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Nordsborg NB, Bonne TC, Breenfeldt Andersen A, Sørensen H, Bejder J. Glucocorticoids Accelerate Erythropoiesis in Healthy Humans-Should the Use in Sports Be Reevaluated? Med Sci Sports Exerc 2023; 55:1334-1341. [PMID: 36878016 DOI: 10.1249/mss.0000000000003156] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
PURPOSE The World Anti-Doping Agency prohibits glucocorticoid administration in competition but not in periods out of competition. Glucocorticoid usage is controversial as it may improve performance, albeit debated. A hitherto undescribed but performance-relevant effect of glucocorticoids in healthy humans is accelerated erythropoiesis. We investigated whether a glucocorticoid injection accelerates erythropoiesis, increases total hemoglobin mass, and improves exercise performance. METHODS In a counterbalanced, randomized, double-blinded, placebo-controlled crossover design (3 months washout), 10 well-trained males (peak oxygen uptake, 60 ± 3 mL O 2 ·min -1 ·kg -1 ) were injected with 40 mg triamcinolone acetonide (glucocorticoid group) or saline (placebo group) in the gluteal muscles. Venous blood samples collected before and 7-10 h, 1, 3, 7, 14, and 21 d after treatment were analyzed for hemoglobin concentration and reticulocyte percentage. Hemoglobin mass and mean power output in a 450-kcal time trial were measured before as well as 1 and 3 wk after treatment. RESULTS A higher reticulocyte percentage was evident 3 d (19% ± 30%, P < 0.05) and 7 d (48% ± 38%, P < 0.001) after glucocorticoid administration, compared with placebo, whereas hemoglobin concentration was similar between groups. Additionally, hemoglobin mass was higher ( P < 0.05) 7 d (glucocorticoid, 886 ± 104 g; placebo, 872 ± 103 g) and 21 d (glucocorticoid, 879 ± 111 g; placebo, 866 ± 103 g) after glucocorticoid administration compared with placebo. Mean power output was similar between groups 7 d (glucocorticoid, 278 ± 64 W; placebo, 275 ± 62 W) and 21 d (glucocorticoid, 274 ± 62 W; placebo, 275 ± 60 W) after treatment. CONCLUSIONS Intramuscular injection of 40 mg triamcinolone acetonide accelerates erythropoiesis and increases hemoglobin mass but does not improve aerobic exercise performance in the present study. The results are important for sport physicians administering glucocorticoids and prompt a reconsideration of glucocorticoid usage in sport.
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Affiliation(s)
| | - Thomas Christian Bonne
- Department of Nutrition, Exercise and Sports (NEXS), University of Copenhagen, Copenhagen, DENMARK
| | | | - Henrik Sørensen
- Department of Anesthesiology, Centre for Cancer and Organ Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, DENMARK
| | - Jacob Bejder
- Department of Nutrition, Exercise and Sports (NEXS), University of Copenhagen, Copenhagen, DENMARK
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Riiser A, Stensrud T, Andersen LB. Glucocorticoids and physical performance: A systematic review with meta-analysis of randomized controlled trials. Front Sports Act Living 2023; 5:1108062. [PMID: 37033881 PMCID: PMC10076788 DOI: 10.3389/fspor.2023.1108062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 03/06/2023] [Indexed: 04/11/2023] Open
Abstract
Introduction This systematic review with meta-analysis investigates the effect of glucocorticoids on maximal and submaximal performance in healthy subjects. Methods We searched for randomised controlled trials investigating the effect of glucocorticoids on physical performance in Web of Science, Scopus, Medline, Embase and SportDiscus in March 2021. Risk of bias was assessed with the revised Cochrane Collaboration Risk of Bias Tool (RoB2). Data from random effect models are presented as standardized difference in mean (SDM) with 95% confidence interval. We included 15 studies comprising 175 subjects. Results Two studies had high risk of bias. Glucocorticoids had a small positive effect on maximal physical performance compared to placebo (SDM 0.300, 95% CI 0.080 to 0.520) and the SDM for the 13 included comparisons was not heterogeneous (I2 = 35%, p = 0.099). Meta regression found no difference in the effect of acute treatment vs. prolonged treatment or oral ingestion vs. inhalation (p > 0.124). In stratified analysis prolonged treatment (SDM 0.428, 95% CI 0.148 to 0.709) and oral ingestion (SDM 0.361, 95% CI 0.124 to 0.598) improved physical performance. Glucocorticoids improved aerobic performance (SDM 0.371, 95% CI 0.173 to 0.569) but not anaerobic performance (p = 0.135). Glucocorticoids did not change energy expenditure during submaximal performance (SDM 0.0.225 95% CI -0.771 to 0.112). Discussion This study indicates that glucocorticoids improves maximal performance and aerobic performance. Glucocorticoids did not affect the energy expenditure during submaximal performance. The conclusions are based on relatively few subjects leading to limited statistical power and uncertain estimates. Still, these results are consistent and should be of interest to WADA and anyone concerned about fair play. Systematic Review Registration Open Science Framework 2021-04-29 (https://osf.io/fc29t/).
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Affiliation(s)
- Amund Riiser
- Faculty of Teacher Education, Art and Sport, Western Norway University of Applied Sciences, Sogndal, Norway
- Correspondence: Amund Riiser
| | - Trine Stensrud
- Department of Sport Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Lars Bo Andersen
- Faculty of Teacher Education, Art and Sport, Western Norway University of Applied Sciences, Sogndal, Norway
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3
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Effect of Glucocorticoids on Athletic Performance: A Systematic Review and Meta-Analysis. Clin J Sport Med 2022; 32:e151-e159. [PMID: 34009793 DOI: 10.1097/jsm.0000000000000911] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 11/23/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the effects of glucocorticoids in enhancing athletic performance. DESIGN At least 2 independent reviewers conducted study selection and extracted demographic and outcome data. Relevant outcomes were stratified by administration time frame and the specific type of drug used. Study quality was assessed using the Cochrane Risk-of-Bias tool and the Cochrane Grading of Recommendations Assessment Development and Education scale. Where appropriate, meta-analyses were performed. Data sources: Embase, MEDLINE, and SPORTDiscus were searched from their beginning to April 2020. PARTICIPANTS Participants of any sex and training status aged 18 to 65 years were included. INTERVENTIONS AND MAIN OUTCOME MEASURES Any type of published randomized controlled trial (RCT) that examined any enhancement in sport as well as aerobic, anaerobic, or body compositional parameters for glucocorticoids compared with placebo. RESULTS There is low-to-moderate evidence suggesting that the administration of glucocorticoids may be more beneficial than placebo in enhancing athletic performance. short-term administration of glucocorticoids significantly improved time to exhaustion, maximal force, and total distance travelled. By contrast, acute administration of glucocorticoids predominantly yielded no changes to athletic performance, except for reductions in total work and maximal power output. CONCLUSIONS Although there is evidence suggesting glucocorticoids have ergogenic effects, these improvements may differ depending on the specific type of drug, dose, and the administration time frame and are also limited by small sample sizes. Therefore, there is a need for large, high-quality RCTs as this may influence future doping policy and athlete care.
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4
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Ventura R, Daley-Yates P, Mazzoni I, Collomp K, Saugy M, Buttgereit F, Rabin O, Stuart M. A novel approach to improve detection of glucocorticoid doping in sport with new guidance for physicians prescribing for athletes. Br J Sports Med 2021; 55:bjsports-2020-103512. [PMID: 33879477 DOI: 10.1136/bjsports-2020-103512] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2021] [Indexed: 01/13/2023]
Abstract
The systemic effect of glucocorticoids (GCs) following injectable routes of administration presents a potential risk to both improving performance and causing harm to health in athletes. This review evaluates the current GC antidoping regulations defined by the World Anti-Doping Agency and presents a novel approach for defining permitted and prohibited use of glucocorticoids in sport based on the pharmacological potential for performance enhancement (PE) and risk of adverse effects on health. Known performance-enhancing doses of glucocorticoids are expressed in terms of cortisol-equivalent doses and thereby the dose associated with a high potential for PE for any GC and route of administration can be derived. Consequently, revised and substance-specific laboratory reporting values are presented to better distinguish between prohibited and permitted use in sport. In addition, washout periods are presented to enable clinicians to prescribe glucocorticoids safely and to avoid the risk of athletes testing positive for a doping test.
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Affiliation(s)
- Rosa Ventura
- Catalonian Antidoping Laboratory, IMIM, Hospital del Mar Institute for Medical Research, Barcelona, Catalunya, Spain
| | - Peter Daley-Yates
- Clinical Pharmacology & Experimental Medicine, GSK, Brentford, London, UK
| | - Irene Mazzoni
- Science & Medicine Department, World Anti-Doping Agency, Montreal, Quebec, Canada
| | - Katia Collomp
- CIAMS, Université d'Orléans, Orléans, France
- Université Paris-Saclay CIAMS, Orsay, France
- Département des Analyses, AFLD, Chatenay-Malabry, France
| | - Martial Saugy
- REDs, Research and Expertise in antiDoping sciences, University of Lausanne, Lausanne, Switzerland
| | - Frank Buttgereit
- Department of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin, Germany
| | - Olivier Rabin
- Science & Medicine Department, World Anti-Doping Agency, Montreal, Quebec, Canada
| | - Mark Stuart
- International Testing Agency, Lausanne, Switzerland
- Division of Medicine, Centre for Metabolism and Inflammation, University College London, London, UK
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5
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Heuberger JAAC, Cohen AF. Review of WADA Prohibited Substances: Limited Evidence for Performance-Enhancing Effects. Sports Med 2020; 49:525-539. [PMID: 30411235 PMCID: PMC6422964 DOI: 10.1007/s40279-018-1014-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The World Anti-Doping Agency is responsible for maintaining a Prohibited List that describes the use of substances and methods that are prohibited for athletes. The list currently contains 23 substance classes, and an important reason for the existence of this list is to prevent unfair competition due to pharmacologically enhanced performance. The aim of this review was to give an overview of the available evidence for performance enhancement of these substance classes. We searched the scientific literature through PubMed for studies and reviews evaluating the effects of substance classes on performance. Findings from double-blind, randomized controlled trials were considered as evidence for (the absence of) effects if they were performed in trained subjects measuring relevant performance outcomes. Only 5 of 23 substance classes show evidence of having the ability to enhance actual sports performance, i.e. anabolic agents, β2-agonists, stimulants, glucocorticoids and β-blockers. One additional class, growth hormone, has similar evidence but only in untrained subjects. The observed effects all relate to strength or sprint performance (and accuracy for β-blockers); there are no studies showing positive effects on reliable markers of endurance performance. For 11 classes, no well-designed studies are available, and, for the remaining six classes, there is evidence of an absence of a positive effect. In conclusion, for the majority of substance classes, no convincing evidence for performance enhancement is available, while, for the remaining classes, the evidence is based on a total of only 266 subjects from 11 studies.
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Affiliation(s)
| | - Adam F Cohen
- Centre for Human Drug Research, Zernikedreef 8, 2333 CL, Leiden, The Netherlands
- Department of Internal Medicine, Leiden University Medical Centre, Leiden, The Netherlands
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Allen H, Backhouse SH, Hull JH, Price OJ. Anti-doping Policy, Therapeutic Use Exemption and Medication Use in Athletes with Asthma: A Narrative Review and Critical Appraisal of Current Regulations. Sports Med 2020; 49:659-668. [PMID: 30887312 PMCID: PMC6459780 DOI: 10.1007/s40279-019-01075-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Asthma is prevalent in athletes and when untreated can impact both respiratory health and sports performance. Pharmacological inhaler therapy currently forms the mainstay of treatment; however, for elite athletes competing under the constraints of the World Anti-Doping Code (Code), a number of established therapies are prohibited both in and/or out of competition and/or have a maximum permitted dose. The recent release of medical information detailing inhaler therapy in high-profile athletes has brought the legitimacy and utilisation of asthma medication in this setting into sharp focus. This narrative review critically appraises recent changes to anti-doping policy and the Code in the context of asthma management, evaluates the impact of asthma medication use on sports performance and employs a theory of behaviour to examine perceived determinants and barriers to athletes adhering to the anti-doping rules of sport when applied to asthma.
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Affiliation(s)
- Hayden Allen
- Carnegie School of Sport, Leeds Beckett University, Leeds, LS6 3QT, UK
| | - Susan H Backhouse
- Carnegie School of Sport, Leeds Beckett University, Leeds, LS6 3QT, UK
| | - James H Hull
- Department of Respiratory Medicine, Royal Brompton Hospital, London, UK.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Oliver J Price
- Carnegie School of Sport, Leeds Beckett University, Leeds, LS6 3QT, UK.
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7
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Vernec A, Slack A, Harcourt PR, Budgett R, Duclos M, Kinahan A, Mjøsund K, Strasburger CJ. Glucocorticoids in elite sport: current status, controversies and innovative management strategies-a narrative review. Br J Sports Med 2019; 54:8-12. [PMID: 31326919 PMCID: PMC6923944 DOI: 10.1136/bjsports-2018-100196] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2019] [Indexed: 01/08/2023]
Abstract
The use of systemic glucocorticoids (GCs), as well as local injections, continues to be a controversial issue in the sport/anti-doping community. There is widespread and legitimate use of GCs for numerous health conditions, yet there are concerns about side effects and the possibility of enhanced athletic performance in limited settings. This is compounded by the uncertainty regarding the prevalence of GC use, mechanisms underlying physiological effects and complex pharmacokinetics of different formulations. While WADA continues to promote research in this complex area, some international sporting federations, major event organisers and professional sports leagues have introduced innovative rules such as needle policies, mandatory rest periods and precompetition guidelines to promote judicious use of GCs, focusing on athlete health and supervision of medical personnel. These complementary sport-specific rules are helping to ensure the appropriate use of GCs in athletes where overuse is a particular concern. Where systemic GCs are medically necessary, Therapeutic Use Exemptions (TUEs) may be granted after careful evaluation by TUE Committees based on specific and strict criteria. Continued vigilance and cooperation between physicians, scientists and anti-doping organisations is essential to ensure that GC use in sport respects not only principles of fairness and adherence to the rules but also promotes athlete health and well-being. The purpose of this narrative review is to summarise the use and management of GCs in sport illustrating several innovative programmes by sport leagues and federations.
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Affiliation(s)
- Alan Vernec
- Department of Science and Medicine, WADA, Montreal, Quebec, Canada
| | - Andrew Slack
- Medical Affairs, Exactis Innovation, Montreal, Quebec, Canada
| | - Peter Rex Harcourt
- Department of Integrity, Australian Rules Football League (AFL), Melbourne, Victoria, Australia
| | | | - Martine Duclos
- Department of Sport Medicine and Functional Explorations, University Hospital (CHU), G. Montpied Hospital, Clermont-Ferrand, France
| | | | | | - Christian J Strasburger
- Endocrinology, Diabetes and Nutritional Medicine, Charite Universitatsmedizin Berlin, Berlin, Germany
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8
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Tacey A, Parker L, Yeap BB, Joseph J, Lim EM, Garnham A, Hare DL, Brennan-Speranza T, Levinger I. Single-dose prednisolone alters endocrine and haematologic responses and exercise performance in men. Endocr Connect 2019; 8:111-119. [PMID: 30673629 PMCID: PMC6373622 DOI: 10.1530/ec-18-0473] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 01/23/2019] [Indexed: 12/11/2022]
Abstract
The aim of this study was to investigate the effect of a single dose of prednisolone on (A) high-intensity interval cycling performance and (B) post-exercise metabolic, hormonal and haematological responses. Nine young men participated in this double-blind, randomised, cross-over study. The participants completed exercise sessions (4 × 4 min cycling bouts at 90-95% of peak heart rate), 12 h after ingesting prednisolone (20 mg) or placebo. Work load was adjusted to maintain the same relative heart rate between the sessions. Exercise performance was measured as total work performed. Blood samples were taken at rest, immediately post exercise and up to 3 h post exercise. Prednisolone ingestion decreased total work performed by 5% (P < 0.05). Baseline blood glucose was elevated following prednisolone compared to placebo (P < 0.001). Three hours post exercise, blood glucose in the prednisolone trial was reduced to a level equivalent to the baseline concentration in the placebo trial (P > 0.05). Prednisolone suppressed the increase in blood lactate immediately post exercise (P < 0.05). Total white blood cell count was elevated at all time-points with prednisolone (P < 0.01). Androgens and sex hormone-binding globulin were elevated immediately after exercise, irrespective of prednisolone or placebo. In contrast, prednisolone significantly reduced the ratio of testosterone/luteinizing hormone (P < 0.01). Acute prednisolone treatment impairs high-intensity interval cycling performance and alters metabolic and haematological parameters in healthy young men. Exercise may be an effective tool to minimise the effect of prednisolone on blood glucose levels.
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Affiliation(s)
- Alexander Tacey
- Institute for Health and Sport (IHES), Victoria University, Melbourne, Victoria, Australia
- Department of Medicine-Western Health, Australian Institute for Musculoskeletal Science (AIMSS), Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Lewan Parker
- Institute for Health and Sport (IHES), Victoria University, Melbourne, Victoria, Australia
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - Bu B Yeap
- Medical School, University of Western Australia, and Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - John Joseph
- PathWest Laboratory Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Ee M Lim
- PathWest Laboratory Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Andrew Garnham
- Institute for Health and Sport (IHES), Victoria University, Melbourne, Victoria, Australia
| | - David L Hare
- University of Melbourne and the Department of Cardiology, Austin Health, Melbourne, Victoria, Australia
| | - Tara Brennan-Speranza
- Department of Physiology and Bosch Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Itamar Levinger
- Institute for Health and Sport (IHES), Victoria University, Melbourne, Victoria, Australia
- Department of Medicine-Western Health, Australian Institute for Musculoskeletal Science (AIMSS), Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
- Correspondence should be addressed to I Levinger:
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9
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Analgesics and Sport Performance: Beyond the Pain-Modulating Effects. PM R 2017; 10:72-82. [PMID: 28782695 DOI: 10.1016/j.pmrj.2017.07.068] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 07/18/2017] [Accepted: 07/25/2017] [Indexed: 11/24/2022]
Abstract
Analgesics are used widely in sport to treat pain and inflammation associated with injury. However, there is growing evidence that some athletes might be taking these substances in an attempt to enhance performance. Although the pharmacologic action of analgesics and their use in treating pain with and without anti-inflammatory effect is well established, their effect on sport performance is debated. The aim of this review was to evaluate the evidence of whether analgesics are capable of enhancing exercise performance and, if so, to what extent. Paracetamol has been suggested to improve endurance and repeated sprint exercise performance by reducing the activation of higher brain structures involved in pain and cognitive/affective processing. Nonsteroidal anti-inflammatory drugs affect both central and peripheral body systems, but investigation on their ergogenic effect on muscle strength development has provided equivocal results. The therapeutic use of glucocorticoids is indubitable, but clear evidence exists for a performance-enhancing effect after short-term oral administration. Based on the evidence presented in this review article, the ergogenic benefit of analgesics may warrant further consideration by regulatory bodies. In contrast to the aforementioned analgesics, there is a paucity of research on the use of opioids such as tramadol on sporting performance. LEVEL OF EVIDENCE III.
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10
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Tacey A, Parker L, Garnham A, Brennan-Speranza TC, Levinger I. The effect of acute and short term glucocorticoid administration on exercise capacity and metabolism. J Sci Med Sport 2017; 20:543-548. [PMID: 28179068 DOI: 10.1016/j.jsams.2016.10.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 08/20/2016] [Accepted: 10/21/2016] [Indexed: 01/24/2023]
Abstract
OBJECTIVES Glucocorticoids (GC) are commonly used in the treatment of inflammatory conditions. Chronic GC administration has severe side effects that can decrease exercise capacity and, as a result performance. The side effects of acute (single dose) and short term (<7 days) GC administration are less severe, therefore the impact on exercise performance is unclear. Consequently, it is of interest to determine the influence of acute and short term GC administration on exercise capacity and performance and investigate the relationship with metabolism. DESIGN Review article. METHODS Included in the review were studies with healthy volunteers that reported exercise capacity and performance outcomes following acute and short term GC ingestion. Additionally, the relationship of exercise, GC ingestion and metabolism was investigated. RESULTS Acute GC treatment appears to have minimal effects on exercise performance at intensities between 60 and 90% of VO2max. Short term GC treatment improved performance in the majority of studies at various exercise intensities. In general, blood glucose values increased whilst insulin and lactate values remained unchanged following GC administration. However, inconsistencies in metabolic results are present and may be due to variations in exercise protocols and the type and dosage of drug treatments. CONCLUSIONS Acute GC administration has a minimal effect on exercise capacity and performance while short-term GC administration is likely to improve performance. Future studies should focus on the effects of GC on exercise performance and exercise metabolism during and post exercise to determine the effects on exercise capacity.
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Affiliation(s)
- Alexander Tacey
- Clinical Exercise Science Research Program, Institute of Sport, Exercise and Active Living (ISEAL), Victoria University, Australia
| | - Lewan Parker
- Clinical Exercise Science Research Program, Institute of Sport, Exercise and Active Living (ISEAL), Victoria University, Australia
| | - Andrew Garnham
- Clinical Exercise Science Research Program, Institute of Sport, Exercise and Active Living (ISEAL), Victoria University, Australia
| | - Tara C Brennan-Speranza
- Department of Physiology and Bosch Institute for Medical Research, University of Sydney, Australia
| | - Itamar Levinger
- Clinical Exercise Science Research Program, Institute of Sport, Exercise and Active Living (ISEAL), Victoria University, Australia.
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11
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Collomp K, Arlettaz A, Buisson C, Lecoq AM, Mongongu C. Glucocorticoid administration in athletes: Performance, metabolism and detection. Steroids 2016; 115:193-202. [PMID: 27643452 DOI: 10.1016/j.steroids.2016.09.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 09/13/2016] [Indexed: 12/12/2022]
Abstract
It is generally acknowledged in the sporting world that glucocorticoid (GC) use enhances physical performance. This pharmacological class is therefore banned by the World Anti-Doping Agency (WADA) in in-competition samples after systemic but not local (defined as any route other than oral, intravenous, intramuscular or rectal) administration, which thus allows athletes to use GCs for therapeutic purposes. According to the 2016 WADA list, the urine reporting level for all GCs is set at 30ng/ml to distinguish between the authorized and banned routes of administration. The actual data on the ergogenic effects of GC intake are nevertheless fairly recent, with the first study showing improved physical performance with systemic GC administration dating back only to 2007. Moreover, the studies over the last decade coupling ergogenic and metabolic investigations in humans during and after GC intake have shown discrepant results. Similarly, urine discrimination between banned and authorized GC use remains complex, but it seems likely to be improved thanks to new analytical studies and the inclusion of the authorized GC uses (local routes of administration and out-of-competition samples) in the WADA monitoring program. In this review, we first summarize the current knowledge on the ergogenic and metabolic GC effects in humans during various types of exercise. We then present the antidoping legislation and methods of analysis currently used to detect GC abuse and conclude with some practical considerations and perspectives.
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Affiliation(s)
- Katia Collomp
- CIAMS, Université Paris-Sud, Université Paris-Saclay, 91405 Orsay Cedex, France; CIAMS, Université Orléans, 45067 Orléans, France; Département des Analyses, Agence Française de Lutte contre le Dopage, 92290 Chatenay-Malabry, France.
| | - Alexandre Arlettaz
- CIAMS, Université Paris-Sud, Université Paris-Saclay, 91405 Orsay Cedex, France; CIAMS, Université Orléans, 45067 Orléans, France
| | - Corinne Buisson
- Département des Analyses, Agence Française de Lutte contre le Dopage, 92290 Chatenay-Malabry, France
| | - Anne-Marie Lecoq
- CIAMS, Université Paris-Sud, Université Paris-Saclay, 91405 Orsay Cedex, France; CIAMS, Université Orléans, 45067 Orléans, France
| | - Cynthia Mongongu
- Département des Analyses, Agence Française de Lutte contre le Dopage, 92290 Chatenay-Malabry, France
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12
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Bishop-Bailey D. Mechanisms governing the health and performance benefits of exercise. Br J Pharmacol 2014; 170:1153-66. [PMID: 24033098 DOI: 10.1111/bph.12399] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Revised: 07/18/2013] [Accepted: 07/23/2013] [Indexed: 12/18/2022] Open
Abstract
Humans are considered among the greatest if not the greatest endurance land animals. Over the last 50 years, as the population has become more sedentary, rates of cardiovascular disease and its associated risk factors such as obesity, type 2 diabetes and hypertension have all increased. Aerobic fitness is considered protective for all-cause mortality, cardiovascular disease, a variety of cancers, joint disease and depression. Here, I will review the emerging mechanisms that underlie the response to exercise, focusing on the major target organ the skeletal muscle system. Understanding the mechanisms of action of exercise will allow us to develop new therapies that mimic the protective actions of exercise.
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Affiliation(s)
- D Bishop-Bailey
- Comparative Biomedical Sciences, The Royal Veterinary College, London, UK
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13
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Zorgati H, Prieur F, Vergniaud T, Cottin F, Do MC, Labsy Z, Amarantini D, Gagey O, Lasne F, Collomp K. Ergogenic and metabolic effects of oral glucocorticoid intake during repeated bouts of high-intensity exercise. Steroids 2014; 86:10-5. [PMID: 24793567 DOI: 10.1016/j.steroids.2014.04.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 02/04/2014] [Accepted: 04/16/2014] [Indexed: 10/25/2022]
Abstract
All systemically administered glucocorticoids (GC) are prohibited in-competition, because of the potential ergogenic effects. Although short-term GC intake has been shown to improve performance during submaximal exercise, literature on its impact during brief intense exercise appears to be very scant. The purpose of this study was to examine the ergogenic and metabolic effects of prednisone during repeated bouts of high-intensity exercise. In a double-blind randomized protocol, ten recreational male athletes followed two 1-week treatments (Cor: prednisone, 60mg/day or Pla: placebo). At the end of each treatment, they hopped on their dominant leg for 30s three times consecutively and then hopped until exhaustion, with intervals of 5min of passive recovery. Blood and saliva samples were collected at rest and 3min after each exercise bout to determine the lactate, interleukin-6, interleukin-10, TNF-alpha, DHEA and testosterone values. The absolute peak force of the dominant leg was significantly increased by Cor but only during the first 30-s hopping bout (p<0.05), whereas time to exhaustion was not significantly changed after Cor treatment vs Pla (Pla: 119.9±24.7; Cor: 123.1±29.5s). Cor intake lowered basal and end-exercise plasma interleukin-6 and saliva DHEA (p<0.01) and increased interleukin-10 (p<0.01), whereas no significant change was found in blood lactate and TNF-alpha or saliva testosterone between Pla and Cor. According to these data, short-term glucocorticoid intake did not improve endurance performance during repeated bouts of high-intensity exercise, despite the significant initial increase in absolute peak force and anti-inflammatory effect.
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Affiliation(s)
- Houssem Zorgati
- Laboratoire CIAMS, EA 4532, Université Paris Sud - Université Orléans, France
| | - Fabrice Prieur
- Laboratoire CIAMS, EA 4532, Université Paris Sud - Université Orléans, France
| | - Thomas Vergniaud
- Laboratoire CIAMS, EA 4532, Université Paris Sud - Université Orléans, France
| | - François Cottin
- Laboratoire CIAMS, EA 4532, Université Paris Sud - Université Orléans, France
| | - Manh-Cuong Do
- Laboratoire CIAMS, EA 4532, Université Paris Sud - Université Orléans, France
| | - Zakaria Labsy
- Laboratoire CIAMS, EA 4532, Université Paris Sud - Université Orléans, France
| | | | - Olivier Gagey
- Laboratoire CIAMS, EA 4532, Université Paris Sud - Université Orléans, France
| | | | - Katia Collomp
- Laboratoire CIAMS, EA 4532, Université Paris Sud - Université Orléans, France; Département des Analyses, AFLD, France.
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14
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Siebenmann C, Bloch KE, Lundby C, Nussbamer-Ochsner Y, Schoeb M, Maggiorini M. Dexamethasone Improves Maximal Exercise Capacity of Individuals Susceptible to High Altitude Pulmonary Edema at 4559 m. High Alt Med Biol 2011; 12:169-77. [DOI: 10.1089/ham.2010.1075] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Christoph Siebenmann
- Institute of Human Movement Sciences and Sport, ETH, Zurich, Switzerland
- Center for Integrative Human Physiology (ZIHP), Institute of Physiology, University of Zurich, Zurich, Switzerland
| | - Konrad E. Bloch
- Center for Integrative Human Physiology (ZIHP), Institute of Physiology, University of Zurich, Zurich, Switzerland
- Pulmonary Division, University Hospital of Zurich, Zurich, Switzerland
| | - Carsten Lundby
- Center for Integrative Human Physiology (ZIHP), Institute of Physiology, University of Zurich, Zurich, Switzerland
| | | | - Michèle Schoeb
- Intensive Care Unit DIM, University Hospital of Zurich, Zurich, Switzerland
| | - Marco Maggiorini
- Intensive Care Unit DIM, University Hospital of Zurich, Zurich, Switzerland
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15
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Abstract
Systemic administration of glucocorticoids (GCs) is banned by the World Anti-Doping Agency (WADA) during competition. Few studies have examined the effects of GCs on exercise performance, but increasing evidence has shown that short-term GC intake enhances performance in animals and humans. However, there are many health risks associated with GC use. Based on the available evidence, as presented in this article, I conclude that GCs are doping agents and should remain on the WADA's list of banned products. Because of the complexity of GCs, however, determining the boundaries between their medical use and abuse (eg, in sports) is a constant challenge for the WADA.
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Affiliation(s)
- Martine Duclos
- Department of Sport Medicine and Functional Explorations, University-Hospital (CHU), Hôpital G. Montpied, Clermont-Ferrand, France.
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16
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Abstract
Certain international sports federations are requesting that glucocorticoids (GCs) be removed from the World Antidoping Agency's list of banned products. Their arguments are based on the fact that GCs are in widespread use in sports medicine and have no demonstrated ergogenic activity. This article shows that there is scientific evidence that GCs mediate ergogenic effects in animals and humans. Moreover, the health risks of using GCs are well characterized. GCs are doping agents and should remain on the World Antidoping Agency's list of banned products.
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Affiliation(s)
- Martine Duclos
- Department of Sport Medicine and Functional Explorations, University-Hospital (CHU), Hôpital G. Montpied, Clermont-Ferrand, France.
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17
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Le Panse B, Thomasson R, Jollin L, Lecoq AM, Amiot V, Rieth N, De Ceaurriz J, Collomp K. Short-term glucocorticoid intake improves exercise endurance in healthy recreationally trained women. Eur J Appl Physiol 2009; 107:437-43. [PMID: 19669785 DOI: 10.1007/s00421-009-1149-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2009] [Indexed: 10/20/2022]
Abstract
The present study investigated whether short-term oral administration of glucocorticoid would modify performance and selected hormonal and metabolic parameters during submaximal exercise in healthy women. Nine recreational female athletes completed cycling trials at 70-75% VO(2) max until exhaustion after either placebo (Pla, gelatin) or oral prednisone (Cor, Cortancyl, 50 mg per day for 1 week) treatment, according to a double-blind and randomized protocol. Blood samples were collected at rest; after 10, 20, and 30 min of exercise; at exhaustion; and after 10 and 20 min of passive recovery for adrenocorticotrophic hormone (ACTH), dehydroepiandrosterone (DHEA), prolactin (PRL), growth hormone (GH), insulin (Ins), blood glucose (Glu), and lactate (Lac) determination. Cycling time was significantly increased with short-term Cor intake (Cor: 66.4 +/- 8.4 vs. Pla: 47.9 +/- 6.7 min, P < 0.01). ACTH and DHEA remained completely blunted throughout the experiment with Cor versus Pla (P < 0.01), whereas GH and PRL were significantly decreased with Cor after, respectively, 20 and 30 min of exercise (P < 0.05). No significant difference in Ins or Glu values was found between the two treatments but Lac concentrations were significantly increased with Cor versus Pla between 10 and 30 min of exercise (P < 0.05). These data indicate that short-term glucocorticoid intake improved endurance performance in women, but further investigation is needed to determine whether these results are applicable to elite female athletes and, if so, current WADA legislation needs to be changed.
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Affiliation(s)
- Bénédicte Le Panse
- Laboratoire AMAPP, EA 4248, Université d'Orléans, Allée du Château, BP 6237, 45062, Orléans Cedex 2, France
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