final report section 3 – definitions and ......fitness against doping – section 3 –...

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FINAL REPORT

SECTION 3 – DEFINITIONS AND BACKGROUND

April 2012

FitnessAgainstDoping–Section3–DefinitionsandBackground 2

AgainstDopingProjectisgrant-aidedbytheEuropeanCommission.ThisreportrepresentstheviewsoftheauthorandnotoftheCommission.

3.1 Background to Doping

3.1.1 History and context of doping in elite sport

Dopinginelitesporthasalonghistory;in1928theInternationalAmateurAthleticFederation(IAAF)becamethefirstInternationalSportFederationtobantheuseofdoping,thendefinedasstimulatingsubstances.1Duringthe1930smanyothersportingfederationsundertooksimilarmeasuresbutrestrictionsremainedineffective.ThepublicdeathofaDanishcyclist,KnudEnemarkJensen,duringcompetitionattheOlympicGamesinRomein1960,duetoasuspectedamphetamineoverdose,increasedthepressureforsportsauthoritiestointroducedrugtests.2Laterinthesamedecade,thedeathofBritishcyclist,TommySimpson,whileundertheinfluenceofamphetaminesduringthe1967TourdeFrance,providedfurtherimpetusfortheimplementationofofficialanti-dopingcontrolsystemsandthebanningofamphetaminesininternationalsport.Similarhighprofiledopingcaseswithinelitesportsuchas,BenJohnson,DanMitchell,andLinfordChristie3haveensuredthatdopingwithinelitesporthasretainedahighlevelofimportance.

MostInternationalFederationshadintroduceddrugtestingbythe1970s,neverthelesstheuseofanabolicsteroidswasbecomingwidespread,especiallyinstrengthevents,asatthattimetherewasnowayofdetectingthem.4Areliabletestmethodwasfinallyintroducedin1974andtheInternationalOlympicCommittee(IOC)addedanabolicsteroidstoitslistofprohibitedsubstancesin1976,whichresultedinamarkedincreaseinthenumberofdrugdisqualificationsinthelate1970s,notablyinstrengthrelatedsportssuchasthrowingeventsandweightlifting.5In1998alargenumberofprohibitedmedicalsubstanceswerefoundfollowingapoliceraidduringtheTourdeFrance,asaresulttheIOCconveneda‘WorldConferenceonDopinginSport’atLausanne.ThisresultedintheLausannedeclarationwhichapprovedthedevelopment

oftheWorldAnti-DopingAgency(WADA).Itdescribesitselfasa“uniquehybridorganizationthatisgovernedandfundedequallybythesports(Olympic)movementandgovernments”.6TheframeworkforWADA’sactivitiesisprovidedbytheWorldAnti-DopingCodewhichfirstcameintoeffectinJanuary2004andhasthetwolistedpurposes:

• Toprotectathletes’fundamentalrighttoparticipateindopingfreesportandthuspromotehealth,fairnessandequalityforathletesworldwide

• Toensureharmonised,coordinatedandeffectiveanti-dopingprogramsattheinternationalandnationallevelwithregardtodetection,deterrenceandpreventionofdoping

TheCodeisthefundamentaluniversaldocumentallglobalanti-dopingactivitiesarebasedon.7Amongstotherthings,theCodeaddresses:thedefinitionofdoping;sanctions;thedopinglist;checks;awareness–raising;researchandlaboratorytesting.AllsportingorganisationsareobligedtoadheretotheCode,howeveritisnotmandatoryforallgovernments.8

Nationalsportsorganisationsaremembersofthecorrespondinginternationalsportsfederationorumbrellaorganisation,andareexpectedtokeeptheiranti-dopingregulationsinlinewiththoseoftheinternationalsportsfederation.Forthemajorityofthesefederations,dopingregulationsissuedbygovernmentsandtheWorldAnti-DopingAgency(WADA)definepolicy.

Thisinfrastructureispresentinalmostallcountries,suchasthe‘Anti-DopingDanmark’9inDenmark,‘Dopingautoriteit’10intheNetherlands,andtheUKAnti-Doping(UKAD)11thenationalbodyresponsiblefortheimplementationandmanagementoftheUK’santi-dopingpolicy.UKADisresponsibleforensuringsportsbodiesintheUKcomplywiththeWorldAnti-DopingCode.ThisistypicalformostMemberStates.

3 FitnessAgainstDoping–Section3–DefinitionsandBackground

Despitethisimpressiveinfrastructureforanti-dopingpracticewithinelitesport,therearemanycriticsofthecurrentdopingsystem.UNIGlobalUnionrecentlystatedthatthereisapaucityofpubliclyavailablestatisticalevidencetosupportcurrentpoliciesandpracticesondrugtestingprogrammesforathletes.12ThesamereportcitesthelackofstandardisedreportingbytheNationalAnti-DopingAuthoritiesasoneoftheprinciplefailingsofthesystem.13Researchersfoundonly20of49EuropeanNationalAnti-DopingOrganizationshadannualreportsavailableonlinedespitebeingboundbyArticle14.4oftheWADACodetoannually"publiclypublish"theirresults.AnanalysisoftheexistingdatafromavailablereportsshowedsomedisturbingtrendsthatchallengeWADA'snarrativesinmanyareas.Outof44,744totalreportedtestsbythe20NADOStherewere445violations-207oftheminBelgium.These445violationswereconcentratedinfivesports-Bodybuilding(121),Cycling(33),Rugby(25),Powerlifting(21),andWeightlifting(21).14

Furthermore,theUKAthleticsAuthority(UKA)suggeststhatwhilea“comprehensivetestingprogramme”playsafundamentalroleasadeterrentandpreventativemeasureagainstdoping,UKAacknowledgesthatfurtherworkmustbeundertakentoprovideathleteswiththeinformationandtechnicaladvicetheyneedtomakeinformedandresponsiblechoicesincompliancewiththeUKA’s(ADregulations).Theneedforeducationisespeciallytruewhenattemptingtopromotetheappropriateuseofsupplements.

IssuesrelatingtosupplementshavelongbeenhandledbytheWorldAnti-DopingAgency.In2004theyanalysed634productsfromstandardretailchannelsin13differentcountriesforthepresenceofsteroidsorpro-hormones(whichthebodywillmetaboliseintosteroids).Outofthe634productsanalysed,15%werefoundtobecontaminatedwithsteroids/pro-hormones.However,despitetheeffortsoftheWorldAnti-DopingAgency,thedistributionofsupplementsishardtoregulateduetotheobviousanddiversedistributionchannelsprovidedbytheinternet.Contentandqualitycannotalwaysbeeasilyascertainedanditseemsthatmanyaredeliberatelyorinadvertentlyadulterated.

Thelabellingofsuchpreparationsdoesnotalwaysreflecttheiractualcontentandsoplatitudessuchas"alwaysreadthelabel"nolongerapply.Forexample,ginsenghasbeenusedasanenergyboosterandwhilstginsengrootsdonotcontainprohibitedsubstances,productscarryingthenameginsenghavetestedpositiveforephedrine.Inonestudy,brandsofOTCandrogenic-anabolicsupplementsdidnotcomplywithlabellingrequirements,infactoneproductcontained77%moresteroidthanthelabelstatedandanothercontained10mgundeclaredtestosterone.15Aseparateanalysisof75supplementspurchasedovertheinternetfoundthat7containedundeclaredhormonesand2containedephedrineandcaffeine.16ThemostcompellingevidenceisfromastudycommissionedbytheInternationalOlympicCommittee(IOC).94outof634"legalsupplements"purchasedin13countriescontainedbannedsubstances;64containingtestosterone,23nandroloneand7steroidhormones.17Capsulesweremorecommonlycontaminatedthantabletformulations.Inthesamestudy,onebatchofcreatinewascross-contaminatedwith7differentbannedhormones.

Thesupplementcultureinsport,andinthiscaseforfitness,needstobeaddressedandthisiswhytheFADresearchhasbeenextendedintothisarea.Knowledgeofnutritionalsupplementsandrecommendeddailyallowancesisgenerallypoor.Despitethedevelopmentofadvanceddrugtestingsystems,dopinginsport,bothdeliberateandinadvertent,isontheincreaseinelite,amateurandschoolsports.Dopinginsportnotonlycontravenesthespiritoffaircompetition,itcanbeseriouslydetrimentaltoathletes'health.Whereassometakedrugstoseekdeliberateadvantage,othersfeelpressurisedintoconsideringdopingastheonlyviableoptiontoleveltheplayingfield.Othersinadvertentlytakeprohibitedsubstancesduetoalackofawareness.Aparticularproblemistheriskoftoday'ssupplementculturetoaccidentalexposureandapositivedrugtest.Aneffectiveanti-dopingprogrammustincorporateeducationalcomponentsinadditiontosystematicandconsistenttesting.Todate,governmentshaveconcentratedonthedevelopmentofrigorousdrugtestingmethodswithoutalsoaddressingtheeducationalneedsofsportsmenandwomenandyouthcultures.Thereis


arelativepaucityofrigorousscientificresearchintotheextentofdopingacrosstheEuropeanfitnesssectorincludingallaspectsofdrugtaking.Manyreportsrelyonsmall-scaleandlocalisedsurveysasanevidencebase18,andtheFADresearchseekstocounteractthisinordertoconstructareliableevidencebaseforfutureinterventionstrategies.

3.1.2 Doping and public health

Itisoftenstatedthatanti-dopingcontrols,asusedwithinelitesport,arenotapplicableorappropriatetofitnessorotheramateursportenvironments.Thisisbecausewhilsttheanti-dopinginfrastructureinelitesportisdesignedtoachievefairplayinglobalelitesport,dopingcontrolinafitnessenvironmenthastheobjectiveofsecuringthehealthoftheexercisingpopulation.Severalsourcesstatethatdopingcanbeseriouslydetrimentaltohealth,andthisisthefocusoftheCommission’sthinking.Mostanti-dopingcampaignshavefocusedonthesideeffectsoflongtermanabolicsteroiduse,suchasimpotence,acne,aggressivebehaviour,anddamagestovitalorgans.19MoststudiesofAASuseshowasignificantdropinhighdensitylipo-proteinsamongstusers,whichmaybelinkedtoanelevatedriskofcardiovasculardiseases.20AASalsocarriesphysicalsideeffectsuniquetofemales,suchasincreasedfacialhair,deepeningofthevoice,andmenstrualdisturbances.21Studieshavealsoidentifiedsideeffectsinwomenthataresimilartothoseexperiencedbymales,suchasincreasedaggression,libido,acne,andthelossofscalphair.22Theuseofanabolicsteroidshasalsobeenassociatedwithliverdamage.ThepotentialdetrimentalhealthsideeffectsofsteroiduseexistinstarkcontrasttothehighnumbersofEuropeansthatclaimtoexerciseforthepurposesofimprovingtheirhealth,inadditiontothepotentialdamagetophysicalappearancewhichcontradictstheideathatdopingmayimprovebodyimage,anothercommonlycitedmotivationforparticipatinginphysicalexercise.23

Therehasalsobeenanincreaseinthegeneraluseofamphetaminesandgrowthhormoneswhichbothcanhavedetrimentalimpactsonhealth.Growthhormonesprimarilyaffectslevelsofmusclemass,itletsthemusclesgrowindirectly,notdirectly,

byincreasingthecapacityforproteinformation:thismechanismincreasestheamountsofinsulinandanabolicsteroidsapersoncanuseeffectively.UseofgrowthhormonesisassociatedwithariskofdevelopingCreutzfeldt-Jacobdisease(priondisease).Acomparativestudyfoundhigherratesofjointpainandcarpaltunnelsyndrome(nerveimpingement)amonggrowthhormoneusers.Additionally,softtissueswelling,breastgrowth,insulinresistancewithanincreasedriskofdiabetesmellitusandextremegrowthofhands,feet,noseandjawhaveallbeendescribedaspotentialsideeffectsinthestudy.24

Useofamphetamineshasalsobeenassociatedwithavarietyofpsychologicalandphysicaleffects.Euphoria,hyper-alertness,emotionalhypersensitivitywithstressandangeralsomayoccur.Therearealsoinfluencesonheartrateandpupildilationandbloodpressurechangesmayoccur.25Inrarecases,liverdisordersandepilepticseizuresmayoccur.Furthermore,amphetaminedependencemayoccurquickly,andisapparentintheinabilitytosustainnormalsocialandprofessionalactivities.Inordertoexperiencethesamefeeling,increasingamountsofthesubstancemustbeused.Physically,thismayleadtosevereweightlossandpsychologicallytoparanoia.

Withinunorganisedsports,dopingisnotonlyusedtoimproveperformance,butalsotoobtainaslim,muscularphysiqueparticularlyformen,andforwomenandgirlsitseemstobearoutetofasterweightloss.Thereisseparateresearchontheworryingpsychologicalandphysiologicaldisorderarisingfromwhatissometimesreferredtoasthe“AdonisEffect”26andwhichcanincludenotonlyobsessivetrainingtodevelopamuscularbody,butalsowitheatingdisordersandtakingofanabolicsteroidstoenhanceoutcomes.Therearemanyreasonswhypeople(andespeciallyyoungmenwhohavebeenthefocusofcurrentdopingresearchandactivity)turntoenhancingsubstancestoacceleratetheirtrainingoutcome.Theseincludetheemulationoftheirfavouriteprofessionalsportsstars,improvingpersonalstrengthandbodybuild,gainingacompetitiveedgeagainstopponents,orsuccumbingtopeer-pressure–andmakingthemselvesmoresexuallydesirable.Butregardless


ofthereason,suchpracticesareoftenillegal,unethical,andmostimportantlycanbeveryharmfultotheirhealth.

DrHarrisonPage27whoiscurrentlyProfessorofPsychiatryatHarvardMedicalSchool,hasaresearchfocusonsubstanceabuse,andespeciallywithAASuse.Hesaysthatthereasonwhypredominantlymentakethemisbecausetheyarehighlyeffectiveandthereisanincreasingexpectationofmalemuscularity.

Thepresentationoflarge,muscledmeninthemedia,heargues,fuelsbodyimagedisordersandalsocanaffectsomewomen.ThetraditionofmuscularityisaWesternconceptandisnotveryprevalentinotherpartsoftheworldsuchasinAsia.HesaysthatusingAAStoincreasemuscularityisayoungformofdrugabuseandtheoldestusersareonlyjustreachingmiddleage.

DrSaraStanford,fromtheSahlgrenskaUniversityHospital,Sweden,saysthatintheirstudiesthereisa10-foldincreaseinthemortalityrateforASSuserswhoareoftenalsousersofothernarcotics.IthasbeenarguedthatthosetakingAAStoincreasetheirbodysizesufferfromareverseofanorexianervosawhichisalsosometimeslinkedtobodydysmorphicdisorder(BDD).Thisisatypeofmentalillness,whereintheaffectedpersonis

concernedwiththeirbodyimage,manifestedasexcessiveconcernaboutandpreoccupationwithaperceiveddefectoftheirphysicalfeatures.28Thepersoncomplainsofadefectineitheronefeatureorseveralfeaturesoftheirbodyorvaguelycomplainsabouttheirgeneralappearance,whichcausespsychologicaldistressthatcausesclinicallysignificantdistressorimpairsoccupationalorsocialfunctioning.OftenBDDco-occurswithemotionaldepressionandanxiety,socialwithdrawalorsocialisolation.29

Extremelevelsofbodybuildinghavelitt letodowithfitnessandwell-beingactivitiesbeingundertakeninmostfitnesscentreswhichpresentamuchmorebalancedrangeofproductsandservicestohelpcitizenstoimprovelevelsofactivityandfortheirhealth.

Thefitnesssectorisincreasinglycharacterizedbyclubswhichhaveabroadrangeofstrengthandcardiovasculartrainingwithacorrespondingreductioninfree-weightareas.

Peopleusingfitnesscentrescomefromaverywiderangeofdemographicsandabilitiesandveryfewseektopursuebodybuildingalone.


Ontheotherside,whilstthe“messaging”abouttheharmfuleffectsoftakingdopingsubstancesispowerful,itdoescontradicttheexperiencesofuserswhofrequentlycitethephysiologicalconsequencessuchasincreasedstrengthandmusclegrowthanddesirability.Thecommonlyacceptedreasonsforwhypeopletakedopingsubstancesandstimulantsareto:

• Increasemusclestrength,andimprovebodyshape

• Loseweight• Improvephysicalcondition• Extendaperiodoftraining• Achieveaspecial(sporting)goal• Aidrecoveryfrominjury

TheFADsurveyhasreviewedtheuseofbannedsubstances,recreational(orsocietaldrugs)andtheuseoffoodsupplementswhichareallusedsingularlyorincombinationbysomefitnessconsumers–anditisnotasingleissueofaminoritytakingAAS’stoimprovemusclesize.Itisamorecomplexsituationthancontrolandenforcementofasinglesubstancecanachieve.

Finally,thereislimitedclarityovertheaimofthedopinginterventionstrategies.MuchoftheresearchandstrategiesintothisareahavepreviouslyfocusedontheuseandprevalenceofAndrogenicAnabolicSteroids(AAS),definedas,“A group of synthetic hormones that promote the storage of protein and the growth of tissue, sometimes used by athletes to increase muscle size and strength”.30Therehasbeenlimitedresearchintotheprevalenceofotherformsofdopingsuchasamphetamines,ephedrine,andpseudoephedrine.Therefore,whilstwithinelitesports,theanti-dopinginfrastructurearecommittedtoreducingtheprevalenceoftheWorldAnti-DopingAgency(WADA)listofbannedsubstances;thereisnoagreementofthesubstancestobetestedwithinthefitnesssector.

TothebestofourknowledgenootheramateursporthasundertakenworkwiththecomplexityanddepthofthisFADresearch.Thereispracticallynoevidenceavailableoftheprevalenceofdopinginotheramateursports,eventhoughmanyoftheseperformance-basedsportspeopleprobablyuse

fitnesscentresaspartoftheirtraining.Itwouldnotbeanunreasonableassumptionthattherearedopingpracticeswithotheramateursportspeopleengagedinactivitieswhere,ataprofessionallevel,dopingisbeingdetected–suchasforinstanceincycling,weightliftingandrugby.

3.1.3 Doping in fitness and amateur sport

‘Unorganised’or‘amateur’sportandfitnessdoesnotcurrentlyhaveasimilarinfrastructureforharmoniseddopingcontrollikethatwhichexistsineliteandcompetitivesport.Thelackofaharmonisedapproachisduetoanumberofreasons.

Firstly,wheredopinginorganised(professional)sportisprimarilyfocusedonimprovingathleticperformance,theuseofdopinginunorganisedsportsmaybeduetoadesiretoobtainamuscularandslimphysique.31TheDutchHealthCouncilstatesthatthisisespeciallytrueoffitnessactivities,whilstseveralsourcesstatethatfitnessandstrengthtrainingarenotsportinatraditionalsense,butratherthatthe“purposeoftakingpartintheseactivitiesisnottocompetebuttotrainandstayfit”.32Bothofthesesourcesdemonstratethatthedesiredoutcomeoffitnessactivitiesdonotoftenrelatetogainingacompetitiveedgebutinsteadrelatemoretopersonalhealth,andattimesphysicalappearance.ProfessorAskVestChristiansenconsistentlyarguesthatitisincorrecttointegratefitnessactivitiesandelitesportunderthesameumbrella,andwhilsttheanti-dopinginfrastructureinelitesportisdesignedtoachievesportingfairplay,dopingcontrolinafitnessenvironmenthastheobjectiveofsecuringthehealthoftheexercisingpopulation.

Secondly,asaresultoftheunclearnatureofdrugusewithinthefitnesssectorandunorganisedsportenvironments,thereisnowidelyagreedprotocolforhandlingtheissue.Incontrastwithelitesports,theprimarytaskofreducingdopinguseinunorganisedsportslieswiththegovernment,33astheCommissionre-statedintheJanuaryCommunication,“DopingpreventionanddopingsanctionsremainwithintheremitofsportorganisationsandMemberStates”.Thisdistinctionis


becausenationalgovernmentsretainresponsibilityforpublichealthservices,andcurrentlyanti-dopingfallsintothisareaofduty.Althoughthepossibleuseofsubstancessuchasanabolicsteroidsisgenerallyregardedasapublichealthproblem,cultural,educationalandpoliticaldifferencesmeantherearemanydifferentapproachestoaddressingtheissue.Forinstance,theNetherlandsAnti-DopingAuthorityFoundationhasdevelopedaneducationalprogrammefocusingspecificallyonathletesinfitnesscentresandgyms,whilstfitnessentrepreneurs,gymownersandinstructorsareakeyintermediatetargetgroup.34However,thisapproachisincontrasttotheDanishprogramwhichhasfocusedoncontrollingandpolicing,withfitnessfacilitiessubjectingthemselvestotestinginordertodemonstratetheirsupportforanti-dopingpractices.

Itisworthemphasisingthatfitnessisnotacompetitive(asinsport)activity–itisanindividualpursuitofhealthandfitness.Theactivitywherefitnesscentresareusedfortrainingforcompetitivesportisforbody-building/weightlifting.Thisisnotreallyabouthealth-enhancingfitnessbutbody-changingbybuildingextrememusclemass,densityandbodyimage.Therearemanyinthefitnesssectorwhosaythatbody-building/weightliftingarenothingtodowith“fitness”butforthepurposesoftheFADprojecttheyhavebeenincluded.

Finally,thereislimitedclarityovertheaimofthedopinginterventionstrategies.MuchoftheresearchandstrategiesintothisareahavepreviouslyfocusedontheuseandprevalenceofAndrogenicAnabolicSteroids(AAS),definedas,“A group of synthetic hormones that promote the storage of protein and the growth of tissue, sometimes used by athletes to increase muscle size and strength”.35Therehasbeenlimitedresearchintotheprevalenceofotherformsofdopingsuchasamphetamines,ephedrine,andpseudoephedrine.Therefore,whilstwithinelitesporttheanti-dopinginfrastructureiscommittedtoreducingtheprevalenceoftheWADAlistofbannedsubstances;thereisnoagreementofthesubstancestobetestedwithinthefitnesssector.

3.1.4 Existing research and findings for doping within the fitness sector

Duetothelackofan‘anti-dopinginfrastructure’whichcanproduceconcisefiguresontheprevalenceofdoping,therewasonlylimiteddataregardingtheprevalenceofdopinginunorganisedsportandinparticularregardingthefitnesssector.SomestudiesconductedintheUS,Netherlands,Denmark,andtheUnitedKingdomhaveindicatedthatAndrogenicAnabolicSteroidsarenolongerpre-dominantlytakenbyeliteathletesandarebeingusedmorebyyoungerpeople.36Theresultssummarisedbelowgiveanindicationoftheprevalenceoftheuseofandrogenicanabolicsteroidsandthefollowingsourcesareroutinelyquoted:

• The1991NationalHouseholdSurveyonDrugAbuseestimatedthattherewereonemillionusersofanabolicsteroidsintheUSA37andby2000thesamestudyestimatedthefigureatasmanyasthreemillion.

• OtherAmericanstudiesstatethat15-30%ofcommunityweighttrainersattendinggymsandhealthclubsregularlytakeAAS.38

• InBritain,in2006,theHomeOfficeestimatedthat1.1%of16-24yearoldshadusedAAS.39

• Alsoin2006aChannelFourdocumentaryindicatedthatAASwasthethirdmostcommonlyuseddrugamongteenageboysintheUK.40

• AlsoinBritaintherewasa51%increaseintheseizureofillegalAASbypolicebetween2004-05.41

• ThefirstnationwidesurveyofAASuseintheUKsurveyed21gymsthroughoutBritainandfoundthat8%ofrespondentsadmittedhavingtakenAASatsometime,5%ofwhichwerecurrentusers(9.1%ofmenand2.3%ofwomen).42Therewas,however,considerablevariabilitybetweengyms,rangingfromnouseinonegymto46%inanother.

• TheBritishCrimeSurveyof2009/2010foundthatabout226,000peopleaged16to59hadadmittedto‘ever’havingusinganabolicsteroids,equivalenttoaround0.7%ofpeopleinthisagegroup.50,000hadusedAASwithinthelastyear,with19,000usingthemwithinthelastmonth.43

• TheDepartmentofHealth’s“Smoking,DrinkingandDrugUseSurvey(2010)foundthatAASusageamongboysaged11-16intheUKstoodataround0.6%in2009,andaround0.1forgirlsofthesameagegroup.2%ofallschoolpupils


thatagestatedthattheyhadbeenofferedanabolicsteroids,and5%ofboysaged14-16hadbeenofferedthem.44

• ASwedishstudyrevealedthatamong16-17yearoldmaleadolescents,3.6%and2.8%hadusedAAS,respectively.45

• ArecentstudyinDenmarkfocusedinparticularonyoungmalesaged15–25yearsoldexercisinginfitnesscentres.5.010individualsaged15-60yearswereselectedatrandomandaskedtorespondtoapostalorweb-basedquestionnaire.1.703individuals(34%)respondedtothequestionnaire.With1,5%reportingthattheycurrentlyuseorhavebeenusingmuscleenhancingdrugs.46

• RecentresearchperformedbyTNOexaminingtheprevalenceofdopingamongvisitorsaged15andoldershowed8.2%ofgymusers–anestimated160,000–useddopingsubstancesinthepastyear.47

• AGermanstudyof11fitnesscentresand484consumersfoundthat22%ofmenand8%ofwomenhadtakenperformanceenhancingsubstancesduringthelastyear.48

• In1993,theCanadianCentreforDrugFreeSportestimatedthat83,000childrenbetweentheagesof11and18yearshadusedanabolicsteroidsintheprevious12months.49

• InFrance,theincidenceofdeliberatedopinginamateursportis5-15%.50

• ABrazilianstudy,conductedin13gymsamong288weightlifters,showedaprevalenceof11.1%forcurrentandpastuseofsteroids,and5.2%foruseofotherhormones.51

• ResearchintodopinguseamongtheDutchpopulationbetweentheagesof15and64revealedthat1.0%haduseddopinginthepastyear,whilst2.1%indicatedthattheyhaveuseddopingatsomepoint.52In22.2%ofthecasesinthis‘usedatsomepointgroup’,thesubstanceinquestionwasanabolicsteroids.53

Theseexamplesofresearcharefrequentlyquotedinsourcesregardingtheprevalenceofdopinginthefitnesssector.Sofarhowever,thisevidencehasseveralfailingswhencomparedtothequalityanddepthofresearchinelitesportinthisarea.TheresearchintothefitnesssectorhasprimarilybeenfocusedonAAS,andnoresearchhasdeveloped

astandardisedmethodacrossseveralEuropeanmemberstates.Furthermore,moststudieshavefocusedonspecialistsubgroupssuchashigh-schoolstudents,bodybuilders,eliteathletes,ordrugclinicpatients.54Finally,studiesemployingmoreheterogeneousgroupsonlyincludedAASusersoroverthecounterdrugusersanddidnotreportparametersrelatedtophysicalfitness55whichisusefulinformationfromwhichtodevelopinterventionstrategies.

AfurtheranalysisofthecurrentsituationinEuropeislaidoutinWorkPackage3laterinthisreport.

3.1.5 Recreational Drug use

Despitethecurrentlackofconcisefiguresanddataavailableontheprevalenceofdopinginamateursportsandthefitnesssector,oneareainwhichconsiderableresearchhasbeenconductedonaregularbasisisin“recreationaldoping”.AgenciessuchastheEuropeanMonitoringCentreforDrugsandDrugAddiction(EMCDDA)andTheUnitedNationsOfficeforDrugsandCrime(UNODC)providereliabledatadrawnfromrepresentativesurveysontheuseandmisuseofarangeoflegalandillegalsubstancesatnational,regionalandgloballevels,allowingforcomparativeanalysis.TheprevalenceofrecreationaldruguseacrossEuropemaybeanareaofinterestforthepurposesofthisstudyinordertoascertainwhetherculturalandnationalattitudestowardsrecreationaldrugs,nationalpreventionstrategies,anddrugpolicyhaveanimpactontheprevalenceofdopingintheamateursportsandfitnesssectors.Itwillalsobepossibletoexaminehowconsistentnationalandlocalauthoritieshavebeenindevelopingstrategiestotackletheseparateproblemsofrecreationaldruguseanddopingineliteandamateursport.

TheEuropeanSchoolSurveyProjectonAlcoholandotherDrugs(ESPAD)56,acollaborativeeffortofindependentresearchteamsinEurope,formsthelargestcross-nationalresearchprojectonadolescentsubstanceuseintheworld.Trendsinrecreationaldruguseareofparticularinteresttothisstudyasyoungpeople(andinparticularyoungmales)arebelievedtobeamongthemostprevalentusersofPIEDs,includinganabolicsteroidsand


stimulantsaswellasrecreationaldrugs.Thedatapresentedherealsoindicatesthegeneralprevalenceofamphetamineuse,whichisoccasionallyusedtoenhancefitnessperformancedespitethedetrimentaleffectitmayhaveonhealth,withpsychologicalandphysicaleffectssuchaseuphoria,hyper-alertness,emotionalhypersensitivitywithstressandangerknowntooccurtousers.Finally,theestimatednumberofintravenousdrugusers(IDUs)andinfectionratesforvirusessuchasHIVandHepatitisBamongintravenousdrugusersmaybeofinterestasonemethodoftakingAASisintravenously,puttingthisgroupatsubstantialriskofinfection.

AlthoughdatacollatedbytheUNODC,ESPADandtheEMCDDAhaveledtosomeprogressinstandardisedresearchmethodsrelatingtorecreationaldruguseinEuropeandelsewhere,issueswithqualityanddepthofresearch,particularlyallowingforcross-nationalcomparison,stillexistastheydoforresearchintodopinginthefitnesssector.Thisisgenerallyduetoalackofco-ordinationbetweenagencies,anddifferentmethodsbeingemployedinthesurveyprocess.

Thebelowtable(Table5.3.1)fromtheESPADsurveyoutlinestheprevalenceofdifferentsubstancesineachofthepartnercountriesandgivesaclearoverviewofthecurrentstateofplayintermsofrecreationaldruguseacrossEurope.


Stat

e Po

pula

tion

(M

illio

ns)

Dat

e of

Su

rvey

G

DP

(PPS

) C

anna

bis

Prev

alen

ce

Ecst

asy

Pr

eval

ence

Am

phet

amin

es

Prev

alen

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Coc

aine

Pr

eval

ence

Can

nabi

s Pr

eval

ence

(1

5-16

Ye

ars)

Ecst

asy

Prev

alen

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(1

5-16

Ye

ars)

Amph

etam

ine

Prev

alen

ce

(15-

16 Y

ears

)

Coc

aine

Pr

eval

ence

(15-

16

Year

s)

Estim

ated

In

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rug

Use

rs

(IDU

s)

Intr

aven

ous

Infe

ctio

n R

ates

~

BU

L 7.

6 20

08

41

7.3%

(L*)

, 2.7

%

(LY

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(LM

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1.7%

(LY

) 2.

1% (L

Y)

1.7%

(LY

) 22

% (L

), 7%

(L

M)

6% (L

) 6%

(L)

3% (L

) 20

,000

-30

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2.

2% (H

IV),

61%

(H

ep B

)

DEN

5.

5 20

08

117

38.6

(L),

5.5%

(L

Y),

2.2%

(LM

) N

/A

1.2%

(LY

) 1.

4% (L

Y)

25%

(L),

10%

(LM

) 5%

(L)

5%

(L)

3% (L

) 13

,000

4%

(HIV

), 12

.2%

(H

ep B

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GER

82

20

07

116

23.7

% (L

), 5.

4%

(LY

), 2.

7% (L

M)

N/A

0.

7% (L

Y)

0.9%

(LY

) 20

% (L

) 7%

(L

M)

3% (L

) 5%

(L)

3% (L

) 82

,235

-13

7,35

4 5%

(HIV

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3.2 Definitions Used in the Report

Inorderfortherecommendationsinthereporttobefocussedandtangible,itwasessentialtoestablishcleardefinitionsforallofthekeytermsintheproject.Itbecameapparentthatthereneededtobeclearunderstandingofwhatisbeingreferredtointhereportinordertoappreciatethecurrentsituationintermsofsubstanceuse,thecurrentprevalenceofdopingandwhatcouldpotentiallybeimplementedinordertocontinuethefightagainstdoping.

Thekeytermsusedintheresearchandthroughoutthereportwhichrequiredadefiniteandcleardefinitionwerefor:

• AFitnessCentre• PerformanceEnhancingDrugs• RecreationalDrugs• FoodSupplements• AmateurSportandFitness• OrganisedSport

3.2.1 Definition of a Fitness Centre

Beforethefieldresearchcouldcommenceitwasnecessarytoagreeadefinitionoffitness–ormoreparticularlyofafitnesscentre.Asthesectorhasdevelopedandmovedawayfromtheold-stylefree-weighttrainingroomsusedforbodybuildingandweight/powerliftingintothemodern,complexfitnesscentreswithavastrangeofcardiovascularandstrengthtrainingequipment,swimmingpools,racquetsportsandwellnessareastherehasclearlybeenashiftinthedefinitionofwhatisnowtobeconsidereda“fitnesscentre”.

Whilstitwasrecognisedthatthereisnowaclearerdistinctionbetweenhardcorebody-building“gyms”whichareaboutphysiquedevelopment,andfitnesscentres,whichareaboutphysicalactivityandhealthpromotion,theperceptionofmanypeopleisthattheyarestillallpartofthesamebroadsectorandEHFAacceptedthispremisefortheFADproject.

Todatetherehasbeennosingle,agreeddefinitionofa“fitnesscentre”,butquiterecentlythere

hasbeenaEuropeanclassificationbyNACE(NomenclaturedesActivitésEconomiques).NACEcodeshavesupersededthepreviousSICandSOCcodingsystemsandtheyprovideacommonstatisticalclassificationofeconomicactivitiesinEuropethroughEurostat.

Thereisnowthecategoryof:

“93.13FitnessFacilities:Fitnessandbodybuildingclubsandfacilities”

Withthe“identification”offitnessfacilitiesataEuropeanlevelthroughtheNACECodeof93.13,EHFAthenappliedsomeotheraspects,products,servicesandcharacteristicstobeusedinthedefinitionfortheprojectresearch.ItwasagreedthatforafitnesscentretobeincludedwithintheFADresearchitshouldmeetthesecharacteristics:

• Itwillhaveanameortitleofhealthclub,fitnesscentre,fitnessclub,wellnesscentreorgym,orwilluseoneoftheseasthedescriptionofitsprinciplebusinessactivity

• Itisaplacewherephysicalactivityandexercisetakesplace(i.e.notjustasaunaorspa)

• Itwillhaveaworkoutareawithequipment-basedstrengthtraining,andmostoftenalsocardiovasculartrainingequipment/machinesandfrequentlyalsogroupfitnesstraininginspecificroomsorinastudio

• Itwillbeopentothepublic• Itwillhaveaminimumofsixpiecesof

equipmentand/ormachines• Exerciseandphysicalactivitycanbeundertaken

onanindividualorgroupbasis• Theservicesaredeliveredinasafeand

controlledenvironment

Foradditionalclarification,twoadditionalpointswereconsideredinselectingfitnesscentrestobepartoftheFADresearch:

• Exercisesandphysicalactivityaresupervisedbyqualifiedexerciseprofessionals(inpersonorvirtually).

• Itmaybestandalone,orbepartofalargersportingcomplex,withotheractivitiessuchasswimming,sportshalls,andracquetsports.


Itshouldbenotedthatbodybuildingandweight-liftingactivitiesandcentresareincludedwithinthisdefinitioneventhoughtheseactivitiesarenotstrictlyspeakingpartoffitnesstraining–theyareentirelybasedonstrengthtraining.EHFAexpectsthat,overtime,theNACEdefinitionwillchange.Asweightliftingandbodybuildingaredifferent“sports”thereshouldbeaseparationwithfitnesstraining.

3.2.2 Definition of a Performance Enhancing Drug

ForthepurposesoftheFitnessAgainstDopingproject,thereferencetoperformanceenhancingdrugswasrestrictedtotheWorldAnti-DopingAgency’sProhibitedList.TheProhibitedList(List)wasfirstpublishedin1963undertheleadershipoftheInternationalOlympicCommittee.Since2004,asmandatedbytheWorldAnti-DopingCode(Code),WADAisresponsibleforthepreparationandpublicationoftheList.TheListisanInternationalStandardidentifyingsubstancesandmethodsprohibitedin-competition,out-of-competitionandinparticularsports.Thesubstancesandmethodsonthelistareclassifiedbycategories(e.g.,steroids,stimulants,genedoping).ItshouldbenotedthattheuseofanyprohibitedsubstancebyanathleteformedicalreasonsispossiblebyvirtueofaTherapeuticUseExemption(TUE).

ThefulllistcanbefoundontheWadalistandisapprovedandupdatedonayearlybasis.57

PerformanceEnhancingDrugsinclude:

• AnabolicSteroids–agroupofsynthetichormonesthatpromotesthestorageofproteinandthegrowthoftissue,sometimesusedby

athletestoincreasemusclesize• Stimulants–achemicalagentthattemporarily

arousesoracceleratesphysiologicalororganicactivity,suchasEphedrine,pseudoephedrine,amphetamines,andgrowthhormones

Themajorityofresearchintothesubstanceabusewithinbothelitesportandrecreationalactivities,includingfitness,hasfocusedontheuseofAndrogenicAnabolicSteroidsalthoughthescopeoftheFitnessAgainstDopinghasbeenwiderthanthis.

3.2.3 Definition of a Recreational Drug

Forthepurposesoftheproject,recreationaldrugsweretermedasanysubstanceusedwiththeintentionofcreatingorenhancingrecreationalexperience,thesetypicallyincludedcocaine,ecstasy,andmarijuana.Thesedrugsarenotaperformanceorimageenhancingdruginasportorfitnesssense.

Itshouldbenotedthattherehasbeenverylittleinvestigationintohighprofilecasesofrecreationalsubstanceabusewithinaneliteor‘unorganisedsportenvironment’.

3.2.4 Definition of a Food Supplement

ThroughouttheprojectandtheresearchitbecameevidentthatacleardistinctionshouldbemadebetweentheusesofbanneddopingproductsontheWADAProhibitedListandtheuseofdietarysupplementstocomplimenttrainingorsport.

Dietarysupplementsaredefinedasproductsthatcontainsubstanceslikevitamins,mineral,foods,botanicals,aminoacidsandareintendedtosupplementtheusualintakeofthesesubstances.Examplesincludetestosteroneboosters,weightlossproducts,creatine,andproteinpowders.

SupplementsmayalsoincludeVitaminC,Multi-vitamins,Magnesium,andskimmedmilkproducts.Contaminationidentifiedintheseexamplesistypicallyduetoinadvertentcross-contaminationwithinthemanufacturingprocess,butalsocanbedeliberatelyadaptedtoincludeotherwisebannedsubstances.


3.2.5 Definition of Amateur Sport and Fitness

Amateursportandfitnessreferstosportorfitnessactivitieswhichdonottakeplacewithinaneliteorstructurallycompetitiveenvironment.ThisincludesalllevelsofsportoractivitieswithinafitnesscentrewhicharenotsubjecttomandatoryinandoutofcompetitiondrugtestsasadoptedbyNADO’s.

3.2.6 Definition of Organised Sport

Organisedsportisgenerallygovernedbyaninternationalfederationwhichadministersitssportataworldlevel,mostoftencraftingrules,promotingthesporttoprospectivespectatorsandfans,developingprospectiveplayers,andorganizingworldorcontinentalchampionships.Manyorganisedsportshaveregionalandnationalgoverningbodiesaswellasataninternationallevel.

Elitesport,whichisessentiallyhigh-levelcompetitivesport,issubjecttotheWorldAnti-DopingAgency’sinandoutofcompetitiondopingtestsandanyoftheperformanceorimageenhancingdrugswhichareonWADA’sProhibitedListcannotbeused.

Therehasbeensignificantresearchundertakenontheprevalenceofdopingwithinorganisedsport.Thedeskresearchsummarisedinthisreportoutlinesthehistoryandcurrentstateofplayinanti-dopingwithinorganisedsport.Althoughtherehasbeenapaucityofevidenceintodopingwithinfitnessandamateursportwhichhasledtothisproject,therecommendationsformedinthisreportwillhaveusedtheexistingresearchintoorganisedsportasabasisdespitethecleardistinctionswithamateursportandfitness.

3.3 Countries

TheresearchteamundertookapanEuropeanresearchstudyoftheprevalenceofdopinginordertoidentifyareaswherethefitnesssectorandotherstakeholderscouldcontributetotheeradicationofthepracticeofdoping.Theprojectmanagementgroupmadethedecisionthattheresearchteamshouldundertakethefieldresearchin9partnercountries:

Bulgaria

• Population(million):7.6• FitnessClubs(Public):n/a• FitnessClubs(Commercial):20• Members(million):0.004• Averagemembersperclub:200• Penetrationrate:0.1%• Estimatedtotalemployees:n/a

Denmark

• Population(million):5.4• FitnessClubs(Public):307• FitnessClubs(Commercial):380• Members(million):0.48• Averagemembersperclub:699• Penetrationrate:8.89%• Estimatedtotalemployees:7,400

Germany

• Population(million):82.6• FitnessClubs(Public):500• FitnessClubs(Commercial):5,574• Members(million):5.9• Averagemembersperclub:975• Penetrationrate:7.14%• Estimatedtotalemployees:70,000

Hungary

• Population(million):10• FitnessClubs(Public):n/a• FitnessClubs(Commercial):270• Members(million):0.2• Averagemembersperclub:741• Penetrationrate:2.0%• Estimatedtotalemployees:4,000

Netherlands

• Population(million):16.5• FitnessClubs(Public):100• FitnessClubs(Commercial):1,930• Members(million):2.4• Averagemembersperclub:1,429


• Penetrationrate:14.55%• Estimatedtotalemployees:26,300

Poland

• Population(million):38.1• FitnessClubs(Public):n/a• FitnessClubs(Commercial):800• Members(million):0.25• Averagemembersperclub:313• Penetrationrate:0.66%• Estimatedtotalemployees:10,000Portugal

• Population(million):10.6• FitnessClubs(Public):n/a• FitnessClubs(Commercial):1,400• Members(million):0.6• Averagemembersperclub:429• Penetrationrate:5.66%• Estimatedtotalemployees:16,000

Switzerland

• Population(million):7.6• FitnessClubs(Public):n/a• FitnessClubs(Commercial):675• Members(million):0.55• Averagemembersperclub:815• Penetrationrate:7.24%• Estimatedtotalemployees:11,000

United Kingdom

• Population(million):60.7• FitnessClubs(Total)5,755• Members(million):7.2• Averagemembersperclub:1,251• Penetrationrate:11.86%• Estimatedtotalemployees:n/a

Theseninecountrieswereselectedinpartinrecognitionofthenationalexpertiseoftheprojectpartners.Furthermore,itwasessentialtohaveabalancebetweencountrieswherethefitnesssectorshadmatureinfrastructureandthosewhichweremoreinthedevelopmentphase.ThedeskbasedresearchidentifiedDenmark,theUnitedKingdomandGermanyashavingthemostdevelopedanti-

dopingstrategiesoverthelastdecade.

Astheabovedemonstratestheparticipationinfitnesscentresrangedfrom0.1%ofthepopulationinBulgariato14.5%intheNetherlands.Therefore,itcanbeshownthatthereisarepresentativesampleofcountriesselectedwhichwillhelptoensurethattherecommendationsinthisreportcanbeimplementedacrossnotonlyinthese9countriesbutalsoacrossthewholeofEurope.

Inordertogetaclearcontextforthefindingsofthefieldresearch,itwasimportanttogetanindicativepicturefromeachcountryonthecurrentanti-dopinginfrastructure,anyworkundertakeninthisareaonanationallevel,thegeneralprevalenceofrecreationaldruguseandthedrugenforcementlegislationcurrentlyinplace,aswellastheexistenceandsophisticationofanti-dopingpolicieswithinthenationalfitnessassociations.

Inaddition,theprojectmakesacleardistinctionbetweenorganisedsport,andamateursportandfitness.Itwasthereforefeltofusetoaskwhichsportsweremostplayedineachofthepartnercountriesandaskwhetherthenationalgoverningbodiesofthosesportshadanyimplementedstrategiestoidentifydopingprevalenceanderadicatetheuseofsubstances.

Theresponsesfromeachofthepartnersarelistedasanappendixtothemainreportandgiveausefulindicationastothestateofplayineachpartnercountry.ThebreadthofresponsesalsodemonstrateshowthesampleofcountriesinthestudyisrepresentativeofdiversityoftheEuropeanhealthandfitnesssector.


References

1J.Woodhouse&M.Dilworth,DrugsinSport,HouseofCommonsLibrary,15September20102Ibid.3D,MacAuley,DrugsinSport,BritishMedicalJournal,1996,313,211-5.4J.Woodhouse&M.Dilworth,DrugsinSport,HouseofCommonsLibrary,15September20105WorldAnti–DopingAgency,ABriefHistoryofAnti-Doping,WADA,2011.http://www.wada-ama.org/en/About-WADA/History/A-Brief-History-of-Anti-Doping/[accessed15.4.11]6Ibid.7J.AKnottnerus,PresentationofadvisoryreportDopinginunorganisedsports,HealthCounciloftheNetherlands,April132010.8Ibid.9Anti-DopingDenmark,http://www.antidoping.dk,[accessed29thSeptember2011]10Anti-DopingNetherlands,http://www.dopingautoriteit.nl[accessed29thSeptember2011]11UKAnti-Doping(UKAD),http://www.ukad.org.uk/[accessed29thSeptember]12W.Palmer.S.Taylor,A.Wingate,‘AdverseAnalyzing:AEuropeanStudyofAnti-DopingOrganisationReportingPracticesandtheEfficacyofDrugTestingAthletes’,UNIGlobalUnion,May122011.13Ibid.14Ibid15GreenGA,CatlinDH,StarcevicB.Analysisofover-the-counterdietarysupplements.ClinJSportsMed2001;11:254-916KamberM,BaumeN,SaugyMetal.Nutritionalsupplementsasasourceforpositivedopingcases.IntJSportNutrExercMetab2001;11:258-6317SchanzerWNewresultsconcerningcontaminationofnutritionalsupplementswithbannedanabolicandrogenicsteroids.SymposiumonDrugsandSport:IssuesandPerspectives.RSCandUKSport.Manchester200218BBCNews,‘Steroidusehighestinvalleys’BBC(3/6/2006)19A.VCristiansen,’Dopinginfitnessandstrengthtrainingenvironments–politics,motivesandmasculinity’,inEliteSport,DopingandPublicHealth,edsV.Moller,M.McNamee,andP.Dimeo,UniversityPressofSouthernDenmark,2004.20J.AKnottnerus,PresentationofadvisoryreportDopinginunorganisedsports,HealthCounciloftheNetherlands,April132010.21Yesalis,C.Bahrke,M,‘Anabolic-androgenicsteroidsandrelatedsubstances’,2002,CurrentACSMSportsMedicine.246-252.22P.Korkia,P.Lenehan,J.Mcveight,‘Nonmedicalusesofandrogensamongwomen’1996,JournalofPerformanceEnhancingDrugs,71-76.23EUSpecialEurobarometerSurvey72.3,‘SportsandPhysicalActivity’(DirectorateGeneralEducationandCulture,2010)24J.AKnottnerus,PresentationofadvisoryreportDopinginunorganisedsports,HealthCounciloftheNetherlands,April132010.25S.AvanWolferen,N.AVonk,A.Boonstra,P.EPostmus,‘Pulmonaryarterialhypertensionduetotheuseofamphetaminesasdrugsordoping’,NedTijdschrGeneeskd2005;149(23):1283-1288.26TheAdonisComplex:HowtoIdentify,TreatandPreventBodyObsessioninMenandBoys;HarrisonGPope,et.al.27Ibid28Berrios,G.E.;Kan,Chung-Sing(1996).”Aconceptualandquantitativeanalysisof178historicalcasesofdysmorphophobia”.ActaPsychiatricaScandinavica29AmericanPsychiatricAssociation.(2000).DiagnosticandStatisticalManualofMentalDisorders(revisedtext).


30D.J.Hall&C.Judkins,‘SupplementsandBannedSusbtanceContamination:Offeringaninformedchoice”HFLSportScience,201031J.AKnottnerus,PresentationofadvisoryreportDopinginunorganisedsports,HealthCounciloftheNetherlands,April132010.32A.VCristiansen,’Dopinginfitnessandstrengthtrainingenvironments–politics,motivesandmasculinity’,inEliteSport,DopingandPublicHealth,edsV.Moller,M.McNamee,andP.Dimeo,UniversityPressofSouthernDenmark,2004.33J.AKnottnerus,PresentationofadvisoryreportDopinginunorganisedsports,HealthCounciloftheNetherlands,April132010.34A.VCristiansen,’Dopinginfitnessandstrengthtrainingenvironments–politics,motivesandmasculinity’,inEliteSport,DopingandPublicHealth,edsV.Moller,M.McNamee,andP.Dimeo,UniversityPressofSouthernDenmark,2004.35D.J.Hall&C.Judkins,‘SupplementsandBannedSusbtanceContamination:Offeringaninformedchoice”HFLSportScience,201036P.Korkia&G.VStimson,‘Indicationsofprevalence,practiceandeffectsofanabolicsteroiduseinGreatBritain’,InternationalJoirnalofSportsMedicine,18,577-562.37A.BParkinson&N.AEvans,‘AnabolicAndrogenicSteroids:ASurveyof500Users’,Medicine&ScienceinSportsandExercise,April2006,38(4):644-51.38Ibid.39HomeOfficeStatisticalBulletin,‘DrugMisuseDeclaredDeclared:Findingsfromthe2006/07BritishCrimeSurvey,EnglandandWales’,200740M.Barbour,‘Buyingbulk–steroiduseintheUK”,http://www.channel4.com/health/microsites/0-9/4health/drugs/dus_steroids.html[accessed20.1.08]41HomeOfficeStatisticsBulletin,‘SeizuresofDrugsinEnglandandWales’,2005.42P.Korkia&G.VStimson,‘AnabolicSteroidUseinGreatBritain:anExploratoryInvestigation’,1993,London:TheCentreforResearchonDrugsandHealthBehaviour.43EconomicandSocialDataService,‘BritishCrimeSurvey2009-2010’TheHomeOffice,Research,DevelopmentandStatisticsDirectorate201044DepartmentofHealth,‘Smoking,DrinkingandDrugUseSurvey’DepartmentofHealth,TheInformationCentre,NationalCentreforSocialResearch201045S.Nilsson,A.Baigi,B.Marklund,&B.Fridlund(2001),‘TheprevalenceoftheuseofandrogenicanabolicsteroidsbyadolscentsinacountyofSweden’,EuropeanJournalofPublicHealth11(2):195-197.46www.steroids.dk47J.AKnottnerus,PresentationofadvisoryreportDopinginunorganisedsports,HealthCounciloftheNetherlands,April132010.48Richter-Kuhlmann,EvaA,‘MedikamentenmissbrauchimFreizeitsport:MuskelnaufPump’,2009,http://www.aerzteblatt.de/v4/archiv/artikel.asp?id=63110[accessed16.5.11]49A.Pipe,‘DrugsinSport:past,presentandfutureSymposuimonDrugsandSport:IssuesandPerspectives’,RSCandUKSport,Manchester.2002.50P.Laure,‘Doping:epidemiologicalstudies’,PresseMed,2000;29:1365-72.51J.AKnottnerus,PresentationofadvisoryreportDopinginunorganisedsports,HealthCounciloftheNetherlands,April132010.52Ibid.53Ibid.54D.Arvary,H.RPopeJr.,‘Anabolic-androgenicsteroidsasagatewaytoopioiddependence’,NewEnglandJournalofMedicine,342,1532.55M.SBahrke,C.EYesalis,a.nKopstein,J.AStephens,‘Riskfactorsassociatedwithanabolic-androgenicsteroiduseamongadolescents’,2000,SportsMedicine,29,397-405.56BjörnHibellandUlfGuttormsson,OverviewoftheESPADProjectBackground,Methodologyand


Organisation.September201057http://www.wada-ama.org/Documents/World_Anti-Doping_Program/WADP-Prohibited-list/2012/WADA_Prohibited_List_2012_EN.pdf


The Project Partners:

AGAP-Portugal(PortugueseFitnessAsociación)www.agap.pt

BAHF -Bulgaria(BulgarianAssociationofHealthandFitness)www.bahf.bg

DFHO -Denmark(DanishFitnessandHealthOrganisation)www.dfh o.dk

DSSV -Germany(GermanFitnessAssociation)www.dssv.de

DADR-Poland(DepartmentofAnti-DopingResearchofInstituteofSport)www.insp.waw.pl

FIA-UK(FitnessIndustryAssociation)www.fia.org.uk

Fit!vak-Netherlands(DutchFitnessAssociation)www.fitvak.com

HCA & ICCE-Hungary(HungarianCoachingAssociationandInternationalCouncilforCoachEducation)www.magyaredzo.hu&www.icce.ws

ISCA-Denmark(InternationalSportandCultureAssociation)www.isca-web.org

QualiCert-Switzerland(SwissQualityAssuranceCompany)www.qualicert.ch

TheFitnessAgainstDopingProjectisgrant-aidedbytheEuropeanCommission