In Blood Stepped: The History Of Blood Doping In Sport

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Jun 27, 2013
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fmk_RoI said:
Peter Janssen's story, in summary.

- reads an article about Conconi and Moser ("I thought hello, if I was a cyclist myself, I'd like to try it sometime, that's at least something. Instead of all this nonsense. '")
- in November (1987?) he's watching the ten o'clock news and sees a story about a blood bank in Velp ("I called them right away the next day, that was the beginning.")
- he practices on himself first and then introduces the procedure to PDM
- in 1988 it was one bag in Nantes (end of stage two or start of stage three?) and two bags in Strasbourg (end of stage nine). He only names Rooks and Theunisse (Bertus Fok's diary also showed Jörg Müller received one bag of blood in Strasbourg)
- the blood bank in Velp was charging 1,500 Guilders per blood bag (that's GBP 400 or USD 750)
- PDM again used blood bags in 1989, one bag on the Thursday before the start in Luxembourg, two bags in Bordeaux (at the end of stage seven)
- Janssen left PDM in 1990 and joined Panasonic where blood bags were also used
- when the blood bank in Velp went bust Janssen was able to make arrangement with a German supplier
- he left Panasonic pretty quickly
- in 1993 former Panasonic rider Eddy Bouwmans (Novemail - Histor) approached him directly and two bags of blood were taken out and stored in the German facility

What's new? We now have Panasonic using blood transfusions in 1990. We have one rider from Novemail - Histor turning to transfusions as late as 1993. We have an actual cost for the procedure. We have a picture of one of the ways knowledge of the procedure was spreading indirectly.

Have I missed anything important?
Why no blood bags after the first week? It's when they'd be most effective
 
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GuyIncognito said:
Why no blood bags after the first week? It's when they'd be most effective
Good question. His dates don't really fit with current understanding of rest-day oil changes. If we discount knowledge - while he is somewhat self-thought on the application of transfusions to sport, he's clearly intelligent and this isn't quite the amateur hour at teh five-and-dime the LA 84 thing was - maybe there is a logistical issue in terms of getting enough bags out and storing them for long enough? I don't know. Any ideas, Aragon?
 
May 26, 2010
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fmk_RoI said:
GuyIncognito said:
Why no blood bags after the first week? It's when they'd be most effective
Good question. His dates don't really fit with current understanding of rest-day oil changes. If we discount knowledge - while he is somewhat self-thought on the application of transfusions to sport, he's clearly intelligent and this isn't quite the amateur hour at teh five-and-dime the LA 84 thing was - maybe there is a logistical issue in terms of getting enough bags out and storing them for long enough? I don't know. Any ideas, Aragon?
I would've thought rest days were more than a blood bag, but a whole cocktail of recovery and performance enhancements. Might all be contained in a BB of course.
 
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GuyIncognito said:
Why no blood bags after the first week? It's when they'd be most effective
If this was frozen autologous blood, there's a limit on how much a rider can produce. You would expect the withdrawals to take place in the off season, spaced several weeks apart at least, and if the riders were training at that time, this would interfere with the training.

Several other relevant factors: 1) While I just said they probably withdrew blood during the offseason, maybe they did it during the season. This would leave them in a weakened condition, and since not much was known at this time about how long it would take for full recovery, they might want to transfuse before a race to make certain they were strong going into it. 2) At this time, not much was known about how long the effects of transfusion, or any other means of blood doping, lasted. They might have thought that a bag before the start of a stage race would last throughout the race. A second transfusion would be regarded as a booster, rather than as necessary because the effects of the first had disappeared. 3) If they had never done this before, and didn't know what to expect, they might want to transfuse early, to give themselves time to get used to it on stages that weren't critical. I take it there's no indication they practiced this before the season began, out of competition, probably at least partly because of the limited amount of blood available.

Also worth noting that while Janssen may have become aware of freezing blood (more precisely, separating RBC from plasma, and freezing them) in the late 1980s, the technique had been developed nearly forty years earlier. I can't remember now if Sniper in his, shall we say, speculations about Lemond, suggested that he may have taken advantage of the technique back in the late 70s.
 
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Merckx index said:
2) At this time, not much was known about how long the effects of transfusion, or any other means of blood doping, lasted.
On the un-orthodox timings of blood infusions, my wild guess would be this even when there could have been some logistical limitations involved. The RBCs are frozen in glycerol solution and they must be thawed and washed before reinfusion, so one would assume that it takes some know-how and equipment where and when it can be done.

It really wasn't that well-known how long the effect lasted, and as the 1984 Los Angeles blood dopers, had Janssen read the literature on the subject, he had encountered the breakthrough study published in 1980 (Buick, Spriet, Gledhill et all) in which after the reinfusion of two blood bags (900 ml), hemoglobin concentration was elevated some 10 % and returned linearly from polycythemia to normal levels in 15 weeks.
 
Mar 15, 2013
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I've looked it up, and the commercial blood bank in Velp went bust in July '88. They had fewer than 40 customers. I can't find any other references to a blood bank in Velp around that time, so I assume that must've been the one.

Here's an article announcing the opening of the blood bank in October '87 with some more info (dutch). They ran incredibly subtle ads.
 
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El_ojo_del_Tigre said:
I've looked it up, and the commercial blood bank in Velp went bust in July '88. They had fewer than 40 customers. I can't find any other references to a blood bank in Velp around that time, so I assume that must've been the one.

Here's an article announcing the opening of the blood bank in October '87 with some more info (dutch). They ran incredibly subtle ads.
Appreciate you digging those stories out.
 
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While there isn't anything strikingly sensational in the recollections of Janssen, if one wants to put this episode in historical context, this could be the first time when a doctor has confessed voluntarily having been involved in blood doping activities, and I mean praxis and not scientific research and even during a time when it was specifically banned.

Yes, there are some doctors such as Eufemiano Fuentes in 2000s and Francesco Conconi, Herman Falsetti and a handful of Finns describing their practices two decades earlier, but they should be read more as damage control when the programs were already revealed rather than "real" confessions (e.g. Alberto Cova confessed transfusions already in 1982). The only even somewhat similar instance I can recall was when one Finnish team doctor in 1985 admitted in passing having administered transfusions to four athletes "all who can be proven to have been very anemic", both the confession and operations taking place when the method was not banned.

It is another question whether Janssen would've been so open without the revelations from the PDM-diaries, but the fallout more or less was already a few years ago. I don't know what is the moral code among the team doctors of 1980s, but I wouldn't be totally surprised if there would be more confessions now that everyone knows that he is not the only one being implicated.

That having been written, when the first confessions about the Finnish blood doping program came into light in 1982, there was similar hope among journalists that everyone could now confess everything and "the truth" about the "secret program" would finally be revealed in public. That was 35 years ago and even today we know next-to-nothing about "secret program", there has essentially been no new material at all.
 
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pmcg76 said:
Ok, dug it up with another interesting anecodte, the first is from a book that was published annually in the UK about the Giro and Tour, it was simply titled Tour 86 published by Kennedy Bros. This refers to the success of Guido Bontempi winning 5 stages at the Giro in 86.This was to be Bontempi's best season winning Ghent-Wevelgem and 3 stages at the Tour. Bontempi did test positive at the Tour in 87.

".....but it was again Bontempi who surged over the line for his third victory of the race, paying tribute afterward to the team doctor, transferred from Mosers entourage and the same doctor who advised Moser on the preparation for his hour record preparation"

The Visentini bit is from Winning magazine review of the 86 Giro.
i][/i]

Visentini rebuffed the cynics who said he owed his Giro victory to the training regime imposed on his squad by a doctor from the team formed by Professor Conconi to help Moser break the World Hour record in 1984.Visentini said at a press conference after receiving his final pink jersey, "I am one of the few riders who doesnt follow all this advice. For one thing, I would never volunteer to undergo a blood transfusion"
.


Carrera did have a fantastic season in 86, Bontempi, Visentini and Urs Zimmermann all had super years in 86. In neither example does it mention who the doctor was, clearly not Conconi himself, was it Ferrari?? I know Ferrari worked with Mosers team in 87 so did he possibly jumps ship for a season or was it someone else? Roche did have his super season in 87, but then Zimmerman was rubbish that same season whilst Bontempi was nowhere near as good.
A bit more on Roberto Visentini, the Carrera doc Giovanni Grazzi, and blood transfusions, this from Barry Ryan's new book about the rise of Irish cycling - Kelly and Roche, Kimmage, Walsh and McQuaid - The Ascent:
There were the faintest murmurs, too, about the part Giovanni Grazzi, Carrera's team doctor, had played in Visentini's success [in 1986]. Grazzi was a close associate of Dr Francesco Conconi who, from his base at the University of Ferrara, had built a reputation as a guru by masterminding Francesco Moser's startling late-career renaissance that saw him smash the Hour Record and win the Giro in 1984. It was heavily suspected - and later confirmed by the rider himself - that Moser had been given blood transfusions to boost performance, a practice that was not illegal at the time. By 1986, however, the IOC had outlawed blood doping, and Visentini was careful when explaining his and Grazzi's links to Conconi immediately after his [1986] Giro victory. 'Conconi? Yes, he's given us a hand, but I don't practice blood transfusions. I'd rather lose an extra race,' Visentini said at the time.

'Grazzi was the doctor for everybody on the team, Visentini says now. 'He wasn't a personal doctor, he was there for everybody, Roche included. Regardless of whether you were one of the stronger riders or one of the weaker, he was the doctor.'
 
May 26, 2010
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Wasn't Roche' name on Conconi files.

Roche admitted giving blood, but alleged it was for testing.

I have no doubt Roche doped.
 
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Benotti69 said:
Wasn't Roche' name on Conconi files.

Roche admitted giving blood, but alleged it was for testing.

I have no doubt Roche doped.
We're talking different years and different products. Post 92 is well known. 1987 isn't.

And - TBH - you having no doubt Roche doped hardly means much - you have no doubt everyone doped, all the time.
 
Feb 23, 2010
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If they haven't already been mentioned upthread, here are a couple of other names:

Ilario Casoni, who was another Ferrara academic working with Conconi on the Moser Hour Record and active with Italian pro teams throughout the nineties. He drops out of sources around the time the haematocrit test was introduced.

Also a Ferrara academic and still teaching today, Fabio Manfredini is a bit more mysterious. He was certainly around in the nineties but I don't know much about him before that. Has worked in cycling but his alumni page suggests he might have been more on the skiing / winter sports side.
 
L'arriviste said:
If they haven't already been mentioned upthread, here are a couple of other names:

Ilario Casoni, who was another Ferrara academic working with Conconi on the Moser Hour Record and active with Italian pro teams throughout the nineties. He drops out of sources around the time the haematocrit test was introduced.

Also a Ferrara academic and still teaching today, Fabio Manfredini is a bit more mysterious. He was certainly around in the nineties but I don't know much about him before that. Has worked in cycling but his alumni page suggests he might have been more on the skiing / winter sports side.
Casoni is well known, from the Ferrara trial (and from Banesto, who named him as a possible successor after Padilla left). That, however, is all EPO. This is blood transfusions.
 
Feb 23, 2010
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fmk_RoI said:
L'arriviste said:
If they haven't already been mentioned upthread, here are a couple of other names:

Ilario Casoni, who was another Ferrara academic working with Conconi on the Moser Hour Record and active with Italian pro teams throughout the nineties. He drops out of sources around the time the haematocrit test was introduced.

Also a Ferrara academic and still teaching today, Fabio Manfredini is a bit more mysterious. He was certainly around in the nineties but I don't know much about him before that. Has worked in cycling but his alumni page suggests he might have been more on the skiing / winter sports side.
Casoni is well known, from the Ferrara trial (and from Banesto, who named him as a possible successor after Padilla left). That, however, is all EPO. This is blood transfusions.
To be fair, I did say that Casoni was known to have worked with Conconi on the Moser Hour Record. Manfredini I didn't know, but it is possible if he too was around that far back. So that was pertinent to blood transfusions.
 
L'arriviste said:
fmk_RoI said:
L'arriviste said:
If they haven't already been mentioned upthread, here are a couple of other names:

Ilario Casoni, who was another Ferrara academic working with Conconi on the Moser Hour Record and active with Italian pro teams throughout the nineties. He drops out of sources around the time the haematocrit test was introduced.

Also a Ferrara academic and still teaching today, Fabio Manfredini is a bit more mysterious. He was certainly around in the nineties but I don't know much about him before that. Has worked in cycling but his alumni page suggests he might have been more on the skiing / winter sports side.
Casoni is well known, from the Ferrara trial (and from Banesto, who named him as a possible successor after Padilla left). That, however, is all EPO. This is blood transfusions.
To be fair, I did say that Casoni was known to have worked with Conconi on the Moser Hour Record. Manfredini I didn't know, but it is possible if he too was around that far back. So that was pertinent to blood transfusions.
Casoni, he was in Ferrara, and we know Indurain visited Ferrara in the 80s, At the moment, though, we have no evidence linking this to blood transfusions.

And IIRC you are right in saying Casoni was part of the Hour team, and I've already noted that, at some stage, we should probably identify who else was there, move it beyond the Holy Trinity (Conconi, Ferrari, Sassi) we've reduced it to. Even PDM's blood programme, ultimately, came out of the Hour programme (the seed of the idea having been planted when Janssen read about it).
 
I don't know how deeply involved Ilario Casoni was in the "autoemotrasfusione" practices of the Ferrara Lab, but if we are to believe the Italian cross-country skier Silvano Barco, Casoni was involved with blood transfusions at least occasionally. He was the doctor who carried out the transfusion operation of Barco shortly before the 1988 Winter Olympics when (Barco's estimation) close to 90 % of the Italian team underwent the procedure.

As far as I know, Barco discussed the matter first time publicly in 1997.

http://ricerca.repubblica.it/repubblica/archivio/repubblica/1997/01/15/pescante-conconi-risponda-sul-doping.html?ref=search
 
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Aragon said:
A brand new academic paper has taken a look into the history of blood doping at the Olympic games:

J Sports Med Phys Fitness. 2017 Jan 17. doi: 10.23736/S0022-4707.17.06948-1. [Epub ahead of print]
Blood doping at the Olympic Games.
Fitch KD1.

https://www.ncbi.nlm.nih.gov/pubmed/28094487

I'll take a look on the paper and review the material as soons as I get a hold of a copy of the article.
This post is barely worth publishing, but just to close this almost a year old post, I finally read the paper described here by Kenneth Fitch and - just as I expected then - the reader shouldn't "expect much new and revolutionary information to be revealed".

It is surprisingly unoriginal paper detailing the evolution of blood doping practices from 1970s onwards and how the athletes have applied this science at the Olympic games and elsewhere. Except some minutia, there was actually nothing new I learned, but it is a well-written introduction into the subject even with a few minor errors (e.g. Santi Pérez wasn't popped during the Vuelta but after the race and remains the second on the GC list).
 
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Aragon said:
It is surprisingly unoriginal paper detailing the evolution of blood doping practices from 1970s onwards and how the athletes have applied this science at the Olympic games and elsewhere. Except some minutia, there was actually nothing new I learned, but it is a well-written introduction into the subject even with a few minor errors (e.g. Santi Pérez wasn't popped during the Vuelta but after the race and remains the second on the GC list).
I'd forgotten about this, and I'd even contacted the author to see what - if anything - new he had. Had hoped he'd have something new, given how the abstract claimed "the author had a medical role at each of the Olympics that is discussed."
 
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fmk_RoI said:
I'd forgotten about this, and I'd even contacted the author to see what - if anything - new he had. Had hoped he'd have something new, given how the abstract claimed "the author had a medical role at each of the Olympics that is discussed."
Because that peer-reviewed paper was unsurprising doesn't mean that he couldn't have any more detailed insight on the matter, he apparently has his interest in the blood doping subject stemming from somewhere and he seems to have commented even earlier on the PED topic and the prestigious jounal The Physician and Sportsmedicine (1983: 11:8, 131-145) has the take of four specialists on how the hormone subject should be dealt with and K.D. Fitch is one of them (the other three being Daniel F. Hanley, E.C. Percy and Herman Adlercreutz)

I should add that he was very cordial in his reply when I wrote an e-mail to him a week or two ago pointing out a few minor errors and omissions in his paper.
 
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Here is one item relating to the intellectual history of blood doping.

Even when there does exist some gossip about athletes using transfusions already in the 1960's, the consensus view is that these claims are unreliable because blood doping was "invented" only in the early 1970 and there was no blood doping research published before that decade. But there was some vaguely blood doping related research preceding the 1972 study as CN readers know from the FMK's transfusion-article:
The first scientific studies to highlight the possible sporting benefits of transfusions appeared after the end of the Second World War. These studies were not aimed actually at sportsmen but came out of the military and were aimed at ways of combating hypoxia...

The next major study on the beneficial effects of transfusions came in 1960 when Gullbring et al published their paper The Effect of Blood Volume Variations on the Pulse Ratio in Supine and Upright Positions and During Exercise. This was based on the transfusion of 610ml blood one week after extraction. In 1966 Robinson et al published another paper, Circulatory Effects of Acute Expansion of Blood Volume based on a study transfusing 1,000ml of blood two weeks after extraction. Both Gullbring and Robinson's studies showed only marginal post-transfusion gains – two to three per cent – in endurance or VO2 max.
Of the two 1960's studies the 1960 study (Gullbring et al) is even somewhat interesting, because it originated from Sweden and one of its authors (B. Gullbring) coauthored blood doping research later with Björn Ekblom, who is usually mentioned as the "inventor" of blood doping. Still it is practically forgotten study by now and most people know about its existence only from secondary sources, such as from the reviews of the blood doping literature by exercise physiologists such as Norman H. Gledhill and James Stray-Gundersen. One can also confidently claim that the modern view (vouched for by FMK) that there was practically no performance benefit found in the 1960 study is almost always based on Gledhill's paper from 1982 who claims that the performance increase was only 3 % and not significant when he listed the available blood doping research papers.

https://pdfs.semanticscholar.org/b64d/f1d95e7a2f99a3df43e6bc677403579b8304.pdf

According to Gledhill, if one did read the study in the 1960's, he shouldn't have been impressed about its findings. But there are still two problems with the Gledhill's assessment even when he is mainly correct in dismissing the significance of the study:

1) The elevation in performance was more than his figure of 3 %, a figure that doesn't originate anywhere from the study. In fact, if one measures the power output of the subjects at constant submaximal heart rate of 170 BPM, the increase in performance from pre-blood withdrawal to the post-infusion is 9.4 %, from 194 to 212 Watts. It is still true that there is no statistical analysis performed and it must've been very underpowered study due to large variation in response and only six subjects. (see the figure below)

2) When the efficacy of blood doping was under debate in the 1970's and it was customary to make crude lists of the earlier handful of transfusion studies where benefit was seen where it wasn't seen, the study was almost always under the former category even when the researhers usually concluded that there were some other factors than blood volume/hemoglobin variations explaining the results (training effects, small cohort etc).

The study itself is strange not because of the protocol but because of the findings. The researchers took out 10 % of the blood volume of only six subjects and reinfused it back only a week later and conducted several exercise tests at 1 h, 2-3 days after the blood removal and right before and after the reinfusion. As should be expected, the performance of the subjects fell significantly after roughly 10 % of the blood was removed, but it returned to the original level in only 2-3 days and had risen 5 % above the pre-withdrawal level in 6-7 days when the hemoglobin level hadn't recovered at all. When the blood was reinfused at this point only after a week, the performance was elevated some 4 % more. That is to say, a huge 9 percent increase in watt output even when the hemoglobin level hadn't increased at all and had only been recovered to the starting point as the time gap between blood removal and reinfusion was only 7 days.


Effect of blood removal and reinfusion on work capacity during the Gullbring study. Left is PWC170 (power output at heart rate of 170, pre-blood removal = 100), below is time, arrow down means the blood removal and arrow up is the reinfusion. Black line represesents the mean of the six subjects whereas the coloured lines are each individual subject. The chart looks nothing like the schematic blood doping charts where benefit is seen after reinfusion (e.g. Gledhill, 1982, p. 185).

The training effect is the most obvious explanation for the strange results and even when one doesn't fully know what to make of the findings, the existence of this research paper might've been known even widely, because - unlike the transfusion reserach of the 1940's at the Bethesda military hospital - this was a research on the exercise physiology and many of its authors were exercise physiologists and the paper was published in a prestigious journal where P.O-Åstrand and his colleagues published regularly.

In addition, the key findings of the study were discussed at the 1958 meeting of the Swedish Medical Association under the extremely blood doping sounding title "Fysisk arbetsförmåga efter blodavtappning och retransfusion" (Physical capacity after blood removal and re-transfusion). As an interesting anecdote, when Björn Ekblom, Bengt Gullbring [sic.] and Alberto Goldbarg published the "first" blood doping study some fourteen years later, it was titled "Response to exercise after blood loss and reinfusion" using almost exactly the same title.

As another anecdote, I can recall a few years ago discussing the subject of blood doping with one prestigious Finnish sports journalist and biographer well-connected with the circles specifically in the 1960's and 1970's and showing him a paper copy of the Gullbring-paper. He instantly recalled the study having being discussed on some level even even when he had never seen a copy of it. Too bad he didn't specify whether it was discussed already in the 1960's or only later, when there was other blood doping research originating from Sweden.

If one can't conclude too much about the 1960 paper, the least one can conclude is that the method of transfusion found its way into the exercise physiology-related research and into the journals of the field.
 
A Q came up recently elsewhere about the current prevalance of blood doping, in light of on going research projects into new detection methods. A new Danish study from the Department of Sport and Nutrition at the University of Copenhagen suggests that micro-transfusions could be offering noticeable performance gains:
Half a bag of blood.

Directly from the fridge and into the veins.

It may feel a bit cold in the arm as the blood runs into the body, but after half an hour the blood bag is empty and you can be a five percent better athlete.
Not sure how 'robust' the study was:
The research project involved a group of nine well-trained men with an average age of 29 years and blooded them with 135 milliliters of red blood cells corresponding to half a bag of blood.

One minute better

The result was not to be mistaken. Their performance in a time drive by bicycle was improved by 4.7 percent.
Danish link

(Excuse the poor Google pidgin.)
 
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The material was published two years ago in one master's degree:

http://curis.ku.dk/ws/files/163093434/Speciale_jvx919.pdf

I went quickly through the PDF-version and the "Discussion"-section makes it clear that there are shortcomings in the study:
Conversely, it should be stressed that the findings of improved endurance performance in the present study and the discrepancy between the present and earlier findings about the performance enhancing effect of ABT of 400 mL, are due to unsuccessful blinding in the present study. Knowledge about the treatment allocation can affect the subjects’ psychological and physiological responses to the intervention. Subjects knowing that they are in the ABT group might harbour favourable expectations. Likewise, subjects in the PLA group can potentially be positively influenced by the “placebo effect”.
I don't personally even get it why people conduct these kind of non-blinded experiments at all other than to finish their degrees and to get the "feeling" on how research and statistical analysis is conducted etc., because they are always prone to criticism.

To think it this way, in the 1980's there were two double-blind placebo controlled studies in which both running speed and Vo2Max were measured before and after blood infusion (760-900 ml). In both of these studies, Vo2Max of the subjects was elevated some 8-12 %, but due to physical and physiological processes, only a quarter of this was "realized" into actual speed increase (c:a 2.5 %). In the present study, there is barely noticeable Vo2Max increase, but the speed increase is amazingly high.
 
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Aragon said:
The material was published two years ago in one master's degree:
Cheers for taking a look at it. It came up on Twitter yesterday and I wasn't near a computer, just a tablet.

It's funny, the EPO-doesn't-work study got torn apart in moments, this one gets a hall pass elsewhere.

This was interesting in it:
Out of the six participants, four subjects (n = 4) underwent a placebo (PLA) intervention and five subjects (n = 5) an autologous blood transfusion (ABT), of which three subjects (n = 3) completed the crossover (ABT -> PLA; n = 2, PLA -> ABT; n = 1) within the master project’s data collection period. One subject became ill just before the last set of performance tests (W6 Post) and was therefore not able to complete these tests. Likewise, no baseline measurement for Hb(mass) was conducted for Subject 3 in the second round due to sickness. Additionally, as the recordings stopped halfway during the 650-kcal TT following microtransfusion for Subject 6, the results from this subject were excluded from the time trial database. Likewise, due to technical problems with the specific heart rate monitor, heart rate data for Subject 1 was not included in the study.
 

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