Exsc Phsy II - Unit 3

Ergogenic Aids Definition

Ergogenic aids are substances or techniques used by athletes to enhance physical work capacity or athletic performance.

History of Ergogenic Aids

• Examples of ergogenic use by athletes can be traced back to antiquity.

• Early sports medicine physicians encouraged athletes to eat raw meat before competing, believing it would enhance their "animal competitiveness."

Classes of Ergogenic Aids

• Nutritional: Includes macronutrients (e.g., carbohydrates, proteins) and micronutrients (e.g., vitamins, minerals).

• Physical/Physiological: Involves techniques such as massage, warm-up routines, and blood doping.

• Psychological: Includes practices like hypnosis and mental imagery.

• Pharmacological: Involves substances like caffeine, amphetamine, and recombinant human growth hormone.

• Mechanical: Incorporates advances in materials technology to improve performance, such as streamlined swimwear and cycling headgear.

Regulation of Ergogenic Aid Use

• Monitoring by organizations such as the World Anti-Doping Agency (WADA), the US Anti-Doping Agency, and various sports governing bodies.

• Scrutiny of performance-enhancing drug (PED) use has increased in the last 50 years.

Issues Surrounding Ergogenic Aid Use

• Legality: Some aids are banned, while others are not.

• Ethics: Practices range from widely accepted to clearly unethical.

• Safety: Some aids are linked to adverse health effects, while others lack long-term safety data.

• Inaccurate labeling and contamination of nutritional supplements pose risks.

• Effectiveness varies, with limited research supporting many claims.

Ergogenic Aids Research Levels

• Category 1: Strongest evidence includes randomized, double-blind, placebo-controlled studies published in peer-reviewed journals.

• Category 2: Involves randomized controlled trials with a limited body of data.

Levels of Evidence - Category 1

• Strongest form of evidence.

• Involves randomized, double-blind, placebo-controlled studies published in peer-reviewed journals.

Levels of Evidence - Category 2

• Involves randomized controlled trials (RCTs) with a limited body of data.

Levels of Evidence - Category 3

• Includes nonrandomized trials and observational studies.

Levels of Evidence - Category 4

• Panel consensus judgment.

• Recommendations are based on a body of research support rather than a single study.

Scientific Examination of Ergogenic Aid Efficacy

• Requires gathering valid, reliable, objective empirical data from an appropriate population.

• Should have a logical physiological mechanism for purported efficacy.

• Well-designed research should utilize randomized controlled trials with proper controls and statistical treatment of data.

Randomized, Double-Blind, Placebo-Controlled Crossover Trial

• Involves a randomized, double-blind, placebo-controlled trial in the first half before the washout period.

• Subjects receive both the supplement and placebo in different orders to minimize bias.

• Important for isolating the efficacy of the supplement and avoiding interactions.

Australian Institute of Sports Classification System

• Group A: Supported and permitted for use in specific situations.

• Group B: Deserving of additional research, permitted for use subject to clinical research or monitoring.

• Group C: Little proof of efficacy, not provided to athletes, but may be permitted on an individual basis.

• Group D: Banned by WADA or at high risk for contamination, should not be used by athletes.

• Groups supplements based on evidence: A for support, B for research, C for uncertain, and D for banned or risky.

Mechanisms of Action for Ergogenic Aids

• Ergogenic aids exert their effectiveness through mechanisms such as central or peripheral nervous system stimulation, increased substrate availability, supplemental fuel sources, etc.

• Ergogenic aids work by stimulating the body, providing extra fuel, or aiding recovery among other mechanisms.

Gene Therapy in Ergogenic Aid

• Recognized as a legitimate medical advance for managing certain conditions, but not typically considered within the realm of ergogenic aids for athletic performance enhancement.

• Gene therapy is a legitimate medical advance but not typically used for athletic performance enhancement.

WADA

• Founded: 1999

• Purpose: Monitors and detects doping, ensures fair competition

• Bans: Anabolic steroids, hormones, stimulants, narcotics, etc.

banned substances

• Examples: Anabolic steroids, hormones, diuretics, stimulants, etc.

• Also banned: Alcohol, glycerol (removed from WADA list)

anabolic androgenic steroids

• Origin: Gained prominence in 1930s

• Uses: Muscle wasting diseases, androgen deficiency

• History: Used by Nazi Germany in WWII, popularized by Soviet athletes in 1956 Olympics

• Development: Methandrostenolone (dianabol) by John Ziegler, marketed by CIBA

• Regulation: Banned by International Olympic Committee in 1975, US regulation since 1990

• Legit Uses: Osteoporosis, severe breast cancer, lean body mass decline counteraction

legit used of anabolic androgenic steroids

• Include: Osteoporosis treatment, severe breast cancer, lean body mass decline counteraction

• For: Elderly men, HIV/AIDS patients, individuals undergoing kidney dialysis

WADA banned substancesnabolic steroids

• Anabolic steroids

• Hormones

• Diuretics

• Stimulants

• Narcotics

• Cannabinoids

• Glucocorticosteroids

• Beta-blockers (in some sports)

• Alcohol and glycerol (removed from WADA list)

anabolic androgenic steroids: structure and action

• Action: Stimulate RNA synthesis, increase protein production

• Binding: Compete with cortisol, bind to androgen receptors

• Location: Produced in testes, adrenal cortex

• Effects: Contribute to male secondary sex characteristics

• Forms: Oral, injectable

• Abuse: Stacking, pyramiding, supra pharmacological doses

synthesis of anabolic androgenic steroids from testosterone

• Testosterone: Short half-life, rapidly metabolized

• Modification: Chemical alterations for resistance to catabolism

• Effects: Higher plasma levels, increased anabolic potential

• Risks: Liver damage (oral), HIV/AIDS, hepatitis (injectable)

anabolic androgenic steroids considerable following

• Usage: Male and female athletes in various sports

• Teen Usage: Improve performance and appearance

• Research: Mostly observational due to bioethical issues

• Effectiveness: Research findings equivocal on body composition, protein synthesis, and strength

• Dosage Discrepancy: Athletes' doses much higher than research

• Practical Use: Difficult to apply research findings to supra pharmacological doses

risks of anabolic androgenic steroid use

• Controversy: Most data from diseased subjects, high AAS doses

• Abuser Doses: 10+ times normal dose

• Health Risks Include:

  • Endocrine Function Impairment

  • Infertility

  • Reduced Sperm Concentration

  • Testicular Volume Decrease (usually reversible)

  • Increased Estradiol (leading to gynecomastia)

  • Prostate Stimulation (increased size)

  • Liver Function Abnormalities

  • Cardiovascular Damage

  • Cholesterol Imbalance

  • Tendon and Connective Tissue Weakness

specific risks of anabolic androgenic steroid use for females

• Virilization

• Disrupted Growth Patterns (premature bone growth plate closure)

• Altered Menstrual Function

• Increased Sebaceous Gland Size (leading to acne)

• Hirsutism (excessive body/facial hair)

• Deepened Voice

• Hair Loss

• Decreased Breast Size

• Clitoral Enlargement

• Hormone Declines (LH, FSH, progesterone)

other negative effects of steroids

• Chronic stimulation of prostate with increased size

• Abnormal liver function 

• Injury to myocardial cells and alterations in central and peripheral cardiovascular structure and function

• Increased LDL-C, decreased HDL-C, increased total cholesterol

• Decreased strength of tendons and connective tissue

dehydroepiandrosterone (DHEA)

• Origin: Produced from cholesterol by adrenal cortex

• Abundance: Most produced steroid in the body

• Role: Considered a testosterone precursor

• Knowledge Gap: Limited understanding of dosages and long-term effects

• Aging: Supplementation believed to mitigate aging effects by raising DHEA levels

• Cardiovascular Research: Findings equivocal, correlation with age and coronary artery disease

• Muscle Effects: Little evidence of increased muscle mass or strength

• Concerns: Potential for benign prostate hypertrophy, tumor growth

• Regulation: Schedule III controlled substance (DEA), prohibited by WADA for training and competition use

DHEA research and use

• Testosterone Precursor: Converts to androstenedione but not testosterone

• Aging Effects: Supplementation thought to mitigate aging effects

• Cardiovascular Health: Research findings inconclusive

• Muscle Mass and Strength: Limited evidence of enhancement

• Health Concerns: Potential for prostate issues, tumor growth

• Regulation: Controlled substance (DEA), banned by WADA for sports use

androstenedione

• Effects: Supposedly stimulates testosterone production, enables intense training, builds muscle mass, and repairs tissue injury

• Exogenous Effects: Reported to increase both testosterone and estrogens, potentially negating anabolic effect

• Scientific Evidence: Little support for ergogenic or anabolic claims

• Regulation: Classified as Schedule III controlled substance, banned by WADA for sports use

evidence on anabolic prohormones

• Testosterone Increase: Equivocal evidence

• Body Composition: No evidence of increased body or lean mass or strength

• Protein Expression: No evidence of increase

• Hormonal Effects: Increased estrogens, decreased HDL-C

clenbuterol and B2-adrenergic agonists

• Purpose: Used by athletes as AAS substitute for tissue-building, fat-reducing benefits

• Benefits: Preserves lean body mass, reduces fat mass before competition

• Animal Studies: Report increased muscle protein gain and lipolysis

• Mechanism: Facilitates adrenergic receptor responsiveness

• Effects in Animals: Increased muscle mass and force, inhibited bone growth, adverse effects on bone microarchitecture and cardiac function

• Risks: Increased fracture risk due to weakened bones

• Human Use: Not approved by FDA, banned by WADA for competition and training

albuterol and salbutamol

• Albuterol (US Generic): Not on WADA prohibited list, shown to increase muscular mass

• Effectiveness: More pronounced in untrained muscles due to B2-adrenergic receptor downregulation in trained state

• Salbutamol (International Generic): No reported ergogenic effects on anaerobic, aerobic, ventilatory, or neuromuscular functions

human growth hormone (hGH)

• Known as: Also known as somatotropin

• Secretion: Released by anterior pituitary gland in response to somatocrinin

• Functions: Stimulates bone and cartilage growth, lipolysis, reduces glucose and amino acid catabolism

• Age Effects: Reduced secretion with age contributes to decreased fat-free mass

• Limitations: Does not reverse aging effects on strength and VO2 max

• Considerations: Benefits vs. potential adverse effects must be weighed

• Side Effects: Not well documented

• Performance: Little evidence for increased strength despite changes in body composition

• WADA: Prohibited by WADA for sports use

NSCA position on AAS and hGH Use

• hGH Effects: Increases lean body mass (mostly water), often taken with androgens

• Combined with Training: Minimal gains in fat-free mass, hypertrophy, and strength compared to training alone

• Medical Use: Appropriate under physician's supervision

• Adverse Events: Dose-related, including depression of H-P-IGF-1 axis, edema, joint pain, insulin resistance

• Education Efforts: Importance of educating athletes, coaches, parents, physicians, and trainers about PED dangers

• Goals: Emphasize optimal training, nutrition, and realistic performance enhancement strategies

• NSCA's Promotion: Documentation of effects, discontinuation of PED use, increased detection strategies

amino acid supplementation

• Belief: Exogenous amino acids boost endogenous testosterone, hGH, insulin, and IGF-1 production

• Goals: Facilitate muscle protein synthesis, increase strength, decrease fat

• Specific Amino Acids: Arginine, tyrosine, lysine, ornithine, and others

• Evidence: No convincing evidence for supplementation above regular dietary levels to increase hormone secretion or performance

• Risks: Excess intake may lead to toxicity and imbalances

branch chain amino acids (BCAA)

• Focus: Leucine as an anabolic building block

• Ketogenic Substrates: Studied, especially when glycogen stores are low

• Benefits: Proposed to delay central nervous fatigue, enhance muscle uptake during prolonged exercise

• Tryptophan Competition: High BCAA levels compete with tryptophan, decreasing serotonin formation and fatigue

• Research: Central serotonin:dopamine ratio and norepinephrine's role are receiving attention in fatigue studies

plasma BCAAs effects from delaying central nervous fatigue

• Prolonged aerobic endurance decreases muscle glycogen and increased serum FFA

• BCAA uptake by exercising muscles is enhanced in prolonged exercise

• Serum free tryptophan: BCAA ratio increases

• Tryptophan and BCAA use the same blood brain barrier carrier protein

• Tryptophan is the precursor for serotonin formation

  • High serum or free tryptophan may induce formation of serotonin

• Elevated brain serotonin levels may induce fatigue through depressant activity

• High BCAA compete with free tryptophan for entry into brain cells thereby decreasing serotonin formation and preventing fatigue

timing of nutrient intake

• Importance: Can stimulate an anabolic effect, affecting responsiveness to resistance training

• Mechanisms: Altered nutrient availability, enzyme activity, hormonal secretions, gene transcription

• Effects: Increased post-exercise concentration of amino acids, fatty acids, glucose; promotes insulin and hGH secretion for anabolic effects and inhibits protein catabolism

carbohydrate-protein supplementation

• Strategy: Used in pre-exercise and/or recovery

• Purpose: Enhances post-exercise and post-prandial concentration of nutrients, promoting anabolic responses

effects of increased post-exercise nutrient concentrations

• Result: Increased secretion of insulin and hGH

• Outcome: Promotes uptake and anabolic effects, inhibits protein catabolism

• Nutrients: Amino acids, fatty acids, glucose

creatine addition to CHO-Protein supplement

• Timing: Taken immediately before and after exercise

• Benefit: Potentially more effective than the same supplement taken at other times of the day

importance of nutrient timing

• Significance: Timing of nutrient intake crucial

• Impact: Influences effectiveness of resistance training

effects of CHO/Protein/Creatine supplement

• Timing: Taken immediately pre and post-exercise

• Changes Compared to Other Times:

  • Increased lean body mass

  • Decreased % body fat

  • Improved bench press and squat performance

  • Increased cross-sectional area of type IIa and IIx muscle fibers

amphetamines

• Definition: Sympathomimetic compounds mimicking effects of epinephrine and norepinephrine

• CNS Effects: Powerful stimulating effects on central nervous system

physical and psychological effects

• Dependency: Physiological/emotional drug dependency

• Performance: Negative ergolytic effect on tasks requiring steadiness and mental concentration

• Tolerance: Increased tolerance with prolonged use, requiring larger doses for the same effect

• Pain and Fatigue: Inhibition/suppression of perceiving/responding to pain and fatigue, risking health and safety

long term effects of amphetamines

• Unknown: Effects of prolonged amphetamine intake are unknown

• Research: Most research is outdated and doesn't support an ergogenic effect

• Blinding Difficulty: Difficult to blind subjects to moderate/high amphetamine doses in experiments

regulation of amphetamines

• WADA: Prohibits use in competition

• Training Use: Athletes may still use them during training

• Research Evidence: Little evidence of efficacy, with available research being over 45 years old

caffeine

• Source: Found naturally in coffee beans, tea leaves, cocoa beans, and cola nuts

• Content: One cup of brewed coffee: 60-150 mg, Instant coffee: about 100 mg, Caffeinated soft drinks: about 50 mg

caffeine mechanisms of action

• Receptor Blocking: Competitive adenosine A1 and A2A receptor blocker

• Metabolic Effects: Acts directly on adipose and peripheral vascular tissues, increasing cAMP, lipolysis, dopamine, and norepinephrine

• Indirect Stimulation: Stimulates epinephrine release from adrenal medulla

factors affecting neuromuscular activity

• Lower Threshold: for motor unit recruitment

• Alteration: in excitation/contraction coupling relaxation

• Facilitation: of nerve transmission

• Increase: in ion transport within muscle

differential effects of caffeine vs adenosine

• Stimulation of A1 Receptor by Adenosine:

  • Actions: Inhibition of adenylate cyclase, decreased cAMP, norepinephrine, opening of K channels, closing of Ca channels, sequestration of Ca in cell fatigue

• Competitive A1 Receptor Blocking Adenosine by Caffeine:

  • Actions: Potentiation of adenylate cyclase, inhibition of phosphodiesterase, increased cAMP, norepinephrine, closing of K channels, opening of Ca channels, arousal

dosage and absorption of caffeine

• Range: 3-9 mg/kg body mass, administered 30-60 minutes pre-exercise

• Absorption: Rapid absorption by small intestine

effects of caffeine on exercise performance

• Endurance: Extends endurance in aerobic exercise

• Strength and Power: Enhances muscular strength and power

• Motor Unit Recruitment: Increases motor unit recruitment

• Perception of Effort: Decreases perception of effort

• Cognitive Performance: Improves cognitive performance and complex cognitive ability

mechanisms from caffeine usage

• Neural Disinhibition: Indirect neuromuscular effects related to adenosine blockade

• FFA Oxidation: Does not significantly increase FFA oxidation or spare glycogen during exercise in trained individuals

caffeine research findings

• Endurance Performance: Meta-analyses indicate significant improvement in various aerobic endurance exercises

• Rate of Perceived Exertion (RPE): Reduces RPE by 5.6%, improving performance by 11.2%

• Withdrawal Effects: Ceasing caffeine may have little effect on performance

• Muscle Glycogen: Recent studies show no significant glycogen-sparing effect

inter-individual variance from caffeine usage

• Response: Considerable variance in response to caffeine's ergogenic effects

concerns from caffeine usage

• Energy Products: Concerns about caffeine content in energy shots and drinks

• Regulation: Calls for greater scrutiny from FDA by health professionals

ginseng

• Purpose: Marketed as a nutritional supplement

• Purported Effects:

  • Modulates hypothalamic pituitary adrenal axis to increase resistance to stressors

  • Enhances myocardial metabolism

  • Increases hemoglobin

  • Promotes vasodilation

  • Enhances oxygen extraction by muscle tissues

  • Increases mitochondrial metabolism in muscle

• Forms: Siberian, Japanese, Korean, and American ginseng

• Active Compounds: Ginsenosides, ginseng saponins, eleutherosides

potential therapeutic uses of ginseng

• Diabetes treatment

• Male impotence

• Immune function stimulation

adaptogenic role of ginseng

Coined by Russian scientist to describe resistance to catabolic effects of stress during high-intensity/volume training

ergogenic evidence of ginseng

Little evidence from well-designed randomized controlled trials to support effectiveness as an ergogenic aid

ephedrine

• Source: Found in dried stem of Ephedra sinica plant (ma huang)

physiological effects of ephedrine

• Central and Peripheral β-adrenergic Effects:

  • Increased heart rate

  • Increased cardiac output

  • Elevated blood pressure

  • Bronchodilation

ergogenicity of ephedrine

Equivocal evidence for promoting weight loss or improving performance

safety concerns of ephedrine

Potential for dangerous side effects, including death, especially when combined with caffeine

regulation of ephedrine

• FDA Ban: Sale banned as a dietary/weight loss supplement

• WADA Prohibition: Use banned in competition, but allowed in training

buffering solutions

Purpose: Counteract accumulation of lactate and H+ (decreased pH) during high-intensity anaerobic exercise

carbonic acid/bicarbonate system

• Function: Provides defense against intracellular increases in H+

• Ergogenic Mechanism: Pre-exercise sodium bicarbonate loading to increase base excess, creating alkaline environment for enhanced performance

• Dosage: 300 mg/kg body mass consumed 1-3 hours prior to anaerobic exercise

sodium citrate

• Alternative: Used in a similar manner as sodium bicarbonate for buffering

practices of buffering solutions

Soda Loading or Buffer Boosting: Refers to the practice of pre-exercise sodium bicarbonate loading

B-alanine supplementation

• Effect: Increases muscle carnosine, a dipeptide histidine and B-alanine, which buffers intramuscular acidity

ergogenic mechanism of bicarbonate buffering

• Objective: Increase base excess (HCO3) levels

• Effect: Creates a more alkaline blood environment

• Purpose: Control acidity and prevent pH decrease during intense anaerobic exercise

effects of bicarbonate loading on exercise performance

• Performance Improvement:

  • Faster 800 m time

  • Tolerance for high post-race HLa

• Physiological Measures:

  • Higher pre-race pH

  • Attenuated decrease in post-race pH

  • Increased post-race HCO3 vs placebo vs control

• Optimal Conditions for Improvement:

  • High-intensity activities lasting 30-120 sec or repetitive high-intensity interval activities with work interval < 1 min

limitation of bicarbonate loading

• No improvement in strength performance

• Potential for gastrointestinal distress with higher buffer loads

regulation of bicarbonate

WADA permits loading in both training and competition

effects of B-alanine supplementation

• Increases muscle carnosine

• enhancing intracellular buffering capacity

HMB for enhanced recovery

• Usage: Attenuates exercise-induced skeletal muscle damage in both trained and untrained populations.

• Timing: Benefits derived from consuming HMB in close proximity to workout.

• Pre-Competition Use: Most effective when consumed for 2 weeks before a competitive exercise bout.

effective dosage and benefits of HMB

• Dosage: 38 mg·kg BM-1·day-1 (~3 g; 80 kg) of HMB enhances skeletal muscle hypertrophy, strength, and power.

• Populations: Effective in both untrained and trained individuals with appropriate exercise prescription.

forms of HMB

• Types: Calcium HMB (HMB-Ca) and free acid form of HMB (HMB-FA).

• Absorption: HMB-FA may have better plasma absorption and retention, but research is limited.

effects of HMB in elderly population

Benefits: Increases lean body mass (LBM) and functionality in elderly, sedentary populations.

impact of HMB on fat mass

• In Conjunction with Exercise: May lead to greater declines in fat mass when combined with structured exercise program.

HMB mechanisms of action

• Proteolysis Inhibition: Reduces breakdown of proteins.

• Protein Synthesis: Increases the production of proteins.

safety of HMB

• Chronic Consumption: Considered safe in both young and old populations.

autologous RBC re-infusion

• Process: Withdrawal of 1-4 units of blood, reinfusion of plasma, and storage of packed red cells in frozen glycerol.

• Interval: Each unit withdrawn at 3-8 week intervals to prevent dramatic blood cell concentration reduction.

• Infusion Timing: Stored cells infused 1-7 days before an important endurance event, increasing RBC count and Hb by 8-20%.

effects of blood doping

• Hemoglobin Increase: Raises Hb for men from 15 g per 100 ml to 19 g per 100 ml, sustained for ~14 days.

• Physiological Impact: Increases RBC mass, Hb, QMAX, and CaO2, enhancing total arterial oxygen content (TaO2).

potential negative effects of blood doping

• Increased Blood Viscosity: Decreases cardiac output, blood flow velocity, and peripheral O2 supply.

• Atherosclerosis Risk: Compromises blood flow through atherosclerotic vessels, raising heart attack or stroke risk.

• Training Impact: May adversely affect training volume immediately following autologous RBC harvest.

VO₂ max relationship of blood doping

• Linear Relationship: Strong, clear, positive correlation between VO2 MAX and total circulating Hb in both males and females.

baseline hematologic status

• Features: Normal levels of erythropoiesis, hematocrit, and hemoglobin.

effects of erythropoesis returning to baseline

• Outcome: Decreased hematocrit and hemoglobin levels.

changes during blood removal

• Effect: Decreased hematocrit and hemoglobin due to blood loss.

during re-infusion of blood

• Result: Increased hematocrit and hemoglobin levels post-reinfusion.

• Physiological Impact: Rise in arterial oxygen content (CaO2) and total arterial oxygen content (TaO2).

• Enhanced Performance: Increase in maximal oxygen consumption (VO2 MAX).

introduction of pharmacological blood doping

• Background: After blood doping was banned, athletes turned to pharmacological methods.

role of erythropoietin (EPO)

Function: Regulates red blood cell (RBC) production in bone marrow, primarily produced by kidneys.

use of recombinant human erythropoietin (rhEPO)

• Purpose: Eliminates the need for traditional blood doping.

• Effect: Increases RBC mass, hematocrit (Hct), hemoglobin (Hb), arterial oxygen content (CaO2), and total arterial oxygen content (TaO2).

health risks of unregulated rhEPO use

• Concerns: Increased hematocrit ≥60% leads to elevated blood viscosity.

• Complications: Higher risk of stroke, heart attack, heart failure, and pulmonary edema.

regulations of erythropoietin

• Prohibition: Both blood doping and rhEpo use are banned.

• Detection: Monitoring blood thresholds; some sports set specific criteria (e.g., cycling Hct ≤50% for males).

challenges with EPO/rhEPO thresholds

• Issue: Normal biological variation may cause non-doping athletes to exceed set limits.

types of warm-up

• General: Involves movements or exercises unrelated to specific performance.

• Specific: Utilizes big-muscle, rhythmic movements related to the anticipated activity.

purpose of warm-up

• Injury Prevention: Believed to reduce the risk of injury during intense activity.

• Psychological Benefit: Establishes a mental readiness for maximal performance.