Anabolic-Androgenic Steroid Misuse: Mechanisms, Patterns of Misuse, User Typology, and Adverse Effects

Anabolic-androgenic steroids (AAS) encompass a broad group of natural and synthetic androgens. AAS misuse is highly prevalent on a global scale, with the lifetime prevalence of AAS misuse in males being estimated to be around 6%, with 15 to 25% of male gym attendees using it at any one time. AAS are associated with sudden cardiac death, neuropsychiatric manifestations, and infertility. The average AAS user is unlikely to voluntarily declare their usage to a physician, with around 1 in 10 actively engaging in unsafe injection techniques. The aim of this paper is to review the current evidence base on AAS with emphasis on mechanisms of action, adverse effects, and user profiles that are most likely to engage in AAS misuse. This paper also reviews terminologies and uses methods specific to the AAS user community.

A Comparative Study of Hematological Parameters of Endurance Runners at Guna Athletics Sport Club (3100 Meters above Sea Level) and Ethiopian Youth Sport Academy (2400 Meters above Sea Level), Ethiopia

Introduction. Endurance running performance is dependent upon hematological, physiological, anthropometrical, diet, genetic, and training characteristics. Increased oxygen transport and efficiency of tissue in extracting oxygen are the major determinants to competitions that require endurance. Thus, altitude training is often employed to increase blood oxygen-carrying capacity to improve sea-level endurance performance. This study aimed to compare hematological parameters of endurance runners’ training at different clubs with different altitudes (Guna Athletics Sport Club at Guna (3100 meter above sea level) and Ethiopian Youth Sport Academy at Addis Ababa (2400 meter above sea level)). Methods. A comparative cross-sectional study was conducted at GASC and EYSA. Data were collected from a total of 102 eligible study subjects (26 runners and 25 controls at Guna and 26 runners and 25 controls at Addis Ababa) from May to October 2019. About 3 ml of the venous blood was drawn from the antecubital vein by aseptic procedure and analyzed using a hematology analyzer (DIRUI BCC-3000B, China). One-way ANOVA and independent-sample t-tests were used to compare means. Result. Male runners in Guna had significantly higher hemoglobin (Hgb), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), and white blood cell (WBC) count than male runners in Addis Ababa. Besides, female runners in Guna had significantly higher MCH and MCHC than female runners in Addis Ababa. However, there were no significant differences between Guna and Addis Ababa runners in red blood cell (RBC) count, Hct, MCV, and platelet count in both sexes, while Hgb and WBC count in females. Conclusion. Decisively, Guna Athletics Sport Club endurance runners had significantly higher hematological parameters than Ethiopian Youth Sport Academy endurance runners. This provides invaluable information for coaches and sport physicians to monitor the hematological profile and the health status of an athlete living and training at different altitudes.

Training for Marathons during a Marathon Pandemic: Effect of the COVID-19 Pandemic on Fitness among High-Level Nonelite Runners

Background. The COVID-19 pandemic has had a profound effect on all aspects of life, including physical fitness and well-being of the general population. In the present study, we assessed the effect of the pandemic on the subjective and objective fitness of high-level nonelite runners. Methods. The MASTERS Athletic Study is an ongoing survey of training and health habits of high-level nonelite runners, the majority of whom compete in marathons and other extreme endurance events. We invited participants to a web-based questionnaire regarding training and fitness during the COVID-19 pandemic. Comparisons were made between subjective and objective fitness as well as well as the relationship of prepandemic training volume and history of COVID-19 on change in fitness during the pandemic, using Mann–Whitney rank-sum tests and chi-square tests for nonparametric and categorical variables, respectively. Results. A total of 189 runners completed the survey, of whom 26 (13.8%) reported prior diagnosis with COVID-19. In terms of the subjective sense of fitness compared to before the pandemic, 49 (25.9%) reported they were less fit, 55 (29.1%) reported they were more fit, and 85 (45.0%) reported their fitness was unchanged. These assessments correlated well with objective measurement of training volume in MET-min/week. Runners with improved fitness at present had a lower calculated training volume before the pandemic versus those who reported unchanged or worsened fitness. There was no relationship between the report of prior COVID-19 and either subjective or objective measures of fitness. Conclusion. The COVID-19 pandemic has had a variable effect on the fitness of high-level nonelite runners. We found an inverse relationship between baseline training volume and the likelihood of runners reporting improved fitness and no relationship between a history of COVID-19 and change in fitness through the pandemic. Understanding the effect of the COVID-19 pandemic on athletic fitness will help guide strategies to maintain physical health and wellness through future public health crises.

Effects of High-Intensity Interval Training Protocols on Liver Enzymes and Wellness in Women

Background. Single-modality, high-intensity interval training (HIIT) using traditional cardiorespiratory exercise selection has been found to provide similar and sometimes superior cardiometabolic effects compared with moderate-intensity continuous training. However, little is known regarding the cardiometabolic and psychosocial effects of HIIT using resistance training modalities. Therefore, this study aims to compare the effects of HIIT using rowing (R-HIIT) and multimodal HIIT (MM-HIIT) using resistance training on liver enzymes, cardiometabolic risk factors, and psychosocial outcomes. Method. Recreationally active females with a body mass index <30 kg/m2 (N = 16, 23.0 ± 5.9 years) were randomized into a MM-HIIT or R-HIIT group and completed a 12-week HIIT intervention (ClinicalTrials.gov registration number: https://clinicaltrials.gov/ct2/show/NCT03093441) using principles of social cognitive theory (SCT). Participants completed pre- and postintervention measurements on anthropometrics, resting heart rate, blood pressure, blood measures (lipids, liver enzymes, and glucose), exercise self-efficacy, and perceived wellness. Analysis of covariance was used to examine differences in postintervention measures between groups after controlling for baseline values, waist circumference, and waist-to-height ratio. Results. R-HIIT group had significantly decreased alanine aminotransferase (mean difference = 13.16, P = 0.013 , effect size (ES) = 0.44, confidence interval (CI) = 3.40 to 22.92) and aspartate aminotransferase (mean difference = 10.79, P = 0.024 , ES = 0.38, CI = 1.67 to 19.90) levels compared with the M-HIIT group, and the whole group had improved wellness scores (14.72 ± 2.6 to 16.89 ± 2.76, P = 0.002 ). Conclusion. R-HIIT may be an effective preventative method for improving liver health in females without obesity. When using principles of SCT, HIIT may enhance overall well-being.

Sleep Quality’s Effect on Vigilance and Perceptual Ability in Adolescent and Adult Athletes

The aim of the study was to investigate the effect of sleep quality in cognitive domains of perceptual ability after exhausting exercise in adolescent and adult athletes. Eighty-six male professional soccer players were included in our study and divided into two groups: adolescents (age: 17.3 ± 0.2 yrs, body mass: 68.9 ± 7.9 kg, body fat: 9.9 ± 3.6 %) versus adults (age: 26.3 ± 5.2 yrs, body mass: 76.5 ± 7.2 kg, body fat: 10.3 ± 3.1 %). For each athlete, prior to cardiopulmonary exercise testing (CPET), anthropometric and morphological characteristics were recorded and Pittsburgh Sleep Quality Index (PSQI) questionnaire was answered. Immediately after CPET, all athletes underwent the perceptual ability test (PATest) for 30 sec and the sum of hits (rep/30 sec) and the time between a visual stimulus and the following stimulus (mean reaction time; RT, sec) were recorded. Oxygen uptake in maximal effort and in anaerobic threshold showed differences between hits ( P = 0.037 ) and RT ( P = 0.025 ). The variable of PSQI questionnaire “had bad dreams” showed correlation with hits ( P = 0.021 ) and RT ( P = 0.011 ) and the RT showed correlation with variables “cannot breathe comfortably” ( P = 0.041 ) and “...enthusiasm to get things done” ( P = 0.041 ). Adolescents showed poorer sleep quality (PSQI score: 5.7 ± 3.6 vs. 2.4 ± 2.6) compared to adults and slower reaction time (0.9 ± 0.1 vs. 0.8 ± 0.1 sec, P = 0.029 ) compared to adolescent athletes with PSQI score ≥5.5. The variable of PSQI score in adolescents is related to HR in maximal effort (r = −0.364, P = 0.032 ) and in adults is related to speed (r = −0.335, P = 0.016 ). Perceptual ability, which requires sustained attention, vigilance, and motor coordination, is often negatively affected by restricted sleep, especially in adolescents.

Evidence That Sleep Is an Indicator of Overtraining during the Competition Phase of Adolescent Sprinters

Although sleep disturbance is a common complaint in overtrained athletes, the role of sleep in the overtraining process is not clear. This study aimed (i) to compare sleep efficiency/quantity at the start of a competition phase in elite adolescent sprinters who adapted to prior training with that in those who maladapt and (ii) to examine the influence of prior training, fatigue, and sleep on performance through a moderated mediation model. Fatigue (via Profile of Mood State) and internal training load (via session rating of perceived exertion and duration of training as volume) were measured in 20 sprinters (mean age: 15.9 ± 1.7 years) across 4 mesocycles (baseline (T1); preparatory (T2); precompetitive (T3); and competitive (T4) phases), over 26 weeks. Performances were assessed during the competitive period (T3, T4), while sleep was monitored (via actigraphy) for a week during T4. It was inferred that sprinters who had increasingly greater fatigue and concomitant decrements in performance (35%) were maladapted to training and the remaining sprinters who improved fatigue and performance (65%) were adapted to training. Sleep efficiency (91 ± 3% vs. 82 ± 3%, p < 0.001 ) and quantity (425 ± 33 min vs. 394 ± 20 min, p < 0.001 ) at the start of T4 were significantly greater in sprinters who adapted. Moreover, higher prior training volume (mean of T1 to T3 training volume) was associated with lower sleep efficiency at the start of T4 (R2 = 0.55, p < 0.001 ) which was associated with poorer performance (R2 = 0.82, p < 0.001 ). Fatigue moderated the indirect effect of prior training volume on performance through its moderation of the effect of sleep efficiency on performance (R2 = 0.89, p < 0.001 ). Impaired sleep as a result of greater prior training volume may be related to performance decrements through fatigue. Athletes should improve sleep during periods of higher training volume to reduce fatigue for better adaptation to training.

Delivering Evidence-Based Online Concussion Education to Medical and Healthcare Professionals: The Concussion Awareness Training Tool (CATT)

Background. Medical and healthcare professionals report an important gap in their training and knowledge on concussion diagnosis and management. The Concussion Awareness Training Tool (CATT) for medical professionals provides evidenced-based training and resources, representing an important effort to fill this gap. The goal of the current article was to summarize and describe the general uptake of the 2018 relaunch of the CATT for medical professionals and to present results of a quality assurance/quality improvement (QA/QI) assessment including qualitative feedback from medical and healthcare professionals. Methodology. Tracking completions via certificates and Google Analytics were used to measure uptake over the first two years following the 2018 relaunch and promotion of CATT for medical professionals. Medical and healthcare professionals who had completed the CATT from the time of the relaunch on June 11, 2018, to July 31, 2019, were invited via e-mail to participate in the survey-based QA/QI assessment. Both quantitative and qualitative data were collected. Results. Year 1 saw 8,072 pageviews for the CATT for medical professionals landing page, increasing to 9,382 in Year 2. Eighty-nine medical and healthcare professionals who had completed the CATT for medical professionals participated in the QA/QI assessment. Results showed that 85% of respondents reported learning new information about concussion; 73% reported changing the way they diagnose, treat, or manage concussion; and 71% reported recommending the CATT to colleagues. Qualitative data also indicated highly favourable opinions and experiences. Conclusions. The CATT for medical professionals has demonstrated promise as a tool to promote knowledge translation practice and help fill the gap in concussion training and knowledge reported by medical and healthcare professionals.

The Effects of Supersaturated Hydrogen-Rich Water Bathing on Biomarkers of Muscular Damage and Soreness Perception in Young Men Subjected to High-Intensity Eccentric Exercise

High-intensity eccentric exercise can cause a delayed onset of muscle soreness (DOMS), a short-term condition characterized by muscle damage and tenderness that might hold up recovery and jeopardize exercise routine. Previous studies indicated that hydrogen-rich water (HRW) might be a helpful topical intervention to boost recovery in musculoskeletal medicine, yet no data are available concerning the effectiveness and safety of whole-body bathing with supersaturated HRW after DOMS-inducing exercise. This study evaluates the effects of a single-session bathing with HRW on biochemical markers of muscular damage in healthy young men. The six volunteers who were exposed to DOMS-inducing eccentric exercise were assigned to either supersaturated HRW or control whole-body bathing in a double-blind crossover design. Immediately after an exercise session, the participants were immersed up to the neck into a 200 L bathtub with supersaturated HRW (8 mg of H2 per L) or control water (no hydrogen) for 30 min. Blood biomarkers of inflammation and muscular damage and Visual Analogue Scale (VAS) scores for muscle soreness were assessed at baseline (before exercise) and at 24-hour follow-up. Two-way ANOVA revealed a significant difference between two groups in serum creatine kinase (CK) response over the period of intervention ( P = 0.04 ). A single-session bathing in HRW prevented a rise in circulating biomarkers of muscular damage induced by exercise at 24-hour follow-up, retaining the levels of all biomarkers similar to the baseline values ( P > 0.05 ). On the other hand, serum CK, aldolase, and aspartate transaminase were significantly elevated at 24-hour follow-up as compared to the baseline levels after the control bath (342 ± 309 U/L vs. 465 ± 295 U/L; P > 0.05 ). HRW bath also induced a significant drop in VAS scores for muscle soreness in comparison with control water, both immediately after an intervention (32.7 ± 8.6% vs. 20.0 ± 12.8%; P = 0.02 ) and at 24-hour follow-up (31.6 ± 24.3% vs. 22.4 ± 27.5%; P = 0.03 ), respectively. No participants reported any major side effects during the trial. This pilot study suggests that the whole-body bathing in supersaturated HRW is a safe procedure that attenuates muscular damage and can ease sore muscles after high-intensity eccentric exercise.

Fibrosis following Acute Skeletal Muscle Injury: Mitigation and Reversal Potential in the Clinic

Skeletal muscle injuries occur often in athletics and in daily life. In minor injuries, muscles are able to regenerate completely and recover their functional capabilities. However, in the case of severe injuries, the injured muscle cannot recover to a functional level because of the formation of fibrous scar tissue. The physical barrier of scars is significantly challenged in both research and clinical treatment. Fibrous scar tissue not only limits cells’ migration, but also contributes to normal tissue biomechanical properties. This scar formation creates an unsuitable environment for tissue structure resulting in frequent pain. Antifibrosis treatment is one of the major strategies used to augment muscle regeneration and accelerate its functional recovery. This review will discuss the currently available methods for improving muscle regeneration with a specific focus on antifibrosis applications. We also discussed several novel hypotheses and clinical applications in muscle fibrosis treatment currently in practice.

The Main and Interactive Effects of Biological Maturity and Relative Age on Physical Performance in Elite Youth Soccer Players

The main and interactive effect of biological maturity and relative age upon physical performance in adolescent male soccer players was considered. Consistent with previous research, it was hypothesised that participants of greater maturity or born earlier in the selection year would perform better in terms of physical performance tests. This cross-sectional study consisted of 84 male participants aged between 11.3 and 16.2 years from a professional soccer academy in the English Premier League. Date of birth, height, weight, and parental height were collected. Sprint, change of direction, countermovement jump, and reactive strength index were considered for physical performance. Relative age was based on the birth quarter for the selection year. Maturity status was based upon the percentage of predicted adult height attained. Linear regression models highlighted that maturation was associated with performance on all but one of the physical performance tests, the reactive strength index. In contrast, relative age only served as a significant predictor of performance on the countermovement jump. This study indicated that physical performance (in the tests studied) seems to be related to the biological maturity status of a player but not their relative age. This finding is important because it suggests that early-maturing players perform better in the majority of physical performance tests, and the commonly held belief that relative age effect influences performance may be overstated.