Sports Medicine: Just the Facts

AMPHETAMINES; DEXEDRINE;
RELATED STIMULANTS

EFFICACY

• Amphetamine and dextroamphetamine are stimulants,
  which are sometimes used to treat obesity and atten-
  tion deficit/hyperactivity disorder.
  
  
  • Acutely, probably improves strength, muscular power
    (endurance), and time to exhaustion, possibly due to
    the masking of fatigue (Smith and Beecher, 1959);
    however, there was no improvement in aerobic power
    (VO2max) nor running speed.
  
  
  • Has been shown to maintain vigilance, reaction
    time, and cognitive function during sleep depriva-
    tion (Chandler and Blair, 1980).
  
  
  • Amphetamines also act as appetite suppressants.
  
  
  
  

SAFETY

• The side effects often depend on dose and can include
  death from cardiovascular complications including
  myocardial infarctions and arrhythmias, cerebrovas-
  cular accidents, and heat stroke (Smith and Beecher,
  1959; Chandler and Blair, 1980).


• Other problems include hypertension, restlessness,
  vomiting, arrhythmias, and seizures.


• Amphetamine and dextroamphetamine are Class CII
  medications and are considered potentially addicting,
  with particular dependency risk with chronic use.

LEGAL

• Amphetamines are banned both by the IOC and
  NCAA (U.S. Antidoping Agency, 2003; National
  Collegiate Athletic Association, 2003).

ANABOLIC/ANDROGENIC STEROIDS
AND ANDROSTENEDIONE

EFFICACY

• Anabolic steroids have both anabolic (tissue building)
  and androgenic effects.


• Anabolic steroids have been shown to increase lean
  muscle mass and strength when used with an adequate
  diet and with progressive weight training. The effects
  seem even more pronounced in athletes who use sup-
  raphysiologic doses (American College of Sports
  Medicine, 1987).


• There appears to be no effect on aerobic power, aero-
  bic capacity, or athleticism.
  
  
  • Enhancement of aggression may also occur.
  
  
  • Androstenedione is one of the few ergogenic aids,
    which is converted into testosterone when ingested.
  
  
  
  

SAFETY

• Anabolic steroids are a class III drug. Legal indica-
  tions to prescribe and common contraindications to
  steroids are listed in Table 70-2.


• Anabolic steroids have a long list of reported side
  effects, some of which may have been exaggerated in
  the literature.


• An increase in low-density lipoprotein (LDL) and
  decrease in high-density lipoprotein(HDL) on aver-
  age of 50% in both male and female users, combined
  with hypertension have been shown with no direct
  link yet to increased cardiovascular mortality is a
  leading concern (American College of Sports
  Medicine, 1987; Blue and Lombardo, 1999).


• Adverse effects have been noted in the liver including
  jaundice, benign tumors, and, rarely, peliosis hepatis
  (blood filled cysts in the liver) that has caused a few
  fatalities when the cysts ruptured. Causation of malig-
  nant liver tumors has not been proven (Blue and
  Lombardo, 1999).


• Other side effects include acne, female masculiniza-
  tion (alopecia, hirsutism, clitoromegaly, deepening of
  the voice), and enhancement of aggression. Side
  effects of androstenedione are likely to be similar to
  anabolic steroids.

LONG-TERM SIDE EFFECTS HAVE

BEEN HARDER TO ESTABLISH

LEGAL

• Steroids are a Class III controlled substance.


• Banned by IOC and NCAA (American College of
  Sports Medicine, 1987; U.S. Antidoping Agency, 2003).

420 SECTION 5 • PRINCIPLES OF REHABILITATION

TABLE 70-2 Indications and Contraindications

for Anabolic Steroids

INDICATIONS CONTRAINDICATIONS

Primary hypogonadism Known or suspected prostate

cancer

Hypogonadotropic hypogonadism Breast cancer in females with

high Ca2+

Hereditary angioedema Breast cancer in males

Antithrombin III deficiency Nephritis

Anemia from renal disease Pregnancy or nursing

Catabolic disease such as AIDS

Delayed onset puberty