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

International society of sports nutrition position stand: coffee and sports performance

Based on review and critical analysis of the literature regarding the contents and physiological effects of coffee related to physical and cognitive performance conducted by experts in the field and selected members of the International Society of Sports Nutrition (ISSN), the following conclusions represent the official Position of the Society:(1) Coffee is a complex matrix of hundreds of compounds. These are consumed with broad variability based upon serving size, bean type (e.g. common Arabica vs. Robusta), and brew method (water temperature, roasting method, grind size, time, and equipment).(2) Coffee's constituents, including but not limited to caffeine, have neuromuscular, antioxidant, endocrine, cognitive, and metabolic (e.g. glucose disposal and vasodilation) effects that impact exercise performance and recovery.(3) Coffee's physiologic effects are influenced by dose, timing, habituation to a small degree (to coffee or caffeine), nutrigenetics, and potentially by gut microbiota differences, sex, and training status.(4) Coffee and/or its components improve performance across a temporal range of activities from reaction time, through brief power exercises, and into the aerobic time frame in most but not all studies. These broad and varied effects have been demonstrated in men (mostly) and in women, with effects that can differ from caffeine ingestion, per se. More research is needed.(5) Optimal dosing and timing are approximately two to four cups (approximately 473-946 ml or 16-32 oz.) of typical hot-brewed or reconstituted instant coffee (depending on individual sensitivity and body size), providing a caffeine equivalent of 3-6 mg/kg (among other components such as chlorogenic acids at approximately 100-400 mg per cup) 60 min prior to exercise.(6) Coffee has a history of controversy regarding side effects but is generally considered safe and beneficial for healthy, exercising individuals in the dose range above.(7) Coffee can serve as a vehicle for other dietary supplements, and it can interact with nutrients in other foods.(8) A dearth of literature exists examining coffee-specific ergogenic and recovery effects, as well as variability in the operational definition of "coffee," making conclusions more challenging than when examining caffeine in its many other forms of delivery (capsules, energy drinks, "pre-workout" powders, gum, etc.).

Are Supplements Consumed by Middle-Distance Runners Evidence-Based? A Comparative Study between Level of Competition and Sex

BACKGROUND

Middle-distance running events have special physiological requirements from a training and competition point of view. Therefore, many athletes choose to take sport supplements (SS) for different reasons. To date, few studies have been carried out that review supplementation patterns in middle-distance running. The aim of the present study is to analyze the consumption of SS in these runners with respect to their level of competition, sex and level of scientific evidence.

METHODS

In this descriptive cross-sectional study, data was collected from 106 middle-distance runners using a validated questionnaire.

RESULTS

Of the total sample, 85.85% responded that they consumed SS; no statistical difference was found regarding the level of competition or sex of the athletes. With respect to the level of competition, differences were observed in the total consumption of SS (p = 0.012), as well as in that of medical supplements (p = 0.005). Differences were observed between sexes in the consumption of medical supplements (p = 0.002) and group C supplements (p = 0.029).

CONCLUSIONS

Higher-level athletes consume SS that have greater scientific evidence. On the other hand, although the most commonly consumed SS have evidence for the performance or health of middle-distance runners, runners should improve both their sources of information and their places of purchase.

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.

Type of Diet and Sports Supplements in Padel Players According to Level of Competition and Sex

Padel is the world's fastest growing racket sport. However, the analysis of the intake of sports supplements in padel players is scarce. The aim of this research was to analyse and compare the type of diet and the use of sports supplements in padel players according to their competition level and sex. A total of 123 players (94 men and 29 women) participated in the study. Subjects were divided according to their sex and competition level. All participants completed an anonymous questionnaire on diet type and nutritional supplement intake. There were differences found in diet type between competition levels. Regarding players' sex, differences in the number of supplements consumed were reported (p < 0.01). Relationships were found between the number of supplements ingested and the perceived effectiveness of supplements with frequency and time of training (p < 0.05). Creatine in men (≈15%) and vitamin complexes (≈10%) in women were the most used supplements. Lower level padel players do not adapt their diet to the physical demands of padel. Male padel players use a greater number of supplements than female padel players. It is important that nutrition specialists advise players to control diets and supplement.

Microbiota Mediate Enhanced Exercise Capacity Induced by Exercise Training

PURPOSE

We investigated the effects of gut microbes, and the mechanisms mediating the enhanced exercise performance induced by exercise training, i.e., skeletal muscle blood flow, and mitochondrial biogenesis and oxidative function in male mice.

METHODS

All mice received a graded exercise test before (PRE) and after exercise training via forced treadmill running at 60% to 70% of maximal running capacity 5 d·wk -1 for 5 wk (POST). To examine the role of the gut microbes, the graded exercise was repeated after 7 d of access to antibiotic (ABX)-treated water, used to eliminate gut microbes. Peripheral blood flow, mitochondrial oxidative capacity, and markers of mitochondrial biogenesis were collected at each time point.

RESULTS

Exercise training led to increases of 60% ± 13% in maximal running distance and 63% ± 11% work to exhaustion ( P < 0.001). These increases were abolished after ABX ( P < 0.001). Exercise training increased hindlimb blood flow and markers of mitochondrial biogenesis and oxidative function, including AMP-activated protein kinase, sirtuin-1, PGC-1α citrate synthase, complex IV, and nitric oxide, all of which were also abolished by ABX treatment.

CONCLUSIONS

Our results support the concept that gut microbiota mediate enhanced exercise capacity after exercise training and the mechanisms responsible, i.e., hindlimb blood flow, mitochondrial biogenesis, and metabolic profile. Finally, results of this study emphasize the need to fully examine the impact of prescribing ABX to athletes during their training regimens and how this may affect their performance.

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.

The Effect of High Nicotine Dose on Maximum Anaerobic Performance and Perceived Pain in Healthy Non-Smoking Athletes: Crossover Pilot Study

Background: In recent years, there has been intensive discussion about the positive effect of nicotine usage on enhancing sports performance. It is frequently applied through a non-burned tobacco form before physical activity. Nicotine is under the World Anti-Doping Agency (WADA) 2021 monitoring program. Therefore, study results that reveal either positive or negative effects are expected. This is the pilot study that reports the effect of 8 mg dose of nicotine on performance and perceived pain. Material and Methods: This research aimed to explore the oral intake effect of a high-nicotine dose (8 mg) on the maximum anaerobic performance and other selected physical performance parameters in healthy, well-trained adult athletes (n = 15, age 30.7 ± 3.6, BMI 25.3 ± 1.7). The cross-sectional study protocol included the oral administration of either sublingual nicotine or placebo tablets before the anaerobic load assessed by a standardized 30 s Wingate test of the lower limbs. Afterward, the Borg subjective perception of pain (CR 10) and Borg rating of perceived exertion (RPE) were evaluated. Wilcoxon signed-rank test was used for the analysis of data with a 0.05 level of significance. Results: The results revealed that oral administration of an 8 mg nicotine dose does not significantly improve any of the physical performance parameters monitored. We only reported the statistically significant positive effect in RPE (p = 0.03). Conclusion: Lower perception of pain intensity that we reported after nicotine application might be an important factor that affects performance. However, we did not report any improvement in physical performance parameters.

Evaluation of Supplement Use in Sport Climbers at Different Climbing Levels

The lack of specific recommendations on the use of supplements for sport climbers may be the reason for their misuse by athletes of this discipline. This study aimed to evaluate choices of dietary supplementation, the reasons for taking them, and the source of information on supplementation among sport climbers at different levels. In addition, how climbers subjectively evaluated the impact of their diets in supporting selected aspects of climbing training was evaluated. We enrolled 110 regular sport climbers (40 women and 70 men) from Wroclaw, Poland, who completed a validated questionnaire, assessing their use of dietary supplements, attitudes towards the influence of diet on sports performance, and climbing level. Their anthropometric measurements were also collected. Participants regarded diet as an important element of sports performance. Sport climbers indicated the Internet to be the main source of information on supplements. Health maintenance and improvement of recovery were the most frequently chosen reasons for taking dietary supplements. The most common supplements were isolated protein, vitamin C, vitamin D, magnesium, and amino acid blends. However, participants rarely used supplements suggested as beneficial for sport climbing performance. Therefore, developing recommendations for supplementation in sport climbing and promoting this should be an elementary part of the preparation for climbing training.

Prevalence and Attitudes Towards Using Protein Supplements Among Female Gym Users: An Online Survey

Background:

Protein supplements have become a widespread practice amongst athletes and gym users worldwide. However, studies on the use of protein supplements among female gym users in Saudi Arabia are lacking.

Objective:

The aim of this study was to investigate the prevalence of protein supplement usage among female gym users and their attitudes towards protein supplementation in Riyadh city, Saudi Arabia.

Methods:

In this cross-sectional study, 502 female gym users aged ≥18 years completed a structured, self-administered online questionnaire on the usage of protein supplementation. Socio- demographic information, anthropometry, health status, exercise frequency, attitudes and knowledge regarding protein supplements were obtained.

Results:

The overall prevalence rate of protein supplement use among the study respondents was 36.3%. There were significant associations between the use of protein supplements and educational level (p< 0.05), the duration of being a gym member (p< 0.05) and frequency of gym visits per week (p< 0.05). Whey protein was the predominantly used supplement (57.8%), and the reason attributed to the use of protein supplement was muscle building (53.9%). The main sources of information regarding protein supplement use included the internet (30.2%) followed by gym coaches (25.3%).

Conclusion:

Our findings demonstrated that a considerable number of females exercising in gyms use protein supplements, and most rely on unreliable sources for decision-making of protein supplements use. Nutritional education and consultations regarding protein supplement use are warranted.

Chronic prescription medication use in endurance runners: a cross-sectional study in 76,654 race entrants - SAFER XV

OBJECTIVE

To determine the prevalence of chronic prescription medication (CPM) use in distant runners (by age and sex) and to compare CPM use in 21.1 km vs. 56 km race entrants.

METHODS

A cross-sectional study of 76,654 race entrants who completed a pre-race medical screening questionnaire during race registration, which included questions on the use of CPM and CPM use in eight main categories of CPM. Prevalence (%, 95%CIs) and prevalence ratios (PR) are reported.

RESULTS

The prevalence of any CPM use was 12.5% (12.2-12.8). CPM use was higher in older age categories vs. the youngest age category (31-40 yrs vs. ≤30 yrs: PR = 1.4; 41-50 yrs vs. ≤30 yrs: PR = 2.1; >50 yrs vs. ≤30 yrs: PR = 3.4) (p < 0.0001) and females vs. males (PR = 1.1; p < 0.0001). The use of any CPM was significantly higher in 21.1 km vs. 56 km race entrants (PR = 1.2; p < 0.0001). Prevalence of CPM use in main categories was: blood pressure lowering medication (3.7%), cholesterol lowering medication (3.6%), asthma medication (3.1%), and medication to treat anxiety/depression (2.6%). The pattern of CPM in the main categories differed between 21.1 km and 56 km race entrants.

CONCLUSIONS

One in eight race entrants use CPM, with a higher prevalence of use among older race entrants, female vs. males, and 21.1 km vs. 56 km race entrants. Frequent CPMs used are blood pressure lowering medication, cholesterol lowering medication, asthma medication, and medication to treat anxiety/depression. The use of CPM medications may increase the risk of medical complications during exercise, and these data help identify subgroups of entrants that may be at higher risk for race medical encounters.

Effects of Cannabidiol Supplementation on Skeletal Muscle Regeneration after Intensive Resistance Training

Cannabidiol supplements (CBD) are increasingly consumed by athletes to improve regeneration. However, the evidence for the pro-regenerative effects of CBD in sports is quite limited. Therefore, our aim was to investigate the effects of a single CBD supplementation in a six-arm placebo-controlled crossover study after resistance training on performance and muscle damage. Before and after the resistance training, one-repetition maximum in the back squat (1RM BS), countermovement jump (CMJ), and blood serum concentrations of creatine kinase (CK) and myoglobin (Myo) were measured in healthy, well-trained participants. 16 out of 21 participants completed the study and were included in the analysis. In 1RM BS, a significant decrease was observed after 24 h (p < 0.01) but not after 48 and 72 h. A significant group difference was detected after 72 h (p < 0.05; ES = 0.371). In CMJ, no significant changes were observed. The CK and Myo concentrations increased significantly after 24 h (CK: p < 0.001; Myo: p < 0.01), 48 h (CK: p < 0.001; Myo: p < 0.01) and 72 h (CK: p < 0.001; Myo: p < 0.001). After 72 h, significant group differences were observed for both muscle damage biomarkers (CK: p < 0.05 ES = 0.24; Myo: p < 0.05; ES = 0.21). The results show small but significant effects on muscle damage and recovery of squat performance after 72 h. However, more data are required for clearer statements concerning potential pro-regenerative effects of CBD supplementation after resistance training.

A Descriptive Study of Pain Relief Practices Among Student-Athletes in Palestine: Focus on Non-Steroidal Anti-Inflammatory Drugs, and Complementary Medicine and Alternative Medicine Use

Many athletes suffering from musculoskeletal pain and dysfunction will use some types of complementary and alternative medicine (CAM) or Non-steroidal anti-inflammatory drugs (NSAIDs). Therefore, this study aimed to determine the prevalence, awareness, and behaviors related to NSAIDs and CAM use in Palestinian student-athletes. This was a cross-sectional study that involved 227 students from the Faculty of Sports at An-Najah National University. A self-administered questionnaire was designed in Arabic; it had six sections and a number of open-ended and closed-ended questions. SPSS version 21 was used to analyze the results. Descriptive statistics (i.e., frequencies, percentages) were used to describe the results including demographic characteristics. Overall, 79.3% of the student-athletes had used NSAIDs in the past and 89.0% had used CAM. The CAM methods used by participants were: herbals (57.3%), supplements (32.2%), cupping (11.9%), acupuncture (2.2%), massage (51.5%), yoga (4.0%), praying (18.1%) and ice packs (20.7%). The herbs commonly used by participants were: sage (20.7%), Menthol (21.1%), Aniseed (10.6%), Chamomile (4.0%), Cinnamon (1.3%), Turmeric (4.0%), Ginger (35.7%), and a mixture of herbs (18.5%); Regarding the perceived advantages of CAM use, 82.2% thought that CAM is beneficial for their health, 79.7% thought CAM is safe, 71.3% used it because of the successful experience of others, and 60.9% used it because it's more available than medical therapy. Among NSAIDs users, 17.2% reported recent use of over-the-counter (OTC) NSAIDs, and 33.9% of users used prescribed NSAIDs within the last three months for sport-related reasons. When asked to report any side-effect of NSAIDs they knew, only 22.6% were able to list at least one side-effect. This study shows a high prevalence of NSAIDs and CAM use among student-athletes in Palestine with a low level of knowledge and awareness of their side-effects. Therefore, education strategies that focus on enhancing and improving student-athletes' knowledge of the proper use and the possible side-effects of NSAIDs and CAM are needed.

Injury patterns among national-level athletes in Lebanon: a retrospective study

Objectives:This study aims to assess the annual prevalence, associated factors, and characteristics of musculoskeletal disorders among Lebanese national-level athletes.Methods: Lebanese athletes aged 18 and over and who competed in a top-level national championship during an entire athletics season were invited to participate in the study. Data were collected through questionnaire assessing self-reported injury during the past year. Injury, dependent variable of the study, was defined as a musculoskeletal condition that made the athlete partially or completely abstains from training or competition for a 1-week minimum injury period.Results: Among the 250 eligible athletes, 210 (84.0%) (25.5±6.7 years) completed the questionnaire. The 1-year retrospective injury prevalence was 51.9% (95% confidence interval, 45.1%-58.7%). Injured athletes reported 150 injuries: 128 (85.3%) affected the lower extremities, and 111 (74.0%) occurred during training. The most common type was muscle cramps/spasm (n=53; 35.3%); and overuse (n=121; 80.7%) was the predominant cause. Athletes who mainly practiced endurance disciplines (-p-value=0.042), who participated in international athletics championships (-p-value=0.047), and who were taking chronic medications (-p-value=0.049) had more injuries in the past year.Conclusion: These findings may help inform potential injury prevention programs, which should target injuries affecting the lower extremities, and consider the factors associated with injury risk among Lebanese athletes.

Dietary Supplement Use According to Sex and Triad Risk Factors in Collegiate Endurance Runners

ABSTRACT

Barrack, MT, Fredericson, M, Dizon, F, Tenforde, AS, Kim, BY, Kraus, E, Kussman, A, Singh, S, and Nattiv, A. Dietary supplement use according to sex and Triad risk factors in collegiate endurance runners. J Strength Cond Res 35(2): 404-410, 2021-This cross-sectional study evaluated the prevalence in the use of dietary supplements among elite collegiate runners among 2 NCAA Division I cross-country teams. At the start of each season from 2015 to 2017, male and female endurance runners were recruited to complete baseline study measures; the final sample included 135 (male n = 65, female n = 70) runners. Runners completed a health survey, web-based nutrition survey, and Triad risk assessment. The prevalence of dietary supplement use and Triad risk factors, including disordered eating, low bone mass, amenorrhea (in women), low body mass index, and stress fracture history, was assessed. A total of 78.5% (n = 106) runners reported taking 1 or more supplements on ≥4 days per week over the past month, 48% (n = 65) reported use of ≥3 supplements. Products used with highest frequency included multivitamin/minerals 46.7% (n = 63), iron 46.7% (n = 63), vitamin D 34.1% (n = 46), and calcium 33.3% (n = 45). More women, compared with men, used iron (61.4 vs. 30.8%, p < 0.001) and calcium (41.4 vs. 24.6%, p = 0.04); men exhibited higher use of amino acids and beta-alanine (6.2 vs. 0%, p = 0.04). Runners with bone stress injury (BSI) history, vs. no previous BSI, reported more frequent use of ≥3 supplements (61.5 vs. 32.8%, p = 0.001), vitamin D (49.2 vs. 19.4%, p < 0.001), and calcium (47.7 vs. 19.4%, p = 0.001). Low bone mineral density was also associated with higher use of vitamin D and calcium. Most runners reported regular use of 1 or more supplements, with patterns of use varying based on sex, history of BSI, and bone mass.

Caffeine Health Claims on Sports Supplement Labeling. Analytical Assessment According to EFSA Scientific Opinion and International Evidence and Criteria

Caffeine is a food supplement widely consumed by athletes, but it has not been established. So far, the veracity of their labeling in terms of the dosage and cause/effect relationship aimed at the consumer. The aim is to analyze the health claims and the dosage presented on the labeling of caffeine supplements and to evaluate if they follow the European Food Safety Authority (EFSA) and international criteria. A descriptive cross-sectional study of a sample of caffeine supplements was carried out. The search was done through the Amazon and Google Shopping web portals. In order to assess the adequacy of the health claims, the guidelines of reference established by European Food Safety Authority were compared to the Academy of Nutrition and Dietetics, International Olympic Committee, and Australian Institute of Sport guidelines; in addition, recent systematic reviews were addressed. A review of labels of 42 caffeine supplements showed that, in less than 3% of the products were the health claims supported by the recommendations and by the labeled quantity of caffeine. The claims that fully complied the recommendations were, "improves or increases endurance performance", "improves strength performance", or "improves short-term performance". In most cases, the recommended dosage was 200 mg/day for these products, which is the minimum for the caffeine effects to be declared. The rest of the health claims were not adequate or need to be modified. Most of the health claims identified indicated an unproven cause and effect, which constitutes consumer fraud, and so must be modified or eliminated.

Suplementos alimentares: uma fonte de doping não intencional?

Resumo O excessivo consumo de suplementos alimentares, aliado a uma legislação inespecífica e a um controle de qualidade ineficiente, faz com que a saúde dos consumidores seja colocada em risco devido à possível existência de contaminantes, em especial pró-hormônios, esteroides anabolizantes e estimulantes. Estes compostos podem proporcionar um aumento do desempenho esportivo e acarretar uma série de efeitos adversos, sendo assim proibidos pela Agência Mundial Antidopagem. A contaminação de suplementos pode ocorrer de maneira deliberada ou através de más práticas de produção, em que são encontrados traços dessas substâncias. Todavia, ambos os casos exigem atenção, já que uma contaminação de apenas 0,00005% em massa pode levar ao doping. Neste sentido, estima-se que de 6,4% a 8,8% dos casos estejam relacionados ao consumo de suplementos contaminados. Perante estes fatos, os objetivos principais do trabalho foram: fazer uma revisão da literatura tanto em trabalhos nacionais quanto internacionais, no que concerne à contaminação de suplementos alimentares e sua relação com a dopagem não intencional, bem como orientar os consumidores a escolherem produtos mais seguros. Neste sentido, foi possível observar que os suplementos nacionais são, geralmente, mais seguros quanto à presença de substâncias proibidas, principalmente em relação à contaminação por agentes anabolizantes. Contudo, ainda é preciso um melhor controle de qualidade perante a contaminação/adulteração por estimulantes.

Influence of Indomethacin on Steroid Metabolism: Endocrine Disruption and Confounding Effects in Urinary Steroid Profiling of Anti-Doping Analyses

Anabolic androgenic steroids (AAS) are prohibited as doping substances in sports by the World Anti-Doping Agency. Concentrations and concentration ratios of endogenous AAS (steroid profile markers) in urine samples collected from athletes are used to detect their administration. Certain (non-prohibited) drugs have been shown to influence the steroid profile and thereby sophisticate anti-doping analysis. It was shown in vitro that the non-steroidal anti-inflammatory drug (NSAID) indomethacin inhibits selected steroid-biotransformations catalyzed by the aldo-keto reductase (AKR) 1C3, which plays a key role in the endogenous steroid metabolism. Kinetic parameters for the indomethacin-mediated inhibition of the AKR1C3 catalyzed reduction in etiocholanolone were determined in vitro using two comparing methods. As NSAIDs are very frequently used (not only) by athletes, the inhibitory impact of indomethacin intake on the steroid metabolism was evaluated, and steroid profile alterations were detected in vivo (one male and one female volunteer). Significant differences between samples collected before, during or after the intake of indomethacin for selected steroid profile markers were observed. The presented results are of relevance for the interpretation of results from doping control analysis. Additionally, the administration of NSAIDs should be carefully reconsidered due to their potential as endocrine disruptors.

Dietary Supplement and Food Contaminations and Their Implications for Doping Controls

A narrative review with an overall aim of indicating the current state of knowledge and the relevance concerning food and supplement contamination and/or adulteration with doping agents and the respective implications for sports drug testing is presented. The identification of a doping agent (or its metabolite) in sports drug testing samples constitutes a violation of the anti-doping rules defined by the World Anti-Doping Agency. Reasons for such Adverse Analytical Findings (AAFs) include the intentional misuse of performance-enhancing/banned drugs; however, also the scenario of inadvertent administrations of doping agents was proven in the past, caused by, amongst others, the ingestion of contaminated dietary supplements, drugs, or food. Even though controversial positions concerning the effectiveness of dietary supplements in healthy subjects exist, they are frequently used by athletes, anticipating positive effects on health, recovery, and performance. However, most supplement users are unaware of the fact that the administration of such products can be associated with unforeseeable health risks and AAFs in sports. In particular anabolic androgenic steroids (AAS) and stimulants have been frequently found as undeclared ingredients of dietary supplements, either as a result of cross-contaminations due to substandard manufacturing practices and missing quality controls or an intentional admixture to increase the effectiveness of the preparations. Cross-contaminations were also found to affect therapeutic drug preparations. While the sensitivity of assays employed to test pharmaceuticals for impurities is in accordance with good manufacturing practice guidelines allowing to exclude any physiological effects, minute trace amounts of contaminating compounds can still result in positive doping tests. In addition, food was found to be a potential source of unintentional doping, the most prominent example being meat tainted with the anabolic agent clenbuterol. The athletes’ compliance with anti-doping rules is frequently tested by routine doping controls. Different measures including offers of topical information and education of the athletes as well as the maintenance of databases summarizing low- or high-risk supplements are important cornerstones in preventing unintentional anti-doping rule violations. Further, the collection of additional analytical data has been shown to allow for supporting result management processes.

Use of nutritional supplements by elite Japanese track and field athletes

BACKGROUND

While scientific evidence supports the efficacy of only limited nutritional supplements (NS) on sports performance, the use of NS is widespread in athletes. Given the serious issues of health damage or unintended Anti-Doping Rule Violations due to ingestion of contaminated NS in sports, accurately understanding NS practices by athletes is crucial. This study therefore elucidated the use of NS by elite Japanese track and field (TF) athletes.

METHODS

The subjects were 574 Japanese TF athletes, including 275 junior athletes (under 20 years) and 299 senior athletes, who participated in international competitions from 2013 to 2018. Data on NS use were collected through pre-participation medical forms obtained from all entrants before their participation in competitions. NS users were requested to report the product names and primary components of all NS they were taking.

RESULTS

The overall prevalence of NS use was 63.9%. The mean number of NS products used per athlete was 1.4. The prevalence was significantly higher in women (69.2%) than in men (59.6%) (p = 0.018) and significantly higher in senior athletes (68.9%) than in junior athletes (58.9%) (p = 0.012). The prevalence of NS use was higher in long-distance runners (75.8%) and lower in jumpers (52.3%) and throwers (49.2%) than other disciplines (p < 0.001). The most prevalent components were amino acids (49.3%), followed by vitamins (48.3%), minerals (22.8%), and protein (17.8%).

CONCLUSIONS

Approximately two-thirds of elite Japanese TF athletes reported the use of NS, and NS practices varied by gender, age, and discipline.

A Dose-Dependent Effect of Carnipure® Tartrate Supplementation on Endurance Capacity, Recovery, and Body Composition in an Exercise Rat Model

The objective of this work is to investigate the effects of Carnipure^® Tartrate (CT) supplementation with or without exercise on endurance capacity, recovery, and fatigue by assessing time to exhaustion as well as body weight and composition in rats. In addition, antioxidant capacity has been evaluated by measuring malondialdehyde (MDA) levels and antioxidant enzyme (superoxide dismutase, SOD; catalase, CAT; glutathioneperoxidase; GSHPx) activities. Fifty-six male Wistar rats were divided into eight groups including seven rats each. A control group did not receive CT nor exercise. Another control group received 200 mg/kg CT without exercise. The other six groups of rats went through an exercise regimen consisting of a 5-day training period with incremental exercise capacity, which was followed by 6 weeks of the run at 25 m/min for 45 min every day. CT was supplemented at 0, 25, 50, 100, 200, and 400 mg/kg per day during the 6 weeks. Rats submitted to exercise and supplemented with CT had a significant and dose-dependent increase in time to exhaustion and this effect seems to be independent of exercise (p < 0.05). Additionally, recovery and fatigue were improved, as shown by a significant and dose-dependent decrease in myoglobin and lactic acid plasma levels, which are two markers of muscle recovery. CT supplementation led to a dose-response decrease in body weight and visceral fat. These effects become significant at 200 and 400 mg/kg doses (p < 0.05). Additionally, the antioxidant capacity was improved, as shown by a significant and dose-dependent increase in SOD, CAT, and GSHPx. Serum MDA concentrations decreased in exercising rats with CT supplementation. CT supplementation led to a decrease in serum glucose, triglycerides, and total cholesterol concentrations with the lowest levels observed at 400 mg/kg dose (p < 0.05). These effects correlated with a significant dose-dependent increase in serum total L-carnitine, free L-carnitine, and acetyl-carnitine, which linked the observed efficacy to CT supplementation. These results demonstrate that CT supplementation during exercise provides benefits on exercise performance, recovery, and fatigue as well as improved the lipid profile and antioxidant capacity. The lowest dose leads to some of these effects seen in rats where 25 mg/kg corresponds to 250 mg/day as a human equivalent.

The determination of common anabolic steroid and stimulants in nutritional supplements by HPLC-DAD and LC-MS

A high-performance liquid chromatography method employing a diode-array detector and mass spectrometry detector was developed, validated and implemented for determining Synephrine, Caffeine, Clenbuterol, Nandrolone, Testosterone and Methylhexaneamine in Nutritional supplements. The use of Nutritional supplements is widespread. Hazards relating to concentration, composition, individual contaminants, supplements interactions as well as positive doping results among athletes present increasing concerns regarding nutritional supplement consuming. The proposed method was validated according to the International Conference on the Harmonization of the Technical Requirements for Registration of Pharmaceuticals for Human Use (ICH) standards. The proposed method observed to be accurate, linear, precise, sensitive, required minimal sample preparation and uncomplicated mobile phase. The implementation of the proposed method on nine commercial supplements shows that inaccurate labeling for some supplements regarding the concentration of the ingredients.

Medication information and supply behaviours in elite and developing athletes

OBJECTIVES

To investigate the behaviours of elite and developing athletes in obtaining medications and medication information, and to identify the role of pharmacists in athlete care.

DESIGN

Cross-sectional survey.

METHODS

An electronic, 39-item questionnaire was developed, piloted and distributed to elite and developing athletes aged 18 years and above at a state-based sporting institute. Quantitative data was analysed using descriptive statistics and free text comments were analysed using an inductive reasoning approach.

RESULTS

A total of 98 responses were analysed. Ninety (n=90/98, 91.84%) participants obtained medications in the six months prior to survey completion. Pharmacies were the most common source of both prescription (n=67/69, 97.10%) and non-prescription medications (n=64/75, 85.33%). Forty-five (n=45/98, 45.92%) participants also attended pharmacies when they had a minor ailment. Sixty-two (n=62/98, 63.27%) participants 'sometimes' consulted pharmacists for medication information. Only 11 (n=11/98, 11.22%) knew, according to their sporting institute medication policy, that athletes were required to consult a medical practitioner before taking anti-inflammatory, pain-relieving or sleep-inducing medications. Forty (n=40/98, 40.82%) participants believed pharmacists could play a role in their medication management.

CONCLUSIONS

Many elite and developing athletes visited pharmacies for medication supply and treatment of minor ailments. Doping regulatory agency websites were the most commonly used and trusted sources for medication information, although some athletes believed pharmacists could also contribute to their medication management. Future research should consider whether pharmacists are ready for a role in sports pharmacy.

Exploring the Progressive Use of Performance Enhancing Substances by High-Performance Athletes

Background: Given implications associated with the use of performance-enhancing substances (PESs), stakeholders must remain informed about usage precipitants and anticipate conditions signaling athlete vulnerability to hazardous exposures. Objectives: To gain deeper qualitative insight into high-level athlete PES usage; explore the variables leading them to escalate their PES use regimens; reveal PES experiences during their careers and, unlike other studies, not to focus exclusively on "doping" as measured by the use of WADA-banned substances. Methods: A macro life course-based framework from which the data could emerge through a thematic coding analysis was utilized. Sixteen narrative life course histories of recently retired high-performance athletes report on the factors impelling their escalation in PES use, including for some, the first use of banned PES. Results: Informant reports, thematically coded, reveal performance maximization urgency to be a central factor in escalating PES use, driven by four variables: Requirements, Opportunities, Influencers and Outcomes. These variables each comprise two key components that stimulate an urgency ecosystem affecting an athlete's proximity to an escalation threshold. Conclusions/Importance: Such a comprehensive investigation of PES use precipitants has not previously been undertaken. Advances in PES use were instantiated by a substantive, sometimes radical and often sudden increase in urgency to improve performance related to output requirements, specific demands, knowledge and access, timing windows, the competitive landscape, loyalty to coaches, efficiency expectations and likelihood of detection. This study informs incremental models of doping, the use of which is encouraged in order to analyze life course narratives to better understand athlete behaviors.

Common Prescription Medications Used in Athletes

Athletes of various skill levels commonly use many different types of medications, often at rates higher than the general population. Common medication classes used in athletes include analgesics such as nonsteroidal anti-inflammatory drugs and acetaminophen, inhalers for asthma and exercise-induced bronchoconstriction, antihypertensives, antibiotics, and insulin. Prescribers must be aware of the unique considerations for each of these medications when using them in patients participating in physical activity. The safety, efficacy, impact on athletic performance, and regulatory restrictions of the most common medications used in athletes are discussed in this article.

Retrospective study of the use of medication and supplements during the 2018 FIFA World Cup Russia

Objective

Examine the intake of medication and supplements used by top-level players during the 2018 FIFA World Cup Russia.

Participants

736 top-level players

Setting

The team doctors uploaded a list of the medications used by each player to the online reporting tool within 72 hours of each match of the 2018 FIFA World Cup Russia.

Outcome measures

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

Results

54% of the players took at least one medication during the tournament and 39% took at least one medication before each match. The most used medications were non-steroidal anti-inflammatory drug (NSAID) (38.6%), followed by other analgesics (13.8%) and medications for insomnia and anxiety (13%). On average, 0.72 medications were taken per player per match and 1.32 per player during the tournament. The mean number of medication intake per player per match was higher during the knockout stage compared with the group stage (0.88±1.36 vs 0.65±1.08, p<0.001). Players from South America and North and Central America took more medications per match compared with the players from Africa (0.9±1.14 and 0.98±1.1 vs 0.48±0.83, p<0.001 in both cases).

Conclusion

The intake of NSAIDs decreased during the 2018 FIFA World Cup compared with previous FIFA World Cups, but stayed at a high level. The high number of medications taken is a cause for concern, and therefore, players, medical staff and coaches should be made more aware of the possible side effects of a high medication intake.

Prevalence and Predictors of Higher-Risk Supplement Use Among Collegiate Athletes

Sassone, J, Muster, M, and Barrack, MT. Prevalence and predictors of higher-risk supplement use among National Collegiate Athletic Association Division I athletes. J Strength Cond Res 33(2): 443-450, 2019-This study aimed to identify the prevalence and predictors associated with the use of higher-risk dietary supplements, defined as supplements containing herbal ingredients, caffeine, or those classified for weight loss, muscle-building, or as a preworkout supplement, among 557 National Collegiate Athletic Association Division I male and female collegiate athletes. Although 252 (45.2%) athletes reported the use of a dietary supplement on ≥2 days per week over the past year, 46 (8.3%) athletes met criteria for higher-risk supplement use. Twenty (3.6%) athletes reported the use of herbal, 1 (0.2%) caffeinated, 5 (0.9%) weight loss, 28 (5.0%) preworkout, and 1 (0.2%) muscle-building supplements. Body mass index status (BMI ≥30 kg·m), sport-type (sports using the phosphocreatine energy system), and college year (≥4th year) were associated with the use of preworkout, muscle-building, or herbal supplements. A multiple regression analysis identified predictors of higher-risk supplement use including the number of dietary supplements used in the past year (odds ratio [OR] = 2.1, 95% confidence interval [CI] = 1.7-2.7, p < 0.001), the reported motivation of taking dietary supplements to gain muscle and lose body fat (OR = 3.5, 95% CI = 1.1-11.7, p = 0.04), and the motivation to increase athletic endurance (OR = 3.5, 95% CI = 4.0, 95% CI = 1.6-9.9, p < 0.005). These factors may be considered as a part of a screening process to evaluate athletes with an increased risk of higher-risk supplement use and potential consequences to health or eligibility status.

Prevalence and patterns of dietary supplement use in elite Spanish athletes

Background

Dietary supplementation is a common strategy to achieve a specific health status or performance benefit. Several investigations have focused on the prevalence of dietary supplement use by athletes. However, information on how athletes manage the use and purchase of dietary supplements is scarce.

Methods

Five hundred and twenty-seven high-performance athletes (346 males and 181 females), participating in individual and team sports, completed a validated questionnaire about use and purchase patterns of dietary supplements. The dietary supplements were categorized according to the International Olympic Committee (IOC) consensus.

Results

Sixty four percent of the athletes (n = 337) used dietary supplements (median = 3; range 1 to 12). Age, sex, type of sport, level of competition, and professionalism influenced the prevalence of dietary supplement use (all p < 0.05). The most prevalent dietary supplement consumed was proteins (41%; n = 137), followed by amino acids/BCAA-based supplements (37%; n = 124). Additionally, as per group of supplements according to IOC consensus, 18% of the supplements were rated as having a low level of scientific evidence (e.g., glutamine, HMB, L-carnitine, etc). Most athletes (45%, n = 152) purchased dietary supplements in a store and 24% (n = 81) obtained them from a sponsor. Most athletes also (42%, n = 141) reported a self-organization of supplementation and did not consult with any professional. Last, 81% (n = 273) of athletes consuming supplements did not know any platform to check supplement safety/quality. For those who do not use dietary supplements (36% of the total sample, n = 190), most reported that they do not consider supplements necessary (72%, n = 137).

Conclusion

Dietary supplementation appears to be widely used in sport with a considerable proportion of athletes consuming supplements with low level of scientific evidence. Additionally, athletes seem to rely on inadequate sources of information and may be largely unaware of sources to detect supplement contamination.

Compliance with needle-use declarations at two Olympic Winter Games: Sochi (2014) and PyeongChang (2018)

Objectives

We describe compliance with the ‘IOC Needle Policy’ at two Winter Olympic Games (Sochi and PyeongChang) and compare these findings to those of the Summer Olympic Games of Rio de Janeiro.

Method

All needle-use declaration(s) (NUD) received during the course of the 2014 and 2018 Olympic Games were reviewed. We recorded socio-demographic data, the nature and purpose of needle use, product(s) injected, and route of administration. Data were analysed descriptively.

Results

In total, doctors from 22 National Olympic Committees (NOCs) submitted 122 NUD involving 82 athletes in Sochi; in PyeongChang, doctors from 19 NOCs submitted 82 NUD involving 61 athletes. This represented approximately 2% of all athletes at both Games, and 25% and 20% of all NOCs participating in Sochi and PyeongChang, respectively. No marked differences in the NUD distribution patterns were apparent when comparing the two Winter Olympic Games. The most commonly administered substances were as follows: local anaesthetics, non-steroidal anti-inflammatory drug and glucocorticoids. Physicians submitted multiple NUD for 24% of all athletes who required a NUD.

Conclusion

A limited number of NOCs submitted NUD suggesting a low incidence of needle use or limited compliance (approximately 2%). A key challenge for the future is to increase the rate of compliance in submitting NUD. More effective education of NOCs, team physicians and athletes regarding the NUD policy, its purpose, and the necessity for NUD submissions, in association with the enforcement of the appropriate sanctions following non-compliance are needed.

SPRINTING. . . Dietary Approaches to Optimize Training Adaptation and Performance

Although sprint athletes are assumed to primarily be interested in promoting muscle hypertrophy, it is the ability to generate explosive muscle power, optimization of power-to-weight ratio, and enhancement of anaerobic energy generation that are key outcomes of sprint training. This reflects the physique of track sprinters, being characterized as ecto-mesomorphs. Although there is little contemporary data on sprinters dietary habits, given their moderate energy requirements relative to body mass, a carbohydrate intake within the range of 3-6 g·kg^-1·day^-1 appears reasonable, while ensuring carbohydrate availability is optimized around training. Similarly, although protein needs may be twice general population recommendations, sprint athletes should consume meals containing ∼0.4 g/kg high biological value protein (i.e., easily digested, rich in essential amino acids) every 3-5 hr. Despite the short duration of competitions and relative long-recovery periods between races, nutrition still plays an important role in sprint performance. As energy expenditure moderates during competition, so too should intake of energy and macronutrients to prevent unwanted weight gain. Further adjustments in macronutrient intake may be warranted among athletes contemplating optimization of power-to-weight ratio through reductions in body fat prior to the competitive season. Other novel acute methods of weight loss have also been proposed to enhance power-to-weight ratio, but their implementation should only be considered under professional guidance. Given the metabolic demands of sprinting, a few supplements may be of benefit to athletes in training and/or competition. Their use in competition should be preceded with trialing in training to confirm tolerance and perceived ergogenic potential.

Analgesic and anti-inflammatory drugs in sports: Implications for exercise performance and training adaptations

Over-the-counter analgesics, such as anti-inflammatory drugs (NSAIDs) and paracetamol, are widely consumed by athletes worldwide to increase pain tolerance, or dampen pain and reduce inflammation from injuries. Given that these drugs also can modulate tissue protein turnover, it is important to scrutinize the implications of acute and chronic use of these drugs in relation to exercise performance and the development of long-term training adaptations. In this review, we aim to provide an overview of the studies investigating the effects of analgesic drugs on exercise performance and training adaptations relevant for athletic development. There is emerging evidence that paracetamol might acutely improve important endurance parameters as well as aspects of neuromuscular performance, possibly through increased pain tolerance. Both NSAIDs and paracetamol have been demonstrated to inhibit cyclooxygenase (COX) activity, which might explain the reduced anabolic response to acute exercise bouts. Consistent with this, NSAIDs have been reported to interfere with muscle hypertrophy and strength gains in response to chronic resistance training in young individuals. Although it remains to be established whether any of these observations also translate into detriments in sport-specific performance or reduced training adaptations in elite athletes, the extensive use of these drugs certainly raises practical, ethical, and important safety concerns that need to be addressed. Overall, we encourage greater awareness among athletes, coaches, and support staff on the potential adverse effects of these drugs. A risk-benefit analysis and professional guidance are strongly advised before the athlete considers analgesic medicine for training or competition.

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.

Novel Factors Associated With Analgesic and Anti-inflammatory Medication Use in Distance Runners: Pre-race Screening Among 76 654 Race Entrants-SAFER Study VI

OBJECTIVE

Analgesic/anti-inflammatory medication (AAIM) increases the risk of medical complications during endurance races. We determined how many runners use AAIM before or during races, AAIM types, and factors associated with AAIM use.

DESIGN

Cross-sectional study.

SETTING

21.1-km and 56-km races.

PARTICIPANTS

Seventy-six thousand six hundred fifty-four race entrants.

METHODS

Participants completed pre-race medical screening questions on AAIM use, running injury or exercise-associated muscle cramping (EAMC) history, and general medical history.

MAIN OUTCOME MEASURES

Analgesic/anti-inflammatory medication use, types of AAIM (% runners; 95% confidence interval), and factors associated with AAIM use (sex, age, race distance, history of running injury or EAMC, and history of chronic diseases) [prevalence ratio (PR)].

RESULTS

Overall, 12.2% (12.0-12.5) runners used AAIM 1 week before and/or during races (56 km = 18.6%; 18.0-19.1, 21.1 km = 8.3%; 8.1-8.6) (P < 0.0001). During races, nonsteroidal anti-inflammatory drugs (NSAIDs) (5.3%; 5.1-5.5) and paracetamol (2.6%; 2.4-2.7) were used mostly. Independent factors (adjusted PR for sex, age, and race distance; P < 0.0001) associated with AAIM use were running injury (2.7; 2.6-2.9), EAMC (2.0; 1.9-2.1), cardiovascular disease (CVD) symptoms (2.1; 1.8-2.4), known CVD (1.7; 1.5-1.9), CVD risk factors (1.6; 1.5-1.6), allergies (1.6; 1.5-1.7), cancer (1.3; 1.1-1.5), and respiratory (1.7; 1.6-1.8), gastrointestinal (2.0; 1.9-2.2), nervous system (1.9; 1.7-2.1), kidney/bladder (1.8; 1.6-2.0), endocrine (1.5; 1.4-1.7), and hematological/immune (1.5; 1.2-1.8) diseases.

CONCLUSIONS

12.2% runners use AAIM before and/or during races, mostly NSAIDs. Factors (independent of sex, age, and race distance) associated with AAIM use were history of injuries, EAMC, and numerous chronic diseases. We suggest a pre-race screening and educational program to reduce AAIM use in endurance athletes to promote safer races.

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.

Creatine Supplementation and Upper Limb Strength Performance: A Systematic Review and Meta-Analysis

BACKGROUND

Creatine is the most widely used supplementation to increase performance in strength; however, the most recent meta-analysis focused specifically on supplementation responses in muscles of the lower limbs without regard to upper limbs.

OBJECTIVE

We aimed to systematically review the effect of creatine supplementation on upper limb strength performance.

METHODS

We conducted a systematic review and meta-analyses of all randomized controlled trials comparing creatine supplementation with a placebo, with strength performance measured in exercises shorter than 3 min in duration. The search strategy used the keywords 'creatine', 'supplementation', and 'performance'. Independent variables were age, sex and level of physical activity at baseline, while dependent variables were creatine loading, total dose, duration, time interval between baseline (T0) and the end of the supplementation (T1), and any training during supplementation. We conducted three meta-analyses: at T0 and T1, and on changes between T0 and T1. Each meta-analysis was stratified within upper limb muscle groups.

RESULTS

We included 53 studies (563 individuals in the creatine supplementation group and 575 controls). Results did not differ at T0, while, at T1, the effect size (ES) for bench press and chest press were 0.265 (95 % CI 0.132-0.398; p < 0.001) and 0.677 (95 % CI 0.149-1.206; p = 0.012), respectively. Overall, pectoral ES was 0.289 (95 % CI 0.160-0.419; p = 0.000), and global upper limb ES was 0.317 (95 % CI 0.185-0.449; p < 0.001). Meta-analysis of changes between T0 and T1 gave similar results. The meta-regression showed no link with characteristics of population or supplementation, demonstrating the efficacy of creatine independently of all listed conditions.

CONCLUSION

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

Athletes and Supplements: Prevalence and Perspectives

In elite sport, where opponents are evenly matched, small factors can determine the outcome of sporting contests. Not all athletes know the value of making wise nutrition choices, but anything that might give a competitive edge, including dietary supplements, can seem attractive. Between 40% and 100% of athletes typically use supplements, depending on the type of sport, level of competition, and the definition of supplements. However, unless the athlete has a nutrient deficiency, supplementation may not improve performance and may have a detrimental effect on both performance and health. Dietary supplements are classified as a subcategory of food, so manufacturers are not required to provide evidence of product safety and efficacy, nor obtain approval from regulatory bodies before marketing supplements. This creates the potential for health risks, and serious adverse effects have been reported from the use of some dietary supplements. Athletes who compete in sports under an anti-doping code must also realize that supplement use exposes them to a risk of ingesting banned substances or precursors of prohibited substances. Government systems of regulations do not include specific laboratory testing for banned substances according to the WADA list, so a separate regulatory framework to evaluate supplements for their risk of provoking a failed doping test is needed. In the high-performance culture typical of elite sport, athletes may use supplements regardless of possible risks. A discussion around medical, physiological, cultural, and ethical questions may be warranted to ensure that the athlete has the information needed to make an informed choice.

Intended or Unintended Doping? A Review of the Presence of Doping Substances in Dietary Supplements Used in Sports

Introduction: The use of dietary supplements is increasing among athletes, year after year. Related to the high rates of use, unintentional doping occurs. Unintentional doping refers to positive anti-doping tests due to the use of any supplement containing unlisted substances banned by anti-doping regulations and organizations, such as the World Anti-Doping Agency (WADA). The objective of this review is to summarize the presence of unlabeled doping substances in dietary supplements that are used in sports. Methodology: A review of substances/metabolites/markers banned by WADA in ergonutritional supplements was completed using PubMed. The inclusion criteria were studies published up until September 2017, which analyzed the content of substances, metabolites and markers banned by WADA. Results: 446 studies were identified, 23 of which fulfilled all the inclusion criteria. In most of the studies, the purpose was to identify doping substances in dietary supplements. Discussion: Substances prohibited by WADA were found in most of the supplements analyzed in this review. Some of them were prohormones and/or stimulants. With rates of contamination between 12 and 58%, non-intentional doping is a point to take into account before establishing a supplementation program. Athletes and coaches must be aware of the problems related to the use of any contaminated supplement and should pay special attention before choosing a supplement, informing themselves fully and confirming the guarantees offered by the supplement.

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.

Analgesics and Sport Performance: Beyond the Pain-Modulating Effects

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.

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

Background

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

Results

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

Conclusions

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