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Boosting in Athletes with Spinal Cord Injury: Implications for Sports

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By Martin Keung

Dr. Krassioukov is a principal investigator at ICORD.  The Krassiokov laboratory researches autonomic dysreflexia, cardiovascular health, locomotor training, physical medicine and sexual rehabilitation in persons with SCI.

Gee, C. West, and A.Krassioukov. (2015). Boosting in Elite Athletes with Spinal Cord Injury: A Critical Review of Physiology and Testing Procedures.Sports Medicine. 1179-2035, May 26 2015. You can find the original article here.

 

What is Boosting?

Boosting in athletes with spinal cord injury (SCI) refers to the use of a medical condition called Autonomic Dysreflexia (AD) with the intention of enhancing performance in sport. Autonomic Dysreflexia is a reaction of the autonomic nervous system to overstimulation. It is typically triggered by exceeding an individual’s bladder capacity or by prolonged sitting in an athlete’s wheel chair. But there are various other methods of inducing AD including twisting of the scrotum or inflicting injury to oneself below the level of the lesion.

Boosting: Why is it dangerous?

It must be emphasized that boosting is dangerous. Symptoms of AD include an abnormal and sudden increase in blood pressure as a result of the excitation of sympathetic nerves. Sympathetic nerves originate from the sympathetic nervous system (SNS), which is part of the autonomic nervous system (ANS). The SNS innervates and excites many of our organs such as the eyes and the heart. It is responsible for the “fight-or-flight” mechanism. In other words, it is activated when we exercise, when we feel fear, and when we get stressed. If the sudden increase in blood pressure is not dealt with, as may occur in some persons with SCI, consequences can include brain damage, seizures, irregular heartbeats, and death.

Why Are Athletes with SCI Boosting?

Despite the fact that boosting has been deemed illegal by the International Paralympic Committee (IPC), there are still many reasons why an athlete with SCI may boost. Boosting will enhance the performance of the athlete with SCI to “level the playing field” with other athletes who do not have an impaired sympathetic nervous system. For instance, individuals who have an upper body SCI may have a lower heart rate and blood pressure in response to exercise because of diminished control over cardiac function, which decreases performance. Boosting also prevents common symptoms from low blood pressure such as reduced physical capability, fatigue, loss of consciousness, and dizziness.

International Standard on Boosting

Boosting is illegal in accordance to the World-Anti Doping Code which deems a substance to be illegal if it meets two of three requirements:

  1. Able to enhance sport performance
  2. Presents an actual or potential risk of some sort to the athlete
  3. Against the spirit of the sport

The IPC requires the blood pressure of all athletes measured before any event. The threshold blood pressure is 180 mmHg. If an athlete’s blood pressure is above 180 mmHg, they will be re-examined 10 minutes after. If after re-examination, the athlete’s blood pressure is still above 180 mmHg, then the athlete will be withdrawn from the competition. Even when the systolic blood pressure is below the threshold of 180 mmHg, heart attacks, seizures, and strokes have occurred.

How to Resolve the Issue of “Unfair Competition” in Paralympic Sports?

To re-emphasize, one of the biggest reasons that motivates an athlete with a SCI to boost is to “level the playing field.” To illustrate, one athlete may have lower heart rate and blood pressure compared to another athlete because the SCI occurred on a higher level of the spinal cord and/or has a more complete injury. A suggested modification to the current testing method of the IPC for boosting is a “boosting passport” for each athlete. This means each athlete will have a different blood pressure thresholds pertaining to how their SCI affects them. Another suggested idea, would be to give additional points to those have a cardiovascular disadvantage to discourage those athletes from boosting.