International Olympic Committee Medical Commission Research Articles

Dr. Richard C. Nelson-Mentor and Visionary: Lessons Learned, Memories Forever.

Richard C. Nelson started the Biomechanics Laboratory, one of the first of its kind in the world, on the campus of the Pennsylvania State University in 1967. His vision focused on connecting the physiological and mechanical elements of human performance analysis, specifically sport performance. The lab's engaging, interdisciplinary environment supported self-designed programs of study, benefiting each individual student. Furthermore, the Biomechanics Lab became the nexus for the development of biomechanics as a field of study internationally. Richard Nelson's diplomatic skills spread the word initially through the formation of the International Society of Biomechanics. This international effort resulted in the development of national societies of biomechanics around the world, for example, the American Society of Biomechanics. Second, these efforts stimulated the concept of sport performance analysis on the international stage. Richard Nelson's passion was to analyze individual performances at the Olympic Games. This goal was finally realized, with the development of the Subcommission within the International Olympic Committee Medical Commission and biomechanical analysis projects completed at the 1984 Olympic Games in Los Angeles. Richard Nelson's vision, mentoring style, and dedication planted and nurtured the seed of biomechanics as a discipline of study around the world.

Measurement of Subcutaneous Adipose Tissue in Pre-School Children using Ultrasound

Studies analyzing the weight status of children, especially in overweight and obese children, often use skinfold measurements as part of a standard anthropometric assessment. This commonly used method to assess body fat has inherent shortcomings in accuracy and reliability. In the HAPPY CHILD study (Healthy eating, Active Play-Promoting a healthy lifestyle in Young CHILDren), we used ultrasound to measure subcutaneous adipose tissue (SAT) in pre-school children. In taking these measurements, we applied a recently introduced protocol developed by the International Olympic Committee (IOC) Working Group on Body Composition, Health and Performance (under the auspices of the IOC Medical Commission). PURPOSE: To determine if the above-mentioned protocol for ultrasound measurements of SAT is a feasible method to assess body fat in pre-school children, aged 3-5 years. METHODS: Ultrasound measurements of SAT were taken at eight body sites from 112 children in ten kindergartens. Site marking was performed in reference to a child’s body height. The sum of SAT (D) from these eight sites is reported as: DIncl (including embedded structures) and DExcl (excluding embedded structures). Fat patterning profiles were established, and boys were compared to girls. RESULTS: Fat patterning profiles of 59 boys and 53 girls with an average age of 4.05 years ± 0.72 were established. A comparison of SAT thickness using the Mann-Whitney U test showed a significant difference between girls and boys in the sum of SAT: DIncl in girls was 52.91 mm ± 19.03 (DExcl: 47.46 mm ± 18.05) vs. 46.9 mm ± 18.48 (DExcl: 41.27 mm ± 17.27) in boys (DIncl: p = 0.036; DExcl: p = 0.024). Both groups had the highest SAT values at the lateral thigh and the lowest values at the erector spinae. CONCLUSION: The applied protocol for ultrasound measurements of SAT is a feasible method to assess body fat in pre-school children. The results show that the girls have a higher amount of SAT than the boys. Adjustments in calculation of measurement sites may be necessary in some cases, depending on the length of a child’s limbs.

Manufactured Dope: How the 1984 US Olympic Cycling Team Rewrote the Rules on Drugs in Sports

At the 1984 Los Angeles Olympic Games, the US cycling team not only won its first Olympic cycling medal since 1912 but also added eight more, marking a triumph for the team and its Polish-born coach, Eddie Borysewicz. Soon, however, news leaked that the seven members of the US cycling team, four of whom won medals, had employed controversial blood transfusions. Though not prohibited by the International Olympic Committee (IOC), the news caused a firestorm within the press and led to a significant revision of the IOC Medical Commission's anti-doping rules. Previous historical scholarship has ignored this event, focusing instead on early doping scandals such as Knud Jensen or more recent controversies such as Ben Johnson and Lance Armstrong. However, this event caused a significant shift within the IOC Medical Commission's attitude towards doping. Prior to 1984, the IOC Medical Commission had hesitated to prohibit any substance, including anabolic steroids, if it could not detect the substance through testing. The willingness of the US team to experiment with new medical procedures to improve performance galvanised the Medical Commission and set in motion new anti-doping policies that remain in place today.

The “Science” of Fair Play in Sport: Gender and the Politics of Testing

This essay reflects on the history of gender verification regulations aimed at female athletes in international sport and the justification for this practice under the rationale that it protects fair play in women’s sport. Beginning with the most recent guidelines for women participants proposed in 2011 following the controversy around the 800-meter world champion runner Caster Semenya, this analysis looks at the politics—gendered, scientific, and international in nature—of policing sex in women’s events through the use of scientific testing. To do so, the article traces the ideological underpinnings of fair play in Olympic sport and the development of international guidelines, providing a historiographic reading of the International Olympic Committee Medical Commission’s early work in this field during the 1960s, subsequent changes to this regulation, and their implications. In advancing this argument, I contend that to date the science aimed at preserving a steadfast binary has only provided evidence to the contrary. Science has yet to prove that female sex is definitive, and its recommendations have in part come to reflect that recognition. The recent revisiting of gender verification protocols nonetheless suggests the technocratic desire for a formation of sex that reflects binary constructions of gender, attesting to the continued power of heteronormative orders in this field and beyond.

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Therapeutic use exemptions (TUEs) at the Olympic Games 1992–2012

The need for therapeutic use exemptions (TUEs) or the permitted use of Prohibited Substances and Prohibited Methods by athletes to treat significant medical conditions arose when several classes of drugs...

The historical roots of today's problems: A critical appraisal of the international anti-doping movement

Embarking from the position that the past offers potentially useful insights into contemporary policy problems, this article traces the international anti-doping movement from 1960 to today. In doing so, it argues that today's problems can be traced to a decision made in the 1960s by the International Olympic Committee (IOC) to portray performance enhancement as an existential threat to the ideals of sport. Not surprisingly, that position resulted in a moral crusade in which the IOC's Medical Commission sought to protect athletes from making “evil” decisions to seek pharmacological assistance. Given the likelihood that they would fail to pass ideological muster under this focus, policies based on other considerations, including health, were given inadequate attention. The regulatory framework based on laboratory analysis and judicial punishment that was instead put in place has failed in multiple dimensions. This article concludes, however, that little progress will be made until anti-doping authorities become more flexible in their thinking.

International Olympic Committee consensus statement on thermoregulatory and altitude challenges for high-level athletes

Challenging environmental conditions, including heat and humidity, cold, and altitude, pose particular risks to the health of Olympic and other high-level athletes. As a further commitment to athlete safety, the...

Canadian Academy of Sport and Exercise Medicine Position Paper: Abuse, Harassment, and Bullying in Sport

Over the past 20 years, there has been an emergence of reported incidents of abuse, harassment, and bullying in Canadian sport (M. Holman, unpublished data, 1995).1-3 In 1994, an Edmonton track coach was charged and convicted of engaging in sexual relations with his female adolescent athletes. In 19

The role of the bronchial provocation challenge tests in the diagnosis of exercise-induced bronchoconstriction in elite swimmers

BackgroundThe International Olympic Committee–Medical Commission (IOC-MC) accepts a number of bronchial provocation tests for the diagnosis of exercise-induced bronchoconstriction (EIB) in elite athletes, none of which have been studied in...

Airway Responses to Eucapnic Hyperpnea, Exercise, and Methacholine in Elite Swimmers

The International Olympic Committee Medical Commission (IOC-MC) requires athletes to provide the result of an objective test to support a diagnosis of asthma or exercise-induced bronchoconstriction (EIB) if they want to inhale a beta-2-agonist. The purpose of the study was to evaluate the airway response to a methacholine challenge and to hyperpnea induced by exercise in the field and in the laboratory or that induced voluntarily by eucapnic hyperpnea in a group of female elite swimmers. Sixteen female nonasthmatic elite swimmers performed a eucapnic voluntary hyperpnea (EVH) test, a field-based exercise test (FBT), a laboratory-based exercise test (LBT), and a methacholine challenge. The criteria suggested by the IOC-MC were used to define a positive response to the challenges (EVH, field test, and laboratory test: minimum 10% decrease in FEV1; methacholine: PD20 < or = 2 micromol). Eight swimmers (50%) had at least one positive test to hyperpnea. Five were identified with the EVH test, four with FBT, and four with LBT. None were identified using methacholine. Three swimmers with airway hyperresponsiveness to exercise would have been identified using a higher cutoff for methacholine (PD20 < or = 8 micromol). The EVH test is the test that diagnoses most swimmers with an abnormal response to hyperpnea, but not all cases of EIB are identified with the EVH test. Performing a methacholine test using IOC-MC's cutoff value does not improve the chances of diagnosing EIB. We recommend performing the EVH test when diagnosing and evaluating EIB in elite swimmers and if EVH test negative then proceeding to a strenuous LBT.

Bronchial challenges in athletes applying to inhale a β2-agonist at the 2004 Summer Olympics

The International Olympic Committee Medical Commission required a medical justification for athletes to inhale a beta2-agonist before an event at the Summer Games in Athens in 2004. We sought to establish the percentage of athletes applying to use an inhaled beta2-agonist on the basis of the results of objective tests to establish a diagnosis of asthma or exercise-induced bronchoconstriction. We also sought to compare this percentage with the percentage of athletes simply notifying the intention to use a beta2-agonist at the previous Summer Games in Sydney in 2000. An analysis was made of tests that measured the change in FEV1 in response to a bronchodilator or in response to a provoking stimulus, such as exercise, eucapnic voluntary hyperpnea, hypertonic saline, or methacholine. Ten thousand six hundred fifty-three athletes competed in Athens; 4.2% were approved to use a beta2-agonist, and 0.4% were rejected. This approval rate was 26% less than the notifications in 2000 in Sydney (5.7%). Compared with Sydney 2000, there was a significant reduction of submissions and approvals for athletes from the United States, New Zealand, Australia, and Canada and in triathlon and swimming sports. The need to provide objective testing has resulted in a reduction in the number of athletes seeking approval to use an inhaled beta2-agonist. Objective evidence has provided information for the doctor that is likely to improve the health of the athlete because many athletes appeared to be undertreated at the time of testing. We show that documentation of airway narrowing in athletes, particularly in response to exercise or surrogate stimuli for exercise, aids in the diagnosis and management of asthma by providing evidence of bronchial hyperresponsiveness that will respond to treatment with inhaled corticosteroids and is usually associated with a reduction in respiratory symptoms on exercise.

Practical use of the International Olympic Committee Medical Commission position stand on the female athlete triad: A case example

The female athlete triad consists of the interrelated problems of disordered eating, amenorrhea, and osteoporosis, and it is believed to affect female athletes in all sports and at all levels of competition. The current article highlights the Position Stand on the Female Athlete Triad of the International Olympic Committee's Medical Commission (IOCMC). The literature related to disordered eating, energy availability, amenorrhea, and bone loss in athletes is briefly reviewed. A hypothetical case is presented to illustrate some of the common issues and problems encountered when working with athletes affected by the triad, such as the effect of weight on performance in "thin" sports, coach involvement, sport participation by symptomatic athletes, and treatment resistance/motivation. Strategies recommended by the position stand for managing those issues and problems are presented regarding the referral, evaluation, and treatment phases of the management process. Implications of the position stand are discussed in terms of the IOCMC's endorsement of the athlete's health being primary to her performance.

Impact Of The International Olympic Committee ??? Medical Commision Change In Asthma Diagnosis ??? A British Perspective

Since 2002 the International Olympic Committee-Medical Commission (IOC-MC) has required athletes, who suffer from asthma, to provide evidence of their condition to qualify to use inhaled beta −2 agonists. PURPOSE To compare the prevalence of asthma at the 2000 and 2004 Olympic Games in the Great British Olympic team (Team GB). METHOD Following local ethics committee approval, athletes (165 males, 106 females) from2004 Team GB volunteered and written, informed consent. An athlete was confirmed asthmatic if they had a positive bronchoprovication or bronchodilator test recognised by the IOC-MC. Pre-Olympic medical forms from the 2000 Team GB were examined to discover the prevalence of asthma at the 2000 Olympic Games. Results The asthma prevalence of Team GB is reported in table 1.Table 1: Team GB asthma prevalence at the 2000 and 2004 Olympics.Thirteen out of 62 (21.0%) athletes with a previous diagnosis of asthma tested negative. A further 7 athletes with no previous diagnosis of asthma tested positive. Swimming and cycling had the highest prevalence of asthma at both 2000 and 2004 (swimming: 41% vs 44% and cycling: 44% vs 39%, respectively). Conclusion The IOC-MC requirement that asthmatic athletes must submit documented evidence of asthma has highlighted that 21.0% of athlete's previously diagnosed asthmatic were unable to provide positive evidence of asthma. Asthma prevalence within Team GB remained unchanged between 2000 and 2004. The more rigorous procedure used in 2004 also yielded a number of athletes who tested positive for asthma who had no previous history, symptoms or diagnosis of asthma. Screening for asthma within elite athletic populations using bronchoprovication challenges appears warrented to assist athletes in preparing more effectively for major sporting events.

Summary and Agreement Statement of the 2nd International Conference on Concussion in Sport, Prague 2004

In November 2001, the 1st International Symposium on Concussion in Sport was held in Vienna, Austria to provide recommendations for the improvement of safety and health of athletes who suffer concussive injuries in ice hockey, football (soccer), and other sports. The 2nd International Symposium on Concussion in Sport was organised by the same group and held in Prague, Czech Republic in November 2004. It resulted in a revision and update of the Vienna consensus recommendations, which are presented here.

The Asthmatic Athlete, Inhaled Beta Agonists, and Performance

The large increase in the number of athletes who apply to use inhaled beta agonists (IBAs) at the Olympic Games is a concern to the medical community. This review will examine the use of IBAs in the asthmatic athlete, the variability that exists between countries and sport, and outline a plan to justify the use of these medications. Much of this article is a result of an International Olympic Committee (IOC) Medical Commission-sponsored meeting that took place in May 2001. Records of the use of IBAs at previous Olympics were reviewed. MEDLINE Searches (PubMed interface) were performed using key words to locate published work relating to asthma, elite athletes, performance, treatment, and ergogenic aids. Since 1984 there have been significant increases in the use of IBAs at the Olympic Games as well as marked geographical differences in the percentage of athletes requesting the use of IBAs. There are large differences in the incidence of IBA use between sports with a trend towards increased use in endurance sports. There are no ergogenic effects of any IOC-approved IBA given in a therapeutic dose. In many cases, the prescription of IBAs to this population has been made on empirical grounds. Beginning with the 2002 Winter Games, athletes will be required to submit to the IOC Medical Commission clinical and laboratory evidence that justifies the use of this medication. The eucapnic voluntary hyperpnea test will be used to assess individuals who have not satisfied an independent medical panel of the need to use an IBA.

The Human Factor

Introduction: This paper analyzes the ways in which the International Olympic Committee (IOC) confronted and made critical policy decisions based on highly technical scientific and medical knowledge, in the period leading up to and including the 1960s. Methods: This paper utilizes the historical method to examine the topics of science and medicine within the Olympic Movement. Additionally, it brings an external and analytical perspective to a question that has thus far been examined either from an intestine approach or in an extensively descriptive manner. Research is drawn from primary sources such as scientific and medical reports from the 1960s, press reports about athletics and science, and the archives of the IOC (including reports of the nascent Medical Commission and correspondence among members of the Commission and the IOC). The 1960s were a crucial time for the IOC; particularly in the way that this group comes to understand the enormous amount of scientific information that became critical to the conduct of elite sport in that decade. Results: Prior to the 1960s, the IOC rarely had to deal with matters of a scientific or medical nature. When necessary, FIMS was consulted in these matters. In the 1960s, however, the IOC was forced to hastily confront complex scientific and medical information and struggled to create a process to assist in understanding altitude physiology, drug testing and gender verification. The composition and influence of the IOC Medical Commission at its inception continues to influence the Commission more than 30 years later. Discussion: The IOC continues to be confronted with critical decisions based on highly technical scientific and medical knowledge. Over the past 30 years the Medical Commission of the IOC has emerged as the vehicle through which this information is analyzed by the IOC. A better understanding of how certain institutions within the elite sports world were created can help us to understand the institution and its operation today. Recent historical research seems to suggest that the IOC was slow in responding to the doping issue in the past. The organization of the IOC was, in large part, responsible for any tardiness. Scientific issues that emerged in the 1960s are still the focus of debate today. There is a belief that the athletes, who “by an accident of geography” are born, grow up and train at a high altitude, are predisposed to success in distance events in track and field. The problem of doping in sport has yet to be eliminated. The more sophisticated the testing procedures become, the savvier some athletes and trainers become in evading those tests. It is not only the money that has entered the previously amateur Olympics that pushes some athletes to take performance enhancing drugs, the fame associated with an Olympic medal is also a motivating factor. The IOC decided, perhaps because of social (not just scientific or medical) pressure, to end the test for gender at the 2000 Games in Sydney (unless accusations were made about a specific athlete). Acknowledgements: Research for this project was funded, in part, by the Postgraduate Research Grant Programme, 1999, of the IOC Olympic Studies Center and the Olympic Museum.

Detection of DNA-recombinant human epoetin-alfa as a pharmacological ergogenic aid.

The use of DNA-recombinant human epoetin-alfa (rhEPO) as a pharmacological ergogenic aid for the enhancement of aerobic performance is estimated to be practised by at least 3 to 7% of elite endurance sport athletes. rhEPO is synthesised from Chinese hamster ovary cells, and is nearly identical biochemically and immunologically to endogenous epoetin-alfa (EPO). In a clinical setting, rhEPO is used to stimulate erythrocyte production in patients with end-stage renal disease and anaemia. A limited number of human studies have suggested that rhEPO provides a significant erythropoietic and ergogenic benefit in trained individuals as evidenced by increments in haemoglobin, haematocrit, maximal oxygen uptake (VO2max) and exercise endurance time. The purpose of this review is to summarise the various technologies and methodologies currently available for the detection of illicit use of rhEPO in athletes. The International Olympic Committee (IOC) banned the use of rhEPO as an ergogenic aid in 1990. Since then a number of methods have been proposed as potential techniques for detecting the illegal use of rhEPO. Most of these techniques use indirect markers to detect rhEPO in blood samples. These indirect markers include macrocytic hypochromatic erythrocytes and serum soluble transferrin receptor (sTfr) concentration. Another indirect technique uses a combination of 5 markers of enhanced erythropoiesis (haematocrit, reticulocyte haematocrit, percentage of macrocytic red blood cells, serum EPO, sTfr) to detect rhEPO. The electrophoretic mobility technique provides a direct measurement of urine and serum levels of rhEPO, and is based on the principle that the rhEPO molecule is less negatively charged versus the endogenous EPO molecule. Isoelectric patterning/focusing has emerged recently as a potential method for the direct analysis of rhEPO in urine. Among these various methodologies, the indirect technique that utilises multiple markers of enhanced erythropoiesis appears to be the most valid, reliable and feasible protocol currently available for the detection of rhEPO in athletes. In August 2000, the IOC Medical Commission approved this protocol known as the 'ON model', and it was subsequently used in combination with a second, confirmatory test (isoelectric patterning) to detect rhEPO abusers competing in the 2000 Sydney Summer Olympics. This combined blood and urine test was approved with modifications by the IOC in November 2001 for use in the 2002 Salt Lake City Winter Olympics.

Predictive climatology for the Olympic Marathon and race walking events in Barcelona 1992

During 1990 in New York and again in Barcelona in the following year, the International Marathon Medical Directors Association (IMMDA) initiated studies to monitor climatological conditions accompanying several endurance outdoor sports events in different locations. The aim was to identify the changing thermal stress on both a competitor and exposed spectator along the course of any major endurance racing event around the world where there were climatological conditions similar to Barcelona during the 1992 Olympic Games. In this way any combination of type of surroundings, time of day climatological conditions, etc., along an event's course found to present a thermal stress to either an athlete or spectator might be avoided by better scheduling, better routing, increasing the number of aid stations along a route, and other precautions. To evaluate a single measure of the climatological conditions surrounding an event, a monitor with three thermometers was used to obtain the wet bulb global temperature value, which is an index of the risk of heat injury. The present article is an historical review of how this work was started and expanded. Data obtained in New York and Barcelona enabled the President of IMMDA to present, in October 1991, a report to the International Olympic Committee Medical Commission on the possibility of determining daily throughout the period of the Olympic Games the level of thermal stress on both competitors and spectators during long‐lasting events. The events contributing these data were the New York City Triathlon and the Hispanic Half Marathon held in New York City in 1990 and the Race Walking Spanish Championships (20 km), the IAAF Mobil Grand Prix Finals, and the XIV Marathon Catalunya, all held in Barcelona, Spain, in 1991.

Drug Testing at the 10th Asian Games and 24th Seoul Olympic Games

Drug testing (doping test) procedures in the 1986 10th Asian Olympic Games and 1988 24th Seoul Olympic Games are reported. The International Olympic Committee Medical Commission (IOC-MC) conducted its first doping tests at the 1968 Olympics in Grenoble. With the guidance of the International Olympic Committee (IOC), the Olympic Council of Asia (OCA) introduced doping tests at the 1986 10th Asian Olympic Games in Seoul, Korea, September 21st to October 5th, 1986. 585 samples were tested at the Doping Control Center, Korea Advanced Institute of Science and Technology (DCC/KAIST), for stimulants, narcotics, anabolic steroids, and beta-blockers by gas chromatography/mass spectrometry, high pressure liquid chromatography, and fluorescence polarization immunoassay. These tests covered about 100 different drugs and another 400 as metabolites in addition to pharmacologically related substances. For the Seoul Olympic Games from September 17 to October 2, 1988, the IOC-MC with the DCC/KAIST conducted doping tests on 1601 samples for stimulants, narcotics, beta-blockers, diuretics, and anabolic steroids using GC, HPLC, GC/MSD, GC/MS, LC/MS, and TDx.