Boosting: Autonomic Dysreflexia in Sport

Definition and Background

In disability sport there is a performance enhancement method known as “Boosting”, when someone intentionally causes a bout of Autonomic Dysreflexia (AD) to improve athletic performance (Gee et al. 2015; Mills & Krassioukov 2011; Blauwet et al. 2013).

Some people with SCI, mostly those with injuries at T6 or above, cannot regulate blood pressure and heart rate in the same way as others (West et al. 2013). Athletes that excel in many sports often have superior cardiac output and/or oxygen uptake. During competition a wheelchair athlete’s heart rate may not increase according to the body’s demands, leading to low blood pressure, fatigue, and often a loss of endurance and poor performance.

What Happens

Some athletes have learned they can subvert these cardiovascular dysfunctions and increase their blood pressure and other cardiac outputs (in the short-term) by causing some pain or discomfort in an area below their injury. They may do this by:

  • Clamping of the urinary catheter to produce bladder distension
  • Excessive tightening of the leg straps
  • Twisting and/or sitting on the scrotum
  • Breaking their big toe before the competition
  • Abdominal binders or pressure stockings on legs


Athletes with SCI who self-inflict physical suffering in order to improve athletic performance take tremendous health risks (i.e. hypertension, cerebral hemorrhage, stroke and sudden death).

In a study of 99 athletes with SCI, 54.5% had previously heard of AD while 39.4% were unaware; 16.7% (all males) had used AD to enhance performance, despite participants reporting that AD is somewhat dangerous (48.9%), dangerous (21.3%) or very dangerous (25.5%) to health. These findings indicate the need for educational programs directed towards enhancing the AD knowledge of rehabilitation professionals, coaches and trainers working with SCI individuals (Bhambhani et al. 2010).

The International Paralympic Committee considers AD doping and has banned its use. Any deliberate attempt to induce AD, if detected, will lead to disqualification from the sporting event and subsequent investigation by the IPC Legal and Ethics Committee.