Review of Peter Brukner and Karim Kahn’s “Clinical Sports Medicine” by Dr Arjun Rao, Sports Physician.

This is primarily a UK written sports medicine book whose primary audience is intended to be at an undergraduate level. With the expansion of the specialty as a whole it is always a difficult task to be comprehensive but the major fundamentals have been covered in a very clear and concise manner. The book is well laid out and presented with a generous number of illustrations.

There is a good balance between musculoskeletal injuries and medical based problems. Basic nutrition and exercise physiology have also been included.

The book has been well researched, as you would expect from the quality of the contributors, and each chapter finishes with a short list of further reference material for those interested. I found the information to be very current and up-to-date. Even an aging Sports Physician such as myself was able to learn an extra thing or too!

I was particularly interested in the sports specific injury section; secretly I was hoping that there may have been a medical explanation or two in there from one of the co-editors as to why Chelsea had a trophyless season – never mind!

Overall this book has very few weaknesses, certainly nothing worth mentioning. I feel it has more than achieved it’s aim of reaching the intended target audience and I can see this material becoming a good source reference book in the years to come, with further revisions, especially when Sports Medicine finally becomes a part of the undergraduate UK medical curriculum. No doubt it will encourage a few undergraduate physiotherapy and medical students to enter a Sports Medicine career path.

The WarmUp which summarizes some key issues in 800 words is available free at the site and you can click on it here or view it as a PDF.

The ‘editor’s choice’ which is available for free is the meta-analysis of walking. This simple daily task has many benefits and the dose-response relationship is explored by Hamer and Chida. There appears to be about a 30% reduction in both cardiovascular risk and all-cause mortality with a casual walking dose of about 3 hours per week. Walking pace was a stronger independent predictor of overall risk compared with walking volume (48% versus 26% risk reductions, respectively). Next month there are several other papers highlighting the benefits of walking (see Online First) so this simple physical activity may be more powerful than is often appreciated. A case of ‘a kilometer a day keeps the doctor away’?

I connected with ACSM president Bob Sallis today - he is heading up the ‘Exercise Is Medicine’ initiative through ACSM.

Bob, a family doctor in California, shared his frustration with mainstream medicine overlooking physical activity as the most powerful therapy available to physicians. The Exercise is Medicine initiative aims to have every family doctor assessing current level of physical activity by a simple questionnaire at every consultation. This question would be asked by the office assistant so that the doctor, of course 100% reliable, would not need to take up time to do that.

Patients who are doing less than 150 minutes of physical activity per week could then be readily flagged for interventions. And that is a whole new ball of wax as they say! But there is hope - more and more interventions are proving successful so combining the best of research from psychology, exercise physiology, engineering and electronics should allow us to make a difference. As Bob says, ‘we can convince patients to have their stomach stapled and take medications that sometimes make them feel awful, so promoting physical activity shouldn’t be that difficult!’.

The Exercise is Medicine initiative aims to have every family doctor assessing current level of physical activity by a simple questionnaire at every consultation. This question would be asked by the office assistant so that the doctor, of course 100% reliable, would not need to take up time to do that.

Do you have a successful way of promoting physical activity in the office? And please remember the BJSM special issue for 2009 - Integrating Physical Activity into Clinical Practice.

The April issue of BJSM has 4 papers related to physical activity and health:
check them out online first!

An active school model to promote physical activity in elementary schools: Action Schools! BC
Patti-Jean Naylor, Heather M Macdonald, Darren E. R. Warburton, Katherine E Reed, and Heather A McKay

Walking or vitamin B for cognition in older adults with mild cognitive impairment? A randomized controlled trial
Jannique G.Z. van Uffelen, Marijke J.M. Chinapaw, Willem van Mechelen, and Marijke Hopman-Rock

Effect of commercial airline travel on oxygen saturation in athletes
Celeste Geertsema, Anthony B Williams, Peter Dzendrowskyj, and Chris Hanna

Best The Practice of Primary Care Sports Medicine in the United States
Jason J Diehl, Jason J Pirozzolo, and Thomas M

Submitted by editorial board member Dr Gavin Davis

As clinicians, we often wish we had expert guidance at hand. There are some list-serves that provide this function and we hope that this blog might do the same thing. Feel free to submit difficult cases, and invite submissions from the readership to assist with patient management.

As a starter example, consider the case of a patient presenting to a sports medicine office with a past history of craniotomy for tumour, and insertion ventriculo-peritoneal shunt. She wants medical clearance to be able to play women’s rugby.

What are your thoughts on this case?