E d ito rial Journal of the South African Sports Medicine Association Olympic Issue The growth and international acceptance of sports medicine owes much to the modern Olympic Games.1 The first significant event was the creation of the International Olympic Committee(IOC) Medical Committee in 1964 with the express responsibility of controlling drug use in Olympic competition. The work of that committee focused global attention on our profes­ sion and its role in contemporary issues in international sport. ° More recently that committee has been respon­ sible for selecting the first recipient(s) of the IOC Olympic Prize which honours scientists with a lifetime of exceptional achievement in the sports sciences. This award, perhaps the equivalent of a Nobel Prize in the Sports Sciences, will be bestowed on Professors Ralph Paffenbarger and Jerry Morris prior to the start of this year’s Atlanta Olympic Games, and will further enhance the stature of the profession before a massive global audience. Professor Ralph Paffenbarger has been a friend of South African sports medi­ cine for many years; he spoke at our International Congress in Cape Town in 1989 and has complet­ ed both the Two Oceans and Comrades Marathons, the latter when he was well into his sixties. The work of these two visionary giants has established that physical inactivity is a major fac­ tor for coronary heart disease and also contributes to the aetiology of a number of other diseases including hypertension, diabetes and cancer of the large bowel. It is appropriate that the Olympian life work of these two great gentlemen of the sports sciences should be appropriately recognised; their work proves the value of physi­ cal activity and provides the intellectual anchor which our professional credibility is secured. The second Olympic event that has helped in the growth of the sports sciences was the quite dramatic rise to dominance of the Eastern German Democratic Republic(GDR), in Olympic competition. During the 1968 Olympic Games, the first Games in which the GDR competed as a team separate from West Germany, their athletes won 25 medals. In the 1988 Olympic Games, athletes from that country won 102 medals, one more than the total medal count for athletes from the United States, a country with a population almost tenfold larger than that of the GDR. Other nations perceiving that this success resulted from a more “scientific” and professional approach to sport in the GDR, began to investigate ways in which science could be profitably applied for the enhancement of human sporting performance. Of the Commonwealth Countries, Australia and per­ haps to a lesser extent Canada, have taken the lead in these developments. The third important factor was the holding of the 1968 Olympic Games at Mexico City at an alti­ tude of 2270m . Never before had the Olympic Games been held in a city so high above sea-level! This single event first exposed, on an internation­ al scale, the very embarrassing inadequacies in our knowledge of some quite basic issues in the applied spoils sciences. For at that time, the real effects of medium altitude on athletic perfor­ mance were simply not known. Nor had the poten­ tial health risks associated with holing Olympic competition at altitude been studied. Many of the great exercise scientists of the modem era first cut their scientific teeth in the research of that question. I would suggest that analysis will show that it was after 1968 and the scientific stimulus provided by those Olympic Games, that our pro­ fession really took off. Mindful of the importance of Olympic Games for our profession, it is appro­ priate that this issue of our journal should be devoted to sports medical issues of special rele­ vance to the Olympic Games. It is often useful to begin in the past. To set the scene, Dr Floris van der Merwe reviews some of the great moments of South African achievements in Olympic track and field competition. He reminds us that only 5 South African athletes have won medals in the Olympic track and field competition. Only one of those gold medals has been won since the Second World War, suggesting that our international standing in international competition has fallen. He points out that politics robbed South Africa of some of its greatest recent track and field athletes like Sydney Mare, Mark Plaatjies and Freddie Fredericks, world-class ath­ letes who might well have won Olympic medals for South Africa in the more recent Olympic Games. If political factors, since corrected, restricted our Olympic potential in the past, I would suggest that the future success of our Olympic athletes will require that they receive the best that our profession can offer, including our capacity for innovation. For analysis of the great Olympic ath­ letes reveals that most were in the forefront of innovative training methods. The great Finnish distance runners who dominated the early Olympic Games owed their success to the intro­ duction of distance training during the winter months.2 These methods were refined by Paavo Nurmi, one of the first runners to include regular speed training in his preparation. Nurmi is con­ sidered to be the greatest Olympian of all time.8 Emil Zatopck refined the techniques of speed training, winning a total of 4 gold medals at the SPORTS MEDICINE JULY 1996 1 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2. ) 1948 and 1952 O lym p ics in cluding the 4 2k m m arathon w hich he c o n s id e r e d the “ most borin g ra ce ” he had ever run! T h e next g reat Furnish nuuier, Lasse V iren, w on 4 g old m e d a ls in 1972 mid 1976 with th is in troduction o f the c o n c e p t o f racing infrequently and “ p e a k in g ” only for the O lym pic G a m es, a tech n iqu e also follow ed by Frank Shorter, g old and silver m ed a llist in the 1972 and 1976 O lym p ic M arathons respectively. W hat innovative training teclm iq u es will our a th ­ letes have follow ed in then- preparation for the 1996 O lym p ic G a m e s ? T h e a rticles b y D rs J o h n H aw ley and H elg o S c h o m c r and Ms. E lskc S ch abort review the p h y s­ iological and p sy ch olog ica l factors that con trib u te to the su cc e ss in international sp ortin g c o m p e t i­ tion. Hawley and S ch abort review the prog ression o f w orld m im in g r e c o r d s and ask w h eth e r there are iden tifiab le ph y siological ch a n g es that might explain the p rogressive pattern o f im provem ent in th ese record s. T h ey c o n clu d e that the m axim um oxygen con su m p tion o f the m o d e m w orld record h o ld e r is not lik ely h ig h e r than that o f earlier re co rd h old e rs. R a th er the variable that has ch a n g e d , is the s p e cific en du ran ce w h ich is the cap acity to sustain a h igh p ercen tage o f the m axi­ mum oxygen con su m p tion for lon ger din ing c o m ­ p etition . Factors that cou ld explain this ch an ge in clu d e im proved running tracks, com m e rcia lism , p r o fe s s io n a lis m , m ore n u m e ro u s c o m p e tit iv e opp ortu n ities, im proved nutrition, anti p erh ap s the use o f p h a m ia co lo g ica l agents in training. hi h is d e ta ile d yet practical article, Dr H elgo S c h o m c r review s the p sych olog ica l preparation for O lym pic com p etition . H e b e g in s with the p rem ise that there are no physical d iffe re n ce s b etw een the very best a th le te s in any sport. R a th er th e w inner is the ath lete w h o is m entally the stron g est on the day o f com p e titio n . S c h o m c r id e n tifie s the four im portan t psych olog ical factors d eterm in in g s u cc e s s and d e s c rib e s the p s y ch o lo g ­ ical sk ills training p rog ra m m e s that are cru cial for d e v e lop in g th ose sk ills. H e su g g ests that sp ortin g su c c e ss c o m e s w hen th ese tech n iq u e s b e c o m e se c o n d nature. H e p ro v id e s appropriate g u id e ­ lin es for p sy ch o lo g ica l training and c o n c lu d e s that lifelon g practice is requ ired to p e r fe c t th ese m en ­ tal sk ills. O f co u rse, the value o f th ese mental sk ills ex ten d s b ey on d th e O lym p ic arena, to all levels, o f sp ort and to d aily life. But th e m ajor O lym p ic ch a lle n g e rem ain s the p rom otion o f fa n com p e tition by elim in atin g the u se o f p erform a n ce en h a n cin g d ru g s in clu d in g the a n abolic ste ro id s , ery th rop oeitin and grow th h o r ­ m one. D r G eo rg e van D ugteren o f the National OhTnpic C o m m ittee o f S outh A frica (N O C SA) has p re p a re d an A n ti-D o p in g p o lic y on b e h a lf o f NOCSA and th e South A frican Institute for Drug- free sport. T h is p o licy is r e p ro d u ce d h ere, as is th e la test(1 9 9 6 ) e d itio n o f th e IOC list o f bann ed drugs. T h is is crucial inform ation for all w h o treat or advise our O lym pic ath letes. A n oth er im portant sou rce o f th is inform ation, the M IM S b o o k , P erm itted and B anned D rugs in S port - has recen tly b e e n p u b lish ed b u t is p erh a p s not as w id ely known as m ight be h op ed . T h e a d d i­ tional value o f that pu blication is that it p rov id e s lists o f ban n ed and perm itted d ru g s a c co r d in g to th eir trade n am es. T h is allow s the ath lete and his or her m ed ica l con sidtan t to b e absolu tely certain o f the status o f any m ed ica tion available in South Africa. T h e b o o k is available only from the M IM S o ffice (PO Box 2 0 5 9 , Pretoria, 0 0 0 1 : ph on e num ­ b e r 0 1 2 3 4 8 5 0 1 0 ). T h e issu e a lso in c lu d e s on e o f th e m ost th ou g h t-p rov ok in g a rticles on d ru g co n trol in sport that I have read. In h is article Australian sp orts ph ysician Dr M anuel C usi p o s e s three d if­ ferent scen a rios th at m igh t b e en cou n tered by any d o c to r treatin g a th letes. T h e first involves the p rescrip tion o f an a b olic ste ro id s or o th e r banned d ru g s bv d o c to r s a p p oin ted in an official capacity to sp ortin g team s. Cusi argu es that such d o c to r s may not p re scrib e bann ed su b sta n ces to team m em b ers. T h e secon d scen a rio is p erh a p s m ore com m on and involves the p rescription o f an abolic s te r o id s for a th le te s involved in non com p etitive sports. Again the eth ica l p ositio n taken by Cusi is that su ch d ru g s sh ou ld not b e p re s crib e d by d o c ­ tors and the reasons for th is position are carefully argued. H is third scen a rio p resen ts the problem o f p rescrib in g m ed ica tion for the treatm ent o f legitim ate m ed ica l co n d ition in an ath lete w h o c o m p e te s in a sp ort in w h ich that sp ecific d ru g is b a n n ed . H is con clu sion m ay seem surprising. P erhaps h is m ost ch a llen g in g statem en t is that his th ree scen a rios “ in dicate that m ed ica l p ra c­ tice is m ore co m p le x than the IO C ’s an ti-dopin g rationale a d m its .” Long may th is d eba te con tin ue. S p ecial thanks are due to all oiu- a u th ors for th eir d ilig e n ce in sh arin g then* k n ow led ge and sp ecia lly to ou r A ustralian co lle a g u e s, Dr C usi and D r P eter Brukner, form er e d ito r o f S p ortH ealth , w h o have given th eir p erm ission for the use o f D r C u si’s article. We w ish our a th letes and th eir m ed ica l su p port team all p o s sib le su c ce ss in the Atlanta O lym pic G a m e s and h ope that th is issue o f ou r jou rn al will porten d a favourable ch an ge in S ou d i A frica ’s recen t a ch ie v em en ts in O lym p ic com p etition . Editor Professor Tim Noakes MRC/VCT Bioenergetics o f Exercise Research Unit and Liberty Life Chair o f Exercise and Spurts Science, Spurts Sciencc institute o f South Africa. Buundary Road. Newlands, 7700, South Africa. REFEREN CES 1. Noakes TD. The Olym pic Gaines and Sports Medicine. British Journal o f Sports Medicine. 2. Noakes TD. Lore o f Running. Oxford University Press. 1992. 3. Johnson WO. H7io is the g rea test? Time Magazine, June 24tli, l996.pp68-89. pi 2 SPORTS MEDICINE JULY 1996 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2. ) Till* SOI T i l A F K I C A W I O l ' K W I OI SPORTS MEDICINE VOLUME 3 NUMBER 2 Editor ProfTD Noakes Dr MP Schwellnas Editorial Board Dr M E Moollu Dr P de Jayer Dr J Skowno Dr P Schwartz Prof R Stretch Dr C de Ridder Prof B C And re ics Dr E W Dennan Mr R H Farman Prof M Mars Dr C A Noble International Advisory Board Lyle J Micheli Associate Clinical Professor o f Orthopaedic Surgery Boston, USA Chester R Kyle Research Director, Sports Equipment Research Associates California, USA Pro) HC Wildor Hollmann Prasident des Deutschen Sportarztebiuides Kohi, West Gennany Howard J Green Professor, Department of Kinesiology' Ontario, Canada George A Brooks Professor, Department o f Physical Education California, USA Neil F Gordon Director, Exercise Physiology Texas, USA Edmund R Burke Associate Professor, Biology’ Department, University o f Colorado Colorado, USA Graham N Smith Physiologist Glasgow, Scotland JULY 1996 C O N TE N TS Editorial TD Noakes Onthullings oor Suid-Afrika se goue medaljes in atletiek FJG Van der Merwe The limits to human performance: A physiological perspective J A Hawley EJ Schabort Psychological preparation for Olympic athletes H Schomer NOCSA - anti-doping policy G Ruijsch van Dugteren South African Institute for drug-free sport 13 18 23 Doping and clinical practice: Ethical Perspectives 27 MF Cusi The Editor, The South .African Journal o f Sports Medicine P O B o x 115, Newlands 7725 PRODUCTION A ndrew T hom as PUBLISHING G lenbarr Publishers ce Private Bag X I 4 ParkJands 2196 Tel: ( O i l ) 44 2-9 759 Fax: ( O i l ) 88 0-7 898 ADVERTISING Marike de W aal/Andrew T hom as REPRODUCTION Output Reproductions PRINTING Hortors Reparil-Gel R elieves m u scula r pain Editore' the Adv^nr^>111 ^ lhc I*?rsonaJ the Authors and are not necessarily shared b v the ------------- e ertlSerb or Ulc Polishers. No articles may be reproduced yyitliout die written consent of the Publishers. SPORTS MEDICINE JULY 1996 3 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2. ) ONTHULLINGS OOR SUID-AFRIKA SE GOUE MEDALJES IN ATLETIEK F J G v a il d e r M e r w e , D Phil, Departement Menslike Bewegingskunde, Universiteit van Stellenbosch Abstract South African sport is back in the international arena and is doing quite well lately. This year is the centenary of the m odem Olympic movement. South Africa is hop­ ing to win a gold medal in the track and Held athletics. So far only five South African athletes have succeeded in winning this much sought-after trophy. They were Reggie Walker (1908), Kenneth McArthur (1912), Bevil Rudd (1920), Sid Atkinson (1928) and Esther Brand (1952). With the exception o f Esther Brand, all o f South Africa’s gold medals were won before the Second World War. Already in 1947 Dr Ernst Jokl predicted that the African athletes would follow in the footsteps o f the Scandinavian achievements. Unfortunately Ihe SAAAU put a colour ban on athletics as early as 1931. This, and the later apartheid policy, deprived many non-white athletes o f the opportunity to win a gold medal in the Olympic Games. Keywords: South Africa, Olympic Games Track and field athletics. Inleiding Die Springbokke is die wereld se rugbykampioen, die Bafana Bafana is Afrika se sokkerkanipioen en die Proteas het hul voete in intemasionale lcrieket gevind en gaan van krag tot krag. Die lang droogte wat die beleid van sportisolasie jeens Suid-Afrika meegebring het, is iets van die verlede. Vanjaar word die m odem e Olimpiese Spelebeweging 100 jaar oud en Suid-Afrika neem vir die tweede keer sedert 1960 daaraan deel. Baron Pierre de Coubertin se Olimpii'sme1 wat behels dat sport eerder karakter moet kweek as rekords najaag, was nog altyd net ’n cLroom. Wanneer daar van Olimpiese helde gepraat word, is die silwer- en brons- medaljewenners van minder belang - die held(in) 1)1 j- nou eenmaal die persoon wat die hoogste plek op die rostrum ingeneem het. H ierdie prestasie het Suid- Afrika slegs tussen 1908 en 1952 te beurt geval. Dit will tans voorkom asof Suid-Afrika ’n goeie kans op ’n goue medalje in Atlanta in atletiek sal he. In retro- speksie het Suid-Afrika van 1908 tot 1960 en in 1992 slegs vyf al l etiekprestasies opgelewer wat goed genoeg was om ’n goue medalje te verower. Daar sal in die onderhawige artikel kori.liks gemotiveer word waarom hul prestasies so uitsonderlik was. Metode In ’n studie van dergelike aard word die histories- wetenskaplike m etode gebruik met die klem op primere bronne ten einde die verlede so noukeurig en volledig moontlik te rekonstrueer. Die primere bronne was onder andere die notules van die Suid-Afrikaanse Olimpiese en RykspeleverenigLiig, notules van ver- gaderings van die Intemasionale Olimpiese Komitee, amptelike verslae van spanbestuurders en afrigters, amptelike verslae van die Organiserende Komitees van elke Spele, en onderhoude en korrespondensie met deelnemers en ander ooggetuies. Nadat die bronne aan interne en eksteme kritiek onderwerp was, is die inligting tot ’n sintese gevoer. Resultate en bespreking Alhoewel Suid-Afrikaners (waaronder twee Zoeloes) al in 1904 in St. Louis aan die Olimpiese Spele deelge- neem het, was die eerste amptelike deelname eers in 1908 toe die Spele in Londen plaasgevind het. Die 19- jarige Reggie Walker van Durban het daar ’n einde aan die Amerikaanse oorheersing in die 100 meter gemaak. Alhoewel James Rector in sy uitdun ’n Olimpiese reko- rd van 10,8 sek. opgestel het, het Walker dit in die semi-finaal en in die linaal geewenaar om sodoende die Amerikaner in die linaal die loef af te steek.~ Afgesien van die feit dat Walker Suid-Afrika se enig- ste Olim piese naelloopkam pioen is, is d it van akademiese belang om hier te let op ’n historiese wan- voorstelling wat met sy geval gepaard gaan. Sedert die Amptelike Verslag van die Londense Spele in 1909 gepubliseer het dat Walker nie oorsponklik in die Suid- Afrikaanse Olimpiese span opgeneem was nie,'! het hierdie fout herhaaldelik in verwante literatuur na vore gekom. Dit was eers toe die “verlore” notules van die Suid-Afrikaanse Amateuratletiekvereniging in die laat 1980’s opgespoor is, dat die voile waarheid ontbloot is. Dit was in werklikheid HT Phillips, ook ’n naelloper, wat eers later in die span opgeneem is nadat Pretorianers sy koste betaal het. Walker was van meet af aan in die span as sesde keuse.4 In die daaropvolgende Spele, in Stocldiolm 1912, was dit die marathonatlete se beurt om roem vir Suid- Afrika te verwerf. Kenned}7 Kane McArthur en Christopher Gitsham het nle net eerste en tweede onderskeidelik geeindig nie, maar Suid-Afrika was ook die laaste land wat so ’n dubbel prestasie in die marathon kon vermag. ’n Persoonlike onderhoud met HB Keartland,” die Olimpiese adetiekafrigter van 1912, het aan die lig gebring dat daar veel meer agter “ Kenneth” MeArther en “ Chris” Gitsham se prestasie skuil as wat die reko- rdboeke wil laat blyk. So byvoorbeeld was die Olimpiese marathon slegs die tweede dergelike nom- mer vir Gitsham. Keartland, wat die potensiaal in Gitsham raakgesien het, het hom oppad na Swede in Londen vir die Polytechnic-marathon ingesltryf. Gitsham het sy vuurdoop met vlieende vaandels ges- laag deur tweede te eindig. Hierdie marathon het ook as proewe vir die Britse Olimpiese adete gedien. Keartland was dit ook eens dat Gitsham meer talent as die gesoute Kenneth McArthur gehad het. Die twee Springbokke het die tweede helfte van die wedloop oor 40,200 km saam in die voortou afgele, maar volgens hom het Gitsham sy pas ingehou om vir sy spanmaat morele ondersteuning te gee. Vyf kilometer vanaf die stadion het Gitsham die roete verlaat om by ’n fontein 4 SPORTS MEDICINE JULY 1996 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2. ) water te gaan drink, f Ty was onder die indruk dat McArthur vir horn sou wag, niaar laasgenoemde het iii daardie tyd sowat 200 meter gevorder. Krampe het Gitsham toe genoodsaak 0111 ’n lang ent te stap voordat hy sy spamnaat agtema kon sit.11 Na afloop van die wed- loop het die saggeaarde Gitsham inderdaad beledig- ings na sy spamnaat geslinger omdat liy nie vir liom gewag het nie.7 McArthur se tyd was 2:36:54," en die van Gitsham, 2:37:52,0." Na die Eerste Wereldoorlog is die Spclereeks in 1920 in Antwerpen hervat. Op hierdie Spele liet Bevil Gordon D ’Urban Rudd die enigste Suid-Afrikaner geword om ’n volledige stel Olhnpiese medaljes te verower. AUioewel hy ten tyde van die Spele ’n Rliodes- student aan die Universiteit van Oxford was, het hy in Springbokkleure geliardloop en teen die verwagting in die Anierikaners onttroon om die goue medalje in die 400 meter te verower met ’n tyd van 49,6 sek. IIv het in die finaal die uitgetrapte binnebaan geloot, niaar desni- eteenstaande sy naaste teenstander met twee meter geklop. In die 800 meter het Rudd in die laaste pjivak voorgeloop toe hy gestruikel en sy enkel beseer liet. Iiy kon egter daarin slaag om steeds die bronsmedalje in te palm. Hy is in die proses deur die Britse en Anierikaanse kampioene geklop. Sy derde medalje was die sihver m die 4x400 meter alios.'1 hi 1928, in Amsterdam, het Sidney Janies Montford Atkinson die enigste Suid -Afrikaner geword om die 110 meter liekkietitel te verower.10 Wat sy prestasie nog meer indrakwekkend maak is die feit dat hy by die vorige Spele, in Parys, die sihvemiedaljewemier in die- selfde nonuner was. Hy het in die finaal ’n 0,25 meter voorsprong geliad toe hy die laaste liekkie raakgesltop en effens gestruikel het. Dit. was genoeg vir sy Anierikaanse teenstander (Daniel Kinsey) om hom na die lint te ldop. Alhoewel beide ’n tyd van 15,0 sek. aangeteken het, is Kinsey eerste geplaas." Vier jaar later het Sid Atlduson die nonimer in 14,8 sek. gewen. Met hierdie tyd het hy die ou Olhnpiese rekord van 1920 geewenaar.1- Dit was ook dieselfde tyd wat sy spamnaat, George C Weightnian-Smith, in die uitdmme behaal het. Weightman-Smitli, het in die semi-finaal egter ’n nuwe wereld- en Olinipiese rekord van 14,6 sek. opgestel. Li die finaal het hy die uitge­ trapte binnebaan geloot, alhoewel dit vir die beamptes mooutlik was om die hekkies so op te stel dat die bin­ nebaan nie gebruik h oef te geword het nie. Die uiteiiule van die saak was dat hy vyfde (15,0 sek.) en Sid Atkinson eerste (14,8 sek.) geenidig het.” Ira Emery, 49 jaar lank die sekretaris van die Snid- Afrikaanse Olnnpiese Spelevereniging en bestnurder van verskeie Springbokspanne na die Spele, het in sy boelt Springboks o f die Olympiad (1956) geskryf dat dit Atkinson -was wat. die binnebaan geloot het en dat liulle op Weightman-Smith se aandrang bane geruil het. Addnson sou toe in die vyfde in plaas van die bnmebaan gehardloop het. Geen ander prnnere bron onderstemi Emery se verliaal nie en die foto in die amptelike ver- slag van die Spele toon dat Atkinson in die derde baan gehardloop liet.11 Snaar Viljoen het as ooggetuie ook die verhaal van Emery ondten.1" Op ’n vraag waaroni hy nie oor die uitgetrapte binnebaan beswaar aangeteken het nie, het Weiglitman-Smidi verldaar dat hy nooit klagtes op die sportveld sal opper nie,10 Suid-Afrika se laaste goue medalje in ’n Olinipiese atletieknominer (en die enigste deur ’n vrone atleet) is in Helsinki in 1952 behaal toe die 28-jarige Esdier (nee van Heerden) Brand die hoogspring vir vrone gewen het. Haai- inshiiting in die Olinipiese span het met baie kritiek gepaard gegaan, niaar liaar wenlioogte van 1,67 meter was goed genoeg 0111 die wereldrekordhouer met 0,02 meter te ldop.17 Die Olhnpiese rekord op daardie tydstip was 1,68 meter.1" Hierdie prestasie het 1 1 jaar 11a liaar wereldrekord- sprong as 17-jarige skooldogter op Coetzenburg gekom. i o e , op 29 Maart 1941, het sjr ’11 lioogte van 1,65 meter behaal. Estlier se rekord is egter nie destyds as ’11 wereldrekord erken nie aangesien die rekordlioogte van 1,67 meter toe agter die naam van Dora Ratjen van Duitsland gestaan het. In 1957 is Raljen as ’11 man ont- bloot en sy rekord is in 1960 op ’11 vergadermg van die IAAF in Rome nietig verldaar. Hermann Ratjen se ver- weer was dat hy in die oorlogsjare deur die Nazi’s ged- 'ving was 0111 as ’11 won deel te lieem ten einde roeni en eer vir Dnitse sport te verwerl. Met die sltrappini? vail S57 rekord is Esdier s ’11 eers 19 jaar later as wereldrekord erken.lu Samevatting ’11 Statistiese ondeding van Suid-Afrika se prestasies op die Olinipiese Spele van 1908 tot 1960 dui aan dat die atlete 11a die Tweede Wereldoorlog nie so goed soos voor die oorlog gcvaar liet nie. Die enigste goeie na-oorlogse prestasie was in 1952 toe die 13 Springbokatlete twee medaljes ingepalm het. I11 1908 het Suid-Afrika se sewe adete twee medaljes verower, in 1912 het die sewe atlete twee, in 1920 het die 13 atlete drie en in 1924 het die 12 adete twee medaljes gewen. In 1928, 1932 en in I960 is slegs een elk behaal. Die atleetgetalle was tien, vier en agt onderskeidelik."" Hierdie artikel het slegs op die goue medaljes wat in 1908, 1912, 1920, 1928 en 1952 gewen is, gekonsentieer. I11 1947 het Prof Ernst Jokl gewaarslai dat Suid- Afrika “ bloedinin kails op die Ohmpiade” sou h e .21 In sy artikel liet hy daarop gewys dat Suid-Afrika se adetiekprestasies gestagneer liet terwyl die res van die wereld merlcwaardig verbeler het. Hy het dit be- klemtoon dat Suid-Afrika voor die Eerste Wereldoorlog ’11 werelclkrag in adetiek was, niaar dat die posisie drastics versleg het. Hy het vcrskillende atletieklande se bevolkingsgetalle met liul prestasies vergetyk en tot die slolsom gekom dat die Skandinawicse lande op daardie tydstip die kern van were]datletick gevorm het. Ily het ui daardie vcrband die volgende otmicrkiiiL! gemaak: A s hulle (Skandinawicse) opperheerskappy ooit be- dreicj gaan word, is daar slegs een antropologiese groep wat in die nabye loekoms 11 ernstige mededinger mag word, nl. daardie lede van die swarlvellige Afrikaanse (sic) rasse wat kontak met liulle bewerkstellig en hul kennis van meer ervare atleliese lande aanwend. Wat gaan Suid-Afrika met sy naturelle-atlete doen?~ Sedert die Olinipiese Spele van Mexiko-stad m 1968 het talle Ali'ikalande nieteoriese opgang in die adetielcwereld geinaak.** hi antvvoord op Jold se vraag omtrent Suid-Afrilca se “ naturelle-atlete” , m oct die blaam op die S.A. Aniateuratletiekvereniging geplaas word. Nog lank voordat die Nasionale Party ami bewind SPORTS MEDICINE JULY 1996 5 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2. ) Pevaryl The No. 1 Topical Antifungal' gckoin lict, het die beheerliggaain iii 1931 bcshiit am die kleiuskeiding toe te pas.'4 Hierdie besluit soil vir die daaropvolgende ses dekades ’11 veniictigende effek op Siud-ACrika se adetiekprestasies lie. Adete soos Sydney Maree, Mark Plaatjies eii Freddie Fredericks (om net ’11 paar van die mees oidangse gevalle te noeni) het hul lied in die buiteland gaaii soek. Daar kaii slegs gespekideer word hoeveel Reggie Walkers, Kenneth McArthurs, Bcvil Rudds, Sid Atkinsons and Esdier Brands in die apartlieidsera uooit hid talente ten voile ontwikkel het nie. VERWYSINGS 1. Van der M enoe FJG. Aspiration towards Olympism. Report o f the First Congress o f the Olympic A ca d em y o f Southern A frica. Port Elizabeth, 2 6 -2 8 June 1990. (P r e t o r ia ): Olympic A ca d em y o f Southern Africa. 1990: 63-70. 2. Van dcr Merwe FJG. Suid-Afrika se deelname aan die Olim piese Spele. 1908-1960. Ongepubliseerde D oktorale proefskrif. P otchefstroom : P U vir C-HO, 1978: 44-45. 3. Official Report o f the Olympic Gaines o f 1908. London: The British Olympic A ssociation , ( 1 9 0 9 ): 51. 4. Lauhscher L. The m yth about Reg Walker and the 1908 Olympic team. SA Sport Communico 1987; 8 ( 2 ) : 8-9. 5. Keartland HB. Persoonlike onderhoud. Johannesburg. 2 3 April 1976. 6. K eartland HB. P ersoonlik e korrespondensie, 31 Maart 1975. 7. Keartland HB. Persoonlike onderhoud. Johannesburg, 2 3 A pril 1976. 8. Kainper E. Encyclopcdia o f the Olympic Games. Dortmund: Harenberg, 1972: 8. 9. Van der Merwe FJG. Suid-Afrika se deelnam e aan tlie Olim piese Spele. 1908-1960. Ongepubliseerde D oktorale proefskrif. P otchefstroom : P U vir CHO, 1978: 143. 145-146. 155. 10. K ainper E. Lexikon der 12000 Olympioniken - W h o’s who al the Olympics. Graz: I^eykain-Verlag. 1975:10. 11 .Z u r Meyecle E. D ie G esch iclite der Olyinpischen Leichtathletik, Band 1. Munchen: B artels & Wernitz, 1968: 165. 12. K am per E. Encyclopedia o f the Olympic Games. Dortmund: Harenberg, 1972: 9. 13. Van der Merwe FJG. Suid-Afrika se deelnam e aan die Olimpiese Spele. 1908-1960. Ongepubliseerde D oktorale proefskrif. Potchefstroom : PU vir CHO, 1978: 250-253. 14. Official report o f the ninth Olympiad, Am sterdam 1928. Am sterdam : Netherlands Olympic Committee. 1928: 436. 15. Viljoen ,JH. Persoonlike onderhoud, Pretoria. 10 September 1975. 16. Zur Megede E. D ie G eschichte der Olympischen Leich­ tathletik, Band 1. Miichen: Bartels & Wernitz. 1968: 198- 199. 17. Van der M enoe FJG. Suid-Afrika se deelname aan die Olimpiese Sjiele. 1908-1960. Ongepubliseerde D oktorale proefskrif. P otchefstroom : P U vir CHO, 1978: 435. 18. K am per E. Encyclopedia o f the Olympic Games. Dortmund: Harenberg, 1972: 35. 19. Quercetani R J A t h l e t i c s - a history o f modern track and field athletics, 1860-1990, men and women. London: IAAJ', 1990: 255; Joubert A . Persoonlike korrespondensie, 1984. 20. Van der Merwe FJG. Suid-Afrika se deelnam e aan die Olim piese Spele, 1908-1960. Ongepubliseerde D oktorale proefskrif. P otchefstroom : P U vir CHO. 1978: 629. 21. Jokl E. Oils a tlete het bloedmin kans op die Olimpiade. Fleur 1947; 2 ( 4 ) : 41-43. 22. Jokl E. Otis a tlete het bloedmin kans op die Olimpiade. Fleur 1947; 2 ( 4 ) : 42. 23. Van der Merwe FJG. Sportgeskiedenis: ‘n Handleiding vir Suid-Afrikaanse studente. Stellenbosch: FJG Publikasies, 1994: 182-186. 24. A nderson PG. A n investigation into the effect o f race and politics on the developm ent o f South African sport (19 70 - 1 9 79 ). Ongepubliseerde D oktora le proefskrif. Stellenbosch: Universiteit van Stellenbosch, 1979: 36. Q 6 If you wish to see more, call your Roche Syntex Division Representative at (011) 974-5335 Universal application Trneo corporis n— _ L I,, _ rropnytoaic treatment tmeo corporis Tinea pedis Dandruff Seborrhoeic dermatitis Tinea capitis Otitis externa Tineo barfeoe T in e a versicolor R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2. ) THE LIMITS TO HUMAN PERFORMANCE: A PHYSIOLOGICAL PERSPECTIVE JA Hawley & E J Schabort ■■Running records are still far below human physiological limits. The i eslrainls on performance are psychological: good runners do not work as hard once they have set a record or won a medal." Ry(lcr c , aI (1()7G) H IS T O R IC A L B A C K G R O U N D Although tlic purest csseucc o f the sporl o f miming is the competition and stmgglc o f one atldelc against another, there has always been sometliing magical about the setting of' a world record, and its constant challenge bums Idee an eternal flame for those individ­ uals capable o f such goals. Those athletes who have bioken a world record belong to a “ super elite” group, for the stretching ofluunan capability, the breaking of barriers, and the conquest o f unknown territory arc pos­ itive qualities which define mankind as a whole. Li ath­ letics, world records also help to give reason and incen­ tive to those outstanding efforts o f a few athletes and ensure that the great names o f the past, as well as those o f the present and the future are never forgot­ ten.Sl But just how fast can men and women nm ? Wliat are the physiological limits to human performance? Will women ever nm as last as men over any distance? These and other questions have recently been the focus o f considerable scientific debate. Li the past, most theories 011 these issues were large­ ly inelegant because they were seldom based upon any scientific rationale and logic but, rather, instinctive pre­ dictions centred upon personal belief's o f die time.1'"'* Latel}-, however, results from competitive running events have provided valuable insight for sports seicn- tists into several key integrative areas o f exercise phys­ iology: world records offer a framework for die discus­ sion of how various physiological factors interact as determinants o f perfonnaiice.10'-,--'7',l:’"-4S Considerable effort is now focused 011 die study o f adiletic perfor­ m a n c e . I n d e e d , diuing die past decades many attempts have been made at providing a mathematical description ofluunan performances based 011 the char­ acteristics of the metabolic processes that provide e lcm ica l energy to power muscle contrac- tion.“' 1, -,,.-,':,?'’M« « A ’ These models (to be discussed sub­ sequently) often provide very accurate predictions o f estimated and actual athletic performance. Undeistandably, however, both coaches and athletes are highly suspicious o f sports scientists’1’ who claim from dicir theoretical mathematical models that “ a Correspondence: Dr John A Hawley, F.A.C.S.M. MRC/UCT Bioenergetics o f Exercise Research Unit sports Science Institute o f South Africa P O Box 115, Newlands 7725 Phonc:(0 2 1 ) 686-7330 Fax:(0 2 l ) 686-7530 muwinun or no training is required for approximately it) clays before a competition to avoid a negative effect of tramuig (fatigue) 011 competition perform;uicc!” I he purpose o f (his article is to investigale (he evo­ lution o f human performance and, within a physiologi­ cal uamcwork, examine the ‘ limits' to future athlciic lecouls. Obviously, a comprehensive disenssion o f all 1 mining eveuls over a wide range o f distances is bcvond (he scope of tliis article. For this purpose, (he men’s and womens record for the one mile ( 1 , 6 0 0 . 3 6 m) has en chosen to focus 011 dicse and other questions. THE PROGRESS OF HUMAN PERFORMANCE At the turn o f the cent my a famous coach o f (he lim e1 stated o f die men’s world mile mark: . . the man who has made this record is ll.’ G. George. His time . . . four minutes 12 seconds, and the probability is that this record will never be broken". Almost one hundred vcars later, die record for the men’s 011c mile is some 3 0 see ( o r approximately 2 1 5 1 1 1 ) faster (Table 1 ). However die current women’s record holder, Paula Ivan o f Rumania woidd still be soundly beaten by Walter George. 11 should be noted for posterity that William Cummimjs, the sole competitor numing against George, collapsed’ 7 0 yards hom the finish o f the race from ‘exhaustion'.51 lablc 1 : The evolution oj the men s one mile ( I.(>()<) metre) world record since the first sub-four minute mile in 1954 Atlilelc Nationality Roger G. Bannister Jolui M. Lnndy Derek Ibbotson Herbert J. Elliot Peter G. Snell Peter G. Snell Michael Jazv Ja m es R Rynn Jam es R. Rynn Filbert Bayi Jolm G. Walker Sebastian N. Coe Si even M. Ovett Sebastian N. Coe Steven M. Ovett Sebastiini N. Coe Stephen Cram N oin cddiiic M orccli Great Britain Australia Great Britain Australia New Zealand New Zealand France U.S.A. U.S.A. Tanzania New Zealand Great Britain Great. Britain Great Britain G reat Britain Great Britain Great Britain Algeria Perfbnuiuice Dale o f ( in in :see) record i 3:5 9.4 00 -05-1954 3 :5 8 .0 21 -00-1954 i 3:57.2 19-07-1957 3:5 4.5 00 -08-1958 3:5 4.4 2 7 -0 1 -1<)02 3:54.1 17-11.1904 3:53. 0 09-00-1905 3:5 1 .3 17-07-1900 3:51.1 23-00-1907 3:5 1 .0 17-05-1975 3:4 9.4 12-08-1975 3:4 9 .0 17-07-1979 3:4 8 .8 01-07-1980 3:4 8.53 19-08-1981 3 :4 8 .4 0 20-08 1981 3 :4 7 .3 3 28-08-1981 3:4 6.32 27 -07-1985 3:4 4 .3 9 12-09-1993 Why then is (lie men’s world mark for one mile still so far ahead o f the women’s? Can (lie differences in improvements seen in the men’s and women’s record over die past forty years be explained on a physiological basis? “ ^ SPORTS MEDICINE .JULY 1996 / R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2. ) Firstly, when considering the progress o f lnunan per­ formance, it should be noted that men have participat­ ed in organised competitions over a wide range o f stan­ dard distances for more than 100 y e a r s . It is oidy dur­ ing the past 20-30 years that similar opportiuiities have been afforded to women. Indeed, the International Amateur Athlctic Federation (IAAF) did not sanction races for women that were longer than 1,000 in until 1967 when the 1,500 in and the mile were “ officially” recognised. The .10,000 m for women was not added until as recently as 1981. It is somewhat miclcar when the IAAF began to aclaiowledgc the women’s marathon (42.195 ltm), but this event was not contested in Olympic competition until the Los Angeles Games in 1984. Secondly, an analysis o f recent, race times for women show that their world records and best performances arc not as consistent as those for men, particularly over the longer distances.1" Of course, one might reasonably argue that this is as a residt o f the shorter liistory of women’s middle and long distance running and die cor­ responding lack o f competitive opportunities. Thirdly, it is only during the past two decades that several coimtries, most notably China and some o f the African nations, have acknowledged and belatedly encouraged women’s participation in liigh level sport. Tims, when “ pre-IAAF” times are considered, the time span available to critically and objectively analyse women’s performances should probably be limited to the last quartcr-ccntiuy because o f insufficient opportu­ nities for women to compete at almost every level males have. Given this position of historical disadvantage, it is perhaps not siuprising to find that since 1954 Die rate of improvement o f the women’s world mile record is more tiian double that o f the men’s mark (14.7% ver­ sus G.3%, respectively). Finally, a closer examination o f Tables 1 and 2 reveal that, o f the 18 men’s mile world records since 1954 (acliieved by 13 numcrs), and the 17 women’s best per- Tablc 2: The evolution o f the women's one mile (1,609 metre) world record since the first sub-five minute mile in 1954 Athlete Nationality Perform ance (in in :scc) Date o f record Diane Leather G reat Britain 4:59.6 29-05-1954 Diane Leather Cheat Britain 4 :5 0 .8 24 -05-1955 Diane Leather G reat Britain 4 :4 5 .0 21 -09-1955 Marisc CIianilx-Tluiii New Zealand 4:4 1.4 OS-12-1962 Aimc Smith G reat Britain 4:39.2 13-05-1967 Aimc Sm ith G rea t Britain 4:37.0 03-06-1967 Maria G onnners Holland 4:3 6.8 14-06-1969 Ellen Tittel East Germ any 4:3 5.3 20-08-1971 Paola Cacchi-Pigni Italy 4:29.5 08 -08-1973 Natalia Maraseseu Rom ania 4:2 3.8 21-05-1977 Natalia Maraseseu Rom ania 4:22.1 27 -01-1979 Mary D cck cr U.S.A. 4:21.7 26 -01-1980 Lyudmila Vcscllcova U .S .S .R 4:2 0 .8 9 12-09-1981 Mary D ccker-Tabb U.S.A. 4:1 8.08 09 -07-1982 M aricica Puica Rom ania 4:1 7.44 16-09-1982 Mary S lan cy-D cck cr U.S.A. 4:16.71 21-08-1985 Paula Ivan Rom ania 4:15.61 10-07-1989 fonnances (set by just 1 1 numcrs), onlv two records have been attained by African runners. Considering the current athletic dominance o f the African nations, niosi notably Kenya, Ethiopia, and Morocco over a wide range o f distances (3,000 m to the marathon) and events (road races, track, and cross country), this is somewhat surprising. With this vastly different background, and with reference to the evolution o f the world record for the mile for the past forty years (Tables 1 and 2), one issue warrants further discussion. Although it was not until May 6, 1954, that Roger Bannister became the first man to ran under lour min­ utes for the mile (3:59.4), it was probably one year ear­ lier in .June 1953 id'ter running 4:02 for an invitation mile race at a schoolboys athletic meeting, that Bannister and his coach, Franz Stampll, realised he was capable o f miming a ‘ sub four’ . In contrast, John Landy from Australia, who by April 1954 had already run the mile in tuidcr 4:03 on no fewer than six differ­ ent occasions, stated “...the four minute harrier is a brick wall. 1 shall not attempt it again.” Yet, only 1 \vo weeks after Baimistcr had secured fame for life as a result of his famous run at Oxford, Landy ran 3:58 for the mile and became the new world record holder. As Bannister later summarised "... though physiology may indicate respiratory and cardiovascular limits to muscular effort, psychological and other factors beyond the ken o f physi­ ology set the razor's edge o f defeat or victory and deter­ mine how closely the athlete approaches the. absolute lim­ its o f performance".' In this vein, and with reference to the women’s record, it was perhaps much more than pure coincidence that Diane Leather o f Great Britain became the first female to break five minutes for the mile just three weeks after Bannister set his historic mark. This and other similar feats have led certain researchers to conclude that "... the barrier to be overcome by the runner who wants to he a champion is psychological. The last record set and the ivillingness o f athletes to try to break it are the deter­ mining factors for the next record. "w The inference is that a highly competitive situation brings out in the finest o f atldetes a level o f performance of which even they are incapable under less challenging circum ­ stances. The magnitude o f this effect, which is almost impossible to quantify, appears to have been ignored by many researchers who have employed “ mathematical equations” to predict future performance. CAN IM PR O V E M E N TS IN P H Y S IO L O G Y E X PLA IN T H E IM P R O V E M E N T IN P E R F O R M A N C E ? There are a number o f key physiological factors related to successful middle-distancc and distance running per­ formance. These include: (i) a high (>70 m l/kg/m in) maximal aerobic power (VO;w); (ii) the ability to utilise a high percentage o f VO--..* for sustained periods; (iii) the ability to sustain high (>20 km /hr) running speeds and resist muscular fatigue; (iv) a fast naming speed at the “ lactate tlueshold” ; (v) an efficient/economical nuuiing tccluiique, and (vi) a high anaerobic (oxygen- independent) capacity. These determinants o f superior performance have been extensively reviewed else• wherc.“H'" lt'~l4" The current issue is whether improve­ ments in any one (or more) o f these factors can explain the large improvements in human performance over the past centiuy 8 SPORTS MEDICINE JULY 1996 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2. ) • For muscular pain • Effective pain relief • Site specific • Non-staining • N on-greasy Reparil-Gel Relieves m uscular pain. I macmusj MADAUS PHARMACEUTICALS (PTY) LTD Reg. N o , 77/00174/07 2nd Road‘ ( c n r W Road), Randjespark, Midrand 1685 Reparir-G el 100 g contains: Aescin 1,0 g; Diethylamine salicylate 5,0 g. Reg. No. G/13.9/2367 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2. ) With regard to a numer’s maximal aerobic power, Sid Robinson and colleagues working at tlie Harvard fatigue laboratory, reported very high VO.,.« values in elite runners over fifty years ago.4' A VOa,,.,,* value o f 82 m l/kg/m in was measured for Donald Lash, one o f tlie first runners to run two niiles in less than nine minutes. These investigators also reported several other numcrs with VO,,,,,* values higher than 75 m l/k g /m in .^ A s tlie highest VO,,,,* ever reported for a runner recorded in the m o d e m era in a reputable laboratory is 85 m l/kg/m in for Dave Bedford, ex-world record holder for 10,000 m ,5 it seems unlikely that increases in maxi­ mal aerobic power are responsible for the large improvements in tlie world records for varying athletic events. Instead, it may b e that the gradual improvements in performance by elite runners are more related to their improved ability to sustain a higher fraction o f VO„,« in competition, and also to better running economy and technique.44 This view is consistent with tlie evolution o f training practices this past century. For example, from tlie early 1900’s to the late 1960’s, there was a steady increase in tlie frequency, intensity and duration o f training so that by tlie early 1970 s most track run­ ners were undertaking several hours o f training a day on a week to week basis. Since that time, tlie training regimens o f top numers has not changed dramatical- | y :*5 .4 0 .4 7 Finally, an analysis o f world records at distances from one mile to the marathon reveal that it is mainly an increase in specific endurance (i.e. tlie ability to resist fatigue) rather than any enhancement in basic speed or “ anaerobic” power that is responsible for tlie gradual improvements in many events over tlie past fifty' years.41 Tlie dominant effect of tliis improvement in spe­ cific endurance or fatigue resistance (i.e. the ability to maintain a given speed) is hidden by tlie tradition to time races at a constant distance, rather than to mea­ sure the distance a runner coidd cover in a specific time. To illustrate tliis point, in 1969 Derek Cku'ton of Australia ran a marathon in 2 lir 08:32, at an average velocity o f -3 2 8 m /min. Tliis was slightly faster than tlie mean running speed for tlie men’s one mile record some hundred years previously set by Britain’s Cadet Marshall in 1852 at -3 2 6 m /m in .53-51 In other words, Clayton demonstrated a specific endurance more than 26.2 times greater than Marshall. In physiological terms, at tlie same speed, Clayton was able to run 26 times further than Marshall! Perhaps more important­ ly, Clayton possessed a relatively m odest VO,..,* o f only 69.7 m l/k g /m in ,11 illustrating that it is a runner’s max­ imal speed and economy o f motion at race pace, rather than her/his VOs,„«« which predicts athletic perfor- maiice.114*’ , . , Apart from tlie physiological improvements associat­ ed with superior performance, there are, o f course, other factors which majr explain why world records have continued to fall. The introduction o f synthetic running tracks can improve competitive performance by 2 -3% compared to older traditional surfaces like grass and cinders.-"'’1’ Professionalism, commercialism, mid more numerous competitive opportunities today com ­ pared with forty years ago mean that more potential record setters have tlie chance to train and compete on an almost full-time basis. It is also possible that the use o f banned substances may have contributed to the improved perform ances o f some athletes. However, whether the m odem athlete’s nutritional practices have contributed to their improved (raining capacity and race performances is somewhat doubtful.*" MATHEMATICAL MODELLING OF HUMAN RUNNING PERFORMANCE As noted previously, there have been many attempts bv sports scientists to “ m odel” or describe atliletie peiloi - mance based on a complex interaction of many input variables such as tlie upper limits o f several metabolic processes involved in power production, and die input, dose-effect o f training interventions. Many more (ac­ tors, however, remain to be specified and precisely quantified.™ Nevertheless, several investigators have presented models that describe, with a high degree of accuracy, running performances over various distances. For example, Ward-Smith45 proposed a model for mate performances where the average absolute error between estimated and actual rumiing times for all dis­ tances from 100 m to 10,000 m was only 0 .86%. Although at first sight tliis model appears very accu­ rate, it was criticised by other workers in the field because it failed to take into account tlie well docu­ mented progressive decline in die aerobic power output that can be sustained as the distance run increases, to r example, even a world-class runner is only capable of sustaining h er/liis VO', -, for —420 sec.1** * Ih cica ltci, the fraction o f VOa,.,.,* that can b e sustained during a race decreases linearly from 100% at time t, to 85-90% for a 60 min race, 80-85% for a 120 min race, 75-80% for a 180 min race and so on.37:18 Taking this factor into account, Peromiet. and Thibault" suggested a modifica­ tion o f Ward-Smith’s4" hyperbolic model which reduced the absolute error between actual and estimated run­ ning times for races from 60 m to tlie marathon foi. both men and women to only 0.73%. Tlie complete m odel of running performances proposed by these and other workers not oidy provides a quantitative description of endurance capability, but also an estimation o f (lie rel­ ative contributions o f the various oxygen dependent and oxygen independent power systems to the total work output according to the duration o f the race."1 The theoretical considerations o f such m odels are complex and outside tlie brief o f tlie current paper. THE LIMITS TO HUMAN PERFORMANCE: WHERE TO FROM HERE? Perhaps o f greater interest and relevance to athletes and sports scientists alike are the projected improve­ ments in rumiing times for various distances based on tlie various mathematical models. Table 3 lists the pro­ jection o f both tlie men’s and women’s world record for Table 3: Projection o f the m en’s and women’s world mile records Year 2000 2088 2040 Ultimate Performance Men 3:41.96 3:33.29 3:29.84 3:18.87 Women 4:10.79 4:00.83 3:59.82 3:43.24 Data arc from Pcroimct and Thibault, 1989 10 SPORTS MEDICINE JULY 1996 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2. ) tlie mile, along with tlie ‘ultimate performance’ for that distance.^ As can be seen, a 3:30 mile is projected for men by die year 2040, even though in 1954 Roger Bannister forecast tliat tliis mark would liave been accomplished by 1990/' In order to attain such a level o f performance, the miler o f tlie future will need a VO,... o f ~91 m l/kg/m in while also possessing suffi­ cient basic speed to run die quarter mile in around 44 sec and tlie 800 m in around 1:42. Although such a range o f performances by the same runner seem some­ what unrealistic at first sight, tlie current world records for tlie 400 in and 800 m already surpass these ‘hypo­ thetical’ marks (43.29 sec for 400 111 by Harry ‘Butc.li’ Reynolds; 1:41.73 for 800 ni by Sebastian Coe). Indeed, as discussed previously, it is likely tliat future improve­ ments in world records wall com e not from any increase in instantaneous speed or power derived from tlie oxy­ gen-independent “ anaerobic” pathways, but rather an increase in fatigue resistance or specific endurance. Tliis being tlie case, then one might reasonably argue tliat tlie current m en’s world mile mark.(Table 4) is already well overdue for revision. There are presently many runners with sufficient basic speed over botli 400 ni and 800 m who, with tlie development o f sufficient specific endurance, should b e capable o f significantly reducing tlie present record. Indeed, according to data derived from performance tables comparing tlie various running distances from 800 m to the marathon,1:1 tlie men’s world mile record ought to be mound 3:42 hi order to be comparable with the present 5,000 m (12:44.39 and 10,000 m (26:43.53) world best times, both held by Ethiopia’s Haile Gebresilassie. Table 4: The fastest mile: A breakdown o f Noureddine Morceli's world record Distance (m) 400 800 1,300 1,600 Lap times (sec) 54.9 57.7 57.3 54.5 Total time (miii:sec) 0:54.9 1:52.6 2:49.9 3:44.39 Set at Reiti, Italy, oil 12 September 1993 @ 1838 lir. Ambient ttanpciatmc 20 C, relative luunidity 50%. Data are from Ziir Megedc and Hymans, 1995. Finally, it has recently been proposed tliat for certain running distances, tlie performance o f women may equal those o f men within tlie next few decades.w Although tliis seems extremely unlikely, the results from a recent study from tliis laboratory2 do suggest tliat for ultra-marathon events at least, women ma}’ be closing tlie gap. Bam et al.,- found that when male and female rtumers were matched for age, training his ton' and race tune over 56 km, tlie women outperformed the males over the ultra-marathon distance o f 90 Ion. hi fact, tlie crossover” point at which the women become faster than their male counterparts was after ~ 66 km. Tliis was in spite o f tlie males being much faster over all distances from 5 Ion to 42 km. It was hypothesised tliat women ultra-marathon runners may have greater fatigue resistance than do cquallv-trained m e n ; Although tlie precise mechanisms for this greater spe­ cific endurance is not clear," it may simply b e related to tlie smaller sizes and lighter body mass o f the females. Figure 1 : The progression o f the men’s (fdled circles) and women’s (open circles) world record for one mile (1,609 m ) since 1954. The extrapolation o f the lines o f best fit for the data sets would estimate that by the Sydney Olympic Games, to be held in the year 2000, the men s record will be 3:42 and the women’s around 4:00. Year CONCLUSION In conclusion, it seems likely tliat any future improve­ ments in tlie current world records for distances from one mile to tlie marathon Mall be achieved by those ath­ letes able to sustain high rumiing speeds and resist the onset o f muscular fatigue, rather than any significant increase in absolute rmming velocity per se. For this to happen, the runners must be in a highly competitive situation which will bring out tlie highest level o f per­ formance: tlie magnitude o f this psychological effect seems to have been somewhat overlooked by those sports scientists who have employed mathematical models to describe and predict future race perfor­ mances. While it seems unlikely tliat women will ever beat men over any distance until such time that the}' caii run shorter trade distances as fast as tlie males, one might speculate tliat women’s performances may one day equal those of the leading men in verv long (i.e.> 421on) distance races. REFERENCES 1. Andrew s H. Training For A th letics and General Health. A rthur Pearson Pub. London. 1903. S. Bam J, N oakes TD, Juritz J. Dennis SC. Could women out­ run men in ultra-maralhon ra ces? Medicine and Science in Sports and E xercise (in review). 3. Bannister RG. The First Four Minutes. Putman. London 1955. SPORTS MEDICINE JULY 1996 11 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2. ) 4. B annister RG. Muscular effort. British Medical Bulletin, 1956; 12: 222-225. 5. Bergh U. P hysiology o f Cross-Country Ski Racing. Human K inetics, Champaign, Illinois, 1982. 6. Brandon U . Physiological fa ctors associated with middle distance running performance. Sports Medicine, 1995; 19: 268-277. „ , 7. Brandon U , B oileau R A . The contribution o f selected vari­ ables to middle and long distance run performance. Journal o f Sports M e d i c i n e and Physical Fitness, 1987; 2 7 :1 5 7 -1 6 4 . 8. Brandon LJ, B oileau R A . Influence o f metabolic, mechani­ cal and physique variables on middle distance running. Journal o f Sports Medicine and Physical Fitness, 1992; 32: 1-9. 9. C oetzer P, N oakes TD, Sanders B, Lam bert MI, B osch AN, Wiggins T, D ennis SC. Superior fatigue resistance o f elite black South A frican distance runners. Journal o f Applied Physiology, 1993;75:1822-1827. 10. Costill D L Inside Running: B a sics o f Sports Physiology. Carmel, In: B enchm ark Press, 1986: pp. 1-189. 11. Costill DL, Branam G, E ddy D, Sparks K . Determ inants o f marathon running success. Internationale Zeitschrift fu r A ngew an dte P hysiologies. 1971; 2 9 : 249-254. 12. Costill DL. F o x EL. Energetics o f marathon mnning. Medicine and Science in Sports, 1969; 1: 81-88. 13. D aniels J, Gilbert JR O xygen power... : Perform ance Tables fo r D istan ce Runners. Tempe. Arizona, 1979. 14. Ekblom B, Berglund B. E ffect o f erythropoietin administra­ tion on maximal aerobic power. Scandinavian Journal o f Medicine and Science in Sports, 1991;1:88-93. 15. Ekblom B, Goldberg A N , Gullbring B. R esponse o f exercise after blood lo ss and reinfusion. Journal o f A p p lied Physiology. 1 9 7 2 :3 3 : 175-180. 16. E ttem a JH. Limits o f human perform ance and energy- production. In tern a tion a le Zeitschrift fu r A n gew a n d te Physiologie, 1966; 22: 45-54. 17. H andelm an GH, Smith DC. Comparison o f running and swimming records. Sportwissenschaft, 1980, 2. 161-168. 18. H a w ley J A . S ta te o f the art training guidelines fo r endurance perform ance. South A frican Journal o f Sports Medicine, 1995; 2: 7-12. 19. H aw ley J A , H opkins W G. A ero b ic glycolytic and aerobic lipolytic p ow er system s. A new paradigm with implications fo r endurance and ultra-endurance events. Sports Medicine, 1995; 19: 240-250. 20. H a w ley J A , D en n is SC, Lindsay FH, N oa k es TD. Nutritional practices o f athletes: A r e they sub-optim al? Journal o f Sports Sciences, 1995: 13: S75-S78. 21. H aw ley J A , My burgh K H , N oakes TD, D ennis SC. Training techniques to improve fa tigu e resistance and enhance endurance p erform an ce. Journal o f Sports S cience ( Supplement) , In press, 1996. 22. Joyner MJ. Modelling: Optimal marathon perform ance on the basis o f physiological factors. Journal o f A pplied Physiology, 1991; 70: 683-687. 23. Joyner MJ. Physiological Limiting F actors and D istance Running: In fluence o f G ender and A g e on R eco id Perform ances. In : H olloszy J O (E d ito r), E xercise and Sports Science Reviews, 1993; 2 1 ; 103-133. 24. K eller B. A theory o f com petitive running. Physician Today. 1973; 26: 43-47. 25. Leger D, Mercier D, Gauvin L. The relationship between : % VO-.... and running perform ance time. In: Landers DM (E d itor). Sport and Elite Performers, Volume 3. Human K in eties Publishers, Champaign, Illinois, 1986; pp. 113- 1.20 26. Lloyd B B . The energetics o f running: an analysis o f world records. A dva n ces in Science, 1966; 2 2 : 515-530. 27. Lloyd BB. W o r l d r u n n i n g records as maximal performances. O xygen d eb t and o th er lim iting fa cto rs. Circulation Research, 1976; X X , X X I : 218-226. 28. Londeree BR. The use o f laboratory test results with long distance runners. Sports Medicine, 1986: 3: 201-213. 29. McMahon TA, Greene PR. Fast runniny tracks. Scientific Am erican, 1978; 239: 148-163. 30. McMahon TA, Greene PR. The influence o f track compliance on running. Journal o f Biom echanics, 1979: 12: 893-904. 31. Mognoni P Lafortuna C, R usso G, M inetti A . A n analysis o f world records in three types o f locomotion. European Journal o f A pplied Physiology, 1982; 49: 287-299. 32. Morton KH. The suprem e runner: IVhat evidence now'? Australian Journal o f Sports Science, 1985; 3: 7-10. 33. Morton RH . Fitz-Clarke JR, B anister EW. Modelling human perform ance in runniny. Journal o f A pplied Physiology. 1 9 9 0 :6 9 :1 1 7 1 -1 1 7 7 . 34. N oakes TD. Im plications o f exercise testin g jo r prediction o) athletic performance. Medicine and Science in Sports and Exercise, 1988; 2 0 : 319-330. 35. Noakes TD. Lore o f Running. Oxford University Press. Cape Town, 1992, pp. 266-270. 36. Noakes TD, Myburgh K II. Schall R. Peak treadmill running velocity during the V O a™ test predicts running perfor­ mance. Journal o f Sports Science. 1990: 8: 33-45. 37. Peronnet F, Thibault G. A n a lyse physiologique de la perfor­ mance en course a pied: revision du modele hyperboliquc. Journal o f Physiologie ( Paris). 1987: 82: 52-60. 38. P eronnet F. Thibault G. M athem atical analysis o f running performance and world running records. Journal o f Applied Physiology, 1989; 67: 453-465, 39. R o b ertson R J , Gilcher R, Metz KF. Hem oglobin concentra­ tion and aerobic work capacity in women follow ing induced erthyrocythem ia. Journal o f A pplied Physiology. 1984; 57: 568-575. 40. Robinson S, Dill DB, R obinson RD, T zankoff SP. Wagner JA. Physiological ageing o f cham pion runners. Journal o f Applied Physiology, 1976; 41: 46-51. 41. Robinson S, Edwards HT, Dill D B . New records in human power. Science, 1937; 85: 409-410. 42. Rumball WM, Coleman CE. A nalysis o f runniny and the prediction o f ultimate performance. Nature, 1970; 228: 184- 185. 43. R yder HW, Carr HJ, H erget P. Future perform ance in footracing. Scientific A m erican, 1976: 234: 109-119. 44. Saltin B, A strand P-O. Maximal oxygen uptake in athletes. Journal o f A pplied Physioloyy. 1967; 23: 353-358. 45. Ward-Smith AJ. A m athem atical theory o f running, based on the first law o f thermodynam ics and its application to the perform an ce o f world-class a th letes. Journal of Biom echanics, 1985; 18: 337-349. 46. Wells CL, P a te PR. Traininy fo r performance o f prolonged exercise. In: Lamb DR, Murray R (E d ito rs ). Perspectives in Exercise Science and Sports Medicine Volume 1. Prolonged Exercise, Benchm ark Press. Indianapolis, 1988: 357-391. 47. Wilt F. H ow They Train. Volume II. Long D istance (second E d ition). Track and Field News, Los A ltos. California. 1973; pp. 1-126. 48. Whipp BJ, Ward SA. Will women soon outrun m en? Nature, 1992; 355: 25. 49. Williams MIL Wesseldine S, Somma T, Schuster R. The effect o f induced erythrocythem ia upon 5-mile treadmill run time. Medicine and Science in Sports and Exercise. 1981. 1 3 :1 6 9 -1 7 5 . 50. Wilkie DR. Equations describing pow er input by humans as a function o f duration o f exercise. In: Cerretelli P. Whipp BJ. (E d itors), E xercise B ioenergetics and Gas Exchange. New York: Elsevier, North Holland, 1980: 75-80. 51. Zur Megede E, H ym ans R. Progression o f World B est Perform ances and Official I A A F World R ecoid s. International A m a teu r A th letic Federation. Multiprint. Monaco, 1995. __□ 12 SPORTS MEDICINE JULY 1996 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2. ) PSYCHOLOGICAL PREPARATION FOR OLYMPIC ATHLETES Dr II Schomer Dept o f Psychology, U.C.T INTRODUCTION After winning 7 gold medals at tlie Montreal Olympics Mark Spitz said: “At tliis level o f physical skill, tlie dif­ ference between winning and losing is 99% psychologi­ cal” .' H ie reason is tliat elite athletes in a specific sporting discipline are, to a large extent, fairly equal 011 phj'siological, technical and tactical factors. When elite athletes compete tlie one who wins is usually tlie one who is mentally the strongest 011 that given day. Where­ as physical abilities are seen as relatively stable, psy­ chological factors primarily determine the daily varia­ tions in performance-.Rtisliall goes as far as advocating sport psychology as “ the key to sporting excellence tuid success” ’. Current thinking and practice in applied sport psy­ chology assumes tliat the athletes’ level o f performance is a direct: consequence o f the way athletes are thinking and feeling.1 Sport scientists and athletes acknowledge that a negative psychological set, such as feelings of frustration, fear, anger and worry, negative thoughts and imagery, and task-irrelevant thoughts typically impairs performance. Sport competitions are stressfiil events. Athletes who overreact to the challenge experience anx­ iety mid tension which can adversely affect physiologi­ cal and cognitive processes to sncli an extent tliat they perfonn below their potential mid expectations. The athlete displaying a palpitating heart, a dry mouth, tight or shaky muscles, rapid breathing, a tight stom­ ach, poor concentration and unfocused negative thoughts cannot hope to perfonn optimally.’ 5 “ What is needed is a positive psychological set that, mobilizes the physiological reactions essential for peak performance. Tlie likelihood o f achieving peak perfor­ mance increases dramatically as athletes consistent^ generate tlie mental climate that lias been identified by numerous studies1-™ to optimize output: Athletes do their best when relaxed and alert: Tlie psychological ideal performance state is difficult to sustain during high-powered competition and years o f tedious train­ ing.” To become an Olympic athlete it has to be experi­ enced consistently and once at the Olympic Games it has to be right there. CHARACTERISTICS OF SUCCESS Although no set distinguishable “ athletic personality”7 has been identified in tlie sport psychological litera­ ture, a certain psychological profile emerges again and again when sport scientists examine succcssfiil elite athletes, regardless o f the source o f the data or the nature o f tlie sport.1 Successful elite athletes display the following characteristics mid psychological slrills: 1) Consistent self-regulations o f arousal (feeling energized yet relaxed) 2) Superior concentration (being appropriately focused) 3) High sell-confidence (positive attitude) mid 4) Determination, commitment and control (clear sense o f direction, meaningfuhiess and aware­ ness). Allowing for individual variations, (lie above-mentioned psychological commonalities are necessary predisposi­ tions foi the psychological ideal performance state to be propagated mid maintained. The ideal performance state does not just; happen. The mental skills needed to achieve and maintain the ideal performance state are learned through knowledge and practice just as the physical skills and strategies o f the sport are learned and practised. The best preparation or countdown to competition rituals involves behavioural sequences that get die athlete physically mid mentally ready for com ­ petition. Tlie physical preparations and training has to go hand in hand with tlie inclusion o f psychological principles and procedures if athletes are to maximise their chances o f being ready to peak at competition time.”-1" H ie ultimate goal oi psychological skills training is for each athlete to learn how to create consistently at com petition time the ideal perform ance state (thoughts, feelings, bodily responses) typically associat­ ed with his or her peak performance.'” 1'1 Psychological skills training programmes emi help athletes’ plan effec­ tive behavioural protocols or preparation rituals that emi be used regularly as pre-competition mid competi­ tion readying procedures. PSYCHOLOGICAL SKILLS TRAINING OUT­ LINE Compieliensive psychological skills training pro­ grammes typically follow a set structure with three dis­ tinct phases.s 1. Education phase: This phase involves explaining to atlilefes the importance o f developing mid learning psychological skills mid how these skills affect per­ formance. 2. Acquisition phase: Ihis phase focuses 011 strategies mid teclmiques to learn the different psychological skills. Rather than imposing a standard package on the athlete, it is important to develop specific psy­ chological strategies tailored to the athlete’s uuique needs, ability and strengths as well as tlie specific demands o f the sport.511 3. Piactice phase: Tliis phase lias tliree main objec­ tives: to automate skills through overlearning, to instruct athletes to consistently integrate psycholog­ ical slcills into their performance situations, and to simulate skills that tlie athlete will draw 011 during tlie actual competition. & The most counter-productive time to implement a psy­ chological skills training programme is after the start o f tlie competitive season mid there is concern because athletes are performing below their potential. At this time psychological skills training amounts to a quick-fix solution and is rarely effective. It can also be detrimen­ tal to malic athletes aware oi psychological aspects of competition that should be addressed'When there is insufficient time to learn the new psychological skills needed for control. f lic most productive time to implement a psycholog- SPORTS MEDICINE JULY 1996 13 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2. ) ical skills training programme is during the off-season or pre-season (long before the competitions begin) when athletes are well-rested and are in a relatively pressurc- tree situation, and there is sufficient time to leam new skills.1:1 Mere exposure and one-off practice o f psychological skills training techniques by 110 means prepare athletes for successful implementation o f these skills in Olympic competition. Rather, they must becom e automatic and second-nature to b e effective. Gould, Eldtuid and Jackson14 reported that 1988 U.S. Olympic wrestlers who had won medals had internalized their mental strategies to the-extent that, they reacted automatically to adversity, whereas 110 11-medalists did not have their coping strategies as internalised and had to make a con­ scious effort, to use them wlieu faced with mishaps. They even suggested that the specific coping strategy used may not b e as important as the elite athlete’s abil­ ity to produce that strategy iu an automized mode. For pS3rchological skills and coping strategies to becom e automatic and second nature, requires the long-term practice o f such skills that need to be integrated with physical skills training.5'811’ It can take athletes several months to a year to master the new psychological skills and successfully apply them in actual competition. Orliclc1" reported that tliis process usually takes the highly committed athletes about three years o f regular practice before things really come together mentally for them. Leading up to the Olympics With respect to providing Hie most effective service dur­ ing die final months leading up to the Olympics, it is imperative not to make major changes to die athletes’ routines and it is not the time to introduce new psycho­ logical, physiological or technical concepts. By tiiis time athletes and coaches should have their plans together. Typically, die closer one gets to the Olympics them­ selves, die aim should be to refine and fine-tune the skills diat have already been practised. A11 appropriate approach focuses 011 suggestions how athletes might handle part icular concerns such as readiness, plans for distractions, preparation du-ougli simulation, familiari­ sation widi d ie Olympic site, lack o f personal space, dealing with media, dealing with interpersonal/person­ al conflicts, developing a plan for being and feeling in control in the Olympic environment, ensuring tiiat ath­ letes and coaches have an effective pre-event plan, espe­ cially just prior to die start o f die event, how to control pre-event anxiety, guarding against overtraining, and emphasizing d ie need for adequate rest when faced with high levels o f stress. 1- 1",1<> Psychological sldlls training guidelines Tire following psychological skills and performance enhancement strategies are structured in accordance widi the psychological characteristics displayed by suc­ cessful elite athletes discussed earlier in tiiis article. Numerous sport psychology consultants have document­ ed d ie application o f tiiese techniques in preparation for and during Olympic games.171" 1"-0-’1-- It should be noted diat a psychological sldlls training programme cannot be expected to compensate for weaknesses or deficiencies in otiier parts of an atiilctes piogiamme (e.g. inadequate physical capacity, training programme, coaching etc).13 A psychological sldlls training pro­ gramme must be viewed as a critical p a il o f the athlet­ ic programme and the psychological input should be placed" in die perspective o f the athlete's life and the athlete’s daily functioning. A psychological skills train­ ing programme is a significant but only one of mail}’ parts o f an athlete’s sport experience.2 ' The sell-regulation ol arousal The inverted U-liypotliesis has been a popular theory to explain the relationship between arousal or anxiety and athletic performance. Initially, performance improves widi increased arousal, up to a certain point, aiter whicli further increases in arousal produce a deteriora­ tion in performance. The critical point lias been referred to as the point o f optimal activation." ’4 The optimal level o f arousal varies as a function of die complexity of the task and the skill level of the ath­ lete. For example, for activities that require precise fine motor sldlls involving steadiness o f control o f uuwauted muscle activity (e.g. high-board diving), very little arousal can be tolerated without impairing perfor­ mance. However, for tasks that require minimal fine motor precision (e.g. weight lifting), a higher level ol arousal can be tolerated before performance is impaired.11 M ien atiiletes reach an optimal level o f arousal they should feel highly energised but still relaxed. This liigli energy state has frequently been described by elite ath­ letes as a feeling o f joy, ecstasy, intensity, boldness, inspiration, challenge, and being “ charged” or “ hot Despite the heightened arousal level, athletes should be physically relaxed with tiieir muscles being loose and able to perform fluid movements. Athletes who find tiiemselves in tiiis optimum level o f arousal will experience a sense ofim ier calm and a high degree o f concentration concurrent widi a time-space disorien­ tation (usually the sense o f time being slowed down). The fear o f failure is completely absent. Sport scientists generally agree that most, perfor­ mance errors arise not so much from under-arousal, but rather from over-arousal, when atiiletes experience dif­ ficulties coping with competitive anxiety.2' Thus, adi- letcs need to learn self-monitoring and recognize how tiieir emotional slates affect their performance during competition. Progressive relaxation Jacobson advanced the concept o f progressive relax­ ation after observing that an anxious mind cannot exist within a relaxed body.27 Relaxation o f a muscle group was found to be physiologically incompatible widi con­ traction o f that saine group. Therefore, relaxation train­ ing was seen to combat the anxiety response by elimi­ nating tension in die muscles. Progressive relaxation involves systematically con­ tracting and tiien relaxing one major muscle group in the body before progressing to the next muscle group while focusing 011 the different sensations o f tension and relaxation. With practice a person can detect ten­ sion in a specific muscle or area o f the body, like the neck, and then relax that muscle. The advantage o f the m ediod o f progressive relax­ ation is that atiiletes can t ake full control o f then- level o f arousal. An athlete who lias mastered the teelmique after several months o f regular pract ice should be able to elicit the relaxation response witliin seconds of encountering a stressful stimulus. 14 SPORTS MEDICINE JULY 1996 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2. ) Autogenic training Autogenic training consists o f a series o f exercises designed to produce two physical sensations: warmth and heaviness. Tlie feeling o f warmth is ascribed to Ihe dilation o f tlie blood vessels with a resultant increase in blood flow, while die sensation o f heaviness is due to the relaxation o f muscle groups. It usually takes several months o f daily practice to becom e proficient in tlie use o f autogenic training. Once mastered, it is especially useful for fast relaxation in a competitive environment and can be effectively applied in tlie field o f sport. Concentration Athletes must focus attention on tlie relevant cues in tlie environment and maintain tlie appropriate atten- tional foci for the duration o f the competition. Concentration problems are usually caused by an inap­ propriate attentional focus and occur when athletes becom e distracted by thoughts, emotions, or other events. Tlie athletes should be focused 011 tlie present and be conscious only o f what they are doing at that specific moment. They should have 110 thoughts about the past or future because these are irrelevant cues that often impair concentration and lead to reduced performance. Some athletes find it difficult to forget what has just happened, especially i f it was a bad mistake. Thinking about die future usually involves focusing 011 die conse­ quences o f certain actions and often t akes tlie form o f “ what i f ’ questions, such as: “ What if I make another mistake?” or “ Wliat if we lose tlie gam e?” .' " Tims ath­ letes should have more task-oriented thoughts rather than a preoccupation with thoughts o f making m is­ takes. Tlie appropriate attentional focus allows tlie athlete to be acutely aware o f liis or her own body and tlie sur­ rounding athletes. Tlie athlete also has tlie sensation of being completely in harmony with die environment"". Nideffer2" -views attentional focus along two dimen­ sions: width (broad versus narrow) and direction (inter­ nal versus external). These combine to give four differ­ ent types o f attentional focus. A broad attentional focus allows athletes to attend to several occurrences simul­ taneously. Tliis is essential in sports where athletes have to be aware o f and sensitive to a rapidly changing environment and be able to respond to multiple cues (e.g. a hockey player leading a ball up tlie field). A nar­ row attentional focus is required when adilet.es have to attend to only one or two cues (e.g. pistol shooting). An external attentional focus shifts attention out ward 011 an object, such as a ball or an opponent’s movements (e.g. in a doubles temiis match). A 11 internal attentional focus is directed inward 011 thoughts and feelings (e.g. moni­ toring calf muscle tension). Athletes must initially control tlie width o f their attention and decide whether to exclude or include tlie many environmental cues available during the competi­ tion. Further, athletes must be able to control tlie direc­ tion o f their attention by either focussing inwards 011 their own feelings, dioughts and arousal level or focus­ ing 011 external cues such as the opponent or ball. Athletes slioidd ideally be able to change their focus o f attention in accordance with die changing attentional demands during competition. Self-talk Self-verbalizations, expressed aloud or as thoughts, have a strong impact 011 a person’s behaviour. 'Die actu­ al words used by athletes during self-talk influence tlie level o f performance. Performance levels o f elite ath­ letes can be improved through thought processes and thought content alone without increased physiological efforts or energy costs.” Self-talk can be positive or negative. Positive self-tall?; enhances the self-esteem, motivation, attentional focus and performance o f athletes. Self-talk tliat helps ath­ letes focus 011 tlie present and prevents their mind from wandering is viewed as positive. It usually has either a motivational component, (e.g. “ I can do it” ) or an instructional component (e.g. “ Keep yoiir eyes 011 tlie ball” ). On the other hand, negative self-talk is critical and demeaning and impairs the realization o f goals. Negative sell-talk (e.g. “ Tliat was a stupid mistake” ) creates anxiety and self-doubt." -7 Thoughts play a crucial role in mediating emotional leactions to situations, and these reactions influence future behaviour. Events in and o f themselves do not cause negative emotional reactions (e.g. depression, anger, anxiety, hopelessness or frustration). Rat her it is how athletes interpret the event that determines their response." Self-talk may be used by atldetes to acquire new skills, change bad habits, initiate action (e.g. numcrs can increase their speed by using cue words sueli as “ fast”) and sustain effort when the athlete feels tired (c.g “ keep it up” , “ liang in there” ). " Several tccliniques can be used to improve self-talk. One strategy to deal with negative thoughts is to stop diem before they impair performance. Athletes are trained to stop negative thoughts as soon as th ey arise by using a cue word (such as “ stop” ) or any physical trigger (such as snapping fingers or hitting a hand against a thigh) and then focus 011 a task-related cue."--'7 It is however not possible to eliminate all negative self-talk. Another way to deal with negative self-talk " h e n it occurs, is to change the negative thoughts into positive thoughts, which refocuses the athlete’s atten­ tion to provide encouragement and motivation and which brings the athlete back into die present to take control o f the event. For example, “ I never play well when the wind blows” can be rephrased into “ Nobody lilies to play in windy conditions, but I will perform at my personal best” ."-7 Cue words can also be used to set in motion a specif­ ic 1 espouse. They can be used as an instruction (e.g. follow-through ’ , “ watch die ball” ) or to motivate (e.g. strong ’ , “ relax” , “ get tough” ). Tlie cue word should be simple and should automatically trigger the planned reaction. For example, gymnasts performing a floor routine can say the word “ forward” to ensure tliat they push ahead at a specific [)oinI dining their routine. Sprinters can say “ explode” to ensm c that tlicv get out of die starting block quickly Atliletes must practice using these cue words so tliat they become habitual and well-learned before being utilized during competition. Cue words are helpful when atliletes me trying to change a movement sequence or when trying to change an ingrained habit." SPORTS MEDICINE JULY 1996 15 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2. ) High se lf confidence Atiiletes’ performance is enhanced as tiieir level ol self- confidence increases - up to an optimal point - alter which future increases in self-confidence result in impairment o f performance. Atiiletes lacking self-confidence doubt tiieir capabili­ ty to perforin tlie skills under pressure during the com ­ petition. Self-doubts hinder atiiletes’ performance by causing anxiety, reducing concentration and creating indecisiveness. Atiiletes lacking self-confidence locus on their weaknesses rather than on tiieir strong points and distract their attention away from the task that has to be completed. On the other hand, the performance of atiiletes who are overconfident (tiieir confidence is greater that tiieir abilities justify) may deteriorate because they think tliat they do not have to prepare them selves for the event or expend the effort to com ­ plete the task.” Atiiletes with optimal self-confidence are charac­ terised by a positive attitude and feelings o f optimism.21' They are able to keep poise and feelings ol strength and control even during adversity or potentially threatening situations. The atiiletes are in control o f their actions and o f the environment.2 The performance seems to be automatic and effortless. Many potential benefits for athletes arise from a feel­ ing o f high self-confidence. Confident athletes arc more likely to stay calm and relaxed tmder pressure. Confidence facilitates concentration so that the atiiletes can focus on die task at hand. Confident atiiletes tend to set challenging goals and pursue them actively and with increased vigour. Confident athletes tend to play to win and are usually not afraid to take chances. Confidence helps atiiletes deal more effectively with errors and mistakes." Goal-setting A good method to improve atiiletes’ confidence is to set effective goals that provide direction and enhance moti­ vation.8 It is important diat atiiletes understand the dif­ ference between outcome goals and performance goals. Outcome goals stress the competitive rcsidt o f an event, such as winning a competition or game. Atiiletes with this orientation are concerned about winning or losing rather than thinking about the quality' o f tiieir perfor­ mance. Achieving outcome goals therefore depends not only on the athletes’ own efforts but also on the abilities and performance o f tiieir opponents. Outcome goals are therefore counter-productive, because they often emphasize aspects that cannot be controlled by the atli - letes (especially in team sports). When atiiletes are too concerned about outcome goals, this causes anxietyr dur­ ing competition, and the atiiletes worry unnecessarily instead o f concentrating on the task. On the other hand, performance goals focus on realizing performance objec­ tives that are compared with the atiiletes’ own previous performance and therefore do not focus on the outcome o f the event.8-*1 Goal setting is a very good method for improving ath­ letes’ performance i f implemented correctly, h i order to promote behavioural change, goals must be specified in a measurable way and in behavioural terms, h i order to be effective, goals must b e set difficult enough to chal­ lenge the athletes, yet realistic enough to be achiev­ able. Short-term goals should be used as a method to achieve long-term goals and should be recorded and kept in a visible place. Strategies or plans must be outlined to achicve the goals diat have bceu set. Athletes must be part, o f the goal setting process which needs, to b e constantly mon­ itored and evaluated. Regtdar performance feedback and support from significant others is important, if goal- setting is to be effective. Imagery j'h c terms mental practice, imagery, visualisation and mental rehearsal are used interchangeably to relate an athlete’s mental preparation for competition. Imagery is the use o f visualization to imagine situations. Internal imagery makes it possible for atiiletes to kiues- tlietically experience the correct execution of a skill, while external imagery lets them see themselves per­ forming tlie skill.2'1 Atiiletes can use imagery to recreate past experiences or visualize future new events to ready themselves men­ tally for performance. When using imagery, the athlete needs to involve as many senses as possible in order to create life-like images. It is also important to generate the emotions or moods associated with specific tasks or sldlls that are being imagined. Athletes should pay attention to environmental detail (e.g. layout o f the facilities, closeness to specta­ tors) and recreate tlie atmosphere o f the actual compe­ tition. Man}r Olympic teams visit tlie actual competition sites months in advance to familiarize themselves with tlie siuTOtuidings so that they can visualize themselves performing in that exact setting, with its specific colour, layout , lighting and construct ion. Atiiletes can use imagery to improve botii physical and psychological sldlls. Concentration may be enhanced by athletes imagining themselves in situa­ tions where they generally lose concentration and then visualizing them selves remaining com posed and focused. Imagery can be used to build confidence in athletes. They can imagine situations that have caused problems in die past and then picture themselves cop­ ing positively with these events. The best-known use o f imagery is practising particidar sport skills in detail (e.g. tluowing a javelin) repetitively to line tune diem or identify wealaiesses and visualize correcting them. For imagery to be incisive, it needs to be practised as part aud parcel o f an athlete’s daily routine. At the beginning, it is best to practise in a setting with 110 dis­ tractions. With practice, athletes learn to use imagery amid distractions and even in actual competitions. The time spent imagining a particular skill should eventual­ ly be equal to the time die sldll actually takes to occur in order to improve the transfer from imagery to real life situations. d e t e r m in a t io n , c o m m i t m e n t a n d CONTROL Determination,"commitment and self-control have been recognized as key psychological ingredients for sporting excellence.™’ Few athletes can achieve high levels of exccllcnce without complementary high levels o f per­ 16 SPORTS MEDICINE JULY 1996 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2. ) sonal determination and commitment. Achieving tlie tdtimate standard possible requires an athlete to make sacrifices: to train harder and longer, to expend more time and effort during practices.' Or licit and Partington’" stated that for the m ost successful Canadian Olympic atiiletes at tlie 1984 Olympics excel­ lence in sport was tlie top priority in tiieir lives: every­ thing revolved around their sport. They were complete­ ly committed atiiletes with clearly defined success goals. Tlie emphasis was 011 quality training, bolstered by pre-set individualized training goals and a clear com ­ mitment to follow tiieir plans. To achieve real athletic success, maturity and self- control are essential. Being able to react effectively in big games and tight situations as well as in normal games requires confidence and composure. CONCLUSION Refining and perfecting mental sldlls takes life-long practice.11’ It is a tedious, tim'e-consuming effort. Just as physical training is. Only a sclect few will bring all com ­ ponents together consistently. They are the elite. Yet each and every athlete can learn, apply and grow through the inclusion o f psychological sldlls training hi tiieir athletic life, at whichever level they choose to compete. For those at tlie top tlie choice is clear. Psychological sldlls training is a must to be part o f the Olympic experience. To be part o f tlie experience o f excellence. Reflecting on tlie sport psychology services provided to the US team at tlie 1988 Summer Olympics in Seoul, Murphy and Ferrante*' concluded: “At a 1110111 cut when tlie whole world seem ed focused on winning versus los­ ing, we becam e even more committed to our basic ph i­ losophy o f helping each individual learn and grow as a function o f h is/h er Olympic experience” . REFERENCES 1. Williams JM. P sychological characteristics o f p ea k perfor­ m ance.In: Williams JM, ed., A pplied Sport Psychology: P ersona l G row th to P ea k P erform ance. P a lo A lto , California-.Mayfield Publishing Company, 1986: 123-132. 2■ Van-den A u w eele Y, D e Cuyper B, Van Mele V, Rxewnicki R. Elite perform ance and personality: From description and prediction to diagnosis and intervention. In: Singer, RN., Murphey, M., Tennant, LK ., eds., H andbook o f R esearch on Sport P sych ology. New York: M acMillan Publishing Company, 1993:257-289. 3. Rushall, BS. Sport psychology: The key to sporting excel­ lence. International Journal o f Sport Psucholoaii, 1989; 2 0 ( 3 ) : 165-190. 4. Gould D. Eklund RC, Jackson .S71. 1988 US. Olympic wrestling excellence: I. M ental preparation, precom petitive cognition, and affect. The Sport Psychologist, 1992; 6: 358 -382. 5. Gould D, Eklund RC, Jackson, S/1. 1988 U.S. Olympic wrestling excellence: II. Thoughts and affect occurring during com petition. The Sport Psychologist, 1992 :6 :3 83 -402. 6. Landers, DM., Boutcher, SH. Arousal-perform ance relation­ ships. In: Williams, JM., ed., A pplied Sport Psychology: P erson a l Groivth to P e a k Perform ance. P a lo A lto , California:Mayfield Publishing Company, 1986: 163-184. 7. Vealey RS. P ersonality and sport: A comprehensive view. In : H orn TS., ed. A d v a n ces in Sport P sych ology. Champaign, Illinois: H um an K in etics Publishers, 1992: 25-60. 8. Weinberg RS. Gould D. Foundations o f Sport and Exercise Psychology. Champaign. Illinois:Human Kinetics. 1995. 9. Toufexis A . Engineering the perfect athlete. Time 1992: July: 46-51. 10. Williams JM. Integrating and implementing a psychological skills training program m e. In : W illiams JM.. ed. A pplied Sport P sych ology: P ersona l Grow th to Peak Performance. P alo A lto, California: Mayfield Publishing Company, 1986, 301-324. 11. Gould D. Murphy S. Tammen V, M ay J. A n evaluation o f US Olympic sport psychology consultant effectiveness. The Sport P sychologist 1991; 5: 111-127. 12. Nideffer RM. Psychological services fo r the US track and field team. The Sport Psychologist 1989; 3: 350-357. 13. Partington J, Orlick I A n analysis o f Olympic sport psych ology consultants' best-ever consulting experiences. The Sport Psychologist 1991; 5: 183-193. 14. Gould D, Eklund RC, Jackson S: 1. Coping strategies used by US Olympic wrestlers. R esearch Quarterhj fo r Exercise and Sport 1993; 6 4 ( 1 ) : 83-93. 15. Noivicki D. Using mental training during residential squad training in com bat sports: A Polish experience. The Sport P sychologist 1995; 9: 164-168. 16. O rlick T. R eflection s on sp o rtp sy ch con su ltin g with individual and team sp ort a th letes at Summer and W inter O lym pic Gam es. The Sport P sych ologist 1989, 3: 358-365. 17. Gipson M. M cK enzie T. L ow e S. The sport psychology programm e o f the USA women's national volleyball team. The Sport Psychologist 1989;3:330-339. 18. Gordin RD, H enschen KP. Preparing the USA women's artistic gym nastics team fo r the 1988 Olympics: A multi­ modal approach. The Sport Psychologist 19S9: 3: 366-373. 19. llalliwell IK Delivering sport psych ology services to the Canadian sailing team at the 19 88 Summer Olympic Games. The Sport Psychologist 1989; 3: 313-319. 20. Kirschenbaum DS. Parham WD, Murphy SM. Provision o f sport psych ology services at Olym pic events: The 1991 US Olympic festival and beyond. The Sport P sychologist 1993; 7: 419-440. 21. Suinn RM. The 1984 Olympics and sport psychology. Journal o f Sport P sychology 1985; 7: 321-329. 22. Salmela JH. Long-term intervention ivith the Canadian m en’s Olympic gym nastic team. The Sport Psychologist 1989; 3 : 340-349. 23. M ay JR. Brown L. D elivery o f psychological services to the US alpine ski team prior to and during the Olympics in Calgary. The Sport P sychologist 1989: 3: 320-329. 24. Gould D, Krane V. The arousal-athletic perform ance relationship: Current sta tu s and fu tu re directions. In: Horn TS, ed. A dvan ces in Sport Psychology. Champaign. Illinois: Human K in etics Publishers, 1992: 119-142. 25. Loehr JE. H ow to overcom e stress and p la y at you r peak all the time. Tennis 1984; March: 66-76. 26. Garfield CA, B en n ett HZ. P ea k P erform an ce:M ental Training Techniques o f the World’s G reatest A thletes. Los A ngeles: Tardier, 1984. 27. Schom er H II. P sych ologica l training techniques fo r ath letes. In: P o tg ie ter JR, ed. R ead in gs in Sport Psychology. University o f Stellenbosch:Institute fo r Sport and Movement Studies. 1992; 1-11. 28. N ideffer RM. A th le te s ' G uide to M ental Training. Champaign. Illinois: Human K in etics Publishers. 1985. 29. Cox RH. Sport Psychology: Concepts and A pplications. 3rd Edition: Dubuque, Iow a: Brown & Benchmark. 1994. 30. Orlick T. In P u rsuit o f E xcellen ce. Champaign. Illinois-.Human Kinetics, 1980. 31. Orlick T, Partington J. Mental links to excellence. The Sport Psychologist 1988; 2: 105-130. 32. Murphy SM, Ferrante A P Provision o f sport p sych ology ser­ vices to the US team at the 1988 Summer Olympic Gaines. Tlie Sport P sychologist 1989: 3: 374-385. Q SPORTS MEDICINE JULY 1996 17 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2. ) National Olympic Committee of South Africa (NOCSA) Anti-doping Policy April 1996 Dr G Ruijscli van Dugteren MB CliB FCP 1. INTERPRETATION In tliis policy, tlie following words have the following respective meanings: "NOCSA" tlie National Olympic Committee o f South Africa. "IDS" tlie Institute for Drug-Free Sport "Agency" any agency throughout tlie world recog­ nised by NOCSA as conducting sampling or testing, or both, o f atliletes for tlie detection o f doping and in accordance with tlie IOC Medical Code; "NSC" the National Sports Council "Athlete" (a) a member or potential member o f a South African Olympic Team; (b) a member o f a NOCSA Affiliate or per­ son competing in any competition under tlie control or auspices o f a NOCSA Affiliate; (c) a person competing in any competition in South Africa contested in tlie frame­ work o f tlie Olympic Movement, in partic­ ular those competitions organised undcr tlie authority, whether direct or delegat­ ed, o f an International Federation, NOCSA or a NOCSA Affiliate. "Doping" is defined as: (a) the administration o f substances belonging to proliibited classes o f phar­ macological agents; and/or (b) tlie use o f various proliibited mediods as described in Chapter II o f tlie IOC Medical Code (as in force from time to time). "IF" an International Federation being a body controlling a branch of sport and recog­ nised as such by Hie IOC. "IOC" tlie International Olympic Committee, being an association created by the Congress o f Paris o f 23 June 1984 and which is entrusted with tlie control and developm ent o f the m odern Olympic Games pursuant to the Olympic Charter. "IOC tlie Medical Code provided for under Medical Code” Ride 48 o f the Olympic Charter. "Affiliate" any Body which is affiliated to NOCSA. "Olympic the Olympic Charter o f the IOC Charter" or any amendment, m odification or replacement thereof. "Responsible Hie IOC, IFs, NOCSA, NSC, IDS, NFs and Authority" NOCSA Affiliates. Trafficking occurs when any person: (a) manufactures, extracts, transforms, prepares, stores, expedites, transports, imports, transits, offers (subject to pay­ ment or free o f charge), distributes, sells, exchanges, brokers, obtains in any form, prescribes, commercialises, makes over, accepts, possesses, holds, buys or acquires in any manner products or sub­ stances which are prohibited under die IOC Medical Code; (b) acts in this respect, finances or serves as an intermediary for the financing o f die latter, provokes in tiny way tlie con­ sumption or use o f such products or pro­ hibited substances or establishes means o f procuring or consuming such sub­ stances; or (c) is concerned or involved in methods which are prohibited by die IOC Medical Code, other than in die course o f die legal cxercise o f professional activities. Any words when used in the plural shall have a corre­ sponding meaning in Hie singular. Any words used in die masculine gender shall have a corresponding meaning in tlie feminine gender. Words not defined in tiiis policy shall have the meaning ascribed to diem in the Constitution o f NOCSA unless a contrary meaning appcai-s from die context . 2. POSITION STATEMENT 2.1 The IOC's Medical Code (Olympic Charter Ride 48) (i) provides for the prohibition o f doping, (ii) determines die classes o f prohibited sub­ stances and proliibited m ediods, (iii) establish­ es die list o f accredited laboratories, (iv) pro­ 18 SPORTS MEDICINE JULY 1996 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2. ) vides for tlie obligation o f competitors to submit themselves to medical controls and examina­ tions, (v) lays down testing procedures, includ­ ing procedures for selection o f athletes, sample collection and sample analysis, (vi) provides for appeals to tlie Court o f Arbitration for Sports, (vii) determines sanctions to be applied in tlie event o f a doping violation and (viii) prohibits the trafficking in prohibited substances. 2.2 On 13 January 1994 representatives o f tlie IOC, the Association o f Summer Olympic International Federations, tlie Association of International Winter Federations, IFs, the Association o f National Ofympic Committees, the continental associations o f NOCs and athletes agreed, among other tilings: ( 1 ) to imify their anti-doping ndes and proce­ dures for the doping controls performed both during and out o f competition; (2) to adopt, each year, as a basic document tlie list o f proliibited classes and methods of doping established by tlie IOC M edical Commission and to undertake tlie necessary controls for each sport; (3 ) to accelerate unification o f tlie minimum sanctions provided for by the IOC Medical Commission for violations o f tlie anti-doping reg­ ulations and to ensure their application at botii international and national level; (4) to recognise tlie sanctions imposed by an IF; (5) to use laboratories accredited by tlie IOC for all international competitions and out o f compe­ tition testing; and (6) to develop co-operation between tlie IOC, IFs, NOCs, National Federations and govern­ ments or other organisations concerned in order to organise and ca n y out doping controls and to combat tlie trafficking o f proliibited substances in sport. 2.3 Tire IOC Medical Code and tliis policy are essen­ tially intended to safeguard tlie health o f atli­ letes and to cnsiue respect for tlie ethical con­ cepts implicit in Fair Play, tlie Olympic Spirit and medical practice. 2.4 Doping is proliibited 2.5 All atliletes must provide samples for testing at the request o f a Responsible Authority or Agency 2.6 Tlie counselling o f tlie use of, permitting tlie use of, or condoning die use o f any substance or method contrary to tlie IOC Medical Code is pro­ hibited. 3. APPLICATION OF ANTI-DOPING POLICY 3.1 Tliis policy applies to: (1) athletes, whether in or out o f competition; (2) coaches, trainers, officials, and medical and paramedical personnel worlting with or treating adiletes; (3) NOCSA Affiliates; and (4) all persons involved in trafficking. 3.2 Sanctions are applicable in tlie event o f any breach o f the provisions of this policy. 4. DOPE TESTING 4.1 NOCSA or an Agency may conduct sampling and testing or both o f athletes for the detection o f doping. 4.2 A Responsible Authority may select an atlilete to provide any number of saniplcvs for dope testing in a year, whether in or out o f competition. 4.3 Sampling and testing o f adiletes must be con­ ducted in conformity with the IOC Medical Code. 4.4 Minor irregularities which cannot reasonably be considered to affect the results o f otherwise valid tests, will not invalidate such results. However, tests may be invalidated in die case of serious irregularities such as a break in the chain o f custody o f die sample, improper scaling o f the container in which die sample is stored, f ailure to request tlie signature o f the athlet e, or failm-e to provide die atlilete with an opportuni­ ty to be present or be represented tit the opening and analysis o f the "B" sample. 4.5 Every NOCSA Affiliate must: (1) pennit NOCSA or an Agency to attend com ­ petitions conducted by it, or under it's auspices, in order to obtain samples for dope testing; (2) perm it NOCSA or an Agency to obtain samples for testing from athletes out o f compet­ ition and provide reasonable assistance for this purpose. (3) infonn adiletes tliat tiiey are liable for selection to provide samples for dope testing whether in Soudi Africa or overseas; (4) arrange for completion and return o f fomis required for dope testing purposes at the request o f NOCSA, an Agency or a Responsible Authority; (5) require and cause atliletes and officials to pennit NOCSA or an Agency to collect samples for testing out o f competition and provide rea­ sonable assistance for tliis purpose; (6) use NOCSA or an Agency to conduct :uiy additional test required by the NOCSA Affiliate SPORTS MEDICINE JULY 1996 19 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2. ) ill South Africa at its own expense; (7) submit its anti-doping policy to NOCSA for approval o f consistency with its policy and there­ after not alter or amend its approved anti-doping policy without first obtaining tlie approval of NOCSA. 5. OTHER DOPING OFFENCES 5.1 Should an athlete fail or refuse to provide a sample upon request, then this will be an infraction o f this policy and for which tlie athlete is subject to tlie same penalty as i f tlie athlete had committed dophig. 5.2 Where an athlete has made a statement admit­ ting doping such statement will be prima facie evidence o f an infraction o f this policy'. Upon notification o f such a statement, the Seeretan' -General may conduct enquiries as he or slie deems appropriate to determine whether there is sufficient evidence that the statement of admission o f doping was made. In conducting these enquiries, NOCSA will not be obliged to conduct any hearing or to receive any evidence or statenieuts by or on b eh a lf o f the athlete concerned. 5.3 Should a NOCSA Affiliate fail to adopt and implement an anti-doping policy' consistent with this policy, it will be in breach o f NOCSA’s Constitution and this policy and liable for tlie penalties described therein for a breach o f tlie Constitution or By-Laws made thereunder. 5.4 Trafficking is prohibited and any person (includ­ ing ail}7 bod}7, corporate or unincorporate) involved hi trafficking is liable to sanction under this policy. 5.5 Any person will be deem ed to be involved in trafficking if that person: (1 ) has aided, abetted, counselled or procured tlie trafficking; (2) has induced, whether by threats or promis­ es or otherwise, tlie trafficking; (3) has been in any way, directly or indirectly, knowingly concerned in, or party to, tlie traffick­ ing; or (4) has conspired with others to effect tlie trafficking. 5.6 Clauses 5.4 and 5.5 do not apply to doctors, pharmacists and other members o f tlie medical profession or holders o f analogous diplomas recognised by tlie public authorities concerned, when one or other o f tlie above clauses is neces­ sary for them within the strict limits o f exercis­ ing tlie art o f healing. 6. ADVICE OF ALLEGED BREACH 6.1 Where NOCSA has requested an Agency or Agencics to conduct sampling or testing or both o f atiiletes, that Agency or Agencies will notify NOCSA o f tlie names and results o f any athlete who returned a positive test result or who failed to comply with tlie requirement to provide a sample for testing. 6.2 Affiliates must notify NOCSA o f tlie names and result o f any athlete who returned a positive test result or who failed to comply with a requirement to provide a sample for testing. Other Responsible Authorities may so notify NOCSA. 6.3 Atiiletes and Affiliates must notify NOCSA o f tlie names o f any person who they know or reason­ ably suspect o f being involved hi trafficking, and must provide NOCSA with all such information and assistance as they are able to give to enable NOCSA to conduct an investigation into the circumstances surrounding the suspected trafficking. Failure to do so will be considered trafficking by tlie athlete or NOCSA Affiliate concerned. 6.4 NOCSA will maintain confidentiality o f informa­ tion provided under clauses 6.1, 6.2, and 6.3 mitil after a decision (if any) to impose a sanction for a breach o f this policy has been determined except as is necessary to conduct or prosecute any hearing under this policy or to notify the relevant Responsible Authorities. 7. NOTIFICATION OF ALLEGED BREACH BY AN ATHLETE OR OTHER PERSON 7.1 Where NOCSA receives notification from an Agency or a Responsible Authority that an athlete has returned a positive test result or has failed to comply with a request to provide a sam­ ple or for another reason believes that a person to whom tiiis policy applies has committed an infraction o f this policy, NOCSA will give to the athlete or person concerned notice o f the alleged infraction. 7.2 This notice o f alleged infraction (clause 7.1 above) must: (1 ) b e hi writing and be delivered to the athlete or person; (2) set out tlie nature and particulars o f tlie alleged infraction; (3) set. out or enclose an extract o f tiiis policy relating to tlie sanctions that may be imposed if it is determined that tlie alleged infraction has occurred, tuid (4) state that a Hearing to decide whether an infraction o f this policy lias occurred and what penalty' to impose will b e determined by a 20 SPORTS MEDICINE JULY 1996 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2. ) Committee appointed by the IDS according to the procedures described in clause 9. 8. OLYMPIC GAMES 8 1 Tlie IOC Executive Board is the only body competent to rule on tlie effects o f a positive test result during the Olympic Games. 8.2 Should an atlilete be found by the IOC' Executive Board to have committed doping dining the Olympic Games, any hearing by a Committee appointed by NOCSA or any appeal therefrom to tlie Court o f Arbitration for Sport will be bound hy that finding and the hearing or appeal will be limited to the sanction to be imposed for the breach o f tliis policy. 9. PROCEDURE FOR THE CONDUCT OF HEARING INTO DOPING 9.1 Where NOCSA gives an atlilete or person a notice pursuant to clause 7, NOCSA will consult with die Affiliate o f tlie atlilete or person concerned with a view to there being a joint hearing on beh alf o f NOCSA and tlie Affiliate to determine: (1) whether the atlilete or person has commit­ ted an infraction o f tliis policy and/or tlie anti- doping policy o f tlie NOCSA Affiliate; (2) what sanction consistent with tliis policy should be applied to the atlilete or person who was found to have committed an infraction o f this policy. 9.2 Should it not be possible or feasible to conduct a joint hearing pursuant to clause 9.1, the hearing will be on behalf o f NOCSA alone. 9.3 Tlie NOCSA Executive will appoint a Committee o f up to three persons to conduct a hearing. 9.4 Tlie Committee may conduct a hearing in such a manner as it determines. Hearings may be conducted by telephone or other conference facilities. 9.5 Hearings are to be conducted with as littie formality and technicality, and with as much expedition, as proper consideration o f the matter before tlie Committee permits. 9.6 At a hearing o f tlie Committee: (1) tlie Committee may examine and cross examine witnesses and may appoint a legal representative or other person to assist it; (2) NOCSA and, if tlie hearing is a joint hearing on beh alf o f NOCSA and an Affiliate, that Affiliate, may separately or jointly examine and cross-examine witnesses and be assisted by legal representation or other person; (3) the atlilete or person concerned may exam­ ine and cross-examine witnesses and may be assisted by a legal representative or other person; and (4) where an atlilete contends that, sampling or testing or both o fliin i or her is not substantially in conformity with the IOC Medical Code, die onus shall b e on the athlete to show on tlie balance o f probabilities that liis or her con­ tention is correct and tliat as a result thereof the results o f (lie sampling and testing have been so affected as to not record doping. 9.7 Tlie Committee will make a statement in waiting stating its findings o f fact and its decision and will send tlie statement to NOCSA. The Committee is not bound to give a statement o f its reasons for its decision. 9.8 NOCSA will send a copy o f (lie statement to: (1) die IOC (2) tlie IDS (3) tlie NSC (4) the Affiliate o f which the atlilete or person is a member; and (5) any other person or organisation that NOCSA believes should be informed. 9.9 Tlie Committee will send to the athlete or person concerned a copy o f die statement so far as it relates to die atlilete or person, but the atlilete or person is not entitled to a copy o f the Committee's statement o f its reasons (if any). 10. APPEALS 10.1 An atlilete or person who is dissatisfied with a decision made in relation to him or her under tliis policy may, within 14 days o f receiving written notification o f (lie sanction imposed, appeal to the Court o f Arbitration for Sport and request tliat an appeal be conducted in relation to: (1) tlie determination that an infraction o f diis policy has occurred and die imposition o f the sanction; or (2) the sanction that has been imposed. 10.2 Auy such appeal will be conducted according to tlie Code o f Sports-Related Arbitration. 10.3 An appeal deals only with die original matters appealed against. 10.4 Upon receiving notice o f (lie outcome o f an appeal from tlie Court o f Arbitration for Sport., NOCSA will give written notice o f tlie outcome to: SPORTS MEDICINE JULY 1996 21 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2. ) ( 1 ) tlie athlete or person making tlie appeal; and (2) tlie persons and/or organisations provided with tlie statement pursuant to clause 9.7. 10.5 An appeal conducted hi accordance with diis policy is tlie sole form o f appeal from tlie decision under this policy. No appeal may be made to a court or other tribunal. 11. SANCTIONS 11.1 Any atlilete who is found to have committed doping will be ineligible for membership o f or selection in any South African Olympic Team, or to receive funding from or to hold any position on NOCSA as follows: ( 1 ) for a first infraction other than cases provid­ ed for hi paragraph (2) - suspension for two years. (2) for a first infraction hi cases o f a positive result for ephedriue, plienylpropanolaniiuc, pseudo-ephedrine, caffeine, strychnine and related compounds - suspension for a maximum period o f three months; (3) for tlie second offence other than hi tlie cases provided hi paragraph (4) - suspension for liis or her lifetime; (4) for a second infraction in cases o f a positive result for ephedriue, phenylpropanolamine, pseudo-ephedrine, caffeine, strychnine and related compounds - suspension for two years. (5) for a subsequent infraction hi cases o f a positive result for ephedriue, phenyl­ propanolam ine, pseudo-ephedrine, caffeine, strycluiine and related compounds - suspension for his or her lifetime. 11.2 Where an atlilete or other person to whom tiiis policy applies is found to have committed an infraction o f tiiis policy other than doping he or she will be subject to at least tlie same penalties as described in clause 1 1 .1 , provided that such penalties are a minimum only and may be increased according to tlie circumstances and culpability involved. 11.3 Tlie above sanctions may be applied to a person regardless o f any sanction or penalty, its duration or timing or whether current or past, imposed by any Responsible Authority PROVIDED THAT NOCSA will recognise previous sanctions imposed by any Responsible Authority to deter­ mine whether tlie breach is a first or second offence. 11.4 NOCSA will, however, recognise sanctions imposed by a relevant IF if its sanctions extend for a longer period than that imposed by NOCSA. 11.5 Failure by an invited atlilete or person to attend to be heard by the Committee in accordance with clause 9 for whatever reason will not invalidate tlie right o f NOCSA to impose a sanction hi accordance with ill is policy. 12. PRESS RELEASE A press release may be issued by NOCSA in relation to ail}- sanction imposed under this policy. 13. REVIEW OF SANCTION 13.1 Where an atlilete or person to whom a sanction has been applied under this policy has new and relevant information concerning the infraction, he or she or it may make written application to NOCSA setting out the grounds for a possible review o f diat sanction. The Executive o f NOCSA may consider the application and determine hi its sole and absolute discretion to either: (a) itself review any sanction imposed imder this policy and whether to alter a decision made previously including a reduction or withdrawal o f die sanction; or (b) refer the matter to the Court o f Arbitration for Sport for that Court to determine whether to review any sanction imposed under this policy and whether to alter a decision made previously including a reduction or withdrawal o f the sanction. 13.2 NOCSA will not alter any decision under clause 13.1 without first consulting with any otlier sports organisation which it knows has a current sanction over the atlilete or person and obtains its agreement, to the alteration. 13.3 Notification o f any change to the previous decision will be made hi accordance with clause 11. 14. EDUCATION AND OTHER INITIATIVES NOCSA will undertake die following anti-doping initia­ tives: (1) Support die anti-doping policies o f the Government through tlie Institute for Drug-Free Sport. (2) Enc.oiu-age the development and implementation by Responsible Authorities o f drug education programmes for atiiletes and officials. (3) Support the information and educational initia­ tives o f Responsible Authorities. Q] 22 SPORTS MEDICINE JULY 1996 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2. ) South African Institute for Drug-Free Sport INTERNATIONAL OLYMPIC COMMITTEE MEDICAL COMMISSION Proliibited Classes of Substances and Prohibited Methods January 1996 Doping contravenes tlie ethics o f sport and medical science. Doping consists of: 1. tlie administration o f substances belonging to selected classes o f pharm acological agents, and/or 2. Tlie use o f various prohibited methods. I. PROHIBITED CLASSES OF SUBSTANCES A. Stimulants B. Narcotics C. Anabolic Agents D. Diuretics E. Peptide and glycoprotein hormones and ana­ logues II. PROHIBITED METHODS A. Blood doping B. Pharmacological, chemical and physical manipu­ lation III. CLASSES OF DRUGS SUBJECT TO CERTAIN RESTRICTIONS A. Alcohol B. Marijuana C. Local anaesthetics D. Corticosteroids E. Beta-blockers EXAMPLES AND EXPLANATIONS Tliis document lists examples representing different doping classes to illustrate tlie doping definition. No substances belonging to the banned classes may be used even i f tlie}- are not listed as examples. For diis reason, tlie term “ and related substances” is intro­ duced. Tliis term describes drugs tliat are related to tlie class by their pharmacological actions or chemical structure. A longer list o f examples belonging to differ­ ent pharmacological classes o f banned substances can be found in annex 1. If substances o f tlie banned classes are identified by an IOC accredited laboratory tlie relevant authority will act. I. PROHIBITED CLASSES OF SUBSTANCES A. Stimulants Stimulants comprise various types o f substances which increase alertness, reduce fatigue and may increase competitiveness and hostility'. Their use can also pro­ duce loss o f judgement, which may lead to accidents to others in some sports. Amfetamine and related com ­ pounds have the most notorious reputation in produc­ ing problems in sport. Some deaths o f sportsmen have resulted even when normal doses have been used under conditions o f maximum physical activity. There is 110 medical justification for tlie use o f “ amphetamines” in sport. One group o f stimulants is die sympathomimetic amines o f which epliedrine, pseudoephedrine, phenyl­ propanolamine and norpseudoephedrinc are examples. In high doses, tliis type o f compound produces mental stimulation and increased blood flow. Adverse effects include elevated b lo od pressure and headache, increased and irregular heart beat, anxiety and tremor. These compounds are often present in cold and hay fever preparations which can be purchased “ over tlie counter” from pharmacies and sometimes from other retail outlets without medical prescription. Another group o f stimulants is tlie beta-2 agonists. These drugs are unusual because diey are classified as botii stimulants and anabolic agents. When taken by mouth or by injection they may exert powerful stimula­ tory and anabolic effects. Oral and injectable adminis­ tration o f beta-2 agonists is banned. Of tlie beta-2 agonists only Salbutauiol, Salmetcrol and Terbutaline arc permitted and only by inhalation. Any physician wishing to administer beta-2 agonists by inhalation must give written notification to tlie relevant medical authority prior to tlie competition. The choice o f medications to treat asthma and other common, respiratory disorders poses a problem because some o f tlie more commonly prescribed substances are powerful stimulants. Furthermore, because these drugs have many different product names, tlie status o f a ding' may be confusing. Tlie most prudent, approach is never to take or prescribe a product-for colds, sore throats, and flu without first checking with a physician or phar­ macist who has special expertise in tliis area. Prohibited substances in class (A) include the fol­ lowing examples: amiphenazole amineptine cocaine fencamfamine pentylentetrazol salbutamol* * salmetcrol ** . . . and related substances. * Caffeine: Tlie definition o f a positive depends 011 tlie concentration o f caffeine in tlie urine. Tlie concentra­ tion in urine may not exceed 1 2 micrograms per milliliter. * * Salbutamol, sahneterol and terbutaline are permit­ ted by inhaler only and must be declared in writing, prior to die competition to tlie relevant medical author­ ity. NOTE: All imidazole preparations are acceptable for topical use, e.g. oxymctazoline. Vasoconstrictors (e.g. adrenaline) may be administered with local anaestliet- ain phetamines caffeine * ephedrines mesocarb pipradol terbutaline * * SPORTS MEDICINE JULY 1996 23 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2. ) ic agents. Topical preparations (e.g. nasal, ophthalmo- logical) o f phenylephrine are permitted. B. Narcotics Morphine and other compounds o f tiiis class are pow­ erful analgesics and are mainly used for tlie manage­ ment o f severe pain. These substances have major side effects, including respirator}7 depression, and they carry a high risk o f physical and psychological dependence. Evidence reveals that narcotic analgesics have been abused in sports. Therefore tlie IOC Medical Commission has issued and maintained a ban 011 their use. Tlie ban is consistent with international restric­ tions and with the regulations and recommendations o f tlie World Health Organisation regarding narcotics. Prohibited substances in class (B) include the following examples: dextromoramide dextropropoxyphenc diamorphine (heroin) methadone morphine pentazocine pethidine . . . and related substances NOTE: Codeine, dextromethorphan, diliydrocodeine, diphenoxylate and pholcodine are permitted. C. Anabolic agents The Anabolic class includes anabolic androgenic steroids (AAS) and Beta-2 agonists. 1. Anabolic androgenic steroids (A A S ) Tlie AAS class includes testosterone and substances that are related in structure and activity to it. They have been misused in sport to increase muscle strength and bulk, and to promote aggressiveness. The use o f AAS is associated with adverse effects 011 tlie liver, skin, car­ diovascular and endocrine systems. They can promote tlie growth o f tumours and induce psychiatric syn­ dromes. I11 males AAS decrease the size o f die testes and diminish sperm production. Females experience mas- culinization, loss o f breast tissue and diminished men­ struation. Tlie use o f AAS by teenagers can stunt growth. Prohibited substances in class (C l) include tlie follow­ ing examples: clostebol fluoxymesterone metandienone metenoloiie liandrolone oxandrolone stanozolol testosterone * . . . and related substances * Tlie administration o f testosterone is banned .Tlie presence o f testosterone (T) to epitcstosterone (E) ratio greater than six (6) to one (1 ) in tlie m ine o f a competi­ tor constitutes an offence unless there is evidence that this ratio is due to a physiological or pathological con­ dition, e.g. low epitestestosterone excretion, androgen production by tumour, enzyme deficiencies. In the case o f a T /E ratio higher than 6 , it is mandato­ ry that tlie responsible authority conduct an investiga­ tion before tlie sample is declared positive. A full report wall be written and will include a review o f previous tests, subsequent tests and any results o f endocrine investigations. In die event that previous tests arc not available, tlie athlete should be tested unannounced at least once per month for three months. The results o f these investigations should be included in the report. Failure to cooperate in die investigations will result in declaring the sample positive. 2. Beta-2 agonists When given syst eniically, beta-2 agonists may have pow­ erful anabolic effects, and tiieir use is therefore banned. (See also section IA) Prohibited substances in class (C 2) include the follow­ ing examples: clenbuterol salbutamol terbutaline salmetcrol fenotcrol . . . and related substances D. Diuret ics Diiu-etics have important therapeutic indications for the elimination o f fliuds from the tissues in certain padiological conditions and for management o f high blood pressure. Diuretics are sometimes misused by competitors for two main reasons, namely: - to reduce weight quickly in sports where weight cat­ egories are involved, and - to reduce die concentration o f substances by diluting the urine. Rapid reduction o f weight in sport cannot be justified medically. Health risks are involved in such misuse because o f serious side-effects which might occiu\ Furthermore, deliberate attempts to reduce weight ar­ tificially in order to compete in lower weight classes or to dilute urine constitute clear manipulations which are unacceptable 011 ethical grounds. For sports involving weight classes, the responsible authorities reserve die right to obtain urine samples from die competitor at the time o f the weigh-in. Prohibited substances 111 class (D) include the following examples: acetazolamide bumetanide chlorthalidone cdiacrynic acid furosemide hydrochlorothiazide mamiitol mersalyl spironolactone triamterene . . . and related substances E. Peptide and glycoprotein liormones and analogues Prohibited substances in class (E) include tlie following examples: 1. Chorionic Gonadotrophin (HCG-human chori­ onic gonadotrophin): It is well knowrn that die administration to males of human chorionic ganodotropllin (HCG) and odier coni- poimds widi related activity, leads to an increased rate o f production o f endogenous androgenic steroids and is considered equivalent to the exogenous administration o f testosterone. 24 SPORTS MEDICINE JULY 1996 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2. ) 2. Corticotrophin (A C T H ): Corticotropliiii lias been misused to increase tlie blood levels o f endogenous corticosteroids notably to obtain tlie euphoric effect o f corticosteroids. Tlie application o f corticotropliiii is considered to b e equivalent to the oral, Lntra-mu scalar or intravenous administration o f cor­ ticosteroids. (See section III. D). 3. Growth hormone (HGH, somatotrophin): H ie misuse o f growth hormone in sport is unethical and dangerous because o f various adverse effects, for exam­ ple cardiomyopathy, hypertension, diabetes niellitus, and acromegaly when given in high doses for a long period o f time. Contamination o f some growth hormone preparations o f human origin can cause Creutzfeldt Jacob disease (a fatal neurological condition). NOTE: All tlie respective releasing factors o f the above- mentioned substances are also banned. 4. Erythropoietin (EPO): Tliis naturally occurring hormone is produced in the kidney and regulates red b lood cell production. Synthetic EPO is currently available and has been demonstrated to induce changes similar to blood dop­ ing (see IIA). II. PROHIBITED METHODS The following procedures are proliibited: A. Blood doping Blood doping is tlie administration o f blood, red blood cells or related products to an atlilete. Tliis procedure may be preceded by withdrawal o f blood from the ath­ lete who continues to train in tliis blood depleted state. These procedures contravene tlie ethics o f medicine and o f sport. There are also risks involved in the trans­ fusion o f blood and related blood products. These include tlie development o f allergic reactions (rash, fever etc.) and acute haemolytic reaction with kidney damage if incorrectly typed blood is used, as well as delayed transfusion reaction residting in fever and jaun­ dice, transmission o f infectious diseases (viral hepatitis and AIDS), overload o f tlie circulation and metabolic shock. B. Pharmacological, chemical and physical manipulation Pharmacological, chemical and physical manipulation is tlie use o f substances or o f methods which alter, attempt to alter or may reasonably be expected to alter tlie integrity and validity o f urine samples used in dop­ ing controls. Examples o f banned methods include, without limitation, catheterisation, urine substitution and/or tampering, inliibition o f renal excretion such as by probenecid and related compounds, and epitestos- terone administration. Tlie IOC Medical Commission bans tlie use o f sub­ stances and o f methods which alter tlie integrity and validity o f urine samples used-in doping controls. I f tlie epitestosterone concentration is greater than 200 ng/nd, tlie laboratories should notify tlie appropri­ ate authorities. The IOC Medical Commission recom­ mends tliat imder these circiunstances further investi­ gations be conducted. III. CIASSES OF DRUGS SUBJECT TO CERTAIN RESTRICTIONS A. Alcohol hi agreement with the International Sports Federations and the responsible authorities, tests may b e conduct­ ed for ethanol. Tlie results may lead to sanctious. B. Marijuana hi agreement with the International Sports Federations and the responsible authorities, tests may b e conduct­ ed for cannabinoids (Marijuana, Dagga, Hashish . . .). Tlie residts may lead to sanctions. C. Local anaesthetics Injectable local anaesthetics are permitted under the following conditions: a) that bupivacaine, lidocaine, mepivacainc, pro­ caine etc. are used but not cocaine. Vasoconstrictor agents (e.g. adrenaline) may be used in conjunction with local anaesthetics. b) only local or intra-articular injections may be administered; c) only when medically justified (i.e. the details including diagnosis, dose and route o f adminis­ tration must be submitted prior to tlie competi­ tion or immediately, if administered dining the competition, in writing to the relevant medical authority). D. Corticosteroids Because o f their anti-inflammatory properties, die nat- lually oceiuring and synthetic corticosteroids are wide­ ly used hi medicine to treat many diseases. When administered system icallv, the)' influence tlie natural production o f corticosteroids by tlie body. Corticos­ teroids may produce mood changes including euphoria and other side-eftects such that their medical use, except when administered topically, demands medical control. Beeausc it was known that corticosteroids were being used non-therapeutically in certain sports by die oral, rectal, intramuscular and even the intravenous routes, die IOC Medical Conunission attempted to restrict dieir use dining competitions by requiring a declaration by doctors. However, as such restrictions failed to solve die problem, stronger measures, designed not to inter­ fere widi the appropriate medical use o f corticos­ teroids, became liccessary. 'Hie use of corticosteroids is banned except a) for topical use (aiual, opthahnological and der- matological, but not rectal; b) by inhalation; c) by intra-articidar or local injection Tlie IOC has introduced mandatory reporting o f adi- letes requiring corticosteroids by inhalation during competitions. ANY TEAM DOCTOR WISHING TO ADMINISTER CORTICOSTEROIDS BY LOCAL OR INTRA-AR11CU- LAR INJECTION, OR BY INHALATION, TO A COM­ PETITOR MUST GIVE WRITTEN NOTIFICATION SPORTS MEDICINE JULY 1996 25 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2. ) PRIOR TO THE COMPETITION TO THE RELEVANT MEDICAL AUTHORITY. E. Beta-bloclters Due to the continued misuse o f beta-blockers in some sports tlie IOC Medical Commission reserves die right, at the Olympic Games, to test tiiose sports which it deem s appropriate. These are unlikely to include endurance events which necessitate prolonged periods o f high cardiac output and large stores o f metabolic substrates in w hich beta-blockers would severely decrease performance capacity. In agreement with tlie rules o f the Internationa] Sports Federations, tests wall be conducted in sonic sports at tlie discretion o f tlie responsible authorities. Some examples of beta-blockers are: acebutalol alprenolol atenolol labetalol metoprolol nadolol oxprenolol propranolol sotalol . . . and related substances. EXPANDED LIST OF EXAMPLES: ANNEX I Caution: This is not an exhaustive list o f banned substances. It is provided only to give tlie reader a more com prehensive list o f baim ed substances. Mail}7 substances that do not appear 011 this expanded list are considered banned under the term “ and related substances” . A. STIMULANTS amfepramone amineptine amfetamine caffeine cathine cocaine cropropamide crotetamide ephedriue etamivan etilamfetamine etilefrine fencanifamiii fenetylline fenfluramine heptaminol medea mefenorex mephentermine mesocarb metamfetamine mcthoxyplienamine methylephedrine methylphenidate nikethamide 1 lorphenflur amine parahydroxyamfctamine pemoline phendiiuetrazine phentcmiine pli ei ly 1 eph e f I r i 11 e phenylpropanolamine pholedrine prolintane p ropy 11 lexed line pseudoephed rine salbutamol strychnine B. NARCOTICS dcxtropropoxyphene cthyhnorpliine hydrocodone morphine pentazocine pethidine propoxyphene C. ANABOLIC AGENTS (1) Anabolic steroids (2) BetaS-agonists boldenone clenbuterol clostebol danazol deliyd rocl llorniethyl- testosterone dihydrotestosterone drostanolone fluoxyniesterone formebolone mesterolone metandienone metenolone metliandriol metliyltestosterone nandrolone noretliandrolone oxandrolone oxymestcrone oxymetliolone stanozolol testosterone trenbolone D. BETABLOCKERS aeebutolol atenolol bctaxolol bisoprolol bunolol metoprolol oxprenolol propranolol sotalol E. DIURETICS acetazolamide bendroflmmethiazide bmiietanide canrenone chlortalidone furosemide liydroclilorotliiazide indapamide spironolactone triamterene F. MASKING AGENTS cpitestosteronc probenecid G. PEPTIDE HORMONES ILCG liGH crytlu'opoietin ACTI-I alprenolol This information was kindly provided by the National Olympic Committee o f South Africa Q Som e im portant points about ovcr-thc- coimter medications and prescription drugs 1. Mail}7 atiiletes purchase from their local phar­ macy over-the-counter medications for tlie treat­ ment o f e.g.headaches, sinusitis, liayfever, asthma, colds, influenza etc. 2. It is a known fact that die majority of d ie brand­ ed medications for treatment o f the above ailments contain banned substances, notably phenylpropanolamine and ephedriue. 3. An atiilete should ask liis/her pharmacist or m cdical practitioner if a medication contains any baimed substances before taking it. 4. An atiilete slioidd request liis medical practi­ tioner to complete a medical notification form whenever any drug is prescribed for treatment. 5. Remember tiiat die accredited Drug Testing Laboratory7 uses the most m odem and sensitive testing m ediods, and any atiilete taking a baimed substance will m ost certainly test positive even s o m e ' time after t aking the substance. 26 SPORTS MEDICINE JULY 1996 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2. ) DOPING AND CLINICAL PRACTICE: ETHICAL PERSPECTIVES Dr MF Cusi, MB, BS, Cert. S ports Med. The use o f performance enhancing agents has been pre­ sent in Olympic sport since the Greek Games, and throughout the modern Olympics.' The term “Doping” has been borrowed from the horse racing fraternity. The word derives from Dop, a stimulant used by the Kafirs in Southeast Africa. Definitions o f doping have been based on the ability to detect forbidden substances and practices.2 34 A more philosophical definition, artificial performance enhanc­ ing, was proposed by the IOC Medical Commission Chairman. The IOC has declared war on three accounts: a) To protect the health o f athletes b) To uphold Sports Ethics, which is contrary to scien­ tific manipulation c) To ensure fair competition5 The official position in Australian sport is quite clear: “1. Doping is forbidden. The ASC condemns the use o f performance enhancing substances as both dangerous and contrary to the ethics o f sport. It recognises the need to take strong and positive action to eliminate doping. ” 8 The means to implement this policy have been to test for banned drugs and to impose heavy penalties on those found “ positive” . Education has been advocated, but no clear goals and guidelines have been set. Knowing athletes’ motives for drug use could also point to possible solutions. Much remains unknown in this area. Surveys on the extent o f doping are plagued by underreporting.78 The severe attitude that prevails at present will preclude controlled studies in future.9 The interest o f doping for a medical practitioner is threefold. 1 . Knowledge o f drug intake is part o f a good medical history. 2. Doctors’ attitudes bear important consequences, as athletes regard doctors as reliable sources o f infor­ mation on drugs.10 Attitudes can vary from assisting athletes to use drugs, to reporting them to the rele­ vant sporting authorities, or simply ignoring the mat­ ter. 3. The extent o f doctors’ responsibility in advising and prescribing in these matters. These difficult issues will be discussed in the context o f three scenarios that medical practitioners may have to face. SCENARIO 1. THE OFFICIAL TEAM DOCTOR May the doctor o f a sports team prescribe banned sub­ stances? The answer is simple: Doctors officially involved in competition sport may not ethically prescribe banned substances by virtue o f the rules that govern that par­ ticular sport. Any exception to the rules must be autho­ rised by the appropriate authorities in advance. SCENARIO 2. ANABOLIC STEROIDS IN A NON­ COMPETITIVE ATHLETE A young man wants to improve his body image lifting weights, and feels that the anabolic steroids (A.S.) will help him achieve his goal. Competition rules cannot be broken because there is no competition. The doctor needs to ask four questions to decide whether it would be ethical to write a prescription for anabolic steroids. 1. Are Anabolic Steroids Effective? The scientific literature has been inconsistent and at times at odds with empirical wisdom o f the athletic community regarding the ergogenic effects o f A.S. However, the answer would have to be YES.11 2. Are there any contraindications? The answer is also YES, but we need not consider this point any further in our argument. 3. Are there side effects and how serious are they? The answer is again YES: there are changes in organ function, energy metabolism and also signs o f psy­ chological dependence.12 Side effects should be com ­ pared to potential benefits before making a clinical decision to prescribe. 4. Can we prevent, cure or alleviate a clinical condition with this prescription? The answer is a definite NO. Therefore the ethical response to a request o f this kind is to decline the prescription. The reaction o f the athlete can be either. a) to accept the advice and not take the A.S. b) to threaten the doctor with taking low' quality black market Steroids “because they were not made avail­ able by prescription.” There are three possible cours­ es o f action open to the medical practitioner who faces this kind o f blackmail. The Damage-Control Approach Presented with a “ Fait Accompli” some Doctors feel inclined to prescribe the desired drug, in an attempt to prevent patients from taking “ street drugs” (with no quality control), and to provide some form o f medical monitoring. Maintaining contact with the patient may also give a chance to wean them o ff for good. This position is well-intentioned, but Hawked for the following reasons: a) The lesser evil approach is never the right choice. If an action is considered to be wrong, this action should not be taken. b) There is no guarantee that the athlete will abide by the conditions that the prescriber may set. Anecdotal experience confirms tliat atliletes easily get whatev­ er drugs they want. c) The prescribing doctor becomes a known source of steroids, and eventually a willing instrument in the spread o f their abuse: the very opposite o f the origi­ nal intention. The Damage-Control Approach is therefore clinical- ly unsound and ethically unwise. Paternalistic Platitudes It is easy to dismiss these athletes with paternalistic platitudes such as “ drugs are no good for you” . Lack o f time or distaste for these matters are not valid reasons for dismissal, because they do not provide the athlete with an answer or a solution to his problem. Counselling Help in these cases requires a mixture o f firmness and gentleness in the right dose. Commitment is related to the “bottom line position” . I will NOT prescribe A.S. Gentleness refers to the counselling required: simple, logical arguments, to make the potential drug-user think twice. A conversation o f this kind may have to cover personal problems, attitudes and misconceptions that the athlete may have about him self and his social SPORTS MEDICINE JULY 1996 27 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2. ) environment. Counselling is difficult, time-consuming, and often frustrating as the final decision remains with the individual. SCENARIO 3. A DESPERATE DECISION The third scenario involves an elite female shooter. A drop in forms leads to the diagnosis o f an essential- familial tremor. The treatment o f choice is Propranolol, a beta-blocker banned by the IOC. She wants to perform well at her next meet to secure a long term sponsorship. This puts her in a no-win situ­ ation, and her increasing anxiety makes her condition worse. She finally makes a desperate decision: to take Propranolol and give herself a chance to live normally and train as well as she can. When she talks with her family doctor, a distinction needs to be made between her actions and the actions o f the doctor. Both face different ethical decisions. If she competes whilst taking beta-blockers she is in breach o f the competition rules. The prescription o f a beta-blocker in this case is good medical practice. In the absence o f contraindications it is the drug o f choice. The ethical position o f the doctor depends on the circumstances: a) If he is involved in the sport in an official capacity he cannot ethically prescribe a banned drug without official permission, as we saw in Scenario 1. b) I f he is not involved in an official capacity he is not bound by those rules. Thus, provided that he does not approve o f rule-breaking and says so, his pre­ scription o f the banned drug wil 1 b e ethical. The pri­ mary effect is good: the appropriate treatment o f a medical condition. There is also a bad secondary effect: the doctor will cooperate in the shooter’s breach o f competition rules i f she competes whilst on a banned drug. Both effects are independent o f each other: the therapeutic effect is not the result o f the doctor’s cooperation with the breach of doping regulations. The proportion between these two effects will deter­ mine the ethical legitimacy o f the prescription. It is ethical if there is due proportion between the good intended (treatment o f a medical condition) and the secondary wrongful effect (cooperation with possible breach o f anti-doping regulations). DISCUSSION The three scenarios presented indicate that medical practice is more complex than the IOC’s anti-doping rationale admits. Both the rationale and a perceived inconsistency in its application have been criticised in some quarters. A summary7 o f these criticisms would include: 1. The concept o f doping being bad per se has not been proved.13 2. The ban on drugs for the sake o f athlete’s health is derived from a paternalistic attitude that denies ath­ letes o f the principle o f autonomy. 3. I f fair competition means that all athletes can com ­ pete on equal terms, most competitions are unfair. Training facilities, coaches, sports physicians and physiology laboratories are not equally available to all athletes. 4. The ban and stigma attached to drugs readily avail­ able in everyday medical practice leads athletes to the perception that they can only receive second- class treatment for a variety o f illnesses. 5. The policy o f protecting athlete’s health will ring hol­ low as long as boxing continues to be a part o f Olympic and Commonwealth Games Programmes.14 All the precautions designed to protect boxers only confirm that the purpose o f boxing is to punch the opposition to defeat. As there is some merit in these criticisms, wide and frank debate o f these issues is required to provide the IOC with a sound rationale for its ethical stand on dop­ ing and for a fair implementation o f its policy. The conflicts that arise need to be addressed both by doctors and sporting authorities, as competitive ath­ letes look to their family doctor as a reliable source o f information on drugs.15 Four basic points can be high­ lighted. 1. Doctors who treat athletes need to be aware o f dop­ ing rules, and to be familiar with the clinical and eth­ ical issues involved in the treatment o f these patients. 2. The need to'maintain independence o f one’s medical practice. Should there be a conflict o f interests, the first loyalty o f a treating physician is to the individual patient’s welfare above all other considerations.16 3. It is important to realise that the patient (athlete) must take the ultimate responsibility for his or her actions, whilst bearing in mind the weight o f a doc­ tor’s advice. 4. Doping charges often carry strong emotional over­ tones, which do not help in finding solutions. A good working knowledge o f the facts - clinical, historical, personal and ethical - will assist greatly to think clearly, to remain objective and to make fair deci­ sions. Acknowledgement This article was first published in SportHealth (Volum e 13 N o 1 ) , an official publication o f the Australian Sports Medicine Federation Ltd. I t is reprinted here with the kind perm ission o f the author and o f the editor o f SportHealth, D r Peter Brukner. REFERENCES 1. H aynes S., “D oping”. A S D A Update. Canberra, 7 May 1991. 2. H aynes S., “D oping”. A S D A Update. Canberra, 7 May 1991. 3. Merode A . , in “L a Vanguardia” (Barcelona, Spain), 3 November 1991. 4. Australian Sports Commission (A S C ). “Doping P olicy”. Canberra. A ugust 1990. 5. Merode A ., in “L a Vanguardia” (Barcelona, Spain), 3 November 1991. 6. Australian Sports Commission (A S C ). “D oping P olicy”, Canberra. August 1990. 7. Nicholson 'A . et al. “Drug use in Sport. A study o f the Knowledge and A ttitudes o f a Section o f the Australian Sporting Community”. A SD A , 1991. 8. Martin MB and Anshel MK. “Attitudes o f elite Australian athletes towards drug Implications for effective drug preven­ tion program m es”. D epartm ent o f H um an M ovem ent Science, University o f Wollongong, Australia. 1990. 9. Frankie M and Leffers D. “A th letes on Anabolic-Androgenic Steroids”. The Physician and Sportsmedicine. 20, 6: 75-87. (1 9 9 2 ). 10. Martin MB, A nshel MK., op. cit. 11. Yessalis CE, Wright JE and Lombardo JA. “Anabolic-andro­ genic steroids: a Synthesis o f existing data and recommen­ dations for future research” Clinical Sports Medicine 1. 109- 134 (1 9 8 9 ). 12. lessalis CE, Wright JE and Lombardo JA. op. cit. 13. In stitu te o f M edical Ethics. “A R eappraisa l”. London, October 1987. 14. Australian Medical A ssocia tion Policies 4/73, 68/90, 69/90. 15. Nicholson A . et al. Op. Cit. 16. World Medicine A ssociation . International code o f Ethics.^J 28 SPORTS MEDICINE JULY 1996 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2. )