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      The evidence underpinning sports performance products: a systematic assessment

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          Abstract

          Background

          To assess the extent and nature of claims regarding improved sports performance made by advertisers for a broad range of sports-related products, and the quality of the evidence on which these claims are based.

          Methods

          The authors analysed magazine adverts and associated websites of a broad range of sports products. The authors searched for references supporting the performance and/or recovery claims of these products. The authors critically appraised the methods in the retrieved references by assessing the level of evidence and the risk of bias. The authors also collected information on the included participants, adverse events, study limitations, the primary outcome of interest and whether the intervention had been retested.

          Results

          The authors viewed 1035 web pages and identified 431 performance-enhancing claims for 104 different products. The authors found 146 references that underpinned these claims. More than half (52.8%) of the websites that made performance claims did not provide any references, and the authors were unable to perform critical appraisal for approximately half (72/146) of the identified references. None of the references referred to systematic reviews (level 1 evidence). Of the critically appraised studies, 84% were judged to be at high risk of bias. Randomisation was used in just over half of the studies (58.1%), allocation concealment was only clear in five (6.8%) studies; and blinding of the investigators, outcome assessors or participants was only clearly reported as used in 20 (27.0%) studies. Only three of the 74 (2.7%) studies were judged to be of high quality and at low risk of bias.

          Conclusions

          The current evidence is not of sufficient quality to inform the public about the benefits and harms of sports products. There is a need to improve the quality and reporting of research, a move towards using systematic review evidence to inform decisions.

          Article summary

          Article focus
          • The marketing of sports products has become a multibillion-dollar industry, but research in this area has previously been labelled as methodologically poor.

          • We aimed to assess the extent and nature of claims regarding improved sports performance made by advertisers for a broad range of sports-related products and the quality of the evidence on which these claims are based.

          Key messages
          • The current evidence is not of sufficient quality to inform the public about the benefits and harms of sports products.

          • There is a need to improve the quality and reporting of research, a move towards using systematic review evidence to inform decisions.

          Strength and limitations of this study
          • We attempted to identify a representative sample of products, but it is possible the products we analysed are at the worst end of the spectrum.

          • We did not give the manufacturers much time to respond to requests for information, given more time a number may have provided more references.

          Related collections

          Most cited references26

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          Physical activity: health outcomes and importance for public health policy.

          This manuscript presents a brief summary of the substantial data supporting an inverse relationship between the amount of habitual physical activity performed and a variety of negative health outcomes throughout the lifespan. It points out that despite these data a large segment of the US population remain insufficiently active resulting in a high population attributable risk for chronic disease due to inactivity. The accumulated data support the need for more comprehensive health promoting physical activity policies and programs, especially for the economically and socially disadvantaged and medically underserved.
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            Physical activity in relation to cognitive decline in elderly men: the FINE Study.

            Physical activity may be associated with better cognition. To investigate whether change in duration and intensity of physical activity is associated with 10-year cognitive decline in elderly men. Data of 295 healthy survivors, born between 1900 and 1920, from the Finland, Italy, and the Netherlands Elderly (FINE) Study were used. From 1990 onward, physical activity was measured with a validated questionnaire for retired men and cognitive functioning with the Mini-Mental State Examination (maximum score 30 points). The rates of cognitive decline did not differ among men with a high or low duration of activity at baseline. However, a decrease in activity duration of >60 min/day over 10 years resulted in a decline of 1.7 points (p < 0.0001). This decline was 2.6 times stronger than the decline of men who maintained their activity duration (p = 0.06). Men in the lowest intensity quartile at baseline had a 1.8 (p = 0.07) to 3.5 (p = 0.004) times stronger 10-year cognitive decline than those in the other quartiles. A decrease in intensity of physical activity of at least half a standard deviation was associated with a 3.6 times stronger decline than maintaining the level of intensity (p = 0.003). Even in old age, participation in activities with at least a medium-low intensity may postpone cognitive decline. Moreover, a decrease in duration or intensity of physical activity results in a stronger cognitive decline than maintaining duration or intensity.
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              Placebo effect of carbohydrate feedings during a 40-km cycling time trial.

              The placebo effect, a favorable outcome from belief that one has received a beneficial treatment, may be an important phenomenon in athletic performance. We have therefore investigated the placebo effect of a carbohydrate supplement on endurance performance. Forty-three competitive endurance cyclists (2 female, 41 male) performed two simulated 40-km time trials on an air-braked ergometer. In the first trial they ingested water to establish baseline performance (mean power 265 +/- 46 W for 58 +/- 4 min, mean +/- SD). For the second trial 6-8 d later they were randomized to two groups: one group ingested 16 mL x kg(-1) of a drink containing 7.6 g x 100 mL(-1) carbohydrate; the other ingested an indistinguishable noncaloric placebo drink. Cyclists in each group were further randomized to three subgroups according to whether they were told the drink contained carbohydrate, placebo, or either (not told). Changes in mean power in the second trial were: told carbohydrate, 4.3 +/- 4.8%; told placebo, 0.5 +/- 5.8%; and not told, -1.1 +/- 8.5%. The difference between the told-carbohydrate and told-placebo groups was 3.8% (95% likely range 7.9 to -0.2%). The change in performance in the not-told group was more variable than that of the told groups by a factor of 1.6 (2.6 to 1.0). The real effect of carbohydrate was a slight reduction in power of 0.3% (4.4 to -3.8%). (a) The placebo effect of a potentially ergogenic treatment during unblinded laboratory time trials lasting approximately 1 h is probably a small but worthwhile increase in endurance power. (b) Blinding subjects to the treatment increases individual differences in endurance effort, which may reduce precision of performance outcomes in controlled trials.
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                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2012
                18 July 2012
                18 July 2012
                : 2
                : 4
                : e001702
                Affiliations
                [1 ]Centre for Evidence-Based Medicine, Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
                [2 ]BMJ, London, UK
                Author notes
                Correspondence to Dr Carl Heneghan; carl.heneghan@ 123456phc.ox.ac.uk
                Article
                bmjopen-2012-001702
                10.1136/bmjopen-2012-001702
                3401829
                22815461
                1f59c1e3-53f4-487b-888f-0b355f9bcb40
                © 2012, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

                This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.

                History
                : 19 June 2012
                : 21 June 2012
                Categories
                Sports and Exercise Medicine
                Research
                1506
                1612
                1694
                1714
                1736
                Custom metadata
                press-release

                Medicine
                Medicine

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