Use of performance-enhancing substances (PESs)

Performance enhancement: not just for athletes anymoreMichele LaBotz, M.D., FAAP

Use of performance-enhancing substances (PESs) traditionally has been considered an issue in athletes, and prevention and screening efforts have primarily focused on that population. However, patterns of pediatric use of PESs have changed significantly over the past few years, with reports of increased rates of use by non-athletes, primarily for appearance-related concerns. This includes use of “diet pills” for weight loss, as well as protein, creatine and anabolic agents to enhance muscularity.

An updated clinical report from the AAP Council on Sports Medicine and Fitness discusses trends in PES use and offers tips for pediatricians, parents and athletes. Use of Performance-Enhancing Substances,, will be published in the July issue of Pediatrics.
The greatest medical risk with attempts to enhance performance/appearance occurs with diversion of controlled substances, according to the report. Several classes of drugs frequently are diverted for these purposes. The following rates of non-medical use have been reported in recent national surveys of high school students: amphetamines, 12%, anabolic steroids, 7% and synthetic human growth hormone, 11%.
Protein, creatine most common
Although generally not considered as dangerous as drugs, the PESs most commonly used by adolescents typically are sold as dietary supplements. Protein and creatine are at the top of the list. Recent surveys of high school students report protein supplement use by 30% of boys and 18% of girls.
Pediatricians may find the following information helpful when counseling patients on protein supplementation:
Protein supplements typically are in the form of powders, shakes or bars. They commonly contain 20-30 grams (g) of protein per serving, which is similar to the amount contained in a 3-4 ounce (oz) chicken breast.

Young athletes may require up to 2 g protein/kilogram (kg) body weight/day (almost 70 g in a 150-pound athlete). This often is readily met with a typical American omnivorous diet.

Vegetarians and others who are restricting their diet may benefit from nutritional consultation, but several easy changes can greatly increase dietary protein intake, as follows:

Traditional yogurt has 7 g protein/6 oz serving, while Greek yogurt provides 17 g and cottage cheese has 21 g.

Nonfat dry milk contains 12 g protein per half cup. This can be added to soups, sauces or beverages as a “hidden” source of added protein.

Peanuts, almonds and cashews all contain over 20 g protein per 100 g serving.

Creatine use has been reported by 18% of 12th-grade males and almost 2% of 12th-grade females.

Creatine is stored in skeletal muscle and helps replenish adenosine triphosphate during maximal effort activities of short duration.

The body requires about 1 g ingested creatine/day, which can be found in 2-3 servings of meat or fish.

There is no added benefit to extra creatine.

Contamination concerns
Pediatricians should remind families that Food and Drug Administration regulation of supplements is much looser than for items sold as foods or drugs. However, it can be very difficult for consumers to distinguish these categories, as supplements often are intermingled on shelves with food and/or over-the-counter drugs at point of sale.
Analysis of supplements sold as PESs revealed that 25% were contaminated with anabolic steroids, 20% with heavy metals and 11% with stimulants.
Concerns regarding contamination and lack of FDA regulation of dietary supplements prompted attendees of the 2016 AAP Annual Leadership Forum to adopt a resolution calling for enhanced education and advocacy.
Risk factors, different motivation
Risk factors for PES use include: male, higher body mass index, body dissatisfaction, training in commercial gym and exposure to appearance-oriented fitness media. While use of PESs correlates with substance abuse and other high-risk behaviors, PES use typically is “goal oriented,” whereas most other substance use in adolescents is recreational. This calls for a different approach when counseling on PES use.
Adolescents base their decisions regarding PES use largely on their hope for benefit, and this significantly outweighs any potential concern about adverse consequences. Therefore, prevention efforts are best focused on the lack of benefit of PES use, and pediatricians can provide information on alternative methods for achieving their goals.
Emphasize the following when counseling patients:
The overwhelming majority of initial claims by supplement manufacturers regarding muscle-building, weight loss or performance enhancement are debunked after further investigation.

Even the most favorable studies on the effects of PESs on athletic performance cannot rival the 30% strength gains that are reported in youth strength-training studies of several months’ duration.

Adherence to fundamental principles of training, rest and nutrition remains the best way for patients to achieve healthy fitness and appearance-related goals.

Dr. LaBotz, a lead author of the clinical report, is a former member of the AAP Council on Sports Medicine and Fitness Executive Committee

Exercise – The Daily Dozen

Cox and rowers The Popular Magazine, 1910,  J. C. Leyendecker (1874-1951)

Cox and rowers
The Popular Magazine, 1910,
J. C. Leyendecker (1874-1951)

My Grandmother used to watch my brothers and I if my parents went out of town, which was infrequent.

She would exercise. her routine was the daily dozen. I am sure it was only calisthenics but it those days that was good exercise. It must have been good for her she passed at 98.
It still is good exercise today.

What is a Calisthenics Workout?

It is very important to have a balanced exercise routine that targets all muscle groups, both upper and lower body.

I would recommend lighter weights with more frequent reps. I discourage the maxing out that some coaches and teens do when there is not adequate supervision in the wt room.

A recent study showed better results with shorter workouts.

All too often we see people who try to bulk up.

In most cases it does not look healthy and in some cases appears to be uncomfortable if not grotesque.

We all enjoy seeing people who are fit.
Not emaciated but healthy.

The best approach is a routine that addresses body health and over all well being.

That means a routine that again targets cardio, core, and extremities with stretching and allows rest and provides for adequate nutrition.

Supplements for Fitness?

If you want to build muscle, lose fat or run, swim or cycle faster, you’re better off with a solid training program and healthy diet than with supplements. In any case, the small effect some of these supplements may have would be meaningless for recreational athletes or exercisers, though the risks are just as great. In particular, if you are counseling children or teenagers who want to excel in sports, persuade them to do it through training, not pills.

Too often my athletes have been told by their “trainer” to bulk up using protein supplements powders and drinks.

In many cases this may add bulk but not strength. and in the cases with creatine may be harmful.

The Bottom Line:
“Increased muscle mass results from small amounts of protein synthesis (positive net protein balance) in response to nutrient intake (carb and protein) combined with resistance exercise (Tipton & Ferrando, 2008). Most of us already get the amount of protein we need to maximize our efforts in the gym.

Eating a high-quality diet with good sources of protein is the best thing to do if you’re looking to gain strength and muscle mass. Lean protein, like lentils, beans, grains, chicken, pork, fish, and lean red meat, are great protein sources. Peanut butter, and other nuts/seeds are also good. Eating a snack post-workout is smart for athletes who are undergoing more than an hour of resistance exercise. However, a protein supplement at this time is not necessarily the best bet; instead, try to eat a mixed meal of carb and protein and, additionally, factor this snack into your day’s diet.”

There is nothing that will hurry puberty and the accompanying increase in muscle mass

I do not want kids to gain weight just to fill a slot for some coach.

I want my athletes to participate in the sports that they enjoy and have coaches and mentors who enjoy sharing their knowledge of the sport or game

It all comes back to facilitating the development of a healthy mind body and soul.

Above all athletics is a means by which we can exercise but also socialize or network with our peers.

The most important thing that some athletes lose site of is that education comes first and sports are secondary.

We do not like to think that our ability to participate in a sport may cease but what we learn from the sport in self determination and perseverance and just the joy of participation cannot be taken away.

The Best Core ExercisesCore workouts that target more than just the ab muscles

Sports – Injury Prevention

 J.C. Leyendecker  Boys Playing Baseball (1915)

J.C. Leyendecker
Boys Playing Baseball (1915)

Young athletes today are bigger and stronger, and they push themselves harder than ever before

10 injury prevention tips to help keep your young athlete on the field rather than on the sidelines:

1. Talk with your young athlete.

Make sure your young athlete understands that he or she should talk with you and seek help if experiencing a pain or something that just doesn’t feel right.

2. Get a preseason physical.

A preseason or back-to-school physical is a great way to determine if your young athlete is fit to play.

3. Encourage cross-training

It’s important for athletes to change the sports or activities they are doing so they are not continuously putting stress on the same muscles and joints. Parents should consider limiting the number of teams their athlete is on at any given time and changing up the routine regularly so that the same muscles are not continuously overused.

4. Stress the importance of warming up.

Stretching is an important prevention technique that should become habit for all athletes before starting an activity or sport.

5. Make sure they rest.

Athletes of all ages need to rest between practices, games and events. A lack of sleep and muscle fatigue predispose an athlete to injury,

6. Provide a healthy, well-balanced diet.

It’s important for athletes to eat a well-balanced diet full of fruits, vegetables and lean proteins, and to maintain a regular eating schedule.

7. Emphasize hydration.

Heat-related illness is a real concern for athletes, especially during hot and humid days. Parents should make sure their children have adequate water before, during and after play, and watch for any signs of a heat-related illness, including fatigue, nausea, vomiting, confusion or fainting.

8. Get the proper equipment.

Protective equipment, like helmets, pads and shoes, are very important for injury prevention. Parents should talk with coaches before the season starts so that they have adequate time to properly outfit their child before practices begin.

9. Emphasize proper technique and guidelines.

In every sport, there is a correct way and a wrong way of doing things. For example, football players should be taught the proper way to tackle an opponent to avoid a concussion, and baseball players should be taught the proper way to throw and follow the guidelines on how many throws to make in a day.

10. Recognize injury and get help early.

If parents notice that there is a change in their athlete’s technique, such as a limp when running, throwing differently or rubbing a leg during activity, they should pull the athlete out of play. If the problems persists, parents should seek an assessment for their child prior to returning to the activity. Athletes will alter the way they do things because of pain, but then they can end up with a more serious injury because of it.

When to see a doctor for your sports-related injury:

Consistently have pain during or after sports
Persistent or new swelling around a joint
Recurrent instability – joints “give way”
Painful pops (nonpainful pops are OK)
Pain that does not respond to a period of rest

10 Tips for Preventing Sports Injuries in Kids and Teen

Helmet safety


A properly fitted helmet should meet the standards of the U.S Consumer Product Safety Commission (CPSC) or Snell Memorial Foundation. Properly fitted helmets should:

Be worn flat on your head with the bottom edge parallel to the ground
Sit low on your forehead

Have side straps that form a “V” shape around each ear

Have a buckle that fastens tightly (there should be room to put only two fingers between the strap and your chin)

Have pads inside that you install or remove so the helmet fits snuggly

Not move in any direction when you shake your head

Not interfere with your movement, vision or hearing

Eye Injury Prevention

 An eye injury can happen at any moment but sometimes can effect a child for a lifetime. Parents, coaches, schools and teams should make eye injury prevention a top priority in order to advocate a more comprehensive awareness about their athlete’s physical health.

Here are some preventative tips to make sure your athlete’s ocular health is protected:

  • If your child wears prescription glasses schedule an appointment with your child’s vision health provider to get fitted for prescription sport eyewear.
  • Make sure your athlete wears their protective gear consistently during practices and games.
  • Make sure the eyewear has anti-fog coating.
  • All athletes should get regular eye exams with their professional provider to monitor eye health and ensure performance.

Protecting Your Athlete’s Eyes