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

Effects of different dietary supplements on athletic performance in soccer players: a systematic review and network meta-analysis

BACKGROUND

As dietary supplements play a crucial role in meeting the unique nutritional needs of soccer players, a growing body of studies are exploring the effects of dietary supplements on athletic performance in soccer players. The effectiveness of certain supplements, such as caffeine and creatine, remains debated due to inconsistent results across studies. Therefore, this systematic review and Bayesian network meta-analysis was conducted to tentatively identify the most effective dietary supplements for soccer players.

METHODS

We searched PubMed, Web of Science, Cochrane, Embase, and SPORTDiscus from database establishment to 5 February 2024 to identify randomized controlled trials (RCTs) evaluating the effects of different dietary supplements on athletic performance in soccer players. The risk of bias was assessed using the revised Cochrane risk-of-bias tool for randomized trials. A Bayesian network meta-analysis was performed using the R software and Stata 18.0. A subgroup analysis was conducted based on the competitive level of the athletes.

RESULTS

Eighty RCTs were included, with 1,425 soccer players randomly receiving 31 different dietary supplements or placebo. The network meta-analysis showed that compared with placebo, carbohydrate + protein (SMD: 2.2, very large), carbohydrate + electrolyte (SMD: 1.3, large), bovine colostrum (SMD: moderate) and caffeine (SMD: 0.29, small) were associated with a significant effect on increasing the distance covered. Kaempferia parviflora (SMD: 0.46, small) was associated with a significant effect on enhancing muscular strength. Beta-alanine (SMD: 0.83, moderate), melatonin (SMD: 0.75, moderate), caffeine (SMD: 0.37, small), and creatine (SMD: 0.33, small) were associated with a significant effect on enhancing jump height. Magnesium creatine chelate (SMD: -3.0, very large), melatonin (SMD: -1.9, large), creatine + sodium bicarbonate (SMD: -1.4, large), and arginine (SMD: -1.2, moderate) were associated with a significant effect on decreasing sprint time. Creatine + sodium bicarbonate (SMD: -2.3, very large) and caffeine (SMD: -0.38, small) were associated with a significant effect on improving agility. Sodium pyruvate (SMD: 0.50, small) was associated with a significant effect on increasing peak power. Magnesium creatine chelate (SMD: 1.3, large) and sodium pyruvate (SMD: 0.56, small) were associated with a significant effect on increasing mean power. Carbohydrate + electrolyte (SMD: -0.56, small) was associated with a significant effect on improving the rating of perceived exertion.

CONCLUSIONS

This study suggests that a range of dietary supplements, including caffeine, creatine, creatine + sodium bicarbonate, magnesium creatine chelate, carbohydrate + electrolyte, carbohydrate + protein, arginine, beta-alanine, bovine colostrum, Kaempferia parviflora, melatonin, and sodium pyruvate, can improve athletic performance in soccer players. This review provides evidence-based guidance for soccer coaches and nutritionists on using dietary supplements to enhance specific performance measures.

The use of pain killers (NSAIDs) in athletes: How large is the risk?

Nonsteroidal anti-inflammatory drug use is prevalent in sport however the risk associated with their use in athletes is not well-understood. This review discusses the pharmacology of nonsteroidal anti-inflammatory drugs and the prevalence of their use in different sports and factors driving this. Use is very high in sports such as professional football and is sometimes by routine without indication and without medical supervision. However there is a paucity of evidence in other sports. There is good evidence for use of nonsteroidal anti-inflammatory drugs following an acute injury but they may prevent normal tissue healing and remodelling if used longer term for musculoskeletal injuries. There are well-known risks of cardiac, gastrointestinal and renal side effects but little specific data for athletes. Renal events are discussed in detail including the cumulative effect that nonsteroidal anti-inflammatory drug use, dehydration and concurrent illness can have to produce significant renal and systemic insult. We then discuss a pragmatic prescribing model enabling clinicians to utilise the beneficial effects of these medications whilst minimising risks.

Investigating Painkiller Use in Amateur Football: A Coach's Perspective

BACKGROUND/OBJECTIVES

Painkiller use in amateur sports and, especially, in football is increasingly being discussed, but the scientific data on this field are very limited. Therefore, the aim of this study was to investigate the prevalence of painkiller use in amateur football from the perspective of coaches, as well as to determine how and to which extent coaches can influence their teams in terms of painkiller use and prevention.

METHODS

Using an online questionnaire, a cross-sectional analysis of painkiller use in German amateur football from the 4th league to the lowest amateur classes was carried out from the perspective of team coaches. A total of 628 participants were contacted, and 400 (63.7%) completed the questionnaire completely and were therefore included in the evaluation.

RESULTS

Of the 400 participating team coaches in amateur football, 369 (92.3%) were male and 31 (7.7%) were female. The coaches reported that 36.2% (SD = 29.1) of their players have used painkillers at some point due to football-related pain in their career. The majority of coaches believed that the use of painkillers is not compatible with competition (74%), and even more believed that it is not compatible with football training (90.8%). Furthermore, 56.2% of the coaches themselves had already taken painkillers in their own football career for football-related pain, and 64% had already bought over-the-counter painkillers without a prescription. The use of painkillers increased in the higher playing levels. The availability of painkillers in first aid kits was reported by around 60%, but they were reported as freely accessible in the dressing room by only 10% of the coaches.

CONCLUSIONS

This is the first study to describe the painkiller use in amateur football from the perspective of coaches. The prevalence of painkiller use in this study was found to be significantly lower than what is indicated in the data from the existing literature. The majority of coaches see the use of painkillers during games and training as incompatible, even though there is a large proportion of coaches who have already bought over-the-counter painkillers for football-related pain. As the first scientific analysis of team coaches, this study provides fundamental data for the prevention of excessive painkiller use in amateur football.

Effects of dietary supplements on athletic performance in elite soccer players: a systematic review

Dietary supplements are widely used among athletes, and soccer players are no exception. Nevertheless, evidence supporting the use of dietary supplements aiming to enhance performance in soccer is somewhat contradictory, scarce, or even nonexistent. Thus, the present study aimed to systematically review and synthesize the effects of dietary supplements on athletic performance (e.g. distance covered, sprinting, jump performance) in elite soccer players. Studies enrolling highly trained, elite, and world-class soccer players using dietary supplements were searched in MEDLINE/PubMed, Web of Science, Scopus, and EBSCO databases in June 2022. In total, 1043 studies were identified, and 18 met the eligibility criteria. The studies evaluated the impacts on athletic performance of several dietary supplements, including caffeine, creatine, protein, beverages with carbohydrates and electrolytes, tart cherry juice, nitrate-rich beetroot juice, sodium bicarbonate with minerals, yohimbine, and a proprietary nutraceutical blend. Caffeine supplementation in doses between 3 and 6 mg/kg of body mass may improve jump height and sprint ability, particularly in female players, but individual response to caffeine must be considered. Creatine may improve sprint, agility, and in female players, jump performance. Protein supplementation can improve sprint and jump performance between matches, especially if protein ingested from food is not up to recommendations. Beverages containing carbohydrates and electrolytes can be used as part of the strategies to achieve carbohydrate intake during training and match-days but used alone do not benefit athletic performance. Tart cherry juice might be useful for maintaining athletic performance after matches that produce higher force loss and exercise-induced muscle damage, although polyphenols from the diet might attenuate the effects of tart cherry supplementation. Nitrate-rich beetroot concentrate can attenuate performance decrease in the days following matches. Further investigation with sodium bicarbonate alone is necessary, as supplementation protocols with elite players included other substances. Finally, the available data does not support yohimbine supplementation or the use of Resurgex Plus® to improve athletic performance in elite soccer players. Still, more well-designed research with elite soccer players is needed to improve support and advice regarding the use of dietary supplements for athletic performance enhancement.

Use of pharmaceuticals amongst athletes tested by Anti-Doping Norway in a five-year period

Introduction

The aim of the study was to map the use of pharmaceuticals by Norwegian athletes registered on doping control forms (DCFs) in a five-year period to examine general and some class specific use of pharmaceuticals across sports and athlete levels.

Method

Anonymous data from DCFs collected in 2015-2019 were manually entered into a database using the Anatomical Therapeutic Chemical (ATC) system for classification of the pharmaceuticals. Variables entered were year of control, gender, age group, athlete level, sport, test type, nationality, and pharmaceuticals (and dietary supplements) used.

Results

Pain killers in the ATC groups M01 A (Nonsteroidal anti-inflammatory drugs - NSAIDs) and N02 B (other analgesics), and anti-asthmatics in ATC groups R03 A and R03 B were the most frequently used pharmaceuticals. National level athletes reported more use of pharmaceuticals (1.4 ± 1.7 pharmaceuticals per form) than recreational level athletes (0.9 ± 1.2). The highest proportion of DCFs containing information about at least one pharmaceutical were found in speed skating (79.1%), alpine skiing (74.0%), rowing (72.4%) and cross-country skiing (71.7%). Painkillers were most frequently used in muscular endurance sports (30.4% and 21.2 % for M01A and N02 B, respectively) and ball and team sports (17.9% and 17.0%). Use of hypnotics was reported from ice-hockey players and alpine skiers in around 8% of the cases.

Coclusion

Use of anti-asthmatics was most often reported amongst athletes specially exposed to cold, chemicals and heavy endurance training. Athletes in specialized sports requiring high levels of strength and/or endurance reported a higher use of pharmaceuticals out-of-competition compared to in-competition, while there was no such difference in complex sports, such as team, gymnastic, aiming and combat sports.

Analgesic Use in Sports

BACKGROUND

Consumption of medication to alleviate pain is widespread in Germany. Around 1.9 million men and women take analgesics every day; some 1.6 million persons are addicted to painkillers. Analgesic use is thought also to be common in sports, even in the absence of pain. The aim of this study was to assess the extent of painkiller use among athletes.

METHODS

In line with the PRISMA criteria and the modified PICO(S) criteria, a systematic literature review was registered (Openscienceframework, https://doi. org/10.17605/OSF.IO/VQ94D) and carried out in PubMed and SURF. The publications identified (25 survey studies, 12 analyses of doping control forms, 18 reviews) were evaluated in standardized manner using the Newcastle Ottawa Scale (NOS) and AMSTAR (A MeaSurement Tool to Assess systematic Reviews).

RESULTS

Analgesic use is widespread in elite sports. The prevalence varies between 2.8% (professional tennis) and 54.2% (professional soccer). Pain medication is also taken prophylactically in the absence of symptoms in some non-elite competitive sports. In the heterogeneous field of amateur sports the data are sparse and there is no reliable evidence of wide-reaching consumption of painkillers. Among endurance athletes, 2.1% of over 50 000 persons stated that they used analgesics at least once each month in connection with sports.

CONCLUSION

Analgesic use has become a problem in many areas of professional/ competitive sports, while the consumption of pain medication apparently remains rare in amateur sports. In view of the increasing harmful use of or even addiction to painkillers in society as a whole, there is a need for better education and, above all, restrictions on advertising.

Analgesia in Athletes: A Review of Commonly Used Oral and Injectable Modalities

Pain is common among athletes at all levels and the treatment of pain can be a challenging and frustrating task. The team physician needs a fundamental knowledge of analgesic strategies as it relates to athletes. It is important to understand the mechanism of action, side effect profile/associated complications, incidence of and indications for use, as well as the controversies associated with the most common analgesic medications used in sports medicine. Several "in vogue" treatment modalities, including cannabidiol, are also becoming more commonly used and are worth discussion.

Supplement intake in half-marathon, (ultra-)marathon and 10-km runners - results from the NURMI study (Step 2)

The primary nutritional challenge facing endurance runners is meeting the nutrient requirements necessary to optimize the performance and recovery of prolonged training sessions. Supplement intake is a commonly used strategy by elite and recreational distance runners to meet nutritional recommendations. This study was conducted to investigate the patterns of supplement intake among different groups of distance runners and the potential association between supplement intake and sex, age, running and racing experiences.In a cross-sectional design, from a total of 317 runners participating in this survey, 119 distance runners were involved in the final sample after data clearance, assigned into three groups of 10-km runners (n = 24), half-marathoners (n = 44), and (ultra-)marathoners (n = 51). Personal characteristics, training and racing experiences, as well as patterns of supplement intake, including type, frequency, and dosage, were evaluated by questionnaire. Food Frequency Questionnaire was implemented to assess macronutrient intake. ANOVA and logistic regression were used for statistical analysis.While 50 % of total distance runners reported consuming supplements regularly, no differences between distance groups in consumption of carbohydrate/protein, mineral, or vitamin supplements were observed (p > 0.05). In addition, age, sex, running and racing experience showed no significant association with supplement intake (p > 0.05). Vitamin supplements had the highest intake rate in runners by 43 % compared to minerals (34 %) and carbohydrate/protein supplements (19 %).The present findings provide a window into the targeted approaches of long-distance runners as well as their coaches and sport nutrition specialists when applying and suggesting sustainable nutritional strategies for training and competition.Trial registration: ISRCTN73074080. Retrospectively registered 12th June 2015.

Sex Differences in Supplement Intake in Recreational Endurance Runners-Results from the NURMI Study (Step 2)

It has been well-documented that female and male athletes differ in many physiological and psychological characteristics related to endurance performance. This sex-based difference appears to be associated with their nutritional demands including the patterns of supplement intake. However, there is a paucity of research addressing the sex differences in supplement intake amongst distance runners. The present study aimed to investigate and compare supplement intake between female and male distance runners (10 km, half-marathon, (ultra-)marathon) and the potential associations with diet type and race distance. A total of 317 runners participated in an online survey, and 220 distance runners (127 females and 93 males) made up the final sample after a multi-stage data clearance. Participants were also assigned to dietary (omnivorous, vegetarian, vegan) and race distance (10-km, half-marathon, marathon/ultra-marathon) subgroups. Sociodemographic characteristics and the patterns of supplement intake including type, frequency, dosage, and brands were collected using a questionnaire. One-way ANOVA and logistic regression were used for data analysis. A total of 54.3% of female runners and 47.3% male runners reported consuming supplements regularly. The frequency of supplement intake was similar between females and males (generally or across dietary and distance subgroups). There was no significant relationship for sex alone or sex interactions with diet type and race distance on supplement intake (p < 0.05). However, a non-significant higher intake of vitamin and mineral (but not CHO/protein) supplements was reported by vegan and vegetarian (but not by omnivorous) females compared to their male counterparts. In summary, despite the reported findings, sex could not be considered as a strong modulator of supplement intake among different groups of endurance runners.

Supplement Intake in Recreational Vegan, Vegetarian, and Omnivorous Endurance Runners-Results from the NURMI Study (Step 2)

Nutrient deficiency is a common cause of underperformance in endurance athletes, and supplement intake is frequently considered compensatory for vegan and vegetarian athletes specifically. This study aimed to investigate the patterns of supplement intake among vegan, vegetarian, and omnivorous distance (>10 km) runners and its association with age, sex, and race distance. From a total of 317 runners who participated in an online survey, 220 distance runners (mean age: 38.5 years; mean BMI: 21.75 kg/m²) were selected for the final sample after data clearance and assigned to 100 omnivores, 40 vegetarians, or 80 vegans. Sociodemographic information, racing experience, and patterns of supplement intake, including type, frequency, dosage, etc., were collected using a questionnaire. Macronutrient intake was assessed using a food frequency questionnaire. ANOVA and logistic regression were used for data analysis. The prevalence of supplement intake was 51% for total runners and 72% among vegan runners. Age, sex, and race distance had no significant effect on the type of supplement intake (p > 0.05). Compared to omnivores and vegetarians, vegan runners reported consuming more vitamin (but not carbohydrate/protein or mineral) supplements (p < 0.05). Vitamin B₁₂, magnesium, and multivitamin had the most prevalent use amongst micronutrient supplements. This study points to a central role for supplementary nutritional strategies in different groups of distance runners. The present findings may help future investigations by design to identify specific requirements of endurance runners when adhering to specific kinds of diet particularly plant-based diets.

Caffeine Ingestion Affects Performance in Different Parts of a Novel Multidirectional High-Intensity Intermittent Exercise in Futsal Athletes

Objective: No study has analyzed the effects of caffeine ingestion on performance during a multidirectional high-intensity intermittent exercise. Thus, we aimed to investigate the effects of caffeine ingestion during a novel repeated agility test in futsal athletes.Methods: Using a double-blind, counterbalanced, and repeated-measures design, ten athletes (mass 71.2 ± 8.7 kg, height 1.77 ± 0.05 m, body mass index 22.7 ± 1.9 km/m², body fat percentage 10.2 ± 3.7%) performed a novel repeated-bout agility test 60 min after ingesting 6 mg · kg^-1 of caffeine or cellulose (placebo).Results: Performance time decreased progressively throughout the trial in both conditions (P = 0.01; η_p² = 0.66), with a significant interaction effect (P = 0.01; η_p² = 0.35) showing a potential beneficial effect of caffeine at the beginning, followed by a decrease at the end of the test. Furthermore, magnitude of decrease in performance was more pronounced in caffeine (-9.0 ± 5.7%) compared with placebo (-4.7 ± 3.9%, P = 0.01; d = 0.88). Interestingly, magnitude-based inferences revealed a possible benefit (70%) of caffeine at the beginning, followed by likely (93%) to very likely (96%) impairments in performance during the last third of the test. Heart rate and rating of perceived effort increased in both conditions over the time (P < 0.05), with similar values between experimental conditions (P > 0.05).Conclusion: Caffeine seems to have a potential beneficial effect at the beginning, with an impaired performance during the final third of a new multidirectional high-intensity intermittent exercise in futsal athletes.

Opioid Use in Athletes: A Systematic Review

CONTEXT

The opioid epidemic has been well-documented in the general population, but the literature pertaining to opioid use and misuse in the athletic population remains limited.

OBJECTIVES

The objectives of this study were to seek answers to the following questions: (1) what are the rates of opioid use and misuse among athletes, (2) do these rates differ compared with the nonathletic population, and (3) are there specific subgroups of the athletic population (eg, based on sport, level of play) who may be at higher risk?

DATA SOURCES

The Embase, MEDLINE, and PubMed were used for the literature search.

STUDY SELECTION

Records were screened in duplicate for studies reporting rates of opioid use among athletes. All study designs were included.

STUDY DESIGN

Systematic review.

LEVEL OF EVIDENCE

Level 4.

DATA EXTRACTION

Data regarding rates of opioid use, medication types, prescription patterns, and predictors of future opioid use were collected. Study quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS) criteria for clinical studies and 5 key domains previously identified for survey studies.

RESULTS

A total of 11 studies were eligible for inclusion (N = 226,256 athletes). Studies included survey studies and retrospective observational designs. Opioid use among professional athletes at any given time, as reported in 2 different studies, ranged from 4.4% to 4.7%, while opioid use over a National Football League career was 52%. High school athletes had lifetime opioid use rates of 28% to 46%. Risk factors associated with opioid use included Caucasian race, contact sports (hockey, football, wrestling), postretirement unemployment, and undiagnosed concussion. Use of opioids while playing predicted use of opioids in retirement.

CONCLUSION

Overall, opioid use is prevalent among athletes, and use during a playing career predicts postretirement use. This issue exists even at the high school level, with similar rates to professional athletes. Further higher quality observational studies are needed to better define patterns of opioid use in athletes.

Analgesic Management of Pain in Elite Athletes: A Systematic Review

OBJECTIVE

To identify the prevalence, frequency of use, and effects of analgesic pain management strategies used in elite athletes.

DESIGN

Systematic literature review.

DATA SOURCES

Six databases: Ovid/Medline, SPORTDiscus, CINAHL, Embase, Cochrane Library, and Scopus.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Empirical studies involving elite athletes and focused on the use or effects of medications used for pain or painful injury. Studies involving recreational sportspeople or those that undertake general exercise were excluded.

MAIN RESULTS

Of 70 articles found, the majority examined the frequency with which elite athletes use pain medications, including nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, anesthetics, and opioids. A smaller set of studies assessed the effect of medications on outcomes such as pain, function, and adverse effects. Oral NSAIDs are reported to be the most common medication, being used in some international sporting events by over 50% of athletes. Studies examining the effects of pain medications on elite athletes typically involved small samples and lacked control groups against which treated athletes were compared.

CONCLUSIONS

Existing empirical research does not provide a sufficient body of evidence to guide athletes and healthcare professionals in making analgesic medication treatment decisions. Based on the relatively robust evidence regarding the widespread use of NSAIDs, clinicians and policymakers should carefully assess their current recommendations for NSAID use and adhere to a more unified consensus-based strategy for multidisciplinary pain management in elite athletes. In the future, we hope to see more rigorous, prospective studies of various pain management strategies in elite athletes, thus enabling a shift from consensus-based recommendations to evidence-based recommendations.

Management of Pain in Elite Athletes: Identified Gaps in Knowledge and Future Research Directions

OBJECTIVE

For elite athletes to train and compete at peak performance levels, it is necessary to manage their pain efficiently and effectively. A recent consensus meeting on the management of pain in elite athletes concluded that there are many gaps in the current knowledge and that further information and research is required. This article presents the crystallization of these acknowledged gaps in knowledge.

DATA SOURCES

Information was gathered from a wide variety of published scientific sources that were reviewed at the consensus meeting and the gaps in knowledge identified.

MAIN RESULTS

Gaps have been identified in the epidemiology of analgesic use, the management of pain associated with minor injuries, and the field of play management of pain for athletes with major injuries. From a pharmacological perspective, there is a lack of information on the prescribing of opioid medications in elite athletes and more data are required on the use of local anesthetics injections, corticosteroids, and nonsteroidal anti-inflammatory drugs during training and in competition. Pain management strategies for the general population are widely available, but there are few for the elite sporting population and virtually none for elite athletes with a disability. More research is also needed in assessing cognitive-behavior therapies in improving specific outcomes and also into the new process of psychologically informed physiotherapy. A key issue is the paucity of data relating to incidence or prevalence of persistent pain and how this relates to persistent dysfunction, exercise performance, and physiological function in later life.

CONCLUSIONS

The identification of the gaps in knowledge in the management of pain in elite athletes will provide a unified direction for the retrieval of information and further research that will provide reassurance, speed return to active sport, and benefit performance.

Medication and Supplement Use in Disability Football World Championships

BACKGROUND

Individuals with an impairment comprise more than 15% of the world's population, many of whom can benefit greatly from participation in sport. The provision of medical services in disability sport is a challenging area with a lack of scientific evidence. Given the positive impact that sport can have on the people with an impairment, it is vital that measures are taken to better understand the medical issues posed by disability sport. It is well established that medications and supplements are overused in sport, particularly within professional football, but there is no current evidence on medication or supplement use in elite disability football.

OBJECTIVE

To examine and describe the use of medication and supplements in disability football, before and during international tournaments, and to identify the profile of substances used by category.

DESIGN

Prospective, descriptive, cohort study.

SETTING

International Blind Sport Association Football World Cup 2015 and the International Federation of Cerebral Palsy Football World Cup 2015.

PARTICIPANTS

Two hundred forty-two elite-level disability footballers, classified with B1 visual impairment or cerebral palsy.

METHODS

Team clinicians were asked to document all medication and supplements taken in the 48 hours before each match.

RESULTS

This study recorded the use of 1648 substances in 242 players, with more than one half (53.1%) classified as supplements. There was an overall rate of 1.26 substances used per player per match and a medication use rate of 0.59 medications per player per match. Seventy percent (170/242) of players reported using at least one substance per tournament, with 57.9% (140/242) using at least one prescribed medication (63.6% of players at International Blind Sports Association World Games and 57.7% of players at International Federation of Cerebral Palsy World Cup). The most commonly prescribed category of medications was nonsteroidal anti-inflammatory drugs, representing 39.3% of all reported medications.

CONCLUSION

This study highlights the potential overuse of medication and supplements in disability football, particularly in the use of nonsteroidal anti-inflammatory drugs. These trends are comparable to previous research in Fédération Internationale de Football Association World Cup competitions.

LEVEL OF EVIDENCE

Not applicable.