Exercise Science and Sport Medicine: An ancient account

Abstract

The benefits of exercise and physical activity is not a new concept but instead, one that has persevered for thousands of years. In this context, physicians emphasised the importance of physical activity and exercise in addition to eating a balance diet in order to promote health rather than just the prevention of disease. The earliest known population to have institutionalised medicine as a fundamental practice was the ancient Egyptians. Materials. The connection between exercise and medicine can trace its roots back to three ancient physicians; Herodicus (480-? BC), Hippocrates (460-370 BC) and Galen (129-210 AD) (5). Research methods. Information sources analysis and summarizing. Results. The first known study of what was termed "therapeutic gymnastics" or "gymnastic medicine" was conducted by Greek physician and paidotribes (a formal tutor in sport, wrestling and gymnastics), Herodicus. Herodicus, both a physical educator and physician, served as both a tutor and mentor to Hippocrates, commonly referred to as the "Father of Medicine". Much of what we know about medicine in the ancient world can be attributed to the writing of Hippocrates. Hippocrates advocated for the inclusion of exercise and physical activity in order to maintain health. Just as Herodicus influenced Hippocrates, it was Hippocrates who was a major influencing factor on Roman physician Claudius Galenus or Galen. Although much of what they believed to be true (Galenic Humoral Theory) has been disproved, they did emphasize the important of exercise and physical activity for health including laying the foundations for the development of exercise science and sports medicine as a medical discipline. Conclusion. Exercise and physical activity are commonly accepted as being beneficial to one's health. Beginning with the ancient Egyptians and spreading into Greece, sport medicine was developed in parallel to preventative medicine chiefly through the efforts of three physicians. It was also during this period that health and the practice of medicine was separated from the supernatural and spiritual world and began to basis it in empirical science. Practices in military medicine were therefore utilised in the gymnasium and at sporting events in order to return athletes to competitive effectiveness in the shortest period possible. Therefore, without Herodicus, Hippocrates and Galen, our understanding of exercise and medicine in sport would be incomplete.

Full text

93
RUSSIAN JOURNAL OF PHYSICAL EDUCATION AND SPORT
Volume 14 No.2 2019
DOI: 10.14526/2070-4798-2019-14-2-110-115
Exercise Science and Sport Medicine: An ancient account
Lee Hill1,2
1Department of Exercise Science and Sports Medicine, Faculty of Health Science, University of
Cape Town, Cape Town, South Africa
2 Division of Gastroenterology and Nutrition, Department of Paediatrics, McMaster University,
Hamilton, Canada
hill.lee.devlin@gmail.com
Abstract: The benets of exercise and physical activity is not a new concept but instead, one that
has persevered for thousands of years. In this context, physicians emphasised the importance
of physical activity and exercise in addition to eating a balance diet in order to promote health
rather than just the prevention of disease. The earliest known population to have institutionalised
medicine as a fundamental practice was the ancient Egyptians. Materials. The connection
between exercise and medicine can trace its roots back to three ancient physicians; Herodicus
(480 -? BC), Hippocrates (460-370 BC) and Galen (129-210 AD) (5). Research methods.
Information sources analysis and summarizing. Results. The rst known study of what was
termed “therapeutic gymnastics” or “gymnastic medicine” was conducted by Greek physician
and paidotribes (a formal tutor in sport, wrestling and gymnastics), Herodicus. Herodicus, both
a physical educator and physician, served as both a tutor and mentor to Hippocrates, commonly
referred to as the “Father of Medicine”. Much of what we know about medicine in the ancient
world can be attributed to the writing of Hippocrates. Hippocrates advocated for the inclusion
of exercise and physical activity in order to maintain health. Just as Herodicus inuenced
Hippocrates, it was Hippocrates who was a major inuencing factor on Roman physician Claudius
Galenus or Galen. Although much of what they believed to be true (Galenic Humoral Theory) has
been disproved, they did emphasize the important of exercise and physical activity for health
including laying the foundations for the development of exercise science and sports medicine as a
medical discipline. Conclusion. Exercise and physical activity are commonly accepted as being
benecial to one’s health. Beginning with the ancient Egyptians and spreading into Greece, sport
medicine was developed in parallel to preventative medicine chiey through the efforts of three
physicians. It was also during this period that health and the practice of medicine was separated
from the supernatural and spiritual world and began to basis it in empirical science. Practices in
military medicine were therefore utilised in the gymnasium and at sporting events in order to
return athletes to competitive effectiveness in the shortest period possible. Therefore, without
Herodicus, Hippocrates and Galen, our understanding of exercise and medicine in sport would
be incomplete.
Keywords: Sport medicine, Sport History, Exercise Science, Ancient Greece.
For citation: Lee Hill. Exercise Science and Sport Medicine: An ancient account. The Russian Journal of
Physical Education and Sport. 2019; 14(2): 93-97. DOI: 10.14526/2070-4798-2019-14-2-110-115
EXERCISE SCIENCE AND SPORT
MEDICINE: AN ANCIENT ACCOUNT
Today, it is well established that exercise is good
for one’s health and that inadequate physical activity
can be detrimental to overall bodily function (1,2)
and has been shown to be benecial to a number
of other systems including mental health (3) and
social well-being (4). Classical Greek preventive
hygiene formed a fundamental part of the formal
medical training through the 18th century and
early 19th century and was later included into the
“laws of health” (5). These laws, their balance and
maintenance were something that was the sole
responsibility of the individual. Accordingly, “self-
help”, “self-regulation”, “self-management”, “health
behaviour” and “personal health” were all popular
terms used to dene and describe preventative
medical literature of the 19th century (5–7).
Although the research supporting these claims
are relatively recent in historical terms, the
recognition of the necessity of sufcient exercise
for healthy living has at least been document since
Herodicus (480 -? BC), Hippocrates (460-370
BC) and Galen (129-210 AD) (5). The concept of

94
RUSSIAN JOURNAL OF PHYSICAL EDUCATION AND SPORT
Volume 14 No.2 2019
RUSSIAN JOURNAL OF PHYSICAL EDUCATION AND SPORT
Volume 14 No.2 2019
medicine as articulated by Hippocrates and Galen
became known as “humoral theory” and up to the
18th century was often referred to “Galen medical
theory” (5). Exercise then was incorporated into
much of the early regimen, hygiene and preventative
medicine literature and was recommended as a cure
for a number of ailments including gout, dyspepsia
and consumption (5).
The benets of exercise and physical activity is not
a new concept but instead, one that has persevered
for thousands of years. Much of the last 200 years of
Western mainstream medicine and healthcare has
focused primarily on the notion of “sick care” and
devoting much of its time to treatment rather than
prevention. (8). However, prior to 19th and 20th
centuries, a large proportion of a physician’s duties
were dedicated to the preservation and promotion of
health through exercise, diet and lifestyle (regimen)
leading to prevention of disease (9). In this context,
physicians emphasised the importance of physical
activity and exercise in addition to eating a balance
diet in order to promote health rather than just the
prevention of disease (5). These ideas can be traced
as far back as antiquity (9). According to the medical
historians Baas and Handerson (10), antiquity
ended with the death of Galen in 210 AD (7,9,11).
Therefore, for the purpose of this essay, as described
by Tipton (7), the term antiquity refers to the time
period between 3000 BCE and 200 CE.
Medicine in some form has been practiced for
thousands of years beginning with primitive folk
ways of diagnosing, treating and preventing diseases;
largely believed to be spiritual in nature (9). The
earliest known population to have institutionalised
medicine as a fundamental practice was the ancient
Egyptians (12,13) with the earliest known physician
being Imhotep (2980 BCE) whose name was give
to a temple university Men-Nefer, now Memphis
(12). It is interesting to note that Hippocrates, the
so-called “father of medicine” studied for a period
under the guidance of the “Kemetic” (Egyptian)
priest-magician-physicians or healers (12).
However, only some fourteen medical papyri have
survived long enough to be discovered in a relatively
intact condition (13). These texts represent what
was known about medical science over the period
of 2000 years beginning with the Kahun Papyrus
(approximately 1850 BCE) to the second century
A.D. with the Vindob Papyrus 6257 (Crocodilopolis)
(14).
Ancient Greek origins of exercise science and
sport medicine
HERODICUS
The connection between exercise and medicine
can trace its roots back to three ancient physicians;
Herodicus (480 -? BC), Hippocrates (460-370 BC)
and Galen (129-210 AD) (5). The rst known study
of what was termed “therapeutic gymnastics” or
“gymnastic medicine” was conducted by Greek
physician and paidotribes (a formal tutor in sport,
wrestling and gymnastics), Herodicus (7). Through
observational studies, Herodicus noted that his
weakest students could be made stronger through
regimented exercise routines (15). A scientic divide
was noted between physicians and paidotribes,
which resulted in physicians being barred from
entering gymnasiums (15). As a result, physicians
had a poor understanding of the world of sport.
However, as Herodicus was trained both a physician
and a physical educators (paidotribes), he was able
to combine both worlds with a unique perspective.
Herodicus believed that body could benet greatly
from exercise and that physicians should be trained
to recognise bodily exercise and its prescription as
a core principle in the maintenance of health (7).,
it was noted that Herodicus was the rst physician
to suggest that a patient should minimise bed rest
and start moving as part of rehabilitation, now a
commonly prescribed treatment in contemporary
medicine (15). His belief that physical activity,
nutrition and disease were inextricably linked, has
persisted through medical literature into present
day (7).
HIPPOCRATES
If Herodicus was considered by many to be
the “father of sports medicine” (5,7,15), then it is
Hippocrates who is considered to be the “father
of scientic medicine” (5,7,9,16). Most historians
believe that Hippocrates’ interest in exercise,
nutrition and health was largely due to the inuence
from Herodicus (5,7,16,17). It was Hippocrates who
was credited as the chief compiler of approximately
78 treatises on Greek medicine that became known
as the “Corpus Hippocraticum” (5,18). However,

95
RUSSIAN JOURNAL OF PHYSICAL EDUCATION AND SPORT
Volume 14 No.2 2019
it appears that Hippocrates also authored two
separate works known as the “Regimen in Health”
and “Regimen” (5,7,9). Within “Regimen in
Health”, Hippocrates advised on a number of topics
including nutrition, exercise and physical activity
for each season and even devoted an entire chapter
to “athletes in training” (7,19). Much of the second
book, “Regimen”, written in 400 BC, was devoted to
exercise and training (5). Further, Hippocrates was
the rst to prescribe discrete amounts exercise for
disease conditions and as treatment was expected
to last a year, the prescription included implicit
instructions on how it should progress during that
time (7).
It is important to note that the contributions
by Hippocrates also extended to surgery and
traumatology (20). A number of surgical
interventions where characterised and described,
specically procedures for injuries that occurred in
war as well as in sport. Sport in the ancient world
originated as war games (21) and were extremely
violent and often resulted in maiming or death (21).
Most events centred around combat sports and war
skills, ie. Boxing, wrestling, javelin and running and
since death was a recognised risk of participation,
athletic fatalities were not considered homicide
(21). The constant threat of injury and death in the
name of victory provided the ancient physicians
and athletic trainers unparallel experience in
emergency medicine, traumatology and surgery.
Hippocrates himself noted that “Whoever wants to
practice surgery needs to go to war” and during that
time, sport was war. Military experience therefore
augmented the understanding or traumatic injuries
and how to treat them in such a way as to return the
soldier or athlete back to combat effectiveness in the
shortest period possible.
GALEN
Just as Herodicus inuenced Hippocrates, it was
Hippocrates who was a major inuencing factor
on Roman physician Claudius Galenus or Galen
(129-210 AD) (7,9,22). Galen was so inuential
on medical and health practices that his ideas
persisted for more than 1400 years (7). Galen was
a strong advocate of exercise for achieving health
and that a lack or excess of exercise could cause
illness, however Galen never quantied the exact
relationship (7). According to Galen, exercise should
be vigorous enough to increase breathing, pulse and
loss of moisture (sweat) (7,9,22). In terms of Galenic
theory, work and exercise were equivalent terms
and a number of activities could be considered
either (7). Galen’s most notable contribution on
health and exercise can be found in the works
called “On Hygiene” (23,24). Galen believed that
exercise formed an important branch of hygiene
with hygiene being one aspect of the science of
medicine (5). The books primarily focused on the
role that exercise has in health-related issues. Their
specic focus was prescriptive, describing when one
should exercise, what is considered exercise and its
intensity. However, some aspects of Galen’s theory
surrounding the physiology and science of exercise
were still accepted and followed (Tipton, 2014)
CONCLUSION
Exercise and physical activity are commonly
accepted as being benecial to one’s health.
Beginning with the ancient Egyptians and spreading
into Greece, sport medicine was developed in
parallel to preventative medicine chiey through
the efforts of three physicians. Although much of
what they believed to be true (Galenic Humoral
Theory) has been disproved, they did emphasize
the important of exercise and physical activity for
health. It was also during this period that health
and the practice of medicine was separated from
the supernatural and spiritual world and began to
basis it in empirical science. Practices in military
medicine were therefore utilised in the gymnasium
and at sporting events in order to return athletes
to competitive effectiveness in the shortest period
possible. Therefore, without Herodicus, Hippocrates
and Galen, our understanding of exercise and
medicine in sport would be incomplete.
REFERENCES
1. Wilson MG, Ellison GM, Cable NT.
Basic science behind the cardiovascular benets
of exercise. British Journal of Sports Medicine
[Internet]. 2016 Jan 4;50(2):93–9. URL: http://
bjsm.bmj.com/lookup/doi/10.1136/bjsports-2014-
306596rep
2. Warburton DER. Health benets of physical
activity: the evidence. Canadian Medical Association
Journal [Internet]. 2006 Mar 14;174(6):801–9.

96
RUSSIAN JOURNAL OF PHYSICAL EDUCATION AND SPORT
Volume 14 No.2 2019
RUSSIAN JOURNAL OF PHYSICAL EDUCATION AND SPORT
Volume 14 No.2 2019
URL: http://www.cmaj.ca/cgi/doi/10.1503/
cmaj.051351
3. Mandolesi L, Polverino A, Montuori S, Foti
F, Ferraioli G, Sorrentino P, et al. Effects of Physical
Exercise on Cognitive Functioning and Wellbeing:
Biological and Psychological Benets. Frontiers
in Psychology [Internet]. 2018 Apr 27;9. URL:
http://journal.frontiersin.org/article/10.3389/
fpsyg.2018.00509/full
4. Wann DL. Understanding the positive social
psychological benets of sport team identication:
The team identication-social psychological
health model. Group Dynamics: Theory, Research,
and Practice [Internet]. 2006;10(4):272–
96. URL: http://doi.apa.org/getdoi.cfm?d
oi=10.1037/1089-2699.10.4.272
5. Berryman JW. Exercise and the Medical
Tradition from Hippocrates through Antebellum
America: A Review Essay. In: Berryman JW, Park
RJ, editors. Sport and exercise science: essays in
the history of sports medicine. 1st ed. Chicago, IL:
University of Illinois Press; 1992. p. 1–56.
6. Reiser SJ. Responsibility for Personal
Health: A Historical Perspective. Journal of
Medicine and Philosophy [Internet]. 1985 Feb
1;10(1):7–18. URL: https://academic.oup.com/
jmp/article-lookup/doi/10.1093/jmp/10.1.7
7. Tipton CM. The history of “Exercise
Is Medicine” in ancient civilizations. Advances
in Physiology Education [Internet]. 2014
Jun;38(2):109–17. URL: http://www.physiology.
org/doi/10.1152/advan.00136.2013
8. Berryman JW. Exercise is medicine: A
historical perspective. Current Sports Medicine
Reports. 2010;9(4):195–201.
9. Tipton CM. Historical Perspective: The
Antiquity of Exercise, Exercise Physiology and the
Exercise Prescription for Health. In: Simopoulos
AP, editor. Nutrition and Fitness: Cultural, Genetic
and Metabolic Aspects. Shanghai, China: KARGER;
2008. p. 198–246.
10. Baas J., Handerson HE. Outlines of the
History of Medicine and the Medical Profession.
Huntington, NY.; 2018.
11. Nutton V. The Fatal Embrace: Galen
and the History of Ancient Medicine. Science in
Context [Internet]. 2005 Mar;18(1):111–21. URL:
http://www.journals.cambridge.org/abstract_
S0269889705000384
12. Ergen E. Roots of sports medicine. Archivos
de Medicina del Deporte. 2014;31(162):263–7.
13. Ritner RK. Innovations and Adaptations
in Ancient Egyptian Medicine. Journal of Near
Eastern Studies [Internet]. 2000 Apr;59(2):107–
17. URL: https://www.journals.uchicago.edu/
doi/10.1086/468799
14. Da Silva Veiga PA. Health and medicine in
ancient Egypt: magic and science. Bar Archaeopress;
2008.
15. Georgoulis AD, Kiapidou I-S, Velogianni L,
Stergiou N, Boland A. Herodicus, the father of sports
medicine. Knee Surgery, Sports Traumatology,
Arthroscopy [Internet]. 2007 Feb 27;15(3):315–8.
URL: http://link.springer.com/10.1007/s00167-
006-0149-z
16. Orfanos C. From Hippocrates to modern
medicine. Journal of the European Academy
of Dermatology and Venereology [Internet].
2007 Jul;21(6):852–8. URL: http://doi.wiley.
com/10.1111/j.1468-3083.2007.02273.x
17. Kritikos A, Bekiari A, Nikitaras N, Famissis
K, Sakellariou K. Hippocrates’ counselling with
regard to physical exercise, gymnastics, dietetics
and health. Irish Journal of Medical Science
[Internet]. 2009 Sep 3;178(3):377–83. URL: http://
link.springer.com/10.1007/s11845-009-0323-7
18. Angeletti LR. The origin of the Corpus
Hippocraticum from ancestors to Codices Antiqi:
the Codex Vaticanus Graecus 276. Medicina nei
secoli [Internet]. 1991;3(2–3):99–151. URL: http://
www.ncbi.nlm.nih.gov/pubmed/11640125
19. Bartoš H. Studies In Ancient Medicine. In:
Scarborough J, van der Eijk PJ, Hanson AE, Ziegler
J, editors. The Hippocratic Treatise On Glands.
Leiden, NL: Koninklijke Brill; 2015. p. 47–99.
20. Appelboom T, Roufn C, Fierens E. Sport
and medicine in ancient Greece. The American
Journal of Sports Medicine [Internet]. 1988 Nov
23;16(6):594–6. URL: http://journals.sagepub.
com/doi/10.1177/036354658801600607
21. Kidd B. The myth of the ancient Games †.
Sport in Society [Internet]. 2013 May;16(4):416–24.
URL: http://www.tandfonline.com/doi/abs/10.108
0/17430437.2013.785753

97
RUSSIAN JOURNAL OF PHYSICAL EDUCATION AND SPORT
Volume 14 No.2 2019
22. Berryman JW. The art of medicine: Motion
and rest: Galen on exercise and health. The Lancet
[Internet]. 2012;380(9838):210–1. URL: http://
dx.doi.org/10.1016/S0140-6736(12)61205-7
23. Papavramidou NS, Papavramidis ST,
Christopoulou-Aletra H. Galen on Obesity: Etiology,
Effects, and Treatment. World Journal of Surgery
[Internet]. 2004 Jun 6;28(6):631–5. URL: http://
link.springer.com/10.1007/s00268-004-7458-5
24. Dunn PM. Galen (AD 129-200) of Pergamun:
anatomist and experimental physiologist. Archives
of Disease in Childhood - Fetal and Neonatal Edition
[Internet]. 2003 Sep 1;88(5):441F – 443. URL:
http://fn.bmj.com/cgi/doi/10.1136/fn.88.5.F441
25. Pavlov S.E. Modern sport medicine as service
of medicobiological physical training ensurance
of highly qualied sportsmen. Pedagogiko-
psihologicheskie I mediko-biologicheskie problemy
zicheskoj kul’tury I sporta = Pedagogico-
psychological and medico-biological problems of
physical culture and sports. 2009; 4(2): 84-106.
URL: http://www.journal-science.org/upload/
article/4/1/6/2_2009_10.pdf (In Russ., In Engl.)
Submitted: 21.05.2019
Author’s information:
Lee Hill - B. Sc (Med)(Hons), PhD (Candidate), Department of Exercise Science and Sports
Medicine, Faculty of Health Science, University of Cape Town, Cape Town, South Africa; Division of
Gastroenterology and Nutrition, Department of Paediatrics, McMaster University, Hamilton, Canada,
e-mail: hill.lee.devlin@gmail.com