Boosting is a method of inducing

autonomic dysreflexia Autonomic dysreflexia (AD) is a potential medical emergency classically characterized by uncontrolled hypertension and bradycardia, although tachycardia is known to commonly occur. AD occurs most often in individuals with spinal cord injuries wi ...

with the intention of enhancing performance in sport. It can be used by an athlete with a

spinal cord injury A spinal cord injury (SCI) is damage to the spinal cord that causes temporary or permanent changes in its function. Symptoms may include loss of muscle function, sensation, or autonomic function in the parts of the body served by the spinal co ...

to increase their

blood pressure Blood pressure (BP) is the pressure of circulating blood against the walls of blood vessels. Most of this pressure results from the heart pumping blood through the circulatory system. When used without qualification, the term "blood pressur ...

and is performed by causing a painful stimulus in the lower part of the body. The International Paralympic Committee (IPC) banned the practice in 1994, but many competitors with spinal injuries are still thought to be using it as a performance enhancer.

Method

Athletes with spinal injuries can have difficulties with autonomic functions and their bodies may be unable to control blood pressure and

heart rate Heart rate (or pulse rate) is the frequency of the heartbeat measured by the number of contractions (beats) of the heart per minute (bpm). The heart rate can vary according to the body's physical needs, including the need to absorb oxygen and e ...

. Because of this their bodies do not adapt to the increased demand of physical activity. Without these changes the athlete can become fatigued and suffer from a lower level of endurance. Boosting works by tricking the body into a state of high blood pressure and heart rate, with an increased utilization of oxygen improving the athlete's performance. Athletes who perform boosting before or during an event will often

self-harm Self-harm is intentional behavior that is considered harmful to oneself. This is most commonly regarded as direct injury of one's own skin tissues usually without a suicidal intention. Other terms such as cutting, self-injury and self-mutilati ...

with some taking extreme measures to achieve the desired boost level. Techniques include: *Clamping the

catheter In medicine, a catheter (/ˈkæθətər/) is a thin tube made from medical grade materials serving a broad range of functions. Catheters are medical devices that can be inserted in the body to treat diseases or perform a surgical procedure. Cat ...

to ensure that the bladder becomes overly full *Overly tightening leg straps *Electric shocks or stress to the feet, legs, scrotum, or testicles *Breaking a bone, usually in the toe.

Effectiveness and risks

Holly Koester, 2007 Chevron Houston Marathon (357322273)

Boosting has been shown in simulated races to give noticeable improvements in the performance of wheelchair marathon athletes. In the 1994 study the athletes attained an average 9.7 percent improvement after their bladder had been over-distended or after sitting in the racing chair for 1–2 hours prior to competing. It is believed to be capable of enhancing performance by up to 15 percent. There are many possible side effects of boosting, including the occurrence of a cerebrovascular or cardiovascular event such as a stroke or heart attack. Other complications include: *

aphasia Aphasia is an inability to comprehend or formulate language because of damage to specific brain regions. The major causes are stroke and head trauma; prevalence is hard to determine but aphasia due to stroke is estimated to be 0.1–0.4% in t ...

bradycardia Bradycardia (also sinus bradycardia) is a slow resting heart rate, commonly under 60 beats per minute (BPM) as determined by an electrocardiogram. It is considered to be a normal heart rate during sleep, in young and healthy or elderly adults, ...

cerebral haemorrhage Intracerebral hemorrhage (ICH), also known as cerebral bleed, intraparenchymal bleed, and hemorrhagic stroke, or haemorrhagic stroke, is a sudden bleeding into the tissues of the brain, into its ventricles, or into both. It is one kind of bleed ...

epilepsy Epilepsy is a group of non-communicable neurological disorders characterized by recurrent epileptic seizures. Epileptic seizures can vary from brief and nearly undetectable periods to long periods of vigorous shaking due to abnormal electrical ...

* hypertension *

hyperthermia Hyperthermia, also known simply as overheating, is a condition in which an individual's body temperature is elevated beyond normal due to failed thermoregulation. The person's body produces or absorbs more heat than it dissipates. When extreme ...

*neurological abnormalities *visual disturbances

Prevalence

The IPC conducted a survey during the 2008 Games with 99 responses. 16.7 percent of the participants indicated that they had tried boosting in training or during a competition, with more than half of them being competitors in

wheelchair rugby Wheelchair rugby (originally murderball, and known as quad rugby in the United States) is a team sport for athletes with a disability. It is practised in over twenty-five countries around the world and is a summer Paralympic sport. The US n ...

. The use of boosting continues in athletes but is very difficult to detect. During the Games 20 athletes were tested just before their event for evidence of boosting but there were no positive results.

IPC view

The IPC made boosting illegal in 1994. Their handbook states in Chapter 4.3:

An athlete with a systolic blood pressure of 180mm Hg or above will be re-examined approximately ten minutes after the first examination. If on the second examination the systolic blood pressure remains above 180mm Hg the person in charge of the examination shall inform the Technical Delegate to withdraw the athlete from the particular competition in question.

Any deliberate attempt to induce Autonomic Dysreflexia is forbidden and will be reported to the Technical Delegate. The athlete will be disqualified from the particular competition regardless of the systolic blood pressure.

Method

Effectiveness and risks

Prevalence

IPC view

See also

References

Further reading