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Editorials 81

Both the lofty aims of the Olympic movement and the Looking to the future the proposed Academy of tangible aim ofwinning Olympic medals means that is likely to provide a large stimulus to change. The BOA the BOA has become involved more broadly in the already provides most of the services to Olympic Br J Sports Med: first published as 10.1136/bjsm.30.2.81 on 1 June 1996. Downloaded from provision and development of sports science and that are planned for the Academy of Sport, and I hope that medicine in Great Britain. We have a responsibility to all the Academy will enable us to provide elite services to a individuals who take part in any Olympic sport, especially far larger population of in co-operation with all the juniors who so often fail to make that difficult leap organisations involved in sports science and medicine. to successful senior . Thus it is good to see The Centenary Olympic and the universal the close cooperation that has developed between the appeal of the Olympic rings will increase the interest in BOA, British Association of Sport and Medicine all types of sport. It is right that we should use this (BASM) and the National Sports Medicine Institute goodwill and enthusiasm to further the development of (NSMI). We are pushing hard together for the sports and exercise medicine. development of sports and exercise medicine as a specialty. The care of present and potential Olympians RICHARD BUDGETT will be served best by full time doctors attracted to the Director of Medical Services specialty by a proper career structure. for the British Olympic Association

The Olympic Games and sports medicine

In my view, the reawakening of modem interest in the Olympic Games been held in a so high above sea sports sciences after the second can be traced level. to three events, all related to the Olympic Games. In this This single event first exposed, on an international Olympic year, it is perhaps appropriate to review that scale, the very real and quite embarrassing inadequacies history and to speculate on possible future intellectual in our knowledge of some quite basic issues in the applied challenges that the Olympic Games may yet pose for our sports sciences. For at that time, the real effects of profession. medium altitude on athletic performance were simply not The first significant event was the realisation in the known. Nor had the potential health risks associated with that drug use in was on the holding Olympic competition at altitude been studied. increase. The creation of the International Olympic Challenged by this ignorance and, perhaps, by the Committee (IOC) Medical Committee, with the express desire to gain a competitive advantage for their athletes, responsibility of controlling drug use in Olympic most nations with capacity in the exercise sciences competition, and the subsequent introduction of drug immediately established exercise at altitude as an urgent testing at the 1968 Olympic Games, focused global research priority. Many of the legendary modern attention on our profession and its role in contemporary physiologists were soon involved. Not unexpectedly, the http://bjsm.bmj.com/ scientific issues in international sport. Besides its many British turned to the late Dr Griffiths Pugh, whose high other functions, this committee has more recently been altitude research in the early 1950s' is considered to be responsible for the establishment of the Olympic Prize to one of the most important reasons why the British were honour individuals with a lifetime of exceptional achieve- the first to reach the summit of Mount Everest in 1953. ment in the sports sciences. This award, to be bestowed For four weeks at the end of 1966, Pugh studied six for the first time at the 1996 Olympic Games, will leading British middle distance runners during a period

further enhance the stature of our profession before a of acclimatisation to altitude at . He showed on September 24, 2021 by guest. Protected copyright. massive global audience. that, compared to performance at sea level in Britain, the The second event was the quite dramatic rise to 's times in a 3 mile (4842 m) running race dominance of the eastern European countries, especially increased by 8-5% within the first week of exposure to the former German Democratic Republic (GDR), in altitude: performance then improved somewhat but was Olympic competition. During the 1968 Olympic Games, still 5 7% slower than sea level performance after four the first Games in which the GDR competed as a team weeks at altitude.2 Thus even after four weeks of separate from West , their athletes won 25 acclimatisation at altitude, performance in a 3 mile race medals. In the 1988 Olympic Games, athletes from that was slowed by about 43 seconds in world class athletes country won 102 medals, one more than the total medal from sea level who were unacclimatised to running at count for athletes from the , a country with altitude. Pugh concluded that while performance a population amost 10-fold larger than that of the GDR. improved with residence at altitude, the time it would The huge social cost of such success is still being take for full acclimatisation was a "matter of months rather counted. than weeks. "2 He also expressed some concern that the But in as much as other nations perceived that this heart "during and after maximum exercise at 2270 m is more success resulted from a more "scientific" and professional irritable than at sea level, and it is conceivable that there might approach to sport in the GDR, so those nations with the be a risk ofventricularfibrillation. "2 capacity began to investigate ways in which science could This classical study sets a standard for the measure- be profitably applied for the enhancement of human ment of the ergogenic effect of a specific intervention in sporting performance. Of the Commonwealth countries, a tightly controlled experimental setting. Subsequent especially has taken the lead in these events confirmed the prediction that the endurance developments. running events in those Games would be dominated by The third important factor was the holding of the 1968 athletes who resided at altitude, most especially those Olympic Games at Mexico City. For Mexico City is sited from East . Sir Roger Bannister's statements that at an altitude of 2270 m and never before had the it would take the competitive lifetime for an athlete born 82 Editorials at sea level to adapt for maximum exercise at medium The second issue concerns the increasing time demands

altitude seemed to be correct. placed on young athletes competing in international Br J Sports Med: first published as 10.1136/bjsm.30.2.81 on 1 June 1996. Downloaded from The postulated dangers of running at altitude also competition. While much ofthe attention has been on the gained some credence in the performance in the 10 000 m effects of such training and competition on the physical final ofAustralian distance runner and world record holder maturation of young athletes,5 it would seem that more at many distances, . Leading the race with attention should be placed on the long term psychological 600 metres to run, Clarke slowed precipitously in the last risks and benefits that such participation can bring, not 400 m, finishing fifth. He collapsed unconscious at the only to those who are successful but, perhaps more finish. When he regained consciousness 20 minutes later, importantly, to the much larger number of children who he could not speak. Fourteen years after that collapse, fail to fulfil their own and (often) their parents' dreams. Clarke underwent corrective heart surgery for a ruptured Many have pointed out that committing a young person mitral valve. The relationship of his collapse at Mexico to a rigorous training programme during childhood is an City to the subsequent development of his heart condition experiment, the long term results of which cannot be is a matter of debate to this day. predicted. Yet few children give informed consent for their Interest in the effects of medium altitude on athletic participation in these experiments. This produces a moral performance has never again enjoyed such sustained dilemma that is yet to be addressed adequately, but which scientific interest, attesting to the power of the Olympic must have an impact on the future development of those Games for focusing the minds of scientists. Indeed the sports. holding of the finals of the 1995 Rugby and It is my prediction that, in the next 20 years, there will the 1996 Africa Soccer Cup of Nations at moderate be a gradual de-emphasis in international competition on altitude in Johannesburg, , failed to initiate those sports that favour early specialisation and intensive any substantive research on the effects of such altitude training at a young age. As the premier promoter of such on performance in team sports in which high intensity sports, the Olympic movement through its medical exercise alternates with periods of rest. What new committee will probably become a primary focus deter- challenges might we expect future Olympic Games to mining the way in which those sports evolve in the excite in the minds of sports scientists? future. The first will continue to be the elimination of unfair The third issue concerns the pressures to which sports- drug use in Olympic and other competition - a topic that persons are exposed by the increasingly nationalistic zeal grows annually more complex and seemingly ever more incited by modern international competition. The resistant to solution. But one doping issue that could be recently completed World Cup on the Asian answered with appropriate testing is the list of drugs that subcontinent brought those passion into stark relief when are truly ergogenic and which should therefore be there were fears that their own supporters would threaten banned. the lives of the members of the defeated Indian and For example, the true ergogenic effects ofthe sympatho- Pakistani teams. When this occurs, there is a need to mimetic amines, responsible for a large number ofpositive question whether victory in international competition has doping tests, often as a result of the athlete's unwise but become too important. Perhaps there are less inflam- nevertheless inadvertent use of over-the-counter 'flu and matory ways in which a nation's patriotic zeal can be cough preparations, needs to be determined. If, as we developed. http://bjsm.bmj.com/ found,4 there seems to be no measurable ergogenic effect Fortunately the more accepting approach ofthe British of some of these agents, at least in some events and at to "losers" is still respected in South Africa. Ifit were not, therapeutic doses, then there is a need to re-evaluate the this editorial contributed by a medical member of the wisdom of listing such agents. A list of banned drugs losing South African World Cup cricket team might never comprising exclusively those agents which have a have been written. Perhaps our profession needs to documented ergogenic effect on athletic performance encourage debate on ways in which the ire of defeat in international competition can be defused. would (a) eliminate the unfair censuring of athletes who on September 24, 2021 by guest. Protected copyright. have unwittingly used currently banned but ergogenically ineffective substances, for the treatment of legitimate TIM NOAKES medical conditions, and (b) discourage the widespread use MRC/UCTBioenergetics ofExercise Research Unit of like the amines and other and Life Chair ofExercise and Sports Science, drugs, sympathomimetic Sports Science Institute ofSouth Africa, Boundary Road, stimulants, by athletes who incorrectly believe that the Newlands, 7700, South Africa IOC would only ban such agents if they are effective. In fact, the majority of the drugs on the IOC banned list are 1 Pugh LGCE. Muscular exercise on Mount Everest. J Physiol (Lond) 1958;141:233-61. included because of a lack of evidence proving that they 2 Pugh LGCE. Athletes at altitude. J Physiol (Lond) 1967;192:619-46. are not effective, a subtle distinction that is lost on most 3 Bannister R. A debt was paid off in tears. Sports Illustrated 1968, November 11:22-3. athletes and indeed on the general public as a whole. 4 Noakes TD, Gillies H, Smith P, Evans A, Gabriels G, Derman EW. The IOC Medical Committee would do international Pseudoephedrine ingestion is without ergogenic effect during prolonged exercise [abstr]. Med Sci Sports Exerc 1995;27:204. sport a major service if it were to initiate this line of 5 Baxter-Jones ADG. Growth and development of young athletes. Should research. competition levels be age related? Sports Med 1995;20:59-64.

Drug control programmes

Drugs in sports has been a popular topic during the latter sports, especially in an Olympic year, the performance part of this century. Drugs used in sports can be divided enhancers become a top priority. Within this group of into three groups: therapeutics, performance enhancers, drugs are included anabolic agents, stimulants, enhancers and mood alterers (drugs of abuse). In the world of of oxygenation, and relaxants. Performance enhancers