Drugs, money, and bioethics: A perspective on performance enhancement in sport.

Brace yourselves folks... this is a long one ^_^

After reading a recent article from the BBC, and having a long chat about steroids in baseball with some friends, I realized that I needed to coalesce my various arguments about the topic of performance enhancing drugs into a cogent form. I spent some time thinking about the practical, medical, and moral issues surrounding performance enhancing substances in sport and decided it was worth blogging about. I don't think that I'll be able to offer any sterling resolution to the topic, but in this blog post I want to clearly articulate why I have problems with performance enhancing substance at all levels of sport, but also acknowledge there are many difficulties with my this position; performance enhancing substances can be used to improve performance with relative safety under medical supervision, there is a tremendous cost associated with testing and monitoring, and there is considerable ambiguity in what constitutes performance enhancement. That said, I am still opposed to the use of performance enhancement on primarily philosophical grounds. Before I get to that, however, let me layout some medical and scientific facts about three common types of performance enhancers: anabolic steroids, exogenous erythropoietin (EPO), and sedatives (e.g., beta-blockers).

Anabolic Steroids.

Anabolic steroids are synthetic versions of the sex hormone testosterone. The functions of testosterone in human development are many, but people use testosterone as a performance enhancement in order to build muscle tissue (hypertrophy). Many athletes who take anabolic steroids will show significant increases in muscle development and thus increased power/strength compared to athletes who engage in training alone (Bhasin et al., 1996; Johnson &; O'Shea, 1969; Johnson et al., 1975, Spiers et al., 1983). The data are mixed however, and some controlled studies find no significant increases in lean-tissue mass or strength as a result of supplemental steroids (Crist et al., 1983; Golding et al., 1974; Loughton et al., 1977). Anabolic steroids also do not seem to increase an athlete's aerobic ability or work capacity (e.g., Fahey &; Brown, 1973; Johnson et al., 1975). In controlled medical environments, anabolic steroids have been used by physicians to stimulate bone marrow generation, treat hormonal imbalances, and prevent muscle wasting associated with severe conditions like cancer and AIDS (Grunfield et al., 2006). Thus, in the hands of medical professionals, anabolic steroid use can be safe and effective. HOWEVER! There are still serious health problems associated with steroid use. Some of these dangers are a direct result of the steroid itself (e.g., jaundice), whereas others are associated with culture surrounding steroid use (e.g., needle sharing).

Abuse of steroids is an enhanced concern for adolescents who are in a vulnerable developmental period with respect to both their endocrine system, where their endogenous hormone cycles changing substantially, but also with respect to their psychological development. Major health concerns include impaired excretory function of the liver (which leads to jaundice; Palva & Wasastjerna, 1972; Sacks et al., 1972), hyperinsulinism (Woodard et al., 1981), elevated blood pressure (Messerli & Frohlich, 1979), and decreased HDL cholesteral levels (all of which contribute to heart disease; Strauss et al., 1983). In females there are added risks associated with the disruption of normal hormonal cycles, including menstrual abnormalities, deepening of the voice, enlargement of the clitoris, and proliferation of body-hair and acne (Maher et al., 1983, Smith et al., 1971).

Ultimately, I would say the risks far out weigh the potential benefits of taking anabolic steroids. Medical administration of a steroid regimen is something that elite athletes may have access too and thus increase potential gains while reducing (not eliminating) potential risks, but most athletes do not have access to team of physicians and specialist. Thus, recreational steroid use, which is believed to account for most steroid use, makes an inherently dangerous activity even more risky.

Exogenous erythropoietin (EPO) and doping.

"Blood doping" is a form of performance enhancement most commonly found in endurance sports because of its positive effects for maximal and submaximal aerobic performance. Blood doping is achieved either by infusing red blood cells (e.g., you extract some of your own blood, extract the red cells, and keep them in the freezer for re-injection later) or by administering an external aid like EPO, which artificially stimulates red blood cell production. (EPO is a gylcoprotein hormone that already exists in the body to serve the same function). Blood doping has been found to increase maximal aerobic capacity (measured as VO2 max) in both highly trained and untrained individuals (Brien et al., 1989; Buick et al., 1980; Goforth et al., 1982; Robertson et al., 1984; Sawka et al., 1988; Thompson et al., 1983).  Data on EPO use in healthy subjects is limited (but see Berglund & Ekblom, 1991), but numerous studies have demonstrated that EPO administration will markedly increase (VO2 max) in anemic hemodialysis patients (e.g., Baraldi et al., 1990). In studies measuring race performance specifically, doping has been found to significantly enhance performance across endurance sports in both single-blind and double-blind trials (Berglund & Hemmingsson, 1987; Brien & Simon, 1987; Brien et al., 1989).

Blood doping and EPO use carry significant medical risks. For instance, infusion and transfusion risks for communicable disease are present in blood doping as in all blood transfusions. Of course, the risk of unsupervised transfusion (which is the probably the case for many athletes) is phenomenally greater than the risks of appropriately screened blood transfusions/infusions given for medical purposes. EPO carries its own risks and, like steroids, some of these risks are associated with EPO itself, but other risks come from the culture surrounding EPO use. Blood pressure increases are the most common side-effect reported (e.g., Berglund & Ekblom, 1991). Increase hemocrit levels, which results from either doping or EPO use, increases blood viscosity (i.e., more red cells makes your blood "thicker"). This is perhaps the biggest danger of all. Increases in blood viscosity (at very high hematocrit levels) increases the risks of thromboembolic events such as stroke or myocardial infarction, especially in extreme environments, in conjunction with dehydration, or in persons with pre-existing heart conditions (which athletes may not be aware of prior to doping; Smith & Perry, 1992).

Again, doping is a complex puzzle but a fundamentally dangerous thing to do. With supervised medical administration, doping can be used to treat conditions like anemia or to enhance athletic performance. The presence of medical supervision is critical to enhancing the benefits while reducing the risk, but the procedure is never without risk. I will discuss one more example of a performance enhancer (sedatives) before I explain why I think that health and safety concerns are not the only reason (and perhaps not the primary reason) to argue against performance enhancement in sport.  

Sedatives.

Sedatives, especially anxiolytics, can be used/abused as performance enhancing substances in a number of sports. Most recently, I have seen sedatives called into question as performance enhancers in aesthetic sports (diving, figure skating, gymnastics) and in target-based sports (archery, biathlon, golf). Sedatives are an interesting point of discussion because they fall into a grey area of performance enhancement. Some performance enhancing substances are never included in banned substance lists (e.g., vitamins, protein supplements, or over the counter medications that athletes use to alleviate cold and flu symptoms during training). Other performance enhancing substances uniformly end up on banned-substances lists by the governing bodies of different sports (such as EPO and anabolic steroids). Sedatives, stimulants, and analgesics fall into a grey area because there often legitimate causes for their use and lower levels of associated risk. Thus, these substances present a problem for classification.

Imagine the advantage a diver might possess by using benzodiazapenes to reduce their anxiety. Clearly, not feeling the pressure of performance might be beneficial for some but it might be detrimental to the performance of others who thrive under the increased arousal (see the wide body of literature on individual responses to anxiety in sport psychology research). Or, consider an athlete who is taking azapirone as part of a treatment for clinical depression. Should that athlete be expelled from competition because of azapirone's anxiety reducing effects even when they are taking the drug for an entirely different reason?

The relative benefits of sedatives on performance are not clear, in part because of individual differences in response to anxiety, and to my knowledge, more research in human subjects needs to be done to understand if there are reliable performance enhancing effects and how the effects manifest. There is, however, considerable research on the dangers of sedatives from clinical studies for the different drugs. Benzodiazapines, selective seratonin reuptake inhibitors (SSRIs), barbituates, alcohol, and azapirone all have their own side-effects. complications, and the potential for addiction (except for azapirone, which can be used for long periods without physiological addiction; Chessick et al., 2006). As with all performance enhancements, associated risks are greatly reduced with qualified medical supervision, but risk is still present. Given that the benefits of sedatives are largely untested and likely subject to a lot of individual variation in their effectiveness, it would seem unwarranted to say the risks are worth it.

The philosophy of performance enhancement.

Governing bodies in most sports create a banned substance list based on the extant laws (i.e, any illegal drug is a banned substance) and the relative health/safety of their athletes (i.e., a substance that can enhance performance without unnecessary risk to the athlete is usually allowed). The goal of such lists is to prevent the enhancement of performance through ergogenic aids... so... there are at least a few terms that we need to define. Ergogenic aids are procedures or agents that provide the athlete with a competitive edge beyond that obtained via normal training methods. Defining normal is problematic but perhaps the best way to define it is to draw a distinction between enhancement of function versus the restoration of function (see the story of Oscar Pistorius). If an athlete needs a supplemental agent (pharmaceutical or technological) to compete evenly against other athletes then performance is arguably not enhanced but is restored. In these cases supplementation is generally allowed, but it can be very difficult to empirically prove that a supplemented athlete is not at an advantage. In these cases, you can argue that abilities have been restored rather than enhanced. 

This still raises a lot of questions. For instance, an athlete who is born and trains at altitude might have an advantage over an athlete who was born and trains at sea level by virtue of their hypoxic living environment. Is this advantage unfair? Would remediating this difference in cardio-respiratory function be enhancement or restoration? Endurance athletes have often suggested that you should "live high" but "train low" because reduced oxygen at high altitude increases the production of red blood cells (which can be maintained for 10-14 days when you return to low altitude) but increased oxygen concentrations at low altitude allow for higher intensities during workouts or races. Athletes have always been allowed to travel from low altitudes to higher altitudes or even use hypoxic tents to simulate respiratory conditions of high altitude (... not to cause hypoxia, which would be terrible!). Nike even created a high-altitude house outside of Portland, Oregon so some of their sponsored athletes could live at altitude while training at sea-level. (Although the subject of much criticism, the Nike Oregon Project and hypoxic tents are not banned by the World Anti-Dopping Agency).

There have been many critics of training centers like the Oregon Project and they criticize it for the same reason many people criticize performance enhancing drugs: they constitute an unfair advantage.This seems appealing at first, ("How can it be fair that one runner gets to train in an elite facility while another can't?") but sport is full of inequity. Financial resources, access to sports medicine, access to good coaching, genetic differences, and sociological differences all put athletes at potential disadvantages to each other. The poetic thing about sport, I would argue, is that people can be successful in spite of disadvantages and struggle despite their advantages. With so much chance and variation in the world, sport can teach excellent lessons about humility and discipline. You can work incredibly hard and still win or lose, the best you can do is work as hard as you can. To quote the legendary Oregon track coach Bill Bowerman, "the athlete makes himself, the coach doesn't make the athlete". Understanding that both our failures and our successes are not completely of our own doing is an important moral lesson to teach understanding and empathy towards others.

To conclude, there are two arguments I would like to summarize against the use of performance enhancing drugs in sport. The first argument is medical and deals with the health and safety of athletes. Any procedure or agent that exposes athletes to unnecessary risk in order to enhance performance certainly needs to be regulated if not banned. The second argument is philosophical and deals the distinction between enhancement of function and the restoration of function.

Enhancement versus restoration is an important moral distinction and although there will most certainly be challenging cases that are difficult to classify, this distinction brings a lot of resolution to the performance enhancement debate. Viewed in this light, performance enhancing drugs become essentially cosmetic surgery compared drugs, treatments, and prosthesis that restore performance and have a real medical need. (I like the idea of put elite cyclists doping or ripped baseball players juicing in to the same category as a woman in the Hollywood hills getting a face lift...). This philosophical argument is complementary to the medical argument, but I think the philosophical argument leads us into questions that crosscut sport and society. The philosophical argument not only forces us to consider the morality of sport and the role of sport in society, but it also forces a number of pragmatic questions to the surface. Imagine, for example, if all of the money from the development, sale, and testing of performance enhancing drugs was instead invested in medical research on restoring function in people with motor disorders? Thus, I do not think that the hermetically sealed house Nike built in Oregon should be banned, because it meets the first criterion of health and safety of athletes. However, I think the second criterion shows that society would be better served by putting money from professional sports back into medical research rather than getting marathon times another minute faster.  

 

References

Baraldi, E., G. Montini, S. Zanconato, G. Zacchello, and F. Zacchello. Exercise tolerance after anemia correction with recombinant erythropoietin in end-stage renal disease. Pediatr. Nephrol. 4:623-626, 1990.

Berglund, B. and B. Ekblom. Effect of recombinant human erythropoietin treatment on blood pressure and some haematological parameters in healthy men. J. Intern. Med. 229:125-130, 1991.

Berglund, B. and P. Hemmingsson. Effect of reinfusion of autologous blood on exercise performance in cross-country skiers. Int. J. Sports Med. 8:231-233, 1987.

Bhasin, S., et al. (1996). The effects of supraphysiologic doses of testosterone on muscle size and strength in men. New England Journal of Medicine, 335, 1-7.

Brien, A. J., R. J. Harris, and T. L. Simon. The effects of an autologous infusion of 400 mL red blood cells on selected hematological parameters and 1,500 m race time in highly trained runners. Bahrain Med. Bull. 11:6-16, 1989.

Brien, A. J. and T. L. Simon. The effect of red blood cell reinfusion on 10-km race time. J.A.M.A. 257:2761-2765, 1987. 


Buick, F. J., N. Gledhill, A. B. Froese, L. Spriet, and E. C. Meyers. Effect of induced erythrocythemia on aerobic work capacity.J. Appl. Physiol. 48:636-642, 1980.

Chessick, C. A. (2006). Azapirones for generalized anxiety disorder. Cochrane Database Sys. Rev. 19,  CD006115.

Grunfeld C, Kotler D, Dobs A, Glesby M, Bhasin S (2006). Oxandrolone in the treatment of HIV-associated weight loss in men: a randomized, double-blind, placebo-controlled study. J. Acquir. Immune Defic. Syndr., 41, 304–14.

Johnson, L. C., & O'Shea,  (1969). Anabolic steroid: Effects of strength development. Science, 164, 957-959.


Johnson, L. C., et al., (1975). Effect of anabolic steroid treatment on endurance. Med. Sci. Sports, 7, 287-289.

Robertson, R. J., R. Gilcher, K. F. Metz, et al. Hemoglobin concentration and aerobic work capacity in women following induced erythrocythemia. J. Appl. Physiol. 57:568-575, 1984.

Sawka, M. N., R. R. Gonzalez, A. J. Young, et al. Polycythemia and hydration: effects on thermoregulation and blood volume during exercise-heat stress. Am. J. Physiol. 225:R456-R463, 1988.

Smith DA, Perry PJ. (1992). The efficacy of ergogenic agents in athletic competition. Part II: Other performance-enhancing agents. Ann Pharmacother. 

Thomson, J. M., J. A. Stone, A. D. Ginsburg, and P. Hamilton. The effects of blood reinfusion during prolonged heavy exercise.Can. J. Appl. Sport Sci. 8:72-78, 1983.

Marathon training continues; On Saturday, I ran 32k in 2:35:37 and felt really good. Sunday I went up with some friends to hike in Squamish. The weather was amazing and as the fog was moving in. We manage to wrap everything up just prior to a rain storm moving in.

This is the divide between the centre peak and the north peak of the Chief. I need to come back with gear and climb here ^_^ 

On the importance of play: Something we should all be worried about...

Don't call it a comeback!

It's been a long time, but I finally have a new blog post. This post is largely a review of the book, “Play:How it shapes the brain, opens the imagination, and invigorates the soul” by Stuart Brown, M. D. 
 

Play is an interesting and revealing popular science book that reviews emerging scientific evidence about play and the applied significance of these findings in everyday life. Although I think this book could have been more critical and scientific in its approach to the subject matter, I think it is an important book to read because play is a topic of burgeoning scientific inquiry, and Brown (2009) makes an excellent case for the evolutionary, social, existential, and even economic value of play.


For instance, in the 1990s, the National Air and Space Administration (NASA) found that newer engineers had difficulty with working in ambiguity and creative reasoning compared to older engineers, despite excellent marks in college and superb research backgrounds. One of the surprising things they found, informed by psychological studies of the relationship between unstructured play and creativity, was that new engineers lacked experience with physical systems compared to abstract knowledge of these systems learned through readings and lectures. Thus, although these highly qualified engineers had significant understanding of the academic details of the propulsion, shielding, or control systems they were working on, they had not “tinkered”, they had not worked with their hands nearly as much as engineers from the previous generation. NASA now includes questions about play history and hands-on mechanical experience in hiring their employees.


Another example comes from the world of business. Google, a company whose influence in information technology continues to grow, has a unique business practice referred to as “20% time,” which means that engineers are allowed to spend 20% of their paid time working on personal projects. Ideally, the engineers are working on projects they are truly passionate about, but importantly these are projects without deadlines and without direction from a supervisor. Google has had tremendous success with this practice and some of Google’s largest innovations are the result of employees pursuing their personal interested during 20% time. Gmail, for instance, is the direct result of 20% time and is one of the most used email services in the world.


Brown (2009) uses anecdotes like this to make strong claims about the role of play in learning and performance, supporting these anecdotes with more scientific, empirical studies of play in humans and animals. But before venturing into personal and historical accounts, psychological or neuro-scientific studies, it is important to answer a few questions. What is play? Why is it important? Brown prefaces his definition of play by saying that defining play is like explaining a joke, “it takes the joy out of it (p. 16).” To a certain extent, I agree with him on this point. After all, play is etiologically a very old behavior making it largely pre-verbal or pre-conscious with respect to our other human abilities. Also, there is tremendous individual variation in what constitutes play. One person might feel “at play” when laboring in front of a computer solving problems with bits of code, parsing complicated error messages, and revising until the program they have been struggling to write finally works. Somebody else (or indeed even the same person!) might feel “at play” climbing rocks a few hundred up on a cliff face, suspended only by their fingers and a kernmantled nylon rope. It is difficult to find a useful definition of play that can incorporate such a wide array of activities. Just using these two examples of computer programming and rock climbing though, we can reason two important conclusions. First, play is not the opposite of work and second, that play is not a lack of structure.


Sitting in front of a computer for hours and solving complex mathematical problems is as much a cognitive labor as scaling a cliff face with burning muscles and bleeding fingers is a physical labor. Clearly one cannot say that these activities are only work or only play, they are made up of a little of both. From a sociological perspective, I think this is a tremendously important point. I feel that as a society, we undervalue the repetitive and laborious nature of what we might traditionally define as “work”. We have, not without reason, elevated the status of inventors, innovators, and geniuses, but it is important to recognize that the creative, playful aspects of innovation are made possible by the determined, work-like aspects. Brown (2009) goes into great detail about this work-play balance and focuses especially on how people can recognize when they are out of balance, and the steps they can take to find balance again. What this distinction reminded me most of, however, was my personal experience with backpacking. For most people, backpacking would be classified as play. Certainly, most of us are not paid to do it, but backpacking also entails no small amount of work. Relatively little time is actually spent atop some picturesque vista. The vast majority of the experience is spent laboriously slogging your way up a steep slope with 15+ kgs of gear strapped across your shoulders, step after step, hour after hour. A tremendous amount hiking (work) goes into the brief experience of bagging the peak (play).


Similarly, although there may be a naïve conception of play being a completely unstructured activity without rules, this criterion quickly evaporates as well. Within a programming language, there are rules and constraints about what you can do and can’t do. These constraints can actually contribute to making the situation feel playful. There is something satisfying about circumventing a limitation of the program you are working with, finding a creative way to get around the structure of a language, or hacking a piece of hardware or software to make it work the way you want. In rock climbing, the same rules apply. There is a tremendous amount of structure that goes into climbing and very rigid rules that ensure the safety of the participants. As Brown (2009) points out, this feeling of safety is intrinsic to separating play from other activities. Indeed, without a ropes, gear, and structure, rock climbing would be an act of survival rather than play. Even in less salacious examples, safety is what allows play to be exploratory. For instance, the success of Google’s 20% time is in part attributable to the fact that employees know that they will be paid for this time regardless of the results. If payment was contingent on the success of an idea, employees probably would not be using this free time to explore creative ideas or personal passions, but would instead be trying to exploit an existing project that is a “sure-thing”. Thus, rules and structure, and the safety that results, provide a stable base of support for exploratory and playful behaviors.


So, if play and work are not opposites, and play is not the absence of structure, what is play? Many years of sociological theorizing and scientific definitions are summarized rather quickly by Brown (2009) in his second chapter to answer this question. But in this summary, he does generate a very useful framework for delineating play from other activities, although not necessarily a seamless definition. Brown focuses on six criteria that he feels, based on a range of evidence (from the more empirical to the more anecdotal) delineate play from other behaviors. First, play has apparent purposeless. This is not to say that play has no purpose, but it does not have a readily apparent purpose in the moment. For example, rock climbing serves a purpose if you are an explorer, a soldier, or a person stranded at the bottom of a cliff, but recreational climbers go many miles out of their way to find crags to climb in and spend lots of money on gas and equipment in order to pursue their sport. Thus, climbing has some purpose, probably the internal, pleasurable sensations that arise during/after climbing, but that purpose is not immediately apparent. This apparently purposelessness has also been phrased as a “means over ends” disposition in research on child development (Rubin, Fein, & Vandenberg, 1983). Secondly, play is largely voluntary. For an action to be playful, it is generated by the individual and not demanded by the environment (i.e., working on some code because you want to, not because your boss has come round and told you what you work on). This does not mean that play cannot arise during involuntary activities. Indeed, when people are forced to do repetitive tasks, I think they seek out opportunities to play, within the limits of the task, in order to break the tedium. For instance, while splitting logs, I might compete against myself for time, sing to myself, or try to split particular sections of specific dimensions. Thirdly, play has inherent motivation. Brown argues that people and animals do not play based on the promise of extrinsic rewards, but in order to fulfill some internal drive. These drives could be evolutionary or social in origin, but Brown argues they are always endogenous.


From subjective reports, play often involves a distorted perception of time. When engaged in play, human beings report paradoxical perceptions of time in which moments feel longer than normal, but the duration of the activity itself feels like it passes much more quickly than normal. I do not personally find this piece of evidence very compelling as a defining characteristic of play because it is based on self-reports after the playful event is over. That said, however, I would introspectively report the same phenomenon, but it I think that distorted perception of time, whether real or illusory as a finding, is actually a result of Brown’s (2009) fifth criterion which is diminished self-consciousness. In playful activities, people lose a certain degree of self-awareness. This can be demonstrated not only through introspection and self-report, but it has been demonstrated experimentally as well. In a study of baseball batting performance, for example, Rob Gray found that when experts where doing better their awareness of how they were moving (i.e., where the bat was at ball contact) was significantly worse than when they were batting poorly, where self-awareness was found to be significantly higher. Finally, Brown suggests a sixth criterion for play that is continuation desire; once an individual is engaged in a playful activity there is strong desire to continue. Again, I don’t necessarily agree with this criterion or see its utility in defining play. Physical play, for instance might continue until everyone involved is tired at which point play stops and there is no desire to continue. Does this mean that the participants have not actually been playing? Of course not. While I agree that during play there might be a strong desire to continue the activity, I do not feel this is a distinguishing feature of play.


Having established a framework, if not a definition, for identifying what play is, we can turn our attention to why do humans and animals play? There is probably no single reason for playful behavior, because play emerges in many forms. However, sociologists, psychologist, and neuroscientists have identified a number of plausible social, psychological, and biological benefits of play. These benefits have likely been selected for either culturally or biologically through evolution. Ethologists have often put forward the “play as practice” theory of play behavior. This theory suggests that animals have an innate drive to play in order to practice behaviors that are evolutionarily advantageous. For instance, young antelope will explore their environment as the herd moves into new areas, staying close to the herd, but venturing around the periphery. This exploratory behavior does not appear to be very systematic, but more playful in nature. The young antelope bound over rocks, jump onto tree trunks, and chase each other around the new environment. Ethologists have speculated that such exploratory behavior serves many beneficial functions. First, the physical activity can cause tissue growth and physiological adaptation to improve joint strength, muscle strength, and cardiorespiratory fitness. Second, neural adaptation can occur as the antelope learns new, coordinated patterns of movement. Indeed, there is neurological evidence that in young antelope the greatest periods of play are associated with the most rapid growth of the cerebellum, compared to other times during the life span (Byers & Walker, 1995). Thirdly, exploration of the new environment might help the young antelope create a richer spatial map of their surroundings, allowing the animal to better orient itself to the environment, or even learn “escape routes” through the environment in case a predator emerges. There is also evidence from rodent studies to suggest that exploratory play improves neural development, whereas a lack of play slows development (Panskepp, Siviy, & Normansell, 1984).


Social play in rats with frontal lobe lesions has also been shown to reduce their impulsivity, which raises interesting questions about the incorporation of play behavior in the treatment of children with attention deficit hyperactivity disorder (ADHD). Potentially, encouraging certain types of play behavior might be useful for reducing the symptoms of impulsivity in children with ADHD. Neuropharmacological studies in rats however, show that many of the modern drugs used in the treatment of ADHD in humans actually reduce the expression of play behavior in rats (Siviy & Panskepp, 2011). Thus, although there is clearly a relationship between play behaviors and impulsivity in both humans and rodents, it is not clear if encouraging playful behavior is useful for reducing impulsivity in other aspects of behavior.


Furthermore, play behaviors are a useful indicator of animal welfare because play behavior generally disappears under stress (Held & Špinka, 2011). There are caveats to this interpretation of play as an indicator of welfare because play can increase in response to reduced parental care or temporarily increase in response to social isolation. Play as an indicator of welfare in animals is also interesting because play has long been an indicator of psychological well-being in human children, and play inhibition is a symptom of clinical depression (Lous, de Wit, De Bruyn, & Riksen-Walraven, 2002).


In humans, and possibly other social animals, play also serves unique the function of allowing us to work through social problems without having to experience these problems directly. Sociologists and anthropologists have suggested this cultural role for play in human children, and even adults, for a long time (Sutton-Smith, 2001). Imaginative play allows children to take on imagined social roles and thus create, solve, and learn from imagined social conflicts without suffering real consequences from their decisions. For instance, young children playing “house” or “doctor” allows them to work they problems they perceive adults facing (correctly or incorrectly) and collaboratively arrive at a solution (in joint-imaginative play) or to talk through possible solutions in their own mind (in isolated-imaginative play).


Physical play allows children the same benefits as physical play in other animals, such as improved musculoskeletal fitness, cardiorespiratory fitness, and neural development as the motor system learns to coordinate new movement patterns. Physical play can also serve a social function, however. Physical play can allow for social disputes to be resolved or hierarchies to be established while reducing the physical harm to the individuals involved. An excellent demonstration of this point comes from the history of the Olympic Games. During the ancient Olympic Games, the city-states of Greece would declare a military truce and suspend all armed conflict against each other. This truce was recognized even during major conflicts, leading to a cessation of hostilities between Athens and Sparta during the Peloponnesian War, and was thus a respected part of ancient Greek culture (Kyle, 2007).


Object-based play allows both children and adults to explore an object’s potential, often with reduced consequences (although “playing” with a table saw is just as dangerous as using it). Object-based play thus allows children to learn about an object’s common functions but also unintended or “inappropriate” uses. In this way, object play is an important way for children to gather information about the material world (Pellegrini & Bjorklund, 2004). Object play is, however, perhaps one of the most difficult forms of play to describe because it hard to disambiguate true play from other object-based interactions. Some studies of object play in human and chimpanzee juveniles suggest that their reliable gender differences in object play. Males tend to use more utilize objects in imaginative and physical play as group. Conversely, females tend toward more constructive play with objects and are more likely to engage in solitary play than males (Rubin et al, 1983). Rather than an inherent or genetic interpretation of these data, however, many authors suggest that these gender differences in object manipulation reflect ontogenetic adaptations related to the perceived demands of adult life (Pellegrini & Bjorklund, 2004).


In summary or these studies of the various types of play, we can see that play in childhood is especially important in the processes of development and evolution, because play allows the exploration of new strategies and behaviors. During play these new behaviors can be developed with minimal costs or, at least, reduced cost compared non-play situations (consider rock climbing for sport versus survival). Thus, play influences the development of new strategies and behaviors preparing an animal for success in novel environments after the juvenile period (Pellegrini, Dupuis, & Smith, 2007).


In his book, Brown (2009) does not spend as much times developing the scientific exploration of play as I would like, but one of the strengths of Brown’s book is to illustrate the importance of play not only during the juvenile period, where most research is focused, but across the lifespan. By pulling in personal anecdotes from his career as a psychiatrist, and more famous examples from current events and history, Brown argues a compelling case for the importance of play for all people of all ages in order to be psychologically healthy life. Brown argues that play has demonstrable advantages in cognition, physical health, and psychological well-being. Research in children and animals suggests that play is a natural mechanism for learning and solving problems. A good example of how imaginative play is given in an anecdote about executives at the design company Ideo who, when confronted with a difficult design problem, pretend to be their competitors (in a very literal and role-playing sense) in order to look at the problem in a different light. The advantages of play for physical health are fairly straight forward; play can serve as a motivator to make physical activity more endogenously motivating than “training” which relies on external motivation. Finally, Brown uses a number of case studies from his career as a psychiatrist to demonstrate being deprived of play can have detrimental effects on person’s psychological well being.


One of the more convincing case-studies that Brown (2009) presents demonstrates all three of these points at once. Brown presents the story of Gillian Lynne, who is now a very wealthy and respected choreographer, former Ballerina, actor, director, and holds the honorific title, “Commander of the Order of the British Empire” (CBE). As a child, Gillian had a tremendous amount of difficulty in school. She had difficulty paying attention in class and frequently caused disruptions because she struggled with staying seated behind a desk. As her school difficulties grew worse, Gillian’s parents took her to a psychiatrist to see if their daughter had some sort of behavioral disorder. Fortunately for Gillian, rather than recommending removing her from school or giving her some sort of medication, as this was prior to the establishment of ADHD as psychological disorder, the psychiatrist recommended that Gillian’s parents enroll her in a specialized school for the performing arts where she was able to study acting and dance. In this less physically constraining environment, Gillian flourished. Rather than being considered a problem child, as she had been, Gillian become one of the star students. After graduating from school, Gillian gained acclaim as a ballerina with the Royal Opera House and went on to become a choreographer for the Royal Opera House, the Royal Shakespeare Company, and is perhaps best known for her choreography in the Andrew Llyod Weber musicals Cats and The Phantom of the Opera.


Gillian’s story may not be typical, but I think it does a very good job of demonstrating the importance of allowing play into a person’s life and recognizing that work and play are not opposing, but complementary activities. Had Gillian not been allowed to explore her more physically playful nature as a child, it is unlikely she ever would have gone on to find the success that she did. In this way, Brown (2009) demonstrates that play is not merely a speculative “feel-good” topic for finding some measure of existential happiness. Instead, play is an area of serious scientific research and play can have profound impact on a person’s physical health, psychological health, and indeed financial success. In conclusion, I can most succinctly say that I would recommend reading this book for its scientific and its practical merits.

References

Byers, J. A. & Walker, C. 1995. Refining the motor training hypothesis for the evolution of play. American Naturalist, 146, 25-40.

Brown, S. (2009). Play: How it shapes the brain, opens the imagination, and invigorates the soul. London: Penguin Books Ltd.

Kyle, D. G. (2007). Sport and spectacle in the ancient world. Oxford, England: Blackwell Publishing.

Lous, A. M., de Wit, C. A. M., De Bruyn, E. E. J. & Riksen-Walraven, J. M. 2002. Depression markers in young children’s play: a comparison between depressed and nondepressed 3- to 6-year olds in various play situations. Journal of Child Psychology and Psychiatry, 43, 1029-1038.

Panksepp, J., Siviy, S. M. & Normansell, L. 1984. The psychobiology of play: theoretical and methodological perspectives. Neuroscience and Biobehavioral Reviews, 8, 465-492.

Pellegrini, A. D., & Bjorklund, D. F. (2004). The ontogeny and phylogeny of children’s object and fantasy play. Human Nature, 15, 23-43.

Pellegrini, A. D., Dupuis, D. & Smith, P. K. 2007. Play in evolution and development. Developmental Review, 27, 261-276.

Rubin, K. H., Fein, G.  & Vandenberg, B. (1983). Play. In E. M. Hetherington (Ed.),  Socialization, personality, and social development (pp. 693-774). New York: Wiley.

Understanding Cardiorespiratory Conditioning : VO to the max?

I apologize for the corny title… exercise physiology jokes are hard to pull off. 

Cardiorespiratory conditioning refers to the body’s ability to utilize oxygen for exercise, however, it involves both aerobic and anaerobic metabolism. Efficient use of oxygen relies on several key physiological factors: pulmonary ventilation; oxygen diffusion across the lungs into the blood; the frequency with which the heart beats and volume of blood pumped with each beat; the ability of skeletal muscle to absorb oxygen from the blood; the metabolic processes to convert oxygen in to energy (ATP). 

Training to improve cardiorespiratory conditioning is important from the perspective of basic health, but also for athletic development (especially for athletes with a large endurance component to their sport, or for “tactical” athletes such as military and fire safety personnel who need substantial endurance to perform their jobs). Like any other form of exercise, training cardiorespiratory conditioning is based on the principles of progressive overload (progressively introducing more intense stimuli and then allowing the body to adapt through super-compensation).  To gauge improvement and exertion during exercise there are two important variables to consider with respect to cardiorespiratory conditioning: (1) maximal oxygen uptake and (2) energy expenditure. 

Maximal oxygen uptake is represented by the VO_2max statistic. VO_2max  is a measure of maximum aerobic capacity representing the amount of oxygen (in mL) that the body takes in per minute. Often, VO_2max  is normalized to body weight, making the units mL/kg/min (mL of oxygen per kg of body weight per minute). For unfit individuals, the VO_2max  might be around 30 mL/kg/min, whereas 60mL/kg/min is a more common level for fit athletes in non-endurance sports. In sports that have substantial endurance components (distance cycling, running, rowing, and cross-country skiing), VO_2max  tend to be much higher, around 80 mL/kg/min. The highest recorded VO_2max  belongs to Bjørn Dæhlie, 8-time Olympic gold medalist in cross country skiing.  Dæhlie’s VO_2max  was recorded to be an uncanny 96 mL/kg/min, and even this figure was taken out of season!

Energy expenditure is often expressed as kilocalories (kcals; or Calories in the US) per hour or per minute and represents the amount of energy an individual is burning over a given period of time. 1,000 mL of oxygen per minute is roughly equivalent to burning 5 kcal/min. At rest, the average person takes in about 3.5 ml/kg/min (… I usually ignore statistics that refer to a non-existent “average person”, but this figure makes a useful point). From this, you can roughly estimate your resting energy expenditure by multiplying 3.5 * (your body weight in kg) to roughly estimate your resting energy expenditure.

I weigh about 88 kg, so:

88 * 3.5 = 308 ml/min /(1,000mL) = .308 * 5kcal = 1.54 kcal/min  

Thus, over the course of a day I burn about 2,218 kcals if I’m just sitting around.

1.54 kcal/min * 60 min/hr * 24 hr/day = 2,217.6 kcal/day

So, how does this relate to training? Both oxygen consumption and energy expenditure can be used as quick tools to determine your work rate. For example, you could work a low level (say, 50%) of your VO_2max  which would be fairly easy, or at 70% were things start to be difficult, or at 90%, which you can probably only sustain for a short period of time unless you are very well trained. You might be thinking, “Okay, but how am I supposed to measure my VO_2max?” The simple answer is that you’re not, unless you have convenient access to an exercise physiologist and really like exercising in a lab. What you can do, however, is estimate your VO_2max by measuring correlated variables like heart rate (in beats per minute; BPM).

Estimating Your Maximal Aerobic Capacity

You can establish the relationship between heart rate and VO_2max  yourself by using a number of estimation techniques. Two protocols that I use when working with athletes are (1) an incremental work-rate test on a stationary bicycle and (2) the Cooper Test on a track (or treadmill).  Incremental work rate on the stationary bike is a little tricky because you need more detailed information, but the calculations are simple. First, you want to have a bicycle that can give your energy expenditure in kcal/hr (or per min) based on your age and weight (being able to input these variables will greatly improve the accuracy of the estimation). Next, you will progress through 4 stages of intensity keeping your RPMs around 60 (again, the closer you can stay to 60 RPMs, the more accurate the estimation will be). For each stage you should cycle for 2 minutes at 450 kcal/hour, 550 kcal/hour, 650 kcal/hour, and 750 kcal/hour, while recording your heart rate at the end of each 2-minute stage. 

Plot these four data points with heart rate (in bpm) on the y-axis and kcal/hr on the x-axis.  You can plot an actual regression line (using a program like Excel, or a real stats program) or just draw a straight line through these data points by eye. Using my own data as an example, it should look something like this:

The red dot is the estimated point of my maximum heart rate (MaxHR). MaxHR can be estimated by subtracting your age from 220; my estimated MHR is thus 195 bpm. This graph is a little hard to interpret because the x-axis is still in terms of energy expenditure. To understand how heart rate relates to VO_2max  we need to convert this axis into oxygen consumption (L/min). Remember that 1,000 mL/min is approximately 5 kcal/min and then we can change the units to make our new graph look like this:

Now my estimated VO_2max  is more interpretable. My estimated MaxHR (195 bpm) corresponds to about 5.52 L of oxygen consumed per minute, which, when adjusted for my mass (88 kg) is about 64.54 mL/kg/min.

5.52 * 1,000 = (5,520 mL/min) / 88kg = 64.54 mL/kg/min

We can corroborate this estimation by doing the Cooper Test. The cooper test is slightly easier to calculate and can be done on a running track or a treadmill. The goal in the Cooper Test is to run as far as you can in 12 minutes. Measure that distance in meters and then subtract 505. Divide what remains by 45 and you will have an estimate of your VO_2max in mL/kg/min. By the Cooper Test, my most recent VO2max is 69.244 mL/kg/min or 6,093 mL/min.

(3620m – 505)/45 = 69.224 mL/kg/min * 88kg = 6,091 mL/min

Looking at the results of both tests, we can see that there is pretty good agreement on my maximum oxygen consumption (and I’m inclined to believe that the Cooper Test is over estimating a little bit, but I do not know the research on any potential bias in this test). My Cooper Test estimate is shown as the purple triangle in the figure:

I’m going to try and establish a little continuity is these posts and in my next post I will talk about training at different levels or zones of intensity based on heart rate and VO_2max. By training in specific zones you can work on improving very specific dimensions of performance (such as your improving your anabolic threshold versus burning fatty acids). In the post after that, I want to address applying these metrics to recreational/novice running specifically. Stay tuned ^_^

Understanding the “Quiet Eye” in Athletic Performance.

“Vision without action is a dream. Action without vision is simply passing the time. Action with Vision is making a positive difference.”  ~Joel Barker

“We are limited, not by our abilities, but by our vision.” ~ Anonymous

The brain is a powerful computational engine, capable of some amazing feats, but the information it puts out is only as good as the information it takes in. Thus, one of the major differences that sports scientists have found between experts and novices is how they orient their attention to take in information. Several dominant theories of attention emphasize the role of “unconscious” or implicit processing. Master’s (1992) conscious processing hypothesis, Wulf’s (2007) constrained action hypothesis, and Singer’s (2000) five-step strategy all suggest that focusing on one’s own body (or the mechanics of one’s actions) disrupts motor performance and therefore recommend that attention be directed externally, to the effect/goal one is trying to achieve, in order to optimize performance. Both Singer and Wulf specifically recommend attending to the goal of the action during performance and during learning (see Singer, 2000, 2002; Wulf 2007 for reviews). All of these theories of attention deal with mental attention or what we might colloquially call concentration (i.e., thinking about the goal versus thinking about my body) but do specify the role of visual attention (i.e., looking at the goal versus looking at my positioning).  

Other areas of sport psychology research however, deal with visual attention specifically. Using sophisticate gaze tracking technology, researchers have shown that in experts, gaze is directed to the most relevant targets/objects in the visual field and that gaze is relatively stable, in novices however gaze is much more erratic (e.g., Vickers, 2007; Williams & Ford, 2008). This finding has been referred to as the quiet eye phenomenon.  Quiet eye specifically refers to duration of fixation on a task-relevant target prior to the execution of movement. Multiple studies have continuously shown the quite eye to be a reliable and valid measure of optimal control of visual attention.

In a seminal study of golf putting, Vickers (1992) found that gaze differences mediated performance. That is, differences in the scanning path during the alignment phase of the putt and timing and orientation differences during the putt itself, predicted the success of the putt. More skilled golfers, with better accuracy, maintained a steady final focus (quiet eye) on the center of the back of the ball for approximately 2s. Less skilled golfers, who had worse accuracy, did not maintain fixation as long (1.2-1.5s) and had a more erratic gaze orientation.

In a later study, Wilson and Pearcey (2009) assessed the gaze behavior of golfers in both the preparation (line reading) and execution (ball striking) of different putts. Six golfers completed 25 3-m putts on five different slopes (flat, 0.9° and 1.8° left-to-right, 0.9° and 1.8° right-to-left), and eye-tracking hardware/software was used track the motion of the golfers’ eyes with high fidelity. In general, steeper break angles (1.8°) resulted in worse performance, and length of the quiet eye period (the duration of gaze fixation prior to putter movement predicted accuracy.  That is, when golfers had longer, more stable fixation times prior to putter movement, they were more likely to be accurate.

Anxiety and Gaze Control

Vickers and Williams (2007) found evidence that choking under pressure resulted in shifts in visual attention (with choking being associated with more erratic eye movement). Ten elite biathlon shooters were tested under separate low-pressure and high-pressure conditions after exercising on a cycle ergometer at 55%, 70%, 85%, and 100% of their maximum oxygen uptake. At lower levels of stress (55% of max), the authors found that accuracy was higher when the differences in eye fixation were smaller between high pressure and low pressure conditions, but only when heart rate and perceived exertion (RPE) were higher than during the low pressure condition.  At higher levels of stress (100% of max) however, accuracy was related to quiet eye (i.e., improved gaze control) independent of heart rate or RPE. Thus, the authors conclude, at the higher levels of stress and fatigue, directing visual attention externally to critical task information appears to protect against the catastrophic effects of choking under pressure.

Recently, Vine and Wilson (2010) studied the efficacy of quiet eye training in improving learning and performance under pressure for novices in a putting task. Subjects performed 320 putts during a training phase in which they received either quiet eye training or standard technical training. During quiet eye training, subjects received similar verbal instructions as during standard training (e.g., “Stand with legs hip width apart and keep your head still.”) but in such a way as to emphasize gaze control and maintaining the quiet eye (e.g. “Assume a stance to ensure that gaze is on the back of the ball”). After training, subjects completed an additional 120 putts during a testing phase that consisted of a retention test, followed by a high-pressure transfer test, and finishing with a low-pressure retention test. The quiet eye trained group maintained more effective attentional control and performed significantly better in the pressure test compared to the control group. Even outside of the high-pressure test,  longer quiet eye periods predicted better performance, suggesting a generally beneficial effect of a long, calm final fixation and that this fixation period is especially vulnerable to anxiety from the increased pressure to perform. Thus, although the specific details that underlie the quiet eye phenomenon remain to be illuminated, at least one lesson seems clear: When you do feel anxious, try to control your visual attention, stay visually focused on your target and keep your gaze steady.

Heavy things? Long distances? I'm in...

As part of learning more about tactical strength and conditioning, I have been experimenting a lot with rucking recently. Early this morning, for instance, I rucked up Flat Top Mountain in Rocky Mountain National Park:


Untitled from Keith Lohse on Vimeo.

Rucking is basically loading up a backpack (or rucksack, hence the name) with enough food and provisions for a day trip and then trying to cover that ground as quickly as possible. The weight of the pack varies depending on what you want bring, but you want extra clothes, food, water, and emergency supplies. In the real world of course, the additional contents of the pack depend on what you are doing (e.g., it changes if you're a soldier, fireman, rescue worker, etc.)... I opted to load my pack with climbing gear. Although I did not actually do any climbing:


Explanation of Rucking from Keith Lohse on Vimeo.

It was a really cold and windy trip. By the end of it, I lamented not bringing proper goggles and only having sunglasses, but it was still a lot of fun!

ABS 12 Nationals

Mercedes Pollmeier (climber and strength coach extraordinaire) posted some excellent video from the ABS 12 Nationals in Boulder a few weekends ago:
http://girlbeta.blogspot.com/2011/02/abs-12-national-championships.html