Background World Anti-Doping Agency (WADA) implemented the first World Anti-Doping Code in 2004 and launched its Social Science Research (SSR) program. Since then, there has been no comprehensive synthesis of the knowledge on how anti-doping SSR evolved. This review, therefore, employed a science-mapping approach to examine the knowledge structures and domain focus within anti-doping SSR. Methods A total of 431 social science research articles published between January 2004 and August 2025 were retrieved from Web of Science Core Collection for science mapping. An expert panel reviewed these publications using a staged cross-validation process, assessing their domain focus, level of influence, alignment with WADA’s SSR priorities, and position within an international consensus on anti-doping SSR agenda. Results Anti-doping SSR over the period 2004-2025 demonstrated enriched knowledge structures at the social (e.g., collaboration networks), intellectual (e.g., research clusters, keyword bursts), and conceptual (e.g., thematic mapping and evolution) levels. The results of the expert panel review revealed significant shifts in the focus of anti-doping SSR domains and methodological approaches, within the level of influence, WADA’s SSR priorities, and the international consensus SSR agenda. Conclusions The findings reveal a shift toward embracing more comprehensive social science methods to inform real-world anti-doping efforts. Researchers should critically address key gaps, such as the underrepresentation of consensus agendas, evaluate alternative anti-doping models, and embrace robust behavioural science. Funders should broaden their priorities to support challenging inquiry. Causal, behaviour-driven, and long-term impact evidence are needed to inform technology-empowered, effective, and ethically sound anti-doping practices.
Objectives The non-medical use of anabolic-androgenic steroids (AAS) is associated with multiple physical and mental health problems. The three objectives of this qualitative study were 1) to define the types of health problems that people who use AAS for non-medical purposes experience, based on the clinical observations of Finnish physicians working in different medical specialties, 2) to define the characteristics of Finnish people who use AAS for non-medical reasons, and 3) to describe how they are treated. Design and methods Data were collected through structured interviews completed by eight physicians and analyzed via thematic analysis. Results This analysis suggests that the Finnish people who use AAS for non-medical reasons often experience endocrinological problems, particularly involving the reproductive system. Cardiovascular problems and psycho-behavioral alterations were also observed. The most severe reported adverse effect associated with AAS use was a stroke in a young male patient. While the typical person using AAS was a 20–40-year-old male with an interest in strength training, other profiles were also observed, particularly individuals with a background of non-medical use of other substances or a criminal history. Treatments were reported primarily as symptom based. Conclusions The results indicate that more research is needed to clarify the range of possible adverse effects attributable to non-medical AAS use, identify optimal ways to treat people who use AAS, and find ways to help them manage their use. Moreover, more strategies to prevent non-medical AAS use are needed in the future.
Purpose This exploratory study aimed to identify affect-related reactions shaping physical activity (PA) among German primary school children. Methods Video and pictorial-based interviews were completed by 86 children (M = 9.50, SD = 0.68 years, 45.3% girls) to explore their perspectives on positive and negative affective processes related to PA elicited by videos of peers engaging in different activities. Thereby, children rated their enjoyment for sport-oriented activities using a seven-point pictorial smiley scale and explained their ratings in verbal responses. For the analysis, interviews were transcribed verbatim and analyzed using inductive qualitative content analysis. Results The study revealed five core categories, each comprising two subcategories, shaping affect-related reactions of children at primary school age in the context of PA: (1) perceived competence (success – failure), (2) body experience (interoception – appearance), (3) variety and challenge (diversity of experience – task demand and performance), (4) psychosocial dynamics (personal and social aspects – fear and safety) and (5) task-related preference (element of activity – environmental factors). Conclusion The study emphasizes the relevance of affect-related reactions in children’s PA, particularly during the initial phase of participation. This highlights the need to systematically integrate children’s affective perceptions in the design of physical education (PE) lessons and extracurricular sports programs to build a basis for sustained enjoyment and enhance a physically active lifestyle in long-term.
Collegiate student-athletes experience similar levels of mental health problems to the general post-secondary student population but are less likely to seek help for their challenges. Mental health literacy programs have shown promise in improving athletes’ attitudes towards help-seeking, but existing programs have largely been delivered face-to-face, limiting their potential reach and scalability. Therefore, this study aimed to assess the feasibility and acceptability of an online, self-paced mental health literacy program co-designed with and for collegiate student-athletes. Participants were 289 US-based collegiate athletes (n women = 187) in late 2024. A mixed-methods pre-post evaluation of a co-designed intervention called MindMoves was conducted. Variables included mental health knowledge, stigma, and help-seeking intentions. Pre- and post-intervention changes in mental health literacy (i.e., help-seeking attitudes; help-seeking intentions; self- and other-stigma; knowledge of mental health) were assessed, and program acceptability and gender differences in effectiveness were explored. Post-intervention focus groups discussed program effectiveness, engagement, and potential improvements. Athletes reported increased knowledge of psychological distress and confidence in seeking and providing mental health support, and decreased stigma following the intervention. Help-seeking intentions increased, and analysis showed minimal gender differences. In focus groups, athletes said MindMoves was relevant, practical and engaging, but wanted opportunities for interaction with other student-athletes, and more content and topic areas. Overall, online mental health literacy interventions seem feasible and acceptable to collegiate student-athletes, and there is likely benefit to including them as part of broader athlete health initiatives.
Gratitude, defined as both a positive emotional state and a dispositional trait arising from recognizing and appreciating benefits or positive experiences, has been linked with numerous mental health and well-being benefits in the general population (e.g., higher life satisfaction and lower burnout). Athletes, in particular, face unique stressors (e.g., performance pressure, evaluation, injury, extensive training, and athletic burnout) that differentially impact their psychological health. Yet, no recent review has summarized research on gratitude and psychological health (i.e., mental health and well-being) in athletes. To address this gap, we conducted a systematic scoping review on this relationship from database inception to March 2026. Study inclusion criteria were peer-reviewed articles with samples described as athletes that quantitatively measured gratitude, a mental health or well-being outcome, and were available in English. The 22 articles (24 studies) included 13 cross-sectional, eight longitudinal, and three intervention studies. Findings suggest promising evidence on gratitude’s role and impact on psychological health in athletes, particularly sport-specific gratitude. Gratitude is associated with lower athlete burnout and team satisfaction by way of leveraging social resources. Limitations within the literature were lack of randomized controlled trials and diversity across competition levels, study locations, and age. Suggestions for future research and clinical implications are discussed.
Background The Spartathlon is a 246-km ultra-endurance running race, considered as one of the most iconic and physically demanding ultra-marathons in the world. In this narrative review, we aimed to synthesize the available current evidence on the physiological responses, performance trends, and health implications associated with participation in the Spartathlon. Methods A systematic literature search was conducted to identify high-quality scientific studies on the Spartathlon. The databases Cochrane, EMBASE, PubMed, Scopus, and Web of Science were used to retrieve articles published up to December 2025. We found a total of 33 publications in Web of Science, 25 in Embase, 24 in Scopus, 23 in PubMed, and 1 in Cochrane. After removing duplicates and applying the eligibility criteria, a final selection of studies was included for analysis in this narrative review. Results The findings on the cardiac system showed reversible changes in echocardiography and cardiac biomarkers. Running the Spartathlon leads to specific effects on the locomotor system, such as an increase in peak pressure in the forefoot area, an increase in biochemical markers of muscle damage and changes in bone metabolism markers. Notably, the use of oral proton pump inhibitors was associated with a lower incidence of gastrointestinal bleeding. The Spartathlon also showed the highest prevalence of exercise-associated hyponatremia (EAH) of up to 65% as reported in the literature on ultra-marathon running. In addition, running Spartathlon leads to an inflammatory response and an increase in oxidative stress. Conclusions Participation in the Spartathlon leads to several well-documented post-race physiological alterations, particularly affecting the cardiovascular and musculoskeletal systems. Overall, the Spartathlon represents a unique model for studying human physiological resilience and adaptation under extreme conditions.
Background: Previous studies established the associations between exercise dependence and thinness-oriented eating disorder (ED) symptomatology in adult women. However, prior studies mainly relied on latent variable approaches, and the symptom-level interplay between exercise dependence and ED symptomatology remains largely unknown. Also, women have increased pressure to be muscular. Thus, research should be extended to muscularity-oriented ED symptomatology. Objectives: Given network analysis has emerged as a powerful tool for understanding complex symptom-level relationships, which contributes to more targeted interventions and prevention, the present study aimed to use network analysis to investigate the interconnections between exercise dependence and thinness-and muscularity-oriented disordered eating in adult women. Methods: We recruited 599 Chinese adult women online (Mage = 29.03 years). Network analysis was conducted to identify network structure and central and bridging symptoms. Results: Five communities were identified (e.g., exercise dependence, strict diet rules, and concerns about weight/ shape and eating/foods). Several nodes were identified as central in the network (e.g., time, tolerance, and reduction of exercise dependence). Also, symptoms, such as food restriction for shape or weight concerns and food restriction, were essential in bridging exercise dependence and thinness-and muscularity-oriented disordered eating. Conclusion: Our findings provide empirical evidence of the symptom-level interconnections between exercise dependence and thinness-and muscularity-oriented disordered eating in adult women from a network perspective, which contributes to the design of management and intervention programs for reducing exercise dependence-related ED symptomatology in women.
Sport-specific well-being (WB) is a multidimensional concept for athletes' overall performance and mental health, yet few context-specific validated instruments exist to assess this construct. Two instruments were developed to provide a holistic assessment of athletes' WB and preliminary evidence for score validity was established using contemporary psychometric methods, including factor analysis and structural equation modeling (Boateng et al., 2018; Rose et al., 2025). The results demonstrated preliminary evidence of convergent, discriminant, and concurrent validity across various psychosocial variables, including stress, global WB, and motivational factors, extending prior development work of the instruments. Cluster analyses identified four distinct WB profiles among athletes, offering deeper insights into the complexities of sport-specific WB. These findings suggest that the WBSQ and SWBEP may be valuable tools for practitioners seeking to enhance athletes' well-being and performance through targeted strategies and comprehensive assessment.
2,4 dinitrophenol (DNP) is an industrial chemical first used during World War I within the manufacture of explosives and ammunition. Adverse experiences from human exposure to DNP were published shortly following the war, providing evidence for the links between DNP and weight loss. Despite being banned for human consumption in the 1930s, DNPs thermogenic properties resulting in weight loss caused it to be popular among bodybuilding communities. The increased availability of online marketplaces and web-based forums in the early 21st century saw a surge in interest around DNP for weight loss, which extended beyond bodybuilders into the general population. This resulted in increased reporting of DNP related harms and deaths in the scientific literature and media. However, in recent years, this interest in DNP has waned, coinciding with increased awareness of DNP's risks following its reclassification as a poison, and the rise in popularity of GLP-1 medicines such as Ozempic. Whilst longer-term risks are currently unknown, GLPs are generally not considered as risky to use when compared to DNP. Furthermore, they are heavily promoted and endorsed through media, social media and by celebrities, and legally available to purchase with a prescription. This commentary article reflects on academic research and media coverage of DNP before and after the introduction of GLP-1 medicines and considers whether the concerns over use of DNP have declined or whether use has reduced. It explores the history of DNP, its shifting user demographics and its current place alongside newer and potentially safer weight loss drugs. Finally, it postulates whether DNP use has simply diminished or as online communities have become more sophisticated, discussion relating to its use has become more hidden.
Objectives Sports injuries have significant physical and psychological impacts on elite athletes. While individual coping strategies have been linked to injury risk, the role of communal coping within teams remains understudied. The aim of the study was to examine how perceived stress, trait anxiety, and individual and communal coping strategies predict sports injuries in young elite rugby union players over a competitive half-season. Methods 148 French elite male rugby union players (Mage = 19.14 years, SDage = 0.98 years), from eight rugby union training centres, completed an online questionnaire once a month over a four-month period (i.e., February-May 2024) measuring perceived stress, anxiety intensity, and individual and communal coping. Sports injuries were tracked throughout the period based on the player's ratio of time lost due to injury. Results Results of the multilevel analyses showed that perceived stress and anxiety intensity were associated to individual (i.e., disengagement-oriented coping) and communal coping (i.e., problem-focused communal efforts, communal management of emotions, communal-goal withdrawal). Disengagement-oriented coping mediated the relationships between perceived stress and anxiety intensity, and time-loss injury. Conclusion This study provides new insights into the psychological adaptation processes of young elite rugby union players. In particular, it highlights the importance of considering coping strategies as key resources in managing stress, which plays a critical role in injury risk among elite rugby union players. It also suggests that communal coping approaches may enhance stress management, although further research is needed to clarify their potential protective effects on injury.
Emotions critically shape decision-making and performance in sport, yet real-time objective assessment during competition remains a methodological challenge. This study introduces an Artificial Intelligence (AI)-driven approach to quantify emotional dynamics in elite futsal goalkeepers (GKs) under ecologically valid conditions, addressing a gap in emotion-performance research for team sports. Four preparatory matches of the Portuguese Women's National Team are analysed. High-definition video is processed using FaceReader software to classify six basic emotions and compute valence and arousal. Contextual variables (action type, outcome, game direction) are coded and integrated with Facial Emotional Recognition (FER) outputs. Non-parametric tests and Random Forest models are used and analysed, as predictors of emotional responses. Results showed that positive outcomes and offensive actions elicited more positive valence scores, while arousal remained stable across contexts. Game events and game direction explain similar to 9 % of valence variance. Happiness correlated positively with valence (rho = 0.49, IC95 % [0.41, 0.57]), and surprise correlated with arousal (rho = 0.49, IC95 % [0.43, 0.55]). It is concluded that AI-based FER enables real-time tracking of emotional states in competitive environments, revealing context-sensitive patterns in valence and the relative stability of arousal. These findings advance emotion research in sport and highlight practical applications for coaches, including targeted regulation strategies and performance optimization.
Background Muscle dysmorphia (MD), a specifier of body dysmorphic disorder, is prevalent across various populations. Individuals engaged in strength training, both females and males, are at elevated risk of developing MD symptoms. These symptoms are linked to adverse outcomes, including functional impairment, anabolic steroid use, depression, anxiety, and negative self-image. Research on MD in females remain limited both in Norway and internationally. This study aims to adapt the Muscle Dysmorphic Disorder Inventory (MDDI) to better capture the experiences of Norwegian females and to examine the psychometric properties of the revised version, the Muscle Dysmorphic Disorder Inventory for Females (MDDI-F). A secondary aim is to explore differences in MD symptoms by age and competition experience. Method The study included 139 Norwegian female strength athletes. Data were collected using a modified version of the MDDI, adapted to better reflect female experiences with muscle dysmorphia. The MDDI-F included three revised items and two additional items. Results Exploratory Factor Analysis revealed a four-factor structure for the MDDI-F, which demonstrated strong psychometric properties comparable to previous studies of the original MDDI. Significant differences emerged between age groups and years of competition. Younger participants scored higher across all factors, with varying effect sizes, while those with less competition experience scored higher on all factors except Factors 3 and 4. Conclusion The MDDI-F appears to be a reliable and appropriate instrument for assessing MD symptoms in Norwegian female strength athletes, demonstrating strong psychometric properties comparable to the original MDDI. Further research is needed to confirm its validity and reliability.
Soccer performance is shaped by various factors, including core executive functions (EFs), which are essential for goal-directed actions and have been linked to performance optimization. However, translating EF measures to on-field performance necessitates accounting for influencing factors like soccer-specific emotional experiences. While research often prioritizes negative emotions (NE), growing evidence suggests that positive emotions (PE) can enhance athletic performance and health. However, the specific situational triggers in sport that elicit PEs, such as praise, achievement or team dynamics, remain underexplored. This study therefore aimed to induce sport-specific PEs and examine their impact on EFs in female elite youth soccer players. A total of 47 players (Mage = 15.32, SDage= 1.53) performed inhibition (i.e., flanker task) and cognitive flexibility (i.e., number-letter task) tests in a counterbalanced order with a soccer-specific motor response. Objective (cortisol, heart rate variability) and subjective measures of affective responses (SAM, VAS) were assessed five times, while emotions (PEs and NEs using the SEQ-d) were assessed three times. Results showed no robust effects of the emotion induction itself but revealed a significant three-way interaction (time & times; condition & times; first task) for PEs and NEs, suggesting limited and context-dependent effects. Exploratory analyses pointed to greater emotional and motivational stability in the positive condition, consistent with theoretical perspectives emphasizing the role of PEs in regulating stress-related responses. The findings are discussed with respect to explanatory frameworks and implications for future research and applied practice in performance and health contexts.
Recent theories of physical activity motivation highlight the potential importance of affective, or hedonic, factors. These include two conceptually distinct future-oriented emotions involved in contemplating potential future physical activity. Anticipated emotion refers to the emotions one predicts feeling if the future event were to happen, whilst anticipatory emotions are experienced in the moment when thinking about a potential future event. The current study investigated the extent to which both future-oriented emotions vary as a function of participants' current activity levels, and their cross-sectional predictive value for physical activity intentions and behavioural expectations. In response to descriptions of potential future physical and non-physical activity events, 133 participants rated the valence and arousal of both anticipated and anticipatory emotions. They also rated behavioural expectation for each event and completed measures of current physical activity level and future physical activity intention. Results were largely in line with pre-registered predictions. Higher levels of current physical activity were associated with more positive anticipated and anticipatory emotions for potential physical activity events. Furthermore, when controlling for physical activity level, the valence of anticipated emotion for physical activity events predicted physical activity intention (beta = 0.39, 95% CI [0.06, 0.72]), whilst anticipatory emotion valence predicted behavioural expectations (beta = 0.52, 95% CI [0.25, 0.79]). These findings provide preliminary evidence that both types of emotional anticipation may play distinct roles in motivating physical activity engagement, which could be further explored using longitudinal designs and accelerometer data.
Doping control is vital for ensuring fairness and protecting athlete health in football. Recent studies in elite European leagues show low rates of adverse findings, but data on South American competitions are limited. We aimed to analyse the number and distribution of doping control tests, as well as the number and types of banned substances reported as adverse analytical findings, in the football disciplines governed by the South American Football Confederation (CONMEBOL). The analysis was performed by using the data provided by the CONMEBOL Medical Commission and Anti-doping Unit from 2014 to 2024. During this period, 24,726 doping control tests were analysed with 89 adverse analytical findings (0.42% +/- 0.27%). The most commonly detected groups of banned substances were anabolic agents (36), diuretics and masking agents (26) and glucocorticoids (19). The proportion of cannabinoids was unusually in futsal (p < 0.05) with no differences in the remaining groups of prohibited substances between football disciplines. From the total number of adverse analytical findings, 78 were detected in men and only 11 in women, with a significantly different distribution between sexes (p = 0.016): men showed higher proportions of anabolic agents (p < 0.05), while women exhibited higher proportions of diuretics and masking agents (p < 0.05). These findings reflect the outcomes of current anti-doping detection strategies in South American football. Although detection rates were low, discipline- and sex-specific differences observed in substance categories may help inform future research and the development of more targeted testing and education approaches.
Research has shown that mental toughness (MT) may be a protective factor for depressive symptoms, however, we know little about how this relationship may emerge. The aim of this preliminary cross-sectional study was to explore potential indirect relationships between MT and depressive symptoms via brooding and reflective rumination. A total of 113 Icelandic national team athletes participated in the study, of which 80 were women (70.8%) and 33 were men (29.2%). Prevalence of clinically significant depressive symptoms was 4.5% (5.13% females and 3.03% males), with non-significant mean differences between genders in total symptom scores. The indirect association between MT and depressive symptoms via brooding was negative, with the confidence interval excluding zero, b = -0.03, 95% CI [-0.07, 0.01]. The confidence interval (95% CI [-0.16, -0.01]), and the standardized coefficient (beta_indirect = -0.08) was consistent with a small indirect association. In contrast, the indirect association between MT and depressive symptoms via reflective rumination was not supported, as the confidence interval included zero. These findings suggest that MT may be associated with depressive symptoms in part through its negative relationship with brooding rumination. These findings should, however, be considered preliminary and limited due to the relatively small sample size and cross-sectional design. We also discuss how MT may overlap with other cognitive-affective constructs and how this conceptual breadth may introduce challenges to its current applied utility. Addressing these conceptual aspects with longitudinal and experimental research would benefit future applied efforts aimed at supporting athlete mental health.
Objectives This study examined changes associated with participation in an online emotional intelligence (EI) training program (API-D) and explored how defense mechanisms predict changes in EI and personality traits throughout the intervention. Method A total of 96 athletes (67 women) participated in this study; a training group (n = 50) received the 8-week, two-phase API-D online program, while a control group (n = 46) did not. All athletes completed self-report measures of defense mechanisms, trait EI, and personality traits at three measurement points: before the intervention, after phase one (knowledge development phase), and after phase two (abilities development phase). Results For the training group, repeated measures ANOVAs showed an increase in adaptive defense mechanisms (ADM) and a decrease in maladaptive defense mechanisms (MDM). Multilevel Growth Curve Analysis revealed a linear increase in the global score of trait EI and a linear decrease in neuroticism throughout the intervention. Findings also indicated that defense mechanisms influenced the trajectories of trait EI and personality traits. Conclusion Participation in the API-D program was associated with increases in trait EI, reductions in neuroticism, and more adaptive defensive functioning across the intervention. ADM were associated with higher trait EI, suggesting that they foster psychological readiness for EI learning. In contrast, MDM predicted lower EI and showed slower improvement over time, underlining their potential role as barriers to EI development during training. Overall, these findings highlight the role that defense mechanisms as psychological processes may play, as they can either facilitate or hinder athletes’ EI development.
Background: Perfectionism is common among athletes and may increase vulnerability to mental health problems. Using Multi-States (MuSt) theory and Compassion Focused Therapy as theoretical frameworks this study examined the relationships between two perfectionism dimensions - strivings and concerns - and athletes' mental health determinants, namely functional psychobiosocial states as adaptive, and dysfunctional states, psychological distress, and shame evaluations as poor mental health indicators. Self-compassion, fear of selfcompassion and inflexible forms of responding to self-critical thoughts were tested as mediators. Methods: Participants were 693 Finnish competitive athletes (248 men, 443 women; Mage= 23.45 years, SD = 8.06) who completed self-report measures. Results: Structural equation modelling revealed that perfectionistic strivings were positively associated with functional states and negatively with poor mental health indicators. Conversely, perfectionistic concerns positively predicted the poor mental health indicators and negatively the functional states. Self-compassion mediated the relationships between both features of perfectionism and functional states but did not buffer the paths to poor mental health outcomes. However, the findings revealed fear of self-compassion to be a significant mediator between dimensions of perfectionism and the outcomes connected to mental health difficulties. Furthermore, unworkable actions as responses to self-critical thoughts mediated the paths from perfectionistic dimensions to dysfunctional states and shame evaluations, but responding with low mindful acceptance was not a significant mediator. Conclusions: The findings may inform development of more targeted interventions for perfectionistic athletes. The proposed model broadens the scope of MuSt theory and offers a foundation for theoretical advancement to understand the mechanisms underlying self-compassion in sport.
Officials in sport face a challenging role encompassing cognitive, physical and emotional demands. This is within a unique and challenging environment, where officials are often subjected to abuse, while they are expected to make rapid accurate decisions and communicate in a clear manner. The aim of this commentary paper is to apply affective learning design to the development of sport officials. Firstly, a brief snapshot of some existing psychological preparation strategies in the officiating literature is provided, then an overview of affective learning design and the relationship between emotions and decision-making. The role of technology in relation to affective learning design and considerations for different levels of sport officials are presented. Future research recommendations are also discussed on the topics of assessing and training decision-making in officiating, with a grounding in understanding in-game performance. It is anticipated that this commentary will act as a call-to-action for further work in this area, leading to not only performance improvements of officials, but also to enhanced health, especially mental health, of officials.
The prohibition of erythropoietin (EPO) in endurance sport is often treated as settled policy, grounded in an assumption of clear performance enhancement. While EPO reliably increases hematological parameters and maximal oxygen uptake in trained athletes, the translation of these effects into meaningful competitive advantage is uncertain. Some studies suggest improved laboratory performance with EPO use, yet high-quality trials yield conflicting results, particularly in ecologically valid, real-world endurance contexts. This review reframes EPO use within the broader science of fatigue and effort regulation. Endurance performance is shaped not only by physiological capacity but also by perception, specifically, regulation of pacing to avoid catastrophic failure. Substances like EPO may exert effects through both physiological mechanism and perception-mediated pathways, including expectation, and motivation. This dual mechanism complicates the attribution of performance gains and challenges the clarity of current anti-doping enforcement. The analysis critiques the evidentiary foundations of the World Anti-Doping Agency’s Prohibited List, arguing that EPO’s status as a paradigmatic enhancer reflects epistemic assumptions rather than conclusive science. When policy is built on weak or selective evidence, it risks enshrining ideology over empirical integrity and imposing ethical harm. A more credible and just framework would elevate research standards, support independent investigation, and prioritize athlete-centered ethics. EPO serves here as a case study in the urgent need for transparent, evidence-based reform in anti-doping policy.
