{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T21:23:33Z","timestamp":1790717013523,"version":"4.1.0"},"reference-count":37,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T00:00:00Z","timestamp":1771891200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Bioengineering"],"abstract":"<jats:p>Background: Technological innovation increasingly shapes modern sport, influencing performance, athlete safety, and regulatory governance. While new technologies enhance training and monitoring, they also raise concerns regarding fairness, health protection, and ethical legitimacy, commonly described as technological doping. The fragmented nature of the literature in this field requires integrative synthesis. Methods: A structured narrative synthesis was conducted using systematic searches and predefined eligibility criteria to identify studies addressing performance technologies, digital monitoring and detection systems, healthcare compliance, and governance and ethical frameworks. Twenty-four studies spanning empirical, policy, and conceptual domains were included. Results: Mechanical technologies, particularly advanced carbon-plate footwear, were associated with approximately 1\u20133% faster marathon performances and measurable alterations in lower-limb kinematics and kinetics under fatigue, while running-specific prostheses demonstrated performance-relevant differences in stiffness and energy return properties. Wearable monitoring systems supported training optimization but raised concerns related to surveillance and athlete autonomy. Artificial intelligence-based medication screening tools demonstrated high operational performance, with reported recognition accuracy ranging from approximately 92% to 98%, sensitivity approaching 1.00, and strong specificity for identifying prohibited substances from prescription images. Healthcare studies identified persistent knowledge gaps, medication risks, and the importance of pharmacists and education programs. Governance analyses revealed disparities in laboratory capacity and regulatory ambiguity when addressing emerging technologies, while ethical scholarship questioned the boundaries of legitimate enhancement. Conclusions: Technological doping reflects an interconnected performance\u2013health\u2013governance challenge rather than an isolated equipment issue. The synthesis demonstrates that technological doping is driven by measurable performance gains, digitally mediated compliance systems, and uneven regulatory capacity, indicating that future governance must shift from reactive equipment bans toward integrated, evidence-based oversight of biomechanical, digital, and healthcare technologies.<\/jats:p>","DOI":"10.3390\/bioengineering13030257","type":"journal-article","created":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T16:58:18Z","timestamp":1771952298000},"page":"257","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Technological Doping in Sport: Performance Enhancement, Health, Ethics, and Regulatory Governance: A Narrative Synthesis"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6396-761X","authenticated-orcid":false,"given":"Dan Iulian","family":"Alexe","sequence":"first","affiliation":[{"name":"Department of Physical and Occupational Therapy, \u201cVasile Alecsandri\u201d University of Bacau, 600115 Bac\u0103u, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6163-8065","authenticated-orcid":false,"given":"Prashant Kumar","family":"Choudhary","sequence":"additional","affiliation":[{"name":"Department of Physical Education Pedagogy, Lakshmibai National Institute of Physical Education, Gwalior 474002, Madhya Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7491-5404","authenticated-orcid":false,"given":"Suchishrava","family":"Choudhary","sequence":"additional","affiliation":[{"name":"Department of Physical Education Pedagogy, Lakshmibai National Institute of Physical Education, Gwalior 474002, Madhya Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-9438-1554","authenticated-orcid":false,"given":"Sohom","family":"Saha","sequence":"additional","affiliation":[{"name":"Department of Sports Psychology, Lakshmibai National Institute of Physical Education, Gwalior 474002, Madhya Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bindiya","family":"Rawat","sequence":"additional","affiliation":[{"name":"Department of Liberal Arts and Social Sciences, Manipal University Jaipur, Jaipur 303007, Rajasthan, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6740-1867","authenticated-orcid":false,"given":"Drago\u0219 Ioan","family":"Toh\u0103nean","sequence":"additional","affiliation":[{"name":"Faculty of Physical Education and Mountain Sports, Transilvania University of Bra\u0219ov, 500036 Brasov, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9262-2816","authenticated-orcid":false,"given":"Ecaterina","family":"Lungu","sequence":"additional","affiliation":[{"name":"Department of Preschool Pedagogy, Physical Education and Dance, \u201cIon Creang\u0103\u201d State Pedagogical University of Chi\u0219in\u0103u, Str. Ion Creang\u0103, Nr. 1, MD-2069 Chi\u0219in\u0103u, Moldova"},{"name":"Department of Life Sciences, \u201cDunarea de Jos\u201d University of Galati, Str. Domneasc\u0103, Nr. 47, 800008 Gala\u021bi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7424-7741","authenticated-orcid":false,"given":"Cristina Ioana","family":"Alexe","sequence":"additional","affiliation":[{"name":"Department of Physical Education and Sports Performance, \u201cVasile Alecsandri\u201d University of Bac\u0103u, 600115 Bac\u0103u, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"524","DOI":"10.1186\/s40064-015-1331-x","article-title":"The controversy of sports technology: A systematic review","volume":"4","author":"Dyer","year":"2015","journal-title":"SpringerPlus"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Lee, S.Y., Park, J.H., Yoon, J., and Lee, J.Y. (2023). A Validation Study of a Deep Learning-Based Doping Drug Text Recognition System to Ensure Safe Drug Use among Athletes. Healthcare, 11.","DOI":"10.3390\/healthcare11121769"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"58456","DOI":"10.12775\/QS.2025.39.58456","article-title":"Revolutionizing Sports: The Role of Wearable Technology and AI in Training and Performance Analysis","volume":"39","author":"Dudek","year":"2025","journal-title":"Qual. Sport"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Glebova, E., Su, Y., Desbordes, M., and Schut, P.O. (2025). Editorial: Emerging digital technologies as a game changer in the sport industry. Front. Sports Act. Living, 7.","DOI":"10.3389\/fspor.2025.1605138"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1196\/annals.1382.020","article-title":"Rethinking enhancement in sport","volume":"1093","author":"Miah","year":"2006","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"ref_6","unstructured":"Guinness, J., Bhattacharya, D., Chen, J., Chen, M., and Loh, A. (2020). An Observational Study of the Effect of Nike Vaporfly Shoes on Marathon Performance. arXiv."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1515\/jqas-2021-0043","article-title":"Influence of advanced footwear technology on sub-2 hour marathon and other top running performances","volume":"18","author":"Arderiu","year":"2022","journal-title":"J. Quant. Anal. Sports"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Xu, Y., Zhu, C., Fang, Y., Lu, Z., Song, Y., Hu, C., Sun, D., and Gu, Y. (2025). The effects of different carbon-fiber plate shapes in shoes on lower limb biomechanics following running-induced fatigue. Front. Bioeng. Biotechnol., 13.","DOI":"10.3389\/fbioe.2025.1539976"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1186\/s40798-020-00250-1","article-title":"A Pragmatic Approach to Resolving Technological Unfairness: The Case of Nike\u2019s Vaporfly and Alphafly Running Footwear","volume":"6","author":"Dyer","year":"2020","journal-title":"Sports Med. Open"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Beck, O.N., Taboga, P., and Grabowski, A.M. (2016). Characterizing the Mechanical Properties of Running-Specific Prostheses. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0168298"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Rahnama, L., Soulis, K., and Geil, M.D. (2024). A review of evidence on mechanical properties of running specific prostheses and their relationship with running performance. Front. Rehabil. Sci., 5.","DOI":"10.3389\/fresc.2024.1402114"},{"key":"ref_12","first-page":"120","article-title":"Assessment of a Carbon Fiber Prosthetic Running Blade for Enhanced Reliability","volume":"25","author":"Siddiqui","year":"2023","journal-title":"Eksploat. Niezawodn. Maint. Reliab."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Migliaccio, G.M., Padulo, J., and Russo, L. (2024). The Impact of Wearable Technologies on Marginal Gains in Sports Performance: An Integrative Overview on Advances in Sports, Exercise, and Health. Appl. Sci., 14.","DOI":"10.3390\/app14156649"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Se\u00e7kin, A.\u00c7., Ate\u015f, B., and Se\u00e7kin, M. (2023). Review on Wearable Technology in Sports: Concepts, Challenges and Opportunities. Appl. Sci., 13.","DOI":"10.3390\/app131810399"},{"key":"ref_15","first-page":"1","article-title":"Gene Doping and the Ethics of Sport: Between Enhancement and Posthumanism","volume":"1","year":"2011","journal-title":"Int. J. Sports Sci."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Pavot, D. (2022). A Gap or Lacuna in the World Anti-Doping Code? Remarks on the CAS Interpretation in IOC, WADA, and ISU v. RUSADA, Kamila Valieva and Russian Olympic Committee (CAS OG 22-08, CAS OG 22-09, and CAS OG 22-10). Front. Sports Act. Living, 4.","DOI":"10.3389\/fspor.2022.946608"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1080\/19406940.2018.1528993","article-title":"Technological capability of doping control laboratories: A metric proposal","volume":"11","author":"Pitassi","year":"2019","journal-title":"Int. J. Sport. Policy Politics"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"449","DOI":"10.2165\/00007256-200838060-00002","article-title":"Use of prescription drugs in athletes","volume":"38","author":"Alaranta","year":"2008","journal-title":"Sports Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1186\/s13011-017-0092-7","article-title":"Korean national athletes\u2019 knowledge, practices, and attitudes of doping: A cross-sectional study","volume":"12","author":"Kim","year":"2017","journal-title":"Subst. Abus. Treat. Prev. Policy"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1016\/j.drugpo.2011.03.002","article-title":"Doping in sport: A review of medical practitioners\u2019 knowledge, attitudes and beliefs","volume":"22","author":"Backhouse","year":"2011","journal-title":"Int. J. Drug Policy"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1016\/j.smr.2015.10.002","article-title":"Doping control in sport: An investigation of how elite athletes perceive and trust the functioning of the doping testing system in their sport","volume":"19","author":"Overbye","year":"2016","journal-title":"Sport Manag. Rev."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Yee, K.C., De Marco, M., Salahudeen, M.S., Peterson, G.M., Thomas, J., Naunton, M., and Kosari, S. (2020). Pharmacists as a Source of Advice on Medication Use for Athletes. Pharmacy, 8.","DOI":"10.3390\/pharmacy8010010"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"12","DOI":"10.24304\/kjcp.2021.31.1.12","article-title":"Sports Pharmacy: New Specialty of Pharmacists and Pharmaceutical Care Services","volume":"31","author":"Kim","year":"2021","journal-title":"Korean J. Clin. Pharm."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1016\/j.peh.2016.01.001","article-title":"Doping prevention through anti-doping education and practical strength training: The Hercules program","volume":"5","author":"Sagoe","year":"2016","journal-title":"Perform. Enhanc. Health"},{"key":"ref_25","first-page":"118","article-title":"Doping in sports and its spread to at-risk populations: An international review","volume":"6","author":"Baron","year":"2007","journal-title":"World Psychiatry"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"83","DOI":"10.23949\/kjpe.2022.9.61.6.7","article-title":"Developement of Doping Drug Recognition System: Application of Deep Learning-Based OCR Technology","volume":"61","author":"Park","year":"2022","journal-title":"Korean J. Physic. Educ."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"l6890","DOI":"10.1136\/bmj.l6890","article-title":"Synthesis without meta-analysis (SWiM) in systematic reviews: Reporting guideline","volume":"368","author":"Campbell","year":"2020","journal-title":"BMJ"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"747","DOI":"10.1146\/annurev-psych-010418-102803","article-title":"How to Do a Systematic Review: A Best Practice Guide for Conducting and Reporting Narrative Reviews, Meta-Analyses, and Meta-Syntheses","volume":"70","author":"Siddaway","year":"2019","journal-title":"Annu. Rev. Psychol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"106908","DOI":"10.1016\/j.infsof.2022.106908","article-title":"Successful combination of database search and snowballing for identification of primary studies in systematic literature studies","volume":"147","author":"Wohlin","year":"2022","journal-title":"Inf. Softw. Technol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1186\/2046-4053-4-6","article-title":"Better duplicate detection for systematic reviewers: Evaluation of Systematic Review Assistant-Deduplication Module","volume":"4","author":"Rathbone","year":"2015","journal-title":"Syst. Rev."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1186\/s13643-016-0384-4","article-title":"Rayyan-a web and mobile app for systematic reviews","volume":"5","author":"Ouzzani","year":"2016","journal-title":"Syst. Rev."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"810","DOI":"10.47197\/retos.v56.105029","article-title":"Athletes\u2019 (Anti) Doping Knowledge: A Systematic Review","volume":"56","author":"Listiani","year":"2024","journal-title":"Retos"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"100168","DOI":"10.1016\/j.etdah.2024.100168","article-title":"A Systematic Review on the Effectiveness of Anti-Doping Education for University Students","volume":"5","author":"Nicholls","year":"2025","journal-title":"Emerg. Trends Drugs Addict. Health"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Reynoso-S\u00e1nchez, L.F., Molgado-Sifuentes, A., Mu\u00f1oz-Hel\u00fa, H., L\u00f3pez-Walle, J.M., and Soto-Garc\u00eda, D. (2025). Effective Intervention Features of a Doping Prevention Program for Athletes: A Systematic Review with Meta-Analysis. Sports, 13.","DOI":"10.3390\/sports13040108"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"463","DOI":"10.5114\/biolsport.2022.106386","article-title":"Guidelines for performing systematic reviews in sports science","volume":"39","author":"Clemente","year":"2022","journal-title":"Biol. Sport"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Madsen, D.\u00d8., and Glebova, E. (2025). Sports Industry 5.0: Reimagining sport through technology, humanity, and sustainability. Front. Sports Act. Living, 7.","DOI":"10.3389\/fspor.2025.1640362"}],"container-title":["Bioengineering"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2306-5354\/13\/3\/257\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T09:46:51Z","timestamp":1772012811000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2306-5354\/13\/3\/257"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,24]]},"references-count":37,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["bioengineering13030257"],"URL":"https:\/\/doi.org\/10.3390\/bioengineering13030257","relation":{},"ISSN":["2306-5354"],"issn-type":[{"value":"2306-5354","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,24]]}}}