HUMAN BIOCHEMISTRY - L. V. Kapilevich - 2016

PART 2. FUNDAMENTALS OF SPORTS PHARMACOLOGY

THE USE OF PHARMACEUTICALS TO ACCELERATE RECOVERY IN ATHLETES AND TO TREAT AND PREVENT STRAIN CONDITIONS IN VARIOUS BODY SYSTEMS

To date, there is no single universally accepted theory of fatigue. Its mechanisms presumably involve biochemical, neuromuscular, and psycho-emotional processes. In The Development of fatigue during physical exertion, a decisive role is undoubtedly played, on the one hand, by the accumulation of METABOLISM/26.html">Energy Metabolism products (such as lactic acid) and fragments of cellular structures that break down during muscular activity (contractile and enzyme Proteins), and on the other hand, by a deficit of energy substrates—namely, a shortage of Energy Sources required for Muscle Function (creatine phosphate, ATP, glucose, Glycogen).

The administration of Pharmaceuticals to treat fatigue implies accelerating the recovery of the athlete's working capacity as a whole, as well as that of individual Organs, systems, Tissues, and Cells, specifically through the pharmacological agent's action on individual links of this integrated process.

When using drugs to accelerate athlete recovery, THE PRINCIPLE OF dosed recovery comes to the forefront. The fact is that fatigue also has a beneficial character. It is precisely fatigue and the biochemical and physiological shifts it induces that help enhance the athlete's adaptation to physical exertion, thereby increasing their level of athletic performance and exerting a genuine training effect. Unbridled use of recovery agents diminishes training effectiveness and prevents athletes from reaching peak athletic form. The continuous use of potent recovery AIDS can not only reduce the training effect but also lead to the loss of acquired skills.

Furthermore, the constant use of such medications as inosine, riboxin, Essentiale, and phosphaden can lead to a significant decrease in their therapeutic efficacy and ultimately to complete desensitization to the drug.

At the same time, excessive fatigue (overfatigue, overstrain) triggers a breakdown in the body's adaptive capacities to load and causes a sharp decline in athletic performance. The Theory of dosed recovery implies that recovery measures in athletes should be "dosed" both in intensity (neither too much nor too little, but in moderation) and—most importantly—in timing; they should not be carried out continuously, but only during specific periods within the training process. This is the general principle, and the details will be discussed below. The degree of an athlete's fatigue can be objectively assessed only through a series of biochemical Blood indicators, such as the levels of lactic acid (produced during the glycolytic, or anaerobic, breakdown of glucose in Muscles), pyruvic acid (Pyruvate), the enzyme creatine phosphokinase, urea, and several others. Recovery agents and measures used in sports medicine can be arbitrarily divided into three groups: pedagogical, psychological, and biomedical. However, it must be emphasized that this division is largely conventional, and only a comprehensive, multidisciplinary approach utilizing all these Methods can achieve the desired effect in the shortest possible time.

Pedagogical recovery measures include: individualization of the training process and the Structuring of training cycles, appropriate intensity and focus of the load, and a rational work-rest regimen. In addition, continuous monitoring and adjustment of training sessions based on the athlete's functional state are of utmost importance.

Psychological methods for athlete recovery include: psycho-pedagogical approaches that account for each athlete's individuality, emotional state, and sociability; ensuring psychological relief and adequate rest; and specialized regulation of mental state—such as Sleep regulation, hypnosis sessions, auto-training, and muscle relaxation techniques.

Biomedical recovery methods include: a complete and balanced diet, proper dietary habits, supplementation with extra Vitamins, Essential Amino Acids, and Trace Elements; physical factors such as various types of manual therapy, sauna use, hydrotherapy, and physiotherapeutic Procedures; as well as the intake of natural and pharmacological agents that promote the normalization of the athlete's well-being and physical fitness. It should be noted that the main groups of pharmacological agents used in sports medicine can be tentatively divided into tactical and strategic agents designed to solve specific tasks.

The first group includes vitamins and multivitamin complexes, energy-boosting preparations, certain metabolic intermediates, specialized targeted protein supplements, antioxidants, immunomodulators, Liver-protecting agents (hepatoprotectors), and medications prescribed for medical indications (i.e., therapeutic drugs).

The second group comprises non-steroidal anabolic agents (not to be confused with anabolic Steroids!), actoprotectors, certain psychomodulators, and a few others. As already mentioned, the pharmacological intervention in accelerating athlete recovery consists in the Prevention and Treatment of acute and chronic strain states. Physical overstrain of the body refers to pathological reactions occurring in response to an excessive level of functioning of a particular organ or organ system. Overstrain is a generalized morbid reaction of the entire Organism, though it is always characterized by the predominant involvement of a specific bodily system.

Depending on the severity of the dysfunction in systems and organs, four clinical forms are distinguished:

1) Central Nervous system strain;

2) Cardiovascular system strain;

3) liver strain (hepatalgia syndrome);

4) neuromuscular apparatus strain (myalgia syndrome).

The treatment of strain conditions aims to regulate and stimulate metabolic processes, typically involving a notable increase in drug dosages and the duration of the course of treatment.

Central Nervous System (CNS) Strain Syndrome

This typically occurs in complex coordination sports during the acquisition of technical skills, in the specialized preparatory period, and in the pre-competitive and competitive Phases of the training process. It may manifest as either CNS depression or hyperexcitation. In cases of CNS depression—characterized by feelings of weakness, reluctance to train, apathy, and low blood pressure—tonic and stimulating agents are prescribed, including adaptogenic preparations of animal and plant origin (pantocrin, ginseng, Rhodiola rosea, Eleutherococcus, Aralia, Sterculia, Zanthoxylum, etc.), as well as imported tonic herbal preparations (Vigorex, Brento, etc.). For hyperexcitability, sleep disturbances, and irritability, mild hypnotics and sedatives are used: valerian, motherwort, passionflower, and sodium oxybutyrate. When administering sodium oxybutyrate, aminolon, gammalon, or piracetam may also be prescribed (sodium oxybutyrate at 30–35 g of a 5% syrup at bedtime; aminolon, gammalon, or piracetam at 1–2 tablets 3 times a day; course duration is 10–12 days). Glutamic acid and calcium glycerophosphate may be prescribed in combination with these medications.

Cardiovascular System Strain Syndrome

Objective indicators of cardiovascular system strain are reflected in changes on the athlete's Electrocardiogram. If signs of cardiovascular strain are present, the volume of physical exertion should be immediately restricted, accompanied by appropriate balneological, physiotherapeutic, and pharmacological interventions. Pharmacotherapy for myocardial strain syndrome in the presence of pronounced cardiac dysfunction includes riboxin (inosine), potassium orotate, safinor, and Amino Acid and vitamin supplements (pyridoxine, cyanocobalamin, Folic acid). The combined use of phosphorus preparations, ATP, Choline chloride, and carnitine (for 15–30 days) is also advisable. In later stages of cardiovascular strain, particularly with pronounced signs of myocardial dystrophy, therapy with veroshpiron (spironolactone) and aldactone is indicated. Prior to course treatment, individual sensitivity to the drug and its effective dose must be established.

Liver Strain Syndrome (Hepatalgia Syndrome)

The hepatic pain syndrome typically develops during endurance training, particularly in sports that require a forced body position (such as speed skating or rowing). As a rule, it is triggered by a single bout of excessive physical exertion, manifesting acutely and without warning signs. When hepatic strain occurs, athletes should pay special attention to dietary control—the diet should include an adequate amount of CARBOHYDRATES alongside a reduced intake of animal fats, complemented by plant-based and dairy products.

To stimulate Bile secretion, it is advisable to prescribe mineral waters, herbal preparations (such as infusions of immortelle, corn silk, and rose hips), choleretic agents (allohol, legalon, karsil), and hepatoprotectors (essentiale). In cases of spastic phenomena, antispasmodics are indicated. Combining these agents with potassium orotate and riboxin (inosine) has also proven effective. Choleretics and hepatoprotectors are recommended to be taken after meals over an extended period, particularly during periods of the most intense and prolonged training.

Neuromuscular overload syndrome (Myofascial Pain Syndrome)

Strenuous muscular activity under anaerobic conditions in athletes with lower skill levels or during forced training can lead to muscle pain. In such cases, training loads should be reduced, particularly anaerobic (strength) workouts. It is advisable to prescribe balneological procedures, massage with warming ointments, and local hyperbaric chamber therapy.

Pharmacological treatment for myofascial pain syndrome involves antispasmodics, vasodilators, and microcirculation-improving agents, such as xanthinol nicotinate, nicoshpan, and Trental (grental), with a treatment duration of 2–5 days. In cases of increased blood viscosity accompanied by impaired platelet and erythrocyte aggregation, combining Trental with vasodilators such as No-shpa and phosphaden is recommended. Sodium oxybutyrate yields good results in preventing fatigue prior to scheduled aerobic workouts and in treating developed muscle stiffness ("clogged" muscles). For persistent pain syndromes, administering Scutamil-C (for 1–2 days) or Mydocalm (1–2 doses) may be beneficial to lower muscle tone. Because these overload syndromes rarely occur in isolation among athletes and are typically combined, the restorative pharmacological regimen generally includes agents aimed at preventing and treating multiple syndromes. Depending on the specific demands of a given sport, the most pronounced fatigue symptoms come to the fore, dictating the specific treatments and preventive measures applied for various overload syndromes.

QUESTIONS FOR SELF-Assessment

1. What is the purpose of using pharmacological agents by athletes?

2. What mechanisms underlie fatigue?

3. What are the consequences of developing extreme (trans-limit) fatigue?

4. What pedagogical means are used to accelerate recovery?

5. What are the recognized forms of overstrain?

6. What is the core nature of central nervous system overstrain syndrome?

7. Which pharmacological agents are indicated when myocardial overstrain syndrome occurs?

8. What agents are used to enhance bile secretion?

9. What causes the onset of neuromuscular apparatus overstrain syndrome?