Neil Chester

Anabolic steroids and cardiovascular risk.

Recent reports from needle exchange programmes and other public health initiatives have suggested growing use of anabolic steroids (AS) in the UK and other countries. Data indicate that AS use is not confined to bodybuilders or high-level sportsmen. Use has spread to professionals working in emergency services, casual fitness enthusiasts and subelite sportsmen and women. Although the precise health consequences of AS use is largely undefined, AS use represents a growing public health concern. Data regarding the consequences of AS use on cardiovascular health are limited to case studies and a modest number of small cohort studies. Numerous case studies have linked AS use with a variety of cardiovascular disease (CVD) events or endpoints, including myocardial infarction, stroke and death. Large-scale epidemiological studies to support these links are absent. Consequently, the impact of AS use upon known CVD risk factors has been studied in relatively small, case-series studies. Data relating AS use to elevated blood pressure, altered lipid profiles and ECG abnormalities have been reported, but are often limited in scope, and other studies have often produced equivocal outcomes. The use of AS has been linked to the appearance of concentric left ventricular hypertrophy as well as endothelial dysfunction but the data again remains controversial. The mechanisms responsible for the negative effect of AS on cardiovascular health are poorly understood, especially in humans. Possibilities include direct effects on myocytes and endothelial cells, reduced intracellular Ca2+ levels, increased release of apoptogenic factors, as well as increased collagen crosslinks between myocytes. New data relating AS use to cardiovascular health risks are emerging, as novel technologies are developed (especially in non-invasive imaging) that can assess physiological structure and function. Continued efforts to fully document the cardiovascular health consequences of AS use is important to provide a clear, accurate, public health message to the many groups now using AS for performance and image enhancement.

Performance enhancing drug abuse and cardiovascular risk in athletes: implications for the clinician

The use of performance-enhancing and social drugs by athletes raises a number of ethical and health concerns. The World Anti-Doping Agency was constituted to address both of these issues as well as publishing a list of, and testing for, banned substances in athletes. Despite continuing methodological developments to detect drug use and associated punishments for positive dope tests, there are still many athletes who choose to use performance and image enhancing drugs. Of primary concern to this review are the health consequences of drug use by athletes. For such a large topic we must put in place delimitations. Specifically, we will address current knowledge, controversies and emerging evidence in relation to cardiovascular (CV) health of athletes taking drugs. Further, we delimit our discussion to the CV consequences of anabolic steroids and stimulant (including amphetamines and cocaine) use. These drugs are reported in the majority of adverse findings in athlete drug screenings and thus are more likely to be relevant to the healthcare professionals responsible for the well-being of athletes. In detailing CV health issues related to anabolic steroid and stimulant abuse by athletes we critique current research evidence, present exemplar case studies and suggest important avenues for on-going research. Specifically we prompt the need for awareness of clinical staff when assessing the potential CV consequences of drug use in athletes.

Dose-dependent apoptotic and necrotic myocyte death induced by the β2-adrenergic receptor agonist, clenbuterol

We have investigated the dose‐ and time‐dependency of myocyte apoptosis and necrosis induced by the β2‐adrenergic receptor agonist, clenbuterol, with the aim of determining whether myocyte apoptosis and necrosis are two separate processes or a continuum of events. Male Wistar rats were administered subcutaneous injections of clenbuterol, and immunohistochemistry was used to detect myocyte‐specific apoptosis and necrosis. Myocyte apoptosis peaked 4 h after, and necrosis 12 h after, clenbuterol administration. In the soleus, peak apoptosis (5.8 ± 2.0%; P < 0.05) was induced by 10 μg and peak necrosis (7.4 ± 1.7%; P < 0.05) by 5 mg.kg−1 clenbuterol. Twelve hours after clenbuterol administration, 73% of damaged myocytes labeled as necrotic, 27% as apoptotic and necrotic, and 0% as purely apoptotic. Administrations of clenbuterol (10 μg.kg−1) at 48‐h intervals induced cumulative myocyte death over 8 days. These data show that the phenotype of myocyte death is dependent on the magnitude of the insult and the time at which it is investigated. Only very low doses induced apoptosis alone; in most cases apoptotic myocytes lysed and became necrotic and the magnitude of necrosis was greater than that of apoptosis. Thus, it is important to investigate both apoptotic and necrotic myocyte death, contrary to the current trend of only investigating apoptotic cell death. Muscle Nerve, 2005

Athletes' Knowledge and Views on OTC Medication

A questionnaire was administered to elite athletes from Australia, Canada, the UK, and the USA representing 10 Olympic sports in order to explore knowledge and understanding of over-the-counter (OTC) medication since the removal of many of these substances from the World Anti-Doping Agency (WADA) Prohibited List, in 2004. Athletes demonstrated limited knowledge and understanding. Around half (50.5 %) knew the penalty incurred following a doping violation involving a banned OTC stimulant. The terms Monitoring Program and Specified Substance List were understood by 43.3 % and 67.5 % of respondents, respectively. Overall, the status of substances in relation to the Prohibited List was correctly identified in just 35.1 % of cases. As a whole, athletes were of the opinion that OTC stimulants posed a risk to health, were performance enhancing and that their use was against the spirit of sport. They were undecided as to whether these drugs should be returned to the Prohibited List. Elite athletes require targeted education programmes that will enable them to make informed decisions on the potential of OTC medications for therapeutic or performance enhancing purposes.

Prevalence of bronchoconstriction induced by eucapnic voluntary hyperpnoea in recreationally active individuals

Abstract Objective: Exercise-induced bronchoconstriction (EIB) is more prevalent in elite athletes than in the general population. Many of these athletes provide a positive eucapnic voluntary hyperpnoea (EVH) challenge without previous diagnosis of EIB. It is unknown whether this is specific to elite athletes or whether the same risk applies to recreationally active individuals. The purpose of this study was to investigate the prevalence of a positive EVH challenge in a population of recreationally active individuals. Methods: 136 recreationally active individuals (Age: 21.9 ± 3.7 years; Height: 175 ± 9 cm; Weight: 70.9 ± 10.0 kg) without previous history of asthma or EIB, volunteered to take part in the study. All participants completed an EVH challenge, which was deemed positive if FEV1 fell ≥10% from baseline at two consecutive time points, and was reversible following inhalation of a short acting β2-agonist. Results: 18 of 136 (13.2%) participants had a positive EVH challenge. Of the 18 individuals, the fall in FEV1 from baseline ranged from −12% to −50%. At baseline, percentage predicted FEV1 (97.5 ± 12.5% versus 104.9 ± 10%; p < 0.01), FEV1/FVC ratio (79.5 ± 6.9% versus 87.8 ± 5.5%; p < 0.01), FEF25-75 (3.73 ± 1.00 versus 4.73 ± 1.00 l/s; p < 0.01) and predicted PEF (89.4 ± 8.8% versus 97.5 ± 13.6%; p < 0.05) values for EVH positive participants were significantly lower than EVH negative participants respectively. Conclusions: Overall, 13.2% of recreationally active individuals with no previous history of asthma presented with a positive EVH challenge. Individuals who are recreationally active may benefit from an objective bronchial provocation challenge, given that self-reported symptoms alone only provide a supportive role towards a valid EIB diagnosis.

Impact of ethnicity, gender, and dehydration on the urinary excretion of inhaled salbutamol with respect to doping control.

Objective:To examine the impact of dehydration, ethnicity, and gender on urinary concentrations of salbutamol in relation to the threshold stipulated by the World Anti-Doping Agency (WADA). Design:Repeated measures open-label. Participants:Eighteen male and 14 female athletes (9 white males, 9 white females, 2 Afro-Caribbean males, 2 Afro-Caribbean females, 6 Asian [Indian subcontinent] males, and 4 Asian females) were recruited. All participants were nonasthmatic. Interventions:After inhalation of 800 &mgr;g or 1600 &mgr;g of salbutamol, athletes exercised in a hot controlled environment (35°C, 40% relative humidity) at a self-selected pace until a target weight loss (2% or 5%) was achieved. Main Outcome Measures:Urine concentration of free salbutamol. Results:After inhalation of 1600 &mgr;g salbutamol, 20 participants presented with a urine salbutamol concentrations above the current WADA limit (1000 ng/mL) and decision limit (1200 ng/mL) resulting in an adverse analytical finding. There were no differences according to gender or ethnic origin. Conclusions:Dehydration equivalent to a body mass loss greater than 2% concomitant to the acute inhalation of 1600 &mgr;g of salbutamol may result in a urine concentration above the current WADA limit and decision limit leading to a positive test finding independent of gender or ethnic origin. Clinical Relevance:Asthmatic athletes using salbutamol should receive clear dosing advise and education to minimize the risk of inhaling doses of salbutamol that may produce urine concentrations of salbutamol above 1200 ng/mL.

The ergogenic effect of long-term use of high dose salbutamol.

Objective:Investigate the effect of inhaling 1600 &mgr;g salbutamol for 6 weeks on endurance, strength, and power performances. Design:Randomized double-blind, mixed-model repeated measures. Participants:Sixteen male athletes (mean ± SD: age, 20.1 ± 1.6 years; height, 179.9 ± 8.2 cm; weight, 74.6 ± 9.1 kg). Interventions:Participants were assigned to either a placebo inhaler (PLA) or inhaled 1600 &mgr;g salbutamol group (SAL). Over 6 weeks, participants inhaled PLA or SAL and completed 4 training sessions per week that focused on endurance, strength, and power. Main Outcome Measures:Participants completed the assessments of peak oxygen consumption (), 3-km time trial, vertical jump height, 1 repetition maximum (1RM) bench and leg press, and peak torque knee flexion and extension. Assessments were undertaken at baseline, week 3, and week 6. Results:Over the 6 weeks, PLA and SAL groups improved (51.7 ± 4.7 vs 56.8 ± 7.1 mL·min−1·kg−1; 53.1 ± 6.1 vs 55.0 ± 6.7 mL·min−1·kg−1); 3-km running time trial (988.6 ± 194.6 vs 947.5 ± 155.5 seconds; 1040.4 ± 187.4 vs 1004.2 ± 199.4 seconds); 1RM bench press (65.7 ± 15.4 vs 70.3 ± 13.8 kg; 64.3 ± 14.0 vs 72.5 ± 15.3 kg); and leg press (250.0 ± 76.4 vs 282.5 ± 63.6 kg; 217.9 ± 54.0 vs 282.8 ± 51.9 kg). The SAL group did not improve significantly greater in any endurance or strength and power measure when compared with the PLA group. Conclusions:Inhaling 1600 µg salbutamol daily over 6 weeks does not result in significant improvements in endurance, or strength and power performances. Clinical Relevance:Athletes using inhaled salbutamol to treat bronchoconstriction during exercise on a daily basis will not gain an advantage over nonasthmatic athletes not using inhaled salbutamol.

The physiological effect of 800 mcg and 1600 mcg inhaled salbutamol during a football specific treadmill run at high ambient temperatures

The World Anti-doping Agency stipulates that athletes who declare salbutamol use should not exceed 1600 μg over a 24 h period. No studies have investigated the physiological effect of 1600 μg of inhaled salbutamol on intermittent sports. This study investigated the physiological effect of inhaling 800 μg and 1600 μg of salbutamol prior to a football specific run at high ambient temperatures. Five male non-asthmatic football players (mean+SD; age 24+4 y; weight 71+4 kg; height 175+5 cm) volunteered. Participants attended the lab on three occasions to inhale either a placebo (PLA), 800 μg of salbutamol (800SAL) or 1600 μg of salbutamol (1600SAL) 15 min prior to performing a football-specific run for 45 min at 30°C. The football specific run consisted of seven stages which included two high intensity stages and five low intensity stages. During each stage VO2, RER, HR and blood lactate was measured. Repeated measures ANOVA were performed to investigate the changes in VO2, RER, HR and blood lactate during each stage. Significance was assumed if p<0.05. During stage one and two HR was higher (p=0.010; p=0.013) in 800SAL (143.3+10.3 b.min-1; 148.0+12.2 b.min-1) and 1600SAL (141.6+2.5 b.min-1; 147.0+4.0 b.min-1) when compared to PLA (119.3+11.9 b.min-1; 129.3+9.6 b.min-1). Following stage two blood lactate was higher (p=0.020) in 800SAL (4.2+1.8 mmol.l-1) and 1600SAL (4.5+1.6 mmol.l-1) when compared with PLA (2.4+1.2 mmol.l-1). Following stage five blood lactate was higher (p=0.014) in 800SAL (4.2+1.6 mmol.l-1) and 1600SAL (5.0+1.4 mmol.l-1) when compared with PLA (2.8+1.0 mmol.l-1). The increased HR (stages one and two) and increased blood lactate concentration (stages two and five) observed following salbutamol inhalation, suggests supratherapeutic doses of salbutamol may increase the physiological cost during a football match.

Drugs in Sport : seventh edition

Glossary of terms. What is a drug? - D R Mottram. Definition of a drug. Development of new drugs. Drugs and their targets. Agonists and antagonists. Drug toxicity. Side-effects of drugs. Complex drug reactions. Drugs and the law. Dietary supplements. References. Drug use and abuse in sport - M Verroken. Historical Perspective. References. Further reading. Sympathomimetic amines and their antagonists - D D Armstrong. Summary. Anatomy and physiology of the automatic nervous system (ANS). Adrenergic agonists. Adregenic antagonists. References. Central nervous system stimulants - A George. CNS neurophysiology. Amphetamines. Cocaine. Caffeine. The future. References. Drug treatment of inflammation in sports injuries - P Elliot. Summary. Introduction. The inflammatory response. The treatment of sporting injuries. References. Further reading. Alcohol, anti-anxiety drugs and sport - T Reilly. Introduction. Anxiety and performance. Alcohol. Benzodiazepines. Marijuana. Nicotine. Beta blockers. Overview. References. The anabolic steroids and peptide hormones - A George. Summary. Introduction. The testosterone family. Anabolic steroids and sport. Anabolic steroid side-effects with particular reference to athletes. Indirect consequences of anabolic steroid abuse. Educational and social aspects of steroid abuse. Human growth hormone (hGH). Adrenocorticotrophic hormone (ACTH). Human chorionic gonadotrophin (hCG). Luteinizing hormone (LH). The future. References. Blood boosting and sport - D J Armstrong and T Reilly. Introduction. Erythropoiesis. Exercise at altitude. Physiological adaptations to altitude. Blood doping. The use of erythropoietin in blood boosting. Blood doping control. Conclusion. References. Doping control in sport - M Verroken and D R Mottram. History of drug testing. IOC accredited laboratories. Government action and policy. The testing programmes.Problems in drug detection. Blood testing in doping control. Problems with over the counter (OTC) drugs. Reporting test results. Education. References. Further reading. Index.

The Impact of Inhaled Salbutamol on Repeated Sprint Ability in Pre- Fatigued Soccer Players

Objectives: Investigate the ergogenic effect of inhaling up to 1600 μg of salbutamol on intermittent running performance in pre-fatigued soccer players. Methods: In a single blind randomised repeated measures design seven male and six female soccer players volunteered to participant. All participants were regularly playing competitive soccer and had no history of asthma. Following familiarisation sessions participants visited the exercise physiology laboratory on three occasions to complete an intermittent running protocol followed by twelve 17.5 m sprints. Prior to each trial participants inhaled either: placebo, 800 μg inhaled salbutamol (SAL800) or 1600 μg inhaled salbutamol (SAL1600). Following completion of the sprints a sample from the first urine passed was analysed for salbutamol concentration. A repeated measures ANOVA was used to compare the mean sprint time, maximal sprint power, peak blood lactate post sprints and post sprint salbutamol urine concentration between conditions. Results: Mean sprint time, maximum power, maximum velocity, peak HR and peak blood lactate during the 17.5 m sprints were not significantly different between treatments in soccer players. There was no significant difference between male and female players in urine drug concentration following SAL800 (mean + SD; 201.47 + 294.47 ng.ml-1 vs. 180.2 + 102.15 ng.ml-1) or SAL1600 (739.24 + 549.21 ng.ml-1 vs. 879.58 + 633.14 ng.ml-1). Three players urine drug concentrations were above the WADA decision limit set at 1200 ng.ml-1. Conclusions: Inhaling up to 1600 μg inhaled salbutamol did not significantly improve repeated sprint performance. However, inhalation of 1600 μg may result in a urine concentration above the current WADA upper limit and decision limit leading to a positive test. Athletes should ensure they use inhaled salbutamol at therapeutic doses to avoid the risk of breaching the WADA decision limit.