Back Clinic Power & Strength Training. These types of conditioning programs are for both athletes and the general population. They can reach higher levels of personal power and strength, making them capable of achieving their personal fitness goals. Power is defined as the ability to generate as much force as fast as possible. It’s needed for athletic movements such as workouts (clean & jerk), swinging a bat, golf club, tennis racket, and running through a tackle.
Power requires strength and speed to develop force. Strength is the amount of force muscle/s can exert against an external load. One rep maximum test is performed where individuals assess the greatest weight they can lift while maintaining proper form. The movement’s speed is not important in a strength test. Dr. Alex Jimenez offers insight into various stretches and exercises and explains the possible risks of injury on strength training through his numerous article archives.
Sports Performance is everything! Regardless of whether you�re a pro football player or a weekend warrior, your level of performance in your chosen athletic activity is what takes you to competitive heights.
There are certain things that every athlete knows will make them stronger, faster, more flexible, and have more stamina. Chiropractic care is becoming increasingly popular as a way for the sportsman in all of us to have that competitive edge.
You may know that chiropractic is great for people with back pain or even headaches, but you may be wondering how it can help an athlete. Solid research, along with a proven track record show that chiropractic helps sports performance in several key areas.
Sports Performance & Chiropractic
Increased Flexibility
Flexibility is important for nearly every sport and chiropractic care helps to increase flexibility throughout the body. As the spine is aligned, the body is better able to perform as it should and flexibility is a big part of that.
Better Mobility
When a person has better flexibility they are able to move around better. Chiropractic loosens the joints and spine, releasing energy to flow through the body. Blood flow is increased which means that nutrients and oxygen are carries much more efficiently to the vital organs and brain. This whole body wellness encourages better mobility.
More Resistant To Injury
Because chiropractic keeps the body flexible, there is a much lower risk of injury. Tight muscles can lead to injuries, sometimes serious injury. When the body well aligned and flexible the chances of a pulled or torn muscle or torn ligament are greatly decreased.
Helps Relieve Sports Hernias
Groin pain is a component of around 20 percent of all sports injuries. The thing is, it is often not due to sudden movements that result in injury like a torn muscle. Most of the time is it due to a condition called athletic pubalgia, or sports hernia.
Sports like hockey and football are full contact sports and injuries are not uncommon. However, even milder sports like horseback riding or cycling can also result in injuries or pain from over exertion. One study showed how chiropractic helped relieve the pain of shoulder instability in hockey players.
Chiropractic aligns the spine and body while increasing blood flow, but endorphins are also released through the treatment. This helps the body combat pain in a natural, less invasive way without the use of medications.
Increases Strength
While chiropractic care is typically regarded as a method for relieving pain and alleviating skeletal and muscular issues, it has also been found to improve physical strength. A study on judo athletes who received just three chiropractic care sessions showed that their grip strength improved by 16 percent.
Helps Sports Related Injuries Heal Faster
Chiropractic care has long been a standard practice for aiding in the healing of many sports related injuries including tennis elbow, hamstring pulls, rotator cuff injuries, back strains, and neck pain. While it does help prevent these injuries, in the event that they do occur, chiropractic care helps the athlete recover faster and get back in the game quicker.
So whether you enjoy the occasional game of touch football with the guys or you are a college basketball star, chances are you too can benefit from chiropractic care. Each of these benefits are exceptional in their own right and athletes rely on their chiropractor to keep them in the game, but all these little benefits add up to one significant plus: it improves sports performance. If you want to be stronger, faster, and more agile, the research shows that chiropractic care can certainly help.
We usually talk of energy in general terms, as in �I don�t have a lot of energy today� or �You can feel the energy in the room.� But what really is energy? Where do we get the energy to move? How do we use it? How do we get more of it? Ultimately, what controls our movements? The three metabolic energy pathways are the�phosphagen system, glycolysis�and the�aerobic system.�How do they work, and what is their effect?
Albert Einstein, in his infinite wisdom, discovered that the total energy of an object is equal to the mass of the object multiplied by the square of the speed of light. His formula for atomic energy, E = mc2, has become the most recognized mathematical formula in the world. According to his equation, any change in the energy of an object causes a change in the mass of that object. The change in energy can come in many forms, including mechanical, thermal, electromagnetic, chemical, electrical or nuclear. Energy is all around us. The lights in your home, a microwave, a telephone, the sun; all transmit energy. Even though the solar energy that heats the earth is quite different from the energy used to run up a hill, energy, as the first law of thermodynamics tells us, can be neither created nor destroyed. It is simply changed from one form to another.
ATP Re-Synthesis
The energy for all physical activity comes from the conversion of high-energy phosphates (adenosine�triphosphate�ATP) to lower-energy phosphates (adenosine�diphosphate�ADP; adenosine�monophosphate�AMP; and inorganic phosphate, Pi). During this breakdown (hydrolysis) of ATP, which is a water-requiring process, a proton, energy and heat are produced: ATP + H2O ���ADP + Pi�+ H+�+ energy + heat. Since our muscles don�t store much ATP, we must constantly resynthesize it. The hydrolysis and resynthesis of ATP is thus a circular process�ATP is hydrolyzed into ADP and Pi, and then ADP and Pi�combine to resynthesize ATP. Alternatively, two ADP molecules can combine to produce ATP and AMP: ADP + ADP ���ATP + AMP.
Like many other animals, humans produce ATP through three metabolic pathways that consist of many enzyme-catalyzed chemical reactions: the phosphagen system, glycolysis and the aerobic system. Which pathway your clients use for the primary production of ATP depends on how quickly they need it and how much of it they need. Lifting heavy weights, for instance, requires energy much more quickly than jogging on the treadmill, necessitating the reliance on different energy systems. However, the production of ATP is never achieved by the exclusive use of one energy system, but rather by the coordinated response of all energy systems contributing to different degrees.
1. Phosphagen System
During short-term, intense activities, a large amount of power needs to be produced by the muscles, creating a high demand for ATP. The phosphagen system (also called the ATP-CP system) is the quickest way to resynthesize ATP (Robergs & Roberts 1997). Creatine phosphate (CP), which is stored in skeletal muscles, donates a phosphate to ADP to produce ATP: ADP + CP ���ATP + C. No carbohydrate or fat is used in this process; the regeneration of ATP comes solely from stored CP. Since this process does not need oxygen to resynthesize ATP, it is anaerobic, or oxygen-independent. As the fastest way to resynthesize ATP, the phosphagen system is the predominant energy system used for all-out exercise lasting up to about 10 seconds. However, since there is a limited amount of stored CP and ATP in skeletal muscles, fatigue occurs rapidly.
2. Glycolysis
Glycolysis is the predominant energy system used for all-out exercise lasting from 30 seconds to about 2 minutes and is the second-fastest way to resynthesize ATP. During glycolysis, carbohydrate�in the form of either blood glucose (sugar) or muscle glycogen (the stored form of glucose)�is broken down through a series of chemical reactions to form pyruvate (glycogen is first broken down into glucose through a process called�glycogenolysis). For every molecule of glucose broken down to pyruvate through glycolysis, two molecules of usable ATP are produced (Brooks et al. 2000). Thus, very little energy is produced through this pathway, but the trade-off is that you get the energy quickly. Once pyruvate is formed, it has two fates: conversion to lactate or conversion to a metabolic intermediary molecule called acetyl coenzyme A (acetyl-CoA), which enters the mitochondria for oxidation and the production of more ATP (Robergs & Roberts 1997). Conversion to lactate occurs when the demand for oxygen is greater than the supply (i.e., during anaerobic exercise). Conversely, when there is enough oxygen available to meet the muscles� needs (i.e., during aerobic exercise), pyruvate (via acetyl-CoA) enters the mitochondria and goes through aerobic metabolism.
When oxygen is not supplied fast enough to meet the muscles� needs (anaerobic glycolysis), there is an increase in hydrogen ions (which causes the muscle pH to decrease; a condition called acidosis) and other metabolites (ADP, Pi�and potassium ions). Acidosis and the accumulation of these other metabolites cause a number of problems inside the muscles, including inhibition of specific enzymes involved in metabolism and muscle contraction, inhibition of the release of calcium (the trigger for muscle contraction) from its storage site in muscles, and interference with the muscles� electrical charges (Enoka & Stuart 1992; Glaister 2005; McLester 1997). As a result of these changes, muscles lose their ability to contract effectively, and muscle force production and exercise intensity ultimately decrease.
3. Aerobic System
Since humans evolved for aerobic activities (Hochachka, Gunga & Kirsch 1998; Hochachka & Monge 2000), it�s not surprising that the aerobic system, which is dependent on oxygen, is the most complex of the three energy systems. The metabolic reactions that take place in the presence of oxygen are responsible for most of the cellular energy produced by the body. However, aerobic metabolism is the slowest way to resynthesize ATP. Oxygen, as the patriarch of metabolism, knows that it is worth the wait, as it controls the fate of endurance and is the sustenance of life. �I�m oxygen,� it says to the muscle, with more than a hint of superiority. �I can give you a lot of ATP, but you will have to wait for it.�
The aerobic system�which includes the�Krebs cycle�(also called the�citric acid cycle or TCA cycle) and the�electron transport chain�uses blood glucose, glycogen and fat as fuels to resynthesize ATP in the mitochondria of muscle cells (see the sidebar �Energy System Characteristics�). Given its location, the aerobic system is also called�mitochondrial respiration.�When using carbohydrate, glucose and glycogen are first metabolized through glycolysis, with the resulting pyruvate used to form acetyl-CoA, which enters the Krebs cycle. The electrons produced in the Krebs cycle are then transported through the electron transport chain, where ATP and water are produced (a process called�oxidative phosphorylation) (Robergs & Roberts 1997). Complete oxidation of glucose via glycolysis, the Krebs cycle and the electron transport chain produces 36 molecules of ATP for every molecule of glucose broken down (Robergs & Roberts 1997). Thus, the aerobic system produces 18 times more ATP than does anaerobic glycolysis from each glucose molecule.
Fat, which is stored as triglyceride in adipose tissue underneath the skin and within skeletal muscles (called�intramuscular triglyceride), is the other major fuel for the aerobic system, and is the largest store of energy in the body. When using fat, triglycerides are first broken down into free fatty acids and glycerol (a process called�lipolysis). The free fatty acids, which are composed of a long chain of carbon atoms, are transported to the muscle mitochondria, where the carbon atoms are used to produce acetyl-CoA (a process called�beta-oxidation).
Following acetyl-CoA formation, fat metabolism is identical to carbohydrate metabolism, with acetyl-CoA entering the Krebs cycle and the electrons being transported to the electron transport chain to form ATP and water. The oxidation of free fatty acids yields many more ATP molecules than the oxidation of glucose or glycogen. For example, the oxidation of the fatty acid palmitate produces 129 molecules of ATP (Brooks et al. 2000). No wonder clients can sustain an aerobic activity longer than an anaerobic one!
Understanding how energy is produced for physical activity is important when it comes to programming exercise at the proper intensity and duration for your clients. So the next time your clients get done with a workout and think, �I have a lot of energy,� you�ll know exactly where they got it.
Energy System Characteristics
Energy System Workouts
Have clients warm up and cool down before and after each workout.
Phosphagen System
An effective workout for this system is short, very fast sprints on the treadmill or bike lasting 5�15 seconds with 3�5 minutes of rest between each. The long rest periods allow for complete replenishment of creatine phosphate in the muscles so it can be reused for the next interval.
2 sets of 8 x 5 seconds at close to top speed with 3:00 passive rest and 5:00 rest between sets
5 x 10 seconds at close to top speed with 3:00�4:00 passive rest
Glycolysis
This system can be trained using fast intervals lasting 30 seconds to 2 minutes with an active-recovery period twice as long as the work period (1:2 work-to-rest ratio).
8�10 x 30 seconds fast with 1:00 active recovery
4 x 1:30 fast with 3:00 active recovery
Aerobic System
While the phosphagen system and glycolysis are best trained with intervals, because those metabolic systems are emphasized only during high-intensity activities, the aerobic system can be trained with both continuous exercise and intervals.
60 minutes at 70%�75% maximum heart rate
15- to 20-minute tempo workout at lactate threshold intensity (about 80%�85% maximum heart rate)
5 x 3:00 at 95%�100% maximum heart rate with 3:00 active recovery
Brooks, G.A., et al. 2000.�Exercise Physiology: Human Bioenergetics and Its Applications.Mountain View, CA: Mayfield.
Enoka, R.M., & Stuart, D.G. 1992. Neurobiology of muscle fatigue.�Journal of Applied Physiology, 72�(5), 1631�48.
Glaister, M. 2005. Multiple sprint work: Physiological responses, mechanisms of fatigue and the influence of aerobic fitness.�Sports Medicine, 35�(9), 757�77.
Hochachka, P.W., Gunga, H.C., & Kirsch, K. 1998. Our ancestral physiological phenotype: An adaptation for hypoxia tolerance and for endurance performance?�Proceedings of the National Academy of Sciences, 95,�1915�20.
Hochachka, P.W., & Monge, C. 2000. Evolution of human hypoxia tolerance physiology.�Advances in Experimental and Medical Biology, 475,�25�43.
McLester, J.R. 1997. Muscle contraction and fatigue: The role of adenosine 5′-diphosphate and inorganic phosphate.�Sports Medicine, 23�(5), 287�305.
Robergs, R.A. & Roberts, S.O. 1997.�Exercise Physiology: Exercise, Performance, and Clinical Applications.�Boston: William C. Brown.
The term �ergogenic� stems from the Greek roots � �Ergon� and �genes,� meaning �work� and �born,� respectively. Any means of enhancing energy production or utilization may be described as an ergogenic aid.1 Ergogenic aids have classically been classified into five categories: mechanical, psychological, physiologic, pharmacologic, and nutritional.2 The present use of the term �ergogenic aid� usually revolves around the physiologic, pharmacologic, and nutritional categories.
While ergogenic aids have been linked to athletic �doping,� the terms are not synonymous. Doping is a term used by the International Olympic Committee (IOC) to describe the administration or use of a substance by a competing athlete with the sole intention of increasing in an artificial and unfair manner his or her performance in competition.3 Not all ergogenic aids are banned by the IOC. A partial listing of substances banned by the United States Olympic Committee is found in Table 1.2,3 Table 2 provides a list of commonly used athletic ergogenic aids.
Ergogenic Aids:
Anabolic-Androgenic Steroids
Anabolic-androgenic steroids (AAS) are testosterone derivatives that exert anabolic (tissue building) and androgenic (masculinizing) influences on the body.3 Since the discovery of the chemical structure of testosterone in 1935, attempts to separate the anabolic and androgenic effects of AAS�have been unsuccessful.3 Athletes have been using AAS since the 1940s in efforts to improve their performance.2 Concerned with widespread abuse of AAS among athletes, the IOC banned AAS use in the early 1960s.2 The Anabolic Steroids Control Act was legalized in 1990, making it a felony to possess or distribute AAS for non-medical purposes in the United States.3,4 Oral, parenteral, transdermal, and intra-nasal forms of AAS are available. The vast majority of AAS used by athletes is thought to be obtained on the �black market,� as only an estimated 10% to 15% of AAS used by athletes for performance enhancement are obtained by prescription.3
AAS are believed to exert their main effect by increasing anabolic processes and inhibiting catabolic processes via specific receptor mediated responses within the target cells.5 Effects of AAS include: the anabolic build-up of muscle mass, the androgenic development of secondary male sexual characteristics, an anti-catabolic reversal of cortisol�s action, and a direct psychological effect thought to allow a more intense and sustained workout.2,5-8 Early studies of AAS and athletes produced mixed results.5,6 More recent reviews support the notions that AAS can provide significant increases in muscle mass and strength in athletes.2,5,6 In order to maximize the effects of AAS on strength and power athletes, an adequate diet and exercise regimen is needed.5 There seems to be little advantage gained while using AAS in the untrained individual.5,9 Benefits obtained from AAS are more established in strength-dependent sports. Data supporting increased aerobic capacity and improved endurance with AAS use is limited and inconclusive.4 AAS effect on endurance sports is currently an area of great interest given the large number of endurance athletes who still use AAS.4,10
An intricate terminology describing the dosing practices of athletes has evolved. Athletes will commonly use AAS over 6 to 12 week �cycles.�4 �Pyramiding� describes a�gradual escalation in the dose of AAS taken over a cycle.2,11 �Stacking� involves the use of more than one AAS, usually with staggered cycles of the individual drugs.2-4 An �array� describes the practice of using other drugs to counteract side effects or enhance the effects of AAS.3 The practices of cycling, pyramiding, and stacking are used by athletes in an attempt to minimize the negative effects of AAS while maximizing the desired enhancements.2,4 At the current time, no solid scientific support exists for these practices.2,4,5
The adverse effects attributed to AAS abuse have been historically overstated.4,12 The majority of AAS side effects are considered minor and reversible following the cessation of use.4 While the incidence of serious side effects from AAS use has been low, devastating consequences have been reported.13 Documented fatalities from myocardial infarc- tion, stroke, and hepatocarcinoma have been attributed to AAS use.2,3 The long-term effects of AAS use are generally unknown.3,11
Dehydroepiandrosterone (DHEA)
Dehydroepiandrosterone (DHEA) is a precursor to testos- terone produced primarily in the adrenal glands.4,14 Natural sources of DHEA include wild yams. The FDA banned sale of DHEA in 1996 due to insuf cient evidence of safety and value; however, DHEA remains a legal and popular item sold as a nutritional supplement.14,15
The mechanism of action of DHEA is poorly understood but most likely revolves around the conversion of DHEA to testosterone in peripheral tissues.4,14 Preliminary studies suggest that DHEA may have a broad range of clinical uses including anti-Alzheimer and anti-Parkinson capabilities, however randomized, double-blinded clinical studies are�lacking.5
DHEA is a pre-cursor to testosterone and theoretically may enhance athletic performance in a manner similar to AAS. Investigations of DHEA use and athletic performance are scarce.14 Existing studies do not support a significant increase in lean body mass, strength, or testosterone levels with the use of DHEA in athletes.14,16-18
Long-term side effects of DHEA use are currently un- known but are probably similar to those associated with AAS use.6,14
Androstenedione
Androstenedione is a testosterone pre-cursor produced in the adrenal glands and gonads. Several professional athletes have used this substance, bringing it to national attention.2 Androstenedione is found naturally in the pollen of Scottish pine trees.19
Similar to DHEA, the mechanism of action and side ef- fects attributed to androstenedione are poorly understood and thought to be related to the conversion of androstenedione to testosterone in the peripheral tissues.5
Despite manufacturers� claims to the contrary, there is little scientific evidence of the purported ergogenic aid effects of androstenedione.2,5,16,20 Recently concerns have grown over the unfavorable alterations in blood lipid and coronary heart disease profiles seen in men using androstenedione as an ergogenic aid.2,20,21
Dietary Supplements
The increased visibility of ergogenic aids in the last de- cade has occurred primarily because of the passage of the United States Dietary Supplement Health and Education Act (DSHEA) of 1994.22 Certain vitamins, minerals, amino acids, herbs, and other botanical preparations can be classified as a �dietary supplement� under the DSHEA guidelines. Dietary supplements, as a result of DSHEA, are no longer under the direct regulatory control of the FDA. In fact, substances sold as a dietary supplement do not require FDA evaluation for safety or efficacy, and do not have to meet quality control standards expected of approved drugs.5 The content and purity of dietary supplements are not regulated and can vary widely.5,23 Since androstenedione and DHEA have been found to occur naturally in plant sources, these testosterone precursors can be labeled as �dietary supplements� and sold legally over-the-counter.
Ephedra
Dietary supplements containing Chinese ephedra, also known as Mahaung, are marketed as performance enhancers and weight-loss aids.24 Ephedra species of herb have been used for over 5,000 years for respiratory ailments.25 Currently, ephedrine alkaloids are found in hundreds of prescriptions and over-the-counter products, such as antihistamines, decongestants, and appetite suppressants.24-26 Ephedra and related ephedrine alkaloids are sympathomimetic agents that�mimic epinephrine effects.
Multiple studies of isolated ephedrine alkaloids have shown no significant enhancement of power or endurance at dosages considered to be safe.24,27-31 In contrast, the combination of caffeine with ephedrine has been associated with improvements in performance and may promote metabolic effects that are conducive to body fat loss.26,32
The actual content of ephedra alkaloids in 20 ephedra- containing dietary supplements was studied using high- performance liquid chromatography.33 Ten of the twenty supplements exhibited marked discrepancies between the label claim for ephedra content and the actual alkaloid content. Between 1995 and 1997, 926 cases of possible Mahuang toxicity were reported to the Food and Drug Ad- ministration.34 A temporal relationship between Mahuang use and severe complications including stroke, myocardial infarction, and sudden death was established in 37 of the 926 cases. In 36 of these 37 cases, the Mahuang use was reported to be within the manufacturers� dosing guidelines.
Ephedra and related ephedrine alkaloids are currently banned by the U.S.O.C. and cannot be recommended for general use given their association with potentially life- threatening side effects.2,34
Creatine
Creatine use in athletes has grown as a result of a 1992 study that showed that creatine supplementation produced a 20% increase in skeletal muscle creatine concentration.2,35 In the phosphorylated form, creatine serves as an energy substrate that contributes to adenosine triphosphate (ATP) re-synthesis during high-intensity exercise.36 Creatine re- mains popular with power and resistance athletes as it is thought to produce increases in strength, muscle mass, and to delay fatigue.2,14,36
Creatine is synthesized from amino acids primarily in the liver, pancreas, and kidney and is excreted by the kidneys. Creatine is found in skeletal muscle, cardiac muscle, brain, retinal, and testicular tissues.2,37 The interest in creatine as an ergogenic aid revolves around its ability to participate as an energy substrate for muscle contraction.14 Creatine, which easily binds phosphorus, can act as a substrate to donate phosphorus for the formation of ATP. Furthermore, creatine-phosphate (PCr) can help buffer lactic acid because hydrogen ions are used when ATP is regenerated.14,36,38 This role of creatine in exercise is governed by the following reaction:
Normally PCr stores deplete within 10 seconds of short, high-intensity exercise.14,39 Increasing the level of PCr in skeletal muscle, in theory, should result in the ability to sustain high-power output longer and lead to a greater re-synthesis of PCr after exercise.14 The beneficial effects of creatine in response to resistance training are most likely mediated by the following sequence: increased muscle creatine concentration, increased training intensity, which lead to an enhanced physiologic adaptation to training with increased muscle mass and strength.36
Studies evaluating the effectiveness of creatine as an er- gogenic aid are mixed.2,36,40 Multiple reports do conclude that short-term creatine supplementation signi cantly enhances the ability to maintain muscular force and power output dur- ing high-intensity exercise.2,36,41,42 Data on results of creatine supplementation with highly trained athletes is inconclusive. While some papers report improvements with creatine use in highly trained individuals with regards to high-intensity exercise, many show no improvements.2,36,43
Most investigators agree that creatine supplementation does not seem to enhance aerobic-oriented activities.2,36,44
Human muscle is thought to have a maximum concen- tration of creatine that it can hold.14,45 There appears to be no additional bene ts of increasing creatine supplementa- tion above this storage capacity of muscle as the excess is simply excreted by the kidneys.2,46 Humans have differing baseline levels of muscle creatine.14 Accordingly, athletes with lower baseline levels of creatine may be more sensi- tive to creatine supplementation than those with a relatively higher baseline creatine level.14,36 The terms �responder� and �nonresponder� have been used to describe two groups of athletes: those with relatively low baseline creatine levels that may show signi cant performance enhancement with creatine supplementation, and those with high baseline creatine levels that do not show marked improvements with creatine supplementation.14,36,47 These differences in creatine concentrations are thought to play a signi cant role in the varied results on performance found in the literature examin- ing creatine supplementation.14
Reported side effects from creatine use have been scarce.2,14 The major reported side effect associated with creatine use is weight gain, which is thought to be primarily a result of water retention.2,14,48 Some reported longer-term side effects include dehydration, muscle cramping, nausea, and seizures.2,49 Given the relative lack of studies, caution still remains about the long-term effects of creatine usage.14 As creatine use among younger athletes continues to increase, concern is growing over the lack of studies that examine the possible side effects speci c to this age group.14,38
Human Growth Hormone
Human growth hormone (hGH) is a polypeptide produced in the anterior pituitary gland. After its release from the pituitary, hGH can exert its effect in all cells of the body via tissue specific receptors. Human growth hormone is shown to promote protein anabolism, carbohydrate tolerance, lipolysis, natriuresis, and bone and connective tissue turnover.4,50
Potential benefits of hGH abuse in athletes revolve around�its anabolic effect on the body.4 Human growth hormone is thought to increase muscle mass, and spare muscle glycogen by stimulating lipolysis during exercise.2,3 The popularity of hGH among athletes is furthered by the fact that hGH re- mains extremely difficult to detect by current drug screening processes.3,51 Human growth hormone may be particularly attractive to female athletes as the virilization side effects associated with AAS use are not thought to occur with hGH.4
There are no studies that demonstrate signi cant increases in athletic performance with the use of hGH.3,52,53 Neither human or animal studies show any signi cant strength gains with supplemental hGH use in non-de cient individuals.4 The abuse of hGH is thought to be increasing despite the lack of scienti c evidence linking hGH to improved athlete performance.3,52 A survey of high school males revealed that as many as 5% reported past or present use of hGH.54 The purity of hGH abused by athletes may be poor as Drug Enforcement Agency estimates project that up to 30% to 50% of the hGH products sold are phony.4,55
Adverse effects of exogenous hGH use are extrapolated from the ndings seen in patients with endogenous over- secretion of hGH.2 Adults with high levels of hGH are at risk for the clinical syndrome of acromegaly. Medical complications associated with acromegaly include: diabetes, hypertension, coronary heart disease, cardiomyopathy, men- strual irregularities, and osteoporosis.2,4 High levels of hGH in individuals with open physis may lead to gigantism.2
Erythropoietin (EPO)
Recombinant EPO (r-EPO) was approved by the FDA for manufacture in 1989 after the EPO gene was cloned in 1985.14 Since its approval, r-EPO has been abused for athletic personal gain as an alternative to blood doping.3,14 Recombinant EPO has largely replaced the practice of blood doping, as r-EPO produces a dose-dependent increase in hematocrit.2 In theory, r-EPO should provide all of the benefits of blood doping without the risks involved in blood transfusion.3
There are few studies evaluating the use of r-EPO in healthy athletes; however, numerous studies have shown a signi cant increase in work capacity due to r-EPO use in patients with renal disease.14 Berglund and Ekblom reported an increased maximal oxygen consumption and increased time to exhaustion in male athletes after a 6 week trial of r-EPO.56
The risks associated with r-EPO abuse involve the potential for dangerously high hematocrit levels.14 A resulting hyperviscosity syndrome may lead to a decreased cardiac output, hypertension, and potential heart failure.3 Further- more, thrombosis could be manifest as myocardial infarction, pulmonary embolism, or cerebrovascular accidents.2,3 Although the use of r-EPO has been banned by the IOC since 1990, its use is extremely difficult to detect with current drug screening measures.2,14
Antioxidants
The antioxidant capabilities of certain vitamins are believed by many to counter-act the production of free-radials that occurs during exercise.14 Most of the research to date involves vitamin E, vitamin C, and beta carotene.2 The existing literature does not support the notion that antioxidants have significant ergogenic capabilities.2,14,57 There are currently no recommendations for antioxidant use in athletes that exceeds the normal adult recommended daily allowance (RDA).
Beta-Hydroxy-Beta-Methylbutyrate
Beta-hydroxy-beta-methylbutyrate (HMB) is a metabolite of the branched-chain amino acid leucine. HMB is theorized to inhibit muscle breakdown during strenuous exercise but its exact mechanism of action remains unknown.14,58 Studies show that HMB supplementation may significantly lower serum lactate dehydrogenase (LDH), lower serum creatine phosphokinase (CPK) levels and delay blood lactate accumulation after endurance training compared to placebo.59,60 Furthermore, short-term HMB use has been shown to significantly increase strength gains with resistance-exercised training over placebo in one double-blinded study.61
HMB is a relatively new ergogenic aid and published results are considered preliminary.14,58 Although there is evidence for a potential ergogenic aid advantage with HMB use in resistance and endurance training, its use can not be recommended until more studies are performed and potential side effects are elicited.
Caffeine
Caffeine is a methylxanthine occurring naturally in many species of plants. Caffeine is thought to work through a variety of mechanisms. The central nervous system effect of caffeine is probably the result of adrenergic receptor antagonism.3 Its use by athletes stems from the theory that caffeine may delay fatigue by enhancing skeletal muscle contractility and spare muscle glycogen levels by enhancing fat metabolism.6 Multiple studies have reported an improved endurance time with caffeine use.6,62,63 There is evidence that caffeine use may enhance performance with more intense short-duration exercise as well.2 The caffeine dosages most associated with an ergogenic effect range in the literature from 3 to 9 mg per kilogram of body weight.2,6
Side effects associated with caffeine use include anxiety, diuresis, insomnia, irritability and gastrointestinal discom- fort.2,6 Higher doses of caffeine ingestion can lead to more serious consequences such as cardiac arrhythmia, hallucina- tions, and even death.2,3
The legal urine level of caffeine for athletes is 12 ?g/ml (IOC standards) and 15 ?g/ml (National Collegiate Athletics Association standards).6 An athlete would need to drink six to eight cups of coffee in one sitting and be tested within 2 to 3 hours to reach urine levels over the IOC legal limit.3 The amount of caffeine needed to produce ergogenic benefits is potentially far less than that required to exceed the athletic�legal limit.3
Ergogenic Aids: Summary
Claims championing exotic substances that produce healing or ergogenic powers have been around for centuries. The�competitive, peer-pressured environment enveloping today�s athletes and adolescences makes these groups particularly susceptible to the uproar surrounding the current ergogenic aid market. Presently, it seems that rumor and anecdotal information overwhelms the available scientific data. While there is evidence that some touted ergogenic aids do indeed enhance performance, there are many unanswered questions about product safety, efficacy, and long-term consequences. A working knowledge of specific ergogenic aids is essential for the treating physician in order to best advise patients and athletes as to the possible benefits and risks of any substance they may be using.
By Adam Bernstein, M.D., Jordan Safirstein, M.D., and Jeffrey E. Rosen, M.D.
Americans’ Perception Of Chiropractic
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body builders. Int J Sports Med 12(4):413-418, 1991.
10. Lombardo JA: Medical and performance-enhancing effects
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11. YesalisCE,Bahrke MS:Anabolic-androgenic steroids: current
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12. Friedl KE: Effects of anabolic steroids on physical health.
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13. Bahrke MS, Yesalis CE, Brower KJ: Anabolic-androgenic
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14. Stricker PR: Other ergogenic agents. Clin Sports Med
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16. Wallace MB, et al: Effects of dehydroepiandrosterone vs
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17. Nestler JE, et al: Dehydroepiandrosterone reduces serum
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18. Welle S,Jozefowicz R, Statt M: Failure of dehydroepiandrosterone
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20. King DS, et al: Effect of oral androstenedione on serum testosterone
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maximal exercise in man. Med Sci Sports 9(2):95-99, 1977.
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35. Juhn MS: Orla creatine supplementation: Separating fact from
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36. Kraemer WJ, Volek JS: Creatine supplementation: Its role in
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38. MetzlJD, et al: Creatine use among young athletes. Pediatrics
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40. Johnson WA, Landry GL: Nutritional supplements: fact vs.
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44. Balsom PD, et al: Creatine supplementation per se does not
enhance endurance exercise performance.Acta Physiol Scand
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47. Casey A, et al: Creatine ingestion favorably affects performance
and muscle metabolism during maximal exercise in
humans. Am J Physiol 271(1):E31-E37, 1996.
48. Volek JS: Creatine supplementation: its effect on human
muscular performance and body composition.J Strength Cond
Res 10:200-210, 1996.
49. Feldman EB: Creatine: a dietary supplement and ergogenic
aid. Nutr Rev 57(2):45-50, 1999.
50. Yarasheski KE: Growth hormone effects on metabolism, body
composition, muscle mass, and strength. Exerc Sport Sci Rev
22:285-312. 1994.
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abuse. Growth Horm IGF Res 11(Suppl A):S71-S77, 2001.
54. Rickert VI, et al: Human growth hormone: a new substance
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58. Williams MH: Facts and fallacies of purported ergogenic
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59. Vukovich MD, Dreifort GD: Effect of beta-hydroxy betamethylbutyrate
on the onset of blood lactate accumulation
and VO2 peak in endurance-trained cyclists. J Strength Cond
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60. Knitter AE, et al: Effects of beta-hydroxy-beta-methylbutyrate
on muscle damage after a prolonged run. J Appl Physiol
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(HMB) additively increase lean body mass and muscle
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8):558-566, 2001.
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63. KalmarJM, Cafarelli E: Effects of caffeine on neuromuscular
function. J Appl Physiol 87(2):801-808, 1999.
Occlusion training involves restricting the flow of blood to a muscle group while training. That is why it is also commonly called �blood flow restriction training.�
Basically you take a wrap or band and apply it to the top of your limb.
The aim of this�isn�t�to completely cut off circulation to the area as that is dangerous and painful.
This means that you aren�t restricting arterial flow to the area, but you are restricting the venous return from the muscles.
Arteries are what takes the blood from your heart to your muscles and it is then returned to your heart through a system of veins.
Restricting the blood flow back to your heart causes a pooling of the blood in the area that you are working.
This is what occlusion training uses to create an�anabolic effect�on your muscles.�
HOW DOES OCCLUSION TRAINING WORK?
The bloodstream is the network that connects the muscles in your body, providing oxygen and nutrients and carrying away waste products
Muscles require a steady flow of blood to operate.
That is why we aren�t cutting off the flow to the muscle, we are only slowing the rate at which the blood releases from it.
When performing any kind of resistance training your body directs more blood to your muscles performing the exercise.
The reason you get a �pump� when working out is that the speed at which your body is pumping blood into your muscles is faster than the amount of blood going out of them.
Your pump reduces when you rest between your sets as more blood is released from your muscle groups.
Blood flow restriction training prolongs and intensifies your pump.
This is done by placing wraps in one of two places during your working sets.
You wrap above your bicep for movements that involve your bicep�s, triceps, forearms, and even chest and back can benefit from this.
While wrapping in this position it makes sense that it would benefit your arms but how does it help your chest and back?
There is no possible way that you can restrict blood flow to your chest and back because of the positions they are located in.
However wrapping your arm allows you to pre-fatigue your arms and as a result chest and back exercises that you perform are going to require more involvement from those muscles rather than your biceps or triceps.
Wrap your upper thigh for movements that involve your quads, hamstrings, glutes and calves.
Building Muscle With Occlusion Training
During training you have two�types of muscle�that are responsible for all muscle growth in the gym.
Fast twitch fibers and slow twitch fibers.
Slow twitch muscle fibers are smaller muscle fibers and generate less power and strength than fast twitch fibers. However slow twitch fibers fatigue slower and can sustain activity for longer.
Fast twitch fibers are larger muscle fibers, generate more power and strength and have the most potential for growth.
Fast twitch fibers are recruited last during contractions and mostly don�t use oxygen. Slow twitch fibers on the other hand use oxygen and are recruited first in the movement.
This means that by restricting the blood flow to a muscle group you are pre-fatiguing the slow twitch fibers and forcing the fast twitch fibers to take control even when you�re using low weights.
Occlusion training seems to�trick your body�into thinking you are lifting heavy weights. This means you can get very�similar benefits�of heavy training by using 20-30% of your 1 rep max.
There are two main factors that lead to muscle growth during training. These are:
Metabolic Stress
Cellular Swelling
Metabolic Stress
When you�re working out your body is burning energy. As your body chews through its fuel stores, metabolic by-product accumulates in your muscles.
Metabolic by-products act as an anabolic signal, telling your body to increase size and strength.
Under normal training most of these by-products would be washed out by blood flow.
Occlusion training keeps them near the muscle helping to increase the anabolic effect that the by-products have on the muscles.�
Cellular Swelling
During resistance training your cells expand and fill with fluid and nutrients. This is known as cellular swelling and has also been shown to be an anabolic�signal for muscle growth.
Occlusion training isn�t a better option than heavy training, but that said it is a nice supplement.
Regularly pushing your muscles to the point of failure or at least close to it (1-2 reps) is an important factor of increasing your strength and muscle mass.
Occlusion training allows you to replicate this without putting anywhere near as much strain on your joints, ligaments and tendons as you would to get the same result from lifting heavy.
This means that you can do more volume without the risk of�overtraining.
Here are a couple of scenarios where this could be really beneficial for you:
If you suffer from joint issues
If you�re travelling and only have access to hotel weights
If you�re injured or have nagging aches and pains.
In short your body might not always feel up to another heavy training day. Occlusion training can be a great way to get a good workout in and help you maintain muscle mass.�
How To Do Blood Flow Restriction Training
As I mentioned earlier you only ever wrap yourself at the top of your biceps and the top of your thighs.
Elastic knee wraps, medical tourniquets and exercise band �are good options to use for your wraps.
Here�s two videos explaining how to wrap your arms and legs
Blood flow restriction training works best when with isolation exercises. If you are going to do compound movements do them at the start of your workout and save the blood flow restricted exercises for the end.
Layne Norton recommends performing lifts at 20%-30% of your 1rm for 20-30 reps of the first set and then the next three sets at 10-15 reps. Have a 30 second rest between sets before going again.
You want to keep the cuffs on your limbs for the entire 4 sets and then release them at the end.
If you�re in pain before the exercise starts that�s a good sign that your wraps are too tight.
Also if you can�t complete the prescribed sets either the wraps are too tight or the weight is too heavy.�
Conclusion
Blood flow restriction training has been getting a lot of hype lately.
While it isn�t better than regular strength training, it is a good supplement for it and can be beneficial when used in conjunction with your regular training.
This is more of an advanced training technique so if you are just starting out lifting it probably won�t give you any more benefits than your normal heavy training.
If you�re an advanced lifter, are injured, or don�t have access to heavier weights than this training technique could benefit you.
Deadlifts are one of the best strength and mass building exercises that you can perform.
When performing the deadlift you are working more muscles than any other exercise, including the squat.
Deadlifts have many different variations and forms. In this article we are going to focus on the difference between the Romanian Deadlift and standard deadlifts.
There are lots of valid arguments as to which exercise is better in a Romanian Deadlift vs regular deadlift battle.
Keep reading to learn the differences.
Romanian Deadlift Vs. Standard Deadlift
The Romanian Deadlift is one of the most�commonly used among the various deadlift techniques.
In fact a lot of people that think they are performing a deadlift are sometimes actually doing a Romanian Deadlift.
Both the conventional and Romanian Deadlifts are great strength and muscle building exercises.
Even though they are both deadlifts�variations the setup, execution and muscles activated are different.
Here�s a quick video that highlights the differences in form and setup between the two.
Regular Deadlift
As the name suggests the deadlift is a strength training exercise that involves�lifting dead weight.
The regular deadlift is one of the best total body exercises you can do as it works just about every fiber in your body.
The deadlift requires you to lift a weight off the ground�and lower it back down again. Although it may sound simple there is a lot going on in the movement and incorrect form can cause injuries.
One of the most common causes for injury while deadlifting is rounding the back. Your lower back must stay neutral during the whole movement. Rounding your lower back during heavy deadlifts puts uneven pressure on your spine. Always lift with a neutral lower back, allowing for the natural inward curve of your lower spine.
Don�t try and rush to lift heavier weights. the quickest way to improve your deadlift is through correct form. By pulling more efficiently you can use more muscles and deadlift heavier. So start out practicing correct form and build your way up.
The best way to approach the exercise is to think as if you were leg pressing the floor as opposed to�using your upper body to lift something. This will help you mentally focus on using your legs rather than your back (which can cause rounding) for the exercise.
The �dead� in deadlift stands for dead weight so each rep must start on the floor, from a dead stop. �Deadlifts are different to other exercises like the bench press or squat where the weight starts at the top. The deadlift movement�starts from the bottom and and you pull the weight up then return it to the floor�for one rep.
Here are�Stronglifts�5 steps to proper deadlift form:
Walk to the bar.�Stand with your mid-foot under the bar. Your shins shouldn�t touch it yet. Put your heels hip-width apart, narrower than on Squats. Point�your toes�out 15�.
Grab the bar.�Bend over without bending your legs. Grip the bar narrow, about shoulder-width apart like on the Overhead Press. Your arms must be vertical when looking from the front.
Bend your knees.�Drop into position by bending your knees until your shins touch the bar. Do NOT let the bar move away from your mid-foot. If it moves,�start from scratch with step one.
Lift your chest.�Straighten your back by raising you chest. Do not change your position � keep the bar over your mid-foot, your shins against the bar, and your hips where they are.
Pull.�Take a big breath, hold it and�stand up with the weight. Keep the bar in contact with your legs while you pull. Don�t shrug or lean back at the top.
Lower the bar by moving your hips back while keeping your legs almost straight. Once the bar is past your knees, bend your legs more. The bar will land over your mid-foot, ready for your next rep.
Rest a second between reps while staying in the setup position. Take a deep breath, get tight and pull again. Every rep must start from a dead stop on the floor. Don�t bounce the weight off the floor or you can end up lifting�with�bad form.
Isaiah Delgado�became involved with Push-as-Rx � to become stronger. Isaiah�began training at Push-as-Rx and with the help of Danny Alvarado and the other trainers, the strengthening routines he practiced greatly improved his performance in wrestling. Isaiah�continues to come to Push-as-Rx �.
PUSH-as-Rx � is leading the field with laser focus supporting our youth sport programs.� The�PUSH-as-Rx � System is a sport specific athletic program designed by a strength-agility coach and physiology doctor with a combined 40 years of experience working with extreme athletes. At its core, the program is the multidisciplinary study of reactive agility, body mechanics and extreme motion dynamics. Through continuous and detailed assessments of the athletes in motion and while under direct supervised stress loads, a clear quantitative picture of body dynamics emerges. Exposure to the biomechanical vulnerabilities are presented to our team. �Immediately,�we adjust our methods for our athletes in order to optimize performance.� This highly adaptive system with continual�dynamic adjustments has helped many of our athletes come back faster, stronger, and ready post injury while safely minimizing recovery times. Results demonstrate clear improved agility, speed, decreased reaction time with greatly improved postural-torque mechanics.��PUSH-as-Rx � offers specialized extreme performance enhancements to our athletes no matter the age.
Please Recommend Us: If you have enjoyed this video and/or we have helped you in any way please feel free to recommend us. Thank You.
Recommend: PUSH-as-Rx ��915-203-8122
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Diana Ramirez, Daniel Alvarado’s sister, has been training alongside her brother to gain strength, conditioning, and fitness. As a physical therapist, Diana knows how important it is for her to be physically and mentally strong in order to perform well in her in any given situation. For Diana Ramirez, Push-as-Rx �� has given her the opportunity to become the best person she can be, both in body and mind.
PUSH-as-Rx ���is leading the field with laser focus supporting our youth sport programs.� The�PUSH-as-Rx ���System is a sport specific athletic program designed by a strength-agility coach and physiology doctor with a combined 40 years of experience working with extreme athletes. At its core, the program is the multidisciplinary study of reactive agility, body mechanics and extreme motion dynamics. Through continuous and detailed assessments of the athletes in motion and while under direct supervised stress loads, a clear quantitative picture of body dynamics emerges. Exposure to the biomechanical vulnerabilities are presented to our team. �Immediately,�we adjust our methods for our athletes in order to optimize performance.� This highly adaptive system with continual�dynamic adjustments has helped many of our athletes come back faster, stronger, and ready post injury while safely minimizing recovery times. Results demonstrate clear improved agility, speed, decreased reaction time with greatly improved postural-torque mechanics.��PUSH-as-Rx ���offers specialized extreme performance enhancements to our athletes no matter the age.
Please Recommend Us: If you have enjoyed this video and/or we have helped you in any way please feel free to recommend us. Thank You.
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We usually talk of energy in general terms, as in �I don�t have a lot of energy today� or �You can feel the energy in the room.� But what really is energy? Where do we get the energy to move? How do we use it? How do we get more of it? Ultimately, what controls our movements? The three metabolic energy pathways are the�phosphagen system, glycolysis�and the�aerobic system.�How do they work, and what is their effect?
The energy for all physical activity comes from the conversion of high-energy phosphates (adenosine�triphosphate�ATP) to lower-energy phosphates (adenosine�diphosphate�ADP; adenosine�monophosphate�AMP; and inorganic phosphate, Pi). During this breakdown (hydrolysis) of ATP, which is a water-requiring process, a proton, energy and heat are produced: ATP + H2O ���ADP + Pi�+ H+�+ energy + heat. Since our muscles don�t store much ATP, we must constantly resynthesize it. The hydrolysis and resynthesis of ATP is thus a circular process�ATP is hydrolyzed into ADP and Pi, and then ADP and Pi�combine to resynthesize ATP. Alternatively, two ADP molecules can combine to produce ATP and AMP: ADP + ADP ���ATP + AMP.
During short-term, intense activities, a large amount of power needs to be produced by the muscles, creating a high demand for ATP. The phosphagen system (also called the ATP-CP system) is the quickest way to resynthesize ATP (Robergs & Roberts 1997). Creatine phosphate (CP), which is stored in skeletal muscles, donates a phosphate to ADP to produce ATP: ADP + CP ���ATP + C. No carbohydrate or fat is used in this process; the regeneration of ATP comes solely from stored CP. Since this process does not need oxygen to resynthesize ATP, it is anaerobic, or oxygen-independent. As the fastest way to resynthesize ATP, the phosphagen system is the predominant energy system used for all-out exercise lasting up to about 10 seconds. However, since there is a limited amount of stored CP and ATP in skeletal muscles, fatigue occurs rapidly.
Glycolysis is the predominant energy system used for all-out 
Since humans evolved for aerobic activities (Hochachka, Gunga & Kirsch 1998; Hochachka & Monge 2000), it�s not surprising that the aerobic system, which is dependent on oxygen, is the most complex of the three energy systems. The metabolic reactions that take place in the presence of oxygen are responsible for most of the cellular energy produced by the body. However, aerobic metabolism is the slowest way to resynthesize ATP. Oxygen, as the patriarch of metabolism, knows that it is worth the wait, as it controls the fate of endurance and is the sustenance of life. �I�m oxygen,� it says to the muscle, with more than a hint of superiority. �I can give you a lot of ATP, but you will have to wait for it.�
Fat, which is stored as triglyceride in adipose tissue underneath the skin and within skeletal muscles (called�intramuscular triglyceride), is the other major fuel for the aerobic system, and is the largest store of energy in the body. When using fat, triglycerides are first broken down into free fatty acids and glycerol (a process called�lipolysis). The free fatty acids, which are composed of a long chain of carbon atoms, are transported to the muscle mitochondria, where the carbon atoms are used to produce acetyl-CoA (a process called�beta-oxidation).
Anabolic-Androgenic Steroids
Anabolic-androgenic steroids (AAS) are testosterone derivatives that exert anabolic (tissue building) and androgenic (masculinizing) influences on the body.3 Since the discovery of the chemical structure of testosterone in 1935, attempts to separate the anabolic and androgenic effects of AAS�have been unsuccessful.3 
Dehydroepiandrosterone (DHEA) is a precursor to testos- terone produced primarily in the adrenal glands.4,14 Natural sources of DHEA include wild yams. The FDA banned sale of DHEA in 1996 due to insuf cient evidence of safety and value; however, DHEA remains a legal and popular item sold as a nutritional supplement.14,15
Androstenedione is a testosterone pre-cursor produced in the adrenal glands and gonads. Several professional athletes have used this substance, bringing it to national attention.2 Androstenedione is found naturally in the pollen of Scottish pine trees.19
The increased visibility of ergogenic aids in the last de- cade has occurred primarily because of the passage of the United States Dietary Supplement Health and Education Act (DSHEA) of 1994.22 Certain vitamins, minerals, amino acids, herbs, and other botanical preparations can be classified as a �dietary supplement� under the DSHEA guidelines. Dietary supplements, as a result of DSHEA, are no longer under the direct regulatory control of the FDA. In fact, substances sold as a dietary supplement do not require FDA evaluation for safety or efficacy, and do not have to meet quality control standards expected of approved drugs.5 The content and purity of dietary supplements are not regulated and can vary widely.5,23 Since androstenedione and DHEA have been found to occur naturally in plant sources, these testosterone precursors can be labeled as �dietary supplements� and sold legally over-the-counter.
Dietary supplements containing Chinese ephedra, also known as Mahaung, are marketed as performance enhancers and weight-loss aids.24 Ephedra species of herb have been used for over 5,000 years for respiratory ailments.25 Currently, ephedrine alkaloids are found in hundreds of prescriptions and over-the-counter products, such as antihistamines, decongestants, and appetite suppressants.24-26 Ephedra and related ephedrine alkaloids are sympathomimetic agents that�mimic epinephrine effects.
Creatine use in athletes has grown as a result of a 1992 study that showed that creatine supplementation produced a 20% increase in skeletal muscle creatine concentration.2,35 In the phosphorylated form, creatine serves as an energy substrate that contributes to adenosine triphosphate (ATP) re-synthesis during high-intensity exercise.36 Creatine re- mains popular with power and resistance athletes as it is thought to produce increases in strength, muscle mass, and to delay fatigue.2,14,36
Human growth hormone (hGH) is a polypeptide produced in the anterior pituitary gland. After its release from the pituitary, hGH can exert its effect in all cells of the body via tissue specific receptors. Human growth hormone is shown to promote protein anabolism, carbohydrate tolerance, lipolysis, natriuresis, and bone and connective tissue turnover.4,50
Recombinant EPO (r-EPO) was approved by the FDA for manufacture in 1989 after the EPO gene was cloned in 1985.14 Since its approval, r-EPO has been abused for athletic personal gain as an alternative to blood doping.3,14 Recombinant EPO has largely replaced the practice of blood doping, as r-EPO produces a dose-dependent increase in hematocrit.2 In theory, r-EPO should provide all of the benefits of blood doping without the risks involved in blood transfusion.3
The antioxidant capabilities of certain vitamins are believed by many to counter-act the production of free-radials that occurs during exercise.14 Most of the research to date involves vitamin E, vitamin C, and beta carotene.2 The existing literature does not support the notion that antioxidants have significant ergogenic capabilities.2,14,57 There are currently no recommendations for antioxidant use in athletes that exceeds the normal adult recommended daily allowance (RDA).
Beta-hydroxy-beta-methylbutyrate (HMB) is a metabolite of the branched-chain amino acid leucine. HMB is theorized to inhibit muscle breakdown during strenuous exercise but its exact mechanism of action remains unknown.14,58 Studies show that HMB supplementation may significantly lower serum lactate dehydrogenase (LDH), lower serum creatine phosphokinase (CPK) levels and delay blood lactate accumulation after endurance training compared to placebo.59,60 Furthermore, short-term HMB use has been shown to significantly increase strength gains with resistance-exercised training over placebo in one double-blinded study.61
Caffeine is a methylxanthine occurring naturally in many species of plants. Caffeine is thought to work through a variety of mechanisms. The central nervous system effect of caffeine is probably the result of adrenergic receptor antagonism.3 Its use by athletes stems from the theory that caffeine may delay fatigue by enhancing skeletal muscle contractility and spare muscle glycogen levels by enhancing fat metabolism.6 Multiple studies have reported an improved endurance time with caffeine use.6,62,63 There is evidence that caffeine use may enhance performance with more intense short-duration exercise as well.2 The caffeine dosages most associated with an ergogenic effect range in the literature from 3 to 9 mg per kilogram of body weight.2,6
