Alcohol in Sport

Chapter 30
Alcohol in Sport
LOUISE M. BURKE AND RONALD J. MAUGHAN
Introduction
Ancient civilizations dating back to thousands of
years bc recorded the intake of drinks containing
alcohol (or, more correctly, ethanol) as part of
social rituals. One practice which has persisted,
even throughout the last decades, is the intake of
alcohol before or during sport in the belief that
it might improve performance (for review,
see Williams 1991). Today, the major strong link
between sport and alcohol is through sponsorship and advertising, with many sporting
organizations, leagues, teams and events being
financed by beer and liquor brewing companies.
While a small number of athletes may still
consume alcohol specifically to attempt to
improve their sports performance, the
overwhelming majority of athletes who drink
alcohol, do so for social reasons. However, this is
often in the context of rituals that are part of the
culture of their sport. The aim of this chapter is to
overview the effect of alcohol on sports performance, particularly related to the typical patterns of consumption by athletes, and to provide
some guidelines for sensible use of alcohol by
sports people.
Alcohol use by athletes
Typically, alcohol intake provides less than 5% of
the total energy intake of adults, although recent
UK data suggest that alcohol accounted on
average for 6.9% of the total energy intake of men
aged between 18 and 64 years (Gregory et al.
1990); the corresponding value for women was
2.8%. Since the contribution to total energy
intake is regarded as minor, it is often excluded
from the results of dietary surveys of athletes.
Furthermore, while the general limitations of
dietary survey methodology are acknowledged,
it is likely that self-reported data on alcohol
intake are particularly flawed. For example,
people are unlikely to report accurately and reliably about their consumption of a nutrient or
food that is regarded so emotively; there is potential for both significant under-reporting and
over-reporting. These factors help to explain the
lack of reliable data on the alcohol intakes and
drinking practices of athletes. It is also important
to note that, because many people abstain completely from alcohol, the data are skewed, and
mean values may be misleading: in the survey of
Gregory et al. (1990) quoted above, for example,
men and women who were alcohol drinkers
obtained an average of 8.7% and 4.3%, respectively, of total energy from alcohol.
There are clearly gender-related differences in
consumption patterns, but age, socio-economic
background, and geographical location also
influence drinking habits. It is not clear whether
the consumption patterns of athletes are greatly
different from those of the non-athletic population. In general, though, dietary surveys of
athletes which include alcohol suggest that it
contributes 0–5% of total energy intake in the
everyday diet. However, there is evidence that
this provides a misleading view of the alcohol
intakes of athletes. For example, in a dietary
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nutrition and exercise
survey of 45 professional football players from
the leading team in the national Australian Rules
Football League, mean daily alcohol intake was
estimated to be 20 g, accounting for 3.5% of total
energy intake (Burke & Read 1988). However,
these players rarely drank alcohol during the
training week, in accordance with the club policy,
and instead confined their intake to weekends,
particularly after the weekly football match.
Closer examination of the football data revealed
that the mean intake of alcohol immediately after
the match was 120 g (range, 27–368 g), with
alcohol providing a mean contribution of 19% of
total energy intake on match day (range, 3–43%
of total energy intake).
Such ‘binge’ drinking practices were confirmed in a separate study in these same subjects.
Blood samples were taken from 41 players
who attended a 9.00 a.m. training session on the
morning following a weekend match. Fourteen
of these players still registered a positive
blood alcohol content (BAC) from their previous
evening’s intake, with levels ranging from 0.001
to 0.113 g · 100 ml–1. Blood alcohol content in four
players exceeded the legal limit for driving a
motor vehicle (0.05 g · 100 ml–1). The lay press
provides ample anecdotal evidence of binge
drinking patterns of some athletes, particularly
in the immediate celebration or commiseration
of their competition performances, or in the offseason. In some cases these episodes are romanticized and the drinking prowess of the athletes is
admired.
Whether total alcohol intake, or the prevalence
of episodes of heavy alcohol intake, by athletes
is different from that of the general population
remains unclear. Surveys which have examined
this issue report conflicting results. Various
hypotheses have been proposed to explain likely
associations between sport and alcohol use. It
has been suggested that athletes might have a
lower intake due to increased self-esteem, a more
rigid lifestyle and greater interest in their health
and performance. Equally, alcohol has been associated with the rituals of relaxation and celebration in sport, and it has been suggested that
athletes might be socialized into certain behav-
iours and attitudes to drinking as a result of their
sports participation.
Several dietary surveys comparing different
groups of athletes have reported that the mean
daily alcohol intakes of team sport athletes
are significantly greater than those of athletes
involved in endurance and strength sports (van
Erp-Baart et al. 1989; Burke et al. 1991). While
these studies were not specifically designed to
collect data on alcohol intake, the findings are
supported by data collected in some population
surveys on alcohol use. Watten (1995), in a
national survey of Norwegian adults, reported
that men and women involved in team sports
reported a higher intake of alcohol, particularly
beer and liquor, than those involved in individual sports or those with no sports involvement.
However, some of these differences were
explained by the age and educational backgrounds of subjects. O’Brien (1993) reported difference between sports in alcohol use by elite
Irish athletes, but the overall intake of this group
was exceptionally low, at an average of 0.5% of
total energy intake.
Clearly, while there is anecdotal evidence to
suggest that some athletes may consume alcohol
in excessive amounts, on at least some occasions,
further studies are needed to fully determine the
alcohol intake and patterns of use by athletes.
Information on the attitudes and beliefs of
athletes about alcohol is also desirable, since
it would allow education about current drinking practices which are detrimental to the
athlete’s performance or health to be specifically
targeted.
Metabolism of alcohol
The metabolism of ethanol occurs primarily in
the liver, where it is oxidized, first to acetaldehyde, and then to acetate. The first step is
catalysed by a number of hepatic enzymes, the
most important of which is the nicotinamide
adenine dinucleotide (NAD)-dependent alcohol
dehydrogenase:
CH3CH2OH + NAD+ Æ CH3CHO + NADH + H+
a lco h o l i n spo rt
407
Aldehyde dehydrogenase catalyses the further
oxidation of acetaldehyde to acetate:
Table 30.1 A standard drink contains approximately
10 g of alcohol.
CH3CHO + NADH+ + H2O Æ CH3COO–
+ NADH + 2H+
Drink
Amount (ml)
Standard beer (4% alcohol)
Low alcohol beer (2% alcohol)
Cider, wine coolers, alcoholic soft
drinks
Wine
Champagne
Fortified wines, sherry, port
Spirits
250
500
250
The NADH which is formed in these reactions
must be reoxidized within the mitochondria, but
transfer of the hydrogen atoms into the mitochondria might be a limiting process leading to
an alteration in the redox potential of the cell.
This can interfere with the conversion of lactate
to pyruvate, and explains the increased blood
lactate concentration that may be observed after
high alcohol intakes.
Acetaldehyde is metabolized within the liver,
and the acetaldehyde concentration in the
blood remains low, but it is acetaldehyde that
is thought to be responsible for many of the
adverse effects of ethanol. The rate of hepatic
gluconeogenesis is markedly suppressed by the
metabolism of ethanol as a result of the altered
NAD/NADH ratio and the reduced availability
of pyruvate (Krebs et al. 1969). If the liver glycogen stores are low because of a combination of
exercise and a low carbohydrate intake, the liver
will be unable to maintain the circulating glucose
concentration, leading to hypoglycaemia. The
rate at which ethanol is cleared by the liver varies
widely between individuals, and the response
of the individual will depend on the amount of
ethanol consumed in relation to the habitual
intake. It is not altogether clear whether the rate
of metabolism of alcohol is increased by exercise,
and there are conflicting data in the literature
(Januszewski & Klimek 1974). Table 30.1 indicates the amount of alcohol contained in some
standard measures.
Effects of acute alcohol ingestion
on exercise
The variety of effects of alcohol on different body
tissues, and the variability of subject responses
to alcohol, make it difficult to study the direct
effects on sports performance. Generally, the
ergogenic benefits of alcohol intake immediately
before and during exercise are psychologically
100
100
60
30
driven. Alcohol has been used to decrease sensitivity to pain, improve confidence, and to
remove other psychological barriers to performance. However, it may also be used to stimulate
the cardiovascular system, or to lessen the tremor
and stress-induced emotional arousal in fine
motor control sports. Although it is no longer on
the general doping list of the IOC, it is still considered a banned substance in some sports, such
as shooting and fencing. In some sports, such as
darts and billiards, it is still popularly used as a
(proposed) performance aid, but it remains to be
seen whether this simply reflects the culture of
sports that are widely played in a hotel environment (for review, see Williams 1991).
Exercise metabolism and performance
The American College of Sports Medicine (1982),
and a more recent review by Williams (1991),
have summarized the acute effects of alcohol
ingestion on metabolism and performance of
exercise. Alcohol does not contribute significantly to energy stores used for exercise, but in
situations of prolonged exercise it may increase
the risk of hypoglycaemia due to a suppression
of hepatic gluconeogenesis. Increased heat loss
may be associated with this hypoglycaemia as
well as the cutaneous vasodilation caused by
exercise, causing an impairment of temperature
regulation in cold environments. Studies of the
effects of alcohol on cardiovascular, respiratory
and muscular function have provided conflicting
results, but ingestion of small amounts of alcohol
408
nutrition and exercise
has been reported not to significantly alter the
cardiorespiratory and metabolic responses to
submaximal exercise (Bond et al. 1983; Mangum
et al. 1986). Dose–response relationships, interand intrasubject variability, and difficulty with
providing a suitable placebo may all help to
explain the difficulty of conducting and interpreting alcohol studies. In general it has been
concluded that the acute ingestion of alcohol has
no beneficial effects on aspects of muscle function and performance tasks: because it may
actually produce detrimental responses, it is best
avoided.
The few studies of acute alcohol ingestion and
actual sports performance show variability in
results and responses. For example, Houmard
and others (1987) reported that the ingestion of
small amounts of alcohol (keeping BAC below
0.05 g · 100 ml–1) did not have a significant effect
on the performance of a 8-km treadmill time
trial, although there was a trend towards performance deterioration at higher blood alcohol
levels. Meanwhile, McNaughton and Preece
(1986) tested the performance of runners over
various distances ranging from 100 to 1500 m,
at four different levels of alcohol consumption
(BAC estimated at 0–0.1 g · 100 ml–1). Alcohol
intake did not affect performance of 100-m times
in sprinters, but reduced performance over 200
and 400 m as alcohol intake increased. Middledistance runners showed impaired performance
in 800 and 1500 m run times, with these effects
also being dose-related. An earlier study by
Hebbelinck (1963) showed no effect of alcohol
(0.6 ml of 94% ethanol · kg–1 body mass) on isometric strength, but a 6% reduction in vertical
jump height and a 10% decrease in performance
in an 80-m sprint.
Motor control and skill performance
There is a limited amount of information available on the effects of acute ingestion of alcohol
on motor control and the performance of skilled
tasks. It is, however, clear from the controlled
studies that have been conducted that alcohol
has an adverse effect on tasks where concen-
tration, visual perception, reaction time, and coordination are involved (Williams 1995). In many
of the earlier studies that showed a detrimental
effect of even small doses of alcohol on components of athletic performance, the performance
measures were not well standardized and
the results are difficult to interpret. Hebbelinck
(1963), however, showed that posture control
deteriorated after alcohol ingestion, with both
the extent and frequency of sway being
markedly increased: this represents a mild
version of the unsteadiness and ataxia that is
apparent after higher levels of alcohol intake.
In 1982, the American College of Sports Medicine published a Position Statement on the use of
alcohol in sports, and this included a review of
the research to date on the effects of alcohol on
performance: this literature was also reviewed
by Williams (1985). The available evidence
showed a detrimental effect of small to moderate
amounts of alcohol on reaction time, hand–eye
co-ordination, accuracy, balance and complex
skilled tasks, with no evidence cited to support
the purported beneficial effects of reduced
tremor. It has, however, been proposed that the
ingestion of small amounts of alcohol may result
in a greater feeling of self-confidence in athletes
(Shephard 1972), and this may, in turn, improve
performance in some situations. The interference
of alcohol with the judgement and skill involved
in the fine motor skills required for driving
accounts for the legislation to prevent individuals who have been drinking from driving
automobiles.
Effects of acute alcohol ingestion on
postexercise recovery
There is evidence that the postcompetition situation is often associated with alcohol intake and
binge drinking, and it is likely that social rituals
after training or practice sessions in some sports
(particularly in lower level competitions) may
also involve moderate to heavy intake of alcohol.
Given that athletes may be dehydrated and
have eaten little on the day of competition, it is
likely that alcohol consumed after exercise is
a lco h o l i n spo rt
more quickly absorbed and has increased effects.
Therefore it is important to examine the effects
of alcohol on processes that are important in
the recovery from prolonged exercise, and on
the performance of subsequent exercise bouts.
Unfortunately, postexercise drinking is subject to
many rationalizations and justifications by athletes, including ‘everyone is doing it’, ‘I only
drink once a week’ and ‘I can run/sauna it off the
next morning’.
Rehydration
The restoration of the body fluid deficit incurred
during exercise is a balance between the amount
of fluid that athletes can be induced to drink
after exercise, and their ongoing fluid losses. The
palatability of postexercise fluids is an important
factor in determining total fluid intake, while
replacement of sodium losses is a major determinant of the success in retaining this fluid (see
Chapter 19). It has been suggested that beer is
a valuable postexercise beverage since large
volumes can be voluntarily consumed by some
athletes! However, the absence of an appreciable
sodium content (unless it is accompanied by the
intake of salty foods), and the diuretic action
of alcohol are factors that are likely to promote increased urine losses. A recent study
(Shirreffs & Maughan 1997) examined the effect
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of alcohol on postexercise rehydration from an
exercise task which dehydrated subjects by 2% of
body mass. Subjects replaced 150% of the volume
of their fluid deficits with drinks containing 0%,
1%, 2% or 4% alcohol within 90 min of finishing
the exercise. The total volume of urine produced
during the 6 h of recovery was positively related
to the alcohol content of the fluid. However, only
in the 4% alcohol drink trial did the difference in
total urine approach significance, with a net
retention of 40% of ingested fluid compared with
59% in the no-alcohol trial, equating to a difference of about 500 ml in urine losses. Subjects
were still dehydrated at the end of the recovery
period with the 4% alcohol drink, despite having
consumed 1.5 times the volume of their fluid
deficit (Fig. 30.1). Although individual variability must be taken into account, this study suggests that the intake of significant amounts of
alcohol will impede rehydration. It also indicated that beer is not a suitable rehydration
drink, even in the low alcohol forms that are
available, because of the low content of electrolytes, particularly sodium (Maughan &
Shirreffs 1997).
In practical terms, low alcohol beers (< 2%
alcohol) or beer ‘shandies’ (beer mixed in equal
proportions with lemonade, thus diluting the
alcohol content and providing some carbohydrate) may not be detrimental to rehydration.
1000
Fig. 30.1 Whole-body water
balance after exercise- induced
dehydration followed by
ingestion of a volume equal to 1.5
times the sweat loss of fluids
containing alcohol at
concentrations of 0% (䊐), 1% (䊏),
2% (䊊) and 4% (䉭). There is
clearly an increasing urine output
in the postingestion period as the
alcohol concentration increases.
Adapted from Shirreffs and
Maughan (1997).
Net fluid balance (ml)
500
0
–500
–1000
–1500
–2000
PrePostexercise exercise
0
1
2
3
Time after rehydration (h)
4
5
6
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nutrition and exercise
Furthermore, notwithstanding other effects of
small to moderate amounts of alcohol, these
drinks might be useful in encouraging large fluid
intakes in dehydrated athletes. However, drinks
with more a concentrated alcohol content are not
advised, since the combination of a smaller fluid
volume and a greater alcohol intake will reduce
the rate of effective fluid replacement. Nevertheless, when aggressive rehydration is required,
the planned intake of fluids containing sodium,
or fluid intake in conjunction with sodiumrich foods, provides a more reliable strategy to
replace fluid losses (see Chapter 19).
Glycogen storage
Since alcohol has a number of effects on the intermediary metabolism of carbohydrate, it is possible that postexercise intake might impair the
restoration of depleted glycogen stores. In the
absence of carbohydrate intake, alcohol intake is
known to impair the carbohydrate status of the
liver by inhibiting hepatic gluconeogenesis and
increasing liver glycogenolysis. Alcohol intake
has been reported to impair muscle glycogen
storage in rats following depletion by fasting or
exercise (for review, see Palmer et al. 1991). The
effect of alcohol intake on muscle glycogen
storage in humans was recently studied by Burke
and co-workers (in press), who undertook two
separate studies to examine refuelling over 8 h
and 24 h of recovery from a prolonged cycling
bout.
In these studies, athletes undertook three different diets following their glycogen-deleting
exercise: a control (high carbohydrate) diet, an
alcohol displacement diet (kept isoenergetic with
the control diet by reducing the carbohydrate
intake) and an alcohol + carbohydrate diet
(alcohol added to the control diet). In the two
diets containing alcohol, the athletes were
required to consume 1.5 g alcohol · kg–1 body
mass of alcohol in the 3 h immediately after exercise (e.g. ª 100 g alcohol or 10 standard drinks).
Muscle glycogen storage was significantly
reduced on the alcohol displacement diets in
both the 8 h and 24 h study compared with the
high carbohydrate diets. There was a trend
towards a reduction in glycogen storage over 8 h
of recovery with alcohol + carbohydrate diet;
however, glycogen storage on the alcohol + carbohydrate diet on the 24-h study was identical to
the control diet. Therefore, there was no clear evidence of a direct impairment of muscle glycogen
storage by alcohol when adequate substrate was
provided to the muscle; however, this may have
been masked by intersubject variability.
The results of these studies suggest that the
major effect of alcohol intake on postexercise
refuelling is indirect, that high intakes of alcohol
are likely to prevent the athlete from consuming adequate carbohydrate intake to optimize
muscle glycogen storage. In general, athletes
who participate in alcoholic binges are unlikely
to eat adequate food or make suitable highcarbohydrate food choices. Furthermore, food
intake over the next day may also be affected as
the athletes ‘sleep off their hangover’. Further
studies are needed to determine the direct effect
of alcohol on muscle glycogen storage.
Other effects
Alcohol is known to exert other effects which
may impede postexercise recovery. Many sporting activities are associated with muscle damage
and soft tissue injuries, either as a direct consequence of the exercise, as a result of accidents, or
due to the tackling and collisions involved in
contact sports. Standard medical practice is to
treat soft tissue injuries with vasoconstrictive
techniques (e.g. rest, ice, compression, elevation).
Since alcohol is a potent vasodilator of cutaneous
blood vessels, it has been suggested that the
intake of large amounts of alcohol might cause
or increase undesirable swelling around damaged sites, and might impede repair processes.
Although this effect has not been systematically
studied, there are case histories that report these
findings. Until such studies are undertaken, it
seems prudent that players who have suffered
considerable muscle damage and soft tissue
injuries should avoid alcohol in the immediate
recovery phase (e.g. for 24 h after the event).
a lco h o l i n spo rt
Another likely effect of cutaneous vasodilation
following alcohol intake is an increase in heat
loss from the skin. This may be exacerbated by
hypoglycaemia, which results from the combined effects of carbohydrate depletion and
impaired liver gluconeogenesis. Therefore, athletes who consume large quantities of alcohol
in cold environments may incur problems
with thermoregulation. An increased risk of
hypothermia may be found in sports or recreational activities undertaken in cold weather,
particularly hiking or skiing, where alcohol
intake is an integral part of après-ski activities.
As in the case of postexercise refuelling, it is
likely that the major effect of excessive alcohol
intake comes from the athlete’s failure to follow
guidelines for optimal recovery. The intoxicated
athlete may fail to undertake sensible injury
management practices or to report for treatment;
they may fail to seek suitable clothing or shelter
in cold conditions or to notice early signs of
hypothermia. While studies which measure the
direct effect of alcohol on thermoregulation and
soft tissue damage are encouraged, these effects
are likely to be minor or at least additive to the
failure to undertake recommended recovery
practices.
Accidents and high-risk behaviour
The most important effect of alcohol is the
impairment of judgement. Coupled with a
reduced inhibition, it is easy to see how intoxicated athletes might undertake high-risk behaviour and suffer an increased risk of accidents.
Alcohol consumption is highly correlated with
accidents of drowning, spinal injury and other
problems in recreational water activities (see
O’Brien 1993), and is a major factor in road accidents. The lay press frequently contains reports
of well-known athletes being caught driving
while severely intoxicated, or being involved in
brawls or other situations of domestic or public
violence. There have been a disturbing number
of deaths of elite athletes in motor car accidents
following excess alcohol intake. Clearly, athletes
are not immune to the social and behavioural
411
problems following excess alcohol intake; there
is some discussion that certain athletes may be
more predisposed (see O’Brien 1993). Further
studies are required before it can be determined
whether athletes, or some groups of athletes,
are more likely to drink excessively or suffer a
greater risk of alcohol-related problems. However, it appears that athletes should at least be
included in population education programmes
related to drink-driving and other high-risk
behaviour.
Effect of previous day’s intake (i.e. ‘hangover’)
on performance
Some athletes will be required to train (or even
compete again) on the day after a competition
and its postevent drinking binge. In some cases,
athletes may choose to drink heavily the night
before a competition, as a general part of their
social activities, or in the belief that this will help
to ‘relax’ them prior to the event. The effect of an
‘alcohol hangover’ on performance is widely discussed by athletes, but has not been well studied.
Karvinen and coworkers (1962) used a crossover
design to examine ‘next day’ performance following the consumption of large amounts of
alcohol (approximately eight standard drinks),
and reported that a hangover did not impair
power or strength, but impaired the ability
to undertake a bout of high-intensity cycling.
O’Brien (1993) undertook ‘aerobic’ and ‘anaerobic’ testing of a team of Rugby Union players on a
Friday night, and then requested them to return
for repeat testing the next day after consuming
their ‘typical Friday night’s alcohol intake’. A
standardized sleep time and breakfast were fol.
lowed. He reported that VO2max. was significantly
reduced the following day, and that any level of
alcohol intake appeared to impair this measure
of aerobic capacity. However, since no control
trial was undertaken, it is hard to dissociate the
effects of alcohol from the effects and variability
of repeated testing. Meanwhile it is interesting to
note that the mean alcohol intake reported by
players as typical of their prematch activities was
approximately 130 g (range, 1–38 units).
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nutrition and exercise
Research in other areas of industrial work (e.g.
machine handling and flying) suggests that
impairment of psychomotor skills may continue
during the hangover phase. Clearly this will be of
detriment in team sports and court sports which
demand tactical play and a high skill level.
Effects of chronic alcohol intake on
issues of sports performance
Athletes who chronically consume large
amounts of alcohol are liable to the large number of health and social problems associated
with problem drinking. Early problems to have
impact on sports performance include inadequate nutrition and generally poor lifestyle (e.g.
inadequate rest). Since alcohol is an energydense nutrient (providing 27 kJ · g–1), frequent
episodes of heavy alcohol intake are generally
accompanied by weight gain. Weekend binge
drinkers tend to maintain their food consumption, since alcohol does not seem to regulate total
energy intake in the short term. However, erratic
eating patterns and choice of high fat foods can
lead to excess energy consumption. A common
issue, particularly in team sports, is the significant gain in body fat during the off-season due
to increased alcohol intake coupled with
reduced exercise expenditure. Many players
need to devote a significant part of their preseason (and even early season) conditioning to
reversing the effects of their off-season activities.
Clearly this is a disadvantage to performance
and to the longevity of a sports career.
Guidelines for sensible use of alcohol
by athletes
The following guidelines are suggested to
promote sensible use of alcohol by athletes.
1 Alcohol is not an essential component of a
diet. It is a personal choice of the athlete whether
to consume alcohol at all. However, there is no
evidence of impairments to health and performance when alcohol is used sensibly.
2 The athlete should be guided by community
guidelines which suggest general intakes of
alcohol that are ‘safe and healthy’. This varies
from country to country, but in general, it is suggested that mean daily alcohol intake should
be less than 40–50 g (perhaps 20–30 g · day–1 for
females), and that ‘binge’ drinking is discouraged. Since individual tolerance to alcohol is
variable, it is difficult to set a precise definition of
‘heavy’ intake or an alcohol ‘binge’. However,
intakes of about 80–100 g at a single sitting are
likely to constitute a heavy intake for most
people.
3 Alcohol is a high-energy (and nutrient-poor)
food and should be restricted when the athlete is
attempting to reduce body fat.
4 The athlete should avoid heavy intake of
alcohol on the night before competition. It
appears unlikely that the intake of one or two
standard drinks will have negative effects in
most people.
5 The intake of alcohol immediately before or
during exercise does not enhance performance
and in fact may impair performance in many
people. Psychomotor performance and judgement are most affected. Therefore the athlete
should not consume alcohol deliberately to aid
performance, and should be wary of exercise that
is conducted in conjunction with the social intake
of alcohol.
6 Heavy alcohol intake is likely to have a
major impact on postexercise recovery. It may
have direct physiological effects on rehydration,
glycogen recovery and repair of soft tissue
damage. More importantly, the athlete is
unlikely to remember or undertake strategies for
optimal recovery when they are intoxicated.
Therefore, the athlete should attend to these
strategies first before any alcohol is consumed.
No alcohol should be consumed for 24 h in the
case of an athlete who has suffered a major softtissue injury.
7 The athlete should rehydrate with appropriate fluids in volumes that are greater than their
existing fluid deficit. Suitable fluid choices
include sports drinks, fruit juices, soft drinks (all
containing carbohydrate) and water (when refuelling is not a major issue). However, sodium
replacement via sports drinks, oral rehydration
a lco h o l i n spo rt
solutions or salt-containing foods is also important to encourage the retention of these rehydration fluids. Low alcohol beers and beer–soft
drink mixes may be suitable and seem to encourage large volume intakes. However, drinks
containing greater than 2% alcohol are not recommended as ideal rehydration drinks.
8 Before consuming any alcohol after exercise,
the athlete should consume a high carbohydrate
meal or snack to aid muscle glycogen recovery.
Food intake will also help to reduce the rate of
alcohol absorption and thus reduce the rate of
intoxication.
9 Once postexercise recovery priorities have
been addressed, the athlete who chooses to drink
is encouraged to do so ‘in moderation’. Drinkdriving education messages in various countries
may provide a guide to sensible and well-paced
drinking.
10 Athletes who drink heavily after competition,
or at other times, should take care to avoid
driving and other hazardous activities.
11 It appears likely that it will be difficult to
change the attitudes and behaviours of athletes
with regard to alcohol. However, coaches, managers and sports medicine staff can encourage
guidelines such as these, and specifically target
the old wives tales and rationalizations that
support binge drinking practices. Importantly,
they should reinforce these guidelines with an
infrastructure which promotes sensible drinking
practices. For example, alcohol might be banned
from locker rooms and fluids and foods appropriate to postexercise recovery provided instead.
In many cases, athletes drink in a peer-group
situation and it may be easier to change the environment in which this occurs than the immediate
attitudes of the athletes.
Conclusion
Alcohol is strongly linked with modern sport.
The alcohol intakes and drinking patterns of athletes are not well studied; however, it appears
that some athletes undertake binge drinking
practices, often associated with postcompetition
socializing. There is no evidence that alcohol
413
improves sports performance; in fact there is evidence that intake during or immediately before
exercise, or that large amounts consumed the
night before exercise may actually impair performance. There are considerable differences in the
individual responses to alcohol intake. It is likely
that recovery after exercise is also impaired;
but particularly by the failure of the intoxicated
athlete to follow guidelines for optimum recovery. Athletes are not immune to alcohol-related
problems, including the greatly increased risk of
motor vehicle accidents following excess alcohol
intake. Not only should athletes be targeted for
education about sensible drinking practices, but
they might be used as spokespeople for community education messages. Athletes are admired in
the community and may be effective educators in
this area. Alcohol is consumed by the vast majority of adults around the world, and merits education messages about how it might be used to
enhance lifestyle rather than detract from health
and performance.
References
American College of Sports Medicine (1982) Position
statement on the use of alcohol in sports. Medicine
and Science in Sports and Exercise 14, ix–x.
Bond, V., Franks, B.D. & Howley, E.T. (1983) Effects of
small and moderate doses of alcohol on submaximal
cardiorespiratory function, perceived exertion and
endurance performance in abstainers and moderate
drinkers. Journal of Sports Medicine 23, 221–228.
Burke, L.M. & Read, R.S.D. (1988) A study of dietary
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