The Triathlete’s Training Bible will make triathletes smarter, stronger and faster

Review by Ross Tucker

Joe Friel’s Triathlete’s Training Bible, now in its 3rd edition, has become an indispensable tool for triathletes of all levels wishing to improve their performance using evidence-based methods and principles. Of most credit to the book is that it is very obviously a sound theoretical treatise, heavily based on scientific truths, as well as Friel’s own experience of having worked with triathletes for many years. Yet it does not overplay its hand, forcing technical scientific information on the reader and aspirant improver. Rather, it guides decision-making for all situations, covering topics ranging from motivation (the art) to metabolism (the science), always in a very clear, concise and practical manner. As for scientists who work with athletes, the value is in appreciating how Friel balances the complexity of the science of performance, with the requirement to give athletes tangible, easily implementable advice, and this is something all sports scientists can borrow from.

[Also, click here for a link to Joe Friel's blog - ed.]

Cold Water Immersion is one of the latest trends in encouraging recovery. At the Olympics several swim teams set up immersion tanks on the warm-up pool deck for “recovery”.

What are your thoughts? Do you have evidence that they help? Please do share your thoughts on Cold Water Immersion with us at the BJSM.

(Via timesonline.co.uk)

The doctor at the centre of the “Bloodgate” scandal at Harlequins has been suspended from practising medicine pending further investigations into her conduct.

Wendy Chapman, a hospital consultant, has been forbidden by the General Medical Council (GMC) from working as a doctor amid allegations that she deliberately cut the lip of Tom Williams, the Harlequins wing, with a scalpel in order to cover up his attempt to fake an injury using a capsule of red theatrical dye. Read more…

Click here to read the original article.

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My concern with the prophylactic use of NSAIDs occurs in endurance athletes. My anecdotal experience is that endurance runners attempting distances categorised as ultra races (ie longer than a marathon) may regularly take NSAIDs during an event in a misguided attempt to delay muscle fatigue. I have even seen NSAIDs being referred to as “Vitamin I” in some running literature.

Acute renal failure with NSAID therapy is mediated hemodynamically as a result of decreased renal perfusion after inhibition of prostacyclin synthesis. Decreased renal perfusion in ultra distance events can be caused by dehydration. Factor into the equation the muscle breakdown that occurs in these events and possible rhabdomyolysis.

This triple insult to the kidneys can lead to renal failure and dialysis, if not death. I suspect that many ultra endurance athletes, whether this be running or triathlon, are unaware of the possibility of renal failure that may occur when prophylactically taking NSAIDs during an event.

Stephen H. Boyce
Consultant Emergency Medicine
Wishaw General Hospital, North Lanarkshire, Scotland

This month TIME Magazine’s website, picked up on BJSM’s IOC Issue - Screening for Sudden Cardiac Death. Read the article at TIME.com here.

The deadline for proposals for the 2011 IOC World Conference on Prevention of Injury & Illness in Sport is November 1st 2009 - act now!

- K. Khan

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Dear Colleagues,

Based on the tremendous success of the 1st and 2nd World Congresses on Sports Injury Prevention in Oslo in 2005 and Tromsø in 2008, their successor, the IOC World Conference on Prevention of Injury & Illness in Sport, will be held in Monaco from 7 to 9 April 2011. The scientific committee now welcomes your proposals for meeting sessions and speakers. The deadline for submission of proposals is 1 November 2009.

When submitting proposals, please refer to the enclosed definitions of meeting sessions. To be considered for inclusion in the programme, your proposal must strictly follow the format outlined in the enclosed instructions. Your proposal will be evaluated by the scientific committee, and the final programme of invited speakers will be ready by 1 February 2009.

The IOC World Conference on Prevention of Injury & Illness in Sport will follow the model of the 2005 & 2008 congresses, with a multidisciplinary perspective on sports injury prevention for different sports and different injury types, including studies on intervention methods, epidemiology, risk factors and injury mechanisms. However, as reflected by the change in title, the scope of the congress will be expanded from sports injury prevention, to also include the prevention of other health problems associated with sports participation.

The three-day programme will include four or five keynote lectures, about 20 symposia, 15-20 workshops, in addition to free communications and posters. Please note that, at this time, we are asking only for proposals for keynote lectures, symposia and workshops – not abstracts for free communications. The deadline for submission of abstracts for free communications and posters will be 1 January 2011.

Please reply to Cherine Fahmy at info@ioc-preventionconference.org at your earliest convenience, but not later than 1 November 2009.

Note that although the congress committee will cover the cost of accommodation and social events for invited speakers, we will not be able to reimburse travel costs, since we plan to invite a considerable number of international speakers to be able to feature a first-class programme. We encourage you to visit the congress website, where more information will be posted over the next few months.

Monaco is situated on the most beautiful coast in Europe, built on a rock between the Alps and the Mediterranean Sea. Its mild climate, easy access, excellent hotels and security are the principal qualities which make Monaco a prestigious destination for an unforgettable event. Furthermore, the Grimaldi Forum, a state-of- the-art conference centre for the 3rd millennium, daringly built out over the sea with a total area of 35.000 m2, is the perfect location to receive a high standard congress such as the IOC World Conference on Prevention of Injury & Illness in Sport”.

We welcome your programme proposals and look forward to a spectacular congress in Monaco in June 2011! Yours faithfully,

Roald Bahr (s)
President, Scientific Committee

Fredrik Bendiksen (s)
President, Organising Committee

Photo by _Pixelmaniac_ (available under a Creative Commons Attribution-Noncommercial license)

Age-limited spot has long been limited by the veracity of birth certificates but MR imaging appears to provide a safe, reliable way of levelling the playing field. This blog post contains an article from the African press providing the background, MR images of a young, and mature, wrist, and a photo of the team that has provided the science that underpins this new policy.

Fifa’s Age-Check Technology Can End This Charade

All Africa, 02 Sep 2009

You have to imagine that several soccer bosses across the continent wet themselves senseless after football governing body Fifa announced this week that new technological advancements would make it possible to determine the ages of players who will be taking part at the Under-17 Soccer World Cup in Nigeria next month.

Tests will be conducted on players from the 24 competing nations with a new bone magnetic resonance imaging scanner that will accurately determine their ages. This bit of news should have been enough to make many stomachs turn, and several teams will no doubt suddenly undergo major personnel changes in the weeks before the start of the October 24-November 15 junior tournament. Read full article…

Related Articles:

Is MRI the beginning of wisdom for NFF? (234next.com)

Coach claims age cheating rampant in Cecafa U-17 (nation.co.ke)

Nigeria: ‘Probe Under-17 Team Age Scandal’ - I Warned The Country Against Age Cheat - Adamu

(www.allafrica.com)

NFF To Dare FIFA On Bone Test Policy (thisdayonline.com)

At Last NFF Admits 15 Failed MRI Test (234next.com)

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We would like to invite you to join us in London UK Queen Mary for the 2nd ECOSEP Congress European College of Sport & Exercise Physicians, 12th Annual Scientific Conference in SEM.

This international interdisciplinary Sports Medicine congress held every two years, attracts over 400 participants from all over Europe and welcomes sports medicine physicians, physicians, orthopaedic surgeons, academics, researchers, physiotherapists, osteopaths, manual therapists, exercise therapists rehabilitation medicine physicians and students.

For more information and to submit and abstract visit the conference website: www.aesculap-academia.co.uk OR www.ecosep.eu.

To view and download a PDF, click here.

Click here to read the original article.

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We thank Professor Thornton for raising these issues and are grateful for the opportunity to clarify details of the trial protocol and analysis.

There is, in fact, no discrepancy between the description of outcomes in the trial protocol published on the trial web site, the protocol that was registered on the Australian New Zealand Clinical Trials Registry, and the report published in the British Journal of Sports Medicine. All three sources describe the same primary outcomes (risk of soreness and time to injury) and the same secondary outcomes (severity of soreness, time to (”preventable”) muscle/ligament/tendon injuries, time to injuries for which professional care was sought, and perceptions of looseness during and after exercise). In addition, all three sources describe the same secondary analyses of the interactions between frequency of activity, age and strength of belief in affects of stretching and each of the two primary outcomes. Confusion may have arisen because in the trial report we refer to the analysis of the interactions as “outcomes”, although the analyses of interactions were conducted on the same primary and secondary outcomes as listed above. And we may have added to the confusion by inconsistently referring to the perceptions of looseness during and after exercise as either one or two outcomes. We acknowledge that the wording may not have been clear but we reiterate that there was no inconsistency between the analyses described in the protocol, register and trial report.

The protocol, register and trial report describe an analysis of the subset of injuries which could plausibly be prevented by stretching. The protocol (which is more detailed than the registry entry) indicated that the classification of injuries into those that could and could not plausibly be prevented by stretching would be classified by an independent expert. We found that the data lacked sufficient detail to inform decisions about whether individual injuries were preventable so we decided simply to classify all muscle, ligament and tendon injuries as potentially preventable. This decision was made before the allocation code was broken without reference to the data. We did not know, at the time that decision was made, that there would be a significant effect of stretching on the subset of muscle, ligament and tendon injuries.

As the protocol indicated, no adjustment was made for multiple comparisons. We interpret frequentist analyses as Bayesian analyses with vague priors[1] and, from this perspective, the decision not to make adjustments for multiple comparisons is justified. At any rate, there were only two primary outcomes so adjustment for multiple comparisons would not have changed the conclusions from the primary analysis. We agree that the finding of an effect on the secondary outcome of muscle, ligament and tendon injuries is less robust than the finding of an effect on the primary outcome risk of soreness because muscle, ligament and tendon injuries were a secondary outcome. That is why we concluded that stretching “probably reduces the risk of some injuries and does reduce the risk of bothersome soreness”.

Gro Jamtvedt
Executive Director
Norwegian Knowledge Centre for the Health Services, Oslo, Norway

Reference:

1. Barnett V (1973). Comparative Statistical Inference. London:
Wiley.

As you know, the American College of Sports Medicine is actively advocating clinicians take a more active role in exercise prescription. The organization also aims to be politically active – an essential for behaviour change. Here you see a letter that Robert Sallis shared with members; also new ACSM president James Pivarnik wrote to President Obama’s nominee for Surgeon-General. Interesting times with much more attention to behaviour change and advocacy than there was in the past.

- K. Khan

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Prevention involves lifestyle changes, not just diagnostics

As health system reform takes center stage in the United States, prevention has become a hot topic among lawmakers, media and the public.

Some question the cost savings of preventive health care. Does it save money in the long run, or is it an expensive indulgence with too little benefit to justify the up-front cost?

Answer: It depends. While many diagnostics, such as colonoscopies and mammograms, save lives and head off expensive treatment regimens, some may be unneeded. Sound medical judgment and appropriate guidelines are required.

But, everyone can practice prevention in the form of healthy lifestyles, and it doesn’t cost a dime. Better nutrition and higher levels of physical activity don’t increase cost, and they bring a huge payoff in terms of lower health-care costs, increased productivity and greater quality of life. Getting more active, eating a bit healthier, incorporating some kind of movement into everyday life – those are the main keys to health, longevity and disease prevention. It was recently reported that treating obesity was responsible for the biggest jump in health care spending in recent years; obese populations accounted for $303.1 billion in health care costs in 2006, nearly doubling the $166.7 billion spent on these individuals in 2001.

In a very real sense, exercise is medicine. Studies repeatedly show that physical activity and exercise can help prevent obesity, cardiovascular disease, diabetes and other chronic conditions.

And leading a healthier lifestyle needn’t mean hitting the treadmill every night or becoming fanatical about exercise. Walking for 30 minutes each night after dinner or during a lunch hour has powerful preventive effects and requires just a pair of comfortable walking shoes.

Physicians and other health care providers should encourage patients to become physically active. A public survey conducted in 2007 by the American College of Sports Medicine found that nearly two-thirds of patients (65 percent) would be more interested in exercising to stay healthy if advised by their doctor and given additional resources.

Bottom line: While we trim unnecessary costs to better manage health-care resources, let’s keep in mind the powerful and necessary cost-effective potential of healthy lifestyles. Truly, exercise is medicine—a prescription for better health.

Sincerely,

Robert Sallis, M.D., FACSM

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Dear Dr. Benjamin,

Congratulations on your nomination as United States Surgeon General. Based on your extraordinary career and your commitment to addressing health disparities among underserved populations, no doubt your tenure will be marked by great progress toward the goal of improved health for all Americans.

Each United States Surgeon General has the unique opportunity to create his or her own lasting legacy. Dr. Koop focused on smoking prevention. Dr. Satcher, one of your own mentors, released the first comprehensive report on mental health. We encourage you to build your own legacy around the concept o prevention through healthy lifestyles – a legacy that is both sustainable and cost-effective.This also is an important issue for Members of Congress, many of whom believe that promoting prevention and wellness initiatives will bring down costs and help people lead healthier lives.  ACSM would be honored to partner with you on such an initiative.

The American College of Sports Medicine (ACSM), the largest sports medicine and exercise science organization in the world, stands ready to work with you to increase healthy behaviors – especially physical activity – throughout the life span.  During this crucial period of health system reform, we’ve been advocating for strategies that support preventive medicine not just through diagnostic testing, but by promoting healthy, active behaviors that all Americans can achieve at little or no cost.

In fact, ACSM already has a working agreement with the Surgeon General’s office, focused initially on a series of healthy-lifestyle public service announcements for our Exercise is Medicine™ program, a program that specifically calls on doctors to encourage their patients to incorporate physical activity and exercise into their daily routine. As you are well aware, physical activity can prevent and treat a host of chronic conditions – such as heart disease, type II diabetes, and obesity – that currently plague our country. Your example as one whose family has suffered from preventable disease and who demonstrates healthy lifestyles can be powerful indeed.

Anytime either before or after your appointment is confirmed, we would welcome the opportunity to meet with you and your staff to discuss how we, along with other leading health organizations, can enhance the prevention paradigm through physical activity.

Again, Dr. Benjamin, I extend our deepest congratulations and best wishes.

Sincerely,

James Pivarnik, Ph.D., FACSM

President, American College of Sports Medicine