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{{Short description|Substance used to improve any form of activity performance in humans}}
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'''Performance-enhancing substances''', also known as '''performance-enhancing drugs''' ('''PEDs'''),<ref>{{Cite web | url=http://www.usada.org/substances/effects-of-performance-enhancing-drugs/ | title=Effects of Performance-Enhancing Drugs | USADA| date=May 2019}}</ref> are substances that are used to improve any form of activity performance in humans.
'''Performance-enhancing substances''', also known as '''performance-enhancing drugs''' ('''PEDs'''),<ref>{{Cite web | url=http://www.usada.org/substances/effects-of-performance-enhancing-drugs/ | title=Effects of Performance-Enhancing Drugs | USADA| date=May 2019}}</ref> are substances that are used to improve any form of activity performance in humans. A well-known example of [[cheating in sports]] involves [[doping in sport]], where banned physical performance-enhancing drugs are used by athletes and [[bodybuilding|bodybuilders]]. Athletic performance-enhancing substances are sometimes referred as '''ergogenic aids'''.<ref name="Pesta2013">{{cite journal |vauthors=Pesta DH, Angadi SS, Burtscher M, Roberts CK |date=December 2013 |title=The effects of caffeine, nicotine, ethanol, and tetrahydrocannabinol on exercise performance |journal=Nutrition & Metabolism |volume=10 |issue=1 |pages=71 |doi=10.1186/1743-7075-10-71 |pmc=3878772 |pmid=24330705 |doi-access=free }}</ref><ref name="Ergogenics">{{cite journal |vauthors=Liddle DG, Connor DJ |date=June 2013 |title=Nutritional supplements and ergogenic AIDS |journal=Primary Care |volume=40 |issue=2 |pages=487–505 |doi=10.1016/j.pop.2013.02.009 |pmid=23668655 |quote=Amphetamines and caffeine are stimulants that increase alertness, improve focus, decrease reaction time, and delay fatigue, allowing for an increased intensity and duration of training ...<br />Physiologic and performance effects [of amphetamines]<br />{{•}}Amphetamines increase dopamine/norepinephrine release and inhibit their reuptake, leading to central nervous system (CNS) stimulation<br />{{•}}Amphetamines seem to enhance athletic performance in anaerobic conditions 39 40<br />{{•}}Improved reaction time<br />{{•}}Increased muscle strength and delayed muscle fatigue<br />{{•}}Increased acceleration<br />{{•}}Increased alertness and attention to task}}</ref> Cognitive performance-enhancing drugs, commonly called [[nootropics]],<ref name="Smart drugs" /> are sometimes used by students to improve academic performance. Performance-enhancing substances are also used by military personnel to enhance combat performance.<ref>[https://dash.harvard.edu/handle/1/8848246 Anon. Better Fighting Through Chemistry? The Role of FDA Regulation in Crafting the Warrior of the Future.] Food and Drug Law: Final Paper. 8 March 2004.</ref>▼
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== Definition ==
The classifications of substances as performance-enhancing substances are not entirely clear-cut and objective. As in other types of [[categorization]], certain [[Prototype theory|prototype]] performance enhancers are universally classified as such (like [[anabolic steroids]]), whereas other substances (like [[vitamins]] and [[protein]] supplements) are virtually never classified as performance enhancers despite their effects on performance. As is usual with categorization, there are borderline cases; [[caffeine]], for example, is considered a performance enhancer by some but not others.<ref>{{cite web |url=http://www.vanderbilt.edu/AnS/psychology/health_psychology/caffeine_sports.htm |title=Caffeine and Sports Performance |publisher=Vanderbilt.edu |access-date=4 March 2012 |archive-date=29 February 2012 |archive-url=https://web.archive.org/web/20120229060541/http://www.vanderbilt.edu/AnS/psychology/health_psychology/caffeine_sports.htm |url-status=dead }}</ref>
== Types ==
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===Anabolic steroids===
{{Main|Anabolic steroid}}
Anabolic steroids are synthetically derived from testosterone and modified to have greater anabolic effects.<ref name=":8">{{Cite journal |last=Kicman |first=A T |date=June 2008 |title=Pharmacology of anabolic steroids |journal=British Journal of Pharmacology |volume=154 |issue=3 |pages=502–521 |doi=10.1038/bjp.2008.165
===Stimulants===
{{Main|Stimulant}}
Stimulants improve focus and alertness. Low (therapeutic) doses of [[dopaminergic]] stimulants (e.g., [[reuptake inhibitor]]s and [[releasing agent]]s) also promote mental and athletic performance, as cognitive enhancers and ergogenic aids respectively, by improving muscle strength and endurance while decreasing [[mental chronometry|reaction time]] and fatigue.<ref name="Ergogenics" /><ref name="Ergogenics2">{{cite journal |vauthors=Parr JW |date=July 2011 |title=Attention-deficit hyperactivity disorder and the athlete: new advances and understanding |journal=Clinics in Sports Medicine |volume=30 |issue=3 |pages=591–610 |doi=10.1016/j.csm.2011.03.007 |pmid=21658550 |quote=In 1980, Chandler and Blair<sup>47</sup> showed significant increases in knee extension strength, acceleration, anaerobic capacity, time to exhaustion during exercise, pre-exercise and maximum heart rates, and time to exhaustion during maximal oxygen consumption (VO2 max) testing after administration of 15 mg of dextroamphetamine versus placebo. Most of the information to answer this question has been obtained in the past decade through studies of fatigue rather than an attempt to systematically investigate the effect of ADHD drugs on exercise. ... In 2008, Roelands and colleagues<sup>53</sup> studied the effect of reboxetine, a pure NE reuptake inhibitor, similar to atomoxetine, in 9 healthy, well-trained cyclists. They too exercised in both temperate and warm environments. They showed decreased power output and exercise performance at both 18 and 30 degrees centigrade. Their conclusion was that DA reuptake inhibition was the cause of the increased exercise performance seen with drugs that affect both DA and NE (MPH, amphetamine, and bupropion).}}</ref><ref name="Amph-DA reaction time">{{cite journal |vauthors=Parker KL, Lamichhane D, Caetano MS, Narayanan NS |date=October 2013 |title=Executive dysfunction in Parkinson's disease and timing deficits |journal=Frontiers in Integrative Neuroscience |volume=7 |pages=75 |doi=10.3389/fnint.2013.00075 |pmc=3813949 |pmid=24198770 |quote=Manipulations of dopaminergic signaling profoundly influence interval timing, leading to the hypothesis that dopamine influences internal pacemaker, or "clock," activity. For instance, amphetamine, which increases concentrations of dopamine at the synaptic cleft advances the start of responding during interval timing, whereas antagonists of D2 type dopamine receptors typically slow timing;... Depletion of dopamine in healthy volunteers impairs timing, while amphetamine releases synaptic dopamine and speeds up timing. |doi-access=free}}</ref> Stimulants are commonly used in lengthy exercises that require short bursts (e.g., tennis, team sports, etc.).<ref>{{Cite web |title=Office of Dietary Supplements
=== Ergogenic aids ===
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==== Examples ====
{{Main|Human growth hormone|Creatine|Beta-Hydroxy-Beta-methylbutyrate}}
* '''Human [[biomolecule]]s''' – creatine and [[β-hydroxy β-methylbutyrate]] are naturally occurring compounds in humans that have well-established ergogenic effects and effects on body composition when supplemented.<ref name="PEDs in sports review">{{cite journal | vauthors = Momaya A, Fawal M, Estes R | title = Performance-enhancing substances in sports: a review of the literature | journal = Sports Medicine | volume = 45 | issue = 4 | pages = 517–531 | date = April 2015 | pmid = 25663250 | doi = 10.1007/s40279-015-0308-9 | s2cid = 45124293 }}</ref>▼
* '''[[Creatine]]''': one of the most popular nutritional supplements, it contributes to 400 million dollars in sales globally every year.<ref name=":12">{{Cite journal |last1=Butts |first1=Jessica |last2=Jacobs |first2=Bret |last3=Silvis |first3=Matthew |date=2017-10-23 |title=Creatine Use in Sports |journal=Sports Health |volume=10 |issue=1 |pages=31–34 |doi=10.1177/1941738117737248 |issn=1941-7381 |pmc=5753968 |pmid=29059531}}</ref> It is a nonessential amino acid that helps to improve an athlete's performance during short-term, high intensity exercises such as weightlifting.<ref>{{Cite journal |last=Kreider |first=Richard B. |date=February 2003 |title=Effects of creatine supplementation on performance and training adaptations |url=https://pubmed.ncbi.nlm.nih.gov/12701815/ |journal=Molecular and Cellular Biochemistry |volume=244 |issue=1–2 |pages=89–94 |doi=10.1023/A:1022465203458 |issn=0300-8177 |pmid=12701815|s2cid=35050122 }}</ref> Supplementation of creatine increases skeletal muscle creatine levels, this boosts performance by increasing the rate at which [[adenosine triphosphate]] can be replenished from [[adenosine diphosphate]], thereby increasing maximal power output.<ref name=":12" /> Potential side effects include gastrointestinal cramps, weight gain, fatigue, and diarrhea.<ref>{{Cite journal |last1=Francaux |first1=Marc |last2=Poortmans |first2=Jacques R. |date=December 2006 |title=Side effects of creatine supplementation in athletes |url=https://pubmed.ncbi.nlm.nih.gov/19124889/ |journal=International Journal of Sports Physiology and Performance |volume=1 |issue=4 |pages=311–323 |doi=10.1123/ijspp.1.4.311 |issn=1555-0265 |pmid=19124889}}</ref> Creatine is currently not recognized as a prohibited substance and can be purchased as a legal dietary supplement.<ref>{{Cite web |last=Perishable |date=2021-03-10 |title=What Do Athletes Need to Know About Creatine? {{!}} USADA |url=https://www.usada.org/spirit-of-sport/education/athletes-need-know-creatine/ |access-date=2022-04-12 |language=en-US}}</ref>
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* '''[[Growth hormone|Human Growth Hormone]] (hGH)''': endogenous hormone that can help decrease fat mass while increasing lean body mass.<ref name=":13">{{Cite journal |last1=Saugy |first1=M |last2=Robinson |first2=N |last3=Saudan |first3=C |last4=Baume |first4=N |last5=Avois |first5=L |last6=Mangin |first6=P |date=July 2006 |title=Human growth hormone doping in sport |journal=British Journal of Sports Medicine |volume=40 |issue=Suppl 1 |pages=i35–i39 |doi=10.1136/bjsm.2006.027573 |issn=0306-3674 |pmc=2657499 |pmid=16799101}}</ref> hGH is one of the most commonly used substances among professional athletes because it has a small window for detection.<ref name=":13" /> It works by promoting the release of [[IGF-1]], insulin-like growth factor, the release of which has anabolic effects on the body.<ref>{{Cite journal |last=Laron |first=Z |date=October 2001 |title=Insulin-like growth factor 1 (IGF-1): a growth hormone |journal=Molecular Pathology |volume=54 |issue=5 |pages=311–316 |doi=10.1136/mp.54.5.311 |issn=1366-8714 |pmc=1187088 |pmid=11577173}}</ref> Potential side effects include: [[cardiomyopathy]], [[diabetes]], [[Kidney failure|renal failure]], and [[hepatitis]].<ref>{{Cite journal |last1=Siebert |first1=David M. |last2=Rao |first2=Ashwin L. |date=October 2018 |title=The Use and Abuse of Human Growth Hormone in Sports |journal=Sports Health |volume=10 |issue=5 |pages=419–426 |doi=10.1177/1941738118782688 |issn=1941-0921 |pmc=6116101 |pmid=29932857}}</ref> If not prescribed by a professional, it is a banned substance in competition per [[World Anti-Doping Agency|WADA]].<ref name=":11" /> Despite its small window for detection, two primary methods of testing have been developed for hGH, one being an isoform test which detects changes in growth hormone structure in the blood,<ref name=":15">{{Cite journal |last=Baumann |first=Gerhard P. |date=April 2012 |title=Growth hormone doping in sports: a critical review of use and detection strategies |journal=Endocrine Reviews |volume=33 |issue=2 |pages=155–186 |doi=10.1210/er.2011-1035 |issn=1945-7189 |pmid=22368183|doi-access=free }}</ref> and the markers test, which detects changes in serum protein ratios.<ref name=":15" />
===Adaptogens===
{{Main|Adaptogen}}
Adaptogens are plants that support health through nonspecific effects, neutralize various environmental and physical stressors while being relatively safe and free of side effects.<ref name="pmid23574283">{{cite journal | vauthors = Koncic MZ, Tomczyk M | title = New insights into dietary supplements used in sport: active substances, pharmacological and side effects | journal = Current Drug Targets | volume = 14 | issue = 9 | pages = 1079–1092 | date = August 2013 | pmid = 23574283 | doi = 10.2174/1389450111314090016 }}</ref> As of 2008, the position of the [[European Medicines Agency]] was that "The principle of an adaptogenic action needs further clarification and studies in the pre-clinical and clinical area. As such, the term is not accepted in pharmacological and clinical terminology that is commonly used in the EU."<ref>{{cite web|title=Reflection Paper on the Adaptogenic Concept
=== Actoprotectors ===
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==== Sedatives and anxiolytics====
{{Main|Sedative|Anxiolytic}}
Sedatives and anxiolytics are used in sports like [[archery]] which require steady hands and accurate aim, and also to overcome excessive nervousness or discomfort for more dangerous sports. [[Diazepam]], nicotine, and [[propranolol]] are common examples. [[Ethanol]], the most commonly used substance by athletes, can be used for cardiovascular improvements though has significant detrimental effects. Ethanol was formerly banned by WADA during performance for athletes performing in aeronautics, archery, automobile, karate, motorcycling and powerboating, but was taken off the ban list in 2017. It is detected by [[Breath test|breath]] or [[blood testing]]. [[Cannabis (drug)|Cannabis]] is banned at all times for an athlete by WADA, though performance-enhancing effects have yet to be studied. Cannabis and nicotine are detected through [[urine analysis]].<ref name="Pesta2013" /><ref>{{cite news |title=
=== Blood boosters ===
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=== Prohormones ===
{{Main|Prohormone}}
Also known as anabolic steroid precursors, they promote [[lean body mass]].<ref name=":18">{{Cite journal |last1=Delbeke |first1=Frans T. |last2=Van Eenoo |first2=Peter |last3=Van Thuyne |first3=Wim |last4=Desmet |first4=Noël |date=December 2002|title=Prohormones and sport |url=https://pubmed.ncbi.nlm.nih.gov/12650722/ |journal=The Journal of Steroid Biochemistry and Molecular Biology |volume=83 |issue=1–5 |pages=245–251 |doi=10.1016/s0960-0760(02)00274-1 |issn=0960-0760 |pmid=12650722|s2cid=46183096 }}</ref> Once in the body, these precursors are converted to [[testosterone]] and
== History ==
While the use of PEDs has expanded in recent times, the practice of using substances to improve performance has been around since the [[Ancient Olympic Games]].<ref>{{cite journal | vauthors = Prendergast HM, Bannen T, Erickson TB, Honore KR | title = The toxic torch of the modern Olympic Games | journal = Veterinary and Human Toxicology | volume = 45 | issue = 2 | pages = 97–102 | date = March 2003 | pmid = 12678299 | url = }}</ref> In the Olympic Games of 668 BC, [[List of Olympic winners of the Stadion race|Charmis]] had consumed a diet consisting of dried figs which was a significant factor in winning the 200-yard stade race.<ref>{{cite journal | vauthors = Holt RI, Erotokritou-Mulligan I, Sönksen PH | title = The history of doping and growth hormone abuse in sport | journal = Growth Hormone & IGF Research | volume = 19 | issue = 4 | pages = 320–326 | date = August 2009 | pmid = 19467612 | doi = 10.1016/j.ghir.2009.04.009 }}</ref><ref name="Breenfeldt2022">{{Cite journal |last1=Breenfeldt Andersen |first1=Andreas |last2=Nordsborg |first2=Nikolai Baastrup |last3=Bonne |first3=Thomas Christian |last4=Bejder |first4=Jacob |date=2022-12-26 |title=Contemporary blood doping—Performance, mechanism, and detection |url= |journal=Scandinavian Journal of Medicine & Science in Sports |volume=34 |issue=1 |pages=sms.14243 |language=en |doi=10.1111/sms.14243 |pmid=36229224 |s2cid=252898039 |issn=0905-7188|doi-access=free }}</ref> Ancient Greek athletes at the time also incorporated stimulants such as wine and brandy into their training routines.<ref>{{cite journal | vauthors = Conti AA | title = Doping in sports in ancient and recent times | journal = Medicina Nei Secoli | volume = 22 | issue = 1–3 | pages = 181–190 | date = 2010 | pmid = 21560989 | url = https://pubmed.ncbi.nlm.nih.gov/21560989 }}</ref> Stimulants derived from plants (e.g., [[Cola nitida|Cola Nitida]], [[Bufotenin|Bufotein]], etc.) were used by the [[Gladiator|Roman Gladiators]] to overcome injuries and fatigue.<ref name=":7" />
In the late 19th century as [[Medicine|modern medicine]] and [[pharmacology]] were developing, PEDs saw an increase in use.<ref name=":0">{{cite journal | vauthors = Baron DA, Martin DM, Abol Magd S | title = Doping in sports and its spread to at-risk populations: an international review | journal = World Psychiatry | volume = 6 | issue = 2 | pages = 118–123 | date = June 2007 | pmid = 18235871 | pmc = 2219897 }}</ref> Supplements were now exclusively being used to enhance muscular work capacity.<ref name=":0" /> The main stimulants being used included [[alcoholic drink]]s, caffeine, and mixtures created by the athletic trainers (e.g., [[strychnine]] tablets made of cocaine and [[brandy]]).<ref name=":1">{{cite journal | vauthors = Knechtle B, Nikolaidis PT | title = Physiology and Pathophysiology in Ultra-Marathon Running | journal = Frontiers in Physiology | volume = 9 | pages = 634 | date = 2018 | pmid = 29910741 | pmc = 5992463 | doi = 10.3389/fphys.2018.00634 | doi-access = free }}</ref>
In the 20th century, testosterone was isolated and characterized by scientists.<ref name=":3">{{cite journal | vauthors = Freeman ER, Bloom DA, McGuire EJ | title = A brief history of testosterone | journal = The Journal of Urology | volume = 165 | issue = 2 | pages = 371–373 | date = February 2001 | pmid = 11176375 | doi = 10.1097/00005392-200102000-00004 }}</ref> In 1941, the first record of synthesized testosterone use occurred when a horse was given testosterone which successfully improved its race performance.<ref>{{Cite journal |last1=Waller |first1=Christopher C. |last2=McLeod |first2=Malcolm D. |date=12 October 2016 |title=A review of designer anabolic steroids in equine sports: Designer steroids in equine sports |journal=Drug Testing and Analysis |language=en |volume=9 |issue=9 |pages=1304–1319 |doi=10.1002/dta.2112|pmid=27732767 |hdl=1885/146363 |s2cid=9056906 |doi-access=free |hdl-access=free }}</ref> Sports trainers soon after began advocating for testosterone use.<ref name=":3" /> Images of [[Bodybuilding|bodybuilders]] with massive muscles began circulating which further perpetuated a desire among athletes to use testosterone.<ref name=":2">{{cite journal | vauthors = Eidelsberg J | title = Testosterone pellet implantation | journal = The Journal of Clinical Endocrinology and Metabolism | volume = 6 | pages = 423–425 | date = June 1946 | issue = 6 | pmid = 20988415 | doi = 10.1210/jcem-6-6-423 }}</ref><ref name=":3" /> In 1967, the first prohibited substance list and anti-doping measures were implemented at the 1968 Olympics.<ref name="Breenfeldt2022" />
In the 1980s, the main PEDs were [[cortisone]] and [[anabolic steroid]]s.<ref>{{Cite web | author =National Institute on Drug Abuse |date= |title=What is the history of anabolic steroid use? |url=https://nida.nih.gov/publications/research-reports/steroids-other-appearance-performance-enhancing-drugs-apeds/what-history-anabolic-steroid-use |access-date=2022-04-05 |website=National Institute on Drug Abuse |language=en}}</ref> In 1988, the United States Congress established the [[Anti-Drug Abuse Act of 1986|Anti-Drug Abuse Act]] to criminalize the distribution and possession of non-medical anabolic steroids.<ref name=":4">{{cite journal | vauthors = Kitagawa H, Hisatsune J, Ohge H, Kutsuno S, Hara T, Masuda K, Aziz F, Sugai M
== Risk factors ==
Adolescents are the most vulnerable group when it comes to taking performance-enhancing substances.<ref name=":5">{{cite journal | vauthors = White ND, Noeun J | title = Performance-Enhancing Drug Use in Adolescence | journal = American Journal of Lifestyle Medicine | volume = 11 | issue = 2 | pages = 122–124 | date = March 2017 | pmid = 30202322 | pmc = 6125030 | doi = 10.1177/1559827616680593 }}</ref> This is in part due to the significance placed on physical appearance by this age group as well as feelings of invincibility combined with a lack of knowledge surrounding long-term consequences.<ref name=":5" /> Studies have shown that the most common gendered risk factors include being an adolescent female dissatisfied with their body weight or an adolescent male who perceives larger body sizes as the ideal.<ref name=":6">{{cite journal | vauthors = Dandoy C, Gereige RS | title = Performance-enhancing drugs | journal = Pediatrics in Review | volume = 33 | issue = 6 | pages = 265–271; quiz 271–272 | date = June 2012 | pmid = 22659257 | pmc = 4528343 | doi = 10.1542/pir.33-6-265 }}</ref> Having a negative body image or a history of depression can also be a significant risk factor.<ref name=":6" /> These are further exacerbated by parental pressures surrounding appearance, media influence, and peer pressure.<ref name=":5" /><ref name=":7">{{cite journal | vauthors = Yager Z, O'Dea JA | title = Relationships between body image, nutritional supplement use, and attitudes towards doping in sport among adolescent boys: implications for prevention programs | journal = Journal of the International Society of Sports Nutrition | volume = 11 | issue = 1 | pages = 13 | date = March 2014 | pmid = 24670105 | pmc = 3986904 | doi = 10.1186/1550-2783-11-13 | doi-access = free }}</ref>
Studies show that adolescent males who engage with fitness magazines are twice as likely to use performance-enhancing substances.<ref name=":7" /> Adolescents who partake in competitive sports are at a particularly high risk, with those involved in gridiron football, basketball, wrestling, baseball, and gymnastics at the top.<ref name=":7" /> == Usage in sport ==
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== See also ==
* [[Cosmetic pharmacology]]
* [[Ergogenic use of anabolic steroids]]
* [[List of doping cases in sport]]
* [[List of drugs used by militaries]]
* [[Natural bodybuilding]]
* [[Neuroenhancement]]
* [[Steroid use in American football]]
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