OUTCOME MEASURES

Average number of medications used per player per match or during the tournament; average number and percentage of players using at least one medication per match or during the tournament.

RESULTS

67.0% of all players took various types of medication during the tournament. The most used medications during the tournament were non-steroidal anti-inflammatory drugs (NSAIDs), by 54.2% of all players, followed by analgaesics (12.6%); β-2 agonists were only used by 0.5%. On average, 0.8 medications per player were used before each match. More players were reported taking medications during the knockout round than during the qualification round (0.36±0.48 vs 0.49±0.50, p<0.001). Players from the South American and Asian Confederations took twice as many medications per match as players from the African Confederation (1.17±1.55 and 1.01±1.26 vs 0.48±0.69, both p<0.001).

CONCLUSIONS

There was high use of NSAIDs during the 2014 FIFA World Cup. Although the intake of NSAIDs per match (0.35±0.46 vs 0.31±0.48, p<0.01) in the 2014 FIFA World Cup decreased compared to the 2010 FIFA World Cup, the average use was still higher than in the 2006 FIFA World Cup, and the average number of all used medications per player remained the same level as 4 years prior, with all its implications for the player's health. More efforts need to be undertaken worldwide in order to reduce the administration of medications in sports, through continuous education for players, starting from a young age, as well as for doctors and paramedics.

Pain, injury and related behaviours among footballers partaking in tournaments

This study sought to determine the prevalence of self-reported pain and/or injury (SRPI) experienced by Caribbean footballers and the associated behaviours associated with SRPI. The prevalence of SRPI among footballers was 46.2%, with 71.5% and 36%, respectively, of players admitting having played one game previously with an injury, and having used a painkiller before playing at least one game previously. Female players were more likely to hide an injury from the coaching staff in order to play a game (OR = 2.9, 95% CI (1.7, 4.8)) and attempt to use a banned substance in order to get fit to play (OR = 4.2, 95% CI (1.2, 14.3)) than males, but males were more likely to use a painkiller before playing games than females (OR = 2.2, 95% CI (1.9, 3.9)). Education of players on analgesics and basic injury management together with the implementation of injury prevention programs are needed for these players.

Personal and psychosocial predictors of doping use in physical activity settings: a meta-analysis

BACKGROUND

There is a growing body of empirical evidence on demographic and psychosocial predictors of doping intentions and behaviors utilizing a variety of variables and conceptual models. However, to date there has been no attempt to quantitatively synthesize the available evidence and identify the strongest predictors of doping.

OBJECTIVES

Using meta-analysis, we aimed to (i) determine effect sizes of psychological (e.g. attitudes) and social-contextual factors (e.g. social norms), and demographic (e.g. sex and age) variables on doping intentions and use; (ii) examine variables that moderate such effect sizes; and (iii) test a path analysis model, using the meta-analyzed effect sizes, based on variables from the theory of planned behavior (TPB).

DATA SOURCES

Articles were identified from online databases, by contacting experts in the field, and searching the World Anti-Doping Agency website.

STUDY ELIGIBILITY CRITERIA AND PARTICIPANTS

Studies that measured doping behaviors and/or doping intentions, and at least one other demographic, psychological, or social-contextual variable were included. We identified 63 independent datasets.

STUDY APPRAISAL AND SYNTHESIS METHOD

Study information was extracted by using predefined data fields and taking into account study quality indicators. A random effects meta-analysis was carried out, correcting for sampling and measurement error, and identifying moderator variables. Path analysis was conducted on a subset of studies that utilized the TPB.

RESULTS

Use of legal supplements, perceived social norms, and positive attitudes towards doping were the strongest positive correlates of doping intentions and behaviors. In contrast, morality and self-efficacy to refrain from doping had the strongest negative association with doping intentions and behaviors. Furthermore, path analysis suggested that attitudes, perceived norms, and self-efficacy to refrain from doping predicted intentions to dope and, indirectly, doping behaviors.

LIMITATIONS

Various meta-analyzed effect sizes were based on a small number of studies, which were correlational in nature. This is a limitation of the extant literature.

CONCLUSIONS

This review identifies a number of important correlates of doping intention and behavior, many of which were measured via self-reports and were drawn from an extended TPB framework. Future research might benefit from embracing other conceptual models of doping behavior and adopting experimental methodologies that will test some of the identified correlates in an effort to develop targeted anti-doping policies and programs.

Is multiculturalism bad for health care? The case for re-virgination

Hymenoplasty is a surgical procedure requested by women who are expected to remain virgins until marriage. In this article, I assess the ethical and legal challenges raised by this request, both for the individual physician and for the health care system. I argue that performing hymenoplasty is not always an unethical practice and that, under certain conditions, it should be provided by the health care system.

Dietary supplement usage and motivation in Brazilian road runners

Background

The consumption of dietary supplements is highest among athletes and it can represent potential a health risk for consumers.

Objective

The aim of this study was to determine the prevalence of consumption of dietary supplements by road runners.

Methods

We interviewed 817 volunteers from four road races in the Brazilian running calendar. The sample consisted of 671 male and 146 female runners with a mean age of 37.9 ± 12.4 years.

Results

Of the sample, 28.33% reported having used some type of dietary supplement. The main motivation for this consumption is to increase in stamina and improve performance. The probability of consuming dietary supplements increased 4.67 times when the runners were guided by coaches. The consumption of supplements was strongly correlated (r = 0.97) with weekly running distance, and also highly correlated (r = 0.86) with the number of years the sport had been practiced. The longer the runner had practiced the sport, the higher the training volume and the greater the intake of supplements. The five most frequently cited reasons for consumption were: energy enhancement (29.5%), performance improvement (17.1%), increased level of endurance (10.3%), nutrient replacement (11.1%), and avoidance of fatigue (10.3%). About 30% of the consumers declared more than one reason for taking dietary supplements. The most consumed supplements were: carbohydrates (52.17%), vitamins (28.70%), and proteins (13.48%).

Conclusions

Supplement consumption by road runners in Brazil appeared to be guided by the energy boosting properties of the supplement, the influence of coaches, and the experience of the user. The amount of supplement intake seemed to be lower among road runners than for athletes of other sports. We recommend that coaches and nutritionists emphasise that a balanced diet can meet the needs of physically active people.

Associations between physical and cognitive doping--a cross-sectional study in 2.997 triathletes

Purpose

This study assessed, for the first time, prevalence estimates for physical and cognitive doping within a single collective of athletes using the randomized response technique (RRT). Furthermore, associations between the use of legal and freely available substances to improve physical and cognitive performance (enhancement) and illicit or banned substances to improve physical and cognitive performance (doping) were examined.

Methods

An anonymous questionnaire using the unrelated question RRT was used to survey 2,997 recreational triathletes in three sports events (Frankfurt, Regensburg, and Wiesbaden) in Germany. Prior to the survey, statistical power analyses were performed to determine sample size. Logistic regression was used to predict physical and cognitive enhancement and the bootstrap method was used to evaluate differences between the estimated prevalences of physical and cognitive doping.

Results

2,987 questionnaires were returned (99.7%). 12-month prevalences for physical and cognitive doping were 13.0% and 15.1%, respectively. The prevalence estimate for physical doping was significantly higher in athletes who also used physical enhancers, as well as in athletes who took part in the European Championship in Frankfurt compared to those who did not. The prevalence estimate for cognitive doping was significantly higher in athletes who also used physical and cognitive enhancers. Moreover, the use of physical and cognitive enhancers were significantly associated and also the use of physical and cognitive doping.

Discussion

The use of substances to improve physical and cognitive performance was associated on both levels of legality (enhancement vs. doping) suggesting that athletes do not use substances for a specific goal but may have a general propensity to enhance. This finding is important for understanding why people use such substances. Consequently, more effective prevention programs against substance abuse and doping could be developed.

Quality assurance issues in the use of dietary supplements, with special reference to protein supplements

The use of dietary supplements is widespread in the general population, in athletes and recreational exercisers, and in military personnel. A wide array of supplements is available, but protein-containing products are consistently among the most popular, especially among those who engage in resistance training. There are significant risks associated with the use of unregulated dietary supplements. Risks include the absence of active ingredients, the presence of harmful substances (including microbiological agents and foreign objects), the presence of toxic agents, and the presence of potentially dangerous prescription-only pharmaceuticals. There is ample evidence of athletes who have failed doping tests because of the use of dietary supplements. There is also growing evidence of risks to health and of serious adverse events, including a small number of fatalities, as a result of supplement use. The risk associated with the use of protein powders produced by major manufacturers is probably low, and the risk can be further reduced by using only products that have been tested under one of the recognized supplement quality assurance programs that operate in various countries. Nevertheless, a small risk remains, and athletes, soldiers, and other consumers should conduct a cost-benefit analysis before using any dietary supplements.

Human inflammatory and resolving lipid mediator responses to resistance exercise and ibuprofen treatment

Classical proinflammatory eicosanoids, and more recently discovered lipid mediators with anti-inflammatory and proresolving bioactivity, exert a complex role in the initiation, control, and resolution of inflammation. Using a targeted lipidomics approach, we investigated circulating lipid mediator responses to resistance exercise and treatment with the NSAID ibuprofen. Human subjects undertook a single bout of unaccustomed resistance exercise (80% of one repetition maximum) following oral ingestion of ibuprofen (400 mg) or placebo control. Venous blood was collected during early recovery (0-3 h and 24 h postexercise), and serum lipid mediator composition was analyzed by LC-MS-based targeted lipidomics. Postexercise recovery was characterized by elevated levels of cyclooxygenase (COX)-1 and 2-derived prostanoids (TXB2, PGE2, PGD2, PGF2α, and PGI2), lipooxygenase (5-LOX, 12-LOX, and 15-LOX)-derived hydroxyeicosatetraenoic acids (HETEs), and leukotrienes (e.g., LTB4), and epoxygenase (CYP)-derived epoxy/dihydroxy eicosatrienoic acids (EpETrEs/DiHETrEs). Additionally, we detected elevated levels of bioactive lipid mediators with anti-inflammatory and proresolving properties, including arachidonic acid-derived lipoxins (LXA4 and LXB4), and the EPA (E-series) and DHA (D-series)-derived resolvins (RvD1 and RvE1), and protectins (PD1 isomer 10S, 17S-diHDoHE). Ibuprofen treatment blocked exercise-induced increases in COX-1 and COX-2-derived prostanoids but also resulted in off-target reductions in leukotriene biosynthesis, and a diminished proresolving lipid mediator response. CYP pathway product metabolism was also altered by ibuprofen treatment, as indicated by elevated postexercise serum 5,6-DiHETrE and 8,9-DiHETrE only in those receiving ibuprofen. These findings characterize the blood inflammatory lipid mediator response to unaccustomed resistance exercise in humans and show that acute proinflammatory signals are mechanistically linked to the induction of a biological active inflammatory resolution program, regulated by proresolving lipid mediators during postexercise recovery.

Doing supplements to improve performance in club cycling: a life-course analysis

Using qualitative life-course and pathway analysis, this article explores the beliefs that serious club cyclists have about performance improvement, and what they think are appropriate and inappropriate ways of achieving it. We interviewed 11 cyclists from suburban clubs in Melbourne, Australia, and invited them to discuss their approach to training, racing, and supplementation. We found that each of the 11 cyclists were not only committed to the sport, but also paid a keen interest in bike technology and training regimes. In addition, they believed that supplement use was integral to meeting the physical and mental demands of their sport, even at club level. They also understood that supplement use, like training regimes, followed a sequential pathway where the accumulation of capacity, know-know, and knowledge, allowed progression to the next level of performance. And, like similar studies of club cycling in Europe, this cohort of cyclists balked at using banned substances, but also believed that in order to effectively transition to the elite - that is, professional - level, some additional supplement and drug-use was essential.

Between medical treatment and performance enhancement: an investigation of how elite athletes experience Therapeutic Use Exemptions

BACKGROUND

Athletes can be allowed to use substances from the prohibited list (the doping list) if they have a medical condition. If so, a Therapeutic Use Exemption (TUE) is required. The boundaries between the use of pharmacological substances due to a medical need and doping are sometimes blurred. Although manipulating the system of TUE granting potentially represents an entry stage for doping, few studies examine how athletes perceive TUE management and relate this to current anti-doping policy.

METHODS

645 Danish elite athletes (mean age 22.12, SD=5.82) representing 40 sports completed a web-based questionnaire about their experience and perception of TUE (response rate: 43%).

RESULTS

19% of the respondents had been granted a TUE. 85% of athletes granted a TUE regarded their use of the TUE system as necessary to compete on equal terms with other athletes. Administrative hurdles for TUE prevented 7% of athletes from applying. 53% of the athletes considered that being "allowed" to dope by means of a TUE was of importance for their (hypothetical) wish to try out doping. 51% believed that athletes in their sport received TUEs without a medical need. Athletes granted TUEs had more than twice as high odds to distrust the efficacy of the system than athletes never granted a TUE. The belief that TUEs were misused was especially common among endurance athletes, regardless of them having experience with TUEs or not. 4% believed it would be okay to receive a TUE without a medical need.

CONCLUSION

The results confirm that TUE is a problem in anti-doping policy. The fact that distrust in TUE administration increases once an athlete has experience of TUEs represents a challenge for anti-doping policy. We suggest more critical research on TUEs be carried out in order to improve harmonization and increase transparency in the regulations.

Preventive Health Perspective in Sports Medicine: The Trend at the Use of Medications and Nutritional Supplements during 5 Years Period between 2003 and 2008 in Football

OBJECTIVE

To assess the prevalence of medication and nutritional supplement use in male Football Super League players and to observe the long term changes of players' attitudes during 5 years period (4 seasons).

STUDY DESIGN

Retrospective study.

MATERIAL AND METHODS

Review and analysis of 4176 doping control forms -declaration reports- about players' medication intake including; Super League, UEFA Cup and the UEFA Champions League matches. Team physician was asked to document all medications and nutritional supplements taken by the Football Super League players in the last 72 hours before each match.

RESULTS

A total intake of 5939 substances were documented, of which almost half 49.2% (n=2921) were classified as medications and 50.8% (n=3018) were nutritional supplements. The average consumption per player was 1.42 substance/match; 0.70 were medications and 0.72 of nutritional supplements. The supplements used most frequently were NSAIDs 24.6% (n=1460) accounting for almost one in four of all reported supplements. Diclofenac Sodium was the most frequently reported active pharmaceutical ingredient. Second most frequently used supplements were vitamins (22.2%). The average drug consumption reported per player has been increasing every passing year. It was 0.7 substance/match/player (0.4 medication; 0.3 nutritional supplement) in 2003-2004 season; was increased to 1.8 substance/match (0.8 medication; 1.0 nutritional supplement) in 2006-2007 season.

CONCLUSION

The trends seen in this survey point to an overuse of NSAIDs and vitamins in comparison with other medications, amoung Turkish Super League football players (p<0.001). The use of NSAIDs has increased but the medication groups did not differ significantly between seasons, in terms of distribution. This increasing use of medications especially of non-steroidal anti-inflammatory drugs and nutritional supplements is alarming and needs to be argued.

Consumption of analgesics before a marathon and the incidence of cardiovascular, gastrointestinal and renal problems: a cohort study

OBJECTIVES

To prevent pain inhibiting their performance, many athletes ingest over-the-counter (OTC) analgesics before competing. We aimed at defining the use of analgesics and the relation between OTC analgesic use/dose and adverse events (AEs) during and after the race, a relation that has not been investigated to date.

DESIGN

Prospective (non-interventional) cohort study, using an online questionnaire.

SETTING

The Bonn marathon 2010.

PARTICIPANTS

3913 of 7048 participants in the Bonn marathon 2010 returned their questionnaires.

PRIMARY AND SECONDARY OUTCOMES

Intensity of analgesic consumption before sports; incidence of AEs in the cohort of analgesic users as compared to non-users.

RESULTS

There was no significant difference between the premature race withdrawal rate in the analgesics cohort and the cohort who did not take analgesics ('controls'). However, race withdrawal because of gastrointestinal AEs was significantly more frequent in the analgesics cohort than in the control. Conversely, withdrawal because of muscle cramps was rare, but it was significantly more frequent in controls. The analgesics cohort had an almost 5 times higher incidence of AEs (overall risk difference of 13%). This incidence increased significantly with increasing analgesic dose. Nine respondents reported temporary hospital admittance: three for temporary kidney failure (post-ibuprofen ingestion), four with bleeds (post-aspirin ingestion) and two cardiac infarctions (post-aspirin ingestion). None of the control reported hospital admittance.

CONCLUSIONS

The use of analgesics before participating in endurance sports may cause many potentially serious, unwanted AEs that increase with increasing analgesic dose. Analgesic use before endurance sports appears to pose an unrecognised medical problem as yet. If verifiable in other endurance sports, it requires the attention of physicians and regulatory authorities.

Dietary supplementation and doping-related factors in high-level sailing

Background

Although dietary supplements (DSs) in sports are considered a natural need resulting from athletes’ increased physical demands, and although they are often consumed by athletes, data on DS usage in Olympic sailing are scarce. The aim of this study was to study the use of and attitudes towards DSs and doping problems in high-level competitive sailing.

Methods

The sample consisted of 44 high-level sailing athletes (5 of whom were female; total mean age 24.13 ± 6.67 years) and 34 coaches (1 of whom was female; total mean age 37.01 ± 11.70). An extensive, self-administered questionnaire of substance use was used, and the subjects were asked about sociodemographic data, sport-related factors, DS-related factors (i.e., usage of and knowledge about DSs, sources of information), and doping-related factors. The Kruskal-Wallis ANOVA was used to determine the differences in group characteristics, and Spearman’s rank order correlation and a logistic regression analysis were used to define the relationships between the studied variables.

Results

DS usage is relatively high. More than 77% of athletes consume DSs, and 38% do so on a regular basis (daily). The athletes place a high degree of trust in their coaches and/or physicians regarding DSs and doping. The most important reason for not consuming DSs is the opinion that DSs are useless and a lack of knowledge about DSs. The likelihood of doping is low, and one-third of the subjects believe that doping occurs in sailing (no significant differences between athletes and coaches). The logistic regression found crew number (i.e., single vs. double crew) to be the single significant predictor of DS usage, with a higher probability of DS consumption among single crews.

Conclusion

Because of the high consumption of DSs future investigations should focus on real nutritional needs in sailing sport. Also, since athletes reported that their coaches are the primary source of information about nutrition and DSs, further studies are necessary to determine the knowledge about nutrition, DSs and doping problems among athletes and their support teams (i.e., coaches, physicians, and strength and conditioning specialists).

Infrared (810 nm) low-level laser therapy in experimental model of strain-induced skeletal muscle injury in rats: effects on functional outcomes

Muscle strains are among the most prevalent causes for athletes' absence from sport activities. Low-level laser therapy (LLLT) has recently emerged as a potential contender to nonsteroidal anti-inflammatory drugs in muscle strain treatment. In this work we investigated effects of LLLT and diclofenac on functional outcomes in the acute stage after muscle strain injury in rats. Muscle strain was induced by overloading the tibialis anterior muscle of rats during anesthesia. The injured groups received either no treatment, or a single treatment with diclofenac 30 min prior to injury, or LLLT (810 nm, 100 mW) with doses of 1, 3, 6 or 9 J, at 1 h after injury. Functional outcome measures included a walking index and assessment of electrically induced muscle performance. All treatments (except 9 J LLLT) significantly improved the walking index 12 h postinjury compared with the untreated group. The 3 J group also showed a significantly better walking index than the drug group. All treatments significantly improved muscle performance at 6 and 12 h. LLLT dose of 3 J was as effective as the pharmacological agent in improving functional outcomes in the early phase after a muscle strain injury in rats.

Is there a danger for myopia in anti-doping education? Comparative analysis of substance use and misuse in Olympic racket sports calls for a broader approach

Background

Racket sports are typically not associated with doping. Despite the common characteristics of being non-contact and mostly individual, racket sports differ in their physiological demands, which might be reflected in substance use and misuse (SUM). The aim of this study was to investigate SUM among Slovenian Olympic racket sport players in the context of educational, sociodemographic and sport-specific factors.

Methods

Elite athletes (N = 187; mean age = 22 ± 2.3; 64% male) representing one of the three racket sports, table tennis, badminton, and tennis, completed a paper-and-pencil questionnaire on substance use habits. Athletes in this sample had participated in at least one of the two most recent competitions at the highest national level and had no significant difference in competitive achievement or status within their sport.

Results

A significant proportion of athletes (46% for both sexes) reported using nutritional supplements. Between 10% and 24% of the studied males would use doping if the practice would help them achieve better results in competition and if it had no negative health consequences; a further 5% to 10% indicated potential doping behaviour regardless of potential health hazards. Females were generally less oriented toward SUM than their male counterparts with no significant differences between sports, except for badminton players. Substances that have no direct effect on sport performance (if timed carefully to avoid detrimental effects) are more commonly consumed (20% binge drink at least once a week and 18% report using opioids), whereas athletes avoid substances that can impair and threaten athletic achievement by decreasing physical capacities (e.g. cigarettes), violating anti-doping codes or potentially transgressing substance control laws (e.g. opiates and cannabinoids). Regarding doping issues, athletes' trust in their coaches and physicians is low.

Conclusion

SUM in sports spreads beyond doping-prone sports and drugs that enhance athletic performance. Current anti-doping education, focusing exclusively on rules and fair play, creates an increasingly widening gap between sports and the athletes' lives outside of sports. To avoid myopia, anti-doping programmes should adopt a holistic approach to prevent substance use in sports for the sake of the athletes' health as much as for the integrity of sports.

Gateway to doping? Supplement use in the context of preferred competitive situations, doping attitude, beliefs, and norms

Nutritional supplement (NS) use is widespread in sport. This study applied an integrated social cognitive approach to examine doping attitudes, beliefs, and self-reported doping use behavior across NS users (n = 96) and nonusers (n = 116). Following ethical approval, 212 competitive athletes (age mean = 21.4, s = 4.5; 137 males) completed self-reported measures of doping-related social cognitions and behaviors, presented in an online format where completion implied consent. Significantly more NS users (22.9%) reported doping compared with nonusers (6.0%; U = 4628.0, P < 0.05). NS users presented significantly more positive attitudes toward doping (U = 3152.0, P < 0.05) and expressed a significantly greater belief that doping is effective (U = 3152.0, P < 0.05). When presented with the scenario that performance-enhancing substances are effective and increase the possibility of winning, NS users were significantly more in favor of competing in situations that allow doping (U = 3504.5, P < 0.05). In sum, doping use is three-and-a-half times more prevalent in NS users compared with nonusers. This finding is accompanied by significant differences in doping attitudes, norms, and beliefs. Thus, this article offers support for the gateway hypothesis; athletes who engage in legal performance enhancement practices appear to embody an "at-risk" group for transition toward doping. Education should be appropriately targeted.

Inside athletes' minds: preliminary results from a pilot study on mental representation of doping and potential implications for anti-doping

BACKGROUND

Despite the growing body of literature and putative links between the use of ergogenic nutritional supplements, doping and illicit drugs, it remains unclear whether, in athletes' minds, doping aligns with illicit behaviour or with functional use of chemical or natural preparations. To date, no attempt has been made to quantitatively explore athletes' mental representation of doping in relation to illegality and functionality.

METHODS

A convenience sample of student athletes from a large South-Eastern Australian university responded to an on-line survey. Competitive athletes (n = 46) were grouped based on self-reported use as follows: i) none used (30%), ii) supplement only (22%), iii) illicit only (26%) and iv) both supplements and illicit drug use (22%). Whereas no athlete reported doping, data provided on projected supplement-, doping- and drug use by the four user groups allowed evaluation of doping-related cognition in the context of self-reported supplement- and illicit drug taking behaviour; and comparison between these substances.

RESULTS

A significantly higher prevalence estimation was found for illicit drug use and a trend towards a biased social projection emerged for supplement use. Doping estimates by user groups showed mixed results, suggesting that doping had more in common with the ergogenic nutritional supplement domain than the illicit drug domain.

CONCLUSIONS

Assessing the behavioural domain to which doping belongs to in athletes' mind would greatly advance doping behaviour research toward prevention and intervention. Further investigation refining the peculiarity of the mental representation of doping with a larger study sample, controlling for knowledge of doping and other factors, is warranted.

The Physiological Effects of Creatine Supplementation on Hydration: A Review

In 1992, Harris and colleagues demonstrated that oral creatine supplementation can enhance muscle creatine stores. Since then, creatine has become an important and popular ergogenic aid for improving athletic performance with reports of up to 74% of athletes supplementing with creatine. Although many recent studies have addressed the safety concerns of creatine supplementation on hydration status in hot and humid environments, anecdotal reports still exist linking creatine usage to heat-related problems. These concerns are based on the premise that creatine is an osmotically active substance resulting in an alteration in fluid balance by increasing intracellular fluid volume and preventing fluid from entering the extracellular environment to aid in thermoregulation. However, a number studies have demonstrated that when recommended amounts of creatine are consumed, creatine does not appear to increase the risk of heat-related problems during exercise and may actually have a positive influence on core temperature and heart rate responses.

An LC-MS screening method with library identification for the detection of steroids in dietary supplements

For many years anabolic-androgenic steroids (AAS) are by far the most frequently detected pharmacological substances in doping control. In order to improve their performances, professional sportsmen are often tempted to take dietary supplements. However, due to the frequent and widespread occurrence of contaminated supplements, the use of such products is not without risk for the athletes involved. In order to minimize the chances of an unattended positive doping test or serious health problems, fast and reliable screening methods for the detection of anabolic steroids in dietary supplements are needed. A general screening procedure requires the fast and unambiguous detection of a large range of steroids. Gas chromatography-mass spectrometry (GC-MS) has been used intensively in the detection of doping substances for the past 40 years. Over time, many laboratories have delivered spectra to be included in standard reference databases, one of which is maintained by the National Institute of Standards and Technology (NIST) (Gaithersburg, MD, USA). In recent years, however, liquid chromatography coupled to mass spectrometry (LC-MS) has gained popularity. Unfortunately, existing GC-MS libraries are not applicable to LC-MS analysis. In the present study, a new mass spectral library of 88 steroids was developed, along with a fast UPLC-MS method. For the construction of this mass spectral library, three different mass spectra were measured for each steroid, with a sample cone voltage of 30, 60 and 100 V, respectively. This method was then successfully tested on contaminated dietary supplements which had previously been tested by means of a targeted LC-MS/MS method. Overall, the library search was shown to identify the same compounds as the MRM method.

Use of dietary supplements in Olympic athletes is decreasing: a follow-up study between 2002 and 2009

Background

The aim of this study was to assess the frequency of use of dietary supplements (DS) among large sample of elite Finnish athletes and to describe possible changes in dietary supplement use between the years 2002 and 2009.

Methods

A prospective follow-up study was conducted on Olympic athletes. The first survey was conducted on Olympic athletes in 2002 (N = 446) and the follow-up study was conducted between May 2008 and June 2009 (N = 372).

Results

In 2002, a total of 81% of the athletes used dietary supplements (a mean of 3.37 ± 3.06 DS per user) and in 2009, a total of 73% of the athletes (a mean of 2.60 ± 2.69 per DS user) used them. After adjusting for age-, sex- and sport type, the OR (95% confidence interval, CI) for use of any dietary supplement was significantly less in 2009 as compared with 2002 results (OR, 0.62; 95% CI, 0.43-0.90). Decrease in DS use was observed in all supplement subgroups (vitamins, minerals, nutritional supplements). Athletes in speed and power events and endurance events reported use of any dietary supplement significantly more often than team sport athletes both in 2002 and 2009. In year 2009, the frequency of all dietary supplement use increased when athlete's age increased and the increase was significant in older age groups: of the athletes under 21 years 63%, 21-24 years 83% and over 24 years 90% consumed nutritional supplements.

Conclusions

Based in our study, there seems to be a lowering trend of dietary supplement use among elite Finnish athletes although differences between sport subgroups and age groups are considerable.

How much is too much? A case report of nutritional supplement use of a high-performance athlete

Although dietary nutrient intake is often adequate, nutritional supplement use is common among elite athletes. However, high-dose supplements or the use of multiple supplements may exceed the recommended daily allowance (RDA) of particular nutrients or even result in a daily intake above tolerable upper limits (UL). The present case report presents nutritional intake data and supplement use of a highly trained male swimmer competing at international level. Habitual energy and micronutrient intake were analysed by 3 d dietary reports. Supplement use and dosage were assessed, and total amount of nutrient supply was calculated. Micronutrient intake was evaluated based on RDA and UL as presented by the European Scientific Committee on Food, and maximum permitted levels in supplements (MPL) are given. The athlete's diet provided adequate micronutrient content well above RDA except for vitamin D. Simultaneous use of ten different supplements was reported, resulting in excess intake above tolerable UL for folate, vitamin E and Zn. Additionally, daily supplement dosage was considerably above MPL for nine micronutrients consumed as artificial products. Risks and possible side effects of exceeding UL by the athlete are discussed. Athletes with high energy intake may be at risk of exceeding UL of particular nutrients if multiple supplements are added. Therefore, dietary counselling of athletes should include assessment of habitual diet and nutritional supplement intake. Educating athletes to balance their diets instead of taking supplements might be prudent to prevent health risks that may occur with long-term excess nutrient intake.

[What illegal substances are used by sportsmen? a study in Midi-Pyrénées Doping Preventing Medical Centre (AMPD-MP)]

OBJECTIVE

Doping Preventing Medical Centres (Antennes Médicales de Prévention du Dopage) were established in France in 2000 in order to help sportsmen using illegal substances. These services are also information centres on illegal substances (drugs or others) used in sport. The aim of the study was to analyze the characteristics of sportsmen outpatient clinics in Antenne Médicale de Prevention du Dopage Midi-Pyrénées (AMPD-MP).

METHODS

We present the results of outpatient clinics in AMPD-MP from 2002 to 2008. A descriptive analysis of demographic data, substances used and sports practised were performed.

RESULTS

During this 7 year-period, 35 outpatient clinics were performed [32 men, 3 women, mean age: 28 years (extreme values: 18-47; 10 patients ≥ 30 years)]. They were mainly involved in national (16), international (8) or regional (7) competitions. The main sports involved were rugby (9) followed by cycling (5), athletics (3) and body-building (3). The most frequently used illegal substances were cannabis (15) followed by glucocorticoïds (9), androgens (4), indirect sympathomimetics amphetaminics (4), beta 2 adrenergic agonists (2) and NSAIDs (2). Two veterinary substances (clenbuterol, boldone-veterinaire) were also found in body-builders.

CONCLUSION

This study shows a clear under use of Doping Preventing Medical Centres by sportsmen and practitioners. It also indicates a relative high age for sportsmen referred to the centre. The main sports involved were rugby and cycling. Cannabis and glucocorticoïds were the drugs more often involved in doping behaviours.