ACSM Eduacting Physicians to Combat Doping: a key step in the fight Dr Alain Garnier, WADA Medical Director

Not responsibility to educate physician, not funds. But to educate.

What is dopng for physicians? -    ethical perspective – cheating -    juridicial perspective – rules violation -    medical perspective – therapeutic use in intentionally diverted into misues or abuse by athlete or entourage

athlete needs a neutral and well informed advisor

program for physician: proposed content -    introduction: rationale to ban doping -    the reality of doping – comeporary doping practices -    athletic entouerage – responsibilities -    vulnerability – critical periods, personalities at risk -    alternatives to doping – training and nutrition -    statute of a drug -    prhiobted list and TUE -    practical issues

aims of program -    to achieve common medical aproacht  in sport medcicine  (harmoniation/best practices) -    to explain t content of the list and TUE process -    encourage use of non prohibited alternatives -    to share exp and knowl

advisor and confidante an advocate for t health of the athlete not providing help in overtaing or supra physio

fight against doping is part of physicians role

Simulating Altitude Training Don McKenzie, UBC, Canada

Principles Does it work What are the effects? Is it safe? What’s new?

Simulated altitude environments -    hypobaric chambers -    normobaric hypoxic systems

when go to altitude, invoke changes across oxoygen cascade

Townsend, N E et al  JAP 93, 1498-1505, 2002 -    from AIS study

Voster, Glan, E et al jP 567(20) 689-699, 2005.

Sheel, A With et al JAP, 100: 1204-1209, 2006.

Lusina S et al, J Physio, (submitted 2006) -    1hr a day, 12 days, signify upregulation

thus, when exposed to chamber, more than sleep happens

Periodic Breathing in sleep -    intermittent hypoxemia -    periodic arousals -    loss of total, slow wave and REM sleep -    excessive daytime sleepiness -    carryover of sympathoexitation?\ -    vascular vasoconstriction during ex?

T Kinsmane, et al JAP, 92, 2114-2118, 2002

Brugniaux, JV ert al JAP, 100: 203-211, 2006

Katayama, K. et al, High Alt Med Biol, 4: 291-304, 2003

Safety -    companies say that they are safe.

What’s newL: the ‘normobaric oxygen paradox’

Balestra, c et al  JAP 100: 512-518, 2006.

Does it work? -    probably -    Levine, etc suggest dose response -    Periodization schedule? -    Nutrition -    Training?

Placebo effect?

Effects? -    alters chemosensitivity/respoiratory control -    alters cardiovascular regulation -    inc sympathetic ns activity -    alters sleep pattern -    potentiation of training post exposure

what do I think? -    it’s a training tool -    complex integrate physiology -    as effective as t scientist, coach and athlete who use it -    demonstrable, signif, pyhysio effects, some of which may influence performance

The Ethics of Altitude Trianign D.C. Malloy, University of Regina, Canada

Training -    ‘the basic goal of training is to use a variety of external stimuli (ex, environment, ..’ (Burke,2006) -    outcome is improved performance

Ethical Training – theory and practice

What is ethical traiiung? – that which results in the best performance? (Teleology – the good) That which employs acceptable means? (Deontology – the right) That which is genuine to the indiv ontologically and physiologically? (existential – the authentic)

The Good: performance outcomes -    goodness of act measured by outcome in producing ‘pleasure’ -    does act avoid pain?

The Right: deontology -    the right o    divine o    social contract •    does training regime X satisfy critieria set by govern bodies? •    Often where debate ends in sport o    intuitive – how we reason.

The Authentic: existential good and bad faith -    authentic physiologiy -    authentic philosophy -    existential – a philosophy of genuineness, freedom and responsibility

adaptation of t human body to a stimulus that does not exceed genetical optential moving t body outside its normal (geuine) physio range -    tf, training regime is authentic if introduces substant that does not bypass training stimulus or beyond range -    eg. Altitude training and nitrogen tents stim prodn of epo within indiv’s normal physio range/genetic potential

inauthentic physio - adaptation of t human body tro stimulus that EXCEEDs genetic potential

inauthentic physiology training

authentic philosophy -    good faith – I am what I am becoming -    bad faith – a way of estalibhins that I am not nwhat I am

Can athlete look in mirror and say ‘this is me’

Is this making me someone I’m not?

Ethical Decision Tree

Questions and Answers

Question: WADA talks about banning hypoxic, are they concenred about ethics or long term effects?

Olivier: must take into account fact that some athletes try to make those devices.