Enhancing Sports Performance: part 3

Amateur and recreational athletes

Recently the World Anti-Doping Agency WADA released details for the 2017 Prohibited List, which will come into effect on 1 January 2017. If you have read part 1 and part 2 of this series of blogs, you might be thinking that illegal doping to enhance sports performance is only of relevance to elite sport. Equally that the discussion of TUEs is only related to elite athletes. Well this blog will explore whether that is the case…

I am writing from a medical perspective based on my experience of working on the international medical research team that investigated the development of dope test for growth hormone GH, supported by the IOC.

The list issued by UK Anti-Doping UKAD of athletes banned from competition due to taking illegal performance enhancing drugs dispels the assumption that doping is confined to elite athletes. Indeed it is concerning that the list is substantial and includes a range of athletes from teenagers to age groupers across a variety of sports. Consider that this only shows results from sports where drug testing takes place.

As discussed in a recent article in British Medical Journal BMJ, there are an estimated 3 million anabolic steroid users in Europe alone. These users may not necessarily be involved in sports where drug testing takes place. From a medical point of view there is the concern of long term, irreversible adverse effects on health: cardiac, hepatic, psychiatric and reproductive complications.

Although professional dance can be viewed as an art form, rather than a sport, the increased technical requirements together with extended rehearsal and performance schedules place high physical and psychological demands on dancers, similar to elite athletes. In a recent article in the Dance Gazette there is discussion of “performance enhancement in dance being more about survival than competitive edge”.  Unlike sport, in classical dance there is a difference between female dancers who might dope in order to reduce body weight and male dancers looking for means to improve muscle strength.

The show must go on but the aim should be to strive for clean sport and to safeguard the health of athletes.

For further discussion on Endocrine and Metabolic aspects of SEM come to the BASEM annual conference 22/3/18: Health, Hormones and Human Performance

References

Enhancing sport performance: part 1 British Association of Sport and Exercise Medicine

Enabling Sport Performance: part 2

WADA

UKAD

BMJ 2016;353:i5023

Dance Gazette issue 3 2016 p.50-53

Enabling Sport Performance: part 2

Medical perspective on Therapeutic Use Exemptions: TUEs

As described in part 1 of this series of blogs I was on the international medical research team investigating the development of a test for identifying athletes doping with growth hormone. This experience helped form my view on the interaction of medicine and sport performance.

Over the next few days the results of anti-doping study will be presented at the International Federation Forum, with one of the discussions being “Medication Abuse in Elite Sport: the Epidemic!”

As doctors, our primary objective is to treat medical conditions in the most effective manner. It would not be ethical to withhold treatment to certain groups of patients, such as elite athletes. Therefore, where the prescribed medication for the treatment of a legitimate medical condition is on the prohibited list issued by the World Anti-Doping Agency (WADA), a TUE should be sought. After all elite athletes are just as likely to become ill as the general population, if not more so with functional immunosuppression due to training loads and possible energy deficient states.

In my opinion, the use of TUEs in the case of preventative treatment appears to be where the main discussion is centred. The athlete might not be acutely unwell, but may have a chronic condition, which can flare in an acute manner especially where there are known triggers. For example in the general population it is better medical practice to offer prophylactic treatment to a known asthmatic in order to decrease the risk of having an acute asthma attack, rather than waiting to treat an acute attack. Following on this argument, there is a case for offering elite athletes preventative treatment, rather than running the risk of an acute exacerbation requiring urgent treatment in difficult circumstances, for example in the middle of a race where access to required urgent treatment might be problematic. A view has been expressed that athletes with severe asthma have no place in performance sport and the paralympics would be more appropriate. Maybe this view is too extreme, after all exercise is recommended as a supportive strategy for asthma. Successful swimmers such as Thorpedo (Ian Thorpe) overcame both asthma and a reported allergy to chlorine to win Olympic and World titles.

In my opinion, the concept of TUEs for prevention of acute exacerbations of documented chronic conditions is valid. However, the issue seems to be the exact nature of such prophylatic treatment. Ideally the minimum dose of a medcation with the least potential performance enhancing qualities should be preferred. This has to be balanced against the most effective treatment for the specific documented medical condition of the individual athlete. Ultimately the athlete should be at neither disadvantage nor advantage due to a chronic, treatable medical condition.

Canadian law professor and sports lawyer Dr Richard Mc Laren (who conducted investigation into Russian state-sponsored doping) suggested that to investigate potential abuse of TUE system, frequency of certain medications being used in specific sports would need to be quantified.

In the meantime this vexed issued is being discussed at the Association of Summer Olympic International Federations (ASOIF) 9-11 November.

For further discussion on Endocrine and Metabolic aspects of SEM come to the BASEM annual conference 22/3/18: Health, Hormones and Human Performance

References

Enhancing sport performance: part 1 Dr N. Keay, British Association of Sport and Exercise Medicine

Relative Energy Deficiency in Sport Dr N. Keay, British Association of Sport and Exercise Medicine

WADA World Anti-Doping Agency

UKAD UK Anti-Doping