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IOC Consensus Statement concludes little evidence of negative outcomes associated with strenuous exercise in pregnancy

13 Oct, 16 | by BJSM

By Professor Gregory Davies, MD

But the overall quality of the available evidence on the impact of intense exercise is not strong, with few studies carried out in elite athletes, the statement warns.


Alysia Montano, 34 weeks pregnant (photo: Getty Images)

The statement is the second in a series of five issued by the IOC on exercise and pregnancy, focusing on elite athletes. It draws on a systematic review of the available published evidence, presented by an international panel of experts at a three day meeting in Lausanne, Switzerland, last September.

Traditionally, there has been concern that strenuous exercise during pregnancy may divert critical oxygen flow to skeletal muscles rather than to the uterus and developing fetus. The systematic review evaluated an extensive list of pregnancy outcomes and reached the following conclusions:

  • Elite athletes planning pregnancy may consider reducing high impact training routines in the week after ovulation and refraining from repetitive heavy lifting regimens during the first trimester as some evidence suggests increased miscarriage risk.
  • There is little risk of abnormal fetal heart rate response when elite athletes exercise at <90% of their maximal heart rates in the second and third trimesters.
  • Baby birthweights of exercising women are less likely to be excessively large (>4000g) and not at increased risk of being excessively small (<2500g).
  • Exercise does not increase the risk of preterm birth.
  • Exercise during pregnancy does not increase the risk of induction of labour, epidural anesthesia, episiotomy or perineal tears, forceps or vacuum deliveries.
  • There is some encouraging evidence that the first stage of labour (before full dilatation) is shorter in exercising women.
  • There is also some encouraging evidence that exercise throughout pregnancy may reduce the need for caesarean section.

The IOC Committee identified the need for more research around these issues, specifically in elite athletes.

You can find the first of the five IOC statements on Exercise in Pregnancy here:

All 5 IOC statements will be Open Access.




Gregory Davies, MD, Professor and Chair, Maternal-Fetal Medicine
Queen’s University, ON


IOC World Conference – Prevention of Injury & Illness in Sport: On the ground recap

24 Apr, 14 | by BJSM

By Liam West (@Liam_West)

IOC conference

For 3 years this conference has been firmly on my “SEM Bucket List” and it did not disappoint. Firstly, Monaco in the sun is a sight to behold and secondly to walk into a coffee break to see the “who’s who” of global sports medicine was simply inspirational. The numbers for the event were equally impressive;

  • 24 symposia
  • 5 keynotes
  • 34 workshops
  • 73 free communications
  • 233 poster presentations (unopposed in the time table)

The only downside was that I could not attend all of the sessions, although I guess that speaks volumes of the quality of presentations on offer. Below is a summary of the 3 days and some take home messages from the sessions I attended.

Dr. Richard Budgett, IOC Medical Director, reminded all the delegates at the opening ceremony that “It’s all about the athlete” and as a former Olympic gold medalist he knows this more than most! The next day the opening keynote lecture showcased a vigorous debate between Karim Khan (@BJSM_BMJ) and Dominic MacAuley (@DMacA) as to whether sports injury & illness prevention research has delivered. The answer? Yes in certain areas (e.g. ACL prevention), but there is much work to be done (or optimistically to be read as opportunities for research!!).

Using the #IOCprev2014, the interactivity between delegates and speakers both in attendance and across the globe was terrific. Perhaps this was triggered by the excellent symposium about “the power of social media” chaired by @CarolineFinch. Learning points? You can to use social media as a platform to market your message. It is now one of the best ways to signpost readers to scientific content and can improve citation rates although @DrJohnOrchard warned about the perils of engaging in non-academic discussions online. @clairebower explained the three top rules of twitter [slides can be accessed here]. 1) Know your audience, 2) keep it simple & 3) image is everything (use photos). @EvertVerghagen explained that using social media can increase subject recruitment for research and apps may be the future of sports injury prevention – you can find his talk here.

Sudden cardiac death (SCD) was an integral theme at the last IOC conference in 2011 and 2014 was no different – read the open access BJSM issue on Advances on Sports Cardiology here. After the overview by @Prof­_MatWilson, the issue of the optimum screening protocol for SCD was tackled – future efforts lie in detecting subclinical disease in older athletes. No guaranteed protocols were given by the experts but Michael Papadakis provided pro-ECG evidence and then educated delegates to the normal ECG changes associated with age, sex and ethnicity – read the Seattle Criteria here and do the online BMJ ECG interpretation module here. Shanjay Sharma (@SSharmacardio) talked about the importance of maintenance of left ventricular cavity size in the athlete’s heart that is lost in cardiomyopathy and that it isn’t the size of the heart that matters but the function. Screening will never pick up all athletes at risk of SCD – Jonathan Drezner (@AMSSM) preached the importance of sideline preparation and the role of the automated external defibrillator (AED) in preventing SCD. The big take home message – “A seizure or loss of consciousness should be assumed to be sudden cardiac arrest until proven otherwise”

Concussion is the current vogue in SEM and the keynote by Neurologist/Sports Physician & PhD Paul McCrory was well attended. He described that whilst technology has improved enabling us to measure impact & biomechanical forces, these show little correlation to rates and severity of concussion. The most recent Zurich guidelines were emphasized to be just that – guidelines. There are no definite answers so far in concussion and currently we are only looking into neurocognitive athletic function but McCrory explained that concussion is a complex systemic pathology with many components; consider mood, sleep, hormonal disturbances etc. – listen to his 4 recent BJSM podcasts on the topic here – 1,2,3, & 4. It is important to note that Chronic Traumatic Encephalopathy is a separate entity to concussion and as clinicians we must not let the media dictate the course of science – education in this area is key! You can access the BJSM journal dedicated to concussion and the 4th International Conference on Concussion in Sport (Zurich, 2012) here.

The recent IOC Consensus Statement “Beyond the Female Athlete Triad – Relative Energy Deficiency Sydrome (RED-S)” was presented and discussed in a fantastic stream led by @margomountjoy – this work has moved on from the Female Athlete Triad and the journal can be read here. RED-S acknowledges this condition affects both genders and has multisystem involvement with more complex pathophysiology than previously described. It’s all about the energy. RED-S describes the imbalance between training load and recovery as the imbalance between energy availability and expenditure. With low energy availability comes susceptibility to short term risks to illness, infection, fatigue etc and long term risks such as decrease in performance and overall health. The paper proposes a traffic light system to RTP issues for athletes with this condition – useful for clinicians.

Some other short take home messages;

  • The legend of running biomechanics, Benno Nigg, spoke on the evolution of footwear and the prevention of running injuries. He concluded from his years of research that the only thing that actually confers injury protection is the ability of athletes to use a “comfort filter” to choose the shoe/insole that works for them.
  • Injury prevention – @benclarsen presented on the difficulty with recording overuse injuries. He stated that we need to move away from the trend of only measuring time loss injuries and look to include injuries that can lead to overuse pathologies.

I’d like to thank the organisers for putting on such a fantastic event that enabled delegates to meet old friends whilst making new connections that will hopefully last for many years to come. I look forward to seeing many of you at the next IOC Conference in 2017!


Dr. Liam West BSc (Hons) MBBCh is a junior doctor at the John Radcliffe Hospital, Oxford. He is a founder and current President of USEMS and is also the founder of Cardiff Sports & Exercise Medicine Society (CSEMS). In addition to his role as an associate editor for BJSM he also coordinates the “Undergraduate Perspective on Sports & Exercise Medicine” Blog Series. He has a passion for developing the SEM movement amongst undergraduates and sits on the Council of Sports Medicine for the Royal Society of Medicine as Editorial Representative and on the Educational Advisory Board for the British Association of Sport and Exercise Medicine. His Twitter handle (as above) is @Liam_West and you can find Liam on Facebook as well.

Preventing sudden cardiac death (SCD) in athletes: the IOC World Conference Prevention of Injury and Illness in Sport session highlights

14 Apr, 14 | by Karim Khan

By Jessica Orchard, Sydney Medical School, University of Sydney


Cutting edge research was presented at many IOC World Conference Prevention of Injury and Illness in Sport 2014 Monaco sessions. Among these, was a focus on cardiology, and specifically, preventing sudden cardiac death (SCD). Speakers discussed the importance of screening, interpretation of athletes’ electrocardiographs (ECGs), the roles of ethnicity, gender and age, and how to prepare for a sudden cardiac arrest (SCA).

Dr Matthew Wilson explained that SCD is rare, with an incidence of about 1 in 50,000. The mean age of death is 23 years; it is more common in males (9:1), with 90% of events occurring during or immediately after exercise (Bille et al, 2006). The most common cause is hypertrophic cardiomyopathy (HCM), accounting for about 36% of SCD (Maron et al, 2003). HCM is frequently genetic, and the prevalence is about 1 in 500, although it can be as high at 1 in 100 for black athletes.

IOC pic

Peak organisations including the American Heart Association, the European Society of Cardiology and the International Olympic Committee recommend pre-participation screening including a 12-lead ECG. However, there remains some debate about screening, regarding which elements to include (history, physical, ECG) and the sensitivity, specificity and cost-effectiveness of a program. The value of screening may be proportional to the background risk of SCD in the population (according to Bayes theorem). For example, on the basis of risk stratification, black male basketball players are a good population to screen because their background risk of SCD is higher.

While the ‘history’ element of screening is frequently used, it has generally poor sensitivity and specificity, and the particular questions asked have not been well-studied. For the physical exam, Professor Mats Börjesson emphasised the importance of looking for Marfan’s syndrome, any heart murmur, the femoral pulses and brachial artery blood pressure. However, the physical exam alone has very low sensitivity. Adding a 12-lead ECG dramatically improves sensitivity and specificity, particularly when interpreted according to the new Seattle criteria.

In terms of the specificity of interpreting athletes’ ECGs, Dr Wilson emphasised that the most difficult thing for physicians is to recognise what is normal. To help sports physicians understand features of athletes’ ECGs, there is a free online unit available through BMJ Learning.

Dr Wilson and Professor Jonathan Drezner explained the key point that a normal athlete’s heart is different from the heart of a sedentary individual due to the athlete’s electrical adaptation for greater cardiac output. The way the heart adapts depends on age, ethnicity and gender. Therefore, interpretation of an athlete’s ECG requires an understanding of these changes and is quite specialised. In this context, an athlete is defined as someone aged 14-35 who has done more than 6 hours per week of organised, intensive physical activity in the year prior to the ECG.

The important role of an athlete’s ethnicity in interpreting their ECG was emphasised by the presenters. While it may be a contentious issue, evidence suggests that there are very big differences between Caucasian and black (African) athletes’ ECGs. What is normal for a black (asymptomatic) athlete may be very concerning in a Caucasian athlete (e.g. anterior T-wave inversions in leads V1-V4, preceded by a convex ST-segment elevation) (Papadakis et al, 2012). Therefore, it is ideal for the person interpreting the ECG to have information about an athlete’s ancestry (including grandparents).

In terms of the anxiety associated with screening, Dr Irfan Asif’s study found that the reason for the false positive (history, physical or EGC) was irrelevant to the level of anxiety. Rather, the level of distress was related to the time taken for the follow-up test.  Once a diagnosis of an underlying pathology is made, it is important to ensure the athlete has mental support at an early stage, as well as having their physical condition treated.

Professor Drezner also gave a very useful presentation highlighting the importance of preparing for the possibility of an SCA. The single greatest factor affecting survival is the time from cardiac arrest to defibrillation. Sporting clubs should have a written emergency access plan, including the location of defibrillators (must be accessible within 3 minutes, batteries working) and who to call, and must practise using it.

In the event of an SCA event, the key steps are:

  1. Recognition. A seizure or loss of consciousness should be assumed to be SCA until proven otherwise.
  2. Chest compressions
  3. Automated external defibrillator (AED).

For more detail, see Toresdahl et al, 2012.

Injury prevention, advances and challenges of the international paralympic committee, and countdown to the next games

7 Aug, 13 | by Karim Khan

Mr. Bean on the pianoIt has been 12 months since Rowan Atkinson plonked the piano with his umbrella to Chariots of Fire in the London Olympic Games Opening Ceremony. Wikipedia says he is worth 85 million pounds, loves cars, has retired ‘Mr Bean’ and has been married to Sunetra Sastry for 23 years. But I digress already.

Now, Professor Lars Engebretsen and Dr Kathrin Steffen, the Injury Prevention and Health Protection (IPHP) editorial team, provide you valuable Olympic content. In 2013’s June and September (forthcoming) issues, you can discover how to prevent and identify injuries, and also learn more about the personpower needed to service major events.

Photo courtesy of Nick Webborn

Photo courtesy of Nick Webborn

In the June 2013 issue, the inspiring and redoubtable Dr Nick Webborn grabbed my attention with his evocative description of his London Paralympic experience. ‘The wall of sound that resonated around the stadium literally made the hairs on the back of my neck stand up.’ Equally importantly he highlights advances in the field and the challenges that face the International Paralympic Commitee (Read Nick’s article HERE).

Enjoy the June 2013 issue, and anticipate the September offerings (which BJSM’s 13 member societies can enjoy via OnlineFirst). For those who insist on reminsicing, the June 2012 issue broke all records for IPHP downloads.

The good news is that there are only 192 days until the next Olympic Games – BJSM will preview the sports medicine of the Sochi Olympic Winter Games in a future IPHP issue. Keep a track of injury prevention and athlete health protection via BJSM – and our special quarterly IPHP issues supported by the International Olympic Committee.

And while we are on things Olympic, injury prevention and memorably occasions – remember the 2014 IOC World Conference on Prevention of Illness and Injury in Sport. Follow @RoaldBahr for regular updates but hold the dates right now. The biggest collection of experts in sports medicine and physio in the one venue for the year – and perhaps years on either side. This 2014 Conference is April 10-12 in Monaco; there is an exclusive post-conference advanced team physician course for just 80 clinicians April 14-16 in Mandelieu. France. Explain it as onnce in a lifetime – cutting-edge education & fun with immediate clinical application. The conference of 2014.

BJSM cover competition – round 2 (Vote now!)

21 Dec, 12 | by Karim Khan

The winner of round 1!

Thanks to everyone who voted in round 1 of our second annual BJSM cover competition. Perhaps due to flexibility envy, BJSM’s issue #2 (ECOSEP special issue) goes through to the final.

See the four awesome covers in this second round. To recap: You (and your friends) vote below for your favourite cover. One click and you would make Abe Lincoln proud. The winner of the remaining preliminary rounds joins the Hamstring Issue in the final.

We will have prizes (a draw from those who vote) in the final. Right now, vote for your favourite cover from April – June 2012. (There were 16 issues of BJSM in 2012 – because of our links with the IOC and their 4 issues dedicated to Injury Prevention and Health Promotion – see the Olympic Rings on those issue covers, e.g, Cover 7, below). If you want to vote along ‘party lines’ remember that issue 5 and 8 were guided by the AMSSM (US) and SASMA (South Africa) respectively. BJSM has 12 actively engaged member societies.

Cover 5

Cover 5

Cover 6

Cover 6













Cover 7

Cover 7


Cover 8

Guest Blog: Peter Brukner on Drugs and the London Olympics

20 Aug, 12 | by Karim Khan


A couple of days ago, London 2012 would have been regarded as a drug-free Olympics – that was before shot put gold medalist Nadzeya Ostapchuk (Belarus) tested positive for the anabolic steroid metenolene in samples taken both before and after her London competition. That was the first positive test by a medallist in London but two other athletes were kicked out of the Games for failing drug tests — Syrian hurdler Ghfran Almouhamad and US judoka Nicholas Delpopolo. In addition, the International Olympic Committee announced a number of positive pre-Olympics tests during the course of the Games.

The positive tests announced during the Games were:

Name Country Sport Banned substance
Ghfran Almouhamad  Syria 400m hurdles Methylhexaneamine (stimulant)
Victoria Baranova  Russia Women’s sprint Testosterone
Kissya Cataldo  Brazil Single sculls EPO
Nicholas Delpopolo  United States Judo Cannabis
Luiza Galiulina  Uzbekistan Artistic gymnastics Frusemide (diuretic)
Hassan Hirt  France 5000 m EPO
Amine Laâlou  Morocco 1500 m Frusemide (diuretic)
Marina Marghiev  Moldova Hammer throw Frusemide (diuretic)
Nadzeya Ostapchuk  Belarus Shot put (gold medal) Methenolone (anabolic steroid)
Diego Palomeque  Colombia 400 m Stanozolol  (anabolic steroid)
Hysen Pulaku  Albania Weightlifting Stanozolol  (anabolic steroid)
Alex Schwazer  Italy 50 km walk EPO
Tameka Williams  Saint Kitts and Nevis 100 m/200 m “Blast Off Red” (? Stimulant)

Pre-Games bans

The World Anti-Doping Agency reported that more than 100 potential Olympians were stopped from competing at the Games because of doping.

Some medal hopefuls had been caught before leaving for London, such as defending 50km walking champion Alex Schwazer of Italy, Moroccan 1500m hope Mariem Alaoui Selsouli and Turkish weightlifter Fatih Baydar. Belarussian hammer thrower Ivan Tikhon, a three-time world champion in 2003, 2005 and 2007, was also excluded from competing before the Games as a result of drug tests dating back to the 2004 Olympics and 2005 world championships.

Six track and field athletes suspended were caught in “biological passport” tests, which measure changes in an athlete’s blood profile. Another three were apprehended in re-tests of samples from last year’s world championship. Inna Eftimova, of Bulgaria, tested positive for synthetic growth hormone, while the samples of the Ukrainians Nataliya Tobias and Antonina Yefremova both contained traces of synthetic testosterone. All three have been banned for two years.

The Moroccan runner Abderrahim Goumri, who finished third in the London marathon and second in the New York marathon in 2008, was among the six athletes who had irregularities in their “biological passports”. The others were: Russians Svetlana Klyuka, who finished fourth in the 800m at the Beijing Olympics; the 2011 European indoor 800m champion Yevgenia Zinurova; and Nailya Yulamanova; long-distance runners Irini Kokkinariou of Greece; and Turkey’s Meryem Erdogan.

The nine suspensions came after it was revealed that the Moroccan 1,500m runner Mariem Alaoui Selsouli had also tested positive for a banned diuretic. The 28-year-old had been the hot favourite to win 1,500m gold in London when she ran three minutes 56.15 seconds to win the Paris Diamond League at the Stade de France earlier this month. A silver medallist at the world indoor championships this year, she has already served a two-year suspension for doping and now faces a lifetime ban under World Anti-Doping Agency (WADA) rules.

Italian race-walking hero tests positive for EPO

The most interesting story among this group was from Italian walker and 50km gold medallist from Beijing, Alex Schwazer, who unusually among those who test positive, admitted doping. Schwazer, told his doping tale in great, and sometimes disturbing, detail. His story clashed starkly with the athlete’s clean-cut image that is highlighted in a ubiquitous Italian advertisement for Kinder chocolate bars set in the idyllic Alps where he lives.

After studying how to take and buy the drug on the internet, he said he flew to Turkey in September 2011 for three days, exchanged 1500 euros for Turkish lira, went to a pharmacy and bought EPO over the counter. He kept the drug in his refrigerator and told his girlfriend, figure skater, Carolina Kostner that they were vitamins.

He said he took the EPO only in the month leading up to the Games, that he had acted alone, and denied that he had taken performance enhancing drugs before the Beijing Games. He challenged the Olympic authorities to re-examine his blood from four years ago.

He gave the following description of the test that found him out.  “I took the last injection on July 29, I remember because it was my mother’s birthday. I went back home to get a document I needed for the Olympics. On the 30th the doorbell rang and I was sure it was anti-doping controllers. I could have told my mother to not answer or say I was not in and nothing would have happened since it’s possible to miss two in a year. But I did not have the strength to lie any more. And I wanted it all to end. I am so ashamed but I am also glad I can start my life again”.

Kenyans test positive

Three Kenyan athletes also tested positive leading up to the Games including Hamburg Marathon winner Rael Kiyara for nandrolone (anabolic steroid) and 2012 Boston Marathon runner-up Jemima Sumgong for traces of cortisone. Sumgong was treated for a hip injury in an Italian clinic, and her use of the banned substance may ultimately be determined as inadvertent.

Mathew Kisorio, history’s third fastest half marathoner (58:46) and a fourth-place finisher at the 2011 World Cross Country Championships, reportedly tested positive for an anabolic steroid at the Kenyan Championships in Nairobi on June 14. Doping expert Hajo Seppelt, in an interview with the German media outlet ARD,  translated (roughly), claimed statements by Kisorio “give the impression that not only he is affected, but it [taking performance-enhancing drugs] is a common phenomenon in Kenya.”

Seppelt says Kisorio told him that doctors like the one who treated him “can be seen in places where preferred athletes live, such as in the training camps in the highlands. His observations on this practice [administering banned drugs] are, that this is not an isolated phenomenon, but is widespread all over Kenya.”

Kisorio has admitted to drug-taking and “apparently hopes that he gets, through the elucidation of the facts, a reduced ban by [Athletics Kenya],” explains Seppelt. “Therefore, he has gone on the offensive and has spoken to us.”

Kisorio “claims that he was incited by his doctor,” reports Seppelt. “The doctor has apparently given him injections of banned substances and also tablets. One of these tablets led to the alleged positive test.”  Kisorio was found to have taken steroids, notes Seppelt, but “he also speaks of seemingly EPO injections, i.e., blood doping, and also of [doping] products that stimulate the mind.”

Seppelt maintains that the complete lack of positive drug tests by the Kenyan Olympic team is “nothing special. In the competition controls only the dumbest get caught, because the [doping] products are already out of the [body] by then.” But Seppelt asserts “nonetheless, the credibility of the Kenyan athletics is shaken” and that East African distance-running success cannot be attributed solely to “the highland, good food and the running culture. It also plays an important role. But you must realize that certain substances are also a part.”

Previous drug cheats in London

Gold medallists at the London Games who had been involved in previous doping offences included Alexandre Vinokourov, the winner of the cycling mens road race, Tatyana Lysenko,  the winner of the womens hammer throw and Asli Cakir Alpketin winner of the womens 1500 metres. Other competitors involved in previous doping cases included American athletes Justin Gatlin and LaShawn Merritt.

Ostapchuk’s positive test

Ostapchuk’s positive test in London should not have come as a big surprise. She had been competing in her third Olympics having finished fourth in Athens in 2004 and won bronze in Beijing four years ago. In the past few years, the New Zealander Valerie Adams has dominated the womens shot, beating Ostapchuk several times. Ostapchuk won the World Championship in 2005, but finished runner-up behind Adams in both 2009 and 2011 and took bronze at the Beijing Olympics in 2008.

In London, Ostapchuk, 31, won the shot put with 21.36 metres, 66 centimetres better than Adams’ best mark. The results raised speculation of doping as Britain’s men’s shot put competitor Brett Morse hinted on Twitter that Ostapchuk was using illegal drugs. The tweet was deleted soon after.

Adams is now the Olympic gold medallist, but has missed out on the opportunity to celebrate her victory on the day and to receive her gold medal at the victory ceremony.

“Suspicious” performances

Whenever there is a surprise outstanding performance involving a dramatic improvement in a short period of time, the suspicion of drug use arises. Two cases that drew a great deal of attention in London. One was the Chinese swimmer Ye Shiwen who won the women’s 400 Individual Medley in world record time and famously swam the final freestyle lap faster than Ryan Lochte in the men’s event (a previously unheard of phenomenon); the other was and the Turkish 1-2 in the women’s 1500 metres (see below).

Shiwen bettered her previous PB by 5 seconds which led the US coach John Leonard to query the performance. A Chinese team mate tested positive for EPO earlier this year. The Chinese claimed Shiwen had been identified at a young age because of her large hands and feet, and her success was due to hard work.

Womens 1500 metres – surrounded by drugs

Asli Cakir Alptekin, who has served a two-year ban for doping offences, won Turkey’s first athletic gold  in the 1500m and was followed across the line by her fellow countrywoman Gamze Bulut. Both their histories are interesting

Asli Cakir was banned for 2+ years as a junior in 2004 on a doping incident. She ran the 3000m steeplechase in Beijing four years ago and failed to progress from the heats. By last year’s world championships in Daegu she had dropped down to the 1500m, but failed to qualify for the final. This year has been different though. She finished third in the world indoors in Istanbul and then at the Diamond League meeting she ran 3min 56.62 sec, a 7 second personal best. Then on the eve of the Games, Cakir Alptekin won the European championships.

Silver medallist Bulut who has just turned 20 years old, virtually came from nowhere. Before 2012, Bulut was a steeplechaser with a 10:13 PB to her name and a 4:18 in the 1500, both times from 2011. This year her times saw massive drops of 39 seconds (9:34) in the steeple and 17 seconds in the 1500 (4:01). Bulut had never been at a global championship in the past, but found her way on the medal stand her in London.

British 1500-meter runner Lisa Dobriskey, who in her whispery voice has been outspoken on this issue before, told BBC Radio 5 Live, “I’ll probably get into trouble for saying this, but I don’t believe I’m competing on a level playing field.” Dobriskey was fourth in the 2010 European Championships when one of the runners making the podium had previously been banned for EPO use and had once been arrested with vials of human growth hormone (HGH) in her luggage. In addition, Dobriskey was fourth at the 2008 Olympics in which the bronze medalist, Ukraine’s Nataliya Tobias, tested positive for testosterone at the 2011 world championships.

The women’s 1500m event has been surrounded by drug convictions in recent years. In addition to Alpketin who tested positive in 2004, Moroccan Mariem Alaoui Selsouli, the world leader and favourite for 1,500m the London Games, tested positive in July and faces a lifetime ban having returned only last year from a two-year doping suspension for EPO.

Also in July, three Russian runners, including major championship middle-distance medallists Svetlana Klyuka and Yevgenia Zinurova, were banned, while four years ago, seven Russians were caught including then-world leader and former indoor 1,500m world record holder Yelena Soboleva and former double world champion Tatyana Tomashova.  Tomashova, a silver medalist in the 2004 Athens Olympics, was later banned when it was discovered that she had tampered with a urine sample that was to be tested for drugs. She returned from the ban in April of 2011. Turkish athlete Süreyya Ayhan was the 2002 European champion in the 1500, but she received a lifetime ban after a positive test for steroids in 2007

Men’s 1500 m

In Beijing there was a surprise winner of the mens 1500 metres –  the Bahraini athlete Rashid Ramzi. Less surprisingly he subsequently lost his gold medal after testing positive for CERA an advanced version of EPO.

When Taoufik Makhloufi of Algeria won the London 1500 metres with a 3:30 personal best, having previously failed to make it out of the semifinals in the previous two World Championships, suspicions were again raised. However Makhloufi’s performance was not out of the blue as he had run a fast 3.30 1500 in Monaco earlier in the year. The most dramatic improvement in the 1500m final actually came from the Norwegian runner Henrik Ingebrigtsen who ran a personal best in finishing fifth.

The interesting aspect of the London 1500m final was the failure of all the favourites to perform on the day, although the defending champion and current World champion Asbel Kiprop was obviously injured. You would imagine that the way the race was run it would have suited a fit Kiprop who was the fastest 800m runner in the field. Makhloufi was the second fastest 800m runner in the final!

Will there be more positives?

Urine and blood samples taken at London 2012 and tested by scientists at the high-tech anti-doping lab in Harlow, east of London, will be stored for up to eight years. As American cyclist Tyler Hamilton, a 2004 time trial gold medallist, found out last week, cheats both past and present can be named, shamed and stripped of their titles even years later.

Experts say the liquid chromatography and mass spectrometry equipment used at the lab to screen samples for more than 240 banned substances in under 24 hours has provided the best anti-doping system officials could have hoped for.

A spokesman for the International Olympic Committee (IOC) said on the Saturday before the Games’ closing ceremony, that there had been 4,686 anti-doping tests so far, of which 3,729 were on urine samples and 957 had analysed blood.

Who gets caught?

The WADA Director General, David Howman, has drawn a distinction between “dopey dopers” who still have traces of banned substances in their system during major competition, and sophisticated cheats who are able to beat the system outside competition.

While strides have been made in the out-of-competition testing regime, including the introduction of the controversial “whereabouts” policy that requires elite athletes in every sport to make themselves available for spot testing at any time, there are huge concerns about whether they are doing enough to keep up.

Although sophisticated new methods are being developed to test for EPO and Human Growth Hormone, they are expensive and require refrigerated blood samples to be carried for sometimes thousands of miles to the labs capable of carrying out the tests. WADA is concerned the cost is preventing many countries carrying out as many tests for blood doping as they should be.

It is feared that of the 258,000 tests conducted annually, as few as 2% include the blood tests that can detect the use of Human Growth Hormone. In 2010 there were just 36 positives – a total WADA regarded as “disappointing”. Across sport, there are fears that one in 10 athletes is attempting to cheat but of those only one in five is being caught.

 Was London 2012 relatively drug-free?

There were very few actual positive tests from the 2012 Olympics. This relative paucity of positive drug tests could mean one of two things.

That we are winning the war against drugs and the extensive testing and prospect of retrospective disqualification had succeeded in putting athletes off.

Alternatively, as has always been the case, that the athletes, coaches and scientists have perfected the art of avoiding detection using regular low dosages of drugs and hormones that are too small to detect. There are certainly plenty of rumours of endurance athletes using daily low doses of synthetic blood products which maintain high red blood cell count rather than using EPO. Victor Conte of BALCO fame was in London (I thought he was in jail!!) and claimed that 60% of athletics medallists were taking drugs. Probably not the most reliable witness, but he certainly knows the drug scene!

I believe that the use of performance-enhancing drugs is still widespread in certain Olympic sports. History tells us that there have always been athletes and coaches trying to gain an advantage. History also tells us that they are invariably ahead of the drug testers, thus the relatively small number of positive drug tests at Olympics. Out-of-competition testing and the co-operation of customs and law enforcement agencies have helped catch some drug cheats, but I cannot believe there are not lots more out there getting away with it.

Dr Peter Brukner (@PeterBrukner) is an Associate Editor of BJSM and an Australian sports medicine physician, author and media commentator living in Liverpool, UK. Currently working with Sky Sports News and one of the sports physicians working with the Australian cricket team. This blog was reposted from Peter Brukner’s website  where you can find other blogs about the Olympics and sport and exercise medicine broadly.

Related BJSM papers:

Traditional Chinese medicine and sports drug testing: identification of natural steroid administration in doping control urine samples resulting from musk (pod) extract.  Mario Thevis et al.

Would you dope? A general population test of the Goldman dilemma. J M Connor, J Mazanov

Doping prevalence among preadolescent athletes: a 4-year follow-up. P Laure, C Binsinger.  Br J Sports Med 2007;41:10 660-663


Is high level snowboard too dangerous to allow your children to participate?

1 Mar, 12 | by Karim Khan

Guest blog by Professor Lars Engebretsen

Photo by Aktivioslo, Flickr CC

The recent World Championship in Snowboard in Oslo, Norway led me to the question in this blog’s title. I am a sports doc with extensive experience in treating high level athletes in almost all kinds of sports (except Aussie rules football and cricket).

Since 2000, I have been involved in studies aiming at preventing sports injuries. We have targeted football (soccer), team handball and Alpine skiing and have had some success.  Newer sports however, keep popping up. Almost like the doping hunters  – often being too late to prevent new, effective performance drugs – it seems that we are too late to prevent injuries in some of the new sports.  I was reminded of this during the recent Snowboard Championship in Oslo: new venues for cross, half pipe and slope style situated beautifully in the Oslo countryside. The first days had bad weather and difficult light and there were some serious injuries- not life threatening, but nevertheless serious.

I have noticed a similarity with the last few Olympic games: the venues get bigger, the athletes better trained and with ever increasing abilities. Unfortunately, there is also an increase in injuries. The numbers from Vancouver showed that 35% of snowboard cross and 13% of half pipers experienced injuries.

What can we do to prevent these? We can count injuries, identify risk factors, study how to reduce these and aggressively implement our knowledge. In the meantime, the sporting venues get larger and more challenging and knowledge from our studies become yesterday’s news. I know that the majority of the athletes appreciate the danger, but I am not sure that the top leaders of the sport have the same awareness.

I need ideas to help the athletes operate in a safer environment- any ideas?

Note that the BJSM publishes 4 issues a year dedicated to Injury Prevention and athletes’ Health Protection (IPHP). You can find these issues of BJSM by clicking here. The next IPHP issue will launch in June and will focus on Olympic Sports. IPHP issues are published as part of BJSM’s partnership with the International Olympic Committee.

Nik Zoricik dcath: News story here. (added March 10th). Updated March 15th


Related Articles

Bakken A, Bere T, and Bahr R et. al. 2011. Mechanisms of injuries in World Cup Snowboard Cross: a systematic video analysis of 19 casesBr J Sports Med. 45:1315-1322 Published Online First: 15 November 2011.

Lars Engebretsen L and  Steffen K. 2009. Warm up The importance of sports medicine for the Vancouver Olympic Games. Br J Sports Med. 43:961-962.

J Torjussen J,  and Bahr R. 2006. Injuries among elite snowboarders (FIS Snowboard World Cup)Br J Sports Med. 40:230-234 .

Engebretsen L, and Bahr R. 2005. Injury prevention – Leader An ounce of prevention? Br J Sports Med. 39:312-313.


Lars Engebretsen MD PhD is a professor and director of research at Orthopaedic Center, Ullevål university hospital and University of Oslo Medical School and professor and co-chair of the Oslo Sports Trauma Research Center. He is also Chief Doctor for the Norwegian Federation of Sports, and headed the medical service at the Norwegian Olympic Center until the autumn of 2011. In 2007 he was appointed Head of Science and Research for the International Olympic Comittee (IOC). Professor Engebretsen is Editor of the IPHP issues of BJSM (Injury Prevention & Health Protection)

Feature issue on young people and sport — all the experts in one room!

21 Aug, 11 | by Karim Khan

The IOC has made many terrific contribution to sports medicine education and policy. We emphasize its partnership with the BJSM through the 2009-2012 Olympic cycle – the IOC has convened conferences on major topics and added tremendous value to the field by publishing summary documents in quarterly themed issues of BJSM. Lars Engebretsen is the editor of these 4 annual IOC issues that focus on Injury Prevention and Health Promotion. For example, the summary statement on non-contact ACL injuries has had well over 25,000 downloads –  just one example of great influence! But enough about the knee already – this blog is about kids!


Check the outcomes of February’s IOC Consensus Meeting on the health and fitness of young people through physical activity and sport. There is an authoritative Consensus Paper (free as editor’s choice).

Papers by Neil Armstrong and by Ulf Ekelund review the current levels of fitness and activity in young people. Have the kids really gone to pot?

How physical inactivity links with cardiovascular disease, obesity, bone health, mental health issues and sports injury are all captured in this issue.

And that’s just a taste! Check out the table of contents and Dr Margo Mountjoy’s overview of the role of sport in the health and fitness of young people.

Keeping with BJSM’s ongoing theme of ‘implementation’, there is also a paper examining ‘Context for Action’ — how various organizations and institutions can promote sport participation and address inactivity in youth.

Check it out! And remember, you can get an alert to our 3 times weekly blogs via Twitter – @BJSM_BMJ.

Did I mention the podcasts? Over 20 experts in sports medicine via the convenience of podcasts.

Enough for now! Have a great, injury-free and physically active day!

IOC partnership: Children and Sport BJSM theme issue

13 Aug, 11 | by Karim Khan

This issue of BJSM – one of the 16 annually – focuses on keeping young people healthy. Many readers are not aware that the IOC and BJSM partner to produce 4 issues of the BJSM annually. These issues focus on the IOC mission of ‘Athlete Protection and Health Promotion’. The special issues, generally appearing in March, June, September and December (issue numbers 3, 7, 11, 15) are tagged as Injury Prevention and Health Promotion (IPHP) issues.

The (IOC) recognises the health and fitness benefits of physical activity (PA) and sport as stated in recommendation #51 from the Olympic Movement in Society Congress  Everyone involved in the Olympic Movement must become more aware of the fundamental importance of Physical Activity and sport for a healthy lifestyle, not least in the growing battle against obesity, and must reach out to parents and schools as part of a strategy to counter the rising inactivity of young people.1

Read the consensus paper from the expert group meeting in Lausanne

The IOC expert group  discussed the role of PA and sport on the health and fitness of young people and to critically evaluate the scientific evidence as a basis for decision making. Specifically, the purpose of this consensus paper is to identify potential solutions through collaboration between sport and existing programmes and to review the research gaps in this field. The ultimate aim of the paper is to provide recommendations for those involved in young people’s sport.

We’ll highlight other papers from the issue this week – check out the table of contents.

Comment via the box below or to Send us a Guest Blog! You just email the word document and we do the rest! Follow BJSM on Twitter @BJSM_BMJ for updates to the blog and links to other interesting practical sports and exercise medicine for clincians.

BJSM in US News and World Report

10 Nov, 09 | by Karim Khan

BJSM aims to be relevant to clinicians and to influence practice. It has been pleasing to see BJSM quoted in the New York Times, the Financial Post, and other major international news outlets. Our September issue (PDF), in partnership with the IOC continues to have an impact the world over. This link is to the widely read US News. To read the editorial about sudden cardiac death for athletes in the September issue click here.

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