performance enhancing modalities
DESCRIPTION
Performance Enhancing Modalities. Mechanical Psychological Physiologic Nutritional Pharmacologic. Stimulants. Stimulants. Caffeine Amphetamines Cocaine Sympathomimetics Ephedrine Pseudoephedrine Phenylephrine Phenylpropanolamine (PPA) Modafinil. Stimulants – proven effects. - PowerPoint PPT PresentationTRANSCRIPT
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!