Effects of Performance Enhancing Drugs: Difference between revisions

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== ADHD Medications ==


== Alcohol  ==
== Introduction ==
[[File:Body Builder.jpg|right|frameless|512x512px]]
Numerous ergogenic aids that claim to enhance sports performance are used by amateur and professional athletes. Approximately 50 percent of the general population have reported taking some form of dietary supplements, while 76 to 100 percent of athletes in some sports are reported to use them.


Alcohol is a mind-altering drug that reduces thinking ability, distorts judgment, and acts as a depressant on the body. Research has suggested that alcohol leads to increased dopamine release in the human brain, bringing on feelings of relaxation and happiness.<ref>Boileau I, Assaad J, Pihl R, Benkelfat C, Leyton M, Diksic M, et al. Alcohol promotes dopamine release in the human nucleus accumbens. Synapse 2003;49:226-31. http://www.readcube.com/articles/10.1002%2Fsyn.10226?r3_referer=wol&amp;amp;amp;tracking_action=preview_click&amp;amp;amp;show_checkout=1&amp;amp;amp;purchase_site_license=LICENSE_DENIED_NO_CUSTOMER (accessed 15 Sep 2015).</ref>&nbsp;Although this drug is often used during recreation for the purpose of feeling good, it should not be used in combination with exercise because of the serious negative physiological effects that it has on the body.  
Performance- Enhancing Drugs (PEDs) are pharmacologic agents that athletes and nonathlete weightlifters use to enhance performance <ref>Pope Jr HG, Wood RI, Rogol A, Nyberg F, Bowers L, Bhasin S. Adverse health consequences of performance-enhancing drugs: an Endocrine Society scientific statement. Endocrine reviews. 2014 Jun 1;35(3):341-75.


One of the most easily observable effects of alcohol on the body is dehydration. When alcohol is consumed, anti-diuretic hormone (ADH) is inhibited, causing less water to be absorbed back into the nephrons in the kidneys when urine is cycling through. This causes urine levels to increase, in turn increasing the frequency of urination. With higher levels of water exiting the body, dehydration is likely to occur. This is especially a problem during exercise, when the body is expelling water in the form of sweat as well. It is important to be fully hydrated for a workout; therefore it is dangerous to consume alcohol before or during exercise. Research has suggested that beverages containing up to 4% alcohol can delay the recovery process from dehydration to rehydration. <ref>Shirreffs S, Maughan R. Restoration of fluid balance after exercise-induced dehydration: Effects of alcohol consumption. Journal of Applied Physiology 1997;83:1152-8. http://jap.physiology.org/content/83/4/1152 (accessed 15 Sep 2015).</ref>&nbsp;Alcohol not only leads to dehydration; it also prevents humans from reaching rehydration in a timely manner, which could be deadly in a situation regarding exercise.
</ref>  


Another important physiological effect that alcohol has on the body deals with blood pressure. Alcohol consumption increases blood and plasma volume, which in turn increases blood pressure. Exercise has a similar effect; the sympathetic immune system is stimulated, leading to vasoconstriction and ultimately increasing blood pressure. To practice safe exercise, it is important not to elevate blood pressure too high beforehand. Research has recommended that alcohol consumption be reduced in order to maintain healthy and safe blood pressure levels.<ref>Xin X, He J, Frontini M, Ogden L, Motsamai O, Whelton P. Effects of alcohol reduction on blood pressure: A meta-analysis of randomized controlled trials. Hypertension 2001; 38:1112-7. http://hyper.ahajournals.org/content/38/5/1112.long (accessed 15 Sep 2015).</ref> Likewise, it is unsafe to consume alcohol before or during exercise because blood pressure levels may rise to dangerous levels.  
Physicians can evaluate these products by examining four factors (method of action, available research, adverse effects, legality) that will help them counsel patients.  


Perhaps the most important physiological effect that alcohol has on the body is that which concerns the heart. Research has shown that intoxication by alcohol directly relates to impairment of cardiac contractility. Depending on how much alcohol was consumed, cardiac contractility was impaired at varying levels; a lighter intoxication lead to less impairment while a heavier intoxication lead to greater impairment.<ref>Kelbaek H, Gjørup T, Brynjolf I, Christensen N, Godtfredsen J. Acute effects of alcohol on left ventricular function in healthy subjects at rest and during upright exercise. The American Journal of Cardiology 1985;55:164-7. http://www.sciencedirect.com/science/article/pii/0002914985903200 (accessed 15 Sep 2015).</ref>&nbsp;Exercise causes heart rate to increase, requiring a great deal of cardiac contractility. If the heart is impaired by because of alcohol intoxication, blood may not be pumped sufficiently throughout the body during exercise. Therefore, if a person plans on exercising, they should either drink lightly or not at all in an attempt to keep their heart working properly.
Common ergogenic aids include
* [[The influence of anabolic steroids on physiologic processes and exercise|Anabolic steroids]], which increase [[muscle]] mass. These illegal supplements are associated with a number of serious adverse effects, some irreversible. They represent one of the oldest classes of drugs of abuse and, accordingly, their effects have been most extensively investigated. When combined with exercise training, AASs increase muscle mass and strength and reduce fat <ref name=":0">La Gerche A, Brosnan MJ. Cardiovascular effects of performance-enhancing drugs. Circulation. 2017 Jan 3;135(1):89-99.</ref>  .
* [[Creatine and Exercise|Creatine]] modestly improves athletic performance and appears to be relatively safe.
* Dehydroepiandrosterone and androstenedione do not improve athletic performance but apparently have similar adverse effects as testosterone and are also banned by some sports organizations.
* [[Caffeine and Exercise|Caffeine]] has mild benefits and side effects and is banned above certain levels. Products that combine caffeine with other stimulants (e.g., ephedrine) have been linked to fatal events.
* [[Exercise and Protein Supplements|Protein and carbohydrate]] supplementation provides modest benefits with no major adverse effects<ref>Ahrendt DM. Ergogenic aids: counseling the athlete. American Family Physician. 2001 Mar 1;63(5):913.</ref>.
Below there are additional links to pages (see also those above) regarding the influence certain drugs and performance enhancers can have on an individual and the exercise process.<ref>Burke LM, Castell LM, Stear SJ. BJSM reviews: A–Z of supplements: dietary supplements, sports nutrition foods and ergogenic aids for health and performance Part 1.</ref>


== Anabolic Steroids  ==
== Side effects of PEDs ==


Anabolic steroids are drugs that have many neuropsychiatric effects in addition to the more commonly known effects they have on skeletal muscles. Anabolic steroids cause not only negative feelings like intense anger, but also some positive moods. Some of the negative feelings people have resulting from the use of anabolic steroids include irritability, mood swings, violent feelings, anger, and hostility <ref name="Su et al.">Su, T., Pagliaro, M., Schmidt, P., Pickar, D., Wolkowitz, O., &amp; Rubinow, D. Neuropsychiatric effects of anabolic steroids in male normal volunteers. JAMA The Journal of the American Medical Association 1993;269:2760-4. http://ovidsp.tx.ovid.com.ezproxy.lib.ou.edu/sp-3.16.0b/ovidweb (accessed 22 Sept 2015).</ref>. Among the positive feelings related to steroid use include euphoria, increased energy, and sexual arousal <ref name="Su et al." />. Steroids are also linked to other cognitive symptoms like distractibility, forgetfulness, and confusion&nbsp;<ref name="Su et al." />. All of these effects result from steroid use alone, without exercise. These impacts on mood could have either positive or negative effects on exercise, depending on feelings of the person exercising.
# Direct Effects: [[Hypertension]], Dyslidipemia, Myocyte Hypertrophy, Interstitial Fibrosis <ref name=":0" />
# Indirect Effects: Extreme cardiac remodelling, Exercise-Induded cardiac injuy, Interstitial fibrosis <ref name=":0" />


== Analgesic Medication  ==
== Clinical Consequences ==


== Caffeine/Stimulants  ==
* Increased risk of arrhythmias
* [[Heart Failure|Heart failure]]
* Sudden cardiac death


== Creatine  ==
== Additional Reads ==


== Human Growth Hormone (HGH) ==
* [[The influence of human growth hormone (HGH) on physiologic processes and exercise]]


== Marijuana  ==
*[[The influence of anabolic steroids on physiologic processes and exercise]]
 
*[[The influence of alcohol on physiologic processes and exercise]]
Marijuana use affects various physiologic processes through its most active substance, tetrahydrocannabinol, otherwise known as THC. Marijuana use has a direct effect on the central nervous system because it contains the receptor sites for THC<ref name="Pesta et al.">Pesta, D. H., Angadi, S. S., Burtscher, M., &amp; Roberts, C. K. (2013). The
*[[Methamphetamine and Exercise|The influence of methampetamine on physiologic processes and exercise]]
effects of caffeine, nicotine, ethanol, and tetrahydrocannabinol on exercise performance. Nutrition &amp; Metabolism 2013;10:71. http://www.nutritionandmetabolism.com/content/10/1/71 (accessed 4 Oct 2015).</ref>. Although marijuana does possess some ergogenic effects in certain situations, it impacts the body oppositely during exercise. The drug has a sedative effect during exercise, resulting in decreased exercise and psychomotor performance like slower reaction time<ref name="Pesta et al." />. In terms of the cardiovascular system, marijuana has been shown to increase heart rate and blood pressure while decreasing overall cardiac output<ref name="Pesta et al." />. This is important for clinicians to consider when treating patients who use marijuana, as it is an ergolytic drug when used in combination with exercise that will negatively affect the patient’s exercise performance and overall health.
*[[The Influence of NSAIDs on Physiologic Processes and Exercise]]
 
*[[Smoking and Exercise|The influence of smoking on physiologic processes and exercise]]
== Methamphetamine ==
*[[Analgesic Medication and Exercise|The influence of analgesic medication on physiologic processes and exercise]]
 
*[[The influence of marijuana on physiologic processes and exercise]]
Amphetamines are a group of drugs with mind-altering capabilites. Methamphetamines are the most potent of the amphetamine group of drugs.&nbsp;<ref name="McAvoy">McAvoy, B. Methamphetamine -- what primary care practitioners need to know. J Primary Health Care. 2009;1(3): 170-176.</ref>&nbsp;Methamphetamine falls under the classification of a stimulant. Typically, stimulants will increases and individuals sensations such as mental awareness while also increasing one's ability to respond to the environment<ref name="NIH">National Institute on Drug Abuse. Prescription drug abuse. United States: NIH, 2014.</ref>. Users of stimulants may also find an increase in energy levels. The effects that users feel while on methamphetamine (METH) causes this drug to be highly addictive. The physiological effect of METH is achieved by increasing the quantitiy and release of stimulatory neurotransmitters dopamine, noradrenaline and serotonin and decreasing their synaptic breakdown.&nbsp;<ref name="McAvoy" />&nbsp;<br>
*[[The influence of ADHD medication on physiologic processes and exercise]]
 
*[[The influence of muscle relaxers on physiologic processes and exercise]]
A primary clinical consideration for methamphetamine is its use with other medications. Acute use of METH with other stimulants can overstimulate the sympathetic nervous system, potenitally resulting in cardiac arrythmia, seizures, cardiovascular collapse, and death.&nbsp;<ref name="McAvoy" />&nbsp;Therefore, physical therapists should take special consideration when prescribing exercise to patients who present with signs suggestive of use. Characteristic presentation of METH use includes restlessness, weight loss, heightened alertness, violent behavior, and pupillary dilation.&nbsp;<ref name="McAvoy" />&nbsp;<br>
 
An acute response to METH use is hyperthermia.&nbsp;<ref name="Matsumoto">Matsumoto R, Seminerio M, Turner R, Robson M, Nguyen L, Miller D, O'Callaghan J. Methamphetamine-induced toxicity: an updated review on issues related to hyperthermia. Pharmacology &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp; Therapeutics; 144: 28-40.</ref>&nbsp;Although the exact mechanism though which this is achieved is unknown, literature suggests that methamphetamine-induced hyperthermia results from heat generation as well as an inhibition in heat loss.&nbsp;<ref name="Matsumoto" />&nbsp;One study conducted in 2009 aimed to explore the effects of brain hyperthermia brought on by METH. The reaserachers of this study injected rodents with differing amounts of METH, and then proceeded to measure how dosages and enviromental factors impacted brain hyperthermia <ref name="Kiy">Kiyatkin EA, Sharma HS. Acute methamphetamine intoxication: Brain hyperthermia, blood-brain barrier and brain edema. International Review of Neurobiology 2009; 88: 65–100.</ref>. METH, especially in large doses, influences the metabolic activity of the brain due to oxidative stress which is what occurs when the body is unable to rid itself of free radicals at a rate to maintain a homeostatic balance&nbsp;<ref name="Kiy" />. Temperatures inside of the brain also increase due to "enhanced release of meluiple neuroactive substance, lipid peroxidation.... and numerous changes combined as oxidative stress" <ref name="Kiy" />. Increases in the metabolic brain activation paried with internal head production by the brain cells seem to be the driving force behind brain hyperthermia&nbsp;<ref name="Kiy" />.&nbsp;Ingesting METH at increased tempertures or during social gatherings when an individual is more likely to be active such as with exercise only exacerbates this increase in core body temperture. Even slight increases in cell tempertures can cause denaturation, which can then lead to impaired cell function or ultimately death of the cell.
 
Thus, combining therapeutic exercise when an individual is experiencing methamphetamine-induced hyperthermia could result in serious harm. The current practice for cooling methamphetamine-induced hyperthermia is placing the individual in a cool environment to try to bring that person back into a homeostatic balance&nbsp;<ref name="Matsumoto" />.<br>
 
Chronic METH use results in a range of physiologic disturbances. An adaptation with the greatest relevance to physical therapists is the presence of congestive heart failure in chronic users.&nbsp;<ref name="Wijetunga">Wijetunga M, Seto T, Lindsay J, Schatz I. Crystal methamphetamine-associated cardiomyopathy: tip of the iceberg? J Toxicology; 41: 981-986</ref>&nbsp;Impaired oxygen delivery to tissues would result in an inability to safely engage in treatment on the part of the patient.&nbsp;Moreover, attempting to engage in such an activtiy could result in cardiogenic shock. If the practitioner engages the patient in these activities without knowing about METH use, the outcome could be fatal.&nbsp;Another clinical implication is that chronic METH use can break down the blood-brain barrier (BBB) over time, and it has been shown that increased permeability in the BBB can lead to damage of myelin <ref name="Kiy" />. Without myelin, the nervous system is unable to communicate effectively to different systems, including muscular, which could have an impact on exercise prescriptions and individual expectations.
 
== Muscle Relaxants  ==
 
== Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)  ==
 
== Smoking<br>  ==
 
Aerobic exercise challenges the body's ability to supply and handle oxygen. For example, when performing high-intensity aerobic exercise, mitochondrial reactice oxygen species' (ROS) grow in number.&nbsp;<span style="line-height: 1.5em;">ROS, is left unchecked, have have the ability to cause genetic mutations.&nbsp;</span><span style="line-height: 1.5em;">However, several enzymes -- including superoxide dismutase -- are present to handle this oxidatve stress caused by ROS.The body responds to chronic aerobic exercise by enhancing its ability to cope with ROS.</span><span style="line-height: 1.5em;">&nbsp;</span><ref name="Vollaard">Vollaard, NB, Shearman, JP, Cooper, CE Exercise-induced oxidative stress. Sports Med 2005; 35: 1045-1062</ref><span style="line-height: 1.5em;">&nbsp;</span>
 
<span style="line-height: 1.5em;">Smoking also induces an oxidative stress; however, smoking-induced oxidative stress also inhibits the body's abiltiy to cope by suppressing the genes responsible for antioxidant production.&nbsp;<ref name="Garbin">Garbin U, Pasini AF, Stranieri C, Cominacini M, Pasini A, Manfro S, et al. Cigarette smoking blocks the protective expression of Nrf2/ARE pathway in peripheral mononuclear cells of young heavy smokers favouring inflammation. PLoS ONE 2009; 4: 1-12</ref>&nbsp;The net result of smoking-induced oxidative stress is vascular and arteriolar inflammation -- further impairing the oxygen-delivering capabilties of the body.&nbsp;<ref name="Garbin" />&nbsp;Clearly, by limiting oxygen delivery, cigarette smoking impairs the ability to generate energy through the oxidative energy system. However, literature also suggests that smoking impairs anaerobic energy provision by altering contractile proteins, creatine kinase, and other glycolytic enzymes.<ref name="Barreiro">Barreiro E, Peinado VI, Galdiz JB, Ferrer E, Marin-Corral J, Sanchez F, et al. Cigarette smoking-induced oxidative stress: A role in chronic obstructive pulmonary disease skeletal muscle dysfunction. Am J Resp Crit Care Med 2010; 182: 477-488</ref> With this in mind, therapists should be weary of setting unrealistic goals for patients who are smokers.&nbsp;</span>
 
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==  ==
 
== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed])  ==
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== References  ==
 
References will automatically be added here, see [[Adding References|adding references tutorial]].


== References ==
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[[Category:Exercise Therapy]]
[[Category:Sports Medicine]]
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Latest revision as of 21:24, 19 February 2023

Original Editor - Josh Williams, Ashley Pittser Lance Ramos Kayla Woods Kyle Culver Jeffrey Jackson Chelsea Miller Alan Tran Madison Kirk Marilyn Kozlowski Eugene DeLoach William Warmka Maddisen Coleman Paul Spann Alyxandria Davis James Williams Hailee Wiese Yen-Oanh Vo Allee Tatum Landon Andrews Kelly Fossard Emily North as part of the University of Oklahoma Exercise Science Project
Top Contributors - Chelsea Miller, Emily North, Kim Jackson, Yen-Oanh Vo, Ashley Pittser, Lance Ramos, Josh Williams, Maddisen Coleman, Lucinda hampton, Hailee Wiese, Eugene DeLoach, Kayla Woods, William Warmka, Jeffrey Jackson, Kirenga Bamurange Liliane, Madison Kirk, Alyxandria Davis, Kelly Fossard, Alan Tran, Kyle Culver, Paul Spann, Marilyn Kozlowski, 127.0.0.1, Allee Tatum, Rucha Gadgil, Oyemi Sillo, James Williams, Kayla Garrett and Landon Andrews


Introduction[edit | edit source]

Body Builder.jpg

Numerous ergogenic aids that claim to enhance sports performance are used by amateur and professional athletes. Approximately 50 percent of the general population have reported taking some form of dietary supplements, while 76 to 100 percent of athletes in some sports are reported to use them.

Performance- Enhancing Drugs (PEDs) are pharmacologic agents that athletes and nonathlete weightlifters use to enhance performance [1]

Physicians can evaluate these products by examining four factors (method of action, available research, adverse effects, legality) that will help them counsel patients.

Common ergogenic aids include

  • Anabolic steroids, which increase muscle mass. These illegal supplements are associated with a number of serious adverse effects, some irreversible. They represent one of the oldest classes of drugs of abuse and, accordingly, their effects have been most extensively investigated. When combined with exercise training, AASs increase muscle mass and strength and reduce fat [2] .
  • Creatine modestly improves athletic performance and appears to be relatively safe.
  • Dehydroepiandrosterone and androstenedione do not improve athletic performance but apparently have similar adverse effects as testosterone and are also banned by some sports organizations.
  • Caffeine has mild benefits and side effects and is banned above certain levels. Products that combine caffeine with other stimulants (e.g., ephedrine) have been linked to fatal events.
  • Protein and carbohydrate supplementation provides modest benefits with no major adverse effects[3].

Below there are additional links to pages (see also those above) regarding the influence certain drugs and performance enhancers can have on an individual and the exercise process.[4]

Side effects of PEDs[edit | edit source]

  1. Direct Effects: Hypertension, Dyslidipemia, Myocyte Hypertrophy, Interstitial Fibrosis [2]
  2. Indirect Effects: Extreme cardiac remodelling, Exercise-Induded cardiac injuy, Interstitial fibrosis [2]

Clinical Consequences[edit | edit source]

Additional Reads[edit | edit source]

References[edit | edit source]

  1. ↑ Pope Jr HG, Wood RI, Rogol A, Nyberg F, Bowers L, Bhasin S. Adverse health consequences of performance-enhancing drugs: an Endocrine Society scientific statement. Endocrine reviews. 2014 Jun 1;35(3):341-75.
  2. ↑ 2.0 2.1 2.2 La Gerche A, Brosnan MJ. Cardiovascular effects of performance-enhancing drugs. Circulation. 2017 Jan 3;135(1):89-99.
  3. ↑ Ahrendt DM. Ergogenic aids: counseling the athlete. American Family Physician. 2001 Mar 1;63(5):913.
  4. ↑ Burke LM, Castell LM, Stear SJ. BJSM reviews: A–Z of supplements: dietary supplements, sports nutrition foods and ergogenic aids for health and performance Part 1.
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