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Vernec A, Healy D, Banon T, Petroczi A. Prevalence of therapeutic use exemptions at the Olympic Games and Paralympic Games: an analysis of data from 2016 to 2022. Br J Sports Med 2024:bjsports-2024-108266. [PMID: 38981660 DOI: 10.1136/bjsports-2024-108266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2024] [Indexed: 07/11/2024]
Abstract
OBJECTIVES The objectives of this study are to describe the prevalence of therapeutic use exemptions (TUEs) among athletes competing in four Olympic and four Paralympic games. The secondary objective was to present the prohibited substance and methods classes associated with TUEs. METHODS Data from the Anti-Doping Administration and Management System were extracted for this cross-sectional observation study. Eight cohorts were created to include athletes with TUEs who competed in the Rio 2016, Pyeongchang 2018, Tokyo 2020 and Beijing 2022 Olympic and Paralympic games. Prevalence of TUEs and proportion of prohibited substance and methods classes were defined as percentages among all athletes competing at each games. RESULTS 28 583 athletes competed in four editions of the Olympic games. Total prevalence of athletes with TUEs was 0.90% among all competitors. At the four Paralympic games, a total of 9852 athletes competed and the total TUE prevalence was 2.76%. The most frequently observed substances associated with TUEs at the Summer Olympics were glucocorticoids (0.50% in Rio) and stimulants (0.39% in Tokyo). At the Summer Paralympics, diuretics (0.79% in Rio) and stimulants (0.75% in Tokyo) were the most common. Winter games had somewhat similar trends, although TUE numbers were very low. CONCLUSIONS The number of athletes competing with valid TUEs at the Olympic and Paralympic games was <1% and <3%, respectively. Variations in substances and methods associated with TUEs for different medical conditions were identified. Nevertheless, numbers were low, further reaffirming that TUEs are not widespread in elite sport.
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Affiliation(s)
- Alan Vernec
- Science and Medicine, World Anti-Doping Agency, Montreal, Quebec, Canada
| | - David Healy
- Science and Medicine, World Anti-Doping Agency, Montreal, Quebec, Canada
| | - Tamar Banon
- Science and Medicine, World Anti-Doping Agency, Montreal, Quebec, Canada
| | - Andrea Petroczi
- School of Life Sciences, Pharmacy and Chemistery, Kingston University, Kingston, UK
- Institute of Health Promotion & Sport Sciences, Eötvös Loránd University, Budapest, Hungary
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2
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Chang WCW, Hsu MC, Liao PC. Detection of emerging patterns of drug misuse in sports via wastewater monitoring: A mini-review and potential strategies. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2023; 333:122087. [PMID: 37348696 DOI: 10.1016/j.envpol.2023.122087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/16/2023] [Accepted: 06/19/2023] [Indexed: 06/24/2023]
Abstract
Biological testing is a key component of the current anti-doping programme implemented by the authorities to detect doping in sports. Strategies such as longitudinal individualised data analysis and sport-specific analysis have been developed to increase the comprehensiveness of the testing. However, the trends of drug misuse in sports might not be effectively captured through today's testing plan. Wastewater testing, assembling individual-level data of a designated group to produce population-level results in one single aggregated sample, can be employed to as a complementary strategy offering added value for doping control. This paper presents an updated summary of the status of anti-doping testing and analytical methodologies for wastewater. The available literature on wastewater-based analyses of drugs prohibited in sports is reviewed. Publications surrounding sporting activities or competitions and others relevant to sports doping are selected. We debate between potential strategies and major limitations of using wastewater monitoring in anti-doping. Knowledge gaps and research directions, specifically on metabolites, stability, sensitivity, and ethical and legal considerations, are discussed. Choosing different wastewater sampling sites allows target sub-population that involved competing athletes and potentially reveal sport-specific or athlete-level-specific behaviour. Sampling from on-board toilets or athlete villages could target international-level athletes, sampling from the dormitories of national training centres allows monitoring of national-level athletes on a daily basis, and sampling from sports stadiums provides a full picture of drug use in the general population during an event. Confounding occurs as (i) the presence of non-athlete composition and the difficulty of analyses to be completely selective to the athlete population; and (ii) the identification of compounds prescribed legitimately with Therapeutic Use Exemptions, only banned in-competition, and naturally occurring. The practicalities of the approach are contextualised in monitoring the non-threshold substances such as anabolic agents, selective androgen receptor modulators, metabolic modulators, and hypoxia-inducible factor activators.
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Affiliation(s)
- William Chih-Wei Chang
- School of Pharmacy, College of Pharmacy, Kaohsiung Medical University, Kaohsiung, 807, Taiwan; College of Pharmacy, Kaohsiung Medical University, Kaohsiung, 807, Taiwan.
| | - Mei-Chich Hsu
- Department of Sports Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 807, Taiwan.
| | - Pao-Chi Liao
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, 704, Taiwan.
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3
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Bizjak DA, Nussbaumer D, Winkert K, Treff G, Takabajashi K, Mentz L, Schober F, Buhl JL, John L, Dreyhaupt J, Steeb L, Harps LC, Parr MK, Diel P, Zügel M, Steinacker JM. Acute Effects of Single Versus Combined Inhaled β2-Agonists Salbutamol and Formoterol on Time Trial Performance, Lung Function, Metabolic and Endocrine Variables. SPORTS MEDICINE - OPEN 2023; 9:79. [PMID: 37640958 PMCID: PMC10462601 DOI: 10.1186/s40798-023-00630-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 08/17/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND High prevalence rates of β2-agonist use among athletes in competitive sports makes it tempting to speculate that illegitimate use of β2-agonists boosts performance. However, data regarding the potential performance-enhancing effects of inhaled β2-agonists and its underlying molecular basis are scarce. METHODS In total, 24 competitive endurance athletes (12f/12m) participated in a clinical double-blinded balanced four-way block cross-over trial to investigate single versus combined effects of β2-agonists salbutamol (SAL) and formoterol (FOR), to evaluate the potential performance enhancement of SAL (1200 µg, Cyclocaps, Pb Pharma GmbH), FOR (36 µg, Sandoz, HEXAL AG) and SAL + FOR (1200 µg + 36 µg) compared to placebo (PLA, Gelatine capsules containing lactose monohydrate, Pharmacy of the University Hospital Ulm). Measurements included skeletal muscle gene and protein expression, endocrine regulation, urinary/serum β2-agonist concentrations, cardiac markers, cardiopulmonary and lung function testing and the 10-min time trial (TT) performance on a bicycle ergometer as outcome variables. Blood and urine samples were collected pre-, post-, 3 h post- and 24 h post-TT. RESULTS Mean power output during TT was not different between study arms. Treatment effects regarding lung function (p < 0.001), echocardiographic (left ventricular end-systolic volume p = 0.037; endocardial global longitudinal strain p < 0.001) and metabolic variables (e.g. NR4A2 and ATF3 pathway) were observed without any influence on performance. In female athletes, total serum β2-agonist concentrations for SAL and FOR were higher. Microarray muscle gene analysis showed a treatment effect for target genes in energy metabolism with strongest effect by SAL + FOR (NR4A2; p = 0.001). Of endocrine variables, follicle-stimulating hormone (3 h Post-Post-TT), luteinizing hormone (3 h Post-Pre-TT) and insulin (Post-Pre-TT) concentrations showed a treatment effect (all p < 0.05). CONCLUSIONS No endurance performance-enhancing effect for SAL, FOR or SAL + FOR within the permitted dosages compared to PLA was found despite an acute effect on lung and cardiac function as well as endocrine and metabolic variables in healthy participants. The impact of combined β2-agonists on performance and sex-specific thresholds on the molecular and cardiac level and their potential long-term performance enhancing or health effects have still to be determined. TRIAL REGISTRATION Registered at Eudra CT with the number: 2015-005598-19 (09.12.2015) and DRKS with number DRKS00010574 (16.11.2021, retrospectively registered).
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Affiliation(s)
- Daniel A Bizjak
- Department of Internal Medicine, Division of Sports and Rehabilitation Medicine, University Hospital Ulm, 89075, Ulm, Germany.
| | - Dorle Nussbaumer
- Department of Internal Medicine, Division of Sports and Rehabilitation Medicine, University Hospital Ulm, 89075, Ulm, Germany
| | - Kay Winkert
- Department of Internal Medicine, Division of Sports and Rehabilitation Medicine, University Hospital Ulm, 89075, Ulm, Germany
| | - Gunnar Treff
- Department of Internal Medicine, Division of Sports and Rehabilitation Medicine, University Hospital Ulm, 89075, Ulm, Germany
- Institute of Sports Medicine, Paracelsus Medical University Salzburg, 5020, Salzburg, Austria
| | - Kensuke Takabajashi
- Department of Internal Medicine, Division of Sports and Rehabilitation Medicine, University Hospital Ulm, 89075, Ulm, Germany
| | - Lennart Mentz
- Department of Internal Medicine, Division of Sports and Rehabilitation Medicine, University Hospital Ulm, 89075, Ulm, Germany
| | - Franziska Schober
- Department of Internal Medicine, Division of Sports and Rehabilitation Medicine, University Hospital Ulm, 89075, Ulm, Germany
| | - Jasmine-Lèonike Buhl
- Department of Internal Medicine, Division of Sports and Rehabilitation Medicine, University Hospital Ulm, 89075, Ulm, Germany
| | - Lucas John
- Department of Internal Medicine, Division of Sports and Rehabilitation Medicine, University Hospital Ulm, 89075, Ulm, Germany
| | - Jens Dreyhaupt
- Institute of Epidemiology and Medical Biometry, Ulm University, 89075, Ulm, Germany
| | - Luise Steeb
- Institute of Epidemiology and Medical Biometry, Ulm University, 89075, Ulm, Germany
| | - Lukas C Harps
- Pharmaceutical Analysis and Metabolism, Institute of Pharmacy, Freie Universität Berlin, 14195, Berlin, Germany
| | - Maria K Parr
- Pharmaceutical Analysis and Metabolism, Institute of Pharmacy, Freie Universität Berlin, 14195, Berlin, Germany
| | - Patrick Diel
- Institute of Cardiovascular Research and Sports Medicine, Molecular and Cellular Sports Medicine, German Sport University Cologne, 50933, Cologne, Germany
| | - Martina Zügel
- Department of Internal Medicine, Division of Sports and Rehabilitation Medicine, University Hospital Ulm, 89075, Ulm, Germany
| | - Jürgen M Steinacker
- Department of Internal Medicine, Division of Sports and Rehabilitation Medicine, University Hospital Ulm, 89075, Ulm, Germany
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Nokoff NJ, Senefeld J, Krausz C, Hunter S, Joyner M. Sex Differences in Athletic Performance: Perspectives on Transgender Athletes. Exerc Sport Sci Rev 2023; 51:85-95. [PMID: 37057897 PMCID: PMC10330580 DOI: 10.1249/jes.0000000000000317] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
Sex hormone concentrations, particularly testosterone, are primary determinants of sex-based differences in athletic and sports performance, and this relationship may inform fair competition and participation for athletes. This article describes the sex-based dichotomy in testosterone and the implications for sex-based differences in individual sports performance, including factors that relate to athletic performance for transgender individuals, and areas of future investigation.
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Affiliation(s)
- Natalie J Nokoff
- Division of Endocrinology, Department of Pediatrics, University of Colorado Anschutz Medical Campus
| | - Jonathon Senefeld
- Department of Anesthesiology & Perioperative Medicine and Department of Physiology & Biomedical Engineering, Mayo Clinic, Rochester, MN
| | - Csilla Krausz
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Sandra Hunter
- Exercise Science Program, Department of Physical Therapy, and Athletic & Human Performance Research Center, Marquette University, Milwaukee, WI
| | - Michael Joyner
- Department of Anesthesiology & Perioperative Medicine and Department of Physiology & Biomedical Engineering, Mayo Clinic, Rochester, MN
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5
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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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6
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Psychosocial aspects of sports medicine in pediatric athletes: Current concepts in the 21 st century. Dis Mon 2022:101482. [PMID: 36100481 DOI: 10.1016/j.disamonth.2022.101482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Behavioral aspects of organized sports activity for pediatric athletes are considered in a world consumed with winning at all costs. In the first part of this treatise, we deal with a number of themes faced by our children in their sports play. These concepts include the lure of sports, sports attrition, the mental health of pediatric athletes (i.e., effects of stress, anxiety, depression, suicide in athletes, ADHD and stimulants, coping with injuries, drug use, and eating disorders), violence in sports (i.e., concepts of the abused athlete including sexual abuse), dealing with supervisors (i.e., coaches, parents), peers, the talented athlete, early sports specialization and sports clubs. In the second part of this discussion, we cover ergolytic agents consumed by young athletes in attempts to win at all costs. Sports doping agents covered include anabolic steroids (anabolic-androgenic steroids or AAS), androstenedione, dehydroepiandrostenedione (DHEA), human growth hormone (hGH; also its human recombinant homologue: rhGH), clenbuterol, creatine, gamma hydroxybutyrate (GHB), amphetamines, caffeine and ephedrine. Also considered are blood doping that includes erythropoietin (EPO) and concepts of gene doping. In the last section of this discussion, we look at disabled pediatric athletes that include such concepts as athletes with spinal cord injuries (SCIs), myelomeningocele, cerebral palsy, wheelchair athletes, and amputee athletes; also covered are pediatric athletes with visual impairment, deafness, and those with intellectual disability including Down syndrome. In addition, concepts of autonomic dysreflexia, boosting and atlantoaxial instability are emphasized. We conclude that clinicians and society should protect our precious pediatric athletes who face many challenges in their involvement with organized sports in a world obsessed with winning. There is much we can do to help our young athletes find benefit from sports play while avoiding or blunting negative consequences of organized sport activities.
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7
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Collomp K, Ericsson M, Bernier N, Buisson C. Prevalence of Prohibited Substance Use and Methods by Female Athletes: Evidence of Gender-Related Differences. Front Sports Act Living 2022; 4:839976. [PMID: 35685685 PMCID: PMC9172204 DOI: 10.3389/fspor.2022.839976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 04/04/2022] [Indexed: 02/05/2023] Open
Abstract
To achieve optimal sports performances, women and men may show specific doping practices because of the physiological and psychological gender differences, but there are few data on this topic. Here, we report the apparent use of prohibited substances and methods by female athletes based on analyses of the doping tests collected by the French Anti-Doping Agency from 2013 to 2019. We compared the frequency of use and the ergogenic and side effects to those of their male counterparts. The results revealed lower use of prohibited substances in female vs. male athletes, with significantly fewer anabolic agents, hormone and metabolic modulators, and cannabinoids. Gender specificity in utilization of substance classes was also shown. Relatively lower use of hormone modulators and cannabinoids and higher use of beta-2 agonists, diuretics and glucocorticoids were found in the woman cohort compared with men cohort, combined with the different choice of substances, possibly because of the altered ergogenic and/or side effects. However, no impact due to gender regarding the sports disciplines was observed, with both women and men showing similar use of anabolic agents, mainly in the anaerobic sports, and EPO and corticoids, mainly in endurance or mixed sports. Further studies are needed to put these French data into a global perspective, comparing uses across countries and exploring possible new developments in the fight against doping in women.
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Affiliation(s)
- Katia Collomp
- CIAMS, Université d'Orléans, Pôle STAPS, Orléans, France
- CIAMS, Université Paris-Saclay, Faculté des Sciences du Sport, Orsay, France
- Laboratoire AntiDopage Français, LADF, Université Paris-Saclay, Chatenay-Malabry, France
- *Correspondence: Katia Collomp
| | - Magnus Ericsson
- Laboratoire AntiDopage Français, LADF, Université Paris-Saclay, Chatenay-Malabry, France
| | - Nathan Bernier
- CIAMS, Université d'Orléans, Pôle STAPS, Orléans, France
- CIAMS, Université Paris-Saclay, Faculté des Sciences du Sport, Orsay, France
| | - Corinne Buisson
- Laboratoire AntiDopage Français, LADF, Université Paris-Saclay, Chatenay-Malabry, France
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Abstract
The rules of fair play in sport generally prohibit the use of performance-enhancing drugs (PEDs). The World Anti-Doping Agency (WADA) oversees global antidoping regulations and testing for elite athletes participating in Olympic sports. Efforts to enforce antidoping policies are complicated by the diverse and evolving compounds and strategies employed by athletes to gain a competitive edge. Now between the uniquely proximate 2021 Tokyo and 2022 Beijing Olympic Games, we discuss WADA's efforts to prevent PED use during the modern Olympic Games. Then, we review the major PED classes with a focus on pathophysiology, complexities of antidoping testing, and relevant toxicities. Providers from diverse practice environments are likely to care for patients using PEDs for a variety of reasons and levels of sport; these providers should be aware of common PED classes and their risks.
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Affiliation(s)
- C James Watson
- Harvard Medical Toxicology Program, Boston Children's Hospital, Boston, MA, USA.,Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Genevra L Stone
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Daniel L Overbeek
- Harvard Medical Toxicology Program, Boston Children's Hospital, Boston, MA, USA.,Department of Emergency Medicine, University of Rochester, Rochester, NY, USA
| | - Takuyo Chiba
- Department of Emergency Medicine, International University of Health and Welfare, Ōtawara, Japan
| | - Michele M Burns
- Harvard Medical Toxicology Program, Boston Children's Hospital, Boston, MA, USA.,Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, USA
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9
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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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10
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Allen H, Price OJ, Hull JH, Backhouse SH. Asthma medication in athletes: a qualitative investigation of adherence, avoidance and misuse in competitive sport. J Asthma 2021; 59:811-822. [PMID: 33504234 DOI: 10.1080/02770903.2021.1881968] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The purpose of this qualitative study was to utilize the Capability, Opportunity, Motivation - Behavior model (COM-B) to: (1) evaluate athlete knowledge and understanding of current asthma-related anti-doping regulations, (2) explore the impact of environmental and societal influences on athletes with asthma, and (3) examine athlete perception of asthma medication use in competitive sport.Methods: Semi-structured interviews were conducted with ten competitive endurance athletes (five athletes with asthma and five without asthma). Interviews were guided by the COM-B model and transcripts were analyzed inductively and deductively using reflexive thematic analysis.Results: Mapping the experiences and perceptions of athletes against an established behavioral framework identified that: (1) athletes' possess limited knowledge and understanding of the World Anti-Doping Agency (WADA) Prohibited List and Therapeutic use exemption (TUE) policy with respect to asthma medication; (2) the use of sub-optimal diagnostic methods is commonplace and increases the risk of misdiagnosis and unnecessary inhaler therapy; (3) negative media portrayal of high-profile asthma-related doping allegations impacts public opinion and contributes to the perception of wrongdoing within the sporting community.Conclusion: The novel application of behavioral science highlights several factors that may contribute to asthma medication avoidance and promote misuse in competitive sport. The findings from this study provide a foundation for the development and implementation of targeted education programmes, and it is hoped that employing this approach will ultimately improve overall perceptions of asthma treatment in athletes, which is necessary to maintain respiratory health, optimize performance and protect the integrity of sport. © 2021 The Author(s). Published with license by Taylor & Francis Group, LLC.
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Affiliation(s)
- Hayden Allen
- Carnegie School of Sport, Leeds Beckett University, Leeds, UK
| | - Oliver J Price
- Carnegie School of Sport, Leeds Beckett University, Leeds, UK.,Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
| | - James H Hull
- Department of Respiratory Medicine, Royal Brompton Hospital, London, UK.,Institute of Sport, Exercise and Health (ISEH), UCL, London, UK
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Abstract
The aim of this investigation was to describe the outcomes of the adverse analytical findings in different Olympic sports. The data included were gathered from the World Anti-Doping Agency Anti-doping Rule Violations Reports (2013-2017). Weightlifting (78.1 ± 9.4%) wrestling (73.2 ± 18.5%) and volleyball (68.3 ± 18.7%) were the sports with the highest proportion of cases that ended in an antidoping sanction. Gymnastics (45.1 ± 10.1%), triathlon (32.6 ± 11.9%) and shooting (29.9 ± 14.1%) were the sports with a higher frequency of cases that were not sanctioned due to medical reasons. Gymnastics (22.4 ± 18.4%), boxing (23.2 ± 16.0%) and taekwondo (17.3.1 ± 16.4%) presented the highest proportion of cases that are still pending resolution. The proportion of cases that ended in no sanction was higher in fencing (26.2 ± 22.7%), skating (23.6 ± 35.1%) and tennis (18.6 ± 26.5%). These results indicate that the sanctions derived from antidoping rule violations were not uniform in all sports disciplines.
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12
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Fincoeur B, Henning A, Ohl F. Fifty shades of grey? On the concept of grey zones in elite cycling. ACTA ACUST UNITED AC 2020. [DOI: 10.1016/j.peh.2020.100179] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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