Sports Pharmacology: A Medical Pharmacologist's Perspective

Comprehensive analysis of prohibited substances and methods in sports: Unveiling trends, pharmacokinetics, and WADA evolution

This review systematically compiles sports-related drugs, substances, and methodologies based on the most frequently detected findings from prohibited lists published annually by the World Anti-Doping Agency (WADA) between 2003 and 2021. Aligned with structure of the 2023 prohibited list, it covers all proscribed items and details the pharmacokinetics and pharmacodynamics of five representatives from each section. Notably, it explores significant metabolites and metabolic pathways associated with these substances. Adverse analytical findings are summarized in tables for clarity, and the prevalence is visually represented through charts. The review includes a concise historical overview of doping and WADA's role, examining modifications in the prohibited list for an understanding of evolving anti-doping measures.

Competence in Sports Pharmacy among Pharmacy Students in Norway

Pharmacists are competent to promote the proper use of medicines. According to the International Pharmaceutical Federation, pharmacists must develop competence in sports pharmacy and the contents of the World Anti-Doping Agency code. This explorative study aimed to identify the status of sports pharmacy in pharmacy education in Norway and competence in sports pharmacy among Norwegian pharmacy students. The study curricula of pharmacy education were examined for the content of sports pharmacy. An online questionnaire was also developed and distributed among pharmacy students. The anonymous survey collected demographic information and data on competence in sports pharmacy. Data from 122 participants were analyzed. Only 22.5% of pharmacy students had acquired a form of training in sports pharmacy and 91.7% wished to gain higher competence. In total, 40.2% of respondents were uncomfortable in advising athletes and trainers on medication use in sports. Study year was found to correlate with competence level with a significant difference between the 3rd year (bachelor) and 5th year (master) students. Age, institution, and number of years engaged in sports were not associated with competence level. The inclusion of sports pharmacy in pharmacy programs holds practical relevance for enhancing competency levels. This implementation can be realized through the integration of sports pharmacy modules and/or the incorporation of research-based activities.

Use of ergogenic aids among Brazilian athletes: a cross-sectional study exploring competitive level, sex and sports

Was investigated ergogenic aids (EAs) used by Brazilian athletes and their association with performance, sex, sports classification, and modality. It identified the main purposes of EAs and their prescription.

Methods

239 athletes of 15 modalities, ranging from regional to international level, answered a survey online.

Results

Highly competitive athletes consumed nutritional and mechanical aids more (OR = 1.96 CI 95% [1.28-2.9]; OR = 1.79 CI 95% [1.29-2.47]), while the use of psychological EAs decreased [OR = 1.66 95% CI (1.18-2.94); p = 0.001]. Male athletes [OR = 1.44 CI 95% (1.11-2.88)] and individual sports practitioners [OR = 1.78 CI 95% (1.02-3.11)] used nutritional aids more. Triathlon athletes had higher nutritional EA use, while soccer athletes had lower. Combat sports athletes had higher pharmacological EA use.

Conclusion

Athletes use nutritional and pharmacological aids more to improve performance and gain lean body mass. Mechanical aids were used for recovery and psychological aids for motivation. Self-prescription is common, especially for pharmacological aids.

Bodybuilding: A Comprehensive Review of Performance-Enhancing Substance Use and Public Health Implications

The use of performance-enhancing substances in bodybuilding is a well-known and long-standing issue. This comprehensive review article provides a detailed overview of the history of performance-enhancing substance use in bodybuilding, the types of substances commonly used, and the short-term and long-term health effects associated with their use. Additionally, the article discusses the regulation of performance-enhancing substances in various countries and the role of healthcare professionals in preventing substance use. The article also highlights the impact of substance use on society and the importance of prevention and intervention strategies. Finally, the article emphasizes the role of policymakers in addressing performance-enhancing substance use, including the development of regulations, penalties for violating rules, and the provision of resources for prevention and intervention programs. Overall, this review article sheds light on the dark side of bodybuilding and provides insight into the public health implications of performance-enhancing substance use.

Past, Present, and Likely Future of Nutraceuticals in India: Evolving Role of Pharmaceutical Physicians

Nutraceuticals are gaining importance owing to the current pandemic situation and increasing focus on overall health. Nutraceuticals include products, which help in maintaining immunity and prevent diseases. It also includes products that support the optimal functioning of the human body. Poor nutrition plays an important role in lifestyle-related disorders as well. Various nutraceuticals have exhibited therapeutic potential, hence gaining popularity. Nutraceuticals are mainly categorized into dietary supplements and functional foods. With multiple factors contributing to the growth of nutraceutical industry in India, we are marching toward global leadership in nutraceuticals. Food Safety and Standards Authority of India (FSSAI) is solely responsible for regulating the approvals, promotions, and labeling standards for health supplements and nutraceuticals. As the understanding of these nutraceuticals is improving, the regulations are becoming stricter and there is a pressing need to monitor the usage of such products regularly and stringently. Nutrivigilance and phytovigilance are relatively new concepts in our country; however, regulatory authorities need to proactively observe the adverse effects and issues related to substandard and counterfeit nutraceutical products. Healthcare professionals including pharmaceutical physicians can play an important role in safeguarding the population by advocating the rational use of nutraceuticals, food supplements, and consumer health products.

A Clinically-Reasoned Approach to Manual Therapy in Sports Physical Therapy

Symptom modification techniques have been recently dichotomously labeled as either passive or active therapies. Active therapy such as exercise has been rightfully advocated for while "passive" therapies, mainly manual therapy have been regarded as low value within the physical therapy treatment spectrum. In sporting environments where physical activity and exercise are inherent to the athletic experience, the utilization of exercise-only strategies to manage pain and injury can be challenging when considering the demands and qualities of a sporting career which include chronically high internal and external workloads. Participation may be impacted by pain and its influence on related factors such as training and competition performance, career length, financial earning potential, educational opportunity, social pressures, influence of family, friends, and other key stakeholders of their athletic activity. Though highly polarizing viewpoints regarding different therapies create black and white "sides," a pragmatic gray area regarding manual therapy exists in which proper clinical reasoning can serve to improve athlete pain and injury management. This gray area includes both historic positive reported short-term outcomes and negative historical biomechanical underpinnings that have created unfounded dogma and inappropriate overutilization. Applying symptom modification strategies to safely allow the continuation of sport and exercise requires critical thinking utilizing not only the evidence-base, but also the multi-factorial nature of sports participation and pain management. Given the risks associated with pharmacological pain management, the cost of passive modalities like biophysical agents (electrical stimulation, photobiomodulation, ultrasound, etc), and the indications from the evidence-base when combined with active therapies, manual therapy can be a safe and effective treatment strategy to keep athletes active.

Level of Evidence

5.

Sports psychiatry: a desideratum on sports arena!

The emerging field of sports psychiatry has been developing steadily in recent years. This is not just a health concern but is likely to impact sporting performance and achievement significantly. An overview of sports psychiatry is provided. Psychiatric disorders of all varieties can and do present in sporting populations. Sports psychiatry keeps evolving to drive forward the importance of good mental health in sport as in life.

Doping and sports endocrinology: anabolic-androgenic steroids

The use of anabolic steroids affects not only professional athletes but also the general population (bodybuilders, gym clients, and adolescents). In the first case, its use is prohibited and sanctioned by the World Anti-Doping Agency and Olympic committees. For the other users, it is difficult to establish its prevalence since many obtain the products via the internet. The reasons for its use are varied and different forms of use and other types of users have been described. Among the side effects of steroid use, hypogonadism is the most frequent cause for endocrinological consultation. After a general introduction to doping, this review describes the historical background of anabolic-androgenic steroids, their classification, forms of use, physiological effects, adverse effects on different organs and systems, treatment of hypogonadism, as well as detection methods.

[Ophthalmic drug therapy in professional athletes-what is allowed, what is doping?]

At first sight, ophthalmic drugs are not necessarily suspected of being used as performance-enhancing agents in competitive sports. However, there are some restrictions that must be noted, especially when certain drugs are taken orally. A structured analysis of the doping relevance of ophthalmic drugs was performed on the basis of a literature review, taking into account the current guidelines of the National Anti-Doping Agency of Germany and the World Anti-Doping Agency. Use of the most common ophthalmological drug groups is possible without restrictions, especially in the case of topical application. An exception is the oral use of diuretics, which is prohibited at all times. For glucocorticoids, topical application to the eye is allowed, but oral application is prohibited in competition. A similar restriction applies to the use of epinephrin, for which all forms of systemic application are prohibited in competition. When taking beta-blockers, the sport being played is the determining factor: use is prohibited in billiards, archery, darts, golf, motor sports, shooting sports, skiing/snowboarding, ski jumping, freestyle aerials/half pipe, snowboard half pipe/big air, and underwater sports. For shooting and archery, beta-blockers are also prohibited outside of competitions. Athletes with pre-existing ophthalmological conditions should seek comprehensive advice from an ophthalmologist before using any medication, and together they should choose a permissible active ingredient, consider the appropriate route of application, and, if necessary, apply for a Therapeutic Use Exemption. It is currently not known how many of the national and international athletes have to be treated with eye drops.

The prevalence of misusing over-the-counter and prescribed drugs in Syrian gymnasiums for performance-enhancing reasons: a cross-sectional study

Background

This study investigates the prevalence of misusing over-the-counter (OTC) and prescribed drugs in Syrian gymnasiums, in addition to types, sources of knowledge, and patterns of use. A structured questionnaire was distributed to 381 members of sports groups on social media, between April 2020 and February 2021. Data were analyzed using IBM SPSS software Version 26 for windows.

Results

A total of 133 participants (about 35%) stated they took OTC and prescribed drugs. Of those, 79 (11.8%) took proteins and amino acids, and 14 (3.7%) claimed they used 50 different products (mentioned 167 times) of anabolic steroids and other hormones (e.g., growth hormone and thyroxine). The most frequently used substance was testosterone (N =25, 15.56%), followed by thyroxine (N = 12, 7.18%) and stanozolol (N = 11, 6.58%). The source of knowledge was the Internet (48.6%) followed by friends (28.4%) and coaches (20.9%). Most users were males (61.6%) and had a bachelor’s university degree (64%). All anabolic steroid users (N = 14) practiced bodybuilding. Statistically significant relationships were found between the usage of anabolic steroids, proteins, and amino acids with each of the monthly income, frequency of training, level of training, and gender. Users claimed that they got benefits from taking these substances, and the majority of users (about 70%) did not experience any adverse effects.

Conclusions

Our results showed significant differences compared to neighboring countries, regarding attitudes towards misusing OTC and prescribed medications.

Psychosocial aspects of sports medicine in pediatric athletes: Current concepts in the 21st century

Behavioral aspects of organized sports activity for pediatric athletes are considered in a world consumed with winning at all costs. In the first part of this treatise, we deal with a number of themes faced by our children in their sports play. These concepts include the lure of sports, sports attrition, the mental health of pediatric athletes (i.e., effects of stress, anxiety, depression, suicide in athletes, ADHD and stimulants, coping with injuries, drug use, and eating disorders), violence in sports (i.e., concepts of the abused athlete including sexual abuse), dealing with supervisors (i.e., coaches, parents), peers, the talented athlete, early sports specialization and sports clubs. In the second part of this discussion, we cover ergolytic agents consumed by young athletes in attempts to win at all costs. Sports doping agents covered include anabolic steroids (anabolic-androgenic steroids or AAS), androstenedione, dehydroepiandrostenedione (DHEA), human growth hormone (hGH; also its human recombinant homologue: rhGH), clenbuterol, creatine, gamma hydroxybutyrate (GHB), amphetamines, caffeine and ephedrine. Also considered are blood doping that includes erythropoietin (EPO) and concepts of gene doping. In the last section of this discussion, we look at disabled pediatric athletes that include such concepts as athletes with spinal cord injuries (SCIs), myelomeningocele, cerebral palsy, wheelchair athletes, and amputee athletes; also covered are pediatric athletes with visual impairment, deafness, and those with intellectual disability including Down syndrome. In addition, concepts of autonomic dysreflexia, boosting and atlantoaxial instability are emphasized. We conclude that clinicians and society should protect our precious pediatric athletes who face many challenges in their involvement with organized sports in a world obsessed with winning. There is much we can do to help our young athletes find benefit from sports play while avoiding or blunting negative consequences of organized sport activities.

Hydroperoxy steroids and triterpenoids derived from plant and fungi: Origin, structures and biological activities

Hydroperoxides (R-OOH) represent a small family of natural metabolites that have been isolated from higher plants, fungi, and marine organisms. This paper is devoted to the distribution of hydroperoxides in plants, fungi and terrestrial fungal endophytes and their biological activity. Hydroperoxides of plants demonstrate a wide range of biological activities however, antineoplastic and anti-ulcerative are most characteristic with confidence from 91 to 98 percent. For hydroperoxides from fungi, the dominant are antineoplastic and anti-hypercholesterolemic activities with confidence from 89 to 92 percent. Very interesting activity was found for some triterpenoid hydroperoxides, which is characterized as a treatment for the symptoms of dementia. The norlupane hydroperoxide shows activity for the treatment of dementia. It is interesting that the reliability of this activity was very high 97.2%. According to our preliminary data, the norlupane hydroperoxide is apparently the first natural metabolite that showed almost 100 percent activity for the treatment of dementia. However, to confirm these data requires practical and clinical experimental work.