Revista de Medicina Desportiva (English) January 2019 | Page 8

done to indicate an eventual cardiac
catheterization. The authors additio-
nally refer that CASD does not con-
traindicate in absolute the regular
physical exercise, except if the age
is above 60 years and the sports are
high-intensity (triathlon, marathon,
and so on). All must be revasculari-
zed if there is functionally important
CAD and the risk factors should
aggressively be treated.
Bibliography
1. Piepoli MF, Hoes AW, Agewall S et al. 2016
European Guidelines on cardiovascular disease
prevention in clinical practice: The Sixth Joint
Task Force of the European Society of Cardio-
logy and Other Societies on Cardiovascular
Disease Prevention in Clinical Practice (cons-
tituted by representatives of 10 societies and
by invited experts) Developed with the special
contribution of the European Association for
Cardiovascular, Prevention & Rehabilitation
(EACPR). Eur Heart J. 2016; 37:2315-81.
2. Thompson PD, Franklin BA, Balady GJ et
al. Exercise and acute cardiovascular events
placing the risks introperspective. Circulation.
2007; 115:2358-68.
3. Berdowski J, de Beus MF, Blom M et al.
Exercise-related out-of-hospital cardiac arrest
in the general population: Incidence and prog-
nosis. Eur Heart J. 2013; 34:3616-23.
4. Marijon E, Uy-Evanado A, Reinier K et al.
Sudden cardiac arrest during sports activity in
middle age. Circulation. 2015; 131:1384-91.
5. Kim JH, Malhotra R, Chiampas G et al. Car-
diac arrest during long-distance running races.
N Engl J Med. 2012; 366:130-40.
6. Braber TL, Mosterd A, Prakken NHJ et al.
Occult coronary artery disease in middle-aged
sportsmen with a low cardiovascular risk score:
the Measuring Athlete’s Risk of Cardiovascu-
lar (MARC) events study. Eur J Prev Cardiol.
2016; 15:1677-84.
7. Dores H, Gonçalves PA, et al. Subclinical
coronary artery disease in verean athletes: is
a new preparticipation required? Br J Sports
Med. 2018; 0:1-6.
8. Mohlemkamp S, Lehmann N, Breuckmann
F, et al. Running: the risk of coronary events:
prevalence and prognostic relevance of coronary
atherosclerosis in marathon runners. Eur Heart
J. 2008; 29:1903-1910.
9. Merghani A, Maestrini V, Rosmini S, et
al. Prevalence of subclinical coronary artery
disease in masters endurances athletes with a
low atherosclerotic profile. Circulation. 2017;
136:126-137.
10. Borjesson M, Dellborg M, Niebauer J, et
al.Recommendations for participation in leisure
time or competitive sports in athletes-patients
with coronary artery disease: a position state-
ment from the Sports Cardiology Section of the
European Association of Preventive Cardiology
(EAPC). Eur Heart J. 2018; ehy408.
6 january 2019 www.revdesportiva.pt
Analgesic and anti-inflammatory
drugs in sports: Implications for
exercise performance and training
adaptations 1
Summary
Dr. João Almeida Santos 2
The non-steroid anti-inflammatory
drugs (NAIDs 3 ) are actually drugs
of free selling, being used by peo-
ple due to their analgesic, anti-
inflammatory and
antipyretics features.
The professional and
amateur athletes
not only are regular
consumers, but also
they sometimes take
high doses, and some athletes do
they take them to get some competi-
tive advantages. In this paper, the
authors make a revision of several
published papers about the effects
of NAIDs on sports performance, on
the acute response to the exercise
and on the long-term adaptation to
training. Regarding to sports perfor-
mance, the initial studies were made
on the 90 ths with acetylsalicylic
acid (ASA). It was concluded that a
single dose of ASA (650 or 1000mg)
before the event didn’t change the
performance. Also, some studies
were performed with paracetamol
and with this drug there is definitely
a better performance related to
several factors: 1. Increase toler-
ance to the pain; 2. Lower percep-
tion of the exercise intensity and,
related to formers; 3. Delay on the
onset of fatigue. This competitive
advantage was also concluded for
high temperature environments
(30°C), where the body temperature
was significantly lower comparing
with placebo, suggesting that the
anti-pyretic effect of paracetamol
could also be of interest on the apy-
retic subjects. Related to the acute
response to exercise, some studies
with ibuprofen and paracetamol
(1200mg/d and 4000mg/d, respec-
tively) showed suppression of the
protein synthesis in the skeletal
muscle after a resistance exercise
with eccentric exercises, and part of
this suppression could be explained
by the decrease of the genetic sign-
aling and transcription. However, not
all studies with NAIDs demonstrated
reduction on the protein synthesis,
possible due to differences on the
protocol and of the route of admin-
istration of the drug. Of note, also,
that this suppression of protein syn-
thesis was not seen with the selec-
tive inhibitors of COX-2 (coxibs),
which points to COX-1 as responsi-
ble for the increase on protein syn-
thesis during the process of repair
that occurs after resistance training.
Another change caused by NAIDs,
and apparently by the specific inhi-
bition of COX-1, is the attenuation of
the number of myogenic stem cells,
whose increase is usually induced by
exercise and it is thought that it has
an important role on the repair of
the muscle fibers. In relation to the
adaptation to the long-term train-
ing, the preliminary evidence shows
a different response to the NAIDs
depending on age: the adapting
response to training (example, mus-
cle mass) is attenuated on the young
subjects, while on the older subjects
(60-80 years) it seems to increase in
relation to the placebo. An expla-
nation proposed to this different
response resides on the eventual
state of pro-inflammation normal
on the elderly. The authors still
discuss the concept of “dichotomy
of recovery”: on one way, it might be
interesting the use of an interven-
tion that speeds recovery, but on
the other side, this acceleration (1)
occurs at the expense of postpone-
ment (or even impediment) of the
resolution of the inflammatory
response initiated by the aggres-
sion (this is, the exercise), (2) can
have repercussion on the maximum
functionality of the athlete and (3)
can even increase the risk of injury
or to aggravate a previous injury,
namely when an athlete doesn’t feel
pain and he feels is ready to train /
compete. It is important to remind
some limitations of a lot of stud-
ies mentioned in this paper, among
them are: (1) they were conducted
on amateur athletes and, as such,
the results can’t directly be extrapo-
lated to the professional athletes; (2)
the results are related to a punctual
intervention (ingestion of NAIDs),