SPORTS MEDICINE
(see also physiology of lungs,
heart,
and skeletal muscles)
: the field of medicine concerned with injuries sustained in athletic endeavors,
including their prevention, diagnosis, and treatment.
Sports medicine now comprises two main areas: the health benefits of
regular physical activity and the health problems associated with sport
and physical activity. The first area has become increasingly important
now that inactivity and obesity are common. The health problems associated
with sport have also assumed increasing importance because of increased
participation and professionalism in sport. One of the most important advances
in medicine is the documentation that regular physical activity reduces
the risk of premature mortality, coronary heart disease, hypertension,
colon cancer, obesity, and diabetes mellitusref.
Recent studies have shown that inactivity and low cardiorespiratory fitness
are as important predictors of mortality and morbidity as overweight, obesity,
smoking, and raised cholesterol levels and blood pressureref1,
ref2,
ref3,
ref4,
ref5,
ref6.
Physical activity also protects against breast cancer, and possibly prostate,
lung, and endometrial cancerref.
Substantial health benefits can be obtained by undertaking a moderate amount
of physical activity on most, if not all, days of the weekref.
Most recommendations suggest moderately intense exercise with large muscle
groupssuch as brisk walkingfor 30 minutes. Recent evidence suggests that
exercise sessions may be split into shorter bouts of 5-10 minutes' duration,
or even shorter bouts if exercise intensity is high enough.
Recent advances :
daily, moderately intense exercise such as walking for 30 minutes yields
substantial health benefits
regular physical activity attenuates the health risks associated with overweight
and obesity
strength training in elderly people prevents bone loss with age and improves
balance, thus reducing the risk of falls and osteoporotic fractures
balance training and bracing and taping of the ankle prevent recurrent
ankle sprain
knee injuries may be prevented by balance training and strength and agility
training
balance training may also prevent injuries to the anterior cruciate ligament,
which are common among female athletes
Most people are capable of this level of physical activity, and expensive
training studios, fashionable tights, and even running shoes are not necessary
to achieve better health. A recent study in previously sedentary healthy
adults showed that a programme incorporating physical activity into the
participants' lifestyle was as effective after two years of follow up as
a structured programme to improve physical activity, cardiorespiratory
fitness, and blood pressureref.
Doctors working in primary care are in a key position to promote this level
of physical activity; practical tools, such as physician based assessment
and counselling for exercise (PACE) (Patrick K, Sallis JF, Long B,
Calfas K, Wooten W, Heath G, et al. A new tool for encouraging activity.
Physician Sportsmed 1994; 22: 45-55), may help them to advise patients
effectively. Body weight has been increasing at an alarming rate worldwide,
mainly as a result of decreasing daily energy demands owing to increased
mechanisation at home and work and during leisure timeref.
Several recent prospective observational studies show that regular physical
activity lowers many of the health risks associated with overweight and
obesityref1,
ref2.
Furthermore, obese people who are active have lower mortality and morbidity
than people whose weight is normal but who are sedentaryref.
This means that for the overweight or obese patient, starting and maintaining
a regular exercise programme yields important health benefits, even in
the absence of substantial weight lossref1,
ref2.
This is encouraging, as maintaining regular physical activity of moderate
intensity may be perceived as more attainable than reducing body weight.
As low functional capacity and a high incidence of chronic disease are
common among elderly people, exercise training should be particularly encouraged
in this populationref.
Advancing age brings progressive loss of muscle strength, muscle mass,
and muscle quality, resulting in a condition known as sarcopeniaref.
Studies in recent years have shown that strength training can reverse the
loss of muscle function and the deterioration of muscle structure associated
with advanced ageref1,
ref2,
ref3.
Strength training improves functional ability and health, not only by increasing
muscle mass, strength, and power, but also by improving bone mineral densityref1,
ref2,
ref3.
Strength training also improves balanceref.
Sarcopenia, osteoporosis, and reduced balance are the main risk factors
for falls and osteoporotic fracturesref1,
ref2.
Strength training may therefore prevent osteoporotic fractures, one of
the main sources of physical disability and obstacles to independent living
among elderly peopleref1,
ref2.
Although exercise has not yet been proved to prevent falls and fractures
in elderly people, epidemiological studies (case-control and prospective
cohort follow up studies) consistently show that both past and current
physical activity do protect against hip fracture, reducing the risk by
up to 50%ref.
Most of the studies on strength training have used high intensity, progressive,
resistance training protocols similar to those used by athletes, focusing
on large muscle groups (hip and knee extensors). Trial subjects have trained
with a resistance of 80% of the maximal load the subject can fully lift
once only, and resistance has been increased as strength improves. For
maximal effect, strength training should be done 3 days a week for at least
3 months. Each muscle group should be exercised in 3 sets of eight repetitions
each session. High intensity strength training can be done at home or in
a group but requires skilled instruction at the start. Regular physical
activity, especially if started in childhood and adolescence, is a cheap,
safe, readily available, and largely acceptable way of improving bone strength
and reducing the propensity to fallref.
Physical activity, including specific strength training for target groups,
should therefore become an essential part of strategies aimed at controlling
the alarming increase in osteoporotic fractures.
The most important factor in creating a champion are :
genetic screening : when East African
runners began competing internationally, for example, it became apparent
that their light frames make them uniquely economical in their use of energy
in 1968, a Kenyan runner named Kip Keino emerged as a shining star of the
Mexico City summer Olympics, setting a world record in the 1500-meter race.
Year after year Keino's success has been followed by equally dazzling feats
by his compatriots: Kenyan men now hold world records in the 3000-meter
track race, the 15-, 20-, and 25-kilometer road races, the half-marathon,
and the marathon. Kenyan men have won 13 of the last 14 Boston marathons.
Kenyan women are also rising fast: they hold half of the top 10 marathon
times and world records in 20-, 25-, and 30-km track races. What is even
more remarkable is that most of these athletes come from a small area in
Kenya's Rift Valley, from a group of tribes called the Kalenjin
who number little more than 3 million people. Altitude is not the key to
the riddle, because there's no difference between Kenyans and Scandinavians
in their capacity to consume oxygen. And the Kenyan diet is on the low
side for essential amino acids and some vitamins as well as fat. The running-to-school
hypothesis was demolished as well: Kenyan children aren't any more physically
active than their Danish peers. Do Kenyans try harder? The researchers
found that the Danes actually pushed themselves harder on a treadmill test,
reaching higher maximum heart rates. An important clue is the ability of
Kenyans to resist fatigue longer. Lactate, generated by tired, oxygen-
deprived muscles, accumulates more slowly in their blood. Comparisons of
lactate levels have suggested that Kenyan runners squeeze about 10% more
mileage from the same oxygen intake than Europeans can. Compared with Danes,
the thinner calves of Kenyans have, on average, 400 grams less flesh in
each lower leg. The farther a weight is from the center of gravity, the
more energy it takes to move it. 50 grams added to the ankle will increase
oxygen consumption by 1%. For the Kenyans, that translates into an 8% energy
savings to run a kilometer. Kenyan runners also have a higher concentration
of an enzyme in skeletal muscle that spurs high lactate turnover and low
lactate production. This results in an "extraordinarily high" capacity
for fatty acid oxidation, which helps wring more energy out of the muscles'
biochemical reactions. Because intense training alters the body's biochemistry,
one can't say for sure whether the ezyme levels are due to genes or training,
but experts think it's genetic. Black South Africans, whose running strengths
are similar to those of Kenyans, have similar VO2 max values
with white runners--that is, when putting out maximum effort, they used
up the same amount of oxygen per kilogram of body weight per minute. But
the black runners were more efficient in their oxygen consumption, lasting
on a treadmill at maximum speed for twice as long as the whites. As with
the Kenyans, the black South African runners accumulated less lactate and
had higher levels of key muscle enzymes. Whereas East Africans dominate
long- distance running, West Africans have surged to the fore in short-distance
events : athletes of primarily West African descent--which includes the
majority of U.S. blacks (e.g. Carl Lewis)--hold all but 6 of the 500 best
times in the 100-meter race. Various studies have shown that West African
athletes have denser bones, less body fat, narrower hips, thicker thighs,
longer legs, and lighter calves than whites. But the differences between
East and West Africans are even more striking. The fabled Kenyan runners
are small, thin, and tend to weigh 50-60 kg, whereas West African athletes
are taller and a good 30 kilograms heavier. West Africans averaged significantly
more fast-twitch muscle fibers--67.5%--than the French Canadians, who averaged
59%. Endurance runners have up to 90% or more slow-twitch fibers. 2 enzymes
that are markers for oxidative metabolism have higher activity in the West
Africans, meaning they could generate more ATP in the absence of oxygen
: in West Africa there may be a larger pool of people with elevated levels
of what it takes to perform anaerobically at very high power output. Although
training can transform superfast-twitch type IIb fibers into the hybrid
type IIa, it is unlikely to cause slow- and fast-twitch fibers to exchange
identities. There is evidence that, with extremely intensive long-distance
training, fast IIa fibers can change to slow type I fibers. So far, however,
there is no evidence that slow-twitch fibers can be turned into fast-twitch
ones. As an athlete puts on muscle mass through training, new fibers are
not created, but existing fibers become bigger. Homozygosity for the less
efficient (X) isoform of a-actinin-3
(ACTN3) (a protein found only in fast-twitch muscle fibers) arising
from a common stop-codon polymorphism (R577X) is found in 18% of the members
of a group of healthy white Caucasians. The absence of a disease phenotype
secondary to a-actinin-3 deficiency is likely
due to compensation by the homologous protein, a-actinin-2
(ACTN2). However, the high degree of evolutionary conservation of ACTN3
suggests function(s) independent of ACTN2. There is a highly significant
associations between ACTN3 genotype and athletic performance. Both male
and female elite sprint athletes have significantly higher frequencies
of the wild-type 577R allele than do controls (only 6% of a group of sprinters
had the 577X SNP). This suggests that the presence of ACTN3 has a beneficial
effect on the function of skeletal muscle in generating forceful contractions
at high velocity, and provides an evolutionary advantage because of increased
sprint performance. There is also a genotype effect in female sprint and
endurance athletes, with higher than expected numbers of 577RX heterozygotes
among sprint athletes and lower than expected numbers among endurance athletes.
The lack of a similar effect in males suggests that the ACTN3 genotype
affects athletic performance differently in males and females. Endurance
runners have 2 copies of ACTN2 gene, expressed exclusively in "slow-twitch"
muscle fibers, and 26% carry the X form of ACTN3 generef.
The less active version, or I allele, of the ACE
gene is associated with less muscle, less fluid retention, and more relaxed
blood vessels--which would enhance oxygen uptake--and appears to be more
prevalent in endurance runners : on the contrary the D isoform is associated
with sprintersref.
Athletes who carry one type of a well-known 'fitness' gene might actually
push themselves so hard that they tire out their hearts. That's the finding
from a study of individuals who competed in one of the most gruelling races
in the world. Exercise experts have long assumed that heart muscles, unlike
those of our legs and arms, don't tire. But a few studies of athletes have
hinted that the heart also gets worn down by many hours of extreme exercise.
Teams of 4 participants of an 'adventure race' that took place in Scotland,
UK battled to run, cycle, kayak, orienteer and swim across some 480 km,
snatching
only a few hours sleep over 90 hours of competition. The researchers offered
the shattered finishers doughnuts as an incentive to take part. The hard-core
exercise did indeed tire out the athletes' hearts, to the point where their
hearts lost around 10% of their ability to pump blood. This is a far greater
drop in performance than that previously observed, after shorter races.
10% could easily be the difference between winning and losing. The hearts
of athletes carrying 2 'endurance' copies of the ACE gene tired out more.
These people's hearts lost around 13% of their power, whereas carriers
of one copy or none lost closer to 8%. People with 2 copies of the endurance
variant may be able to push themselves longer and harder than those with
the other genetic variant, with the result that they tire out their heart.
The drop in heart function does not appear to be damaging, however, because
the group found that the athletes' hearts had returned to normal within
1-2 days. And there was no apparent relationship between heart function
and race times; with all the athletes pushing their entire bodies to a
point of exhaustion, it seems that muscles or lungs could have proven their
limiting factor. Trainers and athletes, particularly in the growing field
of adventure racing, should be aware that their bodies can outstrip their
hearts. In theory, it might even be possible to specifically train heart
muscle, although most exercise does this anyway by getting the heart pumping.
The study may also bear insights for those studying heart disease. During
a condition called atrial fibrillation, for example, the heart can speed
up and eventually tire and weaken. The new results imply that this happens
whenever the heart is over-exerted for too long, and that it may not have
long-lasting repercussions once corrected. Ashley next wants to find out
what causes the heart to tire after being pushed to the edge: a high heart
rate, too much adrenaline, oxygen deprivation or some other explanation?ref.
In < 2 decades, Kenyans came to dominate the top 20 performances in
6 races ranging from 800 m to the marathon :
Web resources : International Centre for
East African Running Science (ICEARS)
long-distance running was crucial in creating our current upright
body form : our early ancestors were good endurance runners, and that their
habit has left its evolutionary mark on our bodies, from our leg joints
right up to our heads. Early humans may have taken up running around 2
million years ago, after our ancestors began standing upright on the African
savannah. As a result, evolution would have favoured certain body characteristics,
such as wide, sturdy knee-joints. The theory may explain why, thousands
of years later, so many people are able to cover the full 42 km of a marathon
and it may provide an answer to the question of why other primates do not
share this ability. Our poor sprinting prowess has given rise to the idea
that our bodies are adapted for walking, not running. Even the fastest
sprinters reach speeds of only about 10 m/s, compared with the 30 m/s of
a cheetah. But over longer distances our performance is much more respectable:
horses galloping long distances average about 6 m/s, which is slower than
a top-class human runner. Our savannah ancestors would have been in competition
with hyenas, who are also good long-distance runners, to get to the site
of a big kill and pick over the remains : you could see a flock of vultures
on the horizon and just take off towards them. Or perhaps early humans
used their endurance simply to chase prey to exhaustion. Not only do we
have springy Achilles tendons and stout leg-joints, our hairlessness and
tendency to sweat make us very good at dissipating heat. Running requires
a lot of delicate coordination: your legs are off the ground and you need
to coordinate your eyes to see where your foot will landref.
Semicircular canals are unusually large in both modern humans and our evolutionary
cousin Homo erectus and this shows that they might have helped primitive
runners stay on their feet. In fact, running seems to be the only reason
that we have prominent buttocks : when humans walk their gluteus maximus
muscles barely fire up, but when they run it goes like billy-o. If the
theory is correct, it means that the genus Homo is unique among
primates in its running ability. But some experts maintain that there is
nothing special about human locomotion, and what separates us from other
apes is simply our outsized brains.
When it comes to athletics, going the distance is not just a matter of
fitness. Researchers have found that there is an ideal
body mass for running at a certain speed, and for a certain distance.
It's common sense that long-distance runners are more lithe than sprinters,
but sports scientists have never before managed to work out how or why
weight relates to event distance. Weyand and Davis argue against the idea
that most of the energy needed for running goes into the effort required
to move and accelerate your limbs. This is an important and somewhat controversial
issue : during steady-speed running on level ground, the body has mechanical
tricks that allow the energy required for swinging and bouncing the limbs
to be recycled from stride to stride. That means our elastic tendons do
most of the work, letting us bounce along once we are up to speed without
requiring much extra energy. Perhaps 90% of work put into our limbs is
conserved this way, Weyand estimates. Instead, most of our energy is spent
pounding the pavement and supporting the weight of the body. There are
no tricks for avoiding gravity. The faster you go, the more energy is spent
hitting the ground. To find the relationship between running speed and
the force needed to support the body, the researchers tested volunteers
on a treadmill. At their personal top speeds both men and women were hitting
the ground with a force of around 2.5 times their own body weight. At lower
speeds, they exerted less forceref.
If running fast requires a more forceful step, the researchers thought,
then you need more muscle, tendon and sinew to support those speeds. But
being too heavy would slow you down, because it takes energy to carry weight
around. This led them to believe that there might be an ideal body mass
for a given speed. The researchers looked at records of élite athletes
from a variety of running events, each of which suits itself to a different
speed. By collecting the heights and weights of the world's 45 fastest
men and women over eight different track distances for the past 14 years,
they uncovered a surprisingly simple relationship between event distance
and a runner's body size. If you are of a similarly athletic frame, you
can find where you lie on this curve, and what your ideal running distance
is. Now look up your BMI on this graph, and read downwards from that point
to find your ideal running distance. Note this is different for men and
women. The graph was compiled using data from athletes, who can attribute
more of their weight to muscle than the average person.
Investigation into the force runners exert on the ground might explain
this curve, with more muscular runners pounding the ground hard for short
sprints and skinny runners having a more gentle step over the long haul.
The research also contributes to ongoing debate about the running ability
of large animals, including dinosaurs. Based on observations of skinny
long-distance runners and the lumbering elephant, scientists have previously
concluded that heaviness of any kind is bad for track times. In 2002, scientists
hit the headlines by suggesting that, at 6,000 kg, Tyrannosaurus rex
would
have been unable to manage more than a brisk walkref.
It may be time for a rethink about the running abilities of larger animals.
Without sufficient musculoskeletal mass, faster running speeds cannot be
attained. Having to carry extra mass is not always a performance detriment.
training :
Roger Bannister, who in 1954 became the first person to run a mile in under
4 minutes - trained for only 35 minutes a day. That's barely considered
a warm up today, when the mile record stands at 3 minutes 43.3 seconds.
video feedback can hep athletes focus their more traditional training
in events such as high-jump and diving
electromyography (EMG)
: the muscle groups coaches had been focusing on for the Maltese cross
- a challenging move on the rings where a gymnast holds his body up in
a horizontal position - were not the ones that the gymnast was actually
using for the trick
many athletes report that training at high altitude helps to boost
endurance. The low-oxygen environment stimulates the body to produce more
RBCs, meaning that more O2 is delivered to muscles. But the
thin air at high altitude makes exercise hard work, so any gains are likely
to be offset by the added physical stress, especially in the case of sprinters
who operate in short, explosive bursts. Trainers are increasingly recommending
the "live high, train low" phylosophy for endurance athletes. Training
at sea levels allows such athletes to exercise hard, while benefiting from
the raised RBC count triggered by their high-altitude lifestyle. Some studies
have shown an increase in the level of haemoglobin found in RBCsref,
whereas other have found no change in blood markers at allref.
If one could look at all the genes that are induced by low oxygen levels
in a big enough pool of athletes, one would learn how to predict which
ones would benefit from altitude training. Eero Mantyranta, the 1964 Finnish
cross-country skiing gold medallist, for example, had a mutation in gene
encoding for EPO, which sports scientists believe accounted for his extraordinary
stamina. What science can bring to the athlete is perhaps 0.1% : 99.9%
is still down to athletes themselves.
technique : Mont Hubbard's Sports Biomechanics
Laboratory on the Davis campus has studied, among other things, the mechanics
of the high jump and the pole vault, the aerodynamics of the discus and
the shot put, the flight of punted footballs, the bend of curveballs, the
flexing of fishing rods and racehorse forelimbs, the swiveling of skateboards,
and the rolling of basketballs around rims. In the 1980s, he developed
a system to help javelin throwers launch their spears at just the right
angles. In the '90s, he built a bobsled simulator for U.S. Olympians. Currently,
Hubbard and his group are analyzing ski jumping, women's gymnastics, trampoline,
bungee jumping, and Frisbee flight. In November 2003, Mont Hubbard and
colleagues argued in the American Journal of Physics that a well-hit curveball
would sail farther than a perfectly struck fastball--even though the curveball
moves slower and packs less energy, both before and after it's walloped.
That's because a batted ball travels farther if it has more backspin to
give it aerodynamic lift. The top-spinning curveball approaches the batter
already turning in a direction that increases the backspin of the batted
ball. On the other hand, the back-spinning fastball comes at the batter
spinning the wrong way, which decreases the backspin of the outgoing orb.
As a result, an optimally struck curveball will travel around 455 feet
(138 meters), about 12 feet (3.5 meters) farther than a well-hit fastball.
But Robert Adair, a physicist at Yale University and author of The Physics
of Baseball, contends that Hubbard and colleagues must have overestimated
the lifting effect of spin. Such ruminations also underscore the appeal
of muscle-building anabolic steroids : once an athlete has perfected a
technique, the only way to throw farther is to boost strength and arm speed--for
some, a pursuit that knows no bounds.
state-of-the-art technology
can be essential, particularly in sports that rely on specialized equipment,
such as tennis or pole vaulting
when the International Olympic Committee declared at the last minute that
"sharkskin" swimsuits were legal for the 2000 games in Sydney, Australia,
swimmers had just 1 day to decide whether to ditch their tried-and-true
swimwear for the flashy new ridged bodysuits that could potentially shave
seconds off their times. In a traditionally low-tech sport, choice of equipment
suddenly took on make-or-break significance. For some of the world's best
swimmers 4 years later, the choice is no longer theirs. Stars such as Michael
Phelps, Inge de Bruijn, Lindsay Benko, and Grant Hackett are obligated
to wear Fastskin, a swimsuit made by Speedo, their sponsor. The companies
TYR and Arena also have swimmers wearing their versions of the suit, inspired
by sharkskin and intended to cut down on drag, the friction that slows
any body moving through water. On its Web site, Speedo states that Fastskin
reduces drag up to 4%. Other companies make similar claims. Sharkskin is
textured with ridges, known as "riblets," that reduce the amount of skin
surface area that comes in contact with water. That allows sharks to glide
through water with much less friction than one would expect. In 1987, the
hull of an America's Cup sailboat was textured to mimic the skin of pelagic
sharks; it won the race and was so fast that the texturing was outlawed.
The advantage made sense: Pelagic sharks cruise long distances at speeds
approaching those of sailboats, around 15 knots, or 28 kilometers per hour,
so the benefit from the riblets was transferred from beast to boat. The
suits are designed to lower two types of drag: skin friction and pressure
drag. The trick for reducing skin friction is making the riblets just the
right size. If they are too big or too small, water floods the valleys,
creating more surface area than a standard suit has. Pressure drag, meanwhile,
occurs when water flowing over irregular shapes, such as eyebrows, chins,
and breasts, peels off in sheets, creating suction. Imagine water flowing
over a beach ball until it reaches a critical angle and falls away, creating
a vacuum that sucks at the ball. To reduce this effect, the Speedo suit
is dimpled, like a golf ball, in strategic places. The indentations set
up miniature eddies; turbulent water is more likely to stick to the swimmer
than is smooth-flowing water. The suits are designed to keep "sticky" water
continuously flowing over the body, thus reducing pressure drag. Speedo's
models are based on body scans of 2 Olympic medalists, a man and a woman
(Speedo will not reveal their names), in a streamlined diving position.
Mannequins of the swimmers match the model's calculated drag predictions
to within a few percent, Bixler says. However, neither the mannequins nor
the computer-generated swimmers, the basis for calculations of passive
drag, stroke or kick the way a human would. We know that if passive drag
is less, active drag will also be less. By Speedo's calculations, the bodysuits
reduce passive drag 4% in men and 3% in women, whose hips and breasts tend
to increase pressure drag. The biggest thing with these suits is the mental
aspect. The suit supposedly makes you swim faster, so when you're wearing
them--you swim faster
specially designed rubber track surfaces absorb the impact of each
footfall, reducing the wear and tear on runners' joints. Not only will
hard surfaces harm runners in the long term, but jarred joints interrupt
the smooth flow of runners' strides, slowing them down. Mondo Track, the
brand used by the Olympics, is made of natural vulcanized rubber and has
a waffle-iron texture on the inside that deforms when stepped on. But it's
not too soft, lets the runners' feet sink as if they were running on sand.
The track is textured to give traction and avoid skids and spillsref
chance also plays a part: cool temperatures or wind might add that
extra push for a runner or long jumper
psychology is vital. Athletes need enormous focus and drive to win.
Many people think that the main barrier to breaking the four-minute mile
was a psychological one: once Roger Bannister did it in 1954, several others
clocked sub-4-minute times shortly afterwards. Sometimes breaking a record
involves taking a risk in an event, such as breaking from the pack with
a full lap to go, and that takes a certain mindset.
the discovery comes from an analysis of combat events in 2004 Olympic
Games in Athens. In 4 of these events (boxing, tae kwon do, Greco-Roman
wrestling and freestyle wrestling) combatants are randomly assigned either
blue or red outfits. Those wearing red won 55% of all competitions.
In bouts deemed to be evenly matched, the bearers of red did even better,
winning > 60% of the time. The reasons for this red advantage are unclear.
A red face is commonly associated with anger and aggression, so a bright
red shirt or headgear may intimidate an opponent. Alternatively, red clothes
could actually boost the wearer's testosterone levels : maybe you get a
surge when you pull on that red shirt. Elsewhere in the animal kingdom,
red coloration is a marker of high testosterone and superior physical fitness.
This has led to some strange effects in studies of animal behaviour : some
male birds given brightly-coloured leg bands for identification in long-term
experiments have found themselves catapulted to the top of the mating ranks.
In human societies, red's aggressive, winning quality may explain why many
military uniforms and medals feature the colour. But colour choice can
also have a cultural basis. Red might not be the top colour around the
world. If you have faith that purple is an imperial colour, then you will
be happy wearing purple. Red makes teams perform better. They looked at
Euro
2004 soccer tournament in Portugal, and in particular at the 5 teams
that wore 2 different colours, one of them red, in different games during
the competition. Those teams tended to perform better when wearing red
as opposed to their other colours. Of course, a red kit is no full substitute
for talent. After all, the perennially successful Brazilian national team
wears yellow. But elsewhere the correlation seems to be borne out: England's
2 most historically successful clubs, Manchester United and Liverpool,
both have red in their uniformsref.
Another data set from the 2004 Olympics showed that similar winning biases
occur in contests in which neither contestant wears red, indicating that
a different mechanism may be responsible for these effectsref.
When statisticians plot how the best performance in a given event changes
over time, they see the graph levelling off. And the shorter the event,
the smaller are the slivers of time being shaved off. So although Paula
Radcliffe has sliced whole seconds off the marathon world record, sprinters
are improving by mere hundredths of a second. Perhaps the only way we can
recognize the ultimate performance will be retrospectively, after a record
has stood for years. Taking the highest value for each crucial physiological
factor ever recorded in an athlete, such as the maximum oxygen uptake,
the greatest efficiency with which energy is burned and the best stamina.
we may one day see a sub-2-hour marathon or even a three-and-a-half-minute
mile, but the probability of finding someone with these exceptional abilities
is pretty low. Not every sport can be accurately measured, of course. Running
and jumping can be quantified with stick or stopwatch, but football and
tennis performances are much harder to gauge. As records become harder
and harder to break, we may start comparing athletes by other standards,
such as the number of gold medals or their performance over time. Lance
Armstrong's 6 consecutive wins in the Tour de France, for example, may
never be surpassed. Athletes might also invent new sports to test themselves.
The emergence of the triathlon in the 1970s was fuelled by runners, swimmers
and cyclists looking for a new challenge; it made its début as an
Olympic event in 2000.
Women's times in 100-metre Olympic games have been improving steadily
faster than men's since 1900. If this trend continues, a woman should be
the fastest person in the world 152 years from now, give or take an ample
statistical margin of 724 years. Women would triumph in a time of 8.079
seconds compared to men's 8.098ref.
As they were about the previous prediction, sports scientists are sceptical
about this one. The reason women's performance has been improving faster
is because women have had growing opportunities to participate in sport
and train at a competitive level. But this faster pace of advancement will
level out before women's times overtake the men's. The conventional view
is that there are basic differences between male and female physiology
that mean men will always maintain around a 10% advantage in strength and
endurance sports. Because the new analysis ignores this, it is flawed at
a fundamental level. The gap between the sexes appears to have plateaued,
with women performing at about 90% of male levels. We are approaching the
limits of human performance in a lot of the one-dimensional events like
the 100-meter sprint or marathon : records will continue to be broken,
but the price is extremely high. And the percentage of the population that
has the genetic potential to excel at this level is infinitesimal. Apart
from the marathon, world records for women have been absolutely static
for more than a decade. That plateau wasn't evident 12 years ago. In a
letter to Nature published on 2 January 1992, titled, provocatively, "Will
women soon outrun men?," Brian L. Whipp and Susan Ward of the University
of California, Los Angeles, looked at the world records of five standard
Olympic running events, from the 200-meter dash to the 26-mile (42-kilometer)
marathon, from the 1920s through 1990. They found that women were improving
their times at double the rate of men in the short distances and were narrowing
the gap even faster in the marathon, in which record-keeping for women
only started in 1955. "The gap is progressively closing," the authors wrote.
At that rate, they projected that marathon times could converge by 1998
(they did not !) and that gender differences in all races could disappear
by 2050ref.
If the marathon --which wasn't an Olympic event for women until 1984--were
excluded, the mean performance gap for running events increased from 11%
in the mid-'80s to 12% in the mid-'90s. Men's world records were broken
far more often in the '90s than women's--largely due to the extraordinary
performance of East African runners. From the world records in 8 main running
events from 100 meters to the marathon, 7 suggest an increasing gender
gap. The marathon is the exception: the gap has narrowed from 11.9% to
8.4%, thanks to Paula Radcliffe's new record in the 2003 London Marathon
ran in just under 135 minutes, shaving almost 2 minutes off the record
she set in 2002. The current average gap is now 11.01%, up from 10.4% in
1989. At the highest levels of performance, the gender gap in running performance
has actually widened over the last 20 years. Much of the female record
is clouded by drug use, especially the records set in the 1970s and '80s
by Eastern European women that have never been bested. In 1984, 38 women,
mostly from the East Bloc, ran 1500 meters in under 4.05 minutes. In 1991,
only 9 did. Although the impressive gains in female marathon performance
have suggested to some observers that women have greater endurance than
men that's not so: women had not developed long distance; that's why the
improvement is much greater on the marathon. We don't see any higher oxidative
capacity in women. A smaller body frame gives women an edge on endurance
but men can run 10% faster even when the difference in body size is controlled
for. The typical young man has a maximum oxygen use capacity, or VO2
max, of about 3.5 liters per minute, compared with 2 liters for a woman.
Although individual levels of testosterone vary widely, males tend to have
at least 10 times as much of the stuff as women. The hormone stimulates
the creation of red blood cells, which means that men's blood holds about
10% more of the oxygen-carrying protein hemoglobin. Further, the performance
of male and female athletes on an exercise bicycle after scientists had
withdrawn blood, leaving the subjects with equal amounts of hemoglobin
in circulation, has a reduced but not eliminated sex difference in VO2
maxref,
indicating that other factors, particularly musculature, play into the
difference. Men have more muscle and larger hearts in relation to body
size and this affects aerobic capacity: a trained woman's heart can pump
out the same volume of blood as a man's can, but it has to work much harder
to do so. Because testosterone spurs growth of muscle tissue, it also affects
anaerobic capacity--the ability to produce energy quickly without oxygen--which
gives males an edge in sprinting as well. And female reproductive hormones
mean that women, including super-lean athletes, tend to carry around more
fat for their body weight than men, and this slows them down : men carrying
weights that mimicked the body-fat ratio of women put them on a treadmill
lose gender gap in performance. Indeed, athletics experts rack their brains
to think of any sport in which women's physical characteristics might allow
them to outstrip their male counterparts : swimming the English Channel
might be one event because fat is so crucial for keeping warm. As for the
gender gap in running, I defer to Norway's marathon queen Grete Waitz,
setter of world records in the 1970s and '80s, who said: "As long as women
are women, I don't think they will surpass men."
environmental conditions
: during the 1984 Olympics in Los Angeles, British runner Steve Ovett collapsed
after the 800-metres final with severe respiratory problems and had to
spend 2 nights in hospital : pollution (O3 levels hit highs
of 500 mg/m3) was one of the major
factors in his exercise-induced
bronchoconstriction (EIB).
2 pollutants of particular concern to athletes are ozone
and particulates — tiny bits of soot and other matter — both of which can
irritate the lungs and cause asthmatic symptoms. In Athens, many August
days are characterized by a brownish–yellow smog of photochemical pollutants,
which the locals call 'nefos'. When the nefos hangs, ozone
levels can rise to > 160 mg/m3, some
40 mg/m3 higher than the WHO's recommended
limit. At the same time, particulate concentrations can hit 50–60 mg/m3
— just above the 40–50 mg/m3 limit
set by the European Commission. Some 7% of the general population suffer
from asthma. Heavy exercise can exacerbate the problem and about 13% of
normal people and 20% of athletes report asthma-like symptoms as a result.
This figure shoots up to 50% for road cyclists, who tend to breathe heavily
during their endurance event. The list of afflicted athletes includes Paula
Radcliffe, who holds the world record for the women's marathon, and cyclist
Jan Ullrich, who won the Tour de France in 1997 and a gold medal at the
Sydney Olympics in 2000. The extent to which athletes are likely to be
affected by pollution depends to some degree on their event. Endurance
and outdoor athletes are more at risk than, say, table-tennis players.
In Athens, road cyclists and marathon runners are likely to be most affected,
because the races will take them close to the Parthenon and the Acropolis
— one of the most polluted districts of the city. Athletes can cycle about
150 litres of air in and out of their lungs every minute during competition
— ten times more than normal — which exposes them to more pollution. To
make matters worse, they also inhale much more deeply, taking pollutants
into the deepest regions of the lungs. Even spectators who are exposed
to these pollutants are easily taken up to the threshold level, but it
is the athletes who are at greatest health risk. The performance of highly
trained athletes exposed to ozone concentrations of 100 mg/m3
— over half the level expected for a hot and calm August day in Athens,
decrease by about 3–4%. The US Olympic Committee took some of its athletes
to Athens to see how they would perform : about 20% of the team members
are known asthmatics, or are known to suffer from exercise-induced asthma.
But a further 30% of the non-asthmatic athletes were sensitive to Athens'
air-pollution levels. The difference was subtle, but for these athletes,
the pollution made breathing just a little harder. Athletes can then be
treated with anti-asthmatic drugs : b2-agonists
are on the Olympic banned list and are available only to proven asthmatics.
But other sensitive athletes can take alternative anti-inflammatory medication,
including leukotriene antagonists — a new class of anti-asthmatic drug
that blocks receptors in the lungs that normally trigger inflammation —
or antioxidizing agents such as vitamins C and E. They might not be as
effective as b2-agonists, but at
least they are legal. Athens could win gold for the hottest games ever
held — a dubious honour currently held by St Louis, the 1904 Olympic host,
where the average daily maximum temperature in summer was 31 °C. At
those games, only 14 of the 34 starters finished the marathon. the United
States has also sent its athletes to islands such as Mallorca and Crete
to try to acclimatize them to the Mediterranean climate. Acclimatization
to such conditions seems to prevent heat injury. But even with the best
preparation, athletes will lose fluid more quickly and will be more prone
to collapse. The 2008 summer games in Beijing will likewise be a challenge
for athletes. The annual average particulate concentration there is as
high as 162 mg/m3 — about 3 times
that in Athens — and temperatures are similar to those in the Greek capital.
Predictions for Athens in August 2004 : O3-level high : 160
mg/m3;
particulate-level high : 50-60
mg/m3
; average daily temperature high : 33°C ; humidity : 49%
contraindications
to agonistic sports
hypertrophic
cardiomyopathy (HCM)
: Domenico Fioravanti won 2 gold medals at the Sydney Olympics in 2000
— for the men's 100-metre and 200-metre breaststroke. In January, the 27-year-old
Italian swimmer was diagnosed with HCM and, under Italian law, he was forced
to retire from competitive sport. Fioravanti suffers from the same genetic
problem that killed Cameroonian footballer Marc-Vivien Foé in June
2003 while he was playing in the Confederations Cup semi-final against
Colombia, followed 7 months later by Hungarian Miklos Feher, who died while
playing for Portuguese football team Benfica. Both men died on the pitch
— suddenly, and in front of the cameras. Even though Fioravanti knows he
has the same condition and is well aware of the risks, his family is campaigning
for a relaxation of the Italian law. They want him to keep on swimming
— or at least to have the option. In Italy, uniquely, athletes are required
by law to get an annual fitness certificate before being allowed to take
part in any competitive event. As part of this assessment they are given
an electrocardiogram (ECG) and questioned about their family history. If
there is a suspicion of disease, they go on to have an echocardiogram which
provides information about muscle thickness and the size of the heart's
chambers. If this shows an abnormality, the athlete is automatically disqualified
— unless the sport is considered low risk, such as snooker or archery.
If an athlete sneaks through the system and goes on to die while playing,
the doctor who signed the authorizing certificate can be held liable if
found negligent. The Italian system seems to prevent instances of sudden
death among athletes : of some 34,000 hopeful athletes screened for the
condition between 1979 and 1996, 22 had HCM and were disqualified from
competitive sport. Only one athlete, who slipped through the tests, subsequently
died of HCMref.
Screening is less efficient at detecting another potentially lethal heart
abnormality called arrhythmogenic
right ventricular cardiomyopathy (ARVD).
Diagnosis of HCM is often not clear-cut, partly because exercise causes
non-harmful changes to an athlete's heart muscle that can be mistaken for
a sign of HCM. Some of this confusion might be avoided if a genetic test
existed. Even if a comprehensive test was available, cost would prohibit
its use for young athletes. The Seidmans admit that the price tag of US$3,000
means their test may not be feasible for screening the vast population
of young athletes. Even ECG and echo tests are currently considered too
expensive for many, but it might be worth considering for the considerably
smaller population of Olympic athletes. One case frequently discussed by
doctors concerned about this issue is that of Nicholas Knapp. A talented
17-year-old basketball player, Knapp had already been offered a sports
scholarship at Northwestern University, Illinois, when his heart stopped
at the end of a game in 1994. He was resuscitated, diagnosed with HCM and
surgically implanted with a defibrillator. Nevertheless, he accepted the
sports scholarship. The university allowed him to keep the scholarship,
but barred him from playing intercollegiate basketball on medical grounds.
A lengthy court battle ensued, in which Knapp argued that the choice was
his, even if by playing he risked death. Northwestern's decision was eventually
upheld, but Knapp was free to enrol in another university's basketball
programme, and did so. 3 years after his first cardiac arrest, he suffered
an episode of tachyarrhythmia — an abnormally fast and irregular heartbeat.
His defibrillator discharged, probably preventing a second arrest and saving
his life. Since Knapp's case, it has been hard for athletes with a known
condition to play competitively in the United States. But, 10 years on,
there are still no formal laws to govern these decisions, only guidelines.
HCM patients had to wait until this June for a guideref
on participating in recreational sport. The American Heart Association
recommends that people avoid 'burst' activities such as sprinting, and
rates the advisability of different sports for people with different conditions.
Swimming is listed as "probably permitted" for HCM patients — although
this is not meant to apply to athletes at the Olympic level. The median
age of HCM sufferers who die while engaged in sport is very young — just
17 years old. In the United Kingdom athletes are not routinely checked
for HCM. And when a sudden death occurs relatives are rarely informed about
the victim's genetic condition or the possible risk to themselves. Fioravanti
considered going to live in another country where he could continue to
swim, but decided he would suffer too much away from home. So after the
closing ceremony of this year's Olympic Games, he will begin building his
new career — as a trainer, rather than a swimmer.
cold baths : after an event, athletes will submerge themselves in
water at about 12çC for up to a minute, jump out for a minute, and
repeat the cycle 3-5 times. Australian swimmers report that it cuts the
time they have to spend doing warm-down laps by about 25% - they do these
laps untile their lactate levels are below a critical level, measured by
pinprick blood samples by the side of the pool. One theory about how cold
baths work is that repeated constriction and dilation of blood vessels
helps to flush out lactate - an acidic byproduct of the body's combustion
of sugars that can stop muscles from contracting properly. And, the baths
dull pain, givign athletes a psychological edge in subsequent events. The
icy baths used by the Autralians may sound alittle extreme, but htey are
not as bad as the cryochambers popular with some European nations
such as Germany and Poland. For these, athletes don socks, gloves and face
masks before braving air at -110°C to -150°C for up to several
minutes. Such chambers may or may not work better than ice baths, but they
require constant medical supervision. The more casual sports-person may
think that heat should be the way to unwind, but saunas and spas are definitely
out as they dehydrate the body, th last thing an overworked athlete needs.
protein-rich sports drinks may help endurance athletes to stay the
pace. Long-distance cyclists pedal up to 40% longer when they regularly
refuel with a drink fortified with whey protein and carbohydrates, instead
of a carb-only beverage. Endurance runners may experience similar positive
effects. Protein-rich drinks may also help to reduce the muscle damage
that occurs during gruelling exercise. Drinking the beverage during a workout
lowers blood levels of CPK (a marker of muscle injury) by 80%ref.
capsaicin,
the chemicals that makes chili peppers hot, is often used in pain-relieving
balms. But the chemical might be doubly useful to endurance athletes -
rats who ingested capsaicin show increased swimming stamina. Capsaicin
causes the body to break down fatty acids, instead of glycogen, for energy.
As fatty acids convert to energy more slowly than glycogen, a runner's
energy stores may last longer, prolonging the time before the athlete "hits
the wall". Could a fiery meal the night before a race therefore help runners
stay the course ?ref
doping (endogenous compounds with abnormal
entry way or dosing or xenobiotics that increase physical performance(s)).
Doping represents a formidable threat to the future of sport, and the recent
advances in this area have been political rather than scientific. The political
events providing momentum to the antidoping movement started in 1998 when
the Tour de France cycle race was hit by the worst drug scandal in its
history. In the same year, authorities investigated the Italian Olympic
Committee's testing laboratory. These and other high profile stories, together
with much negative media exposure, prompted the International Olympic Committee
to reconsider its approach to combating doping and led to renewed discussions
about the list of banned substances and methods to detect their useref1,
ref2,
ref3,
ref4,
ref5,
ref6,
ref7,
ref8,
ref9,
ref10.
Current regulations call for a minimum 2 year suspension and heavy fines
for athletes found guilty of taking steroids and other performance enhancing
substances, and the scientific and technical standards and procedures for
analyses and equipment have been standardised. In November 1999 the World
Anti-Doping Agency (WADA) was established to coordinate testing done
outside competitions. However, the WADA is faced with many challenges,
including the development of effective testing methods. Taking erythropoietin
boosts the body's red blood cell count, improving the blood's ability to
transport oxygen to the muscles, and thereby enhancing endurance performance.
The potential improvement in performance from using erythropoietin is formidable
: maximal oxygen uptake may be increased by more than 10%. Some international
sports federations have excluded athletes with packed cell volume or haemoglobin
levels above certain limits from participation in competition. However,
a substantial improvement in maximal oxygen uptake may be achieved even
with normal haemoglobin levels. Although the World Anti-Doping Agency has
funded considerable research with promising results, it has still not established
efficient testing methods to combat misuse of erythropoietin. The development
of more effective methods to detect the misuse of erythropoietin and other
hormones is one of the biggest challenges for sports scientists. Sport
and physical activity should be part of a healthy lifestyle. Preventing
and treating medical problems in active patients is as important as promoting
exercise. To do both effectively, primary care doctors need to be educated,
and sports medicine must be included in the curriculum at all levels of
medical training. Athletes have been seeking an artificial edge since at
least the late 1800s, when runners and long-distance bicyclists used nitroglycerin
and even cocaine to boost stamina and block pain. But although authorities
began testing for banned substances in the 1970s, their efforts had little
impact. A series of astounding world-record performances in the 1980s,
especially in power sports such as the shot put or hammer throw, were almost
certainly fueled by testosterone and other prohibited anabolic steroids.
Tucked on the wooded edge of this village in the Saxon hills south of Dresden
is a drab, single-story office building with a sinister past. Until 1989
officials of the German Democratic Republic tested their athletes here
to certify them as drug-free before international competitions. But it
was all a charade. Many of the East German athletes, both men and women,
were systematically doped up with testosterone and other anabolic steroids,
often without their knowledge. It was the Kreischa lab's responsibility
to ensure that the regimen was suspended long enough before a competition
to flush out any traces of drugs. Sometimes the drug docs cut it too close
: you would hear that a certain famous athlete couldn't travel to a competition
because of a 'sudden illness. Drug use helped inflate female performance
before the fall of communism :
The competition between testers and abusers is an ongoing cat and mouse
game. It might take them only a week or two to develop a new steroid that
could not be tested for, but it is much harder to determine whether these
chemical tweaks affect the drug's effectiveness. Drug testing was first
introduced to the Olympics in 1968 and was used to detect about 20 drugs.
The roll-call now numbers more than 150, and is still growing. But the
number of illicit substances is probably even larger as we simply don't
know how many designer drugs there are out there. Doping labs must then
make a judgement about whether the level of a certain body chemical has
been artificially elevated. Human beings exhibit a very wide range of body
chemistry, and world-class athletes often find themselves at the extremes
of that range simply because of a mixture of genetics and training. This
has led to a string of appeals against recent bans for alleged nandrolone
doping, which damage the credibility of both the athletes and the doping
labs. The Atlanta Olympic Games in 1996 marked the first time every specimen
was screened by gas
chromatography (GC)
coupled to high-resolution mass
spectrometry (MS).
A further improvement may be seen with GC/MS/MS and quadrupole ion traps.
Electrospray HPLC/MS has also been applied to the detection and confirmation
of peptide hormones in urine. The ability to detect subtle differences
in oligosaccharide structure may provide a way to detect abuse of recombinant
glycoproteins. Simply decreasing detection limits is not enough; new technology
also allows development of a foundation on which to base interpretation.
Application of HPLC/MS/MS has allowed direct measurement of steroid conjugates
in urine. The relative importance of sulfate, glucuronide, and other conjugates
and metabolites of testosterone and epitestosterone can now be assessed.
In East Germany athletes were lavishly funded as an international propaganda
tool, questioning the value of top-level sports. We are not dealing here
with problems of human existence or survival : the world will not come
to an end if dopers go uncaught. The motivation is the example that elite
athletes set for millions of amateurs: it's important for people to be
able to understand that you can do amazing things without doping.
HCO3- : prevents pain perception buffering
lactate but may cause diarrhoea.
L-carnitine
and propionylcarnitine increases fatty acid oxidation in myocardium and
skeletal muscles and lactic acid clearance, allowing better recovery from
efforts (instead the cheaper DL-carnitine lowers L-carnitine
concentrations). No side effects.
creatine occurs naturally in the body. Some
is derived from dietary sources, but endogenous synthesis covers individual
requirements. Creatine deficiency occurs only in subjects with genetic
disorders. Oral creatine supplementation at supraphysiological doses seems
to slightly improve the performance of some types of muscle exercise, but
only those lasting < 30"; even this small effect is inconsistent. The
vague regulatory status of creatine supplements hinders effective monitoring
of adverse events. Serious adverse events have been reported in people
taking creatine supplements, but it's still unclear whether or not the
creatine is responsible. Animal data suggest a link with cancer after long
term exposure. The precise composition of creatine supplements is unclear:
contamination is possible, and other substances, especially doping agents,
are sometimes added. Taking creatine supplements is inadvisable.
autohemotransfusion : 500 mL blood
are collected and concentrated and readministered after > 7 weeks, when
the hematocrit has returned normal. This allow an hematocrit increase of
~10%, which is annihilated in the following 9 weeks. Autohemotransfusion
is considered licit only if practiced within 2-4 weeks, i.e. when it cannot
increase final hematocrit.
splenectomy
decreases hemocatheresis and hence increases hematocrit
anabolic agents : a group of muscle-building compounds that includes
...
non-steroidal anabolic agents
bicalutamide,
a commercial drug used to treat cancer of the prostate
anabolic steroids (AR agonists)
[e.g. Marion Jones and Chryste Gaines and world-record sprinter Tim Montgomery].
Although women produce some testosterone naturally, ratcheting up levels
even slightly leads to increased body hair and acne and can wreak havoc
with the reproductive system. In men, taking steroids suppresses natural
production of testosterone, which can lead to bigger breasts, shrunken
testicles, and infertility. In both sexes, high doses of the drugs damage
the liver and the cardiovascular system. As testing for steroids began
to be enforced more strictly in the 1990s, use of the drugs plummeted --and
the pace of record-breaking tapered off. The antidoping forces seemed to
have the upper hand until 2002, when the sport world was rocked by revelations
that a pair of so-called designer steroids--drugs with no legitimate medical
use--had been synthesized, apparently to elude doping testers. In one case
Catlin's team detected unusually low levels of natural steroids such as
testosterone, epitestosterone, and androsterone in the urine of a female
cyclist, a sign that something was amiss. Probing further, his group found
traces of norbolethone, an androgen developed by Wyeth in the 1960s.
In animal tests, norbolethone appeared to be a very effective muscle builder
while having relatively few masculinizing side effects. It was tested in
short children and underweight patients, but Wyeth shelved the compound,
apparently because of toxic side effects. Evidently, someone was cooking
up a new supply
naturally occurring hormones such as testosterone (cyclist Floyd
Landis and 100-metre sprinter world record Justin Gatlin in 2006) : hormone
levels fluctuate from hour to hour and from person to person, so measuring
absolute amounts can't nail a doper. Some experts have questioned the usefulness
of taking testosterone, especially for endurance sports where muscle bulk
can slow the body down. Athletes could swallow or inject a synthetic version
of the hormone made from plant steroids. This confers the muscle-enhancing
properties of testosterone without the sex-hormone side effects. Labs
often look at urine samples for the ratio of testosterone to epitestosterone,
which is produced alongside the natural version of the hormone. The normal
ratio (T/E) in men is around 1:1, although there is a lot of natural variation
from person to person, and the testosterone ratio thought to be "suspiciously
high" has changed over the years. At the beginning of 2005, WADA set a
threshold of 4:1 as the cut-off for declaring a test positive. The T/E
ratio in one of Landis's samples was reported by his doctor to be 11:1.
But
athletes could inject synthetic epitestosterone along with testosterone,
making the test fallible. Samples from Gatlin were sent straight for
more advanced analysis with isotope ratio mass spectroscopy (IRMS).
This technique, developed a few years ago, looks at isotopes of carbon
in the various compounds in a urine sample. A person's natural hormones
should contain a consistent ratio of carbon-12 to carbon-13. But
synthetic testosterone tends to contain a smaller amount of the heavier
isotope. This test is considered to be far better than T/E ratios at distinguishing
synthetic from natural testosterone. But it can't always be used, as there
is often too little of the individual hormones, including testosterone,
in a urine sample for a reliable result. Unfortunately, it's not really
sensitive enough in many of the sports cases to give us that miracle answer.
It is possible — but rare — for an athlete to have consistently high T/E
ratios. Diet or alcohol may affect the ratio on shorter time scales. But
variations over days or weeks may be indicative of doping. All athletes
should be individually profiled, creating an athlete's 'passport' system
for monitoring them as a matter of course. If their normal levels are disturbed,
one explanation would be that they are doping
synthetic ones such as ... :
tetrahydrogestrinone (THG)
(it has been linked with high-profile sprinters such as Dwain Chambers
in August 2003). It resembles 2 steroids banned for use by professional
athletes: gestrinone, prescribed occasionally for the treatment of endometriosis,
and trenbolone, which has some uses in veterinary medicine. Both
steroids have powerful anabolic effects, and the UCLA team quickly suspected
that the derivative had been designed to activate the same receptors while
foiling standard screens for known steroids. When authorities tested urine
stored from previous competitions, they found at least a dozen THG-tainted
samples, many from athletes who had connections to BALCO. Lawyers for athletes
who tested positive argued that the authorities couldn't demonstrate that
the substance is an anabolic steroid, and therefore it could not be classified
as a banned substance. Indeed, the chemical's effects in animals--much
less humans--had never been characterized in a legitimate lab; standard
animal tests take many months. Under court- imposed time constraints, scientists
resorted to a quicker solution, a test originally designed to ferret out
environmental pollutants that mimic hormones. The test uses yeast cells
altered to make the human version of the testosterone receptor as well
as a luminescent protein that glows when the receptor is activated. Using
the test, David Handelsman of the ANZAC Research Institute in Concord,
Australia, found that THG lights up the cells more brightly than standard
anabolic steroids such as trenbolone and even testosterone.
nandrolone
(it has been linked with soccer players) occurs naturally in the body in
tiny quantities. Tests actually look for molecules that are produced when
the body breaks down this steroid (< 2 ng/mL urine). But traces of the
breakdown products from nandrolone are sometimes found in diet supplements
that are frequently used by athletes. These traces would be insufficient
to affect their performance, but enough to put them over the doping limit.
xenobiotic norsteroids are xenobiotics with androgenic and anabolic
properties known since as far back as the 1930s.
stanozolol (found in Ben Johnson's urine at the Seoul Olympics in
1988).
Markers : even if mass spectrometer fails
to flag unexpected side chains or telltale peaks, it can reveal subtle
differences in the ratio of carbon isotopes that can help identify the
origin of organic molecules. An unusual ratio of carbon-12 to carbon-13
in certain molecules can raise a red flag in a doping test. If a steroid
molecule has a ratio typical of a plant rather than an animal, it is a
sign that it comes from an outside source
xenobiotic norsteroids
increased [either norandrosterone (19-NA) or noretiocholanolone (19-NE)]urine
>
1-2 ng/mL, which are the main metabolites for nandrolone (NT) and most
norsteroids with anabolic properties
testosterone
increased [testosterone (T) / epitestosterone (epiT)]urine (low
specificity, e.g. in abnormally low testicular epiT production, probably
related to genetic factors)
HCG
is manufactured from the urine of pregnant women since it is excreted in
un-changed form from the blood via the woman's urine, passing through the
kidneys. The commercially available HCG is sold as a dry substance and
can be used both in men and women. in women injectable HCG allows for ovulation
since it influences the last stages of the development of the ovum, thus
stimulating ovulation. In a man HCG stimulates production of androgenic
hormones (testosterone). For this reason athletes use injectable HCG to
increase the testosterone production. HCG is often used in combination
with anabolic/androgenic steroids during or after treatment. Since the
body usually needs a certain amount of time to get its testosterone production
going again, the athlete, after discontinuing steroid compounds, experiences
a difficult transition phase which often goes hand in hand with a considerable
loss in both strength and muscle mass. Administering Lepori® HCG directly
after steroid treat-ment helps to reduce this condition because HCG increases
the testosterone production in the testes very quickly and reliably. In
the event of testicular atrophy caused by mega doses and very long periods
of usage, HCG also helps to quickly bring the testes back to their original
condition (size). Since occasional injections of HCG during steroid intake
can avoid a testicular atrophy, many athletes use HCG for 2-3 weeks in
the middle of their steroid treatment. It is often observed that during
this time the athlete makes his best progress with respect to gains in
both strength and muscle mass. Those who are on the juice all year round,
who might suffer psychological consequences or who would perhaps risk the
breakup of a relationship because of this should consider this drawback
when taking HCG in regular in-tervals. A reduced libido and spermatogenesis
due to steroids, in most cases, can be successfully cured by treatment
with HCG. Most athletes, however, use Lepori®-HCG at the end of a treatment
in order to avoid a "crash," that is, to achieve the best possible transition
into "natural training." A precondition, however, is that the steroid intake
or dosage be reduced slowly and evenly before taking HCG. Although HCG
causes a quick and significant increase of the endogenic plasma- testosterone
level, unfortunately it is not a perfect remedy to prevent the loss of
strength and mass at the end of a steroid treatment. Although Lepori®-HCG
does stimulate endogenous testosterone production, it does not help in
re-establishing the normal hypothalamic/pituitary testicular axis. The
hypothalamus and pituitary are still in a refractory state after prolonged
steroid usage, and remain this way while HCG is being used, because the
endogenous testosterone produced as a result of the exogenous HCG represses
the endogenous LH production. Once the HCG is discontinued, the athlete
must still go through a readjustment period. This is merely delayed by
the HCG use. For this reason experienced athletes often take Clomid and
Clenbuterol following Lepori® HCG intake or they immediately begin
another steroid treatment. Some take HCG merely to get off the "steroids"
for at least 2-3 weeks. Lepori® HCG package insert states clearly that
HCG has no known effect of fat mobilization, appetite or sense of hunger,
or body fat distribution." It further states, HCG has not been demonstrated
to be effective adjunctive therapy in the treatment of obesity, it does
not increase fat losses beyond that resulting from caloric restriction.
5000 I.U. of HCG in a single injection resulted in elevated testosterone
levels for six days after the injection. At a dosage of 1500 I.U. the pharmatestosterone
level increases by 250-300% (2.5-3fold) com-pared to the initial value.
The athlete should inject one HCG ampule every 5 days. Since the testosterone
level remains considerably elevated for several days, it is unnecessary
to inject HCG more than once every 5 days. The effective dosage for athletes
is usually 1500-5000 I.U. per injection and should-as al-ready mentioned-be
injected every 5 days. HCG should only be taken for a few weeks. If HCG
is taken by male athletes over many weeks and in high dosages, it is possible
that the testes will respond poorly to a later HCG intake and a release
of the body's own LH. This could result in a permanent inadequate gonadal
function. Lepori® HCG can in part cause side effects similar to those
of injectable testosterone. A higher testosterone production also goes
hand in hand with an elevated estrogen level which could result in gynecomastia.
This could manifest itself in a temporary growth of breasts or reinforce
already existing breast growth in men. Farsighted athletes thus combine
HCG with an antiestrogen. Male athletes also report more frequent erections
and an increased sexual desire. In high doses it can cause acne vulgaris
and the storing of minerals and water. The last point must especially be
observed since the water retention which is possible through the use of
HCG could give the muscle system a puffy and watery appear-ance. Athletes
who have already increased their endogenous test-osterone level by taking
Clomid and intend subsequently to take HCG could experience considerable
water retention and distinct feminization symptoms (gynecomastia, tendency
toward fat de-posits on the hips). This is due to the fact that high testosterone
leads to a high conversion rate to estrogens. In very young athletes Lepori®
HCG, like anabolic steroids, can cause an early stunting of growth since
it prematurely closes the epiphysial growth plates. Mood swings and high
blood pressure can also be attributed to the intake of Lepori® HCG.
HCG's form of administration is also unusual. The substance choriongonadotropin
is a white powdery freeze-dried substance which is usually used as a compress.
Each package, for each Lepori® HCG ampule, includes another ampule
with an injection solution containing isotonic sodium chloride. This liq-uid,
after both ampules have been opened in a sterile manner, is injected into
the Lepori® HCGampule and mixed with the dried substance. The solution
is then ready for use and should be injected intra-muscularly. If only
part of the substance is injected the residual solution should be stored
in the refrigerator. It is not necessary to store the unmixed HCG in the
refrigerator; however, it should be kept out of light and below a temperature
of 25°C. HCG is a relatively expensive compound.
ephedrine, which is found in some decongestant products
in January 2004, the World Anti-Doping Agency removed caffeine from its
prohibited list of stimulants.
narcotics : pain-killing drugs, mostly opiates such as morphine, heroin
and methadone; the chemically similar codeine is allowed, however.
diuretics can help boxers or weightlifters to
lose weight very quickly, allowing them to compete in a different weight
class within their sport. They can also conceal the presence of other drugs
in urine.
peptides and hormones are difficult to detect as they are part of the body's
natural chemistry
recombinant human erythropoietin
(Epo)
(r-HuEPO) (banned by the International Olympic Committee in 1990) increases
the maximum anaerobic power (VO2max, whose upper limit anyway
depends on ventilation, carrying and diffusion rates) but the increased
blood viscosity increases likelihood of irreversible arterial hypertension,
heart failure and thromboses (=> AMI and stroke). It became available in
the late 1980s in Europe and is thought to have played a role in the deaths
of more than a dozen Dutch and Belgian cyclists who died of sudden heart
attacks in the 1980s [e.g. the world champion sprinter Kelli White in June
2004]. The detection of r-HuEPO abuse by athletes remains problematic.
Because the blood test does not measure illegal r-HuEPO directly, it cannot
prove a doping allegation. A new analytical procedure was developed by
Lasne and de Ceaurriz in June 2000 (just before Sidney's Olympic Games)
for detecting r-HuEPO in urine and was applied to specimens from cyclists
participating in the the infamous Tour de France 1998 competition, which
was sullied by scandals about EPO doping. Just in time for the 2000 Olympic
Games in Sydney, Australia, the IOC introduced the new combined blood and
urine test for EPO (the so-called “Australian method”). Owing to
microheterogeneity in their structures, natural and recombinant EPO comprise
several isoforms, some of which have charge differences and can be separated
by isoelectric focusing. The isoelectric patterns of the 2 recombinant
EPO-a and
b forms
are very similar (both have an isoelectric point, pI, in the range 4.42-5.11);
although EPO-a has an extra basic band, both
differ from natural, purified urinary EPO, which has more acidic bands
(pI 3.92-4.42), probably due to post-translational modifications such
as glycosylation, which is species- and tissue-type-dependent. Such
differences in the urine analysis allows to ascribe excreted EPO to a natural
or recombinant origin. An immunoblotting procedure was developed to obtain
a reliable image of EPO patterns in urine. The patterns from control subjects
consisted of about 10 bands of pI 3.77-4.70, in accord with the purified
natural urinary EPO pattern, whereas those from subjects treated with recombinant
EPO contained more basic bands, reflecting the presence of recombinant
isoforms, and sometimes acidic bands as well, depending on the presence
of endogenous isoforms. The presence of exogenous hormone was always evident:
any individual injected with recombinant EPO showed a striking transformation
of their initial EPO urine pattern. 102 frozen urine samples from participants
in the Tour de France 1998 cycling competition were assayed for EPO by
using ELISA : 28 of these samples had EPO levels above the normal range
of 0-3.7 IU/l (mean, 0.48 IU/l, n=103; 77 samples were below the minimum
detectable concentration of 0.6 IU/l). The 14 samples presenting with the
highest concentrations (7-20 IU/l) were analyzed : although characterization
of the EPO source does not require such high levels for urine analysis,
we selected these samples for isoelectric focusing as they were more likely
to contain exogenous hormone; indeed, they all gave rise to a banding pattern
typical of recombinant hormone. This method for detecting recent exposure
to recombinant EPO in athletes could be useful for in-competition controls
in events of long duration (for example, cyclists have been known to use
exogenous EPO continuously for 6 months at a time), but should find its
principal application in out-of-competition testingref.
5 indirect markers of altered erythropoiesis (hematocrit (Hct), reticulocyte
hematocrit (RetHct), percent macrocytes (%Macro), serum erythropoietin
(EPO) and soluble transferrin receptor (sTfr)) are reliable evidence of
current or recently discontinued r-HuEPO useref1,
ref2.
This test cannot find exogenous EPO if administered 48 hours before the
test. Second-generation tests were developed by the Australian Institute
of Sport in 2003ref.
The concentration of EPO in urine is fairly low, however, so the test could
be foiled if an athlete takes diuretics or other urine-increasing drugs.
Analyses performed on the site with a transportable analyser are good and
could enable the federations to perform a urinary test to detect rhEPO
abuse right after the blood analysis. This time saving is essential to
fight efficiently recombinant erythropoietin doping, because the half life
of the hormone is very shortref.
A new 2-dimensional electrophoresis (2DE) method for the detection of recombinant
erythropoietin (rHuEPO) in urine and its separation from endogenous erythropoietin
(HuEPO) involves a one-step acetonitrile precipitation of the proteins
in urine, addition of an internal standard, 2D PAGE, a single Western blot
and chemiluminescent immunodetection. The 2DE method separates HuEPO and
rHuEPO isoforms by both iso-electric point and molecular mass. Several
urinary proteins have been identified with which the monoclonal EPO antibody
used in the current test has non-specific binding. The iso-electric points
of these cross-reactive proteins overlap with HuEPO and rHuEPO however,
they separate distinctly by the 2DE method.
a2-HS-glycoprotein
(HSGP) was identified by peptide mass fingerprinting as one of the urinary
cross-reacting proteins, and commercially available purified HSGP was chosen
to be added into urine samples as an internal standard prior to separation.
Software (EpIQ) was specifically developed that applies four separate criteria
to the detection of the migration of rHuEPO and HuEPO relative to the internal
standard. The combination of sample preparation, 2D separation, internal
standard, standardized blotting procedures and image analysis software
enables the 2DE test for rHuEPO in urine to be performed reproducibly and
accuratelyref.
growth hormone (GH)
: strengthens bone, cartilage and tendons, but also causes a decrease of
fatty tissue and increase of cartilage and muscular tissue (muscles are
less elastic !). Authorities have not yet introduced an official test for
the compound. Detecting hGH is even harder than detecting EPO, because
it doesn't have telltale sugars to betray artificial versions. But in a
lucky break for doping sleuths, the pituitary gland's production of growth
hormone is rather messy. The gland makes a mixture of variations of the
protein as well as protein fragments. The manufactured version, on the
other hand, is much cleaner, consisting chiefly of one of the heavier versions,
so when someone shoots up with the recombinant protein, the ratio of the
different forms is skewed. Endocrinologist Christian Strasburger of the
Charité University Clinics in Berlin and his colleagues at the Medizinische
Klinik Innenstadt at the University of Munich have developed an immunoassay
that measures the ratio of the two forms. The test seems extremely reliable.
Another group led by Sonksen of St. Thomas' Hospital has developed a method
to measure the effects of growth hormone on the production of other proteins,
including insulin-like growth factor-1 (IGF-1) and collagen. The test is
not as clear-cut as that developed by Strasburger and his colleagues, but
it can detect the effects of hGH weeks after someone has injected it. The
Strasburger method works best 24 to 36 hours after injection. Those who
go to the trouble and expense--a month's dose costs more than $2500--may
not be getting their money's worth. In the normal person with normal levels
of growth hormone, adding extra has not been shown to confer a benefit.
Yet at the end of the day, if a 0.01% advantage is the difference between
winning and losing, a minuscule boost from growth hormone--even if it's
purely psychological--might help an athlete to victory. Tackling this murky
question, Ho's group is giving growth hormone to healthy volunteers both
to screen for biochemical changes that might be picked up in a doping test
and to look for performance- enhancing effects. Whether the benefit is
real or not, the hormone is on the list of banned substances, and athletes
caught using it will forfeit any medals they receive next month in Athens.
'restricted' substances : an athlete
will not face a ban if they can prove that the substance was not used to
enhance sporting performance
genetic doping
: scientists have treated roughly 3,000 humans suffering from life-threatening
illnesses with gene therapy, but few cases have been successful and some
have been fatal. Given the risks involved, the first gene doping in the
sports world may be in an animal sport like dog racing. Microarrays that
measure the expression levels of thousands of genes at once could betray
blips that might result from gene doping.
recombinant human GM-CSF-EPO
hybrid protein named MEN 11300 was administered biweekly for a total
of 6 weeks to rhesus monkeys induced a strong antibody response which neutralized
the in vitro biological activity of human EPO while no antibody response
could be detected against human GM-CSF. A severe drop in reticulocyte counts
at approximately 2 weeks after initiation of treatment was followed by
a dramatic decrease in the number of erythrocytes. No effects were observed
on GM-CSF-dependent hematopoietic lineages and the clinical chemistry analyses
did not reveal signs of general toxicity. Reticulocyte and erythrocyte
counts started to recover 3-4 weeks after discontinuation of treatment
in concert with a decline in anti-EPO antibody titres. Nevertheless, cell
numbers remained below basal levels up to 50 days after the last MEN 11300
administrationref.
Dose response to a single intramuscular injection of rAAV-Epo in monkeys
are achievable, although a threshold inoculum of virus is necessary to
produce an effect and the therapeutic window is narrowref.
The 47-year-old Thomas Springstein, a one-time coach of the German Athletics
Association (DLV), faces a stiff jail sentence if found guilty of supplying
drugs to minors back in 2003 particularly if the accusations of genetic
doping (an e-mail containing references to Repoxygen®)
are confirmed. Springstein has also been accused of giving several injections
to one of his female athletes to treat an injury despite not having a viable
medical permit. Before the doping scandal came to light Springstein worked
with some of Germany's top athletes, including East German track stars
Katrin Krabbe and Grit Breuer, who were both suspended for 2 years for
using the banned steroid clenbuterol in 1992. Krabbe won the 100m and 200m
world titles in 1991 while Breuer, who is Springstein's partner, won the
1990 European title at 400 metresref.
marathon mice : the gene engineered in these mice essentially mimics
exercise
engineered mice with constitutively active PPARd
burn fat not sugar and have far more of the muscle fibres that work aerobically,
and fewer of those that burn anaerobically : this confers endurance (they
ran 5,900 feet before quitting and stayed on the treadmill 1 hour longer
than the natural mice, which were able to stay running for 90' and travel
2,950 feet) and prevents the modified mice from becoming obese even when
they were kept inactive and fed a high-fat dietref.
Around 80% of the muscle fibres of marathon runners are aerobic, while
in non-athletes the percentage is typically 30-40%. This is probably partly
due to genetics and partly due to training.
PPARa
inhibitors
increase muscle capacity in mice and stop them gaining weight
mice that lack HIF-1a
are less able to switch to anaerobic activity. The mice are churning out
less lactic acid, a by-product of anaerobic metabolism commonly thought
to cause fatigue, and are clearing it out of their system faster. Again,
this has parallels with long-distance runners, who are thought to turn
over lactic acid more quickly. But in this case, the animals' athletic
feats came at a high price: after four days of extensive exercise, their
performance flagged and their muscles showed signs of damage. This may
have been because by-products of aerobic metabolism, such as free radicals,
had built up to poisonous levelsref
Schwarzenegger mice - as they were dubbed by the press for buff
action movie star and now California Gov. Arnold Schwarzenegger - were
created by Nadia Rosenthal, a developmental geneticist at the European
Molecular Biology Laboratory in Monterotondo, Italy, overexpressing a locally
acting isoform of IGF-1
(mIGF-1) in fully differentiated, non-dividing muscle cells. They have
twice as much muscle as normal mice, live longer, and can recover from
injuries that kill their weaker cousins and they avoid scarring. They build
muscle without exercising (but when you do exercise them they look even
better), and they seem to defy the aging process. EMX2,
a protein that is also increased in the regenerating newt limb, is upregulatedref.
Such a treatment would be difficult to unmask, because the doped-up IGF-1
gene, designed to remain in muscle cells where it is produced, would not
be detectable in blood or urine : athletes would understandably be reluctant
to give muscle biopsies just before a competition. Genentech manufactured
and tested IGF-1 in the 1980s but decided not to market it. Tercica, a
company in South San Francisco, California, is sponsoring clinical trials
of growth hormone plus IGF-1 in short children who don't respond to treatment
with growth hormone alone. Preliminary data suggest that the Tercica version
does encourage muscle growth. It seems that the body makes at least 4 forms
of IGF-1. Another circulates in the bloodstream and suppresses the production
of human growth hormone : when production of this form is increased, mice
develop oversized and weak hearts and are prone to cancer.
a Berlin boy was born with a mutation that turns off the gene for myostatin,
which in animals seems to block the activation of muscle stem cells. Mice
and cattle that carry myostatin mutations have twice as much muscle as
normal animals. At 4-and-a-half years old, the boy had the physique of
a mini-bodybuilder and could hold out two 3-kg dumbbells with his arms
extendedref.
Some experts are thrilled: They suggest that the mutation could be exploited
as a treatment for muscle-wasting diseases.
sport-associated diseases
unexplained
underperformance syndrome (UPS) / over-training syndrome affects perhaps
1 in 10 athletes Although suffereres usually recover after a period of
rest, it can ruin preparation for major events. Rowers seen particularly
susceptible : athletes in this sport typically train twice a days, 5 or
6 days a week. Whe major competitions approach, they often push their bodies
beyond their normal limits for 1 or 2 intense weeks, regularly covering
20 km on the water a day. This overreaching leaves the athletes exhausted
in the short term, but in the long term it usually forces their bodies
to adapt to intense exertion, improving race performance. But sometimes
the strategy results in UPS : continued infections, incrasing fatigue,
sleep and mood disturbances, loss of appetite, slow wound healing and gastrointestinal
disturbances. If an athlete's performance does not recover after 2 weeks
of relative rest, UPS is usually diagnosedref.
Gauging the prevalence of the condition is difficult, as athletes don't
want competitors to know. Researching the condition is also difficult,
as serious athletes aren't willing to give regular blood samples, and it
would be unethical to induce full-blown UPS in test subjects. In burns
patients, levels of anti-inflammatory cytokines, such as IL-4 and IL-10,
go up and, apart from calming inflamamtion, also suppress the ability of
immune cells that usually attack pathogens, leaving burns patients more
vulnerable to long-lasting infections. After a marathon, IL-10
levels shot up, although IL-4
remains constant. But this is nunlikely to be the whole story, as athletes
with UPS often complain of tirednes and aching joints when they are apparently
infection-free. Levels of IL-6
can rise 100-fold during a marathon and are partly responsible for feelings
of tiredness during a race (as when someone has a cold or flu). Injections
of IL-6 into healthy individuals will make them tired within a few hours.
Some people are more sensitive to the cytokine than others : chronic fatigue
sufferers, for example, will become more tired more quickly, and for longer,
than control subjects. Injecting a runner before a race will likewise have
tiring effects; an experienced club runner typically has a minute added
to their time for a 10-km runref.
Some suspect that over-reaching itself sensitizes athletes to IL-6, making
them more likely to feel worse from natural bursts of the cytokine. An
ideal experiment would ask runners wll first do a timed 10-km run after
an IL-6 injection. They will then "over-reach" by running an incredible
90 km - more than twice as far as a marathon. After a few weeks of rest,
they will have an IL-6 injection and run a second 10-km race. If over-reaching
sensitizes them to IL-6, one can predict they will perform particulary
poorly in this last test. Experts recommend a minimum 6-hour rest between
training sessions, as IL-6 levels are significantly higher among subjects
who rest for only 3 hoursref.
Psychological stress is thought to contribute to UPS, although no one knows
why.
kickboxing : traumatic brain injury, which
is a frequent and a worldwide important public health problem, may result
in pituitary dysfunction. Concussion, a common type of lesion after traumatic
brain injury, is an injury associated with sports including boxing and
kickboxing. Kickboxing is one of the most popular martial arts and approximately
1-million people around the world participate in kickboxing sport. Head
is the most common site of injury in amateur and professional kickboxers.
Pituitary consequences of chronic repetitive head trauma in kickboxing
have not been investigated until now. Therefore, the present study was
designed to investigate the pituitary function in both retired and active
amateur kickboxers. 22 amateur kickboxers who have boxed in national and
international championships (16 men, 6 women) with a mean age of 27·3
± 7·1 years, and 22 age- and sex-matched healthy controls
were included in the study. Basal hormone levels were obtained from the
participants. To assess GH-IGF-I axis, GHRH + GHRP-6 test and glucagon
stimulation tests were used. Hypothalamo-pituitary-adrenal axis was assessed
by glucagon stimulation test. When mean basal hormone levels were compared
between kickboxers and the controls, IGF-I level was significantly lower
in kickboxers (P < 0·05). Five (22·7%) and two (9·1%)
of the 22 kickboxers had GH deficiency had ACTH deficiency, respectively.
There were significant negative correlations between IGF-I levels and age,
duration of sports and number of bouts (P < 0·05). Present data
clearly demonstrate for the first time that amateur kickboxing is a novel
cause of hypopituitarism and kickboxers are at a risk for hypopituitarism
especially isolated GH deficiency. Therefore, participants of the combative
sports who were exposed to chronic repetitive head trauma need to be screenedref
gymnastics : when Natalia Yurchenko introduced a new vault at the
1983 World Championships in Budapest, it helped her win a gold medal. The
move is fiendishly difficult: Yurchenko would sprint 20 meters, cartwheel,
land backward on a springboard, and launch herself into the air. Arching
her back, she would reach for a padded apparatus called a horse and then
propel herself into the air again, somersault one-and-a-half times, twist,
and land facing backward. Following that dizzying lead, gymnasts set out
to conquer the Yurchenko vault--and injuries mounted. The vault became
notorious in 1988, when 15-year-old Julissa Gómez broke her neck
while attempting it at the World Sports Fair in Japan. She was paralyzed,
fell into a coma, and later died of complications. Within a year, the U.S.
Gymnastics Federation, predecessor of USA Gymnastics, banned the move at
levels below Olympic competition. Deaths are rare in gymnastics. That's
not the case for injuries. Compared with other kinds of athletics, gymnastics
stands out for its singular combination of bone-jarring impacts, intense
training, young age, and ever-more-demanding skills. Similar injuries afflict
both sexes, but more girls participate and they start training younger.
Experts fear that elite teens and preteens, by pushing their bodies to
the limits, might be raising their risk of osteoarthritis and other health
problems later in life. An elite gymnast trains 25 to 40 hours a week,
typically executing more than 250,000 "skills" a year. In the 1970s and
'80s, elite gymnasts began competing at younger ages. Although that trend
has stabilized, preteens are subjecting their bodies to sprains, fractures,
and sometime even deformities of growing bones. In 1996, established routines
became worth fewer points, so gymnasts who wanted to outscore the competition
had to swing higher into the air, execute more twists and somersaults,
and otherwise raise their game. For a few years after that, the U.S. national
team had problems with a serious kind of knee injury, a tear of the anterior
cruciate ligament. Also raising the risk of injury, equipment has been
modified for higher performance. For example, gymnasts can jump higher
from new vaulting tables with more spring, allowing more air time for acrobatics.
Sports scientists say it is hard to nail down the health risks of competitive
gymnastics for children. For starters, there is no reporting system for
gymnastics injuries. In the one existing system, run by the National Collegiate
Athletic Association, gymnastics usually ranks in the top three sports
for injuries, behind football and hockey. But that doesn't shed light on
the private clubs that train most gymnasts. Coaches of elite gymnasts often
may be too busy to let scientists in for a close look. With fewer than
200 elite gymnasts in the United States, most research is done on less-skilled
athletes. These studies back the impression that injuries are common. In
a 3-year study of 79 female gymnasts aged 7 to 18, Dennis Caine, a sports-injury
epidemiologist at Western Washington University in Bellingham, found that
60 girls suffered a total of 192 sprains, strains, and other injuries.
The study also showed that the risk of injury was significantly higher
for advanced gymnasts. That makes sense, because as gymnasts get serious,
they put in longer hours, work harder, and attempt more difficult routines.
Caine and others have shown that the most commonly injured body parts in
boys and girls include the lower back, shoulder, and ankle. Wrist pain
is especially prevalent. In some cases, the distal end of the forearm bones
can be damaged, stunting the radius relative to the ulna. It can be career-ending
for some kids, because weight-bearing is too painful. Such nagging injuries
can continue to plague gymnasts in college, although he says it's unclear
whether they flare up later in life. For girls, another concern is delayed
growth and sexual maturation. Elite female gymnasts tend to grow more slowly
and go through puberty later than other girls. Some don't think intense
training can be blamed; a confounding factor is that larger girls who mature
earlier tend to drop out from competition. However, other point to several
case and cohort studies that indicate at least a temporary halt in growth
of some top-level gymnasts, likely due to intense training and poor nutrition.
When the gymnasts lightened their load, or retired, their growth rate accelerated.
Many of these issues came to a boil during the 1992 Barcelona Olympics,
when European newspapers ran stories about the injuries of young female
athletes and the extreme training they had undergone. That spurred a research
project that many sports scientists call exceptional in its depth and quality.
The Federal Institute for Sport Science in Bonn, Germany, asked Gert-Peter
Brüggemann, then director of the Institute for Athletics and Gymnastics
at the German Sport University Cologne, to study the effects of high-level
performance on gymnasts. His team examined various training regimens, using
records from the once top-secret facilities of the former East Germany.
Compared with Western gymnasts, the East Germans were put through more
frequent repetitions of skill sets and more difficult maneuvers and got
less rest. In total, their growing bodies had endure a longer, harder pounding
compared with those of West German athletes. Those loads had severe consequences.
After reviewing archived x-rays and reexamining 42 women and 26 men who
once had been elite gymnasts, Brüggemann's group found a much higher
injury rate among the East German team than in 23 West Germans who had
competed between 1968 and 1985. Mild deformities and abnormalities of the
spine were more than twice as common in the East Germans, Brüggemann
and colleague Hartmut Krahl, then of the Alfried Krupp Krankenhaus in Essen,
reported in 2000 in Belastungen und Risiken im weiblichen Kunstturnen (Load
and Risks in Female Gymnastics). Seeking to prevent such injuries, the
group also carried out a 4-year prospective study of 135 young elite gymnasts
on German national squads. Working with high-speed video cameras and force-measuring
devices in the apparatus and landing mats, they analyzed roughly 100 exercises
and measured mechanical loads exerted on the body over time. About half
the spinal deformities could be explained by the amount of loading. They
also discovered that the severity tended to be worse among those with weaker
muscles and connective tissue. Stronger muscles absorb the shock of impacts
and bad landings, protecting joints and the spine. Based on those findings,
Brüggemann's team devised a healthier training regimen in which girls
spent less time learning fancy routines, instead logging more hours in
the weight room. Far fewer gymnasts suffered pain or injury during the
first 3 years of the strength-training program, they found, with ankle
injuries alone falling more than 50%. One beneficiary of the program is
Brüggemann's daughter Lisa, who competed in the 1999 and 2001 World
Championships and will be heading to Athens on the German team. A similar
approach has helped the U.S. national team, which has suffered fewer knee
injuries since putting a greater emphasis on strength training in 2000.
In her lab, McNitt-Gray takes high-speed video of gymnasts, measures forces
and muscle movements, and creates computerized stick models to test the
effects of modifying the moves. The gymnasts are outfitted with tiny sensors
to track their motions and muscle use. This system can be used to warn
trainers if the gymnasts are nearing their limits, McNitt-Gray says. Also
on the agenda is improving the equipment. By filming the vault board and
spring floor with a high-speed camera, Sands and his colleagues found that
it wobbles underfoot before heaving the gymnast up. It looks like the gymnast
has landed on a waterbed. That's part of what makes the equipment risky,
because gymnasts must cope with boards that often compress unevenly and
unpredictably. Boards have improved over the years but are still not good
enough. Similarly, the characteristics of the safety mats that gymnasts
land on depend on their construction, age, and other factors. Brüggemann
and his colleagues have recommended that safety mats be stiffened for better
stability during landing. Most competitive gymnasts cannot avoid an occasional
injury, but little is known about the long-term damage to their health.
Anecdotal evidence suggests that elite gymnasts risk developing osteoarthritis
and chronic musculoskeletal pain. The few studies that have tested this
hypothesis have yielded conflicting results. Experts insist that gymnastics
can be made safer without diminishing its elegance and power. Perhaps the
most important message is not to cross the pain threshold. The old adage
'No pain, no gain' is inappropriate when it comes to kids. In the pursuit
of Olympic gold, however, that message can easily get lost.
When the seat is too high, it can increase stress on the lower back and
hamstrings. If it's too low, problems with the distal quadriceps and anterior
knee can occur. If you pedal slowly with high resistance (using the big
chain ring and smaller cogs), you can strain your quadriceps or knee. Pedaling
fast with low resistance can cause increased pressure on the base of your
pelvic region and back. Most experienced cyclists will have a cadence (revolutions
per minute) between 90-100. For beginning cyclists, a reasonable and energy-efficient
cadency might be between 60-80. For activities, including warm-ups, lasting
less than one hour, water is sufficient. If the activity lasts longer than
an hour, carbohydrate supplements in the form of sports drinks, carbohydrate
bars or gels would be beneficial. Cramping also can be avoided by drinking
plenty of fluids during exercise. Sports drinks are a good source of fluids,
carbohydrates and salts, and between four to eight ounces should be consumed
every 15 to 20 minutes. Most sports drinks have 6 percent to 8 percent
carbohydrates, which have been found to cause fewer gastric problems and
are ideal for absorption. Chafing and skin irritation - often called "saddle
sores" - are a common annoyance for cyclists. But they can be minimized
by buying properly fitted seats and wearing cycling shorts with plenty
of moisture-absorbing padding in the bottom to help protect skin. Cyclists
should remove sweaty clothing as soon as possible after training or racing
and shower. In addition, one should wash clothes after every use to prevent
irritation or infection of broken skin. One of the most important things
for cyclists to learn is how to avoid heat-related problems. It takes approximately
two weeks to acclimate to heat, longer for extreme heat. If preparing to
ride in high heat for a prolonged period of time, a cyclist should build
up slowly, by initially limiting workouts to one hour or less, train during
the cooler parts of the day and always hydrate. The athlete can then increase
training load. In hot temperatures, take a drink every 10 to 15 minutes,
even if not thirsty.
mountain bike
spinal cord injuries
(SCI)
(Apsingi S., Dussa C.U.& Soni B.M. . American Journal of Sports Medicine,
34. 1-3)
Endurance athletes have long been warned about getting dehydrated, and
many tend to drink more on race day than they do during training. Runners,
hikers, bikers, even soldiers on long maneuvers risk dilutional hyponatremia.
Hyponatremia occurs in a substantial fraction of nonelite marathon runners
and can be severe. In participants to the 2002 Boston Marathon considerable
weight gain while running, a long racing time, and BMI extremes were associated
with hyponatremia, whereas female sex, composition of fluids ingested,
and use of NSAIDs were notref1,
ref2.
skiing, sledding and snowboarding : in 1983, Oh and Schmid argued
that helmet use should be mandatory in skiers up to the age of 17 owing
to the risk of severe head injuriesref.
Guided by compelling evidence that helmets are effective at preventing
head, brain, and facial injuries in bicyclists, helmet use would seem to
be reasonableref.
Helmets are not yet widely recommended in skiers and snowboarders because
of the paucity of information on their effectiveness. The best evidence
suggests they are protective, but this was based on a study that was restricted
to participants aged < 13 years, had a small sample size, and lacked
control for potential confoundersref.
Helmets may increase the risk of spinal injury owing to the biomechanics
of the association between the helmet and the head and neckref—a
particular concern for children, who have a greater head to body ratio.
A helmet may exert large bending or twisting forces on the neck in the
event of an otherwise "routine" fall. Wearing a helmet while skiing or
snowboarding may reduce the risk of head injury by 29% to 56%—that is,
for every 10 people who wear helmets, three to six may avoid head injuries.
This may even be an underestimate if, as in cycling, the helmets were worn
incorrectly or were in poor condition, or were not designed for skiing
or snowboarding. The effect of helmet use on neck injuries is less clear.
Although a study found no statistically significant estimates for neck
injury and no evidence of effect modification by age, their sensitivity
analysis suggests an increased risk of neck injuries with helmet useref.
Ankle injuries are the most common, with an incidence of 1 per 100
000 people a day, accounting for about 20% of all sports injuries. Most
ankle injuries are moderate ligament sprains. With proper functional treatment
the patient can return to work or sport within a few weeks or even days,
and most injuries heal without sequelae. Some ankle sprains, however, cause
prolonged disability in the form of persisting pain or instability. The
protective effects of taping and bracing have been shown persuasively in
soccer and basketball, but only for players with previous ankle injuryref1,
ref2,
ref3.
Taping or bracing reduces the incidence of sprains and results in less
severe sprains, whereas the efficacy of "high top" basketball shoes is
unclear. Braces seem to be more effective than tape in preventing ankle
sprainsref1,
ref2.
Bracing is also more comfortable and more cost effective if used long termref1,
ref2.
Different types of braces are widely available commercially. Taping can
be performed by the doctor, physiotherapist, or even the patient with a
little instruction.
An ankle brace (right ankle) or tape (left ankle) should be worn during
sporting and other high risk activities at least until completion of a
supervised rehabilitation programme, including 6-10 weeks of balance training.
How tape and braces work is uncertain; they may simply improve neuromuscular
control of the ankle joint. This view is corroborated by the fact that
their effect is limited to players with previous injuryref1,
ref2,
ref3
when neuromuscular function is reducedand the fact that braces do not seem
to restrict inversion enough to substantiate their prophylactic effectref.
If the protective effect were mechanical, an effect in healthy ankles would
also be expected. Neuromuscular control can be restored after previous
injury with a training programme using a "balance board," which reduces
the risk of reinjury to the same level as in healthy ankles.
Athletes with a sprained ankle should therefore complete supervised
rehabilitation, including a 6-10 week programme of balance training. An
appropriate brace should be worn at least until completion of rehabilitation.
Ideally, the doctor should fit a brace on the first visit to the clinic
after injury or at least refer the patient to a physiotherapist for a brace
and instructions on proper balance training. Balance board training is
performed with the player standing on one leg on a balance board. The objective
is to control balance using an "ankle strategy"that is, without using hands,
hips, or knees to adjust body position, but to correct balance using only
the ankle as much as possible. Thus, arms are held across the chest, and
the opposite leg is held still in 90° knee flexion
prevention of knee injury
Serious knee injuries, particularly those to the anterior cruciate
ligament, are causing increasing concern. The highest incidence is seen
in 15-25 year old athletes in "pivoting" sports such as football, basketball,
and handball, and the incidence is three to five times higher among women
than among menref.
The introduction of stiffer ski boots and "carving" skis (skis designed
to aid turning) has also been associated with an increase in injuries to
the anterior cruciate ligamentref.
These injuries cause lengthy absence from work and sport and greatly increase
the risk of long term sequelaesuch as abnormal joint dynamics and early
onset of degenerative joint diseaseref.
Although better treatments are being researched, there is no good evidence
that reconstructive surgery of either menisci or cruciate ligaments decreases
the rate of post-traumatic osteoarthritis. Nor has repair of isolated cartilage
lesions been proved to prevent or retard the development of osteoarthritis.
Although the development of improved treatments for knee injuries is important,
it is arguably even more important to identify risk factors and try to
prevent them. The anterior cruciate ligament may be injured during activities
that most athletes consider routine to their sport, usually without any
direct contact to the knee (Boden BP, Griffin LY, Garrett Jr WE. Etiology
and prevention of noncontact ACL injury. Physician Sportsmed 2000; 28:
53-60), implying that there may be important intrinsic factors that lead
to rupture of the anterior cruciate ligament. Nevertheless, recent data
suggest that improving knee control may reduce the rate of such injuries.
Caraffa and colleagues studied the preventive effect of a gradually increasing
balance training programme in Italian semiprofessional or amateur footballers
during three seasonsref.
They observed an 87% reduction in the incidence of injuries to the anterior
cruciate ligament. Other studies have observed a reduced incidence of injuries
in young female footballers using a pre-season conditioning programmeref,
in young female European handball players using a training programme (including
balance training) throughout the seasonref,
and in a mixed group of US high school female athletes using mainly jump
training exercises emphasising knee controlref.
Although these latter studies were too small to evaluate statistically
the effect on injuries to the anterior cruciate ligament in particular,
it seems reasonable to conclude that the risk of serious knee injuries
may be reduced through structured training programmes with a focus on neuromuscular
knee control. The clinical importance of these studies and of the similar
studies on ankle sprains is that medical staff need to participate in encouraging
coaches and players to focus on general conditioning exercises to prevent
serious knee injuries. In addition, balance training represents a new form
of training not usually used by coaches. As balance exercises reduce the
risk of injury to the anterior cruciate ligament, doctors have to assume
responsibility in teaching coaches and athletes how to train effectively.
Unfortunately, teaching aids are not readily available yet, except through
postgraduate sports medicine courses for doctors and physiotherapists.
Want to keep your wits about you until a ripe old age? Scientists say that
aerobics does more than mental exercise to keep your brain fit. Regularly
sweating it out on the squash court is like a fertilizer for brain cells,
they say. Exercise for the body helps new brain cells to sprout and make
more connections, which in turn helps to preserve the frontal lobes, the
area of the brain where ageing is most noticeable. In a review of the past
10 years of research in the field, evidence was found that good nutrition,
education, and positive thinking all help to keep your brain young. But
the most important factor is aerobics, he concludes. "It has remarkable
beneficial effects on the structure and function of the brain. One study
in his review looked at a group of over-60s who engaged in "intense walking"
for four months, and compared them with another group who stretched instead.
The cardio folk were sharper, their memory and attention improved, compared
with the stretching group. Exercise helps your brain to make BDNF,
which creates brain cells and connections. New capillaries also grow with
exercise, nourishing these cells and connections that would otherwise wither
away under the pressure of ageing. In the over-50s, exercise is a sort
of wonder drug that makes you more mentally agile, less forgetful and delays
the loss of sharpness. Some have hypothesized that exercise is helpful
because it involves learning new motor skills, a mental challenge that
gives your brain a work out. But this would result in growth specifically
in the motor areas of the brain, and that people learning new stretches
would gain the same benefit as those learning new aerobic routines. Neither
seems to be the case. It is true, however, that mental exercise also helps
the brain to stay sharp. Use your mind as much as possible and learn to
link information to images or sounds in order to strengthen your memory
: do not think about yourself with adjectives such as 'grey' and 'old',
focusing instead on positive ones such as 'healthy' and 'active'. Studies
have shown that simply thinking about these words can affect how someone
behaves, changing how quickly they walk, for example. Robertson's team
plans to work out an optimum mixture of mental and physical exercises to
keep minds sharp.
HIV/AIDS prevention and peace through sport : sport is rapidly gaining
recognition as a simple, low-cost, and effective means of achieving the
Millennium Development Goals: a set of benchmarks agreed on by the international
community to be achieved by 2015. Sport and play are fundamental to healthy
child development, teaching children essential values and life skills,
such as teamwork, cooperation, and respect. These factors help to build
resilience by building confidence through the acquisition of skills, and
create a meaningful connection to adults through positive coaching relationships.
Active children grow into active healthy adults. WHO notes that, with physical
inactivity and poor diet being the major risk factors for non-communicable
diseases, exercise has become a fundamental way to improve the physical
and mental health of individuals. Furthermore, the convening power of sport
and its ability to effectively transmit non-political messages about health
and behaviour change mean it plays a major part in the prevention of infectious
diseases, such as HIV/AIDS, malaria, and tuberculosis. According to reports
from UNAIDS, at the end of 2003 more than 40 million people were living
with HIV/AIDS. 25 million of these individuals live in the countries of
sub-Saharan Africa, where unsafe sexual practices are widespread and remain
the most prevalent mode of HIV transmission. Girls and women are especially
vulnerable to HIV/AIDS, according to UNAIDS, and in sub-Saharan Africa
are 1.2 times more likely to be infected than men. In 2003, a joint UNICEF,
UNAIDS, and WHO report revealed that in the areas where infection rates
were declining, young people were being empowered with information and
the skills to adopt safer behaviours. Sport and play are the natural forums
for knowledge and information sharing, and should be used alongside other
mechanisms to raise awareness of the HIV epidemic and to facilitate prevention.
The convening power of sport can be effectively used to tackle stigma and
discrimination, and to reach out to the most vulnerable populations—namely,
girls, adolescents, and street children or young people—with messages about
HIV/AIDS prevention (panel 1). Indeed, in 2004, in recognition of the power
of sport to break down barriers and of its importance in communities, UNAIDS
signed a memorandum of understanding with the International Olympic Committee,
in which both organisations agreed to combine their efforts to raise awareness
about HIV/AIDS.
Football for Life :
a programme supported by UNICEF in Honduras, Football for Life promotes
HIV/AIDS prevention and strives to protect young people from sexual exploitation.
Older adolescents volunteer as role models for younger football players,
and a weekly match is accompanied by discussion about HIV/AIDS.
Kicking AIDS Out! : this initiative
is a global network partnership, which draws on the strengths of a diverse
network of organisations. The members of the network use sport and physical
activity to motivate behaviour change and increase community awareness
about HIV/AIDS through various programmes, such as peer mentoring and leadership.
Right To Play implements HIV/AIDS
awareness programmes in several countries. In rural Mozambique, for example,
the international organisation works to increase HIV/AIDS awareness. It
trains local coaches to serve as role models for children and young people
and aims to reach the most remote communities with correct information
and prevention messages. By using traditional games, children in Mozambique
readily learn the myths and facts about the epidemic, and convey this information
to others.
Mathare Youth Sports Association (MYSA)
: in Kenya, the MYSA has been training coaches, leaders, and young people
on health-related issues, including HIV/AIDS prevention, often through
organised sport events where young people learn about HIV/AIDS during breaks.
MYSA also holds so-called gender forums, where boys and girls, guided by
coaches, discuss issues related to HIV/AIDS and its prevention. MYSA firmly
believes that sport and fair play—respect for your teammate, your opponent,
yourself, and the game—will help eliminate HIV/AIDS-related discrimination
by including people who live with the disease.
A comprehensive approach to HIV prevention, one that uses various methods
from which people can choose, works best. This fact is especially true
with respect to young people. Empowering them with facts, skills, and means
for protection is crucial to halt the spread of the epidemic. Repetitive
sport and play activities, which emphasise healthy behaviour, provide a
great opportunity for children to learn how to protect themselves from
HIV/AIDS. Reducing HIV-related stigma and discrimination and focusing on
vulnerable populations is another area where sport can help, because of
its inclusive nature. Sport and play activities, which involve children
who live and are affected by HIV/AIDS, encourage open discussions, dispelling
myths and breaking down the stigma that surrounds the illness. In addition
to the important role of sport in the fight against HIV/AIDS, in communities
worldwide it is used to encourage peace. The tradition of the Olympic Truce
is an obvious example. It represents the longest lasting peace accord in
history and is accepted at the highest international level. In 2004, North
and South Korea marched under the same flag of the Korean Peninsula at
the opening ceremony of the Olympic Games, and athletes from Iraq received
an especially warm welcome from the audience. In 1998, during the Nagano
Winter Olympic Games, the observance of the Olympic Truce allowed the UN
Secretary-General Kofi Annan to intervene to seek a diplomatic resolution
to the crisis in Iraq. As an international language for peace, sport is
increasingly being used by agencies of the United Nations and non-governmental
organisations. In partnership with grassroot and local agencies, they deliver
non-political messages about peace, using sport—for example, for the reintegration
of former child combatants into the community, and for teaching refugees,
internally displaced populations, and other vulnerable people peaceful
conflict-resolution skills. In Israel and the Palestinian Territories,
children from both countries play football together, assisted by The Peres
Center for Peace and Right To Play. Children from five Palestinian communities
from the West Bank and East Jerusalem, and from five Israeli communities
from all across Israel come together for regular sport and play activities,
supervised by trained Israeli and Palestinian coaches. The targeted communities
have high unemployment, and little interaction between Palestinians and
Israelis is otherwise seen. Sport is used in this project to bring together
Palestinian and Israeli children in a neutral environment. Through sport
and play, children are encouraged to communicate with one another, and
to learn the importance of teamwork. 100 Palestinian children from Beit
Zafafa and 100 Israeli children from Kiryat Gat, ranging in age from 6
to 13 years, currently take part in the programme. The children are exposed
to cultural differences, and learn to accept them while improving their
sport skills. They experience teamwork and the benefits of cooperation,
while gaining confidence and leadership skills, as well as learning about
fair play and responsibility. The programme involves two training sessions
per week, each lasting 90 minutes, and a monthly organised play activity.
The children are also engaged in auxiliary educational support sessions,
with a view to improving their scholastic abilities. Finally, the children
participate in a peace education component, structured around a manual
that has been developed specifically for the needs of this project. In
their sport and play activities, children are guided by trained coaches
from both countries. In Burundi, to alleviate ethnic conflicts, the International
Olympic Committee and the United Nations Development Programme have supported
an initiative launched by young people in Bujumbura to promote inter-ethnic
tolerance and understanding, by bringing young people from different ethnic
backgrounds together for sport activities. Since the late 1990s various
international forums have discussed the potential contribution of sport
to human development, emphasising its development and peace-building potential.
In 2003, the United Nations General Assembly adopted a special resolution—sport
as a means to promote education, health, development, and peace—that called
on governments to secure a place for sport in national programmes and policies.
However, what seems to be missing from the current discourse is the general
commitment of national governments to give sport and play a chance as actors
in development. Furthermore, an overall acceptance of a comprehensive definition
of sport, which is not limited to the elite sports, but encompasses all
forms of physical activity, is needed. The definition should be built on
the values of inclusion, respect for your opponents, and fair play. In
some countries, already scarce government resources dedicated for sport
are spent entirely on the elite sports, which are open to few and do not
directly benefit many. In other countries, sport for all is regarded as
a luxury. Only a handful of developed countries, such as Canada, Holland,
USA, Norway, and Switzerland, actually use sport in their foreign-assistance
policies, and provide targeted funding to a handful of sport-based initiatives.
Despite the international consensus of their importance for child and community
development, sport and play programmes often remain on the margins of governmental
support and attention. To sustain the available efforts, and to give the
most disadvantaged children a sporting chance, support from national governments
is crucial. Inclusion of sport as a method for development in the national
programmes and policies is key to ensure the lasting legacy of current
development efforts. To achieve this aim, several objectives need to be
met: strong links between sport and achievement of the Millennium Development
Goals need to be established; existing best practices from the field need
to be converted into policy; and viable partnerships—between national governments,
civil society actors, and the United Nations—need to be built in sport
and developmentref
rehabilitation through sport—pilot project with amputees in Angola : “While
sport has value in everyone's life, it is even more important in the life
of a person with a disability. This is because of sport's rehabilitative
influence, and the fact that it is a means to integrate the person into
society … sport teaches independence”. Within the global agenda of sport
for development lies a specific population—people with a disability. The
World Bank estimates that 600 million people, or 10% of the world's population,
have a disability, of whom at least 500 million live in the developing
world. These numbers continue to increase as a result of political conflict,
accidents, and a high incidence of untreated disease for example. Sport
has an important role in the lives and communities of all individuals,
but has benefits beyond those applicable to all for individuals with a
disability (panel). The importance of sport for re-education and rehabilitation
is undisputed. Benefits of sport for individuals with disability :
assists a person to come to terms with their disability
reduces the focus on the impairment or disability and focuses more on a
person's abilities, leading to empowerment and greater self-confidence
that can be applied to other areas of life—eg, education and employment
strengthens participants both mentally and physically, increasing their
capacity for self-help
increases peer interaction and socialisation, since people with a disability
often remain in the home environment, protected and guarded by their families
promotes inclusion of girls and women who are often stigmatised by their
sex as well as their disability
provides opportunities for teaching empathy; by involving participants
with and without a disability in sport programmes, there is increased understanding
and sensitivity about individual differences that can also assist in preventing
social exclusion
After World War II, traditional methods of rehabilitation could not meet
the medical and psychological needs of the large numbers of soldiers and
civilians with a disability. As a consequence, and at the request of the
British Government, Ludwig Guttmann founded the National Spinal Injuries
Centre at the Stoke Mandeville Hospital in UK in 1944. Guttmann introduced
sport as a form of recreation and as an aid for remedial treatment and
rehabilitation. His work was the basis for the Paralympic Movement. When
Pope John XXIII received Sir Ludwig Guttmann at the opening in Rome of
what are now considered the first Paralympic Games he called him the “Coubertin
of people with a disability”. Guttmann himself never tired of repeating
that the best thing he did in his medical career was to introduce sport
into the rehabilitation process, giving three reasons for its importance.
The first was the therapeutic value of sport in improving the functional
capacities of patients and surpassing the constraints imposed by traditional
medicine. Second, was the psychological effect of sport to overcome problems
of identity caused by disability, especially in people who saw themselves
as different, torn between rejection and acceptance of their own body.
The practice of sport, Guttmann noted, leads to motivation, pleasure, courage,
and strength. Finally, Guttmann described sport as a means of social inclusion
because of the visibility of the positive aspects that sport brings in
relation to people with a disability, making them the subject of the action
and empowering them with capacity and potential to be active members of
society. Here, we describe the rehabilitation through sport project in
Angola, which was created and implemented by the International Olympic
Committee, the International Paralympic Committee, the National Paralympic
Committee, the National Olympic Committee, local government, and local
rehabilitation centres. The aim of the initiative is to increase the quality
of life of people with a disability in postconflict or developing nations,
through
the mobilisation of expertise in the import and application of sport in
rehabilitation, through a human-rights based approach. Sport is a perfect
foundation for such a project because it is a universal activity, popular
with mainstream society, can be accessible to all, and can be implemented
at low cost. In theory, for every project set up, rehabilitation professionals,
focusing on physiotherapists, will receive three 2-week training sessions
spread over 12 months. During these sessions, they will learn about the
benefits of sport in the rehabilitation process, how to teach and lead
sport-activity sessions, and appropriate techniques for coaching athletes
through their rehabilitation and on the field of play. They will also be
told about the opportunities that are available in their country for people
with a disability. The professionals will then organise regular sporting
activities both in the rehabilitation centre and in the community. Those
trained will, in collaboration with the National Paralympic Committee,
be responsible for creating or expanding a network of volunteers to ensure
there is communication within the community. A comprehensive toolkit of
training materials and sports equipment for successful implementation of
these projects will be provided, and is being developed through a pilot
project in Angola. Angola was chosen as the site for the pilot project
because it is among the top three countries most affected by landmines.
From 1975 to 2002, Angola endured a civil war during which many people
lost limbs. Unfortunately, the risk from landmines remains. According to
the Vietnam Veterans of America Foundation, there are more than 2200 known
minefields in Angola, which killed or injured 660 people in 2004. The Angolan
National Paralympic Committee, the Angolan National Olympic Committee,
the Angolan Government, and the Bomba Alta Orthopaedic Centre (COBA) are
all involved with the project. COBA is located in the Huambo Province and
was selected as the site for the project because of its sophistication
in providing rehabilitation services, facilities, human resources, and
ongoing help to individuals newly injured by landmines. The centre is under
the supervision of the Ministry of Health and is run at a provincial level
by the Huambo Provincal Health Authority. In Angola, eight physiotherapists
and sport trainers have, as of August, 2005, completed their training with
one of us (JC), an international expert of Portuguese nationality to ensure
effective communication. The sports equipment has been provided and activities
are underway. This project has already achieved a great deal. It has brought
together the International Olympic and Paralympic Committees in their first
international development partnership, and nationally draws them together
with support from local government. The project has also benefited the
Huambo Province, torn apart by the civil war, in enriching the quality
of services at COBA. And it has increased awareness of the abilities, inclusion,
leadership potential, and rights of people with a disability in the province.
The primary challenges now for the project in Angola are effective dissemination
of the knowledge gained to other provinces and rehabilitation centres,
and identification of ways to assist individuals with a disability and
an interest in sport to advance to a higher level to train and compete.
On the basis of the lessons learned during the setting up of the pilot
project, the partners intend to revise the project plan and identify new
nations in which to implement a similar project in the coming years. The
drive to continue this project in other nations is primarily to provide
an impulse to postconflict countries to improve opportunities for people
with a disability and to expand the reach of sport for all. Jorge Carvalho
is a Professor in the Faculty of Human Kinetics at the University of Lisabon,
Portugal, and has been the national technical director for the Portuguese
Sports Federation for the Disabled (FPDD) since 1993. Amy Farkas has a
Masters degree in Disability Studies from the University of Illinois, USA,
works with numerous organisations on international development projects
that use sport as a tool for sustainable development, focusing on the needs
of people with a disability, and is development manager for the International
Paralympic Committee. The International
Paralympic Committee is the international governing body of sport for
athletes with a disability. It supervises and coordinates the organisation
of the Paralympic Summer and Winter Games and other multidisability competitions
on an elite sport level. The Committee is made up of 161 National Paralympic
Committees, five Regional Paralympic Committees, and four International
Organisations of Sports for the Disabled. With the mission to organise
successful Paralympic Games and its expansive membership the International
Paralympic Committee is also responsible for developing sporting opportunities
worldwide for athletes of all standards—from grassroots to the eliteref.
Mrutunjay Padmacharan Mandal a 7 year old boy who was to set an 80 kms
marathon record in Mumbai today collapsed before completing the race. The
boy began his run at 4:35 am early this morning from Durgadi Fort in Kalyan
and was to reach the Gateway of India by 1 pm but the boy collapsed near
Kemps Corner in Mumbai and died at the GT hospital. Mandal has already
completed a 70-km run from Ujeleshwar to Paschimeshwara temple in Behrampore
in 6 hours in April 2006. The boy inspired by long distance runner Budhia
Singh has been practicing for the last 1.5 year and was running a distance
of 20 kms everyday