TheEuropeanHealth&FitnessAssociationRueWashington40B-1050Bruxelles

Belgium

www.ehfa.eu

FINALREPORT

SECTION4–RESEARCHFINDINGS

April2012

FitnessAgainstDoping–Section4–ResearchFindings 2

AgainstDopingProjectisgrant-aidedbytheEuropeanCommission.ThisreportrepresentstheviewsoftheauthorandnotoftheCommission.

3 FitnessAgainstDoping–Section4–ResearchFindings

4.1DeskResearch

Theprojectpartnersagreedthatacombinationofquantitativeandqualitativeresearchusingthemethodologyofdeskandfieldworkwouldgivetheresultstoprovidetheevidencebaseforpotentialfuturetargetedinterventionsforthesectorandtostartanewnetworkofbestpracticetofurtherthefightagainstdopinginfitness.

Theresearchonanti-dopingpolicieswasdividedintothefollowing:

-Identificationofkeyprojectstakeholders

ThekeystakeholdersseenasbeingintegraltotheresearchprojectwereidentifiedbytheEHFAresearchteamasbeingtheleadnationalcontactpointsinthefieldofanti-dopingregulations,theleadnationalcontactpointsforanti-dopinginsports,andthoseinternationalandEuropeanorganisationswithaninterestinanti-dopingmatters.

-Currentsituationanalysis

Anti-doping

Itwasrapidlyfoundduringtheinitialstagesoftheresearchonpoliciesthatanti-dopingandlawenforcementdiffersfromcountrytocountry.Furthermore,whilstthereisagrowinglevelofinter-governmentandinter-sportcooperationsuchasWADA,theuseoftheWADACode,UNESCO,InternationalConventioninAnti-DopinginSport,andCouncilofEuropeAnti-DopingConvention,thereislittleinformationoractivityintheareaofamateursportandfitnessintheapplicationoflawenforcementorforspecificeducationprogrammes.

Thedesk-basedresearchwhichwasundertakenduringtheprojectassessedthefollowingissuesinordertogetacomprehensivesummaryintermsofthecurrentanti-dopingsituationacrossEurope:

• GlobalandEuropeangovernmentalandofficialsourcesforinformationonpoliciesrelatingtoDopingwithinthehealthandfitnesssector.

• Dopingprosecutionstatisticstoassessthe

prevalenceofdopingviolations.• nter-governmentalbodiesandotherofficial

internationalsourcesforinformationonpoliciesrelatingtodopingwithintheEuropeanHealthandFitnesssector.

• NationalandinternationalspecialisttradepressforinformationonpoliciesandresearchrelatingtodopingwithintheEuropeanHealthandFitnessSector.

• WebsitesofnationalandinternationaltradeassociationsforpoliciesrelatingtoDopingandpotentialroleofthehealthandfitnesssector.

• ReportsproducedbyCSRteamsofmajormanufacturers,distributors,suppliers,andtrainingprovidersinthehealthandfitnesssectorandotherrelevantsectorsfortheirviewsonpoliciesrelatingtoanti-doping.

• National,transnational,andinternationalanti-dopingregulationagenciesforinformationforpoliciesorresearchrelatingtodopingwithintheEuropeanHealthandFitnessSector.

• Financial,businessandmainstreampressforopinionsondopingandthepotentialroleofthehealthandfitnesssector

Belowisasummaryofthefindingswhicharefocusedmainlyonfourofthepartnerorganisations–Denmark,Germany,theUKandtheNetherlands–thoughfurtherresearchwasundertakenthroughoutEuropetogainthewidestpossiblepictureofcurrentanti-dopingsituations.ItwasfeltthatthesecountriesweremorelikelytohavethemostdevelopedpoliciesinplaceyetalsoberepresentativeoftherestoftheEuropeanmarket.

Denmark

InDenmarkitisillegalto,“manufacture,import,export,sell,distributeorpossesswiththeexceptionofuseforthepreventionortreatmentofdiseasesorforscientificpurposes,AndrogenicAnabolicSteroids(AAS)”.1TheobjectiveofthelawistopreventtheuseofAASfordopingpurposes.

RegardingtheuseofAASinfitnesscentres,whichconsequentlyisillegal,thereisatwoprongedapproach,whichconsistspartlyoftestandcontrolandpartlyofinformationandeducationalcampaigns.AuniquefeatureoftheDanishanti-

FitnessAgainstDoping–Section4–ResearchFindings 4

dopingeffort,comparedwiththatofothercountries,is,thatsince2005Anti-DopingDenmark(ADD),theorganisationresponsiblefortestingdopingamongeliteathletes,hasbeenrequiredbytheDanishGovernmenttocarryouttestsinfitnesscentresandhealthclubsthathavesigneduptoanationalanti-dopingscheme.

Gymspayapproximately12,000Kroner(approx.1,400€)ayeartobepartofthescheme.Theythenreceiveastickerwitha‘smilingface’reading‘WetestfordopingincollaborationwithAnti-DopingDenmark’,whichtheyarerequiredtodisplayontheentrancedoor.

Gymsthatdonosignupforthetestingschemereceiveastickerwitha‘sadface’reading,“WedonottestfordopingincollaborationwithAnti-DopingDenmark”,whichtheyarealsorequiredbylawtomakevisibletotheircustomerattheentrance.Thereforealthoughtheschemeisnotmandatorysignificantpoliticalpressureexiststoencouragegymstosignup.gymstosignup.

InJune2010,50%ofallcommercialgymsinDenmarkwerepartofthescheme,embracing

approximately80%ofDanishgymmembers2(550,000members).ForthosecentresthatpaytheannualtestingfeeinspectorsfromADDwillnormallyvisitthecentretwiceayeartocarryoutdopingtestsontwosubjectspervisit.In2008507testswereconductedand111individuals(22%)testedpositive.3However,itisimportanttonotethatthetestingistargetedtowards‘suspiciousindividuals’,andthereforepopulationprojectionscannotbemadefromthesefigures.Anumberofotherfitnesscentreuserswerealsobannedbecausetheyrefusedadopingtest.

WhereauseristestedpositiveduringtheADDvisit(orrefusestobetested),heorsheisimmediatelyexcludedfromthecentreinquestion.However,sinceitisillegaltostoreinformationonrecreationalathleteswithdrugstestsinacommondatabase,individualsarethereforefreetosignupasamemberofanothergym.

Alongwiththedopingtests,ADDhastriedtouseeducationalcampaignsandsupportservicestoaddresstheuseofimageenhancingdrugsinfitnessenvironment.Thisincludedthetraditionaleducationalcampaignsandsupportservices.Additionally,ADDdevelopedananonymouscounsellingsystemaccessibleviatheinternetandatelephoneservicewhichreceivedover1398queriesoveran18monthperiod.Almostallquestions(94%)thatwerepostedbyindividualstrainingingymswerefrommaleenquirieswhile6%werefromfemales.Thethreemostcommonperformanceandimageenhancingdrugs(PIEDs)wereAAS(34%),creatineandorprotein(22%),andotherdietarysubstancesin16%ofinstances.OftheindividualsenquiringregardingAAS,61%originatedfrompeopletrainingingyms

MovesarenowbeingmadetolobbytheDanishParliamenttochangethelawtomakeitcompulsoryforallfitnesscentrestojoininthe“smileyface”schemeeventhoughthereisnoevidencethatthepresentstrategyhasledtoanysignificantreductionintheuseofAAS.Anycompulsoryschemewouldalsohavetoovercomedataprotectionissues,suchaswiththeuseofpersonalinformationofpeopletestedpositivelybeingcirculatedthroughagenciesandtootherfitnesscentres.Therearecriticsof

5 FitnessAgainstDoping–Section4–ResearchFindings

thecurrentschemecitingthatitisexpensive(over6,000,000DKKhasbeenpaidbyfitnesscentrestoADD)andthatithasatoonarrowfocus.

Denmarkremainsaloneinusinganenforcementandcontrolregimesuchasthis,andtherecommendationsoftheExpertGrouptotheCouncilandthefindingsoftheStrategyforStoppingSteroidsproject4donotendorsethisdirectformintervention.

Germany

InGermany20,000individualsarecaughtasillegaldrugoffenderseveryyear5,whilstitisestimatedthat37.6%ofpersonsaged18-39havetakendrugsatsomestage.Additionally2-3%ofpupilsandstudentsinGermanyhavealifetimeexperiencewithprescriptionstimulantsforcognitiveenhancement.6

TheprevalenceofillegaldrugsinGermanfitnessandleisurefacilitiesisreportedas15.9%.7Aseparatequestionnairewhichwasusedinthesamefitnessenvironmentthatwasdirectedat‘suspiciousindividuals’reportedthat41.3%individualsuseillegaldrugs.

Germandruglawstatesthatmedicalprofessionalsarenotallowedtoprescribemedicationssolelyforperformanceenhancement,whilsttheGermanNarcoticsDrugActprohibitsthepossessionanduseofnarcotics.

Asinmanycountries,anti-dopingispromotedbytheNationalAnti-DopingAssociation(NADA).ThestatedobjectivesofNADAaligncompletelywiththoseoftheWADA.WhilstNADAdoespromoteanti-dopingspecificallyinamateursportitplacesagreateremphasisonelitesport.Nevertheless,ithasapreventativeprogramaimedatensuringthatyoungathletesareappropriatelyinformedofanti-dopingpolicies.Theprogrammetargetskey‘influencers’ofyoungathletesincludingschooltrainers,teachers,parents,andmedicalprofessiontoensurethattheyallrecommendsafeanti-dopingpractices.

SupplementuseinelitesportisdiscouragedbytheGermanNADAbecauseofthepotentialrisks

ofcontaminationwithinsuchproducts.ThereareanumberofGermansupplementmanufacturerswhohavequalitycontroltestingperformedontheirproductsinordertore-assureathletesthattheyarenotcontaminated.TheproductsaretestedforanumberofsteroidsandoccasionallyforstimulantsatalaboratoryinCologne.8

WithintheGermanfitnesssectortheleadingtradeassociation(DSSV)stronglyadvocatesanti-dopingtoitsmembersandhasdevelopedaneducationalprogrammefortrainersandathletesinwhichthedangersofdopingsubstancesarehighlighted.

UnitedKingdom

IntheUKthereisanestablishedgovernancestructurewithinelitesportwherebynationalgoverningbodiesofsport,suchasUKAthletics,promotetheworkofregulatorybodiessuchasUKAnti-DopingandWADA.However,thereisnoestablishedstructureforinvestigatingdopingwithinthefitnesssector,andtherewouldappeartobelittleresearchtodateonfitnesscentreusersintheUK.9

Itisestimatedthat200,000usersintheUKtakesteroidsfornon-medicalpurposesi.e.toenhancetheirappearanceorstrength.10ThefirstnationwideAASsurveyintheUKsurveyed21gymsthroughoutBritainandfoundthat8%ofrespondentsadmittedhavingtakenAASatsometime,5%ofwhichcurrentusers.11Aseparatesurveyof100AAS-usingathleteswasconductedinthreeSouthWalescounties,reportinghighratesofpolypharmacy(80%)withawiderangeofotherdrugsamongsttheirsample.

WithregardstoAAS,theUnitedKingdomisoftenstatedasadoptinga‘harmreduction’strategy,relyinguponeducationandawarenesscampaigns.TheHomeOfficeclassifyAASasaClassCdrug.Thismakesitanoffencetosupplythedrugbutdoesnotmakeitanoffencetopossessorusethempersonally.Asaresulttherehasbeenanincreaseininternetsaleschannels,wherecompaniesbasedinlocationsoutsideoftheEUcansellAASlegallytoindividualswithintheUK.Oneofthemorepopularwebsitesiswww.anabolicteroidsuk.netwhichstates:

FitnessAgainstDoping–Section4–ResearchFindings 6

“Items you order are sent directly to the United Kingdom. All items are sent from outside the European Union and have delivery times usually in days. For other nationalities please be sure to check your countries laws before ordering. UK customers may also be liable for a 12.8% customs charge on imported items. If you would like more information about this please ask us as we will attempt to keep these charges to a minimum.” 12

Suchsaleschannelsoperatelegallybecausepossessionwithoutprescriptionisnotillegalanditisalsonotillegaltoimportsteroidsaslongastheyareforpersonaluse.However,possessionorimportingwithintenttosupplyisillegal,andcarriesuptofiveyearsimprisonment.Itwasfoundthatthis‘soft’legislativeapproachhasnotresultedinincreasedlevelsofAASuseacrossthepopulationincomparisontocountrieswithmorepunitivelegislationsuchasDenmark.

TheUKHealthandFitnessIndustry(theFitnessIndustryAssociation,theRegisterofExerciseProfessionals,andtheInstitutefortheManagementofSportandPhysicalActivity)hasaddressedtheproblemofsteroidmisusebypublishinganindustryguidancenoteadvisingfitnessprovidersandprofessionalsonhowtorecognizethesignsofsteroidusewithintheirorganisations,theriskinvolvedintheabuseofsteroids,andtheappropriatecourseofactiontotakeifsteroiduseissuspectedamonggymmembers.

Theguidelinesrecommendthatexerciseprofessionalsshouldapproachindividualsbydiscussinggeneralpositivelifestylechoicesratherthanbeingexplicitorconfrontationalabouttheuseofsteroids.Theguidelinealsodetailsthedutyofcareofclubmanagerstothepeopleusingtheirfacilities,andprovidesadviceon‘bestpractice’forensuringthatdutyofcareisfulfilled13.

Netherlands

Incontrastwithanumberofcountrieswherelegislationexiststhatcriminalisesdoping,theNetherlandshasnospecificnationallegislationregardingdoping.In2008theDutchMinisterof

Health,WelfareandSportrequestedtheHealthCounciloftheNetherlandstoinvestigatethenatureandseverityofdopinguseinunorganisedsports,particularlywithregardtotheharmfuleffectsonhealthbothshort-termandlong-term,theimplicationsofhighriskdrugsintermsofhealthrisk,diseaseburdenandcareconsumption,andtomakerecommendationsregardingthesetopics.14

Thereviewstatedthatwithinunorganisedsports,dopingisusednotonlytoimproveperformancebutalsotoenhanceaslim,muscularphysique.Withinthereportthecouncildefinedunorganisedsportas,“anyformofrecreationalsportingactivitynotorganisedbyregularsportsorganisations”,fitnesswasconsideredthemostcommonsportperformedinthiscontext,whilstthemajorityofthissportingactivitytakesplaceingymsandfitnesscentres.

IntheNetherlandsabout2millionpeopleengageinunorganisedsports,andvariousstudieshavebeenperformedintotheprevalenceofdopinguseinunorganisedsports.Mostrecently,theDopingAuthority,Dopingautoriteit,requestedthatanewstudyintotheprevalenceofdopinginunorganisedsportsbeundertaken.15Thestudywasperformedamongvisitorstofitnesscentresaged15andolder,92fitnesscentresand718individualsparticipatedinthestudy.Thestudyincludedarandomisedresponsemethod,whichallowsforsociallydesirableresponses,andaclassicalmethod.Theclassicalmethodrevealedageneralprevalencewhereastherandomisedmethodyieldedaprevalenceof8.3%.Intermsofabsolutefigures,thelatterpercentageindicates160,000peoplehaduseddopingin2008.

Aseparatestudystatedthattheprevalenceofdopinguseamongthegeneralpopulationwas2.1%in2005for‘useatsomepoint’and1%for‘useinthepastyear’.16Accordingtotheresultsgymsandfitnesscentresappeartobethemostimportantplacestocontactdealers(36.4%),otherlistedsourcesincludedoctors(12.7%),drugstores/pharmacy(21.8%).

WithasubsidyfromtheDutchgovernment,theNetherlandsAnti-DopingAuthorityFoundationfocuses,amongstotherthings,onprovidinginformationandadvicetoathletesandtheirdirect

7 FitnessAgainstDoping–Section4–ResearchFindings

environment.Thepreventionprogramme‘EigenKracht’(TrueStrength)developedbytheDopingAuthorityin2004focusesspecificallyonathletesinfitnesscentresandgyms.Fitnessentrepreneurs,gymownersandinstructorsareakeyintermediatetargetgroupofthecampaignwhichsimplyaimstopreventorreducetheuseofdopingbyathletesinfitnesscentresandgyms.Thecampaignprovidesanumberofpiecesofinformationcollateralsuchasthebook,‘Opeigenkracht’,amonthlypublicationinSportandFitnessMagazine,andaseriesonseminarsandappearancesattradeshows.17

Thefitnesssectorhasalsodevelopedananti-dopingstrategywherebythesectortradeassociation,Fit!vak,requiresallmemberstobecertifiedbytheNationalFitnessCentreCertification(LERF).Amongotherthingsthisregulationsetsrequirementsintheareaofdoping.Fit!vakmembersalsosignananti-dopingcovenant.Indoingso,thecentredeclaresitwillimplementpolicywithinthecentrethatcombatstheuseofdopingsubstances,onpenaltyoflossofLERFaccreditation.Evaluationoftheseeffortshaveindicatedthatasplithasoccurredbetweenbodybuildingcentres,wheremoreresistancehasbeenidentified,andfitness/leisurecentreswhichFit!vakrepresentandarethereforecompliantwithAnti-Dopingpolicy.

Regardinguseofnutritionalsupplements,someeliteathletesintheNetherlandscontinuetousetheseandrefertoanationalprogramcalledtheNederlandsZekerheidssysteem-VoedingssupplementenTopsport(NZVT)whichallowsuserstolookforproductsthathavebeentestedforsteroidsandstimulants.18ProductsthataresigneduptothisservicecandisplaytheNZVTlogo.TheoperatorsoftheNZVTprogramalsocollaboratewiththeoperatorsofthetestingprogramInformed-SportintheUK.

OthernationaldopingstrategiesemployedinEurope

Thedesk-basedresearchwasextendedtoexaminetheanti-dopingpoliciesandcurrentsituationsacrossEurope.Anti-dopingstrategiesinPortugalhaverecentlybeenadjustedtoconformtotheprinciplesoftheWADAcode.Althoughno

previousstudieshavebeenconductedtodiscernthelevelsofdopingpracticeforgeneralcitizens,thePortugeseFitnessAssociationAssociaçãodeEmpresasdeGinásioseAcademiasdePortugal(AGAP)hasincludedanti-dopingaspartoftheirCodeofConductforfitnesscentres,inorderto“prohibitriskyactivitiestothephysicalintegrityofpractitionersandthesaleofharmfulproductstothehealthofclients”.Intermsofaregulatoryapproach,fitnessfacilitiesinPortugalaresubjecttoadecree-law(n.271/2009article16)whichprohibitsandrecommendationorsaleofanysubstancesormethodsthatareprohibitedunderPortugueselaw.

ThenewlyoperationalBulgarianAnti-DopingCentrehasalsoyettoestablishananti-dopingstrategyaimedatamateursportspeople,astherearecurrentlynolegalgroundsfortheCentretoengageinanactivecampaignagainstdopingpracticesamongamateurathletesorgeneralcitizens.

AlthoughFinlandisnotapartnercountrytothisstudy,ithasdevelopedananti-dopingstrategyaimedatamateurathletesintheformofaninternet-basedservicewhichprovidesinformationandadviceondopingissues.“Dopinglinkki”,aserviceprovidinginformationandexpertadviceondopingissuesandfundedbytheFinnishgovernment,aimstopromoteawarenessofdopingissuesandhelpreducethehealthhazardrelatingtodopingsubstancesandtheiruse.TheservicewaslaunchedincooperationwiththeFinnishAnti-DopingAgencyFINADA.TheFinnishSportsforAllAssociationalsohaveacertificationsystemdesignedtopromotecooperationonanti-dopinginrecreationalsportsalongsocialresponsibilitylines.220gymshavesignedthecertificateacrossFinland.

TheSTADprogrammeinStockholm,Sweden,combinesresearchandinterventionstovulnerablepeopleanduserscoveringalcoholabuse,useofnarcoticsandsteroidsinaholisticapproach.Themodelisbasedonco-operationbetweeneachofthekeystakeholdersarounddopinginfitnesscentres,aimingtochangetheenvironmentsurroundingdopingratherthanattemptingtochangeindividuals.ThepurposeoftheSTADworkistocreatealongtermdopingpreventionstrategywithinfitnessfacilitiestoeducateeachofthekeyplayersonthe

FitnessAgainstDoping–Section4–ResearchFindings 8

effectsofAASandothersubstances.Participatingfitnesscentresaregivenpracticalsupportandadvicetoprovidetheprofessionals,managers/owners,andultimatelytheenduserswithgreaterknowledgeoftheriskofdoping.Evaluationofthisapproachindicatesthatmorefacilitieshaveanti-dopingpolicies,thenumberofmembersbeingofferedAAShasfallen,andthenumberofmenstatingtheyhadusedAASinthelast30days,12monthsandintheirlifetimes,hadallfallen.SpeakingattheSportvision2012conferenceinCopenhagenonMarch20th,MariaRenström,DirectoroftheMinistryofHealthandSocialAffairssaidthatinSwedenthereareanestimated10,000AASusersfromanationalpopulationof9,300,000people(0.10%).

Anti-DopingNorwayhasrecentlydevelopedanewanti-dopingprogrammefocusedonpromotingadoping-freetrainingenvironmentthroughanemphasisonthepositivevaluesfromtrainingandphysicalactivity.“Cleancentres”identifya“clearandunambiguouscommitmenttoadopingfreetrainingenvironment”,andpromoteawarenessofthisamongmembers.Thereareinternet-basededucationprogrammesdesignedtoeducatestaffonhowtocommunicatehealthyvaluesandthephysical,mentalandsocialsideeffectsofdoping.Anti-dopingstrategiesinNorwayalsohaveanelementofmonitoringandpolicing,asfitnesscentresthatadoptedtheanti-dopingprogrammereceivealicensetocarryouttestingonmemberssuspectedofdoping,withtheconsequencesofterminatingmembershipifproofofdopingisestablished.Centressigneduptothestrategyalsoreceiveananti-dopingcertificatetobemadevisibletocentremembersinordertopromotecooperation.

RecreationalDrugUse

Despitethecurrentlackofconcisefiguresanddataavailableontheprevalenceofdopinginamateursportsandthefitnesssector,oneareainwhichconsiderableresearchhasbeenconductedonaregularbasisisin“recreationaldoping”(seetable1.1).

AgenciessuchastheEuropeanMonitoringCentre

forDrugsandDrugAddiction(EMCDDA)andTheUnitedNationsOfficeforDrugsandCrime(UNODC)providereliabledatadrawnfromrepresentativesurveysontheuseandmisuseofarangeoflegalandillegalsubstancesatnational,regionalandgloballevels,allowingforcomparativeanalysis.

TheprevalenceofrecreationaldruguseacrossEuropewasidentifiedasanareaofinterestforthepurposesofthisstudyinordertoascertainwhetherculturalandnationalattitudestowardsrecreationaldrugs,nationalpreventionstrategies,anddrugpolicyhaveanimpactontheprevalenceofdopingintheamateursportsandfitnesssectors.Itwillalsobepossibletoexaminehowconsistentnationalandlocalauthoritieshavebeenindevelopingstrategiestotackletheseparateproblemsofrecreationaldruguseanddopingineliteandamateursport.

TheEuropeanSchoolSurveyProjectonAlcoholandotherDrugs(ESPAD),acollaborativeeffortofindependentresearchteamsinEurope,formsthelargestcross-nationalresearchprojectonadolescentsubstanceuseintheworld.Trendsinrecreationaldruguseareofparticularinteresttothisstudyasyoungpeople(andinparticularyoungmales)arebelievedtobeamongthemostprevalentusersofPIEDs,includinganabolicsteroidsandstimulantsaswellasrecreationaldrugs.

Thedataaccruedalsoindicatesthegeneralprevalenceofamphetamineuse,whichareoccasionallyusedtoenhancefitnessperformancedespitethedetrimentaleffecttheyhaveonhealth,withpsychologicalandphysicaleffectssuchaseuphoria,hyper-alertness,emotionalhypersensitivitywithstressandangerknowntooccurtousers.

Finally,theestimatednumberofintravenousdrugusers(IDUs)andinfectionratesforvirusessuchasHIVandHepatitisBamongintravenousdrugusersmaybeofinterestasonemethodoftakingAASisintravenously,puttingthisgroupatsubstantialriskofinfection.

AlthoughdatacollatedbytheUNODC,ESPADandtheEMCDDAhaveledtosomeprogressinstandardisedresearchmethodsrelatingto

9 FitnessAgainstDoping–Section4–ResearchFindings

recreationaldruguseinEuropeandelsewhere,issueswithqualityanddepthofresearch,particularlyallowingforcross-nationalcomparison,stillexistastheydoforresearchintodopinginthefitnesssector.Thisisgenerallyduetoalackofco-ordinationbetweenagencies,anddifferentmethodsbeingemployedinthesurveyprocess.

• Interpretationandpresentationofdesk-basedresearchfindings

Thefindingsofthedesk-basedresearchontheanti-dopingstrategiesandpoliciesacrossEuropewerepresentedthroughoutthestudytothemanagementgroupoftheprojectpartners.Thegroupagreedthatitwasimportanttohaveanunderstandingoftheleveloftheuseofnarcotics(recreationaldrugs)ingeneralpopulationgroupssothatcomparisonscouldbemadewiththeresultsoffitnesscentreusers–whichwouldbetestedintheprimaryresearch.

Followingthedesk-basedresearch,theprojectteamproducedaseriesofinterimreportsfordiscussionandscrutinywithinthefitnesssectorandwithotherexperts.Thefindingswerepresentedatanationallevel,notablytheFIAintheUKpresentedthesetoitsleadinggroupofindustryrepresentatives.

Theresultsofthedesk-basedresearch,asoutlinedaboveanddisseminatedtothepartners,demonstratedthatwhilsttherewereevidentlypoliciesandstrategiesinplaceinsomeMemberStates,therewasalsoalackofclarityinmanycountriesastothelevelofdopingintheunorganisedsportsandfitnesssectors.Itwasthereforeimportantforthefieldresearchtocentrespecificallyonthehealthandfitnesssectortounderstandthecurrentlevelofdopingpracticewithinfitnesscentres.

4.2FieldResearchMethodology

Consultationanddesignoffieldresearchmethodology

Throughdiscussionswiththeprojectteam,thepartnernetwork,andwiththeassistanceofotherexpertpartnerorganisations,itwasdecidedthatthe

mostaccurateandrevelatorymethodtoascertainthecurrentlevelsofdopinginEuropewouldbethroughaseriesofsurveyswithinfitnesscentresaimedat:

• Consumersoffitnesscentrefacilities• Exerciseprofessionalsbasedwithinfitness

centres• Ownersandmanagersoffitnesscentres

Furthermore,unlikeotherresearchintodopingandmotivationsbehindtheuseofbannedsubstances,thesurveysinFADaskedparticipantsaboutotherhabitssuchastheiruseofrecreationaldrugsandoffoodsupplements.Italsoaskedexerciseprofessionalswhethertheythoughttherewasadopingproblemintheirworkenvironmentandwhethertheywouldbeconsidersupportingananti-dopingcampaignwiththeirownfacility.

WiththeassistanceoftheDepartmentofAnti-DopingResearchoftheInstituteofSportinPoland(aWADAAgency),HFLSportScienceintheUK(nowownedbyLGC),andLeisure-netSolutionswiththeUniversityofHertfordshire(UK),thescopeandcontentofthesurveyswereagreedbythepartners.Expectationsandtargetswereestablishedforthenumberofsurveyreturnsrequiredtogeneratestatisticallysignificantresultsandthethreesurveys(forconsumers,exerciseprofessionalsandmanagers)thendesigned.

ThecontentwasdevelopedinJune2011andtranslatedintotheninelanguagesofthepartnersandbasedontwoversions.Thefirstwasforcontrolledaccessthroughtheinternet,andthesecondinaface-to-facesetting.Importantly,eachpartneralsoengagedtheservicesofanindependentresearchcompanytooverseeobjectivityandindependence.

Threecountries–Germany,NetherlandsandtheUK–wereselectedtoundertakesomeadditionalface-to-faceinterviewingtocheckforanybiasintheresultsofthemain,web-surveywhichwascompletedinJuly–August2011.Itwasfeltthesecountrieswouldbemostappropriateduetothepartnerorganisationsdeliveringtheservice.

FitnessAgainstDoping–Section4–ResearchFindings 10

Partnerswererequiredtolocateacompanywithanestablishedtrackrecordinconsumersurveyswhocouldmakedirectapproachestoclubstoparticipateinthesurvey.Wheretherewasnotasuitable(orknown)companya“default”positionwasadopted.PartnerswereaskedtoliaisewithEHFAandtheProjectManagementGroupiftherewasanydifficultyinmakinganappointment.

Themainsurveywasconductedthroughtheinternet,andcomprisedatotalof54differentversionstocoverforlanguages,throughtheinternetandforface-to-face.Eachpartnerwasgiveninstructionsonthemethodtobeused,andtheywererequiredtousethirdpartyagenciestoensureindependenceandobjectivity.

Thepartnersagreedtoaimfor95%accuracyinthefindingsgivinga+/-5%marginoferror.Leisure-netSolutionstookadvicefromtheUniversityofHertfordshireonthenumberstobesurveyedasfollows–andtheseapplytoallpartners:

• Numberofclubs(managers) 24• Numberofconsumers 1,200• NumberExerciseprofessionals 120

Responsesrepresentativeofthefitnessindustryineachcountryweresought.Itwasalsoagreedthatwithintheconsumersurveyaminimumof400menand400womeninthetotalof1,200wouldbesurveyed.

Eachpartnerhadanallocationofgrantmoneyfortheirtotalstafftimeforthedurationoftheprojecttocoveralltimespentindeliveringtheoutcomes–thisincludesreadingdocumentation,translations,organisingtheresearch,preparingandattendingconferences,disseminationetc.

Examplesofpartnersurveymethodologiesareavailableintheappendixofthemainreport.

Throughouttheprocessofdesigningtheprimaryresearchmethodology,thepartnerorganisationswerekeptupdatedonprogressandconsultedtoensurethatthemosteffectivesurveyswereproduced.ThiswasdonethroughthepartnermeetingshostedbyEHFAandvirtually,through

internetandemailconsultation.

4.3FieldResearchFindings

Surveyreturnswerereviewedandany“spoilt”papersweredeletedfromthedatabase.Whenthemainsurveyendedon12thSeptember2011therewere:

• 8,238consumerreplies• 1,850exerciseprofessionalreplies• 261manager/ownerreplies

Atotalof10,349werereceivedwhichoverwhelminglycamefromthepartnercountries,althoughsomefurtherreplieswerereceivedfromAustria,Belgium,CzechRepublic,France,MaltaandSlovenia.Thesurveyswerekeptentirelyconfidentialwithnofurthertrackingorreportingtakingplace.Thestructureofthethreesurveysensureda360°viewwithdistinctperspectivesondopingpractices..

TheFitnessAgainstDopingsurveyforconsumersaskedquestionsaboutthelocationoftheirfitnesscentre,theirfitnessregimes,thetypeoffitnessfacilityandtheirmainreasonsforfitnesstraining.ThishelpedtoshowtheresultsweredemographicallyrepresentativeoftheEuropeanfitnesssector.Italsoaskedthemtoidentifyiftheyplayedothersports,andifsowhich.Thisprovidedcontextastopossibleenvironmentorcontextualreasonsfortheuseofdopingproducts.

Thekeyresultsofthestudy,whicharestatisticallysignificantintheirnumbersarelistedbelow.Theseshowthattheperceptionofthefitnesssectorbeingrifefortheuseofdrugsisnotsubstantiatedasonly1.23%ofrespondentsrepliedthattheyhadusedperformanceorimageenhancingproductswhichwerebannedorillegal,andafurther1.85%repliedthattheywereusingrecreationaldrugs.Thisgaveanoveralltotallof2.52%ofthosesurveyedtakingbannedandrecreationalsubstancesassomerespondentsrepliedpositivelytobothcategoriesofdruguse.ThisdemonstratesthatdopinguseisfitnessanexceptionacrossEuroperatherthanbeingcommonpractice.SetagainsttheuseofrecreationaldrugsacrossEuropebycitizens,fitnesscentreconsumerswerefoundtobelesslikelytousethem.

11 FitnessAgainstDoping–Section4–ResearchFindings

Thisdoesnothowevermeanthatthesurveydidnothighlightareaswhichneededtobeaddressedtoensurethattheprevalenceofdruguseinfitnesscentresdoesnotincrease.Indeed,itisclearthatwhilsttheuseofdrugsinfitnesscentresisnotcommonplace,thisdoesnotmeanthatthesectorshouldnotaimtoeradicatedrugusealtogetherwithinfitnesscentres.

4.3.1Consumers

ThefollowingtablesshowsomeofthemainresultsreceivedtothequestionsposedbytheFitnessAgainstDopingSurveys(thequestionnairescanbefoundintheappendix).

22.31%

54.38%

17.31%

6.00%

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

15-24 25-49 50-64 64+

Age Range

%

58.01%

41.99%

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

Female Male

Gender

%

4.90%

32.89%

15.97%

26.89%

19.35%

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

35.00%

Basic Higher Educa�on

Degree

Post-Graduate / Doctoral

Post-Secondary Voca�onal

Educa�on Level

%

42.42%

49.40%

8.17%

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

Large 60+ items equipment Medium 26 - 60 equipment Small 10-25 equipment

Size of Fitness Centre

%

25.71%

17.45% 16.71%

6.32%

34.91%

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

35.00%

40.00%

1 – 3 years 3 – 6 years 6 - 12 months Less than 6 months

More than 6 years

How Long Using a Fitness Centre

%

• 27.70%ofcustomersreportedusingafoodsupplement.Thisincludedelectrolytedrinksandtheirusewasthemostpopularofallsupplementsasanaidtorehydration.Toputthisintocontext,inoralrehydrationtherapy,electrolytedrinkscontainingsodiumandpotassiumsaltsreplenishthebody’swaterandelectrolytelevelsafterdehydrationcausedbyexercise.Athletesexercisinginextremeconditions(forthreeormorehourscontinuouslye.g.marathonortriathlon)whodonotconsumeelectrolytesriskdehydration(orhypernatremia).

FitnessAgainstDoping–Section4–ResearchFindings 12

28.37%

46.73%

37.66%

43.80%

0.00%5.00%

10.00%15.00%20.00%25.00%30.00%35.00%40.00%45.00%50.00%

To help reduce weight

To help rehydrate To improve endurance

To increase muscle

Why Use Food Supplements

%

• Anoverall2.52%(208peopleintotal)ofallrespondentsrepliedthattheyuseperformanceandimage-enhancingsubstances(bannedsubstancesandrecreationaldrugs).

33.17%

16.83%19.23%

11.54%

7.21%

32.69% 32.21%

6.73% 5.77%

19.23%

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

35.00%

Which Enhancing Substances by Posi ve Respondents

%

• InthemorenorthernEuropeancountriesthisfellevenlower(DK2.10%,NL1.81%andUK1.61%).InHungary,BulgariaandPortugaltheirindividualresultswere9.13%,12.6%and4.2%respectivelyasthehighestusers.

37.67%33.80%

41.00%

12.47%8.59%

20.50%

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

35.00%

40.00%

45.00%

To lose weight

To improve your physical

condi�on

To increase muscle

growth and body shape

To achieve a par�cular

goal

To aid faster healing of an

injury

To extend period of

�me to spend on training

Why Use Enhancing Substance by Posi�ve Respondents

%

• Respondentscouldidentifyanumberofsubstances,andthemostpopularwereanabolicsteroids,stimulantssuchasamphetaminesand

“othersubstances”suchasdiuretics–almostinequalmeasure.

• Maleusersoffitnesscentresaremuchmorelikelytotakebannedsubstancesandrecreationaldrugsthanwomenparticipants.

88.41% 91.43% 92.50%

83.33% 86.67%

11.5

9%

8.57

%

7.50

% 16.6

7%

13.3

3%

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

100.00%

Anabolic Steroids Prohormone Substances Reducing Side

Effects

Growth Hormones

Insulin (When Non-Diabe�c)

Which Enhancing Substances by Posi ve Respondents

Male

Female

• Theage“peak”fortheuseofsubstancesisthegroupof25-49yearoldsandnotthe15-24groupwhichhasbecomethe“target”insomepreviousresearch.

31.8

8%

34.2

9%

27.5

0%

16.6

7%

33.3

3%

59.4

2%

51.4

3% 60.0

0%

79.1

7%

53.3

3%

5.80

%

5.71

%

7.50

%

0.00

% 6.67

%

2.90

%

8.57

%

5.00

%

4.17

%

6.67

%

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

Anabolic Steroids

Prohormone Substances Reducing Side

Effects

Growth Hormones

Insulin (When Non-Diabe�c)

Which Enhancing Substances by Posi ve Respondents

15-24

25-49

50-64

64+

• TheuseofrecreationaldrugsbyfitnesscustomersisverymuchlowerthanthegeneralpopulationstatisticsofusagetakenfromtheEuropeanMonitoringCentreforDrugsandDrugAddiction.

• 37.16%ofrespondentsreportedthattheyplayedanothersport,andofthe208respondentsreportingthattheytakeaperformance-enhancingsubstance41.82%ofthemwereinthisgroupwhoplayanothersport.Thisstartstoindicateapossiblelinkthattoimproveanindividual’samateur

13 FitnessAgainstDoping–Section4–ResearchFindings

sportperformanceandcompetitivenessthatfitnesscentresareusedfortheirstrengthandconditioningtraining.

22.99% 28.74%

14.94%

11.49% 18.39%

2.30

%

18.39%

11.49%

0.00

%

1.15

%

0.00

%

0.00

%

0.00

%

0.00%5.00%10.00%15.00%20.00%25.00%30.00%35.00%

Which Sports - Those Taking Substances

%

• Thebelowtableshowsthemotivationsofthe41.82%orrespondentswhosaidtheytooksubstancesandwhoalsoplayedadifferentsport.Thisfurtherreinforcesthelinkbetweenthedesiretoimproveperformanceinanothersportandtheprevalenceofdopinginfitnessfacilities.

28.57%

36.90%40.48%

15.48% 15.48%

26.19%

0.00%5.00%

10.00%15.00%20.00%25.00%30.00%35.00%40.00%45.00%

To Lose Weight

To Improve Your

Physical Condi­on

To Increase Muscle

Growth And Body Shape

To Achieve A Par­cular

Goal

To Aid Faster

Healing Of An Injury

To Extend Period Of Time You

Can Spend On Training

Reason for Taking Substances

%

4.3.2ExerciseProfessionals

• Thereisawarenessthatsubstancescanimproveperformanceandachievements,butamajorityofclientsdonotaskforadviceandabigmajorityofexerciseprofessionalswouldnotgiveadvice.

59.71%

22.85%

12.32%4.00% 1.14%

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

Totally agree Agree Don't know Don't think so Definitely not

Should Enhancing Substances Be Banned (all respondents)

%

19.59%

9.44% 8.14%

26.32%

36.52%

0.00%5.00%

10.00%15.00%20.00%25.00%30.00%35.00%40.00%

Hard to say No, definitely not

Rather not Yes Yes, they definitely do

Do You Think That Substances Improve Achievements

%

• Thereisawarenessofsomedopingactivityinfitnesscentresfollowingthesamepatternofconsumerresults,thehighestlevelsreportedwereinHungary,BulgariaandPortugal.

9.84%

47.91%

13.49%

23.49%

5.27%

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

Hard to say Never Rather Not Yes, occasionally Yes, o�en

Have You No�ced Substance Use

%

2.44%

9.17%

24.42%

30.17%33.80%

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

35.00%

40.00%

Very O�en O�en Somemes Rarely Never

How O�en Do Clients Ask Your Advice On Substances

%

• Despiteawarenessthatdopingcanimproveperformanceonlyjustover3%ofexerciseprofessionalsreportedthattheytookanyformofsubstancethemselves.

FitnessAgainstDoping–Section4–ResearchFindings 14

1.35%

0.56%

0.90%

0.17%0.06%

1.07%1.18%

0.11%

0.39%0.28%

0.00%

0.20%

0.40%

0.60%

0.80%

1.00%

1.20%

1.40%

1.60%

Do You Use Any Enhancing Substances

%

• Asubstantialmajority(81.82%)wouldbepreparedtosupportananti-dopingcampaign.

71.92%

24.61%

3.48%

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

Yes, definitely Perhaps Definitely not

Are You Prepared To Support A Campaign On An�-Doping

%

4.3.3 Managers/Owners

• 27%reportedthattheywereawareoftheuseofperformanceenhancingsubstanceswhichwasconsistentwiththereportingfromexerciseprofessionals.

54.14%

30.08%

10.53%

3.01% 2.26%0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

1 Very low or none

2 Low 3 Don’t know 4 High 5 Very high

How Wide Spread Is Their Use

%

• 69%sellfoodsupplementsattheirfitnesscentre,andamajoritychecktoseeiftherearecertifiedtobeclearofbannedsubstances,butasignificantminorityofmorethan12%wereunawareordidnotcheck.34%ofconsumerspurchasetheirfoodsupplementsattheirfitnesscentreandthesamepercentagethroughtheinternet.

69.31%

30.69%

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

Yes No

Do You Sell Food Supplements

%

• Justoverhalfoftherespondentssaidtheyalreadyoperatedananti-dopingpolicywiththehighestinDenmarkandtheNetherlandsandthelowestinGermany,Hungary,SwitzerlandandtheUK.

67.68%

16.16%12.46%

2.36% 1.35%0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

Yes, definitely Yes Hard to say No No, definitely not

Are Enhancing Substances A Threat To Health

%

87.74%

12.26%

0.00%

20.00%

40.00%

60.00%

80.00%

100.00%

Yes No

Check To See If Supplements Are Cer�fied Clear Of Banned Substances

%

• Asubstantialmajority(over80%)reportedthattheywouldbepreparedtosupportananti-dopingcampaign,buttherewaslessclarityonwhetherdirectanti-dopingtestinginfitnesscentreswouldbeagoodthing.

8.70%

15.72%19.40%

23.75%

32.44%

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

35.00%

Definitely no I would prefer not to

I do not have an opinion

I would not mind This would be a good thing*

Would You Allow An An�-Doping Official/Officer Into Your Site

%

15 FitnessAgainstDoping–Section4–ResearchFindings

References

1Retsinformation,retsinformation.dk(1999),‘Lovomforbudmodvissedopingmidler,Lovnr.232af21.April1999’,(Lawonthebamofcertaindopingdrugs,Lawno.232of21April1999).2A.VChristiansen,‘Bodilyviolations:Testingcitizenstrainingrecreationallyingyms’,Doping,20103Anti-DopingDenmark,2009,http://www.steroids.dk/da/Dopingkontrol/Kontrolstatistik.aspx[accessed17.5.11]4PreparatoryActionintheFieldofSportprojecthttp://www.antidoping.dk/da/Aktuelt/2012/3/~/media/antidoping_dk/filer/Undersoegelser/Strategy_for_Stopping_Steroids_Report_WEB.ashx5Krausetal,‘KurzberichtEpiemiologischerSuchtsurvey:Tabellenband:TrendsderPravlenzdeskonsumsillegalerDrogennachAlter1980-2009’,[accessedonline26.5.11]http://www.ift.de/index.php?id=4106Frankeetal,‘Non-medicaluseofprescriptionstimulantsandillicituseofstimulantsforcognitiveenhancementinpupilsandstudentsinGermany’2011,inPharmacopsychiatry44:60-6.7P.Simonetal,‘DopingimFitness-Sport:EineAnalysezwischenDunkelfeldundsozialerKontrolle.,2008,Baden-Baden,Nomos2008.8Productsarelistedonthewebsitehttp://www.koelnerliste.com.9J.SBaker,M.RGraham,B.Davies,‘Steroidandprescriptionmedicineabuseinthehealthandfitnesscommunity:Aregionalstudy’2006,EuropeanJournalofInternalMedicine17,479-484.10D.J.Hall&C.Judkins,‘SupplementsandBannedSubstanceContamination:Offeringaninformedchoice”HFLSportScience,201011P.Korkia&G.VStimson,‘AnabolicSteroidUseinGreatBritain:anExploratoryInvestigation’,1993,London:TheCentreforResearchonDrugsandHealthBehaviour.12AnabolicSteroids,2011,http://anabolicsteroidsuk.net/[accessed18.5.11]13TheFitnessIndustryAssociation(FIA),RegisterofExerciseProfessionals(REPS)&TheInstituteofSportsandRecreationalManagement(ISRM),Health&FitnessIndustryGuidanceNote,“Managinguserswithsuspectedhealthproblems:steroidabuse”14HealthCounciloftheNetherlands.Dopinginunorganisedsports.TheHague:HealthCounciloftheNetherlands,2010;publicationno2010/03.15Stubbeetal.Performance-enhancingdrugsbyathletesvisitingDutchfitnesscentres.Dopingautoriteit/TNO,Capellea/dIJssel,2009.16Rodenburgetal.NationaalPrevalentieOnderzoekMiddelengebruik2005.IVO,Rotterdam,2007.17J.AKnottnerus,PresentationofadvisoryreportDopinginunorganisedsports,HealthCounciloftheNetherlands,April132010.18See(http://antidoping.nl/nzvt/zvt)19STAD,StockholmPreventsAlcoholandDrugProblemshttp://stad.org/en/

FitnessAgainstDoping–Section4–ResearchFindings 16

The Project Partners:

AGAP-Portugal(PortugueseFitnessAsociación)www.agap.pt

BAHF-Bulgaria(BulgarianAssociationofHealthandFitness)www.bahf.bg

DFHO-Denmark(DanishFitnessandHealthOrganisation)www.dfh o.dk

DSSV-Germany(GermanFitnessAssociation)www.dssv.de

DADR-Poland(DepartmentofAnti-DopingResearchofInstituteofSport)www.insp.waw.pl

FIA-UK(FitnessIndustryAssociation)www.fia.org.uk

Fit!vak-Netherlands(DutchFitnessAssociation)www.fitvak.com

HCA&ICCE-Hungary(HungarianCoachingAssociationandInternationalCouncilforCoachEducation)www.magyaredzo.hu&www.icce.ws

ISCA-Denmark(InternationalSportandCultureAssociation)www.isca-web.org

QualiCert-Switzerland(SwissQualityAssuranceCompany)www.qualicert.ch

TheFitnessAgainstDopingProjectisgrant-aidedbytheEuropeanCommission