Recent reports from needle exchange programmes and other public health initiatives have suggested growing use of anabolic steroids (AS) in the UK and other countries. Data indicate that AS use is not confined to body-builders or high-level sportsmen. Use has spread to professionals working in emergency services, casual fitness enthusiasts and subelite sportsmen and women. Although the precise health consequences of AS use is largely undefined, AS use represents a growing public health concern. Data regarding the consequences of AS use on cardiovascular health are limited to case studies and a modest number of small cohort studies. Numerous case studies have linked AS use with a variety of cardiovascular disease (CVD) events or endpoints, including myocardial infarction, stroke and death. Large-scale epidemiological studies to support these links are absent. Consequently, the impact of AS use upon known CVD risk factors has been studied in relatively small, case-series studies. Data relating AS use to elevated blood pressure, altered lipid profiles and ECG abnormalities have been reported, but are often limited in scope, and other studies have often produced equivocal outcomes. The use of AS has been linked to the appearance of concentric left ventricular hypertrophy as well as endothelial dysfunction but the data again remains controversial. The mechanisms responsible for the negative effect of AS on cardiovascular health are poorly understood, especially in humans. Possibilities include direct effects on myocytes and endothelial cells, reduced intracellular Ca2+ levels, increased release of apoptogenic factors, as well as increased collagen crosslinks between myocytes. New data relating AS use to cardiovascular health risks are emerging, as novel technologies are developed (especially in non-invasive imaging) that can assess physiological structure and function. Continued efforts to fully document the cardiovascular health consequences of AS use is important to provide a clear, accurate, public health message to the many groups now using AS for performance and image enhancement.

The use of performance-enhancing and social drugs by athletes raises a number of ethical and health concerns. The World Anti-Doping Agency was constituted to address both of these issues as well as publishing a list of, and testing for, banned substances in athletes. Despite continuing methodological developments to detect drug use and associated punishments for positive dope tests, there are still many athletes who choose to use performance and image enhancing drugs. Of primary concern to this review are the health consequences of drug use by athletes. For such a large topic we must put in place delimitations. Specifically, we will address current knowledge, controversies and emerging evidence in relation to cardiovascular (CV) health of athletes taking drugs. Further, we delimit our discussion to the CV consequences of anabolic steroids and stimulant (including amphetamines and cocaine) use. These drugs are reported in the majority of adverse findings in athlete drug screenings and thus are more likely to be relevant to the healthcare professionals responsible for the wellbeing of athletes. In detailing CV health issues related to anabolic steroid and stimulant abuse by athletes we critique current research evidence, present exemplar case studies and suggest important avenues for on-going research. Specifically we prompt the need for awareness of clinical staff when assessing the potential CV consequences of drug use in athletes.

The aim of the study was to assess the effect of maximal therapeutic dosing of sympathomimetic amines found in over-the-counter (OTC) decongestant preparations on endurance running. Following familiarisation and a graded exercise test to determine maximal oxygen uptake (VO2 max), trained male runners (n = 8) completed four exercise sessions each separated by a minimum of one week. Each session was comprised of 20 min of sub-maximal treadmill running (70 % VO2 max) followed by a 5,000-m time trial on the treadmill under drug, placebo or control conditions. Drugs were administered in their commercial format over the 36-hour period prior to testing in the manufacturer's recommended maximal doses (i. e. 25 mg of phenylpropanolamine and 60 mg of pseudoephedrine four times daily). During sub-maximal endurance running no statistical differences were observed in heart rate, VO2, minute ventilation, respiratory exchange ratio, blood lactate, glucose or non-esterified fatty acids (NEFA) or ratings of perceived exertion with respect to the treatment administered. Similarly there were no statistical differences according to the condition during the 5,000-m running time trial, in terms of heart rate, ratings of perceived exertion, time of completion and pre and post exercise blood lactate, glucose or NEFA. The results indicate that in maximal, multiple therapeutic doses both pseudoephedrine or phenylpropanolamine as present in common OTC decongestant formulations do not affect, nor possess any ergogenic properties with regard to, endurance running.

Professional jockeys are unique among weight-making athletes, as they are often required to make weight daily and, in many cases, all year-round. Common methods employed by jockeys include dehydration, severe calorie restriction, and sporadic eating, all of which have adverse health effects. In contrast, this article outlines a structured diet and exercise plan, employed by a 22-yr-old professional National Hunt jockey in an attempt to reduce weight from 70.3 to 62.6 kg, that does not rely on any of the aforementioned techniques. Before the intervention, the client's typical daily energy intake was 8.2 MJ (42% carbohydrate [CHO], 36% fat, 22% protein) consumed in 2 meals only. During the 9-wk intervention, daily energy intake was approximately equivalent to resting metabolic rate, which the athlete consumed as 6 meals per day (7.6 MJ, 46% CHO, 19% fat, 36% protein). This change in frequency and composition of energy intake combined with structured exercise resulted in a total body-mass loss of 8 kg, corresponding to reductions in body fat from 14.5% to 9%. No form of intentional dehydration occurred throughout this period, and mean urine osmolality was 285 mOsm/kg (SD 115 mOsm/kg). In addition, positive changes in mood scores (BRUMS scale) also occurred. The client was now able to ride light for the first time in his career without dehydrating, thereby challenging the cultural practices inherent in the sport.

This study was undertaken to examine self-reported caffeine consumption and reasons for its use, amongst UK athletes, following its removal from the 2004 World Anti-Doping Agency (WADA) Prohibited List. A convenience sample of track and field athletes (n = 193) and cyclists (n = 287) completed a postal or Web-based questionnaire. Messages were posted on athletics and cycling club Web sites and mailing lists to direct athletes to the Web-based questionnaire. Postal questionnaires were distributed at domestic sporting events. A higher proportion of cyclists (59.9 %) compared with track and field athletes (32.6 %) consumed caffeine to enhance performance (p < 0.001). A higher proportion of elite as opposed to sub-elite athletes representing cycling (p = 0.031) and athletics (p = 0.010) used caffeine to enhance performance. Of all caffeine containing products used, coffee, energy drinks, pharmaceutical preparations and caffeinated sports supplements were most prevalent. Results revealed that amongst UK athletes, the intention to use caffeine as an ergogenic aid was high, and that use was more widespread and accepted in competitive sport, especially at elite level, when compared to recreational sport.