"Boosting" in paralympic athletes with spinal cord injury: Doping without drugs

The intentional activation of autonomic dysreflexia (AD, also called “boosting”), a practice sometimes used by athletes affected by spinal cord injury (SCI), is banned by the International Paralympic Committee (IPC). Although various studies have addressed dop- ing and AD as separate issues, studies evaluating AD as a doping method are lacking. The aim of this brief review is to contribute to better understanding of the relationship between doping and AD. We conducted a literature search of the PubMed data- base (from 1994 onwards). The key search terms “autonomic dysreflexia” and “boosting” were cross- referenced with “sport performance”. The official Paralympic website was also viewed. AD is a potent sympathetic reflex, due to a massive release of nora- drenaline, that results in marked vasoconstriction distal to the level of the lesion. Athletes with SCI often self-inflict physical suffering in order to induce this phenomenon, which carries high health risks (i.e., hypertension, cerebral hemorrhage, stroke and sud- den death). Boosting is a practice that can be com- pared to doping methods and the IPC expressly pro- hibits it. Any deliberate attempt to induce AD, if detected, will lead to disqualification from the sport- ing event and subsequent investigation by the IPC Legal and Ethics Committee.