Effects of Performance Enhancing Drugs

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Introduction

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.

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.
• 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.

Below there are additional links to pages regarding the influence certain drugs and performance enhancers can have on an individual and the exercise process.

The influence of human growth hormone (HGH) on physiologic processes and exercise

The influence of alcohol on physiologic processes and exercise

The influence of methampetamine on physiologic processes and exercise 

The Influence of NSAIDs on Physiologic Processes and Exercise

The influence of smoking on physiologic processes and exercise

ADHD Medications

As the number of people receiving medication for ADHD is ever expanding, it is becoming exceedingly important to understand how these medications affect the body during exercise. Currently the most common forms of medication used to tread ADHD symptoms are stimulants. These stimulants are often classified as either amphetamine stimulants (i.e. Adderall) or methylphenidate stimulants (i.e. Ritalin). Stimulants increase the levels of some neurotransmitters in the brain by inhibiting them from being reabsorbed. The increase in the level of neurotransmitters, especially dopamine and norepinephrine, helps control ADHD symptoms by temporarily improving focus and other cognitive functions.

ADHD medications, especially those consisting of methylphenidate (MP) have been known to suppress appetite. Studies have shown that women may experience a more suppressed appetite than men while taking MP, especially obese women . Those taking MP stimulants may  experience a higher resting heart rate and a higher average heart rate during physical activity . However, due to the neurological effects of MP, the increase in heart rate may not be percieved during exercise, which can lead to cardiac episodes, including cardiac arrest . 

Analgesic Medication

Analgesic medication is a category of drug that is meant to cause the cessation of pain within an individual. Because of the effect that analgesic have on the body, these types of medication are more commonly referred to as painkillers. They can come in both prescription form and over the counter form, and are typically used by individuals who have experienced some type of injury or who suffer from painful diseases.

As with all medication, there are positives and negatives associated with usage of analgesic medications. One study set out to determine the effects of opioid usage on activities of daily living (ADL). The medication used in the study was the buprenorphine transdermal delivery system (BTSD), and this medication was evaluated for its effectiveness in helping patients with chronic low back pain (CLBP) perform ADL’s. The results showed that those individuals with CLBP who wore the BTSD patch experienced a reduction in pain and a significant improvement in abilities to carry out ADL’s . The BTSD could benefit those who wish to implement a strengthening or stretching regime because it ultimately reduces pain and allows increased participation in ADL’s.

 Analgesic medications can also have a potential effect on an individual's pulmonary system. One study found that methadone used as an analgesic in a clinical setting resulted in significantly increased hypoxic ventilatory response compared with similar patients who did not receive  methadone treatment . Hypoxic ventilatory response occurs when a lack of oxygen results in the respiratory system increasing ventilation. The study concluded that respiratory rate was responsible for the change in the ventilation response because the subject's tidal volume did not increase . Height, weight, age, and use of other medications were all taken into account in the study and there was still a significant difference in respiratory rate, but an exact cause of this increase could not be determined .

Analgesic medications can have effects that are not immediately noticed. One analgesic drug in particular, morphine, has latent effects on ventilation. Researchers found that even though morphine may seem to have waned its effect on the blood stream, it can still linger and compromise the ventilatory processes. Specifically, even after the arterial blood-gas chemistry eventually reaches stability, morphine can inhibit minute ventilation and negatively alter ventilatory responses, especially in cases where oxygen or carbon dioxide levels change drastically . These effects can be devastating for a patient undergoing a rigorous exercise regimen and at potential risk for either hypoxia or hypercapnia.

Athletes often take analgesic drugs to relieve soreness after exercise. A couple common analgesic drugs that can be found over-the-counter and are taken post-exercise are ibuprofen and acetaminophen. Although these drugs have been suggested to relieve muscle soreness after exercise, they may have negative physiological effects as well. Typically, after exercise, muscle protein synthesis increases, leading to hypertrophy of the involved muscles. In a study done by Trappe, White, Lambert, Cesar, Hellerstein, and Evans (2002), subjects who had consumed ibuprofen and acetaminophen post-exercise actually experienced weakened protein synthesis. These results suggest that long-term use of analgesic medications such as ibuprofen and acetaminophen may actually decrease the typical hypertrophy that follows eccentric training. Therefore, if an athlete is trying to build muscle, they may not benefit from taking analgesic drugs often.

Another important and less well-known physiological effect of analgesic medication on the body is that on the kidneys. Farquhar, Morgan, Zambraski, and Kenney (1999) suggested that it is safer to consume acetaminophen than ibuprofen because it has less severe renal effects. In individuals who had recently exercised, ibuprofen was more likely to decline renal function. These findings suggest that it may not be safe to consume certain analgesic drugs during exercise in order to maintain the function of the kidneys so that an individual may avoid dehydration during exercise.
Marijuana

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. 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. In terms of the cardiovascular system, marijuana has been shown to increase heart rate and blood pressure while decreasing overall cardiac output. 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.

Tetrahydrocannabinol is the primary constituent of marijuana that binds to G-Protein-Coupled CB1 receptors which are found throughout the brain in the frontal and medial temporal lobe. Marijuana is one of the most frequently used drugs among young adults. Marijuana induces tachycardia which can decrease the maximal work capacity after smoking this drug.  Marijuana creates an increase in carboxyhemoglobin concentration of blood due to large amount of carbon monoxide created from the smoking of this drug.  Some other factors that could affect the maximal work capacity after smoking marijuana are bronchodilation, decrease in perception of dyspnea, and increase blood flow to exercising muscles. The utilization of marijuana with exercise has a negative correlation that affects their overall health greatly. 

Marijuana use has both acute and prolongued effects on the cardiovascular system, drastically altering the normal functioning of the entire system. The initial intake of THC increases heart rate, causes hypertension during sitting, and hypotension whilst standing. In addition, there are potential risks of orthostatic hypotention and dizziness that can come with frequent marijuana use. Concerns over the decrease in blood pressure and quick loss of mental orientation should be brought to the attention of physical therapists during evaluation and treatment of patients using recreational marijuana. The influence of marijuana would affect how a patient responds to stardard examinations and exercise during treatment. Prolongued effects of frequent marijuana use could have more adverse effects as tolerance level is increased including alterations to the plasma volume.

Marijuana also has its effects on the pulmonary system. Specifically, research has shown there to be a high association between marijuana use and certain respiratory issues, such as coughing and wheezing. In addition, the drug causes inflammation, bronchodilation, and diffusion impairment. These conditions would have a negative impact on a person's ability to adhere to a rigorous exercise routine. Diffusion impairment would especially affect the amount of oxygen successfully entering the alveoli of the lungs, decreasing the amount of oxygen available for use during stenuous activity. Therefore, physical therapists should take extra precautions and plan exercise treatment accordingly as to prevent overexertion and fatigue.

Muscle Relaxants

Muscle relaxers are a class of drug that effectively decreases skeletal muscle function which in turn produces a tranquilizing effect. Botulinum toxin type-A (BoNT-A) is one type of muscle relaxer that could be commonly seen within a rehabilitation type setting. Research has shown that BoNT-A injections can produce positive outcomes when it comes to controlling spasticity and muscle tone. When considering the effects of exercise and BoNT-A, children who have cerebral palsy (CP) are a good target population to consider given the spasticity that often accompanies the disease. Research has shown that children who receive BoNT-A injections and strength training programs show both an increase in muscle volume as well as a rise in strength . The timing of the injections in relation to strength training did not seem to be a factor in strength improvement, and overall children with CP who received this injection had positive outcomes in their functional ability . This is clinically significant because therapists will be able to increase strength in areas that may be contracted with the assistance of BoNT-A injections.

Another Study looked at the effects of BoNT-A injections for treating spasticity in individuals who had suffered a stroke. As one could imagine, spasticity in the lower extremities can have detrimental effects on an individual’s ability to walk, and this can directly influence their ability to ambulate and gain back independence in life. Many individuals who have been affected by a stroke will have BoNT-A injections to reduce spasticity, but do not include therapeutic activities to either increase strength or function. The results of this study show that those who receive BoNT-A injections and a self-rehabilitation program improve their maximal gait speed, distance covered and max speed during 6MWT-modifeid (6 minute walk test), and time taken to go up or down a flight of stairs in comparison to those who only receive the injections. This research shows that a home stretching and strengthening program can help prevent muscle wasting, and can also improve gait patterns which will then increase an individual's ability to move around independently.