The danger of Paralympic boosting

After years of hard work, Dr. Andrei Krassioukov has finally earned admission to the Athletes Village at the 2010 Vancouver Paralympic Games.

But Krassioukov isn’t a competitor — he’s an internationally recognized expert in spinal cord injury (SCI) and leader of the only research team to be granted access to the Vancouver Athletes Village during the Games.

Krassioukov and research team members will investigate the controversial practice of “boosting.” Practiced by some individuals with spinal cord injury (SCI), boosting involves intentionally raising blood pressure to stimulate the body’s energy and endurance. Non-athletes with SCI may use boosting to feel more energetic and alert. Paralympic athletes use boosting to win — it can improve performance by up to 15 per cent. Stressing techniques to stimulate parts of the body below the level of the spinal cord injury, and to produce a spike in blood pressure, can range from wearing pressure stockings, to compressing the testicles by sitting on a handful of ball bearings, or blocking a urinary catheter to distend the bladder.

Injury to the spinal cord disrupts control of heart and blood vessels that are normally regulated by the autonomic nervous system, part of the nervous system that provides non-voluntary control to various organs. This disruption — which varies in severity between individuals — means the body cannot properly replenish energy consumed through exercise leading to a drop in peripheral blood flow, sweating, shortness of breath and faintness . This creates significant disadvantages during competition, leading some athletes to use boosting as a drastic measure to correct functions lost through injury.

Besides creating an unfair competitive advantage, boosting is a dangerous practice. The sudden surge in blood pressure typically seen during boosting is known as autonomic dysreflexia and can lead to stroke, heart attack or death. But the International Paralympics Committee (IPC) 1994 ban on boosting has been difficult to enforce.

A physician-scientist at Vancouver Coastal Health’s GF Strong Rehabilitation Centre, Krassioukov has studied autonomic functioning in SCI patients for more than 30 years and has collected data from paralympic athletes headed for competition since 2006. During the last five years he has urged the IPC to go beyond the ban to address how differences in autonomic function affect elite athlete performance.

Krassioukov believes that adding autonomic functioning to the athlete classification system that currently measures only motor and sensory functioning will more evenly match competitors and reduce motivation to boost.

“Being allowed to conduct research in the Athletes’ Village is an exciting milestone for me,” says Krassioukov, an associate professor in UBC’s Dept. of Medicine and co-director of the International Collaboration on Repair Discoveries (ICORD), part of Vancouver Coastal Health Research Institute (VCHRI). “It suggests the IPC will consider how differences in autonomic function create inequities in performance and fuel the risky practice of boosting.”

Autonomic functioning varies between individuals according to the level and severity of their SCI. Currently, athletes with higher-level injury and significant autonomic function impairment compete directly with individuals with lesser impairment. Athletes have used boosting to close the gap.

During the 2010 Paralympic Winter Games, expected to draw 650 athletes from more than 40 countries, he plans to test 50 curling and sledge hockey athletes with spinal cord injury in a Cardiovascular Health Education Clinic in the Village and at ICORD. Volunteers will participate in a 90-minute assessment of autonomic functioning, complete a questionnaire and receive educational brochures about autonomic dysreflexia and risks of boosting.

Krassioukov expects it will be at least four years before his team will provide the IPC with possible guidelines on testing of autonomic functioning in paralympic athletes. Additional data from other paralympic sports must be collected and analyzed and recommendations developed and tested. He hopes research advances will ultimately eliminate the need for boosting but accepts that individuals with SCI are always looking for ways to improve their functioning.

“I am amazed by my patients’ incredible tenacity to achieve what they want to do in life — how they not only survive but fully engage in their adventure with a new body.”

Krassioukov’s work is supported by the Heart and Stroke Foundation of Canada; the Disability Health Research Network; the Craig H. Neilsen Foundation; and the Rick Hansen Foundation.

VCHRI is the research body of Vancouver Coastal Health Authority, which includes BC’s largest academic and teaching health sciences centres: VGH, UBC Hospital, and GF Strong Rehabilitation Centre. In academic partnership with the University of British Columbia, VCHRI brings innovation and discovery to patient care, advancing healthier lives in healthy communities across British Columbia, Canada, and beyond. www.vchri.ca.