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Testing for boosting at the Paralympic games: policies, results and future directions
  1. Cheri A Blauwet1,2,
  2. Harry Benjamin-Laing3,
  3. Jaap Stomphorst2,4,
  4. Peter Van de Vliet5,6,
  5. Pia Pit-Grosheide5,
  6. Stuart E Willick2,7
  1. 1Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
  2. 2International Paralympic Committee Medical Committee
  3. 3Institute of Sport, Exercise and Health, University College London Hospitals, London, UK
  4. 4Department of Sports Medicine, Isala Klinieken, Zwolle, The Netherlands
  5. 5Medical and Scientific Department, International Paralympic Committee, Bonn, Germany
  6. 6Faculty of Kinesiology and Recreation Management, Health, Leisure and Human Performance Research Institute, University of Manitoba, Winnipeg, Canada
  7. 7Department of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, Utah, USA
  1. Correspondence to Dr Cheri A Blauwet, Department of Physical Medicine and Rehabilitation, Harvard Medical School, 125 Nashua St, Boston, MA 02118, USA; cblauwet{at}


Background ‘Boosting’ is defined as the intentional induction of autonomic dysreflexia (AD) by athletes with a spinal cord injury (SCI) at or above the level of T6 for the purpose of improving sports performance. Boosting has been shown to confer up to a 9.7% improvement in race time. Additionally, to compete in a hazardous dysreflexic state, whether intentional or unintentional, would present an extreme health risk to the athlete. For these reasons, the International Paralympic Committee strictly bans the practice of boosting, and has developed a protocol to test for its presence.

Methods Testing was performed at three major international Paralympic events. Education regarding the dangers of AD was provided to athletes and team staff. Testing was conducted on athletes from the relevant sport classes: Athletics (wheelchair racing classes T51/T52/T53) and Handcycling (H1). Key parameters included the athlete's demographics (gender, country of origin), classification and blood pressure measurements. An extremely elevated blood pressure was considered to be a proxy maker for AD, and a systolic blood pressure of ≥180 mm Hg was considered a positive test.

Results A total of 78 tests for the presence of AD were performed during the three games combined. No athlete tested positive. The number of athletes tested, by classification, was: 6 in Athletics T51, 47 in Athletics T52, 9 in Athletics T53 and 16 in Handcycling H1. Of those tested, the average systolic and diastolic blood pressures were 135 mm Hg (range 98–178) and 82 mm Hg (range 44–112), respectively. All athletes were compliant with testing. No athletes were withdrawn from competition due to the presence of AD.

Discussion Testing for the presence of AD in paralympic athletes with SCI prior to competition has been carried out for the first time at three major international paralympic competitions. There have been no positive tests thus far. Knowledge gained during these early testing experiences will be used to guide ongoing refinement of the testing protocol and the development of further educational initiatives.

  • Disabled
  • Doping
  • Injury Prevention
  • Physiology

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