Barefoot running and injuries

Barefoot running - it was a stimulus plan for physical therapists after all

About four months ago, we did a lengthy series on barefoot running, which began with this post on the latest research from the Harvard lab looking at how habitual barefoot runners' mechanics different from shod runners'.  That was followed up by a six-part series, done in Q & A format, where we looked at the evidence for barefoot running as a means to prevent injury.

In that very first post, looking at the Harvard study, we made mention of barefoot running being a "stimulus plan for physical therapists".  This was entirely predictable, because the media jumped all over the Harvard study and reported it as "proof" that running barefoot was less likely to cause injury as a result of the lower impact forces it caused.  This was despite the paper actually reminding people that it had NOT shown this at all.  Its final sentence was "controlled prospective studies are needed to test the hypothesis that individuals who do not predominantly RFS either barefoot or in minimal footwear, as the foot apparently evolved to do, have reduced injury rates". 

This research came along into a "market" that was increasingly moving towards barefoot running.  The book "Born to Run" described the feats (pardon the pun) of a tribe of Mexican Indians, and gave legs to the movement that was picking up followers all over the world.  Barefoot was suddenly the way of the future.  It inspired our series, and much debate on the issue.  All the while though, people were trying to advocate caution, warning that simply going from shoes to barefoot would guarantee injury.

Increased injury rates - the stimulus plan is working

It should come as no surprise that medical doctors and physical therapists are now beginning to pick up on a potential fall-out from the "Born to Run" movement.  Our friend (and book co-author) Matt Fitzgerald has hunted a few down, and his report details of a sudden increase in injuries caused by barefoot running. According to those he interviewed, the nature and number of injuries has changed in recent times.

There is however a missing piece of the puzzle here.  First, the increase in the number of people running barefoot would produce more barefoot injuries even if the relative risk was the same.  Imagine that in a community, 100 people run, 80 of them in shoes and 20 of them barefoot.  If the injury rate is equal for both at 10%, therapists will treat 10 patients, 8 who run in shoes, 2 who run barefoot. 

But if a book or research studies plus the media inspires 40 people to switch to barefoot running rather than shoes, the split would now be 40 in shoes, 60 barefoot.  Now, even if the injury risk stayed the same, they'd suddenly treat fewer injuries from shod runners (4) and more from barefoot runners (6).  Has barefoot running caused more injuries?  Or has running caused the same injury rate, regardless of what is on the foot?  That's why properly controlled prospective studies are still needed. 

However, one of the doctors who Matt interviews is still of the opinion that the barefoot running is responsible for specific injuries.  He explains how plantar fasciitis injuries are on the rise, and attributes this not to overuse, but to barefoot running.  He also pins down why those who swtich to barefoot running often don't report injury.  His words: “There are a fair amount of people who have tried it but have stopped pretty quick, just because they realized that it was not going to work for them,” he says.

The spike in injuries - the stimulus plan

The potential spike in injuries is similar to that which I once saw reported as a result of Pose.  I recall reading how therapists always saw increased patient numbers about two weeks after a Pose running course had been held in the city.  Runners, armed with a new, injury-preventing running technique, were going away to implement what they had learned without due caution, and breaking down at either the calf, foot or Achilles tendons.

The same will happen for barefoot running, unless the runner is a) very, very careful to manage the transition slowly, and b) mechanically able to do it.

I raise point b) because this is something we don't fully understand yet, but I am convinced that there are individuals who simply cannot get away with barefoot running.  I may yet be shown to be incorrect, but only evidence will convince me of this, not the anecdotes of the few who are successful at making the transition.  Those who fail rarely speak out - they just switch back to shoes.  Those who are successful tend to be vocal, and I believe this is why the risk has been under-recognized.

Having said all this, I don't believe that barefoot running is without its merits.  And please, before I get slated for selling out to shoe-companies, take some time to read the series we did on barefoot running (especially Part 5).  I know it's long, but it lays out all the thoughts, and ultimately concludes that there is merit, but that caution must be used, and if you advocate that barefoot is the only way to go, you're making the same 'extremist' error that shoe-companies are being accused of making.  I don't want to rehash all the same arguments again - they're in that series. 

Conclusion - universal truth doesn't exist

But bottom line - don't buy into the hype.  Try it out, with caution.  See if you enjoy it (it is a lot of fun), see if you feel different and then build it slowly into the programme. But if it doesn't work, don't believe the 'criticisms' that it's your fault.  I've heard these re both Pose and barefoot running - if you run Pose and get injured, you may be told that it's because you've failed to do it right.  If you run barefoot with injury, you will be told that it you haven't made the transition gradual enough, or that you're landing with a stiff ankle, or pointing your toes, or some variation which ultimately boils down to "It's you, not the concept".

It is not true.  It may just be that you cannot do it.  One-size-fits-all fits exactly no-one.  So rise above the generalization and hype!

Ross

Denials, acceptance and anti-doping progress

Finger-pointing, a catch 22 and a reaction to move cycling forward

The aftermath of Floyd Landis' allegations have continued to dominate the cycling news of late, and have produced some lively discussion here, in response to Jonathan's post regarding the pressures faced by cyclists.

In those discussions, I've seen what I believe to be a great deal of rationalization taking place from those who defend cycling as a whole, or individuals within it, against these latest allegations.  I call them rationalizations under-advisement, and perhaps I should begin by acknowledging that in some instances, perhaps many, rationalizations are in fact true.

But there are two main responses that I believe exist, neither of which moves cycling forward.  The first is the finger-pointing at other sports.  It is pretty widely accepted that cycling, by virtue of its history, perhaps beginning with the Festina scandal of 1998, has had the spotlight cast squarely on its doping problem.  One scandal after another, every major champion tainted, many confessing or being caught, and cycling was eventually at a precipice.  Police took over and raided hotel rooms.  Media began to refuse to cover the sport, focusing instead on doping stories.  Sponsors threatened to withdraw (and some did in response to doping scandals).  And as a result of this turbulent, harshly exposed environment, came the biological passport, more 'Draconian' anti-doping measures, and sport that many have defended as being the most tightly controlled, scrutinized in the world.

My objection to this is that cycling's anti-doping status in relation to others sports is utterly and completely irrelevant to the current problem.  Imagine a criminal court where the judge is about to rule on a man convicted of robbery.  In the robber's defence, it is argued that other men are getting away with murder, and hence the robber should go free.  Each situation should be treated on its merits, and it is NOT a defence to point out the failures of others!   It is widely acknowledged that other sports have doping problems, and yes, some of them (NFL and MLB foremost among them, it seems) are doing little to clamp down on it.

One can argue whether the problem is as bad in athletics - I would argue that it is not, for a variety of reasons, but the main drivers are the calendar, the team environment, the culture of the sport, and its socio-economic status and "meritocracy", which I think add up to create a "perfect storm" for doping.  Doping no doubt exists, but I think there's a reason cycling has been exposed, and that reason is that cycling had (or has) the worst problem.  And, according to some, it still does.  In the words of David Walsh, who I agree with 100%, cycling needs to be torn down.  And also, don't forget that athletics has gone through its fair share of scandals - Marion Jones, THG, BALCO, Victor Conte, Ben Johnson and Charlie Francis, so is not devoid of the same media attention and focus.

But to use cycling's "more stringent" controls as justification for leniency on cyclnig is precisely the attitude that will keep the sport from moving forward and making progress.

And make progress it has - we got a few really good comments regarding the Giro, and Ivan Basso's stage win on the Zoncolan the other day.  It turns out the Basso rode the climb 1:45 slower than the stage winner in 2007, and that the top 7 on the day were on average 1:30 slower than the top 7 three years ago.  Basso's average power output was estimated as 395 W, or 5.7 W/kg.  Compare this to values in the Tour in recent years, where much longer climbs were done at 6.5 W/kg or higher.  Basso's own coach, Professor Aldo Sassi, has said that he believes that a power output above 6.2 W/kg on a long climb at the end of a stage is an indication of doping.  

I agree with him on this, and it's possible to show this principle using physiological concepts.  This is something I worked on last year during the Tour, and will post on during this year's Tour again, when it is relevant.  However, the point is that cycling has slowed up, and while there are numerous factors (race situation, conditions etc.) that contribute to this, the suppression (not the removal) of doping is one strong possibility.

At least someone is listening - the biological passport and Floyd Landis

On another positive note, it seems that some of Floyd Landis' claims are inspiring action.  The following two pieces detail the response of Mike Ashenden, a scientist involved with the biological passport, to Landis' claims.  The first article by ESPN is interesting because it reveals some of the tricks behind how Landis claims it was easy to avoid being caught.  And if you're looking for high-tech science and deception, look no further than the simple fact that the team knew when the testing would happen, so they could take steps to avoid detection.  It's not rocket-science, in some regards.

The second article explains what Ashenden calls the "missing piece of the puzzle".  This is exactly the response that is required, because scientists involved in actually preventing cheating often do so without full information.  Landis offers them a hypothesis to test and that can only be a good thing.  What should be of concern is that Ashenden recently did a study where he injected subjects intravenously twice weekly with microdoses of EPO over a period of three months, then ran their blood values through the biological passport software. "Not one of them failed," he said.

That doesn't make the biological passport "a joke" as Landis has called it.  But it does raise some serious question marks, and to all those people who bluntly defend cycling by saying it has a biological passport system, the response has to be "so what?".  A lot of houses have very fancy alarm systems, but they're still broken into.  It may be a deterrent, but it's naive to think it's preventing doping altogether, and it's good to see that Ashenden is realistic enough to know this and that hopefully it will improve as a result.

Cycling's Catch 22 situation and the ease of denial

Then finally, the second problem for cycling (and indeed in any sport, as Dwain Chambers showed two years ago), is that it's very easy to dismiss "tell-all" confessions because the people they come from are by nature "untrustworthy".

It occurred to me (and no doubt to many others) that cycling has a deniability problem, in that the people who are credible and trustworthy don't know about the doping problem and how doping is done, whereas the people who know about the doping procedures are deemed as untrustworthy and lacking credibility.

Floyd Landis is too easy to dismiss as lacking credibility - he cheated, lied, spent a fortune of other people's money to defend himself all through denials of ever having doped, and then promptly turned around and admitted to doping.  Of course, the obvious tactic, even if you hadn't perfected it on half a dozen people before (ranging from a mechanic to a few journalists to a masseuse) is to attack credibility.  "I like our credibility" was Armstrong's response to Landis' claims - as one would when the person making the allegations is, by making them, incriminating himself as a liar.  The only problem is, he might be telling the truth.

And on that note, one of the best comments we've received, in three years on this site, came from Steve, and it deals with exactly this point.  I know that a lot of people don't read the comments and so I am pasting his comments, in their entireity, below.  You can also read them at this post.

I'm not a scientist; but I have received law enforcement interrogation training. Landis's initial denials of doping in 2006, when interviewed immediately following the revelations of his positive test from the TdF (and before being lawyered up), showed many of the classic signs of deception: unable to muster an emotional denial, assumed belief that no one would believe such a denial, and, most particularly, misplaced outrage--his most emotional response was directed to comments about his mother. "Leave her out of this," he said (as memory serves). "She's a saint. She would never get involved in stuff like this." She wouldn't; but he would. That Landis couldn't muster outrage on his own behalf ("Hell no I didn't!") but could for his mother was a clear indicator of deception. Even in his colloquy with Greg Lemond, Landis reportedly said, he was concerned that a confession would only "hurt innocent people." Tellingly, in the Bonnie Ford interview, Landis now says that the hardest part of his confession was calling his mother to tell her the truth.

So I believe that Landis was lying then, and that his confession regarding his own doping is truthful now. And I feel sorry for those who staked their own beliefs, and money, behind his defense. I also believe that the accusations Landis makes against other cyclists (he primarily names Americans in his emails to USA Cycling, as I understand it, because that body is responsible for the licensing of the American pros) are sufficiently credible and specific to merit serious consideration and investigation. I agree with the other posts that note that the details regarding the techniques of doping appear to be corroborated by the available public details of other confessed and contemporaneous dopers such as Patrick Sinkewitz. Any such accusations will, by and large, consist of one person's detailed oral history--mob families have been brought down with less. Contemporaneous training diaries, as Landis suggests he has, could be very powerful evidence.

The sport of cycling has all the financial incentives in the world to push past practices under the rug and try to move on. But the fact that many riders of a dirty past continue to ride in the pro peleton, and have success, points to serious unanswered questions. Just ask the riders who compete against the Vinokourovs, Valverdes, and others of the world. It's time for the sport to clean house. 

About a top cyclist riding clean speaking out about suspicion of others' practices: the history of omerta (the "code of silence") and accusation in the sport suggests otherwise. For example Christian Vandevelde was asked a similar question about his strong ride at the 2008 TdF and the nature of his competitors. Vandevelde said that he didn't know about other riders, he knew that he was riding clean, and so therefore assumed that others around him on GC were, as well. Vandevelde's team published and allowed independent analysis of his year-long profile, to establish Vandevelde's bona fides.

Of course, several of the performances around Vandevelde were not clean--including Bernhard Kohl, who finished ahead of Vandevelde on GC, as well as those of Stefan Schumacher, Leonardo Piepoli, and Ricardo Ricco, among others. But Vandevelde wasn't in position to have evidence of those others' practices. One can imagine the difficulty that a rider might have to make such accusations without proof against a competitor. Given the sordid history of the sport, one might also well imagine how difficult it would be if, say, someone were demonstrably riding clean now, but was aware of questionable practices in one's own past. The riders and professionals associated with the current Garmin-Transitions team, which appears to be among those making the most effort to practice and demonstrate clean riding, are pointedly mute about their own past practices while on other teams. It's the glass houses effect.

Even if always clean, throwing stones would damage the sport, reduce one's own standing as a competitor, and yield little in reward. Ask, among others, Gilberto Simoni, who famously accused Ivan Basso of riding "like an extra-terrestial" at the 2006 Giro di Italia. While not accused of doping himself, Simoni was heaped with scorn and tagged as a sore loser; little was said or done to Simoni's benefit when, just months later, Basso's involvement in the Operation Puerto scandal became clear. Infamously, too, Fillipo Simeoni accurately accused Dr. Michele Ferrari in 2004 of being involved with doping; for his trouble, Simeoni's presence in a break at the TdF was chased down. Simeoni was not rewarded for his accurate accusation.  

Typically, knowledge of doping practices appears to come from first-hand knowledge--to know for certain what happened and where, one had to be directly involved. To accuse others with substantial evidence therefore typically means indicting oneself. The track record of cyclists who admit to doping regaining high-level employment in cycling is very poor--they have typically been shunned. The few who have gained some measure of a restored career are the exceptions that prove the rule. Most riders or team professionals with knowledge of doping practices--and there must be many, given what is confirmed about, just as examples, the old T Mobile team, Phonak, Saunier Duval, Festina, and many of the former members of US Postal-Discovery--must weigh the likelihood of ending their gainful employment in their chosen profession, and quite likely risking ruining the careers and endorsements of all of the people with whom they have been associated. Even, and perhaps paradoxically particularly, teams committed to "clean racing" such as T-Mobile-High Road, when faced with the Patrick Sinkewitz revelations, risk sponsor withdrawals over positive tests. The risks are high and the individual rewards are few.

In sum, the nature of the cycling community creates strong disincentive to defect from omerta and to display what one knows about doping practices, even if those practices are in the past, and the defections (those who admit doping practices and supply evidence against others) are, typically, those with nothing left to lose.

Those dynamics are little different from many criminal conspiracies, from drugs to racketeering to white collar crimes like price-fixing. As a prosecutor with the US Department of Justice's Antitrust Division, I worked with agents and fellow prosecutors to encourage witnesses to defect from price-fixing conspiracies and cooperate with government investigations. There, too, the incentive to defect is low and the risks are high--those who admit to price-fixing subject themselves and their companies to criminal fines and imprisonment, as well as treble civil damages. Like in cycling, those individuals who "turn state's witness" can be assured that they will never work in their chosen field again, and that they will be contributing to the ruination of everything and everyone around whom they have worked throughout their careers. The Antitrust Division offers an amnesty program to incentivize defection: immunity from criminal prosecution, de-trebled (single) damages for wrongdoing, legal protection for whistleblowers--even the opportunity for whisteblowers to share in the recoveries of certain ill-gotten gains. The system isn't perfect, but it at least begins to provide incentives for conspirators to defect.

Until cycling properly incentivizes those with knowledge to come forward--for example, with protection from suspension, guarantees of employment on clean teams, and harsh penalties for teams and individuals that do not cooperate--the incentives for those who are dirty, and even those who are clean, to keep what they know silent will remain strong.

It could not be said better!

Ross

Beyond a simple explanation of doping

Taking an integrated approach and looking beyond the physiology

First of all, who watched the Giro stage on Sunday up the Zoncolan?  If we put down the the debate about doping for just a second, and examine the stage out of the doping context, it was epic.  The final climb up the Zoncolan was insane, and more so when you consider that they did things like 4.3 km at nearly 10% average before hitting the Zoncolan---which averaged 11.8% and had sections of 20-22%.  Ivan Basso prevailed, dropping Cadel Evans about halfway up the climb.  You know the guys are going slow (and therefore the gradient steep) when the spectators are practically walking alongside then cheering!

Anyway, we had plenty of feedback from our posts on Floyd Landis' admission to doping and his naming names.  One reader commented that our coverage sounded more like the "Psychology of Sport" than the Science of Sport.  But in fact he was exactly right.  The issue is that to really understand exercise performance and the physiology behind it, you have to take an integrated approach.  By that I mean that we cannot simply say that is low muscle glycogen concentrations alone that cause fatigue during endurance exercise, but instead that factor is one of many "inputs" that lead the the slowing down we see during that type of exercise.  (For the full explanation, check our series on Fatigue.)

In a similar manner, to understand and explain doping we also must take an integrated approach.  The physiology is but one piece of the puzzle, and we try to understand what the effects of certain substances are on performance, the characteristics of the muscle, the effects on the brain, etc.  But beyond that you also have to consider the psychology of the athlete and the culture of the given sport (the "Social Science of Sport," perhaps?).

The culture of cycling:  omerta is enforced directly and indirectly

In cycling the rule of silence, or omerta, has been well known for decades.  We all know the colloquialism, "spitting in the soup," referring to cyclists that vocalize their concerns about doping or who admit to it and name names.  Therefore this force works to keep many from speaking up about what they did or saw, because to do so will immediately make you a pariah and might eliminate your chances of working in the sport.  When one considers the typical European cyclist (i.e. most of the pro peloton), who are these individuals?  To go back to the "social science of sport," typically they have no formal training, probably no advanced degrees, and as a consequence have few options upon retiring from the peloton.

The one option they likely do have, though, is remaining in the sport, perhaps as a coach, team director, or serving a pro team in some regard.  In this way the omerta serves to keep them quiet because speaking up will almost certainly eliminate their chances of working in the sport, which might be their best chance at a very decent living.  Cycling is the sport they love and therefore want to be a part of, and by the time they retire from the peloton it is probably all they know, having spent a sizable proportion of their lives to that point in the saddle.

Perhaps it is the result of omerta or perhaps from something else, but I am amazed that since Trevor Graham mailed a used syringe was sent to USADA and started an investigation that would lead to the BALCO scandal, not one cyclist has banked some used supplies, photos, or other evidence to help protect himself down the line.  In the age of cell phone cameras it would be relatively easy, it seems, to photograph or record people in the act to help corroborate a story at later time.  What if Landis had taken photos or salvaged a part of the medical equipment that might contain DNA when he was allegedly left at Armstrong's house for a few weeks to look after their blood in the closet fridge?

The psychology of a cheat - psychopath or just bad judgment?

Although we are not trained psychologists, it is possible to understand how the psychological component is expressed in doping.  I will rely on the psychologists in the audience to chime in and correct me where applicable!  First let me say, however, that everyone does indeed have choices, and no one is forcing athletes to dope.  The reasons why one chooses this path are varied, and we hear admitted dopers like David Millar and now Landis talk about making changes so younger athletes are not faced with the kinds of choices they were---namely, start doping or retire from the sport because you cannot compete in spite of your best efforts.  That might simply be considered bad judgment, because the logical choice should to go ahead and retire rather than compromise one's ethics and morals.

Taken together with the "Prisoner's Dilemma" described by Michael Shermer in his Scientific American article, these athletes realize that the risk of getting caught is far less than than the benefits to be gained by doping, and therefore it becomes a rational choice to adopt a doping program.

But based on the information I have, I classify dopers into at least two categories.  First are the ones mentioned above, the ones trying to survive, trying to keep their contract.  In cycling these are the athletes doping simply to be able to do their jobs as domestiques for their teams.  They are not interested in getting to the pinnacle of the sport, but might enjoy the occasional stage win in a Grand Tour because this adds value to your profile as a cyclist and helps you "survive" by getting another contract.  These are the ones who, when caught with a positive sample, mostly suck it up, refuse the "B" sample analysis, which is an admission in and of itself, and either retire from the sport or serve their ban.

The other category contains the champions, the athletes willing to do practically whatever it takes to get to the top of the their sport.  For them winning might even be a positive consequence of annihilating the competition.  Think of the angry, macho athlete, in contrast to the quiet but humble champions.  I am not saying the the quiet types are not doping, but rather that they have better control of their behaviour and can keep their mouths shut.

In this category we find the athletes who deny, deny, deny, often making grand public statements declaring their innocence.  It is possible that in their own minds they do not believe they are doing anything wrong.  This might be the result of their psyche or the rationalization of their behaviour along the lines of, "I see all the others doing it, so I am just leveling the playing field, and therefore it is not cheating."  One striking feature of many convicted dopers is, looking back, we ask ourselves how these people can sit there and lie and lie and lie to the camera, and this is one explanation---that they do not even perceive themselves to be lying.

Psychopathy as a contributing factor for success?

One final point here is that perhaps those who express some degree of psychopathy are more likely to achieve greatness in their given sport (or profession), because these individuals are often willing to climb over anyone and do anything to get to the top.  Keep in mind that I am not saying all champions are psychopaths!  Rather, I am saying that the lack of traits such empathy, for one, will be a contributing factor that "allows" an athlete to strive to demolish the competition.  Again, the idea of winning being a positive consequence of beating the pants off the competition.

To use an example outside of cycling, think about Tiger Woods.  Especially for those who might not follow golf closely, myself included, he seems like the consummate "nice guy" champion.  Then came the scandal at the end of 2009, and suddenly we see that perhaps he is not such a nice guy after all, but again, this might help explain why he has achieved what he has.

To be sure, this is an oversimplification of these issues.  But part of the point I am trying to make is that it is indeed a complex series of issues, and to understand doping fully we must try to understand all of them.  Physiology is part of it, but only a part, and so we must think about these other "sciences" if we really want to understand the problem fully.

On the horizon - Comrades!

Meanwhile, This Sunday 30 May is the Comrades Marathon.  It is televised in full each year in South Africa, but unfortunately Ross is in the UK with the South African Sevens team, so we will not be doing any live updates on the day and will have to rely on other sources for any analysis.  For American running fans, Josh Cox is running, although I do not rate his chances for the win at all.  We mentioned a few posts on ultra-marathons recently, and I hope to deliver a couple of those this week prior to Comrades.  For now there is plenty of racing left in the Giro with a few cyclists still in contention for the maglia rosa---be sure to watch the mountain time trial on Tuesday!

Jonathan

Floyd Landis case - new developments

Emails were leaked, better controls are the aim

The web, sports, and cycling world is buzzing as the initial story breaks and as more details trickle in.  Since the story broke and since we posted it here earlier, there are have been responses from the likes of Lance Armstrong, Jonathan Vaughters, and former Phonak owner Andy Rihs. 

In addition, to illustrate how cycling fans have responded, in the past 18 h over 1316 posts on the Cyclingnews.com forum on this topic.  The responses there cover everything from legal strategies to support for Landis to support for Armstrong.  So far it has all remained pretty civil, amazingly!

Strength in numbers---n = 1

A common hope is that now Landis has owned up, another cyclist that was named or part of USPS during that era will also now own up.  Tyler Hamilton is the name most feel is in the best position to also admit, but the key is that many think without physical evidence Landis's claims will be quashed by the infamous Armstrong PR machine.  Already, Sally Jenkins published a text that begins to deflect the spotlight from the athletes and instead asks more philosophical questions.

So the fans are all hoping that Landis's admission will in some way encourage at least one other cyclist, current or former, to speak out and break the omerta.  Whether or not this is the case is anyone's guess, but this is the optimistic opinion.

No credibility for Floyd

On the other side, the pessimists point out that Landis lost much credibility over the past few years by denying to no end that he doped.  Placed against the well-known PR machine behind Armstrong, these fans are sure that Landis's claims will be easily quashed and the status quo will remain.

The latest info of sorts comes from Neil Brown, writing for Versus.com.  He claims to have spoken to Landis directly this morning, and Landis says the email was leaked to the media without his knowledge.  Ok, fair enough, we all know how easy it is to hit the "Forward," after all.   The interesting and newer info:

• Landis alleges Amrstrong knew about the emails from Landis to USA Cycling
• Armstrong allegedly contacted Landis's friend and sponsor Dr. Brent Kay, and made veiled threats about revoking Kay's medical license
• Landis responded by telling Armstrong to stay away from his friends and rather deal directly with him
• On 5 May Landis wrote to Armstrong:

"As you certainly know I've been living with a very complex situation for the last four years and have been, for my own sake and for the sake of my former friends and peers, misleading the public about the truth about performance enhancing drug use in cycling about which I have first-hand knowledge. My only goal in enlightening the public and the press regarding these matters is to clear my conscience and thereafter be able to sleep at night.

He said/he said

Of course right now this is still a "My word against yours" scenario, and one can only hope that Landis does indeed have some stronger evidence to back up his claims.  If not, and if no one helps corroborate his story, he will quickly be discredited, and will add the title "Sore Loser" to his "Doper" label.

In the meantime the discussion rolls on, and if you have not yet read the Cyclingnews.com thread, you should do so as it will provide you with all the different arguments for and against all sides of the debate.  For now we will continue to watch it unfold, and provide our insight and analysis in due course.

Jonathan

Floyd Landis admits to doping and other allegations

Floyd Landis - I doped.  Admission and allegation

"I want to clear my conscience," Landis said. "I don't want to be part of the problem any more.

Just a quick post to bring to your attention the following big news from cycling.  The Wall Street Journal (I only point this out because the WSJ is one of the most respected papers around, not a tabloid, because had I seen this elsewhere, I'd be skeptical) is reporting that Floyd Landis has sent a series of emails to officials within US Cycling and the IOC in which he has:

• Admitted to doping.  He says that he began with testosterone patches, then progressed to blood transfusions, EPO, and a liquid steroid, taken orally.  Upon leaving the US Postal team in 2006, he requested support from his new team, Phonak, to continue the same blood doping programme.  The Phonak manager, Andy Riis, is alleged to have provided funding to do this.
  
  
• Alleged extensive doping, as well as encouraged doping from Lance Armstrong and Johan Bruyneel.  He explains how on training rides, Armstrong would explain the process, how to avoid detection and what worked and how.
  
  His reported words were: "In the same email, Mr. Landis wrote that after breaking his hip in 2003, he flew to Girona, Spain—a training hub for American riders—and had two half-liter units of blood extracted from his body in three-week intervals to be used later during the Tour de France. The extraction, Mr. Landis claimed, took place in Mr. Armstrong's apartment, where blood bags belonging to Mr. Armstrong and his then-teammate George Hincapie were kept in a refrigerator in Mr. Armstrong's closet. Mr. Landis said he was asked to check the temperature of the blood daily. According to Mr. Landis, Mr. Armstrong left for a few weeks and asked Mr. Landis to make sure the electricity didn't go off and ruin the blood. George Hincapie, through a spokesman, denied the allegations".
  
  
• Called anti-doping processes a "charade".  He claims that he once helped team-mates Levi Leipheimer and David Zabriskie take EPO before a Tour of California race, and explained in his emails how this was possible without being caught.

You can read the WSJ article here.

And CyclingNews have what seems to be the actual emails written by Floyd Landis, though I can't vouch for their authenticity.  And then just in, ESPN have actually interviewed Landis and obtained his confession independently.  That piece, along with initial and predictable responses from the UCI, can be read here.

The implication - same revelations, different context?

There is obviously much to be said on this latest allegation.  Allegation is nothing new in cycling, of course.  But these kinds of allegations have historically been made by bike mechanics, physiotherapists, and disgruntled team-mates or rivals who usually are dismissed as having a hidden agenda or financial incentive to do so.

In Landis' case, it's not clear what the purpose may be.  It must be pointed out that WSJ had been unable to obtain comment from any of the other cyclists or men named in the emails - Leipheimer, Zabriskie, Rihs, Bruyneel and Armstrong all could not be reached.

Also, the WSJ have stated that the claims could not be independently verified.  However, I know the WSJ and the reporter who did the piece, and I know them both to be quality sources, and so I would take these allegations very seriously indeed.  ESPN have also obtained the same confession telephonically, so at least we know it is not a hoax with someone else passing themselves off as Landis.  In Landis' words, the confession comes because he was suffering psychologically from years of deceit, and that he had become a cycling pariah (if he thought he was a pariah, he's now entering a whole new world of being shunned by cycling by alleging others' involvement.  The UCI, Armstrong and others will be vicious in their condemnation of Landis).

What is most striking is that disclosure in cycling is very rare from within the sport.  Landis is the highest profile rider to confess, and also his confession comes off years and years of denial.  That alone is enough to spark curiosity, maybe even skepticism, regarding the motives and reasons for the confessions.

I'm sure the story will have legs.  I hope it does.  This kind of admission is long, long overdue, and if it can be verified (which is the next step), then it should be taken very seriously indeed.  Floyd Landis offers cycling the prospect of disclosure.  We wrote a piece on doping in cycling recently, and a number of readers were very defensive, saying that cycling has done the most to combat the problem, and had cleaned up its act.

Floyd Landis has called those efforts a "charade".  I agree with him (or whoever alleges he said it), because cycling's current efforts to clean the sport have been driven by market forces, nothing else.  The sport began to clean up when the media and sponsors started to say that they had had enough.  Then, spurred by the financial threat of lost sponsorship and media exposure, efforts were made to clean up a problem that before had been dismissed as "small".  Certain federations stood alone in their genuine attempts to keep the sport clean, but from the top, it was indeed a charade.

I hope that Landis' claims, if they can be verified, drive further efforts in that regard, and they are not dismissed as being "sour grapes" or "tabloid journalism".  Indeed, this has already begun to happen.  We've just received a mail from Joe, with this link, in which Pat McQuaide (the head of the UCI, who, incidentally, is the man who denied that cycling had a doping problem until all its money started retreating and the media refused to cover it) has said the following:

"What's his agenda?  The guy is seeking revenge. It's sad, it's sad for cycling. It's obvious he does hold a grudge."  McQuaid said he received copies of the e-mails sent by Landis to the U.S. cycling federation, but declined to comment on their contents. He said Landis' allegations were "nothing new."

"He already made those accusations in the past," McQuaid said. "Armstrong has been accused many times in the past but nothing has been proved against him. And in this case, I have to question the guy's credibility. There is no proof of what he says. We are speaking about a guy who has been condemned for doping before a court."

Let us not pull any punches here - Pat McQuaid is as much part of cycling's problem as Armstrong, Bruyneel and others are alleged to be.  As the highest ranking person in the sport, his response should surely be to investigate the allegations, regardless of their source, and then to make an extreme statement afterwards.  If the allegations are true, then he must act, and act very, very seriously.  If they are shown to be false, then he must act to condemn the slander and to defend the image of the sport.

Instead, what we have from this poisonous organization is a response that simply dismisses the allegations, just as they have done in the past.  It is not the first time the response has been such, and it will continue in this vein, particularly from Armstrong, who has in the past ripped into high-quality journalists like David Walsh and Paul Kimmage, for their efforts to expose cycling's cancer (and yes, I use that word with full understanding of its historical implications in the context of this debate).

Time will tell what emerges from this article, but I am hopeful it is further revelation.  Who else will stand up and be counted? 

Ross

Sports news and sports science in the news

Sports variety – tennis insights, athletics anticipation and Caster Semenya viewpoints

It’s been a frantic few weeks in the world of sport. Sadly, our schedules have prevented us from doing it justice! I am now in the UK for two weeks, and likely to have as little time, but while I had a moment on a flight, I thought I’d recap on some of the bigger sports events of late, and some sports science/management issues that struck me.

Tennis – the red clay and Nadal back on top and finally, some analysis using technology

The clay-court tennis season is building to its usual Roland Garros climax, and it has been a return to 2008 in the men’s game. Rafael Nadal had a relatively poor season in 2009. His year began unraveling in Madrid last year, where he lost convincingly to Roger Federer before going on to lose for the first time ever in Paris. This year, there was to be no repeat, as he beat Federer in straight sets to win in Madrid, becoming the first man to win three consecutive Masters Series events (having won Monte Carlo and Rome earlier this year).

What I found most interesting was an analysis shown during the final using tennis’ Hawkeye system. It showed where Nadal’s groundstrokes were landing in Federer’s half of the court, and where Federer was standing when hitting his strokes in return. This is data that is obtained from the Hawkeye system, and it is an illustration of just how powerful this technology could be if it was used to enhance the viewing experience.

Alas, this was the only time I’ve seen such an analysis, and what it showed was a comparison of Nadal’s shot depth in 2009, when he was beaten by Federer, and 2010, when he won at the same event. To sum up, in 2009, 32% of Nadal’s shots were landing inside the service box. As a result of this lack of depth to Nadal’s shots, Federer was hitting most of his shots from on or inside the baseline. Jump to 2010, and only 18% of Nadal’s shots were landing inside the service area, and Federer was playing from 1m behind the baseline, and up to 3 m behind the baseline at least a third of the time.

Was this a difference caused by Nadal’s relative fitness levels (last year his knee problem was hampering his mobility and power), or was it that Federer was either more negative or off his game on the day? Nadal has certainly worked on his game – I often felt (guided by good commentary, I must admit) that Nadal had a problem of going for too much topspin, which tended to drag the ball down short. He also fell into defensive play easily, especially in pressure situations. This year, there has been a clear effort to play more directly and maintain the depth, and perhaps this is responsible for the shift in Sunday’s final.

You’d need more data to investigate this fully, but I found the analysis fascinating. I wish it were done more. I actually emailed the company Hawkeye last year to ask whether I could obtain some of the data, I offered to analyze it for them. They wrote back to say they don’t keep it. Which is clearly not true, given what they showed on Sunday. Their lack of vision of their own potential is tennis fans’ loss.

Athletics – Diamond league kicks off

On a more positive note regarding broadcast and sport, the Diamond League began in Doha last week, and the TV package was definitely improved. Shorter, fewer breaks, and very helpfully, real-time graphics showing who was in the groups of the middle-distance races made watching it more interesting. Particularly for those who don’t follow the sport, watching middle and long-distance events can be daunting, but to “personalize” the athletes, simply by flashing up graphics of where they are in the race at say 1,000m helps a great deal. It’s a simple thing, but hopefully a sign of more to come.

On the track, the action was hot. So were conditions – up above 30 degrees, but the performances didn’t seem too affected. Eliud Kipchoge produced a 12:51.21 over 5,000m, maybe the most impressive performance, given the heat. David Rudisha of Kenya continued to show impressive form, running a 1:43.00 in the 800m for men. On the other end of the distance spectrum, Asafa Powell was impressive in his heat (9.75s) and the final (9.81s with a very poor start) to win the men’s 100m. Powell was impressive, but I was struck by what I felt was a peculiar running style. He seemed to really be reaching out for the landing in front of him. Imagine a horse doing dressage and kicking out in front and you have the idea. Maybe Powell has analyzed Bolt’s 100m races, and noted that Bolt takes 41 steps while everyone else was taking 44, and he has developed a plan to increase his stride length! I’m being partly facetious here, but certainly Powell does seem to have changed something mechanically. His hamstring contraction at the end of the float phase and during the first moments of ground contact must be enormously powerful to the leg back before toe-off. Or am I alone in noticing this?

Powell’s performance was followed only 2 days later by a Tyson Gay 19.41 s world record in the rarely run 200m straight race in Manchester. Reports are that Gay ran the 100m from 50m to 150m of the race in 8.72 seconds, which is about as fast as Bolt when he broke the 150m record last year. Gay also broke 45 seconds for 400m recently, becoming the first man in history to crack 10 seconds for the 100m, 20 seconds for the 200m and 45 seconds over 400m, and he is clearly in great shape at the start of 2010.

The third member, and the most illustrious of this sprinting triumvirate, Usain Bolt, is in action tomorrow. He has already reportedly run a 8.79 s relay leg (reportedly) and so all three big guns seem ready to fire this year! Already, only a few weeks in, and 2010 is looking like a magnificent year for sprinting!

Caster Semenya – Tim Noakes’ view

On another athletics note, the Caster Semenya story is drifting slowly and mercilessly towards its own climax. First, Lamine Diack, President of the IAAF, announced that results were certain to be released by the end of June (this was not news as much as it was confirmation of what has been said for a while now).

And then just this last weekend, Prof Tim Noakes, who I have the highest respect for as my PhD supervisor and now employer, was reported to have said that Semenya was the victim of an “image management campaign”, and that she should be allowed to compete since her advantage did not make her as fast as men.

He was quoted as saying “As many as eight intersex women may have been expelled from athletics in the past and I gather that they were warned that if they made a fuss, they would be exposed. So it seems it's not about athletic advantage, it's about keeping the Olympics free of unwanted complications. It sends the message that women must do what men say and if the eight athletes had to be sacrificed, so be it, which I find very disturbing,"

He goes on to say “My view is that Caster Semenya should be allowed to run. She is not running as fast as men nor is she running as fast as some other women. If she was running 1:41, then we would have a problem. There are some genetic variants allowed in sport. I would argue, for example, that Usain Bolt is genetically different. If these genetic variants are linked to gender, then so be it”.

I agree with Noakes on the image management issue and that athletes may have been threatened before. The management of the whole intersex issue has been an absolute disaster for sports authorities. There is without doubt an agenda to keep the image of the sport “clean” (whatever that means – it’s open to interpretation). Whether it is driven by male chauvinism, financial pressure, archaic thinking, I don’t know. I would say, somewhat in defence of the IAAF and IOC, that if they did not act, then they would undoubtedly face objections to Semenya’s participation, and many (possibly most) would come from women. So the IAAF, as the custodian of the sport, is in a difficult situation, where they have to act on behalf all parties, and from this perspective, it is very much about athletic advantage because that would be the basis for the challenges and complaints by others. As many would be unhappy with inaction as are currently unhappy, though for different reasons, which some will disregard as trivial.

As for the second issue, Semenya’s eligibility to compete, I have already written a great deal on this topic, in particular the argument that any genetic advantage that Semenya possesses is analogous to that possessed by an Usain Bolt or Michael Phelps. To read that post, click here. My position is that the two are dissimilar because we don’t compete in categories of fast-twitch fiber or enzyme type or lung volume or foot size (or whatever you believe makes Bolt and Phelps the world record holders). We do however compete as males and females, and thus the distinction between the two should be defended. A genetic advantage that pushes an individual from one category into another is not the same as one which moves an individual up or down within the same category.

Consider basketball. People are largely born to play it, because if you’re 1.70m tall, your chances are slim. But we don’t compete in categories of height, and so within the “open population”, we accept that height is advantageous. If we had a category for under 1.70m, then the line would have be enforced, and a genetic “abnormality” causing someone to be tall would exclude them from competing at the lower level. The same goes for male and female.

So I respectfully disagree with the assertion that gender variants linked to gender are acceptable. And this is fine, because everyone is entitled to a position and I certainly don’t think that Prof Noakes is wrong. This is not a matter for which there is overwhelming proof (even the PIstorius controversy has mountains of proof compared to this). Nor is his opinion an isolated one – many will agree with it. I just don’t see the issue that way.

I also would not agree that there is no problem with her participating, just because she is running slower than 1:41 (which is the men’s record, by the way). My position here is that she runs against women, and so whether an advantage pushes her into the men’s range is irrelevant. The issue is that it pushes her out of the women’s range, and well into a higher percentile of men’s performance than women can achieve, without suspicious circumstances.

As for not running faster than some other women, if you look at the history of women’s 800m running, and you see some of the women who have run 1:54 or faster, you’ll appreciate that only women with massive amounts of testosterone (that is, dopers) get to those levels. I am sure Prof Noakes and I will debate this one in due course, and I look forward to it! We’ve discussed it before, and so I wasn’t surprised by the quotes, just as I’m sure he knows my views. This kind of debate is the fuel of research, after all. I suspect the difference in opinion is because I am coming from an athletics paradigm, where he is speaking from outside it. Nevertheless, an intriguing viewpoint.

Upcoming events

As I said upfront, I’m in London, with the SA Sevens team for the last two events of the International Rugby Board Sevens Series. At some point, when the science and sports world is a little quiet, I will look at the commercial failures of rugby to capitalize on the Sevens product, and what a shame it is that the Unions and the International body have failed to recognize that they posses rugby’s equivalent of 20-over cricket. It would revolutionize the game, but for the lack of desire and vision of those driving it forward commercially. Meanwhile, the 15-man version of rugby is suffering through a recession of interest and money, based on TV figures and financial reports, as clutter and competition detract from rugby’s following everywhere but in the UK and South Africa.

Failure to act may bring to those exactly what is deserved for inaction, but that is for another day, another post, on the management of sport.

There’s the FIFA 2010 World Cup to look forward to – 24 days to go, and much science to be discussed there. Plus, with the Diamond League now on the go, athletics will take centre stage!

Apologies again for the snippets today, but hopefully one of the three stones hits a bird!

Chat soon!

Ross

The sub-27 10km limit: An exclusive club

An exclusive club of sub-27 minute 10km runners

So it turns out that over 3,000 people have summitted Mount Everest.  Only 31 have broken 27 minutes for 10,000m.

Admittedly, no-one has died ever trying to break the 27-minute barrier (at least, not directly during the attempt), whereas more than 100 people have died trying to reach the earth's highest point.  But it's amazing to think that this exclusive club, consisting of only 31 men, had never had a non-African in it, until last weekend.

Now, Chris Solinsky is a member, the first man from outside of African to break the barrier.  The other day, we also reported on LetsRun.com's analysis that Solinsky is the heaviest athlete ever to break the barrier, and by some margin.  Just to repeat, below is a very basic graph of the sub-27 club members, showing the mass of the runners by rank, and you'll see the obvious outlier that is Solinsky in red.

It turns out that the average mass of the men in this list, without Solinsky, is only 55.6kg.  The heaviest, as mentioned the other day, were 64kg.  In other words, only small men need apply!

There was some quite good discussion in response to that post.  Size in distance runners has received quite a lot of attention in the literature - about 10 years ago, Frank Marino did research showing that smaller men had a performance advantage over larger men during 8km time-trials in hot, but not cold environments (Marino et al. Pflugers Arch, 2000).  That is, they performed similarly in cool conditions, but as soon as it got a little warmer, the smaller men outperformed the bigger men.

What was most interesting is that the bigger athletes started the trial at a slower pace, probably an anticipatory reduction in speed so that they wouldn't overheat.  Why?  Because the bigger you are, the more heat you produce during exercise, and even though it is possible to lose more heat, it doesn't quite make up for the extra heat gain.  As a result, the larger athlete stores more heat, sees a more rapid rise in body temperature, and thus selects a lower speed in anticipation of this "thermoregulatory failure", and is thus outperformed by the smaller athlete.

This is not the sole reason why smaller men have the advantage - there is the obvious advantage of carrying additional weight, a power-to-weight ratio, that gives the smaller men at advantage.  Particularly in cooler environments, where heat storage and the attainment of a critically high core temperature are unlikely, thermoregulation is much less of a factor (hence the reason that the two groups in Marino's study performed similarly in the cool condition).

A first-of-his-kind member - a non-African joins the club

But in terms of size, the other thing that jumps out from Frank Marino's study on size, is that he could just as easily have analyzed his results by ethnicity.  It turns out that the smaller men in his study were African, whereas the larger men were European/white. And so, he duly did this - produced a second paper showing what he called "Superior performance of African runners in warm humid but not in cool environmental conditions" (Marino et al., J Appl Physiol, 2004).

So the African runners tended to be smaller, and this was postulated to be part of the reason for their advantage.  Note that I'm saying "part of", because of course there are many, many factors that contribute to their advantage - training, culture, diet, altitude, lifestyle, genetics, biomechanics, metabolism, and then thermoregulation.

But it is striking, and the other notable observation of Solinsky's performance is that not only is he the largest runner every to make it into the sub-27 club, he's also the first man from outside Africa to do.  Of the 31 members, 20 are Kenyan (including a few who happened to be running in Qatar vests), 6 are Ethiopian, 2 are Moroccan (one of whom ran for Belgium and then got caught doping), and one each for Uganda and Eritrea, and now America.

I could go on for hours and hours about why this might be, but I haven't the time right now, unfortunately.  The African dominance in running is well-known by anyone who follows the sport - I dare say that in some respects, it's a problem for the sport because the sheer depth and quality of the Kenyan and Ethiopian athletes makes in much more difficult to follow the sport with a passing interest - you're either a full fan and know the characters, or it is almost overwhelming how much talent comes through year after year if you don't follow it closely enough.  I think it's fantastic to watch the races which are less predictable, and I find this a source of strength, but to the "marginals" with only a passing interest, the continued dominance does present a challenge to marketing the sport.

There is a lot to be said for the value of "stability" of athletes in sport - in tennis, you know that Federer, Nadal and Djokovic will build a great rivalry over many years.  In distance running, it's much more transient, partly because of the depth.

I am reliably informed by colleagues in sports science in Nairobi, that many Kenyan athletics meetings feature no hurdles events, no field events, and few sprint events, but they do have ten 10,000m races, each with 30 runners, and every single one breaks 30 minutes!  At altitude.  There are a lot of "myths" about the sport in Kenya - this may be another where the truth expands every time it's told!  But one thing that is without question is that for sheer depth of talent, they are unmatched, and hence for quality, with the right management and coaching support, they produce two-thirds of the world's great runners.  They may have relatively short-spans at the top (this would make for a fascinating analysis), but they certainly dominate.

So it's a breakthrough, and again, that sub-27 minute club is unbelievably exclusive.  By way of comparison, there are 72 men who have broken 13-minutes for 5km, which is the other barrier often spoken of for track distance runners.  Admittedly, 10,000m is raced much less frequently than 10,000m, but it highlights how special a sub-27 minute time is.

Coming soon - more on hGH

We haven't forgotten about the Growth Hormone paper, which has now been published.  We have it (thanks, Andrew) and we'll have a look at it.  Both been incredibly busy though, so that in-depth reading will have to wait, hence these shorter, "filler" posts.

But watch this space!

Also, the FIFA 2010 World Cup is now just over a month away.  Being in South Africa, it would seem wasteful to not use the opportunity to do some posts on the science of soccer.  I'm actually about to give a talk on this within the department, so I'll be offloading some of that here in the coming weeks!  Much to look forward to!

Ross

Chris Solinsky - the fastest "big guy" ever

Chris Solinsky - "A fatty world record"

The interesting stories are coming thick and fast just lately.  Too fast to post on, which is why we didn't cover the story of Chris Solinsky, who, last weekend, because the first American runner below the 27-minute barrier over 10,000m.  In a race that was set up as an attempt on the record by Galen Rupp, Solinsky stole the show, and won in 26:59.60.  Rupp did succeed at breaking the record, but he finished ten seconds back, in fourth.

Solinsky, however, is a name that not many would have picked to get anywhere close to the record.  But just as Dathan Ritzenheim shocked everyone when he (comfortably) broke 13 minutes for 5,000m in Zurich last year, Solinsky produced the big surprise of the year so far.

His performance is further confirmation of a golden period for US-distance running.  Yes, they have a long, long way to go to challenge the very best Kenyans and Ethiopians for depth and sustained quality of performance, but in the current generation of US-runners, you have an Olympic marathon medalist, a sub-60 half marathoner, a sub-13 5,000m runner, a New York Marathon champ, and now a sub-27 min 10,000m man.  On the women's side, top performers over 800m, 1500m (probably the best nation over this distance in 2009), and medals on the track over 10,000m and the marathon, and suddenly US-running is mighty competitive, which is brilliant for the sport.

Solinsky - the "fatty" world record holder

The Solinsky story will be interesting to follow later this year, when he runs more 5,000m races.  For now, what is most interesting, in a quirky way, is the analysis that Letsrun.com produced yesterday, showing that Solinsky is the heaviest runner ever to break 27 minutes, and by some margin too.

Check out the table at the bottom of this post, and compare Solinsky, a relative giant at 73 kg (161 lbs) to the runners above him.  Bekele at 54 kg (119 lbs), Gebrselassie (56 kg/123 lbs), Tergat (63kg/132 lbs) and Sammy Wanjiru (52kg/115 lbs) are some of the names on that list.

There are only 30 men in history who have done it, but Solinsky is 9 kg heavier than the next heaviest guys (Mohammed Mourhit and Mark Bett at 64 kg/141 lbs).  In other words, until Solinsky, nobody heavier than 65kg had run sub-27 minutes, which is quite remarkable!

He is also the tallest (Paul Tergat held that record, but Solinksy is 3 cm taller than him, and the second slowest in history over 5,000m to break 27 minutes, but that should change when he gets to the track later this year.

Solinsky himself earned Letsrun's quote of the day when he joked that his friends used to tell him that he'd broken the "fatty world record".  All things are relative, as distance running teaches us all the time, but well done to a guy who on paper, would stand little chance of achieving what he has.  The tide continues to rise in the USA, and hopefully the European season sees them racing the Kenyans and Ethiopians to even faster times.

Ross

Does human growth hormone improve performance?

Breaking down the findings on hGH

When our resident maven Jim Ferstle sent us the story about the how human growth hormone (hGH) can produce a 0.4 second improvement in 100 m sprinting, our ears pricked up and we were listening.  It got us searching for the article immediately, only to find that the current issue of Annals of Internal Medicine is not yet available electronically.  If you are at a university and want to read it now, maybe try heading down to your health sciences library and checking the current issues section for Issue #9 of that journal, where you will find the text by Udo Meinhardt.

But what we did find were several other articles on the topic, including a good review that examines several studies that have administered hGH in various subject populations.  So as a prelude to the most recent study, we thought we would provide some background on what the current evidence tells us about this hormone.

All athletes use it?

The first issue to address here is the widespread belief that those athletes who are doping are using hGH as part of their alleged cocktails of drugs.  We do know from books like Game of Shadows and by other admissions (Ben Johnson, Tim Montgomery, Lyle Alzado, and more) that some of the top athletes have indeed used the substance.  However until recently there has not been a test for the hormone, and so the reality is that we have absolutely no idea exactly how widespread its use really is.

But one thing we can be sure of is that, independent of what the science and physiology say, athletes are using it.  If we have learned anything from those athletes who have been caught and described their doping programs, it is that if they think it will provide some advantage, and if there is no test for it, it will quickly become a widely (ab)used substance.  Exhibit A:  Marion Jones taking EPO.  Too much is on the line for the athletes and the sporting administrators, and to think that top athletes in any sport do not dope is to be grossly naiive.

What the evidence tells us about hGH

We have not performed an exhaustive search by any means, but rather in response to the article that is about to be published in Annals of Internal Medicine we have rounded up an "executive summary" of what we know about hGH and sport.  Below is a table that we have reproduced from the review article "Growth hormone administration:  Is it safe and effective for athletic performance?" by the same group who have authored the Annals paper (click to enlarge):

The first thing you see is that the subject populations are varied, ranging from "highly trained" to "untrained."  In many ways this is no fault of the scientists---I can only imagine the difficulty in executing these kinds of studies, and so to add an additional high hurdle in the form of elite or even sub-elite athletes as the test subjects would be crazy.  No, these investigators have done the best they can for the most part, and so we cannot fault them outright for that, although we all would like to see the effects of hGH on much better athletes.

The real limitation:  Your model or mine

The problem as I see it is not one of the test subjects, but rather the paradigm within which these authors work and attempt to answer their questions.  On browsing through these studies it seems the primary approach is one of two paths.  First, some are interested in an acute dose on the effects of (fat) metabolism during exercise and rest, and second, others hypothesize that enhancing muscle mass and strength by itself translates into better performance.

And therein lies the limitation to this body of work---because from where we sit as sports scientists, the main effect of hGH (and most doping products) is that they allow the athlete to complete more training and harder training.  Thus they allow the individual to sustain a larger overload without breaking down and becoming injured, and therefore the adaptations they make are larger, which in turn leads to better performance.

Few drugs have an acute effect, or rather what we should say is that the drugs that do have an acute effect are easily detected---read, amphetamines---and these went by the wayside many years ago as testing for them became cheaper and more prominent and therefore the likelihood of getting caught increased.

The study we want to see is one in which trained runners or cyclists are administered hGH and then prescribed specific training that has been shown to improve their type of performance.  For example, a typical training intervention that has been proven to improve cycling performance is 4-5 min intervals at ~80% of peak power output.  Most cyclists respond well to this training, but we have always mentioned individual variation here---the "responders" vs. the "non-responders."  And so the question becomes whether or not the hGH administration alters this response to the training, either by allowing the "non-responders" to cope and make adaptations or by enhancing the adaptations of the "responders."

Coping with stress, the real advantage

In addition to elevating the amount of stress an athlete can sustain during periods of heavy training, the other thing hormones like hGH will affect is one's ability to recover between competitions, which of course are in and of themselves periods of high physiological stress.  One of the most interesting and telling articles I have read about doping is not scientific in nature, but was written by ultra-endurance cyclist and journalist Stuart Stevens for Outside Magazine back in November 2003 (you can also listen to an interview with him here).  The magazine fronted him the money to seek out and pay for doping products while he trained for Paris-Brest-Paris, a quadrennial 1200 km "fun ride" in France.  Stevens went on to take hGH, testosterone, EPO, and eventually anabolic steroids.  Here is a quote about a 200 mile qualifying race he completes:

"The last time I'd ridden 200 miles, I felt awful the next day, like I'd been hit by a truck. After the Solvang race I woke up and felt hardly a touch of soreness. I also felt like I could easily ride another 200, and I realized that I'd entered another world, the realm of instant recovery. I'll be frank: It was a reassuring kind of world, and I could see why people might want to stay there."

So when we say something "enhances performance," it is a qualified statement because that might mean it changes something directly related to performance, or it might also mean that something reduces recovery time thus allowing an athlete to complete more high-quality training and therefore make larger adaptations.  And not to mention the beneficial effects for athletes who complete in multi-day events who can wake up feeling, in Stevens' words, "hardly a touch of soreness," and ready to punish themselves for 4-5 h again the next day.

Sports Science meets Internal Medicine

The future of these studies will be when sports scientists team up with the internal medicine physicians who study the hormones and produce the training studies that will measure the true effect of drugs such as hGH on performance.  In the mean time, as is most often the case, how you interpret the available evidence depends entirely on your paradigm.  So if you think VO2max predicts performance, you administer hGH, show no effect, and conclude accordingly that hGH does not enhance exercise performance.  For now we will wait for the most recent study by Meinhardt to be published, and will follow up on this this post when we have a chance to digest it.

Jonathan


Some articles of interest:

Anything by HOLT and SONKSEN on Pubmed, they have written a virtual thesis on hGH.

Widdowson WM et al., The physiology of growth hormone and sport.  Growth hormone & IGF Research.  19:308-19, 2009.

Birzniece V et al., Growth hormone administration:  is it safe and effective for athletic performance?  Endocrinology and Metabolism Clinics of North America.  39:11-23, 2010.

Growth hormone - 0.4s faster over 100m

Growth hormone improves performance by 0.4 seconds - WADA funded research

I'm sure that by now, many of you have seen the initial reports on a WADA-funded growth hormone study, which was published yesterday in the Annals of Internal Medicine.  It's an intriguing study, one that is bound to stimulate discussion, so I thought I'd do a very short post more to say that I've seen the reports, I am hunting the study down as you read this and I hope do a more comprehensive post on it as soon as time allows.

I've found the news reporting quite vague and uninformative about the study, and so hopefully I'll be able to bring out much more of the study's findings when I get hold of the original paper and then do a post, hopefully tomorrow.  But in a nutshell, what has been found is that in a group of recreationally active men, aged 18 to 40, growth hormone use improved their sprint capacity enough to lead researchers to conclude that it was worth 0.4 seconds in a 100m race.

If you think that's a pretty small difference, think back to to when Usain Bolt won the 100m title in a world record of 9.58s last year in Berlin.  The man who finished seventh was Marc Burns, in a time of 10.00s.  Now remember the race...did you notice Marc Burns, finishing 0.42 seconds behind Bolt?  Doubtful, and that's because at 0.42 seconds, he was a life-time behind Bolt in sprinting terms, but that is the same difference made by growth hormone, according to the research paper.

There will be, as there always are, problems and questions about the paper's method and the conclusions drawn from it.  For one thing, the study didn't use elite, highly trained sprinters, and so the margin of performance improvement may over-estimate the actual benefit gained by elite athletes.  Or under-estimate it, depending on what your inclination is - this is always a problem with these kinds of studies.  We've discussed this before with reference to EPO use, where studies find improvements that are probably inflated compared to what an elite athlete would achieve.  Then again, the elite athlete gaining even 2% is going to change their "life" as a result, and they benefit from a controlled, systematic environment within to dope, so this is a contentious issue.

Further, the study used a dose that the researchers described as lower than what athletes are reported to use, and for a shorter time, which means, in theory, that the 0.4s improvement predicted may be less than what is actually achieved.  According to the lead researcher, Ken Ho: "The drug’s effects on performance might be greater than shown in this study, and its side effects might be more serious".

So there is lots to discuss, but unfortunately, that's for another time, as I said.  Hopefully tomorrow, when I'll try to break down the method and findings in a lot more detail.

Ross