Can Viagra enhance athletic performance?
If, as the Rolling Stones once proclaimed, a little yellow pill is mother's little helper, what is the little blue pill for Daddy?
So is there any validity to the notion that Viagra could be used to enhance athletic performance? As is typical in the medical world, there is no simple black-and-white answer. We do know that no definitive, well-controlled, randomized clinical trial studies exist that have specifically examined the effects of sildenafil -- the active ingredient in Viagra -- on athletic performance.[+] EnlargeAP Photo/Keystone/Karl MathisAn athlete's secret weapon? Not according to the experts.
How does that relate to athletics? Naturally, one has to start by looking at scenarios in which minimized lung capacity could be a limiting factor. Everyone can appreciate that a high-altitude environment seriously affects the workload on an athlete's lungs because of the decreased availability of oxygen. Cyclists who traverse mountain ranges, marathoners who run courses in high elevations and winter-sport athletes such as competitive cross-country skiers all participate in some form of altitude training as a means of conditioning for their environment.
Dr. Robert Nied, a sports medicine physician at Kaiser Permanente in Santa Rosa, Calif., emphasized that the studies thus far that have found improved performance with the drug were done only at extremely high elevations at which oxygen levels were seriously diminished or in laboratory environments that replicated extreme-altitude hypoxic environments. Nied explained that studies attempting to establish the presence of performance improvements at normal elevations found no such benefit. This is critical because the highest elevation in baseball stadiums is 5,200 feet (Coors Field), and that doesn't even begin to approach the 12,000-plus feet of elevation environments used in these studies. So although the thinner air at Coors Field may allow the baseball to travel farther, it does not appear that the little blue pill would play a role in improving an athlete's performance at that stadium or any other. In fact, a study published in the Journal of Applied Physiology in 2006 suggests the effects of the drug eliminate a decrease in performance (due to low-oxygen environments) but don't provide enhancement beyond normal. Simply said, as far as exercise capacity, the drug could be considered a treatment in response to the effects of high altitude as opposed to an ergogenic, or performance-enhancing, aid.
But besides potentially counteracting the effects of altitude, how does lung-capacity improvement help a baseball player? It doesn't really, because playing baseball does not rely on aerobic endurance as a variable for success. There have been some suggestions that the vasodilation effects of Viagra could improve the effect of anabolic steroids if taken together, but no real medical basis has proven that to be true. Viagra's vasodilation effect is fast-acting; it has a quick onset (as soon as 30 minutes) and is removed from the bloodstream within hours. The anabolic steroid effects of increased testosterone, on the other hand, are not available immediately, and steroids work via an entirely different mechanism of protein synthesis at the cellular level, not via arterial blood flow.
Dr. Gary Green, a clinical professor in UCLA's division of sports medicine and adviser to Major League Baseball on anabolic steroids, says he has not specifically heard of athletes' combining Viagra with anabolic steroids. But he is aware of over-the-counter supplements such as NO2 -- whose main component is an arginine compound purported to increase nitric oxide levels and therefore increase blood flow, effects similar to the effects of Viagra -- being used in conjunction with steroids. Green is quick to point out that scientific studies have shown there is no benefit from this combination, but he also adds that the placebo effect in athletes can be quite strong, and if they firmly believe that something is helping them, their performance can, in fact, improve.
Athletes could be saying they take [Viagra] for one reason to cover up the real reason.
--Dr. Gary Green
As will no doubt forever be the case in sports, some athletes will try to gain an unconventional competitive edge, be it through drugs or other means. Viagra is not currently listed as a banned drug in sports, although eventually that may change. The World Anti-Doping Agency is concerned enough about the potential abuse of Viagra in cycling that it is funding a study, currently under way at the University of Miami, examining whether the drug can improve the performance of cyclists who are riding at altitude. Given that cyclingnews.com reported last month that Italian cyclist Andrea Moletta was suspended after a police search of his father's car at the Giro d'Italia turned up 82 Viagra pills and a syringe hidden in a tube of toothpaste, the Agency may be on to something.
In the meantime, no current evidence suggests that Viagra can enhance performance in baseball or any other sport. Nor is there any evidence to support the idea that Viagra and anabolic steroids, when taken together, enhance or accelerate steroid delivery. Be that as it may, history demonstrates that some athletes will continue to seek out new and different methods of performance enhancement, whether or not the science supports those methods. After all, as Green points out, the first definitive study showing the muscle-building effects of testosterone was not published until 1996, but athletes have been using testosterone for such a purpose since at least the 1950s. At least for now, medicine tells us that the benefits of the little blue pill can be realized only in the bedroom, not in the locker room.
Stephania Bell is an injury expert for ESPN.com. She is a physical therapist who is a board-certified orthopedic clinical specialist and a certified strength and conditioning specialist.
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