ADHD Prescription Medications and Their Effect on Athletic Performance: A Systematic Review and Meta-analysis

Background Stimulant medications used for the treatment of Attention Deficit-Hyperactivity Disorder (ADHD) are believed to provide a physical advantage in athletics, but several of these medications are not regulated by the World Anti-Doping Association. Given the prevalence of ADHD among the athlete population and concern for abuse of ADHD medications, this review and meta-analysis aimed to evaluate effects of ADHD medications on athletic performance, thereby appraising the validity of claims of performance enhancement. Methods A search of MEDLINE, Embase, CINAHL, and Cochrane Review databases was performed for all randomized controlled trials evaluating athletic performance after ingestion of placebo or ADHD treatment medications from August 2020 through November 2020. All RCTs identified from these search criteria were included for screening, with exclusion of any animal studies. Two reviewers (JB, CK) assessed methodological quality and risk of bias using CONSORT 2010 and Cochrane Collaboration tools. Study results were compiled with corresponding p values for each finding. Effect sizes (Cohen’s D) for athletic performance and physiological changes were aggregated for each study. Studies were further screened for homogeneity that would allow for meta-analysis. Heterogeneity was calculated using I2. Results A total of 13,033 abstracts evaluating amphetamine, methamphetamine, methylphenidate, and bupropion were screened. The final analysis included nine studies, six of which found significant improvement in athletic performance with use of stimulant medications (p < 0.05). Methylphenidate and amphetamine were consistently identified to have a performance effect. Secondary effects identified included significant increase in heart rate, core temperature, and elevation of various serum hormone levels (p < 0.05). Effect size evaluation found seven studies demonstrating small to large effects on physical performance, as well as in categories of cardiometabolic, temperature, hormone, and ratings of perceived exertion, to varying degrees. A meta-analysis was performed on two studies, demonstrating conflicting results. Conclusions Dopaminergic/noradrenergic agonist medications appear to have a positive effect on athletic performance, as well as effects on physiological parameters. Further consideration of medications currently not regulated, i.e. bupropion, is warranted given evidence of athletic performance enhancement. PROSPERO trial registration number: CRD42020211062; 10/29/2020 retrospectively registered.

Optimizing Health and Athletic Performance for Women

Purpose of Review The exponential growth of women participating in competitive sports throughout the years was made possible through several initiatives by the International Olympic Committee and the passage and implementation of Title IX as a federal law in the United States. However, this positive trend towards gender equity in sports has not transpired for women in medicine, especially in fields that care for elite athletes. This current review will discuss specific areas that can be tailored to help female athletes prevent injuries and optimize their athletic performance. We will also highlight how increased female team physician representation in sports may help optimize care for female athletes. Recent Findings Female athletes are considered high risk for certain conditions such as ACL tears, patellofemoral pain syndrome, bone stress injuries, sport-related concussions, and sexual violence in sport. Addressing factors specific to female athletes has been found to be valuable in preventing injuries. Strength and conditioning can optimize athletic performance but remains underutilized among female athletes. Although diversity in healthcare workforce has been found to be beneficial for multiple reasons, women remain underrepresented in sports medicine. Increasing female team physician representation may positively impact care for female athletes. Summary Team physicians must understand the physiologic, biomechanical, and anatomic factors that are unique to female athletes in order to tailor injury prevention programs and optimize their athletic performance. Advocating for gender equity in sports medicine to advance representation of women in the field will increase workforce diversity and promote excellence in sports medicine care.

Ingestion of Carbohydrate Solutions and Mouth Rinse on Mood and Perceptual Responses during Exercise in Triathletes

Triathlons are endurance events that include swimming, running, and cycling. Triathletes need to eat optimally during training and competitions to maximize their potential for success. The presence of carbohydrates in the mouth could activate regions in the brain to enhance athletic performance in exercise. Methods: This study examined the effects of glucose and mouthwash in ten male triathletes (age: 26.0 ± 8.7 years, height: 173.6 ± 10.4 cm, BMI 22.0 ± 1.7 kg/m2). The four oral test solutions included (A) Rinse with placebo, (B) Water + gel with placebo, (C) Rinse with 15% CH concentration, and (D) Water + gel with 15% CH concentration (25 g gel in 165 mL water). The Rate of Perceived Exertion (RPE), Sensation Scale (FS), Felt Arousal Scale (FAS), Profile of Mood States (POMS), blood glucose, sprints, and dietary habits were assessed in each subject. All preceded ingestion of the oral-based test solution during workouts. Results: RPE showed no significant differences for subjective perceptions. The same was observed for FS and sprints. FAS scores increased over time (p = 0.039) in all groups. POMS score increased significantly in group D (p = 0.041). There was no effect of time on plasma glucose levels (p = 0.737). As for correlations, positive correlations were observed between sprint and FAS variables (p = 0.011). Conclusions: It appears that CH intake correlates positively with mood, but in all other variables, there are no differences depending on the product.

Effects of the Withania somnifera supplementation on sports performance: a systematic review and meta-analysis

Background: Withania somnifera has been used as an ergogenic resource in recent years. In this scenario, a systematic literature review is justified to compile the findings in the scientific literature and to evaluate the methodological quality of these investigations. Aims: Our objective with this review was to evaluate the effects of Withania somnifera supplementation on sports performance in physical exercise practitioners. Material and Methods: This systematic literature review with meta-analysis addresses the effects of Withania somnifera supplementation on sports performance. Results: Of the parameters evaluated in the articles, the maximum oxygen uptake was shown to improve significantly in the three studies in which it was evaluated. Maximum strength was not influenced by the supplementation. Conclusions: The results of the present systematic literature review showed evidence that the supplementation of Withania somnifera over 500 mg to 1,250 mg before or after exercise can improve physical performance. Keywords: Withania, Sports, Dietary Supplements, Athletic Performance.

The Effects of Six-Month Subalpine Training on the Physical Functions and Athletic Performance of Elite Chinese Cross-Country Skiers

Purpose: This study investigated the changes in the blood indices, specific athletic abilities, and physical fitness of outstanding cross-country skiers, trained in the subalpine; Methods: Twenty-eight athletes (twenty males and eight females) from the National Cross-country Ski Training Team completed sub-alpine training during the 2020–2021 snow season. The athletes′ physical functions were evaluated by collecting blood from elbow veins and measuring blood biochemical indexes. To compare the treadmill roller-skiing athletic ability and physical fitness of athletes before and after subalpine; Results: Male and female athletes showed different trends in red blood cells (RBC), hemoglobin (Hb), cortisol (C), Creatine Kinase (CK) and blood urea (BU) (p < 0.05 or p < 0.01). Overall, the female athletes’ mean values of RBC, Hb, CK, and BU were lower than that of male athletes, while C was just the opposite. Comparing the athletic performance of athletes before and after the subalpine, it was found that blood lactate concentrations were significantly lower in both male and female athletes at the same load intensity (p < 0.05 or p < 0.01), whereas 10 km endurance running and 1 RM deep squat were significantly higher in both male and female athletes (p < 0.05 or p < 0.01). Conclusions: After 6 months of subalpine training, cross-country skiers improved their oxygen-carrying capacity and anabolism, and showed significant improvements in specific athletic ability, physical endurance, acid tolerance and 1 RM absolute strength for both male and female athletes.

A POSSIBLE CORRELATION BETWEEN MYOSTATIN AND TESTOSTERONE AIDED BY GENETIC FACTORS ENHANCING ‎ATHLETIC PERFORMANCE AND MUSCLE RECOVERY

Background: multiple factors can affect athletic performance including nutrition, environmental, ‎physiological, physical fitness, and genetic factors. Hormonal factors such as testosterone, and ‎myostatin (MSTN) or GDF8 can be named to show significant effect on muscle growth and ‎recovery after intensive training. Illustrating the combined relationship between the latest factors ‎may help in developing efficient program for athletic care and exceled performance.‎ Methods: participation in this work came from 67 male divided into two groups of 35 endurance ‎and sprinters and 32 power athletes, with 36 females fall into two groups of 20 sprinters and 16 ‎power athletes. Testosterone and MSTN levels were measured in both genders before, and after ‎intensive training program followed by third measurement after 5 hours rest and recovery. The ‎MSTN gene was analyzed for the presence of genetic polymorphism using specific PCR ‎amplification.‎ Results: data obtained showed the presence of negative relationship between testosterone and ‎MSTN, whereas genetic analysis showed presence of three genotypes with different frequencies ‎each one of them affected MSTN with different rate ranging from normal production levels with ‎normal function to lack of function found in power athletes showing speedup muscle recovery and ‎higher muscle mass.‎ Conclusions: higher levels of testosterone reduced MSTN levels significantly showing negative ‎correlation between them. Low expression or production of nonfunctional MSTN protein enhanced ‎muscle recovery, higher muscle mass, and improved athletic performance.‎

Prevalences of lumbosacral articulation anatomic variants identified on nuclear scintigraphy and transrectal ultrasonography of Selle Français Warmbloods, French Standardbred Trotters, and Thoroughbreds and agreement between results from the imaging modalities

OBJECTIVE To describe scintigraphic and transrectal ultrasonographic anatomic variants of the lumbosacral (LS) articulation in horses and to determine the agreement between results obtained with each imaging modality. ANIMALS 243 horses (81 Selle Français Warmbloods, 81 French Standardbred Trotters, and 81 Thoroughbreds). PROCEDURES A retrospective search of clinical records was conducted to identify horses that had undergone nuclear scintigraphy and transrectal ultrasonography of the LS region of the vertebral column between January 2016 and December 2019. Scintigraphic images were evaluated by 2 observers blinded to the other’s results for classification of LS articulation anatomic variants (scintigraphic type); intra- and interobserver agreement were determined. Ultrasonographic images were evaluated for classification of LS intervertebral symphysis anatomic variant (ultrasonographic grade) by 1 observer blinded to horses’ identities and scintigraphic findings; agreement analysis was performed between scintigraphic type and ultrasonographic grade. Descriptive and statistical analyses were performed to describe distribution of anatomic variants. RESULTS The scintigraphic classification system (scintigraphic type) had excellent intra- and interobserver agreement. Agreement between results for scintigraphic type and ultrasonographic grade was moderate (κ = 0.61; 95% CI, 0.52 to 0.70). Anatomic variants of the LS articulation were observed in all groups. The distribution of variants differed significantly among breeds but not sexes. CLINICAL RELEVANCE Anatomic variations of the LS articulation in horses must be known to avoid misinterpreting them as clinically meaningful findings. Further research is needed to determine potential relationships between these anatomic variants and LS lesions, their clinical manifestations, and their influence on athletic performance.

Relación entre la estabilidad del core y el equilibrio postural en las habilidades biomotoras de los jóvenes atletas de baloncesto: una revisión sistemática (Relationship between Core Stability and Postural Balance on the Biomotor Capabilities of Young B

El baloncesto requiere exigencias físicas variadas, caracterizadas por esfuerzos intermitentes y situaciones de desequilibrio. Core Stability (EC) y Postural Balance (EP) son temas asociados como un factor significativo en la prevención de lesiones y dolor. Sin embargo, los resultados de los estudios en relación con las habilidades biomotoras son contrastantes, lo que indica que no hay efectos sobre el rendimiento deportivo en el contexto de alto rendimiento, pero es necesario profundizar las investigaciones sobre esta relación en la población adolescente.El objetivo del estudio fue verificar la relación entre la EC y la EP sobre las habilidades biomotoras en practicantes de baloncesto adolescentes. Utilizando la estrategia PICO, se realizaron búsquedas en las bases de datos PubMed y Scielo, buscando estudios experimentales con intervención de ejercicios EC / EP y pruebas de rendimiento atlético. Los resultados apuntan pocos estudios con efectos positivos sobre el rendimiento deportivo de los jóvenes atletas de baloncesto, pero no fue posible identificar pruebas sólidas de la influencia positiva del entrenamiento de EC / EP en las habilidades biomotoras de los adolescentes practicantes de baloncesto. Es necesario realizar más investigaciones sobre la influencia en los indicadores de rendimiento deportivo. Abstract. Basketball demands varied physical demands, characterized by intermittent efforts and situations of imbalance. Core Stability (EC) and Postural Balance (EP) are themes that have been associated as a significant factor in the prevention of injuries and pain. However, the results of studies in relation to biomotor skills are contrasting, indicating that there are no effects on athletic performance in the context of high performance, but investigations on this relationship in the adolescent population need to be further investigated. The aim of the study was to verify the relationship between EC and PE on biomotor skills in adolescent basketball players. Using the PICOS strategy, searches were performed in the PubMed and Scielo databases, looking for experimental studies with EC / EP exercise intervention and athletic performance test. The results point to studies with positive effects on the athletic performance of young basketball athletes, however few among them used a specific additional intervention. There is a need for further investigation regarding the influence on athletic performance indicators.