Forsknings- og evalueringsprosjekter

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Research projects and publications

  • 2024: Attitudes and doping prevalence among Norwegian youth across exercise activities

    Background: Use of image and performance enhancing drugs (IPEDs), such as anabolic-androgenic steroids, has in the last decades spread from elite athletes to recreational exercisers seeking a shortcut to a lean and muscular physique. The drugs are associated with multiple potential negative health consequences, some of which may be particularly harmful for adolescents. To better develop adequate and targeted preventive measures, identifying individuals and groups at risk for using IPEDs are important.

    Methods: By analyzing quantitative data extracted from Ungdata, a national data collection survey on adolescent health and well-being, this study describe self-reported physical activity and exercise habits, IPED prevalence, and attitudes and intentions towards IPEDs among 88 412 Norwegian adolescents aged 13–19 years.

    Results: 72 % participated in weekly sport or physical exercise. Young adolescents mostly exercised in sport clubs while older adolescents preferred training in gyms. Average lifetime IPED prevalence was 2.2 % (0.7 %–4.0 % depending on exercise activity). Respondents reported more favorable attitudes and higher intentions to use IPEDs when it was related to increasing muscle size (18 % and 5.8 %, respectively) and reducing weight (19 %, 8.1 %), compared to improving sport performance (5.6 %, 3.0 %). Large variations in attitudes and intentions were found between exercise groups, with individuals exercising in gyms having more favorable attitudes toward IPEDs than other groups.

    Conclusion: The study finds a low relative prevalence, but high acceptance for IPED use in certain exercise groups. Education and preventive measures should specifically target groups at risk for future use of these drugs.

    Read more:Performance Enhancement & Health

  • 2024: The purpose and effectiveness of doping testing in sport

    Maintaining an effective testing program is critical to the success and credibility of the anti-doping movement. However, a low detection ratio compared to the assumed real prevalence of sport doping has led some to question and criticize the effectiveness of the current testing system. In this perspective article, we review the results of the global testing program, discuss the purpose of testing, and compare benefits and limitations of performance indicators commonly used to evaluate testing efforts. We suggest that an effective testing program should distinguish between preventive testing and testing aimed at detecting the use of prohibited substances and prohibited methods. In case of preventive testing, the volume of the test program in terms of number of samples, tests and analyses is likely to be positively related to the extent of the deterrent effect achieved. However, there is a lack of literature on how the deterrent effect works in the practical context of doping testing. If the primary goal is to detect doping, the testing must be risk- and intelligence-based, and quality in test planning is more important than quantity in sample collection. The detection ratio can be a useful tool for evaluating the effectiveness of doping testing, but for the calculation one should take into account the number of athletes tested and not just the number of collected samples, as the former would provide a more precise measure of the tests’ ability to detect doping among athletes.

    Read more:
    Frontiers in Sports and Active Living

  • 2024: Medicalization of Sport? A Mixed-Method Study on the Use of Medications in Elite Ice Hockey

    Ice hockey is a high-risk sport known for its dominant macho culture. The purpose of this study was to examine experiences surrounding medication use among male, elite ice hockey players in Norway. A mixed-method design was employed, which first examined medications registered on doping control forms (DCFs) (n = 177) and then involved semi-structured focus group interviews (n = 5) with elite athletes (n = 25). Overall, 68% of the DCFs contained information about ≥1 medication. Among the most registered medications were NSAIDs and hypnotics (20% and 19% of all DCFs, respectively). During the interviews, numerous athletes reported using analgesics to manage injuries and pain caused by the sport, often being motivated by sacrificing themselves for the team during important matches and playoffs. Hypnotics were used due to high cumulative stress due to heavy training and competition load, late-night matches, and playing in a semi-professional league. Athlete support personnel (ASP), including physicians and trainers, were the athletes’ main sources of information. The athletes often displayed a profound and non-critical trust in the advice and products provided to them by their team physician. The findings indicate that male, elite ice hockey players, through their excessive and somewhat ignorant use of medications, expose themselves to health risks and inadvertent doping.

    Read more:Sports

  • 2023: Use of pharmaceuticals amongst athletes tested by Anti-Doping Norway in a five-year period

    Introduction: The aim of the study was to map the use of pharmaceuticals by Norwegian athletes registered on doping control forms (DCFs) in a five-year period to examine general and some class specific use of pharmaceuticals across sports and athlete levels.

    Method: Anonymous data from DCFs collected in 2015-2019 were manually entered into a database using the Anatomical Therapeutic Chemical (ATC) system for classification of the pharmaceuticals. Variables entered were year of control, gender, age group, athlete level, sport, test type, nationality, and pharmaceuticals (and dietary supplements) used.

    Results: Pain killers in the ATC groups M01 A (Nonsteroidal anti-inflammatory drugs - NSAIDs) and N02 B (other analgesics), and anti-asthmatics in ATC groups R03 A and R03 B were the most frequently used pharmaceuticals. National level athletes reported more use of pharmaceuticals (1.4 ± 1.7 pharmaceuticals per form) than recreational level athletes (0.9 ± 1.2). The highest proportion of DCFs containing information about at least one pharmaceutical were found in speed skating (79.1%), alpine skiing (74.0%), rowing (72.4%) and cross-country skiing (71.7%). Painkillers were most frequently used in muscular endurance sports (30.4% and 21.2 % for M01A and N02 B, respectively) and ball and team sports (17.9% and 17.0%). Use of hypnotics was reported from ice-hockey players and alpine skiers in around 8% of the cases.

    Conclusion: Use of anti-asthmatics was most often reported amongst athletes specially exposed to cold, chemicals and heavy endurance training. Athletes in specialized sports requiring high levels of strength and/or endurance reported a higher use of pharmaceuticals out-of-competition compared to in-competition, while there was no such difference in complex sports, such as team, gymnastic, aiming and combat sports.

    Read more:Frontiers in Sports and Active Living

  • 2023: Trends in dietary supplement use among athletes selected for doping control

    Background: Dietary supplements (DS) may be beneficial for athletes in certain situations, whereas incorrect or excessive use may impair performance, pose a risk to the athlete's health and cause positive doping tests by containing prohibited substances. To provide athletes with relevant and tailored information on safe supplement use, a better knowledge about DS trends over time and between sport disciplines are needed.

    Methods: This study examines the use of DS among athletes who have participated in doping controls by extracting information derived from 10,418 doping control forms (DCF) collected by Anti-Doping Norway from 2015 to 2019.

    Results: Overall, 51% of the DCFs contained information about at least one DS. National level athletes (NLA) more often reported using DS than recreational athletes (RA) (53 vs. 47%, p < 0.001). Athletes in strength and power (71%), VO2max endurance (56%) and muscular endurance sports (55%) had the highest proportion of DCFs with information about DS. Medical supplements were the most used supplement category for both genders and across all sports. Dietary supplements with a high risk of containing doping substances were most common among male, RA in strength and power sports. There were small and non-significant year-to-year variations in the prevalence of athletes using DS, while the number of products used concomitantly peaked in 2017 before declining in 2019 (2.30 vs. 2.08, p < 0.01). The use of medical supplements and ergogenic substances increased slightly for both NLA and RA from 2015 to 2019, while the use of all other supplement categories declined.

    Conclusion: Half of the 10,418 DCFs contained information about DS, with variations within the athlete population. DS with high risk of containing prohibited substances were mostly seen in sport disciplines requiring a high degree of specialization in strength/power, including powerlifting and weightlifting, as well as in some team sports, such as cheerleading and american football.

    Read more:Frontiers in Nutrition

  • 2022: Intelligence-based doping control planning improves testing effectiveness: Perspectives from a national anti-doping organization

    Anti-doping organisations are mandated to provide a comprehensive anti-doping programme, which aims to detect, deter and prevent doping in sport. Direct detection of prohibited substances and methods by collection of biological samples from athletes makes up about half of the global anti-doping budgets but has in the last decade been under critical scrutiny for its lack of efficiency. To ensure optimum detection and deterrence of testing and prevention efforts, a better understanding of doping practices and comparison of different doping test strategies are needed. This study evaluates 17 years of doping test statistics and Anti-Doping Rule Violations (ADRVs) from the perspectives of a national anti-doping organisation. A total of 48 709 samples (2865 ± 220 annually) were collected by Anti-Doping Norway in the period 2003–2019, which resulted in total 216 ADRVs (12.7 ± 3.7 annually), providing an average sample-to-ADRV rate of 0.44% when including urine, blood and ABP samples. Most athletes who committed ADRVs were men participating in ball and team or strength sports at a national or recreational level. Few ADRVs were recorded among elite athletes and in most high-risk sports, despite these groups being subjected to the highest number of doping tests. The number of annual ADRVs did not correlate with the corresponding number of collected doping samples. However, systematic use of intelligence in the test planning process was associated with an increase in ADRVs. Anti-doping organisations would benefit from improving their target testing capability and to take an intelligence-led approach in planning doping tests.

    Read more:Drug Testing and Analysis

  • 2022: Guidelines for Anti-Doping Education for Coaches, Instructors, and Trainers who are actively engaged in Recreational Sport
  • 2022: Dietary Supplements as a Major Cause of Anti-doping Rule Violations

    Dietary supplements encompass a large heterogenic group of products with a wide range of ingredients and declared effects used by athletes for a multitude of reasons. The high prevalence of use across all sports and level of competition, combined with the well-documented risks of such products containing prohibited substances have led to several doping cases globally. Despite being a considerable concern and persistent focus of sport organizations and anti-doping agencies, the magnitude of anti-doping rule violations associated with supplement use is not well-known. This study examines 18-years of doping controls of a national anti-doping program to determine the relationship between the presence of prohibited substances in athlete's doping samples and the use of dietary supplements. In 26% (n = 49) of all the analytical anti-doping rule violation cases in the period 2003–2020 (n = 192), the athlete claimed that a dietary supplement was the source of the prohibited substance causing an adverse analytical finding. Evidence supporting this claim was found in about half of these cases (n = 27, i.e., 14% of all analytical ADRV's). Stimulants were the most prevalent substance group linked to supplements (n = 24), of which methylhexanamine was associated with 16 cases. High risk products were predominantly multi-ingredient pre-workout supplements (n = 20) and fat-burning products (n = 4). Anti-doping organizations should develop strategies on how to assist athletes to assess the need, assess the risk and assess the consequences of using various dietary supplements.

    Read more:Frontiers in Sport and Active Living

  • 2022: Ten years of collecting hematological athlete biological passport samples – perspectives from a National Anti-doping Organization

    The hematological module of the Athlete Biological Passport (ABP) aims to reveal blood doping indirectly by looking at selected biomarkers of doping over time. For Anti-Doping Organizations (ADOs), the ABP is a vital tool in the fight against doping in sports through improved target testing and analysis, investigations, deterrence, and as indirect evidence for use of prohibited methods or substances. The physiological characteristics of sport disciplines is an important risk factor in the overall risk assessment and when implementing the hematological module. Sharing of experiences with implementing the hematological ABP between ADOs is key to further strengthen and extend its use. In this study, we present 10 years of experience with the hematological ABP program from the perspectives of a National ADO with special attention to sport disciplines' physiological characteristics as a potential risk factor for blood doping. Not surprisingly, most samples were collected in sport disciplines where the aerobic capacity is vital for performance. The study highlights strengths in Anti-Doping Norway's testing program but also areas that could be improved. For example, it was shown that samples were collected both in and out of season in a subset of the data material that included three popular sports in Norway (Cross-Country Skiing, Nordic Combined, and Biathlon), however, from the total data material it was clear that athletes were more likely to be tested out of competition and on certain days of the week and times of the day. The use of doping control officers with a flexible time schedule and testing outside an athlete's 60 min time-slot could help with a more even distribution during the week and day, and thus reduce the predictability of testing. In addition to promoting a discussion on testing strategies, the study can be used as a starting point for other ADOs on how to examine their own testing program.

    Read more:Frontiers in Sport and Active Living

  • 2022: Plantebaserte legemidler – er de forbudt i idretten?

    Alle legemidler i Felleskatalogen skal merkes med et symbol som angir om de inneholder stoffer på WADAs (World Anti-Doping Agency) dopingliste, dette gjelder også de plantebaserte legemidlene. Hensikten med denne studien var å undersøke om planter som inngår i de plantebaserte legemidlene som har markedsføringstillatelse i Norge, inneholder stoffer på dopinglisten, og om de aktuelle plantene eller ekstrakter fra dem kan ha en prestasjonsfremmende effekt i idretten. Det ble utført substanssøk i SciFinder og litteratursøk i SciFinder, PubMed, Scopus, Web og Science og Embase på de 30 aktuelle plantene. Ingen av plantene inneholdt stoffer på WADAs dopingliste, og det var svært få artikler som beskrev dopingrelaterte effekter av de undersøkte plantene. Basert på denne studien bekreftes det at de plantebaserte legemidler som er beskrevet i Felleskatalogen per 1. april 2022 er korrekt merket med grønn silhuett da det ikke er grunnlag for å si at plantene de kommer fra inneholder forbudte stoffer.

    Les mer: Norsk Farmaceutisk Tidsskrift

  • 2021: Når pasienten er idrettsutøver

    Pasienter kan være idrettsutøvere og dermed underlagt Verdens antidopingbyrås (World Anti-Doping Agency, WADA) antidopingregelverk – noen ganger uten å være klar over det selv. Da kan det være til stor hjelp at behandlende lege har kunnskap om regelverkets retningslinjer for medisinsk behandling.

    Les mer:Tidsskriftet for den Norske legeforening

  • 2021: A Mixed-Method Evaluation of a Prison Anti-doping Intervention: The Hercules Prison Program

    The Norwegian Offender Mental Health and Addiction study denotes the need for physical activity and anti-doping interventions in Norwegian prisons. We developed and evaluated the efficacy of such intervention—the Hercules prison program. The program combines theoretical anti-doping lessons with practical strength training. The study adopts a mixed-methods approach (pretest-posttest design) comprising a longitudinal survey, observation, informal conversations, and in-depth interviews. Survey respondents were 104 male prisoners aged 18–56 (M = 34.81, SD = 9.34) years from seven Norwegian prisons. Of these, 52 provided both baseline and posttest responses. Participants completed questionnaires including demographic, doping use, and psychophysical items/measures. At the end of the intervention, in-depth interviews were conducted with 11 of the survey respondents. The survey data were analyzed using descriptive statistics, as well as independent and paired samples t-tests. The qualitative data were analyzed using Interpretative Phenomenological Analysis. A total of 7.5% and 33.3% of participants were current and former AAS users respectively, whereas 86.1% personally knew at least one current or former AAS user. Consistent with our expectation, there were increases in self-rated physical strength (t = −4.1, p < 0.001, d = 0.46) and strength training self-efficacy (t = −8.33, p < 0.001, d = 1.36), and a decrease in moral disengagement in doping (t = −4.05, p < 0.001, d = 0.52) from baseline to posttest. These findings are supported by the qualitative data. Notable success factors are relationship-building, instructors' expertise and acceptability, and gatekeepers' navigation and co-creation. The program provides valuable evidence of the potential benefits of combining anti-doping education with practical strength training in doping prevention in correctional settings.

    Les mer:Frontiers in Sport and Active Living

  • 2020: Disposition of Urinary and Serum Steroid Metabolites in Response to Testosterone Administration in Healthy Women

    Context: Little is known about how exogenous testosterone (T) affects the steroid profile in women. More knowledge would give the antidoping community keys as to how to interpret tests and detect doping.

    Objective: This work aimed to investigate the steroid profile in serum and urine in young healthy women after T administration.

    Methods: In a randomized, double-blind, placebo-controlled study, 48 healthy young women were assigned to daily treatment with T cream (10 mg) or placebo (1:1) for 10 weeks. Urine and blood were collected before and at the end of treatment. Serum steroids were analyzed with liquid chromatography-tandem mass spectrometry, and urine levels of T, epitestosterone (E), and metabolites included in the Athlete Biological Passport (ABP) were analyzed with gas chromatography-tandem mass spectrometry.

    Results: In serum, T and dihydrotestosterone levels increased, whereas sex hormone-binding globulin and 17-hydroxyprogesterone decreased after T treatment as compared to placebo. In urine, T and 5α-androstanediol increased in the T group. The median T increase in serum was 5.0-fold (range, 1.2-18.2) and correlated to a 2.2-fold (range, 0.4-14.4) median increase in T/E in urine (rs = 0.76). Only 2 of the 24 women receiving T reached the T/E cutoff ratio of 4, whereas when the results were added to the ABP, 6 of 15 participants showed atypically high T/E (40%). In comparison, 22/24 women in the T group increased serum T more than 99.9% of the upper confidence interval of nontreated values.

    Conclusion: It seems that the T/E ratio is not sufficient to detect exogenous T in women. Serum total T concentrations could serve as a complementary marker of doping.

    Les mer:J Clin Endocrinol Metab

  • 2020: Idrettsfarmasi og antidoping – hvilken rolle kan farmasøyten spille?

    Farmasøyters tverrfaglige kunnskap innen legemiddelbruk, farmakologi, legemiddelkjemi og -analyse er ettertraktet i antidopingarbeidet. For apotekansatte farmasøyter er det viktig å ha kjennskap til dopingreglementet når kunder som driver med organisert idrett skal veiledes og bevisstgjøres om egen legemiddelbruk.

    Les mer:Farmatid

  • 2020: Utilsiktet doping – de største risikoområdene

    Når man snakker om doping, tenker folk flest på det å ta et stoff som står på dopinglisten til World Anti-Doping Agency (WADA) for å øke en idrettslig prestasjon. Nasjonale antidopingmyndigheter bruker mye ressurser på å forhindre dopingbruk blant idrettsutøvere gjennom avdekking, avskrekking, utdanning og holdningsskapende tiltak, slik at utøvere ikke blir fristet til å ta snarveier for å vinne medaljer, heder og ære. Statistikk fra WADA viser en årlig forekomst av positive dopingprøver på ca. 1-2 prosent av totalt 340 000 prøver på verdensbasis [1]. I en del tilfeller hevder utøver å ha fått i seg det forbudte stoffet ubevisst, for eksempel gjennom bruk av kosttilskudd og legemidler, eller gjennom kontaminert mat. Regelverket fastsatt av WADA (World Anti-Doping Code) er tydelig på at det er utøvers ansvar hvilke stoffer vedkommende får i seg. Utøver kan bli ilagt sanksjoner i form av tap av plasseringer og eventuelle prispenger fra konkurransen hvor prøven ble avlagt, og/eller utestenges fra idretten i en kortere eller lengre periode selv om dopingbruken ikke var tilsiktet [2]. Dette etterlater et stort ansvar på utøver, som bør være bevisst på områder hvor det er høy risiko for å få i seg forbudte stoffer. Dersom utøver kan vise til at han har tatt nødvendige forholdsregler, kan dette føre til redusert sanksjon ved en eventuell positiv prøve. Selv om antidopingregelverket er tydelig på utøvers objektive ansvar, er det viktig at medisinsk støttepersonell kjenner til risikoområdene for utilsiktet doping slik at de kan gi gode og velkvalifiserte råd til utøverne. Vi vil i denne artikkelen sette søkelys på problemstillingen rundt utilsiktet doping, som i dette tilfellet kan defineres som inntak av forbudte stoffer som ikke er et resultat av - eller oppnådd etter bevisst planlegging.

    Les mer:Norsk Idrettsmedisin

  • 2020: Fluctuations in hematological athlete biological passport biomarkers in relation to the menstrual cycle

    The interpretation of athlete biological passport (ABP) is strengthened by understanding the natural fluctuations in its biological parameters. Here we have assessed the influence of the menstrual cycle on the hematological module of the ABP.

    Seventeen women with regular menses were included. Blood samples were collected once a week for two consecutive cycles and analyzed for hematological parameters. Menstrual phases were hormonally determined.

    The intra-individual variation in the hematological parameters was similar between the two cycles. Reticulocyte percentage was significantly lower in the follicle phase (median 0.95%) than in the ovulatory (median 1.10%) and luteal phases (median 1.16%), P = 0.006, whereas no differences were found in hemoglobin concentration, hematocrit, red blood cell count, or red blood cell indices. When the values were entered into the ABP model, findings outside the program-calculated individual thresholds were identified in two participants. One woman showed an atypical low OFF-score in the last sample collected, mainly because of increased reticulocyte percentage. This was likely a response to treated insufficient iron stores. One woman displayed an atypical hemoglobin value at the lower limit 2 weeks after ovulation, which was likely due to fluctuations in plasma volume.

    In conclusion, the ABP parameters in general are stable throughout the menstrual cycle. Significant differences between the menstrual phases were found in reticulocytes; however, the variation was not related to findings outside the individual thresholds, except in one individual. Moreover, our results highlight the importance of having information about iron supplementation available when evaluating hematological passports.

    Read more: Drug Testing and Analysis

  • 2020: Kosttilskudd – dopingfelle eller en nødvendig del av treningen?

    Det globale markedet for idrettsernæring er en multimilliardindustri. Internasjonale studier tyder på at 40-100 % av idrettsutøvere bruker kosttilskudd. For helse- og antidopingmyndigheter er det en bekymring at kosttilskudd kan føre til utilsiktet dopingbruk og helseskader. Er det verdt risikoen?

    Les mer: Norsk tidsskrift for ernæring

  • 2019: Doping substances in dietary supplements

    Background: International studies have shown that 12-58 % of all dietary supplements intended for people who exercise and engage in sports contain substances prohibited by the World Anti-Doping Code (WADC). In some cases, the doping substances are not declared on the product label, and the consumer may therefore be unaware of what he/she ingests. Many of the substances may cause adverse health effects, and sale of such products is illegal in Norway.

    Material and method: To investigate the prevalence of doping substances in dietary supplements sold on the Norwegian market, a total of 93 high-risk products from online shops targeting Norwegian consumers were analysed for substances on the WADC Prohibited List and pharmaceutical drugs. All supplements were marketed as able to boost energy levels and/or having a muscle-building or fat-burning effect. The products were selected on the basis of tips received, online forums and/or international lists.

    Results: Altogether 21 of 93 (23 %) products analysed contained prohibited substances, pharmaceutical drugs and/or illegal amounts of caffeine. Substances on the WADC Prohibited List were detected in 8 of the 93 (9 %) dietary supplements. All products containing doping substances were declared as containing one or more banned substances.

    Interpretation: The results show that using apparently legal dietary supplements purchased in online shops targeting Norwegian consumers involves a risk of inadvertent doping and adverse health effects.

    Read more:Tidsskriftet for den Norske legeforening

  • 2016: Doping prevention through anti-doping education and practical strength training: The Hercules program

    There is a paucity of well-controlled anti-doping interventions. We developed and evaluated the efficacy of a doping prevention program for adolescents – the Hercules program. The program is different from most anti-doping interventions in the combination of theoretical lessons with practical strength training and inclusion of three groups of participants. A total of 202 high school students (females = 98) aged 15–21 years (mean = 16.9) were randomised to the three groups: control (n = 50), theory only (n = 88), and theory with workout (n = 64). Participants completed baseline and posttest questionnaires including demographic, doping use, and psychophysical items/measures. Data were analysed using chi-square tests and mixed between-within analysis of variance. From baseline to posttest, the theory with workout group gained a higher knowledge of anabolic–androgenic steroids (AAS) and their harmful effects as well as a higher increase in strength training self-efficacy. The Hercules program seems valuable in providing adolescents knowledge on AAS and their harmful effects as well as positive strength training skills. The program elucidates the benefits of combining anti-doping education with practical strength training in doping prevention.

    Read more: Performance Enhancement and Health