Bright future for exercise prescription? – Guest blog by Dr. Stephen Chew

Sport and Exercise Medicine: The UK trainee perspective (A monthly series on the BJSM blog)

I was lucky enough to spend Thursday evening at a dinner with Professor Parveen Kumar of  “Clinical Medicine” [1] fame. In her impromptu after dinner speech, she gave us some down to earth advice. One of her themes was don’t moan, because if you do, you tie yourself into rectifying what you’re moaning about. Hence after moaning that I didn’t know enough applied physiology, I find myself in a sabbatical year studying for a Masters in Sport Sciences (Human Performance) at Brunel University.

Sport & Exercise Science and Physiology has developed immeasurably since the first edition of Kumar and Clark. In the UK, the University of Birmingham was the first to appoint a sports science lecturer in 1971 in the shape of Craig Sharp. In the late 1970s a leap forward occurred with the formation of the precursor to BASES (British Association of Sport and Exercise Sciences). Services to elite sport were sporadic and ad hoc (largely observational and under-utilised) prior to the inception of the British Olympic Medical Centre (part of the BOA) in 1987 founded by Professor Craig Sharp and Dr Mark Harries, a chest physician and Chief of Clinical Services at Northwick Park Hospital. Mark served as Chair of the Intercollegiate Board on Sports Medicine and was instrumental in having sports medicine recognized as an independent medical specialty.  This now provides a training route for those wishing to be qualified as Consultants in Sport and Exercise Medicine.

Fast forward to the 21st century and our knowledge of the benefits of exercise for the health of the population has also developed exponentially. For example, the Hagberg et al 2010-review paper [2] on the previous years advances in exercise genomics literature provides strong evidence for gene-exercise interaction effects in diabetes medicine. In terms of obesity medicine, regular exercise may reduce the obesity promoting effects of over ten genetic loci associated with obesity. More research is required to elucidate the exact phenotypic relationships to obesity that these GWAS (Genome Wide Association Studies) have within individuals and populations.

Cardiovascular and pulmonary rehabilitation, as well as obesity medicine all stand to benefit greatly from advances in our understanding of exercise with even a suggested move away from low level aerobic exercise to high intensity interval  [3] and resistance exercise [4].

Potentially the days of ” just go for a gentle walk” are over. Doctors in the future may have to collaborate and learn much more about the “exercise sciences”.  This has seen a pivotal moment in the UK health system whereby the new physical activity guidelines released in July of this year now predetermine exercise levels and intensity for all age groups to promote health for the nation [5].

But where do I work predominantly with these sport scientists? Unfortunately it’s not within the NHS. Usually the Sport Scientist is seen within the realms of an elite sports team. Periodising macro, meso and micro cycles, liaising with coaches, and passing on pitchside tactics and generally getting the players off their behinds.

Along with Hagberg and Rankinen’s next Advances in Exercise and Fitness review due to be published early in the new year, I eagerly await the NHS catching up and incorporating a multi-disciplinary approach where sport and exercise scientists and physiologists, physiotherapists, doctors, nurses and affiliated specialties collaborate fully for the benefit of our patients.

References:

1. Kumar P, Clark M.  Clinical Medicine. 7th Edition. Imprint Saunders Ltd. Published 2009. ISBN 978-0-7020-2993-6

2. Hagberg J, Rankinen T, Loos, R et al. Advances in Exercise, Fitness and Performance Genetics. Med. Sci. Sports Exerc., Vol. 43, No. 5, pp. 743–752, 2011

3. Wisloff U, Ellingsen O, Kemi OJ. High-intensity interval training to maximize cardiac benefits of exercise training? Exerc Sport Sci Rev. 2009;37(3):139-146

4.  Anagnostakou V, Chatzimichail K, Dimopoulos S et al. Effects of interval cycle training with or without strength training on vascular reactivity in heart failure patients. J Cardiac Failure. 2011;17(7):585-591

5. Department of Health (July 2011) Start Active, Stay Active: A report on physical activity from the four home countries’ Chief Medical Officers http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_128209

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Dr Stephen Chew is a Sport and Exercise Medicine Registrar in the London Deanery. Currently on an OOPR (Out of Program Research) year he is enrolled and studying for a Masters in Sport Sciences alongside balancing rugby team doctoring and holding an honorary clinical fellow post at UCLH and the OMI. With thanks to Dr Richard Godfrey for his insights into the origin of Sport Sciences in the UK.

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