Performance Enhancing Modalities

Mechanical PsychologicalPhysiologicNutritionalPharmacologic

Stimulants

StimulantsCaffeineAmphetaminesCocaineSympathomimetics– Ephedrine– Pseudoephedrine– Phenylephrine– Phenylpropanolamine

(PPA)Modafinil

Stimulants – proven effectsIncreases Endurance– Increases use of free fatty acids and

triglycerides– Spares muscle glycogen early in

exercise– Decreased perceived exhaustionEnhances Anaerobic Exercise– Decreases time to exhaustion – Decreases perception of exertion– Hypoanalgesic effectSmall amount of weight loss

Stimulant Use PrevalenceEphedrine: – 3.5% in NCAA athletes

Clin J Sports Med 2001– 12% of HS boys/26% of girls have tried

Med Sci Sports Exer 2002Caffeine– 33% of British club track/field athletes– 60% of British club cyclists

Chester N, Int J Sports Med 2008

Caffeine’s Proven Effects

Increased time to fatigue in prolonged, moderate intensity exercise No effect on repeated sprints/heavy exercise

Caffeine in Endurance Running

4.2-sec faster 1.5-km1-3% faster 5-km24-sec faster 8-km50-sec faster 10-km military pack marchNo change in 21-km raceImproved treadmill time-to-exhaustion in marathoners

Caffeine in Other SportsRowing: 1-3% faster 2000m raceSwimming: 24-sec faster 1500m race – About 21 minCycling: 3.5% higher mean power in 40km race

Caffeine DosingDoses 2-9 mg/kg in studies

2-5 mg/kg usually effective250-500 mg

– Cola: 40 mg– Coffee: 100 mg– Tea: 20-100 mg– Red Bull: 115 mg– Vivarin: 200 mg

Caffeinated Sports DrinksNo proven performance benefit– 18-km run times– Pl vs carb drink vs

carb+150mg caffeine – consumed 4x in race– Int J Sports Med 2005

Ephedrine

78-sec faster 10-km run (with backpack & helmet) vs placebo– 30-sec faster than caffeine

-0.8 mg/kg– No benefit when added to caffeine

ModafinilCycling at 85% VO2max– 22% longer time to exhaustion vs

Placebo18.3 min vs 15.6

– Central mechanism: decreased RPE– Dose 4 mg/kg– No side-efx seen

Stimulants - Side EffectsAnxiety*Dysrhythmias*Hypertension*HallucinationsAddictionDeath

Stimulant regulationMost banned by USADA & NCAA– Ephedrine– PPA– Most ADHD meds

Some still allowed (cold meds)– Pseudephedrine– Phenylephrine

Caffeine– USADA: no longer monitored– NCAA < 15 mcg/ml– 1 cup coffee = 100mg = 1.5

mcg/ml in urine

Blood Doping

Increasing the number of red blood cells in the body to increase the oxygen carried to muscle– Administration of blood, red blood

cells, or related blood products– Erythropoietin

Stimulates bone marrow to produce red blood cells

Blood Doping – proven effects

7% increase in Hgb5% increase in VO2 max34% increase in time to exhaustion at 95% VO2 max44 second improvement in 5 mile treadmill run time

(Williams and Branch summarized study findings)

Blood Doping - Side EffectsTransfusion reactionsInfectionsIncreased viscosity of blood– Stroke, MI, PE

Blood Doping - regulation Erythropoietin only by prescriptionDoping banned by USADA, NCAABlood tested for antigensCeiling on allowable Hct level at 50

Beta-2-AgonistsPhysiology– Bronchodilation, increased ventilation– Examples: albuterol, terbutaline,

salmeterol

Beta-2-Agonists – proven effectsClear benefit in asthma and EIB– Increased ventilation

No increase in performance in NON-asthmatic athletesSide effects: tremor, tachycardiaRegulation– USADA: prohibited– NCAA: inhalation permitted

Creatine

Replenishes ATP in anaerobic exerciseNo federal assessment of quality, performance, or safetyProven to increase lean body mass, strength

Creatine – disproven effectsMeta-analysis 2003: – No significant difference in field-based

athletic performance (e.g. running, swimming)

Branch JD. Int J Sports Nutr Exerc Metab June 2003

X X XX X XX X

Creatine - Side EffectsStudies of 2-10 weeks: no side efxLong term:40% non-responders

Anabolic SteroidsAnalogs of testosteroneMore than 100 typesForms:– Oral – Injection– Topical (gels, creams)

Prevalence of use– 2001: 1% in US college

athletes– 2006: 13% of German fitness

center attendees had used in past

Anabolic Steroids – Proven Effects

• Increase in fat-free mass

• Increase in body weight• Increase in arm girth• Increase in leg girth• Increase in bench press

and squat scores

Anabolic Steroids—Disproven Effects

No effect on endurance exercise– Males on treadmill

Eur J Appl Physiol 2006– VO2max in rats

Med Sci Sports Exer 2004

Anabolic Steroids - Side Effects

Hepatocellular damageCardiovascular diseasePsychological disturbance

Effects can sometimes be permanent!

More side effects…

Men– Acne– Premature baldness– Prostatic hypertrophy– Female

masculinization– Injection

complications*– Testicular atrophy– Impotence*– Gynecomastia*(some may be

permanent)

Nitric Oxide-releasing agentsPhysiology– Arginine is a precursor of NO– NO regulates BP and blood flow

to organs– Most supplements: Arginine α-

ketoglutarateClaims– Improves “pump” and blood

flow to muscles– Increases strength and size– Speeds recovery

Nitric Oxide-releasing agents

Endurance exercise studiesNo benefit in endurance athletesLimited evidence of benefit in debilitated pts

Strength exercise: mixed results, no proven benefitMore studies needed

Sodium BicarbonateMechanism: buffers metabolic acidosis after strenuous exerciseProven ergogenic efx in high-intensity exercise– 100m & 200m swim– Repeated sprints– Repeated judo throws

BicarbonateLimited & conflicting evidence of benefit in aerobic exercise– High-intensity running: 17% better time-

to-exhaustion (30 vs 26 min)– 60-min max-effort cycle ergometry: 14%

higher power vs Placebo– 60-min high-intensity cycling: no

difference vs Placebo

Bicarbonate

Dose: 0.2 - 0.3 mg/kgGI side effects common

Carbs

Sports drink consumptionCarbohydrate loading

Sports Drink ConsumptionEvidence supports enhanced endurance performance vs water in events >60 minNo benefit from added protein

Carbohydrate Loading

Known to increase muscle glycogen levels 13% - 100%Prolongs time to exhaustion 2-3% in endurance events >90 minutesHigher effect in Untrained persons– 25-km treadmill

Methods of Carbo Loading

Classic 6-day regimen– 3 days intense glycogen-depleting exercise– 3 days high-CH diet, no exercise

Modified 6-day regimen– 3-day exercise taper, normal diet– High-CH (70%) & light exercise 3d prior

Single-day regimen– 10 gm/kg/day CH 1-day prior– Normal exercise regimen

Carbohydrate Loading ‘s Little standardization of methods– Athletes need to try methods prior to

competition to see what worksExact roles of glycogen-depleting exercise, type of CH, and timing are unclear

Miscellaneous Losersin endurance exercise performance

Vitamin E and other vitaminsMinerals: Cr, Mg, Zn, SeL-CarnitineAntioxidantsPyruvateArginineHydroxy-methyl-butyrate (HMB)

Anti Doping in Elite Athletic Competition

Permitted/Prohibited?

http://www.usantidoping.org.dro 1-800-233-0393

Therapeutic Use Exemptions- “TUE”

Abbreviated TUE– Doc fills out; athlete faxes to USADA– Effective immediately, up to 1 year– IM/IJ/inhaled corticosteroids– Inhaled beta-agonists

Regular TUE– All other substances– Doc fills out, send to USADA, along with

supporting documents– Process takes 1-2 months to approve– Variable duration

No substitute for hard work…

Questions?

Thank You!