GP Paediatric update 2017 Sports in Children: Medical and Ethical dilemmas Dr Leigh Gordon Sports & Exercise Medicine Physician
Outline • Safeguarding the Child Athlete? • Potential types of ‘violence’ which threaten our athletes • RED-S • Supplements • Doping • Questions
IOC Consensus statement: Youth athlete development model for safeguarding the child athlete (B ergeron MF , Mountjoy M, Armstrong N, et al. Br J Sports Med 2015;49:843 – 851.) 1) IOC Olympic Charter (2013) 2) IOC Olympic Movement medical code (2009) all stakeholders “ should take care that sport is practiced without danger to the health of the athletes and with respect for fair play and sports ethics … [and should take] measures necessary to protect the health of participants and to minimize the risks of physical injury and psychological harm .” Mountjoy M, Rhind DJA, Tiivas A, et al. Br J Sports Med 2015;49:883 – 886.
Mountjoy M, Rhind DJA, Tiivas A, et al. Br J Sports Med 2015;49:883 – 886.
RED-S Relative Energy Deficiency in Sport with or without disordered eating (DE) or eating disorders (ED) The syndrome of RED-S refers to impaired physiological function including, but not limited to, metabolic rate, menstrual function, bone health, immunity, protein synthesis, cardiovascular health caused by relative energy deficiency. Prevalence of EDs in adolescent sport
Health Consequences of RED-S Mountjoy M, Sundgot-Borgen J, Burke L, et al. Br J Sports Med 2014;48:491 – 497.
Supplements Why are they used? • Increase muscle mass • ? Increase performance • Targeted marketing
Supplements: do they work? Maybe…
Supplements Are they safe?
Supplements Not regulated… (don’t have to prove safety / efficacy) Ingredients do not have to declare everything Risk of contamination Not everything herbal is safe…
Supplements How to mitigate your risk…
Supplements
Anti-Doping: WADA
Anti-Doping: WADA Prohib ohibited ited Su Substances stances MANIPULATION OF BLOOD AND BLOOD COMPONENTS ANABOLIC BOLIC AGENT ENTS AAS AAS CHEMICAL AND PHYSICAL MANIPULATION Other r anab abolic olic agents ts eg eg tib ibolo lone ne and d cle lenbu buterol terol GENE DOPING PEPTIDE TIDE HO HORMONES ONES, , GROWTH OWTH FACT CTORS ORS, , RELATE TED D SUBSTANCES ANCES, , AND MIMET ETICS ICS Incl Epo po-stim stimulati lating g agents, nts, GH BE BETA-2 2 AGONIS ONISTS TS NB inh B inhale led d sa salb lbutamo utamol l / fo / formote moterol rol / s / salm lmeterol eterol HO HORMONE ONE AND METAB ABOLIC OLIC MODULA DULATORS ORS DIURET RETICS ICS AND MASKI KING NG AGENT ENTS
Anti-Doping: WADA Prohib ohibited ited In Comp mpetition etition STI TIMULANTS MULANTS (sp speci ecifi fied ed or no non-speci specifi fied) ed) NB: Methy hylph lphenidate enidate – Rit itali lin n / / Concer ncerta ta NARCO COTICS TICS CANNAB NABINOIDS INOIDS GLUCOC UCOCORT ORTICOIDS ICOIDS (All glucocorticoids are prohibited when administered by oral, intravenous, intramuscular, or rectal routes) PARTICULAR RTICULAR SP SPORT ORTS: : Alc lcoho ohol l / Beta ta blo lockers ers
Anti-Doping: WADA
Anti-Doping: WADA AAS S – how common mmon are e they ey in our r scho hools? ols? SA SAID IDS S / S / SARU U have e NO j O jurisdict risdiction ion over er scho hoolboy olboy rugby gby On Only y yo youth th wee eeks ks and U1 U19 9 Curri rrie e cup Data a from m SA SAIDS DS school hools s pilot lot study udy 20 2015 15 (23 23%: : 12 12/5 /52) 2) 2011 2011-201 2016: 6: 62 % 62 % increase crease in ADRV RV (21+ 21+ in 201 2016); 6); 48 48% junior nior rugby gby players yers
Anti-Doping: WADA “Gym, Shake & Spuit ”
Adverse effects of AAS (eg eg stanaz anazol ol / / Nandrol drolone one): ): St Stunted nted gr growth, owth, acne Traits its of op opposite osite ge gender: er: gy gynaecomast ecomastia/smaller ia/smaller tes estes/voice tes/voice In Incre creased ased agg ggression ression Raised ised BP / / cholesterol olesterol Liver ver toxic xicity ity Psychosis ychosis / / Sz Szp Dizziness, ziness, chest est pain n and SC SCA NB Biogen gen Tes estoF toForte orte
Adverse effects of other substances Peptide H (incl GF): EP EPO - ↑ blood viscosity/ MI • HgH: allergic rx / diabetogenic, acromegaly • IGF-1: acromegaly / organomegaly / hypoglycaemia • Insulin (anabolic): Hypoglycaemia • B2 agonists: tachycardia, tremor, palps • HCG: gynaecomastia •
Useful websites www.boksmart.co.za www.informed-choice.org or www.informed-sport.org http://www.drugfreesport.org.za/ https://www.wada-ama.org http://www.usada.org/substances/supplement-411:
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