Whether training for the Olympics or jogging around the block, many people spend a significant amount of time trying to increase strength and endurance, build muscle, or reduce body fat. For these reasons, health/fitness professionals are often faced with ethical issues regarding the growing trend of ergogenic drugs and supplements (EDS) and their use among students and clients. EDS have been used to enhance sexual, military, intellectual, and work performances (1). They also have been used for sport and cosmetic purposes. The smallest, most visible group connected to EDS use is elite athletes, but a slightly larger group is made up of recreational exercisers. Fitness enthusiasts are often introduced to EDS by their peers, including gym partners, and sometimes by their personal fitness trainers.
This article discusses current issues that arise with the use of EDS among recreational athletes and exercisers and the problems and debates of their use. It also addresses the challenges that fitness professionals face while working with clients who are attracted to or involved in the use of EDS.
What Are Ergogenic Drugs and Supplements?
Identifying a formal definition of EDS is problematic because it is disputable what exactly constitutes an item within that group (1). In a pure sense, the EDS group is comprised of any substance (legal or illegal) taken in abnormal quantities with the intent to enhance performance in an artificial way (2). EDS have also been defined as strategies and treatments, which are designed to improve physical performance above and beyond the effects of physiologic and biomechanical training (3). It is difficult to operationalize enhanced performance because a substance that tends to help performance in one activity may hinder or have no effect on performance in another recreational sport. For instance, the ingestion of caffeine before a marathon may help endurance; however, it could inhibit performance if taken before a shooting event, such as archery. EDS can be costly, and the ergogenic claims are frequently supported by little or no scientific research (3).
Examples of EDS include stimulants, creatine supplementation, testosterone patches (2-inch square patches that are put on the body, releasing testosterone slowly through the skin), chromium, glutamine, glycerol, anabolic-androgenic steroids (AAS), the use of alcohol in shooting events, and blood doping among endurance athletes.
The History of EDS Use
Some highlights in the intriguing history of EDS include the following:
- Ancient Greek Olympians ate hallucinogenic mushrooms to enhance performance (4).
- The winner of the 200-meter dash in the 668 BC Olympic Games had a special diet of dried figs to improve physical capabilities.
- It is reported that Aztec athletes ate the human heart before competition (4).
- Ergogenic use of hormones, such as testosterone, began during World War II. German troops were thought to be the first group to take advantage of testosterone with the intent to increase strength and aggressiveness before battle (1).
- During the war, EDS were used for the recovery of burn victims, starvation victims, depressed patients, and patients recovering from surgery in an attempt to decrease the amount of muscle lost (5).
Table 1 displays some revelations from Voy’s Drugs, Sport, and Politics (6).
EDS Usage Data
The 1994 Dietary Supplement Health and Education Act (DSHEA) allows supplements to be sold as long as they also occur naturally in foods (7). Supplement claims (on the labels or in advertisements) are not evaluated by the U.S. Food and Drug Administration (USFDA) and thus may not have any scientific basis (7). The sale and use of a wide variety of EDS is on the upswing among individuals who are trying to enhance their athletic performance and appearance (7). Some mainstream food companies are currently adding herbal supplements, such as Ginseng, to popular foods and drinks (7). More than one million people in the U.S. currently use EDS, spending more than $14 billion annually for these products (7). A 2002 survey conducted by Blue Cross/Blue Shield indicated that one million adolescents aged 12 to 17 years had used EDS (7).
The United States has over three million current or former users of illegal EDS, and AAS are the most widely abused (8). More than one million people in the United States are lifetime users of AAS, and more than 70% of these individuals do so for bodybuilding purposes (9). Of AAS users, 175,000 are female athletes (8), and the National Institute on Drug Abuse (NIDA) reported in 2002 that 2.7% of eighth graders have used AAS (7).
Why Are People Using EDS?
There are a number of reasons why people choose to use EDS. They seek to prevent disease, reduce fatigue, enhance sexuality, delay aging, enhance looks, augment physical appearance, and increase vitality (10). EDS are widely available and in popular use by individuals trying to cope with the daily challenges of life, such as increasing work performance, energy, and mood (1).
The desire for EDS use by athletes has evolved from a U.S. fixation on winning in athletics (1). Elite and recreational athletes, who are struggling to enhance performance, often view EDS as essential training aids (10). Well known for their use of EDS, bodybuilders use these agents primarily for cosmetic purposes (8).
Bodybuilders started experimenting with EDS in the 1970s, finding that the greater the use, the closer their physiques came to their goals of perfection (11). Having adopted a similar mindset, today both elite athletes and recreational exercisers strive for similar results (11).
There is no single reason why recreational athletes use EDS. However, body image is a significant concern of recreational athletes regarding their participation in exercise (1). Body image refers to the perception of attractiveness according to cultural standards and the extent to which one’s self-evaluation matches this standard (11). Exercisers are predominantly influenced by the media, depicting women with slender bodies and men with muscle, strength, and power (11). It should be noted that people are slightly more reluctant to use EDS when their use is deemed illegal or harmful (1).
The Debatable Issues of EDS Use
Today, people argue whether it is acceptable for recreational athletes to use EDS. A definitive answer to this question, unfortunately, does not exist. EDS use is sometimes adopted by recreational athletes as they observe the rewards generated among elite athletes. The following are some prominent ethical and philosophical arguments about the use of EDS among recreational exercisers.
The Unnatural Argument
The unnatural argument states that athletic drug use by individuals should be discouraged because it is abnormal (1). On the other side of this argument is the assertion that there is no agreement about which EDS are considered natural and unnatural (1). Some natural agents are permitted in sport, and some are not (1). For instance, ephedrine (also called ephedra or ma huang) is a natural stimulant, yet its use is prohibited in many sports organizations, including the International Olympic Committee.
The Coercion Argument
It is argued that if intense training and diet control are shown to enhance performance, then everyone is encouraged to adopt these measures to remain competitive with other athletes (1). One side of the coercion argument states that the use of EDS is not any different (1). When athletes use EDS to help them perform better, other athletes are coerced into using them as well. Others argue that the pressures produced by athletes who use EDS do not encourage others to use them because the word coerce lacks an objective meaning (1). For example, students who study hard do not necessarily coerce all other students into studying hard; thus, the argument postures, it is unclear why EDS use would be any different (1).
The Harm Argument
The objection to athletes using EDS exists because it is believed that in doing so, they are causing harm to the body (11). Athletes are notorious for taking EDS far in excess of the recommended dosage (5). However, the other side of this argument is that of paternalism or maternalism. Those on this side of the argument say that the intrusion into the life of a competent adult should not be permitted, even to protect one from harm that one may inflict upon oneself (1).
Ethical Issues of EDS
Ethics and social values of society are widely modeled in competitive and recreational athletics (10). Ethical issues are addressed less often by participants in the health/fitness industry. There is a drive for excellence that often leads dedicated athletes and exercisers to achieve their goals in ways that are considered by society to be dangerous and unethical (1).
The existence of EDS requires some exercisers to think about how perfect their bodies or performance could be, or in some cases, whether they should be improved. As science increases the ability to transform human bodies, workout enthusiasts may be pressured to make decisions as to what extent they want to alter or preserve certain human traits (1). EDS will continue to influence the life of recreational exercisers as they continue to discover ways to improve their appearance or performance (1).
Competitive and recreational athletes who follow rules and behave ethically are rarely applauded for their ethical achievements; the focus is put on the outcome of the performance (1). The ethical principles that individuals adopt are guided by the ethics and morals by those around them (1). In addition, all athletes and fitness enthusiasts bring their own personal values and beliefs to the training environment (1).
The Responsibility of Health/Fitness Professionals
Health/fitness professionals need to take the responsibility to learn and evaluate the undistorted pharmacologic facts of EDS for their clients. Here are four steps to help educate clients:
- Always complete a lifestyle and health history evaluation with clients to evaluate and educate them on lifestyle and health risks they need to be aware of and perhaps attempt to modify.
- Remind students that supplement companies do not have the same USFDA regulations that drug companies must obey. Thus they are able to make unsubstantiated claims (2).
- When your clients inquire about specific EDS, inform them of the facts of the product based upon current scientific research and withhold any type of recommendation.
- Finally, Yesalis et al. (9) suggest that professionals try to refocus the thinking of their clients toward a healthy diet and proper training, discouraging them from nontraditional supplementation.
Condensed Version and Bottom Line
There are many debates, arguments, and ethical issues that arise from the use of EDS among recreational exercisers. However, EDS use by exercisers is becoming increasingly popular because of the focus upon alternative ways to improve athletic performance and physical appearance. From a professional perspective, it is essential that health/fitness professionals remain up-to-date on the most recent research on EDS. Reading periodicals such as this Journal is recommended. It is important that you help frame the thinking of your clients and support them towards a positive approach to well being through a sensible diet and training regimen. Finally, establish and maintain an open and honest line of communication with your students and clients about EDS use.
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. Champaign, IL:Human Kinetics, 2001.
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. Champaign, IL:Leisure Press, 1991.
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. Champaign, IL:Human Kinetics, 2002.
8.Silver, M. D. Use of ergogenic aids by athletes. Journal of the American Academy of Orthopaedic Surgeons
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10.Stephens, M. B. Ergogenic aids: powders, pills and potions to enhance performance. American Family Physician
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. Champaign, IL:Human Kinetics, 2001.