Chapter 23 -Special Aids to

Exercise Training and

Performance (DOPING)

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 INTRODUCTION
• Considerable literature exists about ergogenic aids
and athletic performance—ergogenic referring to
the application of a nutritional, physical,
mechanical, psychologic, or pharmacologic
procedure or aid to improve physical work capacity
or athletic performance

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 DOPING
• Definition: the use and abuse of performance
enhancing substances in elite sport.
• Derivation: from the Dutch word “dop”, a
beverage that Zulu warriors used prior to
battle.
• Term became current ~ start of 20th century
in reference to illegal drugging of racehorses

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 INTRODUCTION
• This literature includes studies of potential
performance benefits of
• Alcohol
• Amphetamines
• Ephedrine
• Hormones
• Carbohydrates
• Amino acids
• Fatty acids
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 INTRODUCTION
• Additional red blood cells
• Caffeine
• Carnitine
• Creatine
• Phosphates
• Oxygen rich breathing mixtures
• Massage
• Wheat germ oil
• Vitamins
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Minerals
 INTRODUCTION
• Ionized air
• Music
• Hypnosis, and even
• Marijuana and cocaine!

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 Mechanism for How Purported Ergogenic
Aids Might Work

• Act as a central or peripheral nervous system

stimulant (e.g., caffeine, choline, amphetamines,
alcohol)
• Increase storage and/or availability of a limiting
substrate (e.g., carbohydrate, creatine, carnitine,
chromium)
• Act as a supplemental fuel source (e.g., glucose,
medium-chain triacylglycerols)
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 Mechanism for How Purported Ergogenic
Aids Might Work

• Reduce or neutralize performance-inhibiting

metabolic byproducts (e.g., sodium bicarbonate or
sodium citrate, pangamic acid, phosphate)
• Facilitate recovery (e.g., high-glycemic
carbohydrates, water)
• Enhance resistance-training responsiveness
(anabolic steroids, human growth hormone,
carbohydrate/protein supplements immediate
postexercise)
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 Pharmacologic Agents
• IOC-banned substance categories
– Stimulants
– Narcotic analgesics
– Androgenic-anabolic steroids
 -Blockers
– Diuretics
– Peptide hormones and analogs
– Substances that alter urine sample integrity
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 Anabolic Steroids
• Structure and action
– Sterol structure similar to testosterone
– Increases muscle growth
– Used to treat muscle wasting, osteoporosis
• Stacking
– Combining multiple steroid preparations in oral and
injectable form
• Pyramiding
– Progressively increasing the dosage

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 Anabolic Steroids
• Drug with a considerable following
– Becoming increasingly popular with more than
just strength athletes
• Effectiveness
– Dosage is an important factor.
– Training volume accompanies use.

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 Side effects and Medical risk of
Steroid use
Males
• Increase • Decrease
– Testicular atrophy – Sperm count
– Gyneacomastia – Testosterone levels

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 Side effects and Medical risk of
Steroid use
Females
• Increase • Decrease
– Voice change – Breast tissue
– Facial hair
– Menstrual irregularities
– Clitorial enlargement

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Side effects and Medical risk of Steroid
use-Males and Females

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 Anabolic Steroids
• Side effects and medical risks
• Cystic acne, “roid rage,” peliosis hepatitis,
increased plasma lipoproteins
• In males: testicular atrophy and
gynecomastia
• In females: clitoral enlargement, squaring of
the jaw, lowering of voice

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 Growth Hormone or Somatotropin
• Genetic engineering comes to sports
– Human growth hormone
• Produced in the pituitary gland
• Stimulates bone and cartilage growth
• Enhances fatty acid oxidation
• Reduces glucose and amino acid breakdown
– Excess GH may result in
• Gigantism
• Acromegaly
– Side effects
• Swollen feet and ankles, joint pain, carpal tunnel syndrome
– No unanimity among researchers
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 DHEA: A Worrisome Trend?
• DHEA- Dehydroepiandrosterone
– Steroid hormone produced by the adrenal glands
• Claims for DHEA
• Testosterone booster
• Bolsters immune system
• Preserves youth
• Decreases fatigue and joint pain
• Slows aging
• Invigorates sex life
– An unregulated compound with uncertain safety

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 Androstenedione

• Claims
– Stimulates production of endogenous
testosterone
– Enables one to train harder
– Increases muscle mass
– Rapidly repairs tissue injury
• Research shows no effect of supplementation on
basal serum testosterone or any training response
on muscle size and strength.
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 Amino Acid Supplements for an
Anabolic Effect
• Claims
– Boost body’s natural production of
• Testosterone
• Growth hormone
• Insulin-like growth factor I
– Resulting in an increase in muscle mass and a
reduction in fat mass
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 Amino Acid Supplements
• Stimulating an anabolic effect
– Consuming carbohydrate and/or protein
immediately after resistance training
augments hormonal response to the training.

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 Amphetamines
• Stimulate the CNS = sympathomimetics
• Claims
– Increase alertness
– Decrease sensation of muscle fatigue
• Dangers
– Physiologic or emotional dependence
– Headache, fever, dizziness, tremors
– Suppression of normal responses to pain
• Use and athletic performance
– Do not enhance physical performance.
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 Caffeine
• Ergogenic effects
– Proposed mechanism for ergogenic action
• Increases use of fatty acids, sparing glycogen
– Effects on muscle
• May act directly on muscle to enable more
prolonged endurance performance

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 Warning About Caffeine
• Possible side effects
– Nervous irritability
– Muscle twitching
– Psychomotor agitation
– Elevated HR and blood pressure
– Increased occurrence of PVCs
– Insomnia

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 Ginseng
• Claims
– Boosts energy
– Diminishes stress
• No compelling scientific evidence of
ergogenic effect

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 Ephedrine
• Effects
– Increases heart rate, cardiac output, blood
pressure
– Bronchodilation
– Hypertension, insomnia, irritability
– Increases anaerobic power output, endurance
– Possibly heart attack, stroke, death

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 Buffering Solutions
• Maximal exercise for 30 to 120 seconds alters
the chemical balance between intracellular and
extracellular fluids because the active muscle
fibers rely more on anerobic energy transfer
• Lactate accumulates with a fall in intracellular
pH
• Increased acidity inhibits energy transfer and
contractile dynamics in the active muscle fibers
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and exercise performance deteriorates
 Buffering Solutions
• Claims
– Pre-exercise alkalosis facilitates H+ efflux from
the cell, delaying the fall in pH.
– May be ergogenic for high-intensity endurance
performance
– Effect related to dosage and degree of
anaerobic metabolism
– Not banned by WADA

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 Glutamine
• It is non essential aminoacid abudant in
plasma and skeletal muscle
• Promotes muscle glycogen accumulation
• Plays important role in immune function
• Glutamine plasma concentration
decreases following prolonged intense
exercise
• Glutamine supplementation lessen URTI
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 Phosphatidylserine
• It is a glycerophospholipid of natural lipids
that compose the structural components of
the internal layer of the plasma membrane
that surrounds all cell
• May modify neuroendocrine response to
stress
• Diminishes ACTH and cortisol release
• Does not affect growth hormone release
• PS create differences in physiologic action
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including the potential for ergogenic effects
 ß-Hydroxy-ß-Methylbutyrate
(HMB)
• It is bioactive metabolite generated in the
breakdown of essential amino acid leucine
• Claims
– Inhibits protein catabolism
• Research
– Ergogenic benefits may be transient.
– FFM tends to revert to baseline.

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 Nonpharmacologic Approaches
• Red blood cell reinfusion—blood doping
– How it works
• Withdrawal of 1 – 4 units of blood
• RBC are frozen.
• Reinfusion 1 – 7 days prior to competition
– Effects
• Increases RBC number, oxygen-carrying
capacity, and ability to perform endurance
exercise
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 Hormonal Blood Boosting
• Erythropoietin (EPO)
– Synthetic version of a hormone produced by
the kidneys
– May increase RBC number by 12%
– Unconventional or nonmedical
administration may create < 60% increase.
• Increases risk of stroke, heart attack, heart
failure, pulmonary edema

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 Other Means to Enhance Oxygen
Transport
• New substance classes
– Perfluorocarbon emulsions
– Bovine and human hemoglobin solutions
• Potentially lethal side effect
– Increased systemic and pulmonary blood
pressure
– Renal toxicity
– Impaired immune function
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 Warm-Up (Preliminary Exercise)

• General warm-up
– Unrelated movements
• Specific warm-up
– Sport-specific movements
• Psychologic considerations
– Athletes feel better prepared

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 Warm-Up (Preliminary Exercise)
• Physiologic considerations
– Faster muscle contraction and relaxation
– Greater movement economy from lowered viscous
resistance
– Facilitated oxygen delivery—Bohr effect
– Facilitated nerve transmission and muscle metabolism
– Increased blood flow to active tissues
• Effects on performance
– More research needed
• Sudden strenuous exercise
– Risk of MI in sedentary or those with CHD
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 Oxygen Inhalation (Hyperoxia)
• Athlete breathe oxygen enriched or
hyperoxic mixtures during time outs or
following strenous exercise
• The belief that this procedure enhances the
blood’s oxygen carrying capacity to facilitate
oxygen transport to active or recovering
muscles.

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 Oxygen Inhalation (Hyperoxia)
• Preexercise oxygen breathing
– Not beneficial if ambient air is breathed before
performing
• Oxygen breathing during exercise
– Improves performance
– Not practical for most sports
• Oxygen breathing during recovery
– Research does not support use.
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 Modification of Carbohydrate
Intake
• Increased carbohydrate intake before and during
intense aerobic exercise including periods of
strenous training benefits exercise performance,
lower ratings of perceived exertion and improves
psychologic state
• Popular nutrional exercise modifications used by
endurance athletes to augment glycogen reserves
involves carbohydrate loading or glycogen
supercompensation
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 Modification of Carbohydrate
Intake
• Carbohydrate loading
– Helps prevent/postpone “hitting the wall”
– Glycogen depletion stage
– Glycogen loading stage
• Creatine supplementation

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 Modification of Carbohydrate
Intake
Glycogen depletion stage
Day 1- Exhausting exercise to deplete muscle glycogen in
specific muslces
Day 2,3,4- Low carbohydrate intake (60-100 g/dl) and
high % of protein and lipid in daily diet
Glycogen loading stage
Days 5,6,7, High carbohydrate intake (400-700g/dl normal
% of protien in daily diet
• Competition day
High carbohydrate precompetition meal
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 Modification of Carbohydrate
Intake
• Negative aspects
– Increased water retention
– Added weight increases the energy cost of
weight-bearing exercise.
– Depletion phase may inhibit ability to train.
– Low carbohydrate intake may create ketosis.
– Vitamin, mineral deficiencies
– Lean tissue loss
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 L-Carnitine
• Facilitates influx of fatty acids into
mitochondria
• Rate of fatty acid oxidation affects aerobic
exercise intensity.
• Research does not support ergogenic
benefits.
• Potential benefits
– Vasodilation
– Less postexercise pain, tissue damage
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 Chromium
• Potentiates insulin function
• Promotes carbohydrate uptake into cells
• Numerous alleged benefits
– Fat burner
– Muscle builder
• Research does support claims
• Potential downside
– Competes with iron for binding to transferrin
– Possible chromosomal damage
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 Coenzyme Q10 (Ubiquinone)
• Used therapeutically for cardiovascular
disease
• Claims: improve stamina and enhance
cardiovascular function
• Research does not support ergogenic
benefits.

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 Creatine
• Important component of high-energy
phosphates
• Documented benefits in humans
– Improves muscular strength and power
– Augments short bursts of muscular endurance
– Enables greater muscular overload
• Limited research on potential risks
• Creatine loading
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 Inosine
• Claims
– Improves training quality, performance
– Facilitates oxygen release, insulin release
– Augments cardiac contractility
– Vasodilator
• Research does not support ergogenic
effect.
• Risks contraindicate use.
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 Choline
• Claims
– Fat burning, metabolism “optimizing”
• Research does not support claims.

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 Medium-Chain Triglycerides

• Claims
– Fat burning, glycogen sparing, muscle
building
• Research is inconclusive.

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 Hydroxycitrate (HCA)
• Claims
– Fat burning, endurance enhancing
• Research is inconclusive.

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 Pyruvate
• Claims
– Fat burning, endurance enhancing
• Additional research is needed.

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 Conclusions
• Sports doping is widespread
• Lack strong data on safety and efficacy
• Potential benefits in amateur athletes (our
patients) probably negligible
• Unclear risks, especially on long-term use
and mega dosing
• First, do no harm.
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