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Sport and exercise medicine: A hot topic thanks to the Olympics

February 2013
British Journal of General Practice 63(607):96-7

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PubMed

Authors:

University of Oxford

The recent London Olympic Games have seen an increase in the attention given to the area of sport and exercise science/ medicine, particularly in the UK context. For example, the House of Lords Science and Technology committee have completed an inquiry into sports and exercise science and medicine,1 considering how the legacy from the London Games can be used to improve understanding of the benefits of exercise for prevention and treatment of chronic conditions. Moreover, GPs are being encouraged to ‘make every contact count’ on the back of a report2 recommending health professionals to ask patients about their lifestyle, smoking, alcohol consumption, diet and, for the point of this article, exercise at every contact. The paramount questions appear to be around the evidence for the benefits of exercise (including sport), particularly specific training in athletic populations and how this may transfer to the general public, as well as the need to get people doing more exercise and how we go about doing this. The evidence for the benefit of exercise goes back to ancient times. According to Plato (427–347 BC) medicine was the sister art of physical exercise. Hippocrates noted that in order to remain healthy ‘the entire day should be devoted exclusively to ways and means of increasing one's strength and staying healthy, and the best way to do so is through physical …

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The recent London Olympic Games have

seen an increase in the attention given to

the area of sport and exercise science/

medicine, particularly in the UK context.

For example, the House of Lords Science

and Technology committee have completed

an inquiry into sports and exercise science

and medicine,1 considering how the legacy

from the London Games can be used to

improve understanding of the benefits

of exercise for prevention and treatment

of chronic conditions. Moreover, GPs

are being encouraged to ‘make every

contact count’ on the back of a report2

recommending health professionals to

ask patients about their lifestyle, smoking,

alcohol consumption, diet and, for the point

of this article, exercise at every contact.

The paramount questions appear to

be around the evidence for the benefits

of exercise (including sport), particularly

specific training in athletic populations and

how this may transfer to the general public,

as well as the need to get people doing

more exercise and how we go about doing

this.

THE EVIDENCE FOR EXERCISE

The evidence for the benefit of exercise

goes back to ancient times. According to

Plato (427–347 BC) medicine was the sister

art of physical exercise. Hippocrates noted

that in order to remain healthy ‘the entire

day should be devoted exclusively to ways

and means of increasing one’s strength and

staying healthy, and the best way to do so is

through physical exercise’. Asclepiades of

Bithynia in the 2nd century BC founded as

scientific theory the therapeutic effect of

healing exercises, massage, and movement

in water, all of which are used in modern

health and sports medicine practice.

Jumping forward a few thousand years

to our modern world of evidence-based

approaches and published databases;

there is a large body of quality evidence for

the benefits of exercise and physical activity

that spans over 20 health problems. There

is also a growing body of evidence linking a

sedentary lifestyle as a risk factor for early

mortality irrespective of physical activity

participation.

The importance of physical activity for

national health was identified by seminal

work in the 1950s. By comparing bus

drivers to more physically active bus

conductors and office-based telephonists

with postmen, Jerry Morris demonstrated

lower rates of coronary heart disease

and smaller uniform sizes in the more

physically active occupations.3 Five

decades of further research has revealed

the benefits of exercise for patients with

arthritis on pain and disability; in dementia

progression; on risk of developing diabetes

in high risk patients; in post-menopausal

women and hip-fracture rates; reduction in

symptoms in patients susceptible to anxiety

and depression; as a treatment for chronic

fatigue syndrome; and on quality of life

across multiple patient groups.4

Recent focus has turned to the importance

of increasingly sedentary lifestyles adopted

by many in the developed world. According

to the World Health Organization, physical

inactivity is the fourth leading risk factor

for global mortality, accounting for 6% of

deaths globally.5 Data from a large well

conducted longitudinal study (Aerobic

Centre Longitudinal Study) puts a lack of

cardiorespiratory fitness (low fitness) above

obesity, hypertension, diabetes, and other

risk factors as the strongest predictor of

death,6 and improving fitness is better than

a reduction in fatness for risk of death

and cardiovascular disease.7 While there

are drugs for favourable improvement in

many of the other risk factors, the only

way to improve cardiorespiratory fitness

is through physical activity and exercise.

Moreover, numerous pharmacological

agents are available that will effectively

lower values for a variety of disease and

mortality-related risk factors in lots

of people. However, they will not, by

themselves, give the prescribed a sense

of self-worth, achievement, belonging,

friendship, challenge, adrenaline, better

mood, sleep, functional capacity, a social

network, and a potential new friend (dog

walking). However, there is one form of

medication that has the potential to give all

of these benefits as well as improving risk

factor scores; exercise.4

HEALTHCARE PROFESSIONALS

AND EXERCISE

The evidence then for the benefit of exercise

and the harms caused by not doing it

appears strong, robust, and creditable.

And even if some disagree, do we need

a randomised controlled trial to convince

us that 3 weeks in bed is bad for an

otherwise healthy person? So what about

healthcare practitioners themselves? The

House of Lords committee cite a recent

survey of 48 London GP practices where

no GP was aware of the latest physical

activity guidelines.1 In those that are

aware, there may be a blurring of the

line between ‘exercise advice’ and ‘exercise

prescription’.8 Moreover, some healthcare

professionals may demonstrate confidence

and enthusiasm for giving advice, but this

may not be supported by the knowledge

of what to actually recommend.9 Arming

healthcare professionals with more

knowledge on what, when, and how much

could result in significantly better results.

As far back as 1982 Dr Domhnall MacAuley

was encouraging GPs to at least ‘know

“Now is an opportune time for general medicine in

the UK to take the practice of exercise prescription

and sports medicine as seriously as the prescribing

of drugs.”

96 British Journal of General Practice, February 2013

Sport and exercise medicine:

a hot topic thanks to the Olympics

The Review

“According to the World Health Organization, physical

inactivity is the fourth leading risk factor for global

mortality, accounting for 6% of deaths globally.”

British Journal of General Practice, February 2013 97

enough basic exercise physiology and its

applications’ and that the old advice ‘to

take more exercise’ is simply not enough.10

Others advocate that we should be

‘prescribing’ exercise, in much the same

way we prescribe medications, to promote

the ethos that ‘exercise is medicine’.11 Any

increase in prescription of a treatment will

see an increase in the number reporting

side effects. In the case of exercise, these

are most likely to be minor musculoskeletal

injuries, with major side effects (for

example, cardiac arrest) a very uncommon

occurrence, at least in marathon running.12

The GP is often the first port of call for

an individual with a sports-related injury

and they should therefore have sufficient

expertise in management of sports-related

injuries to ensure as quick a return to

active sport as possible. I’d be interested to

know how many GPs would still treat such

patients with the ill-advice to ‘rest up for a

few days’?13 Dr MacAuley asked whether

we ‘care enough for those who try to help

themselves?’10 Twenty years on and I’m not

totally certain that we do.

An estimated 80% of the UK population

visit their GP once a year.1 Having hosted

the biggest sporting event of all time, very

successfully may I add, and with a legacy

of increasing sport participation, GPs in

the UK would do well to be armed with the

knowledge and skills to prescribe exercise

and deal with the minor risks associated

with it. However, based on the current

curriculum for GP qualification in Britain,14

I’m not sure that it won’t simply fall on

those practicing doctors that like to go for

a run.15 Perhaps now is an opportune time

for general medicine in Britain to take the

practice of exercise prescription and sports

medicine as seriously as the prescribing

of drugs, the way some of our Australian

peers seem to be doing.16

David Nunan,

Research Officer, Primary Care Health Sciences

University of Oxford, Oxford.

Provenance

Freely submitted; not externally peer reviewed.

DOI: 10.3399/bjgp13X663163

ADDRESS FOR CORRESPONDENCE

David Nunan

University of Oxford, Primary Care Health Sciences,

Radcliffe Observatory Quarter, Woodstock Road,

Oxford, OX2 6GG, UK.

E-mail: david.nunan@phc.ox.ac.uk

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Sport and exercise science

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1st Report of

Session 2012–2013. London: The Stationery

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2. NHS Future Forum.

Summary report —

second phase.

London: DoH, 2012. http://

www.dh.gov.uk/prod_consum_dh/groups/

dh_digitalassets/documents/digitalasset/

dh_132085.pdf (accessed 14 Jan 2013).

3. Morris JN, Heady JA, Raffle PAB,

et al

Coronary heart-disease and physical activity

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4. Kokkinos P, Myers J. Exercise and physical

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5. World Health Organization.

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Recommendations on Physical Activity for

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6. Blair SN. Physical inactivity: the biggest

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J Sports Med

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7. Lee DC, Sui X, Artero EG,

et al

. Long-term

effect of changes in cardiorespiratory fitness

and body mass index on all-cause and

cardiovascular disease mortality in men.

Circulation

2011; 124(23): 2483–2490.

8. Cottrell E, Roddy E, Foster NE. The attitudes,

beliefs and behaviours of GPs regarding

exercise for chronic knee pain: a systematic

review.

BMC Fam Pract

2010; 18(11): 4.

9. Douglas F, Torrance N, van Teijlingen E,

et al

Primary care staff’s views and experiences

related to routinely advising patients about

physical activity. A questionnaire survey.

BMC

Public Health

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general practice?

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32(244): 700–701.

11. Khan KM, Weiler R, Blair SN. Prescribing

exercise in primary care. Ten practical steps

how to do it.

BMJ

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12. Kim JH, Malhotra R, Chiampas G,

et al

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Associated Cardiac Arrest Event Registry

(RACER) Study Group. Cardiac arrest during

long-distance running races.

N Engl J Med

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et al

Resting injured limbs delays recovery: A

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J Fam Pract

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706–712.

14. Royal College of General Practitioners.

curriculum statements.

London: RCGP, 2011.

http:// www.rcgp-curriculum.org.uk/rcgp_-_

gp_curriculum_documents/gp_curriculum_

statements.aspx (accessed 14 Jan 2013).

15. Lobelo F, Duperty J, Frank E. Physical activity

habits of doctors and medical students

influence their counselling practices.

Br J

Sports Med

2009; 43(2): 89–92.

16. Barry Y. Doctors taught to prescribe

exercise.

Herald Sun

2011; Sept 9: http://

www.heraldsun.com.au/news/more-news/

doctors-taught-to-prescribe-exercise/story-

fn7x8me2-1226132613115 (accessed 14 Jan

2013).

International Sport Science and Sport Medicine Conference, Newcastle upon Tyne, UK

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