Clean Sport For Masters Athletes

March 23rd

“It is a sad commentary on human nature and society that so much effort is spent trying to detect and deter drug abuse among athletes. But a big-money, winning-is-everything mentality grips much of our social life. Since sport mirrors society, the field of competition is a stage where athletes enact social values. And if winning is everything, some athletes may try anything to win."

R.E. Eichner (1997, p.70)

World Anti-doping Association (WADA) Prohibited List 1

The WADA Prohibited List may include any substance and methods that satisfy any two of the following three criteria:

1. It has the potential to enhance or does enhance sport performance

2. It represents an actual or potential health risk to the athlete

3. It violates the spirit of sport (this definition is outlined in the Code).

Substances or methods which mask the effect or detection of prohibited substances are also prohibited. In addition, a substance which has not been approved for human use is likely to be prohibited as well.

World Anti-doping Association (WADA) Prohibited List 2

The Prohibited List is reviewed annually in consultation with scientific, medical and anti-doping experts to ensure it reflects current medical and scientific evidence and doping practices. The Prohibited List comes into effect on January Ist of each year and is published by WADA three months prior to coming into force; however, in exceptional circumstances, a substance may be added to the Prohibited List at any time.

Masters Athletes

• Aging typically = Decrease in lean muscle mass

• Masters Athlete:

• IMGA (International Masters Games Association) - founded 1995

• Masters-Level Athletics Participants compete in 5-year age brackets

• Challenge – many seniors on prescription medications

• Most meds are not banned substances, but some have ingredients that are.

Masters Athletes

• Aging typically = Decrease in lean muscle mass

• Masters Athlete:

  • typically older than 35

  • train and involved in athletic competition for older adults

  • many are experienced athletes

  • Age depends on sport

    • 25 swimming

    • 30 track and field

    • 35 weight lifting

    • 40 long distance running

    • 50 senior games

• IMGA (International Masters Games Association) - founded 1995

  • Recognized by IOC

  • Organizes:

    • World Masters Games

    • Winter World Masters Games

    • European Masters Games

    • Pan-American Masters Games

    • Asia-Pacific Masters Games

• Masters-Level Athletics Participants compete in 5-year age brackets

  • 35-39; 40-44; 45-49; 50-54; 55-59; etc.

• Challenge – many seniors on prescription medications

  • 65.7% of seniors prescribed 5 or more drug classes

  • 26.5% of seniors prescribed 10 or more drug classes

  • 8.4% of seniors prescribed 15 or more drug classes

• Most meds are not banned substances, but some have ingredients that are.

Aging typically

Decrease in lean muscle mass

Masters Athlete:

• typically older than 35

• train and involved in athletic competition for older adults

• many are experienced athletes

• Age depends on sport

Age depends on sport (masters)

• 25 swimming

• 30 track and field

• 35 weight lifting

• 40 long distance running

• 50 senior games

IMGA

(International Masters Games Association) - founded 1995

• Recognized by IOC

Organizes (IMGA)

• World Masters Games

• Winter World Masters Games

• European Masters Games

• Pan-American Masters Games

• Asia-Pacific Masters Games

Masters-Level Athletics Participants compete

in 5-year age brackets

• 35-39; 40-44; 45-49; 50-54; 55-59; etc.

Challenge (Masters athletes)

many seniors on prescription medications

• 65.7% of seniors prescribed 5 or more drug classes

• 26.5% of seniors prescribed 10 or more drug classes

• 8.4% of seniors prescribed 15 or more drug classes

Hormones

• Hormone replacement therapy (HRT)

• Human Growth Hormone (HGH)

Hormone replacement therapy (HRT)

• Estrogen (help menopause)

• Testosterone (help andropause)

Human Growth Hormone (HGH)

Controversial (harms vs benefits)

Estrogen

• With menopause

• Estrogen Combats

With menopause (Estrogen)

• Less estrogen

• Menstrual cycle ceases

Estrogen Combats (Estrogen)

• Vaginal dryness

• Night sweats

• Hot flashes

• Insomnia

• Difficulty concentrating

Testosterone

Declines with age (serum testosterone)

• Changes in:

  • Lean muscle mass

  • Muscle strength

  • Physical function

  • Exercise performance

Testosterone (age)

Changes in:

• Lean muscle mass

• Muscle strength

• Physical function

• Exercise performance

Human Growth Hormone (HGH)

• Exercise stimulates GH

• Response to that GH decreases over time

• Secreted by the pituitary

• Stimulates liver and other tissues to make IGF-1

  • Promotes bone growth

  • Promotes muscle growth

  • Reduces body fat (lipolytic)

• Detriments: cardiac instability, hypertension, insulin resistance

(HGH) stimulates liver and other tissues to make IGF-1

• Promotes bone growth

• Promotes muscle growth

• Reduces body fat (lipolytic)

Anabolic Steroids

• Derivatives of testosterone

• Enhance athletic performance

• Needed for asthma and rheumatologic conditions

• Serious side effects

• Athletes should be counselled on prevention

Anabolic Steroids - Enhance athletic performance

• Strength gains of 5-20%

• Increase lean body mass 2-5kg

Anabolic steroids - Serious side effects:

• Unhealthy cholesterol profile (increase overall, decrease HDL); Heart Attack (from BP and atherosclerosis); stroke; blood clots; liver failure; hepatic neoplasms; ligament/tendon injury; hairloss, acne

• Psychological side effects: aggression; confusion; disordered sleep; anxiety; paranoia; hallucinations

Anabolic steroids - Psychological side effects

aggression; confusion; disordered sleep; anxiety; paranoia; hallucinations

Male specific side effects - Anabolic steroids

atrophy of the testes, decreased sperm production, erectile dysfunction, gynecomastia, prostate issues

Female specific side effects - Anabolic steroids

inhibition of ovulation, irregular menstrual cycle, lower voice, facial hair, breast atrophy

Analgesics & Anti-Inflammatories

Wanting to compete “Pain Free”; pain is very common after 50

• Narcotic Analgesics (opioids)

• Adverse effects: drowsiness, mental fog, nausea, vomiting, dizziness, constipation, trouble with urination

• High doses: respiratory depression, apnea, circulatory depression, hypotension (low BP), muscle rigidity, coma, shock, cardiac arrest

• Non-Steroidal Anti-Inflammatories (NSAIDS)

Narcotic Analgesics (opioids)

• Euphoria; false feeling of invincibility

• Increase pain threshold – may ignore early warning of injury (more damage)

• Physical and psychological dependence

Adverse effects: (Analgesics & Anti-Inflammatories)

drowsiness, mental fog, nausea, vomiting, dizziness, constipation, trouble with urination

High doses: (Analgesics & Anti-Inflammatories)

respiratory depression, apnea, circulatory depression, hypotension (low BP), muscle rigidity, coma, shock,

cardiac arrest.

Non-Steroidal Anti-Inflammatories (NSAIDS) {Analgesics & Anti-Inflammatories}

• Useful for mild to moderate pain and inflammation

• Commonly used for DJD and OA

• Available OTC

• Complications/toxicity: GI bleeding, dyspepsia, peptic ulcer disease, acute renal failure (due to renal vasoconstriction), worsening of hypertension, and congestive heart failure

NSAIDs and COX-2 Inhibitors

Adverse effects of nonsteroidal anti-inflammatory drugs

Hypertension Medications

• Common in general population

• Often not as big a problem for endurance athletes (exercise keeps blood pressure down)

Exercise and sport participation in athletes and other physically active persons with hypertension

Recommendations on exercise restrictions

Diuretics

• Less desirable in distance athletes – dehydration

• Effective way to lower HBP

• Misuse – forces weightloss (used for making weightclass)

• Can lead to muscle cramps

Angiotensin Converting Enzyme Inhibitor (ACE)

• High blood pressure medication

• No negative effect on training or competition

• Sanctioned by WADA

Calcium Channel Blockers

• Well tolerated for physically active patients

• Effective blood pressure medication

• Should not impact performance

Beta Blockers

• Decreases BP

• Can inhibit Glycogenolysis (causing hypoglycemia post intense exercise)

• Anti-tremor effects – banned in high accuracy sports

  • Archery, shooting, diving, ice skating

Eryhthropoietin

• “Blood Doping”

• Increase oxygen carrying capacity

• Popular for endurance athletes

• Increased risk of MI or stroke

Dietary Supplementation and Ergogenic Aid

• The changing needs that occur with age

• The changing needs that occur with exercise

• The presence of chronic illness or disease

• The level of competition

Consequently supplements may

• Intentionally contain prohibited substances

• Unintentionally be contaminated with prohibited substances (eg. contaminated source ingredients, erroneous source ingredients, cross-contamination during manufacturing)

• Be mislabeled

additionally, supplements may:

• Not accurately list the ingredients (eg. falsify, omit)

• Not accurately list the relative amounts of each ingredient per dose

• Make false certification claims (e.g., "WADA-approved")

• Make false health benefit claims

• Not list important cautionary information (eg, health side effects)

Alcohol

• Inhibits Antidiuretic Hormone (ADH) and is therefore a diuretic

• Post exercise exacerbates fluid loss

• May limit glycogen replenishment

  • So fatigue and dehydration may occur during subsequent exercise bout

• Increased blood pressure, and heart rate.

Cannabis

• Under review

• Little is known

• Possibly pain relief?

• On WADA prohibited list since 1984 (still there for THC)

• CBD (non psychoactive) no longer prohibited since 2018

Caffeine

• Most frequently used drug in the world

• CNS stimulation

• Enhanced muscular force (strength and endurance), concentration, energy levels, less reported fatigue, enhanced alertness

• No negative performance effects

• Increased time to exhaustion

• For doses exceeding 200mg

• Removed from WADA Prohibited list in 2007

• Can lead to insomnia, increase BP, HR

Creatine

• Taken to “bulk up” muscle mass

• Increase strength and mass, explosive power

• Decrease fatigue

• Not banned, may impact renal health

Energy metabolism

The production of energy in the body

Glucosamine

• To minimize joint degeneration

• Retain hyalin cartilage

Summary

Every health professional working with older competitive athletes should, at a minimum, be familiar with the following facts:

• Drug use and abuse is a major problem facing sport today.

• Taking performance-enhancing drugs, or "doping," has a long history in sport.

• The elderly athlete has certain elevated nutritional needs compared to younger athletes.

• Estrogen in women may prevent osteo-porosis, maintain physical vitality, treat postmenopausal symptoms, and reduce depression —but certain HRT drugs are banned.

• High doses of testosterone, especially when combined with strength training, increase fat-free mass, muscle size, and strength in men.

• Performance-enhancing drugs can have a deleterious effect on the prostate.

• Anabolic steroids can cause an unhealthy cholesterol profile, heart attack, stroke, liver failure, and type 2 diabetes.

• HGH can cause hypertension, pedal edema, carpal tunnel syndrome, and a prediabetic condition.

• Caffeine causes increased alertness, shortened reaction time, and improved concentration.

• Older athletes do not respond to creatine supplementation to the same extent as young athletes.