Technological Doping in Sport: Performance Enhancement, Health, Ethics, and Regulatory Governance: A Narrative Synthesis

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 1–3% 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–health–governance 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.