GUEST EDITORIAL edition oi the South African Journal o f Sports Medicine which is devoted to Drugs in Sport I have been involved in drug testing for 9 years and have been campaigning for at least 6 of those for the establishment of a government funded cen­ tral drug control agency. It is therefore a great pleasure to confirm that such an agency is now £ p ace. Similarly,it is a pleasure to note that Dr Pieter van der Merwe’s Analytical Laboratory in the Pham m colo^ Department of the University of the Orange Free State has o ffic ia l been accredited by the International Olympic ^ Xt Is the & s t * Africa and the seS ond m the southern hemisphere. r e s^ J r fd d™ ^ T e V ^ tiStiCal arialysis of the results oi drug testing for banned substances over a 9 year period makes fascinating reading X mS Ef "f* tef *is " < * « S d e S iv w h lf ' aS 9 C eterrenL Table I shows this clearly when one notices that the average oer- fo r ^ ffk s u T v e iT W&S hetwecn 5 and 6%tirst b years. Then over the na«=;t S £ n t £ £ , f “ “ S tests> t a g conducted t h l per.’ S v e ^ tte T n ';? to only 1,1% of pos- uves. the most unportant aspect of the control Wi( hn ' f 111 spor' is an education programme With e recent establishment of Sie g S T S T o g l t h ^ ^ ’ e f f ^ t - ^ f JOn become a reality, outof,™ , . ! fectlve education campaign and w a p 3 S on a regular basis’ 'vil1 sport Ct ° n Contoll“ g ^ e abuse of qUltc familiar the t risks and dangers to athletes taking anabolic-androgen steroids (A.A.S) so it is re­ freshing to read D r Lambert’s scientific analysis o f the proposed mechanisms of action of AAS on s n o rr r b!em of harmlul and ergolytic drugs in sport is comprehensively covered bv n r O-nstmttaou He gives . J L r o T S L X t f the potentially harmful side effects of ordinarv and acceptable drugs. So, for the elite snorter,e7 tion’ n o ^ o ^ i f b ^ S t S S f ^ gSsp"r ‘Sns.-t's'te in selected events. There “ especially legal and ethical issues but also several practical ones. Once these havp f e ^ l S h ™ " e “ 5 1Utel5' *° blood tesUnl(.sampling) bemg used more widely especialW in competition. So far, there have L t S e n Z . p o f n » r t^ r “g<-teStS' 11,6 editortol b « m l o f t h S w . d T f l the and p iy e re a drug and scandal .free to u rn a m e n t! Dr Joe Skowno SPORTS MEDICINE JUNE 1995 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. ) E /asiopiasi; 0 N g o i n g S U P P O R T . FOR f u r t h e r i n f o r m a t i o n C O N T A C T T R O Y B I N G H A M O N SmithONephew Leadership in Worldwide H ealth canj ( 0 3 1 ) 7 0 1 5 2 4 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. ) r m ; s o i h i a f k i c a x .101 u x a l o r SPORTS MEDICINE VOLUME 2 NUMBER 2 JUNE 1995 Guest Editor Dr J Skowno Editorial Board Dr M P Schwellnus University of' Cape Town Dr M E Moolla Private Practitioner Durban D r P de Jager Private Practitioner Pretoria Dr J Slcowno Private Practitioner Johannesburg Dr P Schwartz Private Practitioner Port Elizabeth P r o fR Stretch University of Port Elizabeth D r C de Ridder Private Practitioner Bloemfontein International Advisory Board Lyle J Micheli Associate Clinical Professor of Orthopaedic Surgery Boston, USA Chester R K yle Research Director, Sports Equipment Research Associates California, USA P ro f H C Wildor Hollmann President des Deutschen Spo rtarztebund c s Koln, West Gennany Howard J Green Professor, Department of Kinesiology Ontario, Canada George A Brooks Professor, Department of Physical Education California, USA Neil F Gordon Director, Exercise Physiology Texas, USA Edmund R Burke Associate Professor, Biology Department, University of Colorado Colorado, USA Graham N Smith Physiologist Glasgow, Scotland C O N T E N T S Editorial J Skowno Blood doping and blood testing J Skowno Anabolic-androgenic steroids: 'f ~ effects on muscle size and strength MI Lambert, A St Clair Gibson Ergolytic and harmful drugs in sport D Constantinou Verbode Middels in Sport: Resultate van toetsing vir die tydperk 1986-1994 PJ van der Merwe Relationship between psychological factors and injuries in a non-contact sport, M Marthinus, JR Potgieter Inspired air humidity effect on respiratory function in normal ad tilts during exercise CG Hartford, C Maldonado, GG Rogers Highest accolade for new SASMA president 6 10 15 19 24 28 THE EDITOR THE SOUTH AFRICAN JOURNAL OF SPORTS MEDICINE PO Box 38567. Pinelands 7430 PRODUCTION Andrew Thomas PUBLISHING Glenbarr Publishers ce Private Bag X14 Parldands 2196 Tel: (O il) 442-9759 Fax: (0 11 )8 8 0 -7 8 9 8 ADVERTISING Marika tie Waal/Ajidrew Thomas REPRODUCTION Output Reproduction PRINTING Hortors Cover sponsored by Ciba-Geigy The views expressed in individual articles are the personal views o f the Authors and are not necessarily shared by the Editors, the Advertisers or the Publishers. No articles may be reproduced without the written consent o f the Publishers. SPORTS MEDICINE JUNE 1995 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. ) Introduction There is an ever increasing interest in the sport community about the use of blood sampling and testing for doping control purposes. In conjunc­ tion with the 1994 Commonwealth Games in Vic­ toria, Canada, the Canadian centre for Drug free Sport held a workshop to discuss blood sampling for doping control and the issues it raises for drug free sport. As one of the South African team doctors I was invited to the workshop and much of the information in this article was obtained from this workshop. Definition The International Olympic Committee banned list defines blood doping as "... the administra­ tion o f blood or related red blood products to an athlete other than for legitimate medical treat- Blood doping is based on the principle that the amount of oxygen available to body tissues is lim- ited by the number of red cells in the blood. In theory, increasing the red blood cells increases the amount of oxygen to the tissues which in turn allows the athlete to exercise more vigorously or for longer. An explanation of how this could be achieved is that an athlete could have blood removed, the red cells (erythrocytes) separated from the plas­ ma, and the red blood cells freeze preserved. Meanwhile the athlete’s own red blood cells would gradually return to normal in about two months. Shortly before a competition, the red blood cells could be thawed, reconstituted with normal fluid, and then reintroduced into the ath­ lete’s blood stream. Consequently, the athlete would have the benefit of an abnormal number oi red blood cells, a condition known as erythro- cythemia. The preservation of blood requires a sophisticated process and considerable laborato­ ry assistance. However, there is an easier method, that of transfusing someone else’s blood into the athlete (non-autologous or homologous blood doping). Benefits o f blood doping Blood doping would be of benefit to athletes in events taking place over a long time. For example, long distance running, cross country skiing and cycling. Address for correspondence Dr Joe Skowno, PO Box 67196, Bryanston, 2021. Tel: (O il) 706-1231. Fax: (O il) 706-1235 Risks of blood doping • Infections, including HIV infection. • Potentially lethal reactions from incompatible blood. • Allergies • H ig h blood pressure Blood sam pling The use of blood sampling (as opposed to urine testing) has advantages and disadvantages. Advantages o f using blood samples • Relatively fast procedure to collect sample • Allows more reliable quantitative analysis for some substances • Identity of samples indisputable • Required to detect homologous (non-autolo­ gous) blood doping • Provides best matrix to detect autologous blood doping • Probenecid (masking agent) is now easily detected • Corticosteroids are more easily detected • Blood may be useful to confirm testosterone doping although urine may give much greater concentrations • Plasma usually has greater concentration oi peptide hormones • There are population-based reference ranges for clinical haematological tests Disadvantages for using blood samples • Legal/Ethical issues • Sampling by medically trained person; small sample size (20m l); preparation of sample • Reference ranges for peptide hormones and their secondary factors are unknown • Analysis methodology is not fully established to do a complete profile, therefore urine analy­ sis is still required • Urine is a better matrix for measuring Beta-4 agonist (eg Clenbuterol) • Because of quick half-life of peptide hormones (6-24 hours) and steroids (72 hours) in blood, they may be hard to detect • Haematological parameters may be altered by altitude and hard training • Concentration of substances with low molecu­ lar weights are lower than in urine by a factor of 100-1000 Although progress is being made on the detec­ tion of blood doping, there is at present no fool­ p r o o f method to determine that a high red blood cell count is the result of blood doping. Dr Norman Gledhill, an exercise physiologist and former president of the Sports Medicine Council of Canada, met with IOC Medical Com­ SPORTS MEDICINE JUNE 1995Re pr od uc ed b y Sa bi ne t 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. ) mission representative Dr Arnold Beckett in July 1978 and presented him with the evidence that blood doping definitely enhances performance. Dr Gledhill suggested that blood doping be banned specifically. He was of the view that blood doping need not be detectable to be on the banned list. Athletes would know that blood dop­ ing was considered cheating and they would have to make the personal decision whether to cheat or not. Dr Beckett however, took the position that blood doping should not be banned until it could be detected. After the Los Angeles Olympic in 1984, members of the US Cycling team admitted having competed with the aid of blood doping. They had used blood from donors, not their own blood. O f seven athletes involved, three had become ill. Shortly thereafter, blood doping was banned by the IOC. Blood sampling not blood testing From a legal point of view, the analysis or actual testing itself is only one and perhaps the least problematic step in the use of blood samples for doping control. A preferable term is blood sam­ pling because it is this “front end” of the process that is legally the most sensitive. Blood sampling in doping control: some practical considerations. Sampling procedure: 1. Blood sampling can be quicker than urine sampling. There is no need to wait for dehy­ drated athletes to produce a sample. 2. While physically invasive, blood sampling is far less a disruption to personal dignity. Fe­ male athletes in particular, may be more com­ fortable giving a blood sample than being scrutinised while giving a urine sample. Analytical: Non-autologous (homologous) blood can be test­ ed. Autologous blood at present cannot be detected. Possibilities for the detection o f autologous blood transfusions. 1. Repeated testing of erythropoeitin ratio to haemoglobin and haematocrit to establish normal values? 2. Parameters to detect haemolysis after the transfusion of stored blood? 3- Markers for senescent erythrocytes? Legal and ethical aspects These aspects are potentially very complicated betweSe ° f tllC overlap 811(1 possible conflict Inte rnationa 1 laws such as the European Charter of Human Rights. National laws such as domestic constitutional documents guaranteeing certain individual rights or protections. 3. State or provincial laws in nations with feder­ al systems of government. 4. The rules of international sport governing bodies and the rules of their national affili­ ates. 5. The requirements o f international games organisers, the International Olympic Committee and the Commonwealth Games Federation being obvious examples. One area where conflict already manifests itself is dispute resolution, particularly the role, if any, o f domestic courts in intervening in otherwise private sporting matters. Particular issues 1. Consent: Without informed consent the taking of a blood sample, being physically invasive, is considered legally to be an act of assault and battery with criminal and/or civil liability. This requires an additional and specific consent form, above and beyond consent to participate in doping control which is a condition of membership for all national sporting bodies and teams. 2. Use o f blood sample: It must be clearly stated on the consent form that the blood samples will be used for the testing for banned substances only. Under no circumstances may the sample be used for research or any other purposes unless clearly stated and endorsed and understood by the athlete concerned. Conclusions In view of the continuing problems associated with the relatively simple process of requiring, collecting, identifying and securing urine sam­ ples, the practical difficulties of a successful blood sampling programme should not be under­ estimated. I f urine sampling can still problemat­ ic, due to human failure if nothing else, blood sampling will give rise to no fewer errors. At the Winter Olympic in Lillehamer, Norway in 1994, limited blood sampling was done for the first time. This was discussed at the Workshop held in Victoria, and as a result two countries, Canada and Norway made the decision to use blood sampling as part of their doping control measures. Other countries will be monitoring their progress with interest and once many of the more serious problems have been ironed out it is likely that blood sampling will become an addi- tional tool in doping control internationally. REFERENCES 1. D u b in Charles L . (C o m m is sio n er ), C om m ission o f Inquiry into the U se o f D ru gs and B a n n ed Practices In ten d ed to In crease A th le tic Perform ance. O tta w a Canada 1 9 9 0 . P a y n e, Sim on D .W . M edicine, Sport and the L aw . B lackw ell Scientific Publications L on don . 1 1 9 0 . 3. Yesalis, C harles, E. A n a b o lic S ter o id s in S p o rt and L xercise. H u m a n K in etic Publishers. 1 9 9 3 . Q SPORTS MEDICINE JUNE 1995 5Re pr od uc ed b y Sa bi ne t 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. ) Anabolic-androgenic steroids: effects on muscle size and strength MI Lambert PhD, UCT Medical School A St Clair Gibson MBChB, UCT Medical School Introduction Androgens are a class of steroid hormones which are secreted mainly by the testes, but also by the adrenal gland and ovaries. Testosterone is the main androgen secreted by the testes. Testoste­ rone regulates differentiation and secretory func­ tion of the male sex organs and stimulates pro­ tein synthesis in muscle, bone and kidneys. Testosterone was isolated in 1935 and by 1937 pharmaceutical companies were already perform­ ing clinical trials with testosterone to determine it’s potential muscle building properties and uses in medicine.2 However, treatment with testos­ terone was not successful, because it was difficult to sustain high circulating plasma levels of testosterone after testosterone treatment. Orally ingested testosterone is rapidly absorbed into the portal blood and degraded by the liver, and injected testosterone is rapidly absorbed from the injected medium and degraded/ However, from the, early 1940’s synthetic mod­ ified versions of testosterone were developed. These drugs were more resistant to degradation and were used clinically to promote muscle growth after chronic illness, as a hormone replacement therapy for hypogonadal males, and as treatment for depression. These synthetic forms of testosterone have become known as ana­ bolic-androgenic steroids (AAS). Given the results of the early tests which showed positive effects on muscle growth, it was not surprising that sports participants started experimenting with AAS with the aim of trying to improve their physical performance.9 By 1976 AAS’s reputation among athletes and officials had grown to the point that the International Olympic Committee banned their use. However, that has not reduced their use and currently in South Africa they are being used across the spectrum from school­ children45 to elite bodybuilders'1 in an attempt to improve muscle size or strength. Address for correspondence MRCAJCT Bioenergetics of Exercise Research Unit, Department of Physiology, UCT Medical School, Observatory, 7925. Phone (021) 4066-535 Fax (021) 477669 Email M IK ELAM B @P H YSIO .U CT.A C.ZA There are many issues about drug use in sport, ranging from ethical considerations, the concept of cheating, and the problem of side-effects. It is beyond the scope of this review to discuss all these issues. The following discussion will there­ fore focus on the ergogenic and myogenic proper­ ties of AAS, with the aim of developing an expla­ nation for their mode of action based on well con­ trolled mechanistic and observational studies. Readers interested in the side-effects of AAS are referred to Hickson et al (1989) for a detailed discussion.7 Do AAS promote an increase in muscle mass and strength? _ _ , In a recent study 97% of all subjects who had used AAS believed they had become stronger as a result of AAS.1’ The perceived average increase in strength as a result of AAS use was around 30%.e However, this overwhelming belief in the ergogenic properties of AAS is not shared with the same enthusiasm by many scientists, proba­ bly because of the lack of sound scientific evi­ dence. This can be attributed to the inherent problems in conducting well-controlled studies on the effects of AAS which has resulted in an unclear understanding of the mechanisms of action of AAS administered in suprapharmalogi- cal doses. Inherent problems in AAS experimentation ( i) Blind experiments It is impossible to do a blinded experiment with subjects either using suprapharmacological doses of AAS or placebos, because the subjects in the AAS group will know they are using AAS within a few days from the overt symptoms which they develop. This may affect the outcome of the experiment because it has been shown that ath­ letes get stronger if they believe they are ingest­ ing AAS, even if they are in fact ingesting place­ bo.8 In addition, other factors which may increase strength (training intensity, motivation, nutri­ tion) are all affected by AAS.9 Therefore, many studies have been confounded by poor control over these factors. (ii) Ethics It is illegal to provide AAS to subjects in the actu­ al doses and combinations used by sports partic­ ipants. The doses used by sports participants 6 SPORTS MEDICINE JUNE 1995Re pr od uc ed b y Sa bi ne t 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. ) mailto:MIKELAMB@PHYSIO.UCT.AC.ZA sometimes exceed the maximum clinical doses by 18 fold,6 with potentially serious side-effects.7 Therefore, the results from studies in which clin­ ical doses of AAS have been used, cannot be gen­ eralised to AAS use among sports participants.10 Concensus studies The experimental constraints have resulted in a paucity of scientific literature on the ergogenic and myogenic properties of megadoses of AAS. In a position statement in 1977 the American College of Sports Medicine concluded that "... there is no conclusive scientific evidence that extremely large doses o f anabolic steroids will aid or hinder athletic p e r f o r m a n c e However, the studies used in developing this position state­ ment were later criticised because many used inexperienced, untrained subjects, lacked dietary controls, used low intensity training and used non-specific forms of testing muscle strength Therefore, in 1984 the ACSM revised the posi­ tion statement to conclude: “anabolic steroids in the presence o f an adequate diet can contribute to increases in body weight, often in the lean mass compartment ... and the gains in muscle strength achieved through high intensity exercise and prop­ er diet can be increased by use o f anabolic steroids in some individuals”.1' Subsequently, other reviews of the literature have concluded from carefully selected studies that “anabolic steroids have the most pronounced affect in those athletes who have trained to the point that they are in a chronic catabolic state”, 1:1 and “anabolic steroids may slightly enhance muscle strength in previous­ ly strength trained athletes”.10 Therefore, it may be concluded from the anec­ dotal and scientific evidence that AAS increase muscle mass and strength providing the athlete is (i) highly trained, (ii) training hard while using the drugs, and (iii) eating a high energy, high protein diet. The proposed mechanisms of action will now be discussed in more detail. Mechanism o f action of AAS (i) Circulating androgens ^ e testes secrete about 5-10mg testosterone per day/ which maintains a circulating plasma con­ centration of 0.5-0.6Vig/100rnI.' About 40% of cir­ culating testosterone is bound to albumin and 58% to sex hormone binding globulin. The remaining testosterone is free and reflects the testosterone available for interaction with target cells.1 This concentration of circulating free testosterone remains fairly constant until the age of 50 years, after which it starts to decrease. (H) Androgen receptors Free testosterone binds to androgen receptors ’ located in the cytoplasm and nuclei of cells, these receptors are protein molecules and occur ui most tissues.14 Androgen sensitive tissue, such as the prostate glands, may have 25 times the SPORTS MEDICINE JUNE 1995 EASING THE ACHES OF REAL EFFORT! People who make an e ffo rt invariably feel the results. It doesn't have to stop them trying. N orflex Co tablets w ill help ease muscle pain a n d sports injuries. Effort - free re lie f w ithout drowsiness. [S2] Norflex Co Reference No: B1098 (Act 101/1965) Each tablet contains: Orphenadrine Citrate 35mg and Paracetamol 450mg. njuuss. 3M Innovation 3M Pharmaceuticals S.A . (Ply) Ltd Co. Reg. No. 5 2 /0 1 6 4 0 /0 7 181 Barbara Rood, Elandsfontein, Tvl, 1406 Tel: ( Oi l ) 922-2081 BO H & A 688 6/JS M 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. ) number of androgen receptors compared to skele­ tal muscle.15 AAS and endogenous androgens bind with equal affinity to the receptors. Tmj androgen receptors in most tissue are saturated in men with normal circulating testosterone con­ centrations,17 therefore, the number of androgen receptors may be a limiting step in AAS action.18 An increase in circulating testosterone concen­ trations, for example after AAS treatment, down- regulates these receptors19 and a decrease in cir­ culating testosterone concentration, for example after castration, up-regulates the receptor con­ centrations.20 Exercise training also increases the receptor concentrations in skeletal muscle. Inoue et al., (1993) showed that the androgen receptor concentration in rat muscle increased by 25 /o three days after starting an exercise programme. However, by 4 weeks the muscles had not stopped growing, even though the androgen receptor concentration had by this time plateaued.21 The authors concluded that an increased receptor concentration is an important trigger for initiating muscle hypertrophy, but thereafter other factors are necessarily for the maintenance of the hypertrophic response in skeletal muscle. (Hi) Metabolic action o f androgens The generally accepted model explaining andro- gen-receptor action is that the testosterone mole­ cule binds to the androgen receptor in the cyto­ plasm and induces a conformational change to the receptor. The androgen-receptor complex is translocated into the nucleus and subsequently binds to chromatin acceptor sites where it initi­ ates the transcription process, resulting in new messenger RNA formation.18 After translation on ribosomes, new protein is synthesized. The nature of the protein synthesized is dependent on the target tissue. This theoretical model shows that AAS exert their ergogenic and myogenic effects by stimulat­ ing protein synthesis. However, as described ear­ lier, there is a limited capacity for anabolic steroid binding to androgen receptors since the receptor number is a limiting factor and may be d o w n -regulated after AAS treatment. Although protein synthesis may increase slightly after AAS treatment,23 this increase does not account for the total increase in muscle mass. Therefore, fur­ ther explanation is required. (iv) Anti-catabolic effects Another mechanism for the action of AAS is that they exert their effects through the glucocor­ ticoid receptor. Glucocorticoids are a class of hor mones secreted mainly from the adrenal cortex during a bout of exercise or in response to any stressful stimuli. These hormones, of which cor­ tisol predominates, promote amino acid efflux from muscle and increase protein degradation.24 In essence, androgens have an anabolic, whereas glucocorticoides have a catabolic action. These catabolic processes, as a result of glucocorticoid action, seem to be exacerbated following high intensity training. The exposure to excessive training loads for prolonged periods causes the overtraining syndrome which results in elevated circulating cortisol concentrations at rest.& This causes a catabolic state in the athlete.20 There are separate receptors for androgens and glucocor­ ticoids in skeletal muscle27 28 with 20 to 100 times more glucocorticoid receptors compared to androgen receptors in muscle.-7- fUJ The results of several experiments have shown that androgens can compete with glucocorticoids for glucocor­ ticoid receptor binding in skeletal muscle.'4'9 This antagonism can block the action of glucocor­ ticoids, and therefore, through this process androgens have an anti-catabolic effect. The net effect of this anti-catabolism wall be to increase muscle mass. Therefore, there is a strong argument that AAb exert their myogenic effects, not through increas­ ing protein synthesis alone, but rather though reducing muscle breakdown. In addition, the anti-catabolic effect of AAS may allow the subject to train harder without developing the overtrain­ ing syndrome. Additional training alone may also stimulate muscle growth and strength. Summary There is both anecdotal and scientific evidence that suprapharmacological doses of AAS increas­ es muscle mass and strength in previously trained athletes undergoing intensive training and eating a diet sufficient in protein and energy. Although an increase in protein synthesis con­ tributes to the increase in muscle mass and strength, it is likely that the more significant mode of action of AAS is through reducing the catabolic processes which occur following inten­ sive training. REFERENCES 1. Schwartz, F .L . & Miller, R .J . A n d r o g en s and anabolic steroids. In M od ern P h arm acology, 2 n d edition, ed s C .R . Craig and R .E . Stitzel, 1 9 8 2 ,-9 0 5 -9 2 4 , L ittle, B row n and C om pany, B o s to n , U S A . 2 . H oberm a n , J .M . and Yesalis, C .E . The h istory o f syn th etic testosteron e. Sci A m , 1 9 9 5 ;2 :6 0 -6 5 . 3 . W ilson, J .D ., & Griffin, J .E . The use and m isu se o f andro- qens. M eta bolism , 1 9 8 0 ;2 9 :1 2 7 8 -1 2 9 5 . 4 . Schwellnu.% M.P., L am bert, M .I ., Todd, M.P., & J u n t z , J .M . A n d r o g en ic anabolic stero id use in m atric pu p ils. S. A fr.M ed .J ■ 1 9 9 2 ;8 2 :1 5 4 - 1 5 8 . 5 S kow no,J. D r u g su rvey am ong first-tea m s ch o o lb oy rugby players. S.A fr.M ed .J . 1 9 9 2 ;8 2 :2 0 4 . 6. Titlestad, S .D ., Lam bert, M .I. & Schwellnus, M.P. A su rvey to determ ine ty p e s and d osa g es o f anabolic androgenic steroids used b y com petitive bodybuilders in S outh Africa. S .A . J .S p o rts M ed, 1 9 9 4 ;1 :2 4 -2 8 . 7. H ickson , R .C ., Ball, K .L . a n d F a ld u to , M .T. A d v e r s e effects o f anabolic steroids. M ed. Toxicol. A d v e r s e D ru g E xp . 1 9 8 9 ;4 :2 5 4 -2 7 1 . , 8 . A riel, G . a nd Saville, W. A n a b olic stero id s: the p h ysio lo gi­ 8 SPORTS MEDICINE JUNE 1995 iRe pr od uc ed b y Sa bi ne t 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. ) cal effects o f p la cebos. M ed Sci Sports. 1 9 7 2 ;4 :1 2 4 - 1 2 6 9. Yesalis, C .E . A n a b o lic Steroids in Sport and E xercise. 1 9 9 3 ; H u m a n K in etics Publishers, Cham paign. Illinois, U SA . 10. Ela sh off J .D . Jacknow , A .D ., Shain, S .G . & B raunstein, ( j.D . E ffects o f anabolic-androgenic steroids on m uscular strength. A n n . Intern. M ed. 1 9 9 1 ;1 1 5 :3 8 7 -3 9 3 . 11. A m erica n College o f Sports M edicine. P o sition S ta tem en t on the use and a bu se o f anabolic-androgenic steroids in sports. M ed Sci. Sports Exerc. 1 9 7 7 ;9 :x i-x ii 12. A m erica n College of Sports M edicine. P o sition sta n d on the use of anabolic-androgenic steroid s in sports. A m. J. Sports M ed. 1 9 8 4 ;1 2 :1 3 -1 8 . 13. H a u p t, I I .A . and R overe, G .D . A n a b olic stero id s: a review o f the literature. A m . J . S ports Med. 1 9 8 4 ;1 2 :4 6 9 - 4 8 4 14. H ickson, R .C . & K u row ski, T.G. A n a b olic stero ids and training. Clin.Sports M ed. 1 9 8 6 ;5 :4 6 1 -4 6 9 . 15. K rieg, M . & Voight, K .D . B iochem ica l su b stra te o f andro­ genic a ctions at a cellular level in p r osta te , bulhocaver- n o su s /le v a to r ani and in skeletal m uscle. A c t a Endocrinol 1 9 7 7 ;8 5 (suppl. 2 1 4 )-.4 3 -8 9 . 1 6 . Sa artok. T. Dahlberg, H. & G u sta fsson , J .A , R e la tive bind­ ing affinity of anabolic-androgenic stero id s: com parison o f the binding to the androgen receptors in skeletal m uscle and in p r o s ta te , as well a s to sex -b in d in g globulin. E ndocrinology. 1 9 8 4 ;1 1 4 :2 1 0 0 -2 1 0 6 . 17. Wilson, J .D . A n d rog en abuse b y a thletes. Endocr. R ev. 1 9 8 8 ; 9 :1 8 1 -1 9 9 . 18. Snochow ski, M . W olinska-lVitort, E & P erkow ski, W .A .M . S ter o id h o rm o n e re c ep to r s in sk e le ta l m u scle. In B io ch em istry o f E xercise V I. ed s B. Saltin. 1 9 8 6 ;9 5 - 1 1 0 , H u m a n K in etics Publishers. Cham paign, Illinois, U S A 19. Sinnet-Smith, P .A ., Palmer, C .A ., B u tter y. P.J. A n d rog en receptors in skeletal m uscle c y to so l fro m sh eep treated with trenbolone acetate. Ilo rm . M eta b. R e s .1 9 8 7 ;1 9 :1 1 0 - 1 1 4 . 2 0 . R anee, N .E . & M ax, S.R . M odulation o f the cyto so lic andro­ g e n re cep to r in str ia te d m u scle b y s e x ste ro id s . E ndocrinology. 1 9 8 4 :1 1 5 :8 6 2 -8 6 6 . 2 1 . Inoue, A '., Yamasaki, S., Fushiki, T. K a n o , T„ M oritani T, Itoh , K . & Sugim oto, E . R a p id increase in the num ber o f androgen receptors follow ing electrical stim ulation o f the rat m uscle. Eur. J. A p p l. P hysiol. 1 9 9 3 ;6 6 :1 3 4 - 1 4 0 . 2 2 . G ro d y W.W., Schrader. W.T., & O ’M alley, B . W. A ctiva tio n , transform ation, and subunit structure o f stero id horm one receptors. Endocr. R ev. 1 9 8 2 ;3 :1 4 1 -1 6 3 . 2 3 . Griggs, R .C ., K in gston , W., J ozefow icz. R .F ., Herr, B .E . Forbers, G & H ollid a y, D . E ffect o f testo stero n e on ’m uscle ™ M 9 - 6 6 - 4 9 8 5 0 3 e Pr° tetn s^ nthesis- J - A PPl■ P hysiol. 2 4 . H ick so n , R .C .. Czerwinski. S.M ., Falduto, M .T. & Young, A.P. G lucocorticoid antagonism b y exercise and andro­ gen ic-a n a b olic s te r o id s . M ed . Sci. S p o rts E x e r c 1 9 9 0 ;2 2 :3 3 1 - 3 4 0 . ■ u Z " " 1' , ' 1" ’ N o “ kes' T-D -’ L evy, W„ Smith, C. & Millar, R.P. H yp oth a la m ic d ysfunction in overtrained athletes. J Clin. Endocrinol. M ela b ., 1 9 8 5 ;6 0 :8 0 3 - 8 0 6 . 2 6 . K u ipers, H . & Keizer, H .A . Overtraining in elite a thletes Sports M ed ., 1 9 8 8 ;6 :7 9 -9 2 . 2 7 . D a h lb e rg , E ., S n o ch o w sk i, M . & G u s ta fss o n , J .A . R egula tion o f the androgen and glucocorticoid receptors in skeletal m uscle cyto so l. E n d o crin olo g y 1 9 8 1 ;1 0 8 :1 4 3 1 -1 4 3 9 . 2 8 . D ube, J.Y, L esag e, R .L . & Tremblay, R .R . A n d rog en and estrogen binding in rat skeletal m uscle and perineal m us- cles. Can. J . B iochem . 1 9 7 6 ;5 4 :5 0 -5 5 . 2 9 . M ayer, M and R o sen . F. Interaction o f anabolic steroids with glucocorticoid receptor s ite s in rat m uscle cutosol. A m . J. P hysiol. 1 9 7 5 ;2 2 9 :1 3 8 1 -1 3 8 6 . [ J APPOINTMENT: EXECUTIVE EDITOR SA JOURNAL OF SPORTS MEDICINE SASMA aims to continue to produce a journal o f international standard or its members and to create an opportunity for national researchers to publish their work. The SA Journal o f Sports Medicine wishes to appoint a dynamic active executive editor to promote Sports Medicine and raise academic levels of the practicing disciplines and sporting fraternities. Qualifications: MB ChB, Post graduate degree: Sports Medicine/Sport Science/Sport physiology. Publications in recognised journals. Experience as Editor or Editorial board member recommended. Curriculum vitae and certified copies of qualifications addressed to: The Editorial Board, Dr Phdda de Jager, Suidstr 1253, Hatfield, Pretoria, 0083. Closing date: 30 July 1995. SPORTS MBDICINE JUNE 1995 9 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. ) “Ergolytic and harmful drugs in sport” D ( onstant inou . , Tt̂ \ MBBCh (Rand) BSc(Med) (Hons) Sport Science (UC1) Private practice in Sports Medicine_______________ ______ Drugs in sport evokes certain dark images in one’s mind, with behind the scenes, secretive use of tablets and injections to improve on optimum preparation; and beat an opponent. Cheating in this way may involve so-called ergogenic aids. “Ergo” is derived from the Greek word ergon1 and “gen” from the Greek “to be produced” 1 and has come to mean any means used to enhance energy utilization (performance)." “ Lytic” is an adjective for “dissolution and ergolytic therefore defines means of impairing performance. This of course is something that no athlete would deliberately or intentionally pur­ sue. Even small ergolytic effects may have vastly significant effects on performance, particularly significant in elite athletes. Doping control is covered elsewhere in this journal, and is necessary for several reasons. One such reason relates to the potential health risks.4 This paper highlights this aspect in relation to potential ergolytic effects and also classes of drugs that may not be banned, but may be harm­ ful to sportspeople. Those drugs that have a blan­ ket banning by the International Olympic Committee (IOC), and sporting codes that follow those guidelines, will not be alluded to here, and will be discussed elsewhere. There are however some that are banned only in some sports, or have special conditions that may be applied: and include caffeine, alcohol, marijuana, corticosteroids and beta-blockers. These will be discussed, as they have relevance to the emphasis of this paper. It should be remembered that all drugs, by virtue of having pharmacological properties, may have side effects. It is beyond the scope of this paper to cover the vast array of these and various drug interactions, and should be referred to as necessary. a r. a Some drugs may be necessary to modify dis­ eases, sustain or improve quality of life. These can be used for acute or chronic conditions, and many of these populations may be partaking in exercise. Some are used only for recreational pur­ poses. Address for correspondence Dr D Constantinou P.O. Box 1171, Sunninghill, 2157. Tel: (Oil) 883-4988. Fax: (Oil) 883-4980 The moral and ethical issues of the use of ergo­ genic aids has been greatly deliberated,4"’ and to extend these arguments to include ergolytic and potentially harmful drugs complicates matters exponentially. Therapeutic drugs will now be discussed in alphabetic order o f class. Analgesics! (see also anti-inflanxmatories) Paracetamol is widely used as an analgesic due to the safety profile, and has no known ergolytic effect. High doses may lead to hepatic toxicity/’ It is often found in combination analgesics, which may contain prohibited substances. Codeine is no longer banned by the IOC, and may be an effective analgesic. This too is often found in combination analgesics and remedies for the relief of common colds. High doses may lead to narcotic side effects such as nausea, vomiting, dizziness, respiratory depression, and may have addictive properties.7 8 Antiarrhythinics: (see also beta-blockers, antihypertensives) Often patients requiring these may be restricted form exercise for medical reasons, but others may be encouraged to exercise. These may have arrhythmias as side-effects and may impair car­ diac output with exercise and lead to hypotension and syncope.8'1 Antibiotics: All classes of antibiotics have side effects that may be severe enough in some individuals to affect performance. These vary from headache, gastro-intestinal (GIT) disturbances, nausea, vomiting, diarrhoea and idiosynchratic reac­ tions.6 Often the reason antibiotics were pre­ scribed for will limit one’s participation in exer­ cise and sport, and antibiotics per se are not con­ tra-indications to participation. Anticoagulants: Warfarin and heparin type anticoagulants may have significant drug interactions with non­ steroidal anti-inflammatories drugs (NSAID) and anabolic-androgenic steroids, which sportspeople may be taking. Their side effects of nausea, vom­ iting, skin reactions and fat necrosis*’ may affect performance. Their real dangers are that haem­ orrhage may occur. This may be secondary to acute injuries, and are therefore relative contra­ indications in collision and contact sports. in SPORTS MEDICINE JUNE 1991Re pr od uc ed b y Sa bi ne t 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. ) Haemorrhage may also occur in an occult form and lead to GIT, cystic or renal blood loss, with subsequent anaemia and impaired work capacity. Antidiarrhoeals: In endurance athletes and particularly in runners there is an increased incidence of GIT symptoms including diarrhoea.8,10 The management may include antidiarrhoeals such as loperamide,810 H^-antagonists8 with side effects of nausea, dizzi­ ness, fatigue and allergic reactions.0 Anticholinergics may be included in some prepa­ rations and cause dry mouth, blurred vision, tachycardia and urinary retention.0 Antiemetics: Most drugs in this class have sedation as side effects, and some have extrapyramidal neurologi­ cal impairment, both which may significantly affect performance. Antiepileptics: Most anti-epileptic drugs lead to poor concentra­ tion, co-ordination and cognitive function.0-8 They may also cause nystagmus, ataxia and drowsi­ ness, and therefore have special reference for participation in contact sports, those requiring fine dexterity skills and scuba diving. Antihistamines: Oral and injectable preparations of the older types cause drowsiness, muscle weakness, dizzi­ ness, headache, visual disturbances, dry mouth, thirst, feeling of heaviness in upper limbs, inco­ ordination, tight chest, and may precipitate con­ vulsions.6 Their use will certainly lead to ergolyt­ ic effects. The newer generation long-acting forms are more selective, and are said to lack signifi­ cant sedative effects, but may still cause nausea, fatigue, dizziness, myalgia and arthralgia, and so may still have undesirable effects on perfor­ mance. Topical creams may cause local irritation with minimal systemic effects, but nasal prepara­ tions may cause somnolence, headache, tired­ ness and epistaxis. Antihypertensives: Diuretics are prohibited by the IOC11 and may have side effects that may impair performance and be harmful to health. Some of the older, non­ specific, calcium channel blockers may impair cardiac output with exercise.08 Beta-blockers are banned in some sports, but may be used therapeutically for hypertension, certain arrhythmias, angina, anxiety and migraine prophylaxis.6 y They may aid in fine co- ordmation sports such as archery and pistol shooting by blunting anxiety and fine tremors.48 However, reduced aerobic capacity4 and lethar­ gy’ may impair performance in endurance activi­ ties. Other side effects may be risks to health and include bronchospasm, masking of hypogly- caemic symptoms and adversely affecting lipid Profiles,6'2 Alpha-blockers may cause syncope, hypoten­ sion, acute tachycardia.09 Angiotensin Converting Enzyme inhibitors may cause chronic cough hypotension, headache, dizziness, fatigue, dys­ pepsia, nausea and interact with NSAIDs.69 Anti-hypereh°1 esterolacrn ics (and dyslipidaemic modifying drugs) There are various classes of such drugs, and have important implications as people talcing these are (or should) be participating in controlled or supervised exercise programs. The following side effects may affect performance. Fibrates - GIT disturbances, sweating, nausea, arrhythmias, blurred vision, fluid retention, headache, dizziness.6'8 Nicotinic acid - Abdominal pain, hyperglycaemia, hyperuricaemia (?gout), blurred vision, hypotension. HMGCoA reductase inhibitors - nausea, consti­ pation, headaches, insomnia, myal­ gia, muscle stiffness, postural hypotension and peripheral neuropa­ thy. Probucol - diarrhoea, abdominal pain, arrhyth­ mias, hyperuricaemia. Anti-inflammatories: Non-steroidal anti-inflammatories are used extensively by sportspeople in prescription and over the counter formulations. They function by inhibiting prostaglandin production46813 and are used mostly for acute injuries, some believing in their use for fractures and chronic injuries too.4 Among the side effects that are significant and dangerous are GIT blood loss,7814 peptic ulcera­ tion (often asymptomatic)8 and renal damage with acute tubular necrosis and renal failure.7813 This is particularly of risk in the presence of de­ hydration. Other side effects include broncho­ spasm, tinnitus, allergic reactions, headaches and hepatic dam age/8 Some have strong anal­ gesic properties and partaking in exercise or sport under their influence of analgesia (or com­ bined with analgesics) may w7orsen injuries and increase the risks for other injuries. Under these exercising conditions the risks for GIT haemmor- rhage, diarrhoea and renal damage are particu­ larly high. Aspirin may have all the above prob­ lems and in addition has strong anti-platelet adhering properties, which may lead to increased bleeding in acute injuries.0 8 Use of aspirin in chil­ dren has the risk of Reye’s syndrome, \vh ich may be fatal.34 Some of the drugs and formulations report fewer side effects, but are all still at risk of the above. Topical NSAIDs (gels, creams, ointments, tran- scutaneous patches, sprays) can lead to systemic effects if used in high doses, frequently or for prolonged periods of time. Corticosteroids have potent anti-inflammatory properties with little data supporting their bene­ fits in most acute or chronic sports injuries, but SPORTS MEDICINE JUNE 1995 11Re pr od uc ed b y Sa bi ne t 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. ) have significant side-effects.4" Inhaled corticos­ teroids and topical preparations are permitted by the IOC (with written mcdical support) and the small doses have few side effects."" Oral and injectable forms interfere with collagen synthesis and may lead to poor tissue healing, with in­ creased risks o f further injury. T he systemic cata­ bolic effects may impair performance and the side effects include myopathies, fluid retention, immunosuppression, electrolyte disturbances, inhibition o f growth, GIT disturbances and bleeding.4'*78 Antimalarials: These are often taken by sportspeople travelling to compete. Most antimalarial drugs may cause GIT side effects with abdominal pain, nausea, vomiting and diarrhoea; which may affect perfor­ mance.1' These are often transient and in general are not a problem. Mefloquine has neurological and neuropsychiatric disturbances that makes it the only anti-malarial drug contra-indicated in scuba diving. Anxiolytics: These may affect psychomotor skills, reaction time, cognitive function, level o f wakefulness and thermoregulation™ and can therefore be ergo lyt­ ic and increa.sc risks o f injury. These and other psychoactive drugs arc definitely contra-indicat­ ed with scuba-diving, and can be life-threaten­ ing.1 Haeinatinics (and iron supplements): These can lead to GIT disturbances, nausea, vomiting, abdominal pain and constipation.1'They will however tend to have an improving perfor­ mance effect as the anaemia is corrected. Hypoglycae mics: As with hypertension and dyslipidaemias, dia­ betics often include exercise as part of their man­ agement protocol. Oral hypoglycaemics may cause GIT disturbances, headaches and dizzi­ ness." These and insulin may cause hypogly- caemia, and exercise prescription in diabetics should address the issues o f nutrition, timing o f taking insulin/medication, intensity and volume o f exercise. As a rule insulin dependent diabetics should not partake in scuba diving. Recreational habits may include the use o f ergolytic substances or harmful drugs. Here ref­ erence is made in alphabetic order of substance. Alcohol: The IOC bans alcohol in riflery'81” lor the obvious dangers, and has special considerations for other sports. Several sports ban alcohol, and locally Basketball South Africa has recently baimed its use (personal communication). There has been no evidence o f ergogenic effects, but there may well be ergolytic effects with alcohol intake. Certainly there are health risks with abuse. Alcohol may cause hypoglycaemia by reducing glucose release from the liver,7 cause diuresis by reducing vasopressin secretion’0 and impairing psychomotor ability, memory and decision mak­ ing skills, up to 48 hours after ingestion,'7 with obvious consequences. Alcohol may also have addictive properties.471721 Caffeine: Although a stimulant and banned in certain quantities by the IOC,47811 it is included here b e­ cause it is often taken recreationallv in coffee and colas. No studies have shown significant improved physiological performance in smaller doses,' but the side effects may in fact impair performance, and include irritability, anxiety, insomnia, palpitations, headache, diarrhoea, hypertension and diuresis.8" '17 In high doses there have been reports o f seiziue, coma and even death.18 Tobacco: Smoking tobacco may have deleterious effects on physical perform ance.7 This common habit affects mucous membrane cilia function and mucous production with increased incidence of dyspnoea and coughing with exertion.7 Carbon monoxide has a 300 X affinity for oxygen over haemoglobin (HI)) and smokers o f 15-25 ciga­ rettes per day can have 6-7% carbon monoxide combined to Hb. This may significantly affect physical exertion and this together with mucous plugging and air trapping may lead to increased risks o f gas embolism in scuba divers. Nicotine is readily absorbed and although undergoes hepatic metabolism and excretion, can lead to increased adrenaline and noradrenaline with tachycardia and hypertension for several hours after smoking.7'" For this reason alone smoking should be discouraged for 24 hours before competition. Nicotine also has addictive properties.7 Tar is also a respirator)- irritant and carcinogen. The risks o f passive smoking arc voUb iw i 0750 Diclophenac sodium 50 mg K/3.1/253 SPORTS MEDICINE JUNE 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. ) O n -th e -s p o t pain re lie f. • For muscular pain • Effective pain relief Site specific Non-staining • Non-greasy Reparil-Gel Relieves muscular pain. ******* v> m e d a l s ; M A D A U S P H A R M A C E U T I C A L S ( P T Y ) L T D ' ■ ' X ! ' ° ' ; 7 7 / 0 0 1 7 4 / 0 7 2 n d R o a d (Act/Wet 101,19*51 U C e l e s t o n e ® ;< S o l u s p a n ® i ̂ 1 ml Ampoule Not IV SCHERAG (PTY) LIMITED 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. ) T abel3 ANABOLIESE STEROIEDE GEIDENTIFISEER Naam Aan till Nandroloon Testosteroon Metenoloon (Primobolan®) Okslmetoloon (Anapolon®) Boldenoon* Oxandroloon* * Stanozolol** Dianabol* * Mesteroloon (Proviron®) Drostanoloon* * Metieltestosteroon Probenesied* * * Presentasie van totale aantal steroiede SA IOK 72 62.0 29.9 12 10.2 33.9 10 8.5 9.4 8 6.8 1.1 7 3 2 1.7. 9.4 1 0.8 8.0 1 1 1 5 * Slegs vir veterinere gebruik * * Nie in Stud Afrika geregistreer me *** Gebruik as maskeermiddel vir anaboliese steroiede _________________ Tabel 4 ANDER VERBODE MIDDELS GEIDENTIFISEER Groep Naam Aantal Presentasie van aantal stimulante SA IOK Stimulante Fenkamfamien 26 30.2 1.4 Feniel- propanolamien 18 20.9 10.4 Pseudo- efedrien 16 18.6 25.8 Efedrien 15 17.4 10.0 Prolintaan 4 Norpseudo- efedrien 3 Amfetamien 3 3.5 12.2 Metielfenidaat 1 Narkotiese Kodeiien* 16 Analgetika Propoksifeen 2 Diuretika Hidro- chlorotiasied 3 Furosemied 2 B-blokkers Propranolol 5 Sotalol 1 Oxprenolol 1 Atenolol 1 * Word sedert 1994 nie meer as ’n verbode middel geklassifiseer nie. Tabel 5 AANTAL MONSTERS WAT EFEDRIENE BEVAT Jaar Aantal Presentasie van totale aantal positiewes 1986 5 62.5 1987 1 16.7 1988 2 16.7 1989 8 44.4 1990 8 29.6 1991 11 26.2 1992 10 19.2 1993 4 19.0 1994 3 30.0 totale aantal positiewe monsters. Hierdie ver- bindings word dikwels aangetref in vele verkoue, griep en hoes niedisynes en kan sonder ’n voor- skrif van ’n medikus in apteke gekoop word. Dit veroorsaak dat sommige deelnemers medisynes gebruik sonder om te besef dat dit verbode mid- dels bevat. Die onus rus egter op die deelnemers self om toe te sien dat hulle nie enige medisyne kort voor ’n kompetisie gebruik wat verbode mid- dels bevat nie. Onkunde word nie as ’n verskon- ing aanvaar as ’n urienmonster positief toets nie. Gevolgtrekking Hierdie resultate toon dat: 1 sportliggame in Suid Afrika moet voortgaan met ’n verbode middel toetsingsprogram en dat so ’11 program vir alle sportsoorte in Suid Afrika moet geld. 2. inligtings- en opvoedingsprogramme ingestel moet word om deelnemers, afrigters en sport administrateurs in te lig oor verbode middels en die gevare aan die gebruik daarvan. 3. geneeshere bewus moet wees daarvan dat sommige griep-, verkoue en hoespreparate verbode middels bevat en dus nie deur deel­ nemers gebruik mag word kort voor of gedurende sportbyeenkomste nie. 4. ’11 program van buite-kompetisie toetsing deur alle sportliggame in Suid Afrika ingestel moet word. LITERATU U RVERWYSSINGS 1 H u n d t H K L , Van der M erw e PJ, Van Velden DP. D ra g s in sp ort: a report o f laboratory investigations into the preva­ lence o f their itse in South A frica. S A f r M ed J 1 9 8 4 , 00. 8 7 8 -8 8 8 . „ . , . , L h o D Shin I I. Kant] B, Park J. S y stem a tic a nalysis oj stim ula nts and narcotic analgesics b y g a s chrom atography with nitrogen-specific detection and m ass sp ectrom etry. J A n a l Toxicol 1 9 9 0 ; 1 4 : 7 3 -7 0 . 3. Charui B , C h oo IIP, K im T, E o m K . K w o n O, Suh J, et a l A r u d ysis o f anabolic steroids using G C /M S w ith selected ion monitoring, J A n a l Toxicol 1 9 9 0 ; 1 4 : 9 1 -9 5 . 4. H a tto n C K , Catlin D H . D etection o f androgenic anabolic steroid s in urine. Ther D ru g M on it 1 9 8 7 ; 7: 6 5 5 -0 6 8 . 5. van der M erw e P J and K ru ger H S L . D r u g s in Sport - re- su lts o f the p a st 0 yea rs o f dope testin g in Sou th Africa, b A fr M ed J 1 9 9 2 : 8 2 : 1 5 1 -1 5 3 . 1— 1 2. 18 SPORTS MEDICINE JUNE 1995 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. ) Relationship between psychological factors and injuries in a non-contact sport M Marthinus MA, University of Stellenbosch JR Potgieter PhD, University of Stellenbosch Abstract The incidence and perceived impact of injuries sustained by forty-four athletes were monitored during a competitive season of road running in order to ascertain relationships between illness/ injury and selected psychological factors. No sig­ nificant relationships were found between ill­ ness/injury and the psychological variables of locus of control, extroversion, neuroticism and life events. Modest, but significant relationships were present between competitive anxiety, daily hassles and illness/injury. These results under­ line the desirability for athletes to acquire coping skills. Key words: Sports injuries, Road running, Stress. Introduction In addition to obvious physical reasons, psycho­ logical factors may also play a role in the occur­ rence of sports injuries. For example, the rela­ tionship between personality and injury has been the subject of earlier research. However, results have been inconsistent. (Brown, 1971; Irvin, 1975; Jackson, Jarret, Barley, Kausch, Swanson & Powell, 1978; 1982; Passer & Seese, 1983; Valliant, 1981). The relationship between stressful life events and sports injuries became the focus of more re­ cent research. In 1970 Holmes reported that football players scoring high on the Social Read­ justment Rating Scale (SRRS) were more likely to get injured than their low-scoring team-mates (Andersen & Williams, 1988). Bramwell, Masu- da, Wagner and Holmes (1975) adapted the SRRS for use in a sports setting and found simi­ lar results to Holmes among football players. In more recent studies, Coddington and Troxell Address for correspondence Prof. Justus Potgieter, Department o f Human Movement Studies, University o f Stellenbosch, Stellenbosch 7600. Tel (021) 808-4915. Fax (021) 808-4817. E-Mail JKP@MATIES.SUN.AC.ZA (1980) reported an increase in injuries among high-school football players as a result of factors such as stressful family events. Cryan and Alles (1983) also found a higher rate of injury among high-stress football players when compared to lowr-stress players. Hardy, Richman and Rosenfeld (1991) concluded that injury rate increased with an increase in life events and a decrease in social support. Passer and Seese (1983) made a distinction between positive and negative life events and found a relationship between negative life events and football injuries. This relationship did not apply to positive life events. Although the life events/stress- i n jury relation­ ship has been established in football, it is not so clear-cut whether this also holds for non-contact sports (Hard)7 et al., 1991). Kerr and Minden (1988), in one of the few7 studies dealing with non-contact sport (gymnastics), found that timing of injury7 was related to impending competition wi th an increase in injury rate as the competition drew7 nearer. They suggested that this pattern could be attributed to heightened stress associ­ ated with the impending competition. The study of Kerr and Minden (1991) is significant, but the results do not concur w7itli those of Williams, Tonyman and Wadsworth (1986), who found no relationship between life stress and injury in another non-contact sport, namely volleyball. One of the possible shortcomings of earlier research is the focus on major life events, to the exclusion of the stress caused by minor daily problems or irritations. It is hypothesized that these everyday stressful events decrease the ath­ lete’s coping ability and consequently increase the incidence of injury (Miller, Vaugh & Miller, 1990). The study of the relationship of stress and injur)7 would be incomplete without considering personality7 variables (Williams & Roepke, 1993). The purpose of this study was to ascertain the relationship between illness/injtuy and selected moderator personality factors and life stressors in a non-contact sport by monitoring athletes throughout a competitive season. This method of investigation differs from most previous studies, where factors such as life stressors were investi­ gated post hoc only after the occurrence of the injury. SPORTS MEDICINE JUNE 1995 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. ) mailto:JKP@MATIES.SUN.AC.ZA Method Sample A group o f 37 male and 7 female competitive road limners (Mean age - 24.4 vr) was used in this study. The sample consisted o f experienced run­ ners, ranging from provincial, national athletes to an Olvmpic silver medalist, who competed in a four month Winter league. Instruments The following questionnaires were mailed to the runners: Sport Competition Anxiety Test (SCAT) (Martens, Vealey & Burton, 1990) This 15 item questionnaire assesses differences in competitive trait anxiety, or the tendency to perceive competitive situations as threatening. The Internal-External Locus of Control Scale (Rotter. 1966) Locus o f control is a personality trait dealing with the degree to which individuals view their lives and siuTOimdings as under their personal con­ trol. Individuals who function on an internal locus o f control believe that they can control their destiny on the bases o f relatively permanent per­ sonal abilities and efforts. The I-E scale compris­ es 29 pans o f items. The score is the total mun- ber of external choices made by the respondent. Eysenck Personality Inventory (Eysenck & Eysenck, 1964) The EPI measiu-cs personality on two dimen­ sions, namely introversion-extroversion and neu- roticism-stability. Extroverts tend to be outgoing, impulsive and uninhibited and like to take part in group activities. Introverts are usually quiet and introspective. Persons scoring high on the Neuroticism scale are emotionally unstable and tend to overreact to everyday events. They fre­ quently complain o f vague somatic problems and tend to worry excessively The Social Readjustment Scale This scale, developed by Holmes and Rahe (1967), ranks the magnitude o f various life change events. A preset numerical weighting is given to each event on the presumed degree of the adaptation required by a typical individual. Respondents indicated the frequency o f each event during the past three months. Because some events are o f a personal and confidential nature, the values awarded to life events were relatively reduced to simplify calculating the fmal score. Respondents were requested to complete the questionnaire, calculate their score them­ selves and return only the fmal score. They were instructed to destroy the completed question­ naire. Daily Hassles Sccde (Kanner, Coyne, Schaefer & Lazarus, 1981) A list o f daily hassles was presented to respon­ dents on two occasions (approximately three weeks after the commencement o f the study and three weeks before the end oi the season). Respondents checked the items for personal rel­ evance and indicated the degree to which they were negatively affected on a 7-point Likert type scale ranging from (“ little negative influence” to “ excessive negative influence” ). Examples o f daily hassles are: Losing your keys, having to wait a long time for somebody, malfunctioning o f a household appliance. Respondents could also report their own personal hassles. The number o f hassles reported was multiplied with the rating o f negative influence to calculate a total score. The stun o f the totals of both lists was used in the analysis o f data. Injury Report Forum This questionnaire was administered 5 times at regular intervals (approximately every three weeks) during the season. Respondents were asked to report the incidence o f personal illness/ injury. Respondents indicated the date and nature o f illness/injury as well as its perceived severity on a 7-point Likert-type scalc ranging from “ Not at all serious” to “Very serious” . The number o f illnesses/injuries was multiplied with perceived seriousness to calculate a total ill­ ness/injury score. The sum o f the scores of the five reports was used in the final analysis ol results. Results A distinction was made between illness (e.g. in­ fluenza) and injury. A total o f 58 illnesses/injuries were recorded over a period o f four months. All of the subjects suffered some form o f illness or another during the coiuse o f the season. Only 7 (16%) o f the 44 athletes enjoyed an injury-free season. The following were the most prevalent ill­ nesses/injuries reported: common cold (13), call muscle injury (7), influenza (6), knee injury' (5), hamstring injury (4), Achilles tendonitis (3), Iliar Tabular band syndrome (3), and groin injury (3). WILSENACH 9 3 06 2Sf m t a n e n s m o Diclophenac sodium 100 mg M/3 1/63 O l O 1/M 20 SPORTS MEDICINE JUNE 1995 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 notable absence o f shin splints among this group of iimners cannot be explained. The rela­ tionship between the psychological variables o f competitive anxiety, locus o f control, extrover­ sion, neurotic ism. and il hi ess/injury scores was investigated (Table 2). A significant, but modest correlation, was found between competitive anxi­ ety and the com bined illness/injury scores (r=.313; p<.05), as well as the injury-only scores (r=.302; p<.05). The data revealed an interesting positive relationship between competitive anxiety (SCAT) and daily hassles scores (r=.464; P<.001). No significant relationships were found between the other variables and illness/injury scores. TABLE 1 CORRELATIONS (PEARSONS’S r) BETWEEN PSYCHOLOGICAL VARIABLES AND ILLNESS/ IN JURY Combined Injuries Illnesses/Injuries only SCAT .313* .302 Locus o f control -.009 .117 Extroversion .183 .109 Neuroticism .123 .087 Life events .103 -.027 Daily hassles .334* .299 * p < 0.5 The effect o f life events and daily hassles on ill­ ness/ injury was investigated further. The median score o f the sample for the combined illness/in­ jury scores was /, while the median for injuries only, was 3. The median scores were used to divide the sample into two groups, viz. a high ill­ ness/ injury group (scores above the median) and a low illness/injury group, who produced scores at and below the median. No significant differ­ ence was found between the mean scores o f the high injury and low injury groups regarding life events (Table 2). However, the high injury group produced significantly higher daily hassles scores than the low injury group, both in terms o f combined illness/injury and injury only scores (Table 3). TABLE 3 COMPARISON OF INJITRY-ONLY SCORES OF LOW AND HIGH INJURY RATE ROAD _________________ RI7NNERS________________ Variable N Mean SD t p Life events Low rate 24 31.00 17.93 0.123 .903 High rate 20 30.35 16.79 Daily hassles Low rate 24 58.21 33.26 2.098 .042 High rate 20 78.20 29.14 No significant relationships were foimd between life events and the number o f combined illness/injuries (r=.l45; p>.10). When anah'sing the total illness/injury scores (which take into consideration the incidence and perceived impact o f illness/injury), no significant relation­ ship was found with life events scores (r=.103; p>.10). However, significant relationships were found between daily hassles scores and com ­ bined illness/injury scores (r=.334; p<.05) and injury only scores (r=.299; p<.05). Conclusion With the exception o f competitive anxiety, the results o f this study did not indicate significant relationships between the psychological vari­ ables under investigation, namely locus o f con­ trol, extroversion, and neuroticism. The failure to find a relationship between locus o f control and the incidence o f illness/injury is consistent with the results o f earlier investiga­ tions (Lysens, Amvelle & Ostyn, 1986; Passer & Seese, 1983). The relationship between competi­ tive anxiety and illness/injury partly supports the findings o f Blackwell and McCullagh (1990), who concluded that competitive trait anxiety influ­ ences the severity but not the frequency o f injury. However, in the present study, there may have been an overlap in the effect o f anxiety and daily hassles scores and consequently both these vari­ ables could possibly explain a significant portion o f variance in illness/injury occurrence. The injury/illness could render the athletes sensitive to daily hassles rather than the converse. The failure o f the present investigation to find a relationship between major life events and ill­ ness is not consistent with the earlier findings o f Kerr and Minden (1988) with gymnasts. The ret­ rospective design o f the gymnastic studies may account for these inconsistencies. TABLE 2 COMPARISON OF COMBINED ILLNESS/INJURY SCORES OF LOW AND HIGH ILLNESS/INJURY RATE ROAD RUNNERS Variable N Mean SD t P Life events Low rate 24 8.13 16.88 High rate 20 33.80 17.55 1.09 .282 Daily hassles Low'rate 24 57.75 31.34 High rate 20 78.75 31.22 2.22 .032 SPORTS MEDICINE JUNE 1995 21Re pr od uc ed b y Sa bi ne t 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. ) A problem in studying mid tipi e moderator vari­ ables is the need for large sample sizes. This would necessitate investigations that cover larger groups in diverse geographical areas. In addition, in order to gather objective data, rather than sub­ jective and retrospective information, a more stringent method o f recording illness/injury inci­ dence is needed than utilising the personal re­ ports o f the athletes themselves. Despite the failure o f this investigation to unequivocally identify the moderator psychologi­ cal variables associated with injury, the associa­ tion found between daily hassles and illness/in- jury points to the importance o f coping resources in the stress-illness relationship. Coping re­ sources comprise a variety o f behaviours and social support systems that assist the individual in dealing with life’s day to day problems. The presence o f a supportive social network o f family, friends, coach and team-mates may have a posi­ tive effect on the stress-injiuy relationship. It is therefore desirable to assist athletes psychologi­ cally to counter the effects o f daily stress. REFERENCES A n d ersen M B, & W illiams J M ( 1 9 8 8 ) . A m odel o f s tr ess and athletic injury: Prediction and prevention. Journal o f Sport and Exercise Psych ology, 10, 2 9 4 -3 0 6 . Blackwell B . & McCullagh P ( 1 9 9 0 ) . The relationship o f a th ­ letic injury to life stress, com petitive a n xiety and co]>ing resources. A th letic Training. 2 5 . 2 3 -2 7 . Bram w ell ST, M asuda M, Wagner NN, & H olm es TH ( 1 9 7 5 ) . Psychological factors in athletic injuries. D evelopm ent and application o f the Social and A th letic R ea dju stm en t Scale ( S /{ R R S ) . Journal o f H um an Stress. 1, 6 -2 0 . Brown R B ( 1 9 7 1 ) . P erson ality characteristics related to injuries in football. R esearch Quarterly, 4 2 , 1 3 3 -1 3 8 . Coddington R D & Troxell J R ( 1 9 8 0 ) . The effects o f em otional fa ctors on football injury rates: / I pilot stu d y. Journal o f Hum an S tress, 6, 3 -5 . Cryan P D & A lies W F ( 1 9 8 3 ) . The relationship betw een s tr ess and college football in ju ries..Journal o f Sports M edicine and Physical Fitness, 2 3 , 5 2 -5 8 . E ysen ck I1J & E y se n c k S B C ( 1 9 6 4 ) . The Manual for the E y se n ck P erson a lity In ven tory, L ond on: U n iversity o f London Press. H a rd y CJ. Ricliman J M & R osenfeld L B ( 1 9 9 1 ) . The role o f social support in the life str e s s/in ju r y relationship. The Sport P sych olog ist, 5, 1 2 8 -1 3 9 . H olm es. T H & R a h e R H ( 1 9 6 7 ) . The social readjustm ent rat­ ing scale. Journal o f P sych o so m a tic Research. 11. 2 1 3 -2 1 8 . Irvin R F ( 1 9 7 5 ) . Relationship betw een person a lity and the incidence o f injuries to high school footba ll participants. D isserta tion A b str a c ts International, 3 6 , 4 3 2 8 -A . Jackson D W , Jarret H . B arley D, K a u sch J , Sw anson J J & Powell J W ( 1 9 7 8 ) . Injury prediction in the yo u n g athlete. A preliminary report. A m erica n Journal o f Sports Medicine. 6, 6- 12. K a n n er A D . C oyn e JC . Schaefer C & Lazarus R S ( 1 9 8 1 ) . C om parison o f tw o m od es o f str ess m ea surem ent: Daily hassles and uplifts versus m ajor life events. Journal o f B ehavioral M edicine, 4, 1 -39. K err G & Minden H ( 1 9 8 8 ) . Psychological factors related to the occurrence o f athletic injuries. Journal o f S]>ort and E xercise P sych o lo g y. 10, 1 6 7 -1 7 3 . L ysen s R, Auu-eele Y V & O styn M ( 1 9 8 6 ) . The relationship betw een psychologica l factors and s])orts injuries. Journal o f Sports M edicine and Physical F itness, 2 6 , 7 7-84 . M artens R . Vealey R S & Burton D ( 1 9 9 0 ) . C om petitive anxi­ e ty in sport. Cham paign. 1L: H um an K inetics. Miller TW. Vaugh M P & Miller J M ( 1 9 9 0 ) . Clinical issues and treatment stra tegies in stress-orien ted athletes. Sjiorts Medicine. 9. 3 7 0 -3 7 9 . P a sser M W & S eese M D ( 1 9 8 3 ) . Life str ess and athletic injury: Exa m ination o f p o sitive versus negative even ts and three m oderator variables. Journal o f H um an St ress, 9, 1 1-16. R o tter J B ( 1 9 6 6 ) . G eneralized expectancies for internal versus external control o f reinforcement. P sychological M on o ­ graphs. 8 0 : 1-28. Valliant P M ( 1 9 8 1 ) . P erson ality and injury in com petitive runners. Perceptual and M otor Skills. 5 3 , 2 5 1 -2 5 3 . W illiam s J M . T o n y m an P & W ad sw o rth I VA ( 1 9 8 6 ) . R elationship o f s tr e s s to injury in intercollegiate volleyball. Journal o f Hum an Stress. 12, 3 8 -4 3 . Williams J M & R o e p k e N ( 1 9 9 3 ) . P sych o lo g y o f injury and injury rehabilitation. In R N Singer. M M urphey & L K Tennant ( E d s .) . H a n d book o f research on sport p sych ology (pp. 8 1 5 - 8 3 9 ) . N ew York: Mcmillan. o oR 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. ) c a r d i o s p v r t s Ic s u s rs x Th e a r t r a t e MONI T ORS / ' t * • l a c t a t e m e t e r s F O R M ORE INFORM ATION OR THE STOCKIST N E A R E S T Y O U , C A L I B I O M A R C T O L L F R E E : 0 8 0 0 2 2 4 6 8 4 w Double Act • o n t h e \ s p a t / Accusport is the first truly p orta ble m eter fo r m easu ring loctate levels on the spot - offordable convenience a t its best! Accusport weighs o mere 20g, it's a cinch to use, ond the vital inform otion displayed could result in a PB. By meosuring heart rate and loctate levels during exercise you can monitor degrees o f exertion, optimise heolth benefits, moximise endurance and ovoid over exertion. • Trainers ond sports group leaders know that customized training improves individuof performance. • High-performonce othletes and health-conscious sports people need to have personal control over their training. • Physicians, physiotherapists and biokineticists in rehabilitation can provide greater safety in sport. •• Heort rale * 12 ar 24 hour time o f day 9 Stopwatch sampling intervals recorded heart rate low heart rote limit alarms * Target zone indication • ’ Water resistant * Bike adapter included ► H E A R T S A F E Excludes, Time o f day v Heort rote v Time of doy with doily alarm • r Calendar * Stopwotch with 3 0 lap time memory * Target lop time * Time spent & overage HR recordings, within, obove & below target zone 9 Heart rote memory with 256 memory recordings * Event morkers * Kcolaries burnt * Water resistant * Bike adopter included A D D IT IO N TO THESE PRODUCTS, A W IDE RANGE OF A R D IO S P O R T HEART RATE M O N IT O R S IS A VA ILAB LE 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. ) Inspired air humidity effect on respiratory function in normal adults during exercise CG Hartford MB BCh MSc, University of the Witwatersrand, Medical School C Maldonado BSc (Hons), University of the Witwatersrand, Medical School GG Rogers MSc PhD, University of the Witwatersrand, Medical School___________ Abstract Inspired air humidity effect on respiratory func­ tion and expired air water vapour pressure (EWVP) during submaximal exercise was assessed at fixed inspired air temperature. Spirometry in six healthy male subjects was performed at rest (baseline), after each of four consecutive ten minute exercise sessions (phases I-IV) and ten minutes post exercise (recovery), on humid inspired air (HIA), and on dry inspired air (DIA) one week thereafter. Peak expiratory flow rate, forced vital capacity and forced expiratory volume in one second val­ ues were not significantly different between the DIA and HIA groups when compared with each group’s baseline. EWVP with exercise was signif­ icantly decreased at phase IV versus phase II within the DIA group. No significant decrease in EWVP on HIA was noted. Decreasing inspired air humidity, without simultaneously changing inspired air tempera­ ture, does not significantly influence respiratory function at submaximal exercise in normal adults. Key words: Humidity, Spirometry, Exercise. Introduction The humidity and temperature of inspired air varies widely with ambient conditions and pha­ ryngeal discomfort caused by the passage of under-humidified air is a common complaint amongst exercising laboratory subjects during oral breathing through a two-way non-rebreath- ing valve, and during the use of self-contained breathing apparatuses. Decreased forced expira­ tory volume in one second (FEVi) and an Address for correspondence CG Hartford, Dept o f Physiology, University o f the Witwatersrand Medical School, 7 York Road, Parktown, Johannesburg, South Africa. Tel: ( Oil) 647-8363. Fax: ( Oil) 643-2765. increased airways resistance with cold dry (10°C, 10% Relative Humidity (RH)), cold humid (10°C, 50% RH) and hot dry (37°C, 15% RH) inspired air compared with hot humid inspired air in exercis­ ing asthmatic patients, and an increased FEVi with hot humid (37 °C, 60% RH) inspired air com­ pared with hot dry and cold dry inspired air in normal exercising subjects, has been noted.1 However, most studies have concentrated on changing inspired air humidity and inspired air temperature simultaneously, and then examined the effects of these on asthmatic patients only.' 3 * One investigator"5 has showTi that inspired hot humid (45 °C, 95% RH) air during exercise increases tidal volume and decreases respiratory rate5 6 as compared with cool dry (26 °C, 60% RH) air, in normal subjects. Most research experi­ ments are conducted in a laboratory with a con­ stant room temperature. The effect on pulmonary function and expired air water vapour pressure of breathing DIA and HIA through a two-way non-rebreathing valve, at equal inspired air temperatures, was assessed in normal persons during prolonged submaximal laboratory-based exercise. METHODS Subjects The protocol was approved by the Committee for Research on Human Subjects of the University of the Witwatersrand. Subjects with a history of health problems; pulmonary disease, asthma, smokers and current use of any medication, were excluded from the study. After initial spirometry instruction, subjects failing to demonstrate repro­ ducible flow-voltune loops were excluded. Six vol­ unteer consenting healthy sedentary male sub­ jects aged between twenty and twenty-two years, 175,1 ± 3,2 cm in height and weighing 69,4 ± 4,7 kg participated in the study after written informed consent was obtained. Procedure Subjects underwent spirometry (Schiller SP 200, Switzerland), in accordance with the American Thoracic Society guidelines7 after each of four consecutive ten minute bicycling periods (Medifette 400L ergometer, Netherlands) at 75% 24 SPORTS MEDICINE JUNE 1995 iR 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. ) of maximal predicted heart rate ((220 minus age) beats/m in). There was a three minute rest period in between each ten minutes of exercise followed by three consecutive spirometry recordings per­ formed at rest each made one minute apart, on room am Measurements were taken prior to the first exercise period (baseline), three minutes after each ten minute exercise period (phases I- IV) and ten minutes post the fourt h exercise peri­ od (recovery) whilst breathing oral humid inspired air (HIA), or oral dry inspired air (DIA) one week thereafter at the same exercise work­ load. Mean expired air water vapour pressure (EWVP) was measured over each ten minute exercise period. Apparatus Compressed air (Afrox Medical Air, South Africa) was bubbled through two in-series triple-dis­ tilled water cylinders at room temperature to two reservoir anaesthetic bags, from which the sub­ jects inhaled air at 85% RH or at 0% RH by cir­ cumventing the water cylinders (Fig. 1). Air flow was regulated to be close to the subjects’ minute ventilation at all times. The subjects inspired and expired through a two-way non-breathing T-shape valve (Hans Rudolf 2700, MO, USA), the expira­ tory circuit of which was heated to between 38 °C and 42 °C to prevent condensation on the humid­ ity and temperature sensor inserted therein (Solomat MPM 500E, Devon, UK). The humidity sensor was calibrated using 2% RH and 75% RH saturated salt solutions, and readings were aver­ aged over each ten minute exercise session from which mean EWVP in kPa was calculated using psychrometric charts. Inspired air temperature was measured using a thermocouple inserted into the mouthpiece of the subject and attached to an electronic ice-point reference (Physitemp Bat-12, NJ, USA) plus calibrated analogue recorder (Hellige Servomed, Freiburg, Germany), and averaged every thirty seconds during exer­ cise. Standard bipolar electrocardiographic mea­ surements of heart rate were recorded. Statistical Analysis All data are expressed as absolute sample mean ± SEM, or the absolute change (A) in sample mean ± SEM at any phase compared to baseline values for spirometry (Aphases I-IV) and com­ pared to phase I values for heart rate and EWVP (Aphases II-IV). The highest of the three spirom­ etry measurements’ values at each phase was used for analysis. Data within the HIA and DIA groups were analyzed by repeated measures ANOVA followed by Student’s paired t test and Student-Newman-Keuls post-test correction for multiple comparisons,8 and between groups using Student’s paired t test. Two tailed probability val­ ues of p < 0.05 were considered significant. Heated cavity Analog recorder Figure 1. Schematic representation o f apparatus for supply o f 0% and 85% RH inspired air. R H = relative humidity. SPORTS MEDICINE JUNE 1995 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. ) Results Room air temperature was 22-23 °C and room %RH 48,9 ± 2,8 in the vicinity o f the subjects. Mean inspired air temperature was recorded as 26,7 ± 0,4°C and 27,1 ± 0,03°C for the HIA and DIA groups respectively. The subjects’ submaxi- mal workloads ranged from 100-130 watts and heart rates between the two groups were not sig­ nificantly different for any o f Aphases II-IV. All spirometry data at baseline were not signif­ icantly different between the two groups (Table I). Peak expiratory flow rate (PEFR), forced vital capacity (FVC) and FEVi were not significantly different between the groups for any Aphase I-IV values. There were no significant differences between the groups for any Aphase I-IV values of forced expiratory volume in 0,5 second (FEVo.s), average flow rate between 0,2 litres and 1,2 litres (FEE>21.2), 25% and 75% (FEF 7̂s%), and 75% and 85% (FEF7sk=,-,) o f forced expired vital capacity, maximum expiratory flow rate at 75% (MEF?s%), 50% (MEFsm) and 25% (MEF^%) o f forced vital capacity. Peak inspiratory flow rate recovery minus baseline value (Arecovery) was significant­ ly more negative (p<0,05) on DIA than on HIA (- 0.45 ± 0,27 vs +1.01 ± 0.64 I'/min) but there were no differences in any o f the Aphase I-IV values. EWVP absolute values at phases I-IV were sig­ nificantly lower (p<0,005) for DIA compared to HIA. The EWVP phase IV absolute value and the Aphase IV value within group DIA (3,92 ± 0,01 and -0,19 ± 0,11 kPa respectively) were signifi­ cantly decreased (p<0,05) compared with the absolute phase II and the Aphase II values (4,16 ± 0,10 and +0,04 ± 0,06 kPa respectively), how ­ ever there ŵ ere no significant differences between the groups for any Aphase II-IV values. There was no significant change in the absolute or Aphase II-IV EWVP values within the HIA group with exercise. Discussion In this study we have shown that, despite the laryngo-pharyngeal discomfort experienced by many subjects from the oral breathing o f air through a two-way non-rebreathing valve during laboratory-based exercise, indices o f pulmonary function do not change following alterations in inspired air humidity at constant inspired air temperature. No significant difference in heart rate was observed between the two inspired humidity groups at constant w-ork loads. Inspired air humidity therefore had 110 effect on heart rate, and this outcome correlates with the finding that certain changes in the responses to exercise are related to inspired air temperature rather than to inspired air humidity.1 Decreased FEVi in asthmatic patients during inspiration o f cold dry air has been document­ ed,'"’ whilst changes in inspired air temperature alone are noted to alter pulmonary function in patients with exercise-induced asthma (EIA).4 However, it has been suggested that airway water loss itself, and not the changing temperature of inspired air, is important in exacerbating EIA.4910 Under ideal conditions o f inspired humidity and temperature there is a certain degree o f bron- chodilation secondary to exercise,11 howrever bronchoconstriction has been shown to predomi­ nate imder conditions o f decreased inspired air w'ater content,1 whilst the bronchospasm precipi­ tated by altered inspired air temperature in EIA has been noted to be reduced by the addition of water vapour to the inspired air.4 The exact mechanism by which a decreased in­ spired water vapour content may affect pulmo­ nary function is unclear. Experiments designed to demonstrate an impairment o f pulmonary func­ tion in normal persons by nasal obstruction have produced inconsistent results, and interpretation is further complicated by the dissimilar variables Table 1. SPIROMETRY BEFORE AND AFTER SUBMAXEMAL EXERCISE ON HUMID AND DRY INSPIRED AIR Variable BASELINE HIA DIA APHASE IV HIA DIA PEFR ( I'/min) 9,55 ± 0,40 9,69 ± 0,49 +0,57 ± 0,34 -0,07 ± 0,07 FEVi ( 0 4,84 ± 0,21 4,69 ± 0,20 +0,01 ± 0,08 -0,07 ± 0,04 FVC (10 5,26 ± 0,29 5,10 ± 0,23 +0,02 ± 0,06 -0,13 ± 0,11 FEE*.?.™ (P./min) 5,74 ± 0,38 5,59 ± 0,32 -0,21 ± 0,26 +0,12 ± 0,18 MEFsw (P/min) 6,28 ± 0,47 6,15 ± 0,51 -0,41 ± 0,43 +0,03 ± 0,28 PIFR (I'/min) 8,73 ± 0,78 9,87 ± 0,55 +1,21 ± 0,87 -0,37 ± 0,32 BASELINE = at rest before exercise; APHASE IV = absolute change from baseline at phase IV measure­ ments; H IA = humid inspired air; D IA = dry inspired air; PEFR = peak expiratory flow rate; FEVi = forced expiratory volume in one second; FVC = forced vital capacity; FEFzh-jm = average flow rate o f expired air between 25 and 75% o f FVC; MEFam, = maximum expiratory flow rate at 50% o f FVC; PIFR = peak inspi­ ratory flow rate. 26 SPORTS MEDICINE JUNE 1995 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. ) measured by different researchers.1' 15 In assess­ ing die role o f nasal humidification o f dry air in healthy persons at rest, a decreased dynamic lung com pliance was recorded while orally breathing dry air compared with humidified air15 (the inspired air temperature was not stated in this study), however no change in spirometry or functional residual capacity was noted. The researchers concerned suggested that during dr)7 aii- breathing increased evaporation from the liuigs could increase the concentration o f surfac­ tant thereby decreasing the lung compliance, and that DIA could be a stimidus for bronchocon- striction via desiccation and cooling o f the small­ er airways. The consistently lower EWVP phases I-IV absolute values on DIA compared with HIA, in the absence o f a significant difference in the EWVP Aphases II-IV values between the groups, was related to the DIA supply present in the apparatus dead space o f the T-shape two-way valve, which effect has also been noted by other researchers/1 Although there was no significant difference between the groups’ EWVP Apliase II- IV values, the trend towards a decreased expira­ tory vapour pressure within the DIA group over tinie, and the late significant EWVP decrease within the group DIA (DIA absolute phase IV and Aphase IV versus DIA absolute phase II and Aphase II) may be explained by the airway lumi­ nal surfaces dehydrating due to oral DIA breath­ ing,"’ the dehydration being exacerbated by the increased minute ventilation o f exercise in our study, thereby decreasing the humidity o f the air­ way dead space air. The role o f the humidifica- tion o f dead space air by the non-nasal airways lias been shown to be lim ited,15 inspired air being largely humidified by the nasal passages, in the absence o f which pulmonary tract dehydration ensues residting in a limited ability o f the non­ nasal respiratory airways to humidify expired air. Decreased mean expiratory %RH from breathing hot dry air in exercise has also been attributed to a change in the secretion o f water by the mouth, pharynx and upper airway epithelium .5 D e­ creased EWVP when exercising on DIA may in addition be due to the reabsorption o f water by the dehydrated respiratory tract and mouth from the expired humidified alveolar air. In summary, this study shows that, in normal adults exercising submaximally under laboratory- based conditions, decreasing inspired air humid­ ity without concomitantly altering inspired air temperature does not significantly affect respira­ tory function with respect to spirometry or the humidification o f dry inspired air. REFERENCES 1. Eschenbacher W L. M oore TB. Lorenzen TJ. Weg J G , G ross K B . P ulm onary responses o f a sth m a tics and normal su b ­ j e c t s to different tem perature and hum idity conditions in an environm ental chamber. Lung 1 9 9 2 ; 1 7 0 : 5 1 -6 2 . 2. Stra uss R H . M cFa dd en E R , Ingram R H , J a eger JJ. E nhancem ent o f exercise-induced a sth m a b y cold air. N Engl J M ed 1 9 7 7 ; 2 9 7 : 7 4 3 -7 4 7 . 3 . Strauss R H , M cFadden ER. Ingram R H . D eal E C , Jaeger JJ. Influence o f heat and hum idity on the airw ay obstruc­ tion induced b y a sthm a in exercise. J Clin Invest 1 9 7 8 : 6 1 : 4 3 3 -4 4 0 . 4. D ea l E C , M cFadden E R , Stra uss R H , J aeger JJ. Role o f respiratory heat exchange in production o f exercise-induced asthm a . J A p p l P h ysiol 1 9 7 9 ; 4 6 ( 3 ) : 4 6 7 -4 7 5 . 5. Turner N. Parker J. Iludnall J. The effect o f dry and humid hot air inhalation on expired relative hum idity during exer­ cise. A m erica n Industrial H yg ien e A s so c ia tio n Journal 1 9 9 2 ; 5 3 ( 4 ) : 2 5 6 -2 6 0 . 6. Giesbrecht G G , Younes M. Ventilatory effect o f a cute pul­ m ona ry hypotherm ia. J A p p l Ph ysiol 1 9 9 0 : 6 9 ( 4 ) : 1 4 3 5 - 1 4 4 1 . 7. Gardner R M . H ankinson JL, Clausen K L , Crapo R O . J oh n son R L , Epler G R . Standardisation o f spirom etry - Am erica n Thoracic S ociety Update. A m R ev R esp ir D is 1 9 8 7 : 1 3 6 : 1 2 8 5 -1 2 9 8 . 8. G lantz . S V l. A Prim er o f B io sta tistics. 3rd edition: N ew York: M cGraw -H ill. 1 9 9 2 : 9 1 -1 0 4 . 9. Hahn A , A n d e rso n SD , M orton A R , B lack JL, Fitch K D . A reinterpretation o f the effect o f tem perature and water con ­ tent o f the inspired air in exercise-induced a sthm a. A m R ev R esp ir D is 1 9 8 4 : 1 3 0 : 5 7 5 -5 7 9 . 10. E schenbacher W L. Shepard D . R esp ira to ry heat loss is not the sole stim ulus for bronchoconstriction induced b y iso- capnic hyperjm ea with dry air. A m R ev R esp ir D is 1 9 8 5 : 1 3 1 : 8 9 4 -9 0 1 . 11. Gelb A F , Tashkin DP. Epstein J D . G o n g H , Zam el N. Exercise-induced bronchodilation in a sthm a. C hest 1 9 8 5 ; 8 7 ( 2 ) : 1 9 6 -2 0 1 . 12. C ook T A . K o m orn R N . Sta tistica l a nalysis o f the alter­ a tio n s o f b lood g a s e s p r o d u ced b y nasal packing. L aryn g oscop e 1 9 7 3 ; 8 3 : 1 8 0 2 -1 8 0 9 . 13. C a ssissi NJ, Biller HF, Ogura J H . C hanges in arterial ten­ sion and pu lm on a ry m echanics with posterior nasal p a ck­ ing. L a ryn g oscop e 1 9 7 1 : 8 1 : 1 2 6 1 -1 2 6 6 . 14. J a co b s J R , Levine L A , D a vis II, Lefrak SS. D ruck NS. P o s te r io r p a c k s and the n a so -p u lm o n a r y reflex. L aryn g oscop e 1 9 8 1 : 9 1 : 2 7 9 -2 8 4 . 15. W oodson G E , R ob bin s KT. N asal obstruction and pul­ m onary function: The role o f humidification. O tolaryngol H ea d Neck Surg 1 9 8 5 ; 9 3 : 5 0 5 -5 1 1 . 16. M cCutchan JW , Taylor CL. R esp iratory heat exchange with varying tem perature and hum idity o f inspired air. J A p p l P h ysiol 1 9 5 1 ; 4 : 1 2 1 -1 3 5 . f l E i Voltanen 75 WIL5ENACH 9 3 0 6 2 5 f T A B L E T S Diclophenac sodium 75 mg Y/3 1/346 VH SPORTS MEDICINE JUNE 1995 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. ) J u s t w h a t a t h l e t e s w o u l d e x p e c t F R O M A C O M P A N Y C O M M I T T E D T O S P O R T . SmithONephew Leadership in Worldwide H ealthcare 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. )