Performance enhancement in sport: summary of findings

Lisa Whitaker Carnegie Research Institute January 2012

Performance enhancing practices are commonplace in sports as athletes strive to be the best that they can be. Therefore, the aim of the present study was to determine athletes attitudes, perceptions and willingness towards the use of legal and illegal performance enhancing substances in sport.

How many athletes have previously used banned substances or currently use banned substances/ nutritional supplements?
Athletes reported whether they currently use nutritional supplements and/or banned substances and whether they had previously used any banned substance. Table 1 provides a breakdown of the number and percentage of athletes within each sport who use (d) either nutritional supplements or banned substances. 1 Table 1: Number and percentage of athletes who use nutritional supplements or banned substances All sports (n=729) Nutritional supplement use 541 (74%) Current banned substance use 17 (2%) Previous banned substance use 33 (5%) Take home message: Athletes competing at national or international level reported current and/or previous use of banned substances despite the current anti-doping policy. Drug testing alone is not an effective deterrent. More emphasis needs to be placed on doping prevention and altering any damaging or distorted doping-related perceptions athletes may have (e.g., possible outcomes which can be achieved from doping, other athletes doping behaviour) as drugs testing alone is not a sufficient deterrent to prevent athletes from using banned substances. In addition the development of life skills such as effective decision making and coping strategies are important.

What outcomes do athletes perceive to be associated with the use of nutritional supplements and banned substances?
Nutritional supplements
Table 2 highlights the percentage of athletes who either agreed or disagreed that the use of nutritional supplements could result in each of the listed outcomes. Percentages may not add up to 100% as some participants did not provide responses to all questions.

It is important to be aware however that under-reporting may have taken place because of the sensitive nature of the topic. The number of athletes declaring previous use or current use of banned substances may be inaccurate as a result of athletes purposefully failing to disclose correct information or not answering the questions (85 athletes did not respond to the supplement use or current use of banned substances questions and 78 athletes did not answer the previous use of banned substances question). A greater number of athletes may therefore currently use banned substances and/or nutritional supplements or have used banned substances previously than actually reported.

Table 2: Percentage of athletes who agree/disagree that nutritional supplement use can result in each outcome All sports Using NS can: Enhance performance Enhance fitness components Increase energy Aid recovery Enhance psychological characteristics Improve diet Improve health Achieve optimal muscle size Make you become dependent Result in contamination Lead to overdose Result in health problems Put unknown substances into body Imbalance diet Agree 87% 77% 91% 90% 49% 61% 65% 61% 36% 45% 34% 34% 53% 42% Disagree 12% 22% 8% 9% 50% 38% 34% 38% 63% 54% 65% 65% 46% 57%

Take home message: Education needs to focus on the risks associated with nutritional supplement use to increase athletes knowledge o A large proportion of athletes are consuming nutritional supplements, yet the findings of this study indicate that athletes lack sufficient knowledge of the risks associated with the use of nutritional supplements and that further education is necessary. o Contamination was not seen as a possible outcome to occur following the use of nutritional supplements by 54% of athletes. This is despite the lack of regulation within the supplement industry and the increasing number of cases portrayed in the media in the last 12 months, particularly associated with the ingestion of methylhexaneamine. o Similarly, 65% of athletes disagreed that using nutritional supplements could lead to overdose; whilst 65% believed that the use of nutritional supplements would not result in health problems. Using nutritional supplements incorrectly can result in potential side effects such as renal failure, seizures and caffeine intoxication. o The findings suggest that athletes need to be made aware of these side effects as well as the importance of eating a balanced diet. The ingestion of nutritional supplements is not needed if athletes eat a balanced diet, even though 61% of athletes believed nutritional supplement use was associated with an improved diet.

Banned substances
Table 3 highlights the percentage of athletes who either agreed or disagreed that the use of banned substances could result in each of the listed outcomes. Again percentages may not add up to 100% as some participants did not provide responses to all questions.

Table 3: Percentage of athletes who agree/disagree that banned substance use can result in each outcome All sports Using PES can: Enhance performance Enhance fitness components Result in financial gain Achieve optimal muscle size Enhance psychological characteristics Result in winning Enhance training Make you become dependent Lead to a negative reputation Result in a ban Lead to health problems Result in an unfair advantage Make you feel guilty Result in losing medals/records Agree 85% 84% 65% 80% 60% 70% 81% 84% 89% 89% 90% 89% 85% 89% Disagree 10% 11% 30% 15% 36% 25% 15% 12% 6% 6% 5% 6% 10% 6%

Take home message: Athletes agree that there are a number of positive and negative outcomes associated with the use of banned substances. If an athlete was considering the use of a banned substance, they would weigh up the positive and negative outcomes they perceive to be associated with taking banned substances prior to use. If the negative outcomes outweighed the positive outcomes, an athlete may be less likely to use a banned substance. However, if an athlete perceives the negative outcomes unlikely to occur and the positive outcomes highly likely, they may be at a greater risk of doping. The high agreement rates for positive outcomes (e.g., enhance performance, enhance fitness components, achieve optimal muscle size) may represent reasons for athletes to consider using banned substances. Therefore, if athletes are provided with alternative ways to achieve the outcomes identified above (e.g., strength and conditioning), then they may be less likely to use banned substances.

How similar do athletes perceive themselves to be to an athlete who uses banned substances?
Male athletes perceived themselves to be more similar to athletes who use banned substances when compared to female athletes. In addition, athletes competing at national level reported themselves to be more similar to athletes who use banned substances than individuals competing at any other level. The more an individual perceives an image to be similar to themselves, the more willing they are to engage in that behaviour. Therefore, if athletes perceive themselves to be similar to someone who uses a banned substance, they may be more likely to engage in doping compared to an athlete who perceives themselves to be similar to someone who doesnt use banned substances.

How favourable do athletes perceive those who use banned substances to be?
Club/university athletes portrayed the greatest favourability towards athletes who use banned substances compared with athletes competing at any other level. Similarly, males perceived athletes who use banned substances are more favourable than female athletes. If an individual decides that a persons image is unacceptable due to the behaviour they engage in and dont want to be perceived that way themselves, then that individual will be unlikely to engage in the displayed behaviour. Alternatively, the more favourable an athlete perceives another who uses banned substances, the more likely that athlete may be to use a banned substance themselves in the future. Take home message: Male, club/university and national level athletes perceptions of athletes who use banned substances need to be targeted through prevention programmes Male athletes and those competing at national level perceive themselves to be more similar to athletes who use banned substances than any other athletes. Males and club/university level athletes also perceive athletes who use banned substances more favourable than any other athletes. Athletes perceptions of those who use banned substances need to be targeted through education so that the images become more negative and athletes perceive themselves more like those who do not use banned substances. If the images of athletes who use banned substances can be made more negative to athletes, perceptions will become more negative, resulting in athletes less likely to use banned substances.

Do athletes have positive or negative attitudes towards doping?

Overall, athletes displayed relatively negative attitudes towards doping in sport. Males portrayed more positive attitudes towards doping than females. In addition, athletes competing at club/ university and national level held more positive attitudes towards doping than athletes competing at any other level. Attitudes usually correlate strongly with behaviour. Therefore, an athlete who portrays strong positive attitudes towards doping may be more likely to use banned substances. Take home message: Prevention programmes aimed at instilling negative attitudes towards doping in athletes need to be aimed at male, club/university and national level athletes. Only six athletes portrayed extremely positive attitudes towards doping, therefore the results of the study suggest that athletes generally see doping as a negative behaviour. However, as male athletes and those competing at club/university or national level tend to have the most positive attitudes towards doping, anti-doping programmes need to recognise that it is important to target these groups.

Which athletes are most willing to use banned substances?

Males appear more willing to use a banned substance than females. Athletes competing at national level reported greater willingness to use a banned substance than athletes competing at any other 5

level.

When are athletes most willing to use banned substances?

Nine athletes reported that they were extremely willing to use a banned substance if they were faced with any of the listed scenarios. Most athletes portrayed little or no willingness to use banned substances. However, athletes appear to be most willing to use a banned substance if they were to suffer a dip in performance and their funding was under threat, if they were to suffer an injury before a major competition or they thought others were using and getting away with it. Take home message: Education and support may need to be put in place when athletes suffer an injury prior to a major competition to prevent them from turning to banned substances. Athletes perceptions of what other athletes are doing (i.e., taking banned substances) need to be targeted and corrected so that athletes dont believe that others are using banned substances and getting away with it.

Who do athletes think would approve of them using nutritional supplements or banned substances?
Athletes identified whether or not they thought significant others would approve of them using nutritional supplements or banned substances. Table 4 highlights the percentage of athletes who perceived their significant others would either approve or not approve of them using nutritional supplements or banned substances. Table 4: Percentage of athletes who believed significant others would approve/not approve of them using nutritional supplements Nutritional Supplements Banned Substances Approve Wont approve Approve Wont approve Coach 87% 13% 6% 94% Doctor 71% 28% 1% 99% Fellow athletes 88% 12% 7% 93% Family 71% 28% 1% 99% Athletes perceived that coaches and fellow athletes would approve of them using nutritional supplements and banned substances more than doctors and family members. Take home message: If athletes believe that significant others would be accepting of them performing a particular behaviour, they are more likely to engage in that behaviour. Coaches are highly influential on athletes behaviour; therefore they need to receive education relating to the use of both nutritional supplements and banned substances. Education also needs to highlight to coaches the extent to which their behaviour and perceptions can influence an athletes behaviour. This will enable coaches become more 6

self-aware of the implications of their actions.

Do athletes think others in their sport would use a drug if it was undetectable and guaranteed winning?
Athletes believed that 37% of their fellow athletes would use a drug if it was undetectable and guaranteed winning. This reduced to 9% if the drug would lead to death after five years. Previous research has found that athletes who use banned substances tend to overestimate doping more than those who report non-use. Therefore, prevalence estimates of doping are important and could highlight athletes who are more likely to use banned substances in the future. Forty one percent is high and highlights the importance of targeting athletes perceptions associated with doping through education and intervention programmes.

Take home message: Anti-doping education programmes need to target athletes perceptions of other athletes doping behaviour.

Summary and implications

Overall, athletes portrayed negative attitudes and low willingness to use banned substances. Athletes provided an indication that they would be most willing to use a banned substance if they were to suffer a dip in performance and their funding was under threat, if they were to suffer an injury before a major competition or they thought others were using and getting away with it. In addition, athletes perceived individuals who do not use banned substances as much more favourable than athletes who use banned substances. Athletes also reported that they would receive either no or little approval from significant others in relation to using banned substances.

Males and athletes competing at club/ university or national level need to be specifically targeted Further education is required surrounding the risks of using nutritional supplements (e.g., contamination, side effects) Anti-doping programmes need to target athletes doping-related perceptions (e.g., other athletes doping behaviour, outcome expectations)