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Faculty of Sport and Exercise Medicine UK to host International Visiting Fellows

13 Sep, 17 | by BJSM

News Release

The FSEM (UK) will welcome three visiting fellows from the United States of America, on the 30 September 2017, for a two week programme. The travelling fellowship programme will take in centres of excellence in Sport and Exercise Medicine in the UK, ending with all three international guests presenting at the FSEM (UK) and BASEM Annual Conference, 12-13 October 2017, in the historical town of Bath.

The programme is an exchange between the FSEM (UK) and the American Medical Society for Sports Medicine (AMSSM), to encourage academic interchange, shared research and exploration of common clinical interests among Sport and Exercise Medicine leaders throughout the world. The experience includes the opportunity to view live patient encounters, tour Sport and Exercise Medicine facilities, share cases and spend time with regional experts.

This is the second half of the joint fellowship programme, during the first half of the exchange Dr Simon Kemp, MA, MB, BS, MRCGP, MSc (SEM), FFSEM visited sports medicine centres in Los Angeles, Seattle and the San Francisco area before serving as a keynote speaker at the 2017 AMSSM Annual Meeting in San Diego from May 8-13.

Dr Paul D Jackson, President of the Faculty of Sport and Exercise Medicine UK, comments“We are delighted to welcome our three visiting SEM fellows from the U.S .on this the first reciprocal AMSSM/FSEM travelling fellowship exchange. Our visitors will experience various aspects of SEM as it is practised across the UK including two of our National Centres, Headley Court, The National Football Centre and the EIS in Bath as well as the national conference.” 

AMSSM President Matt Gammons commented: “Hosting a physician with Dr. Kemp’s expertise and experience has added great value to our annual meeting. We are so pleased he was willing to serve as the International Traveling Fellow and allowed us to learn from his perspectives on the treatment and prevention of sports injuries.”

The second half of the exchange will include visits to centres of excellence in Sport and Exercise Medicine around the United Kingdom including the Institute of Sport Exercise and Health (ISEH) in London, the National Centre for Sport and Exercise Medicine in Loughborough, St George’s Park, Twickenham, the English and Scottish Institutes of Sport, the Royal Ballet School and the Defence Medical Research Centre in Headley Court.

The Faculty is looking forward to welcoming its visiting fellows:

Dr E. Lee Rice DO, FAAFP, FAOASM. Dr Rice will be joining as Senior Visiting Fellow, is an AMSSM Founder and Past President and Founder of the Lifewellness Institute. With over thirty years experience as a family and sports medicine physician Dr Rice is an internationally known authority in sports medicine, wellness and preventative medicine having authored numerous medical texts and journal articles.

Dr Ken Barnes MD MSc. Dr Barnes will be joining as a Junior Visiting Fellow and is a Sports Medicine Physician at Greensboro Orthopaedics focusing on the diagnosis and treatment of MSK injuries and conditions with a special interest in non-operative fracture management and sport related concussion. His current research is examining the impact of concussion history on balance, cognitive function, sensory processing, brain electrical activity and the influence of various genetic markers in both collegiate and high school student-athletes.

Dr Mederic Hall MD. Dr Hall will be joining as Junior Visiting Fellow and is Director of Musculoskeletal and Sports Ultrasound at the University Iowa specialising in the diagnosis and treatment of tendon disorders and other sport related MSK disorders with a special interest in the endurance athlete. An internationally recognised expert in diagnostic ultrasound imaging and ultrasound guided procedures. Dr Hall is board certified in sports medicine, physical medicine and rehabilitation, and is team physician for the Uni of Iowa Hawkeyes and the U.S. Ski Team.

The trip will conclude with the three AMSSM Visiting Fellows presenting at the 2017 joint conference of the Faculty of Sport and Exercise Medicine (UK) and British Association of Sport and Exercise Medicine Sport & Exercise – Bringing us all together

The programme was made possible by the generous support of SEMPRIS in the UK and DJO Global in the US.

Canberra physiotherapy students’ commit to making every contact count for physical activity!

10 Sep, 17 | by BJSM

By Nicole Freene @NicoleFreene

A recent Australian study found no change in physical activity levels over the last 20 years. Nearly 60% of Australian adults are not doing enough to receive the health benefits of physical activity [1].

Health professionals need to take advantage of any opportunity to promote physical activity.

In 2015, Ann Gates (@exerciseworks) and her team launched a worldwide interdisciplinary, undergraduate teaching resource on exercise medicine for the prevention and treatment of non-communicable diseases. The physical activity resources consist of national and international strategies and infographics, background introductions, specific disease and health condition slide-sets, a text module, and advice on how to use the resources effectively.  They created a ‘Movement for Movement’ [2, 3]. Part of their mission states:

“A qualified doctor, nurse, midwife or allied health professional may see nearly half a million patients during their career: this has enormous potential for advocacy and the promotion of physical activity. Let’s make every contact count, for physical activity!”

At the University of Canberra we are cultivating this culture of physical activity promotion in our future physiotherapists. We aim to contribute to the movement of global health professionals that are ready to address the worldwide increase in non-communicable diseases. We have introduced the ‘Movement for Movement’ teaching resources to complement our current curriculum. Educating health professionals on the importance of physical activity is a strategy that has been clearly outlined in action plans to promote physical activity around the world [4-6].

The University of Canberra is ranked among the top 100 young universities in the world and is committed to preparing professional and highly employable graduates with the right mix of skills and knowledge. At the University of Canberra we have approximately 320 pre-qualification physiotherapists, a combination of both undergraduate (240) and postgraduate students (80).

In semester-1 2017 the ‘Movement for Movement’ disease and health condition slide-sets were made available to undergraduate and postgraduate physiotherapy students within the unit Cardiothoracic Interventions, and also distributed among the physiotherapy teaching staff. A focus of this unit is exercise-based cardiac rehabilitation. The ‘Movement for Movement’ slide-sets provide information on exercise and physical activity in heart disease and hypertension. The slide-sets also cover a number of non-communicable diseases, such as type 2 diabetes and cancer, and other conditions including pregnancy, surgery, and primary prevention of chronic disease.

Physiotherapy students were provided with the ‘Movement for Movement’ slides for review and future reference. All students were allocated time for self-directed learning to review all the slide presentations. Some of the material within the slide-sets was also covered in face-to-face lectures during the unit. Those that used the resource were asked to provide feedback via a brief survey. Students agreed that the ‘Movement for Movement’ content was engaging, presented in an interesting way and had excellent visual impact. The content in all topics increased their understanding of the benefits of physical activity and exercise; in particular, osteoarthritis, rheumatoid arthritis and dementia.

The students commented:

Really great resource for future and general understanding [of the health benefits of physical activity].

Having a background in exercise science, the material was nothing new, however it was a good refresher for me and I learnt the most from the pregnancy slides 🙂

Was presented very well. Was good for people wanting to complete at their own pace.

Great resources, thank you!

There are plans to distribute these resources more widely within the Faculty of Health to other disciplines such as Pharmacy, Nursing, and Occupational Therapy.

Physiotherapists should use their exercise specialization skills to promote physical activity in any setting. Providing the ‘Movement for Movement’ slide-sets has introduced and reinforced to our students the benefits of exercise and physical activity for a number of conditions early in their pre-qualification training. By educating our future physiotherapists at the University of Canberra to promote physical activity at any opportunity, we aim to make every contact count!


  1. Chau J, Chey T, Burks-Young S, et al. Trends in prevalence of leisure time physical activity and inactivity: results from Australian National Health Surveys 1989 to 2011. Aust N Z J Public Health 2017 doi: 10.1111/1753-6405.12699 [Published Online First: 27 July 2017].
  2. Gates AB. Making every contact count for physical activity–for tomorrow’s patients: the launch of the interdisciplinary, undergraduate, resources on exercise medicine and health in the U.K. Br J Sports Med 2016;50(6):322-23 doi: 10.1136/bjsports-2015-095489 [Published Online First: 19 October 2015].
  3. Gates AB, Kerry R, Moffatt F, et al. Movement for movement: exercise as everybody’s business? Br J Sports Med 2017;51(10):767-68 doi: 10.1136/bjsports-2016-096857 [Published Online First: 2 May 2017].
  4. National Heart Foundation of Australia. Blueprint for an active Australia. 2014.
  5. World Health Organisation. Physical Activity Strategy for the WHO European Region 2016-2025. 2016.
  6. World Health Organisation. Draft WHO global action plan on physical activity 2018 – 2030. 2017.



Clinical Assistant Professor Nicole Freene is a physiotherapist at the University of Canberra.



Ann Gates @exerciseworks

Let’s get physical! It’s ‘Physical activity for life’ today on World Physiotherapy Day 2017

8 Sep, 17 | by atarazia

The Physical Activity and Population Health BJSM Blog Series 

By Sonia Cheng (@soniawmcheng)

Today, September 8 is none other than World Physiotherapy Day, and this year the World Confederation of Physical Therapy (WCPT) is celebrating the profession with the message ‘Physical activity for life’. This message builds on the World Health Organisation’s call for global efforts to reduce physical inactivity by 10% by 2025, and highlights the critical role played by physiotherapists in keeping people active.

Emma Stokes, President of the World Confederation for Physical Therapy, lends us her thoughts on how the physiotherapy profession can promote physical activity through the years and in the wider community.

Sonia Cheng (SC): Emma, we used to think that increasing physical activity was just a matter of “If you can move more, you will move more”. Then both clinical trials and clinical experience started to show us that you could not simply address pain, dyspnoea, or impairments in strength and mobility in isolation. Physical activity is a behaviour, and it is a complex behaviour. How do physiotherapists start to tackle this issue in everyday practice?

Emma Stokes (ES): Regardless of the reason why a person attends a physiotherapist, it represents an opportunity to have a conversation about physical activity. It’s important to be curious about how that person is meeting physical activity recommendations.

SC: Do you think it should become standard care for physiotherapists to set activity goals with their patients with respect to minutes of moderate-vigorous intensity physical activity per week, for example, or steps per day?

ES: It’s not necessarily about being prescriptive about practice, it’s more about raising awareness and exploring solutions to promote healthy levels of exercise and activity. This is a key responsibility for us as a profession as we respond to the challenges facing our communities in living active and healthy lives.

SC: What are some of the steps we can take as a profession to address physical inactivity on a population scale?

ES: World Physiotherapy Day 2017 is one component of the rich tapestry of solutions needed to promote physical activity across the lifespan and in all communities. As part of this year’s theme, the WCPT has a wonderful range of educational resources about the health benefits of physical activity. We also unpack the concept of metabolic equivalents (METs), and try to give examples of how different activities at different intensities can be combined over the course of a week to reach health-enhancing physical activity levels.

SC: How else can we get involved on our special day?

ES: Physiotherapists around the world can organise events in their workplaces and communities to promote “Physical activity for life”. We also come together on social media – last year, we had a rolling tweetchat across the twenty-four hours and three different time zones. See what celebrations and events have been organised in the past. The challenges of enhancing physical activity are enormous, and the solutions will require multifarious collaboration and coordination. World Physiotherapy Day is just one way the global physiotherapy community can come together to advocate for and celebrate our role in promoting health.

Well, you heard Dr Stokes. Get physical on September 8: discuss the physical activity guidelines with your patients and clients, put up posters in your workplace, check out the WCPT toolkit for some great resources about moving more and moving better.

Happy World Physiotherapy Day to all!

We invite you to share and support the Physical Activity and Population Health BJSM Blog Series. Join the conversation on ‘how change happens’ at #PAblogBJSM and #brightspotsBJSM.

If you have ideas for this series please contact:

Sonia Cheng graduated from The University of Sydney with a Bachelor of Applied Sciences (Physiotherapy) (Honours Class I) in 2014. Sonia is currently employed as a physiotherapist with Royal Prince Alfred Hospital and Westmead Hospital in Sydney. 

Invitation to the FIMS Team Physician Advanced Course 23 – 26 September 2017

5 Sep, 17 | by atarazia

By Alexandre Rebelo-Marques (@ARebeloMarques)

On behalf of the Organising Committee, I am pleased to welcome our outstanding faculty and delegates to the Best European Destination in 2017 – Porto, Portugal for the Fédération Internationale de Médecine du Sport (FIMS) Team Physician Advanced Course (TPAC). The course will be held from 23 – 26 September at the auditorium of the FC Porto Stadium right after the 4th Saúde Atlântica & ISAKOS & ESSKA International Meeting.

This FIMS TPAC is a result of the strategic partnership between FIMS and our Institution – Clínica do Dragão, Espregueira-Mendes Sports Centre – FIFA Medical Centre of Excellence and has already received mass attention in the sports medicine world with over:

  • 50 world renowned Speakers
  • 20 countries represented
  • 70 attendees confirmed from 3 continents

As such, it promises to be another highlight in the international sports medicine calendar especially for the new generation of Team Physicians.

The course has been granted 28 European CME credits (ECMEC®s) by the European Accreditation Council for Continuing Medical Education (EACCME®). In addition to this, has received the BJSM Quality Education stamp of approval.

Why is this course important? 

Sport and Exercise Medicine (SEM) is a fast-growing healthcare field, allowing health workers who specialize in sports medicine to help not only athletes, but the general population too. Physical wellbeing among the general public is a growing area, too. Regular, moderate physical activity is essential for staying fit. Participating in sports, however, also carries a risk of being injured.

In the below table, we see that about 6.2 million people are being treated annually in a hospital setting for a sports-related injury as defined by the EU IDB catalogue of sports. Of those, about 7% (402 000 cases) are admitted for further treatment. ‘Team ball sports’ account for about 42% of all (specified) hospital treated sports injuries; by specific type of ball sports the ranking is: Soccer (71%), Handball (9%), Basketball (6%), Volleyball (6%).

Given this, the primary role of the sports medicine physician in competitive sport is the comprehensive health management of the athlete, to facilitate optimal performance along with the diagnosis and treatment of injuries and illnesses associated with exercise to improve athlete performance and prevent injuries. And, in a multidisciplinary team, working with coaches and physiotherapists, this can be a challenge. But, who’s not up for a good challenge?

We suggest that the first step to address the challenges is to be part of this group and show up in September in Porto! You are very welcome and one thing we can promise, is that you’ll love our wine!

Follow us on Facebook and Twitter: #FIMSPORTO2017


  1. Dijkstra, H. P., & Pollock, N. (2014). The role of the specialist sports medicine physician in elite sport. Managing athlete health while optimising performance – a track and field perspective. Aspetar Sports Med J, 3, 24-31.
  2. European statistics on hospital discharges: Eurostat, statistics database, population and social conditions, health, public health, health care activities, hospital discharges by diagnoses. See also: European Community Health Indicators (ECHI): Hospital inpatient discharges (ECHI No. 67).
  3. European Injury Data Base (IDB): DG Health and Consumers, “Health in Europe – Information and Data Interface” (HEIDI): See also European Community Health Indicators (ECHI): Injuries at home, school, and during leisure activities (ECHI No. 29).

One road to Rome: Exercise

24 Aug, 17 | by atarazia

By Dr Nicky Keay (@nickykfitness)

Metabolic syndrome comprises a cluster of symptoms including: hypertension, dyslipidaemia, fatty liver disease and type 2 diabetes mellitus (T2DM). The underlying pathological process is insulin resistance which distorts metabolism. Temporal and mechanistic connections have been described between hyperinsulinaemia, obesity and insulin resistance. Insulin levels rise, potentially stimulated by an excess intake of refined carbohydrates and in addition the metabolic actions of insulin are attenuated on target tissues such as the liver, skeletal muscle and adipose tissue. At a cellular level, inflammatory changes play a part in this metabolic dis-regulation. Mitochondrial action in skeletal muscle is impaired, compromising the ability to oxidise fat as a substrate, thus resulting in muscle glycolysis and a consequent rise in blood lactate.

Although much attention has been focused on restricting calories and treating elevated lipids with medication (statins), evidence is now emerging that this does not have the anticipated effect of reducing mortality from cardiovascular disease. In addition, it has been proposed that the gut microbiota plays a pivotal role in metabolism, inflammation and immunity.

Metabolic syndrome usually conjures an image of an overweight person with or on the verge of developing T2DM. However, there is an interesting group of slim people who are also are at risk of developing metabolic syndrome due to insulin resistance. The majority of women with polycystic ovary syndrome (PCOS) present with menstrual disturbance of some description. However not all display the textbook characteristics of Stein-Leventhal syndrome (overweight, hirsute and with skin problems). There is in fact of spectrum of clinical phenotypes ranging from the overweight to the slim. In all phenotypes of PCOS, the crucial uniting underlying metabolic disturbance is insulin resistance. The degree of insulin resistance has been shown to be related to adverse body composition with increased ratio of whole body fat to lean mass. Although this confuses the picture somewhat, it also simplifies the approach. In all cases one important lifestyle modification is exercise.

Exercise improves metabolic flexibility: the ability to adapt substrate oxidation to substrate availability. Endurance exercise training amongst athletes results in improved fat oxidation and a right shift of the lactate tolerance curve. Conversely metabolic inflexibility associated with inactivity is implicated in the development of insulin resistance and metabolic syndrome.

What about nutritional strategies that could improve metabolic flexibility? Ketogenic diets can either be endogenous (carbohydrate restricted intake) or exogenous (ingestion of ketone esters and carbohydrate). Low carbohydrate/high fat diets (terms often used interchangeably with all types of ketogenic diets) have been shown to improve fat oxidation and potentially mitigate cognitive decline in older people.

In the case of athletes, the benefits of a ketogenic or low carb/ high fat diet do not necessarily translate to better performance. Despite reports of such diets enhancing fat oxidation and favourable changes in body composition, a recent study demonstrates that this, in isolation, does not translate into improved sport performance. A possible explanation is the oxygen demand toincreas oxidation of fat needs to be supported by a higher oxygen supply. The intermediate group of endurance athletes in this study, on the periodised carbohydrate intake, fared better in performance terms. Another recent study, where the majority of participants were women, confirmed that a ketogenic diet failed to improve the performance of endurance athletes, in spite of improving fat metabolism and body composition.

In all likelihood, the reason that these type of diets (ketogenic, high fat/low carb)did not improve sport performance is that only one aspect of metabolism was impacted and quantified. Although fat oxidation, modified via dietary interventions, is certainly an important component of metabolism, the impact on the interactive network effects of the Endocrine system should be evaluated in the broader context of circadian rhythm. For athletes this goes further, to include integrated periodisation of nutrition, training and recovery to optimise performance, throughout the year.

In addition to dietary interventions, medical researchers continue to explore the use of exercise mimetics and metabolic modulators, to address metabolic syndrome. Unfortunately, some have sought their use as a short cut to improved sport performance. Many of these substances appear on the WADA banned list for athletes. However the bottom line is that it is impossible to mimic, either through a dietary or pharmacological intervention, the multi-system, integrated interplay between exercise, metabolism and the Endocrine system.

There is only one road to Rome!

Whatever your current level of activity, whether reluctant exerciser or athlete, the path is the same to improve health and performance. This route is exercise, supported with periodised nutrition and recovery. Exercise will automatically set in motion the interactive responses and adaptations of one’s metabolic and Endocrine system.

For further discussion on Endocrine and Metabolic aspects of SEM come to the BASEM annual conference 22/3/18: Health, Hormones and Human Performance

 Dr Nicky Keay BA, MA (Cantab), MB, BChir, MRCP, Clinical and research experience in Endocrinology applied to Sport and Exercise Medicine


  1. Insulin action and resistance in obesity and type 2 diabetesNature Medicine 2017
  2. Inflammation: Why and How Much?Dr N. Keay, British Association of Sport and Exercise Medicine
  3. The cholesterol and calorie hypotheses are both dead — it is time to focus on the real culprit: insulin resistanceClinical Pharmacist 2017
  4. Skeletal muscle mitochondria as a target to prevent or treat type 2 diabetes mellitusNature Reviews Endocrinology 2016
  5. The essential role of exercise in the management of type 2 diabetesCleveland Clinic Journal of Medicine 2017
  6. β cell function and insulin resistance in lean cases with polycystic ovary syndromeGynecol Endocrinol. 2017
  7. The many faces of polycystic ovary syndrome in Endocrinology. Conference Royal Society of Medicine 2017
  8. Association of fat to lean mass ratio with metabolic dysfunction in women with polycystic ovary syndromeHum Reprod 2014
  9. Sedentary behaviour is a key determinant of metabolic inflexibilityJournal of physiology 2017
  10. International society of sports nutrition position stand: diets and body compositionJ Int Soc Sports Nutr. 2017
  11. A cross-sectional comparison of brain glucose and ketone metabolism in cognitively healthy older adults, mild cognitive impairment and early Alzheimer’s diseaseExp Gerontol. 2017
  12. Low carbohydrate, high fat diet impairs exercise economy and negates the performance benefit from intensified training in elite race walkersJ Physiol. 2017
  13. Ketogenic diet benefits body composition and well-being but not performance in a pilot case study of New Zealand endurance athletesJ Int Soc Sports Nutr. 2017
  14. Sports Endocrinology – what does it have to do with performance?Dr N. Keay, British Journal of Sports Medicine 2017
  15. Hormones and Sports Performance
  16. Endocrine system: balance and interplay in response to exercise training


Premier league injury watch – same old story?

18 Aug, 17 | by BJSM

Undergraduate perspective on Sport & Exercise Medicine  a BJSM blog series

By Jonathan Shurlock (@J_Shurlock)

A new football season is upon us, with the premier league back in action alongside the lower divisions which recently kicked off. Already much of the focus is on who is going to be contending for the premier league title this year, with pundits everywhere adding their two cents. Sporting commentary is filled with often repeated; supposedly insightful phrases. One such adage, which remains true is that to win the league you need to win games. One of the most important undertakings in this process is keeping players healthy, as was nicely explored by Michael Davison recently.[1] In this vein, and inspired by the injury tracking work at the PhysioRoom website, we thought it pertinent to carry out a semi-regular review of premier league injuries. We will aim to give a brief overview of recent injury profiles, and which teams are struggling with injury burden, followed by a more in-depth look at specific injury types.

A review of the weekend’s premier league action indicates seven new injuries picked up by players from five different teams. Before reading ahead, we challenge you to have a go at predicting which injury type was most prevalent amongst these seven. Are you at all surprised that the most frequent injury type seen in the opening weekend is of the hamstring muscles? Simon Francis of Bournemouth, Isaiah Brown of Brighton & Hove Albion, and Paul Dummet of Newcastle all picked up new hamstring injuries; the most common single injury seen in football (More on this topic in this past blog).[2] It certainly seems to be a relevant time to discuss hamstring injury, off the back of watching Usain Bolt bow out from his track career with a potential hamstring injury.

Despite increasing knowledge of the mechanism of hamstring injury, and ongoing research outputs on diagnosis, management and re-injury, the burden of hamstring injury has actually increased in recent years.[3] Perhaps this is due to increased work load, or perhaps due to clubs not utilising evidence based prevention programmes.[4] One thing appears clear, we’re still not getting it right.

The BJSM team have covered hamstring injury in almost every multi-media format, including one of their most popular podcasts with Gustaaf Reurink ( It’s certainly worth checking out the various outputs from Gus’ PhD as they give some great insight into topical areas of hamstring injury including Platelet-rich-plasma use and role of MRI.

Struggling to remember useful hamstring exercises? Have a watch of the following videos for a refresher:

There’s plenty more BJSM hamstring to get into get stuck into via blog posts, podcasts and editorials (just click on the “Hamstring” tag to the right). We’ll revisit in a few weeks and keep an eye on which teams are struggling with injuries, and whether hamstring remains the most common injury type. Additionally we will develop a more in-depth look at the diagnosis, management and return-to-play decisions for some of these injuries.


  1. Davison M. Extra workload will disrupt rhythm of the champions. The Telegraph. 2017;
  2. Askling C. Types of hamstring injuries in sports. Br J Sports Med. 2011 Feb 1;45(2):e2–e2.
  3. Ekstrand J, Waldén M, Hägglund M. Hamstring injuries have increased by 4% annually in men’s professional football, since 2001: a 13-year longitudinal analysis of the UEFA Elite Club injury study. Br J Sports Med. 2016 Jun;50(12):731–7.
  4. Bahr R, Thorborg K, Ekstrand J. Evidence-based hamstring injury prevention is not adopted by the majority of Champions League or Norwegian Premier League football teams: the Nordic Hamstring survey. Br J Sports Med. 2015 Nov;49(22):1466–71.


Jonathan Shurlock is an academic foundation year 2 doctor based in Sheffield. He coordinates the BJSM Undergraduate Perspective blog series. If you would like to contribute to the blog series please email

One small step for a human, and a giant leap for humankind

16 Aug, 17 | by atarazia

Introducing the Physical Activity and Population Health BJSM Blog Series 

By Sonia Cheng (@soniawmcheng)

As you’ve likely read from these previous posts on the BJSM blog, the case to increase population-wide participation in physical activity is stronger than ever. And, like the unsung space heroes at NASA, who crunched the numbers and successfully launched humans into orbit and to the moon1, we as health professionals, researchers, and students play a pivotal role in developing and implementing strategies to address one of the leading risk factors for chronic disease and disability worldwide.

It is an honour to launch the new ‘Physical Activity and Population Health’  BJSM Blog Series. Throughout this series, we’ll bring to you the latest developments in physical activity research, resources, and policy in the area of public health – a small step to raise awareness, discussion, and action amongst researchers and clinicians to address a major health priority.

Some vital stats

The statistics related to physical inactivity are not new to us, but still shocking. Physical inactivity is a key risk factor for non-communicable disease (NCDs) – including cardiovascular disease, type 2 diabetes, cancers, respiratory disease, dementia, and poor mental health. This places it as the fourth leading cause of global mortality, contributing to over five million preventable deaths each year2.

However, physical inactivity is also one of the key modifiable risk factors for NCDs, and the health benefits of regular physical activityare evident across the lifespan (click here for current PA recommendations). Maintaining regular physical activity levels helps to (1) promote growth and development in children and young adults, (2) prevent weight gain in mid-life, and (3) maintain independence and quality of life in older adults and in those living with chronic disease3.

Yet, despite high-quality evidence to implement effective strategies, global efforts to reduce physical inactivity have not been sufficient. It is estimated that one in three adults and more than 80% of adolescents do not meet current physical activity recommendations4.

The call to action

Increasing physical activity at a population level requires a whole-of-community approach. We need to effectively implement our knowledge through policy and practice changes in healthcare delivery, education, environment, infrastructure and media. We need to support individuals and communities to be physically active every day in ways that are enjoyable, accessible, and safe in this highly urbanised and digitalised world of ours. We need to advocate for the development, financing and implementation of evidence-informed national plans so that all countries can achieve the World Health Organisation global target to reduce physical inactivity in children and adults by 10% by 20255.These key messages have been distilled into a seven-point plan developed by the International Society for Physical Activity and Health (ISPAH) in 2012, ‘Best Investments for Physical Activity – What Works’6 and the infographic is published here7.

The Physical Activity and Population Health’ BJSM Blog series supplements the brand new BJSM Editorial articles Bright Spots, Physical Activity Investments that Work Jointly8 that feature exciting and novel physical activity programmes from around the globe. Expect both series to keep you updated on research, policy, education, and practice developments in increasing population levels of physical activity.

We invite you to share and support the Physical Activity and Population Health BJSM Blog Series. Join the conversation on ‘how change happens’ at #PAblogBJSM and #brightspotsBJSM.

If you have ideas for this series please contact:

Sonia Cheng graduated from The University of Sydney with a Bachelor of Applied Sciences (Physiotherapy) (Honours Class I) in 2014. Sonia is currently employed as a physiotherapist with Royal Prince Alfred Hospital and Westmead Hospital in Sydney. 


  1. The True Story of ‘Hidden Figures’ and the Women Who Crunched the Numbers for Nasa
  2. Lee IM, Shiroma EJ, Lobelo F, Puska P, Blair SN, Katzmarzyk PT; Lancet Physical Activity Series Working Group. Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy. Lancet. 2012;380(9838):219-29.
  3. World Health Organisation. Interventions on Diet and Physical Activity What Works? Summary Report Geneva, Switzerland: World Health Organization; 2009.
  4. Hallal PC, Andersen LB, Bull FC, Guthold R, Haskell W, Ekelund U. Global physical activity levels: surveillance progress, pitfalls, and prospects. The Lancet 2012;380(9838):247-57.
  5. World Health Organization. Global action plan for the prevention and control of NCDs 2013-2020. Geneva, Switzerland: World Health Organization; 2013.
  6. Investments that Work for Physical Activity. Br J Sports Med. 2012;46:709-712.
  7. Best Investments for Physical Activity – What Works
  8. Stamatakis E, Murray A Launch of new series: Bright Spots, Physical Activity Investments that Work Br J Sports Med Published Online First: 29 June 2017. doi: 10.1136/bjsports-2017-098096


Mental health of elite young athletes: spot and support them before it’s too late

14 Aug, 17 | by BJSM

Undergraduate perspective on Sport & Exercise Medicine – a BJSM blog series

By Johnson Pok-Him Tam (@tamph4) and Manroy Sahni (@manroysahni)

Image credit:

Elite sport is results driven. Each generation of new athletes is pushing themselves to new limits, to reach new heights and eclipse records set by their predecessors. But what impact can this constant cauldron of pressure and expectation have on the mental health of a young athlete? Are young athletes speaking out when they need help? And what help is available?

Elite young athletes have daily gruelling training regimes to help reach the potential suggested by their outstanding natural talent. To achieve these goals, they are usually guided by an expert coach, medical team and close family and friends[i]. This network is intended to be a support system in both a sporting and an emotional sense. However, at times it can contribute to a high level of expectation placed on the shoulders of young sports stars.

Determining the burden of mental health issues in sport can be difficult. Especially considering the (1) stigma associated with speaking out given the sporting culture in which professional athletes are enmeshed (read past blog in link for more), as well as (2) the research suggesting a positive association of physical activity on the prevention and treatment of mental health issues.[ii]An American study found 21.4% of elite athletes, compared to 29.2% of the general public of the same age (18-25 years old) reported clinical symptoms of depression[iii]. This is in stark contrast to other reports indicating similar or higher levels of mental health issues in young elite athletes when compared to the general population[iv]. To help shed light on the important issue of young athletes and mental health, this blog identifies:

  • common risk factors for young athletes developing mental health issues,
  • coping strategies, and;
  • potential barriers when seeking professional help.

Common risk factors

Common risk factors for developing mental health problems can be categorised into intrinsic and extrinsic factors. Some elite young athletes have an exclusively athletic identity of self-worth, which is often dependent on their performance. If they perform below expectation, their perception of self-worth and esteem can decrease and lead to potential mental health issues[v]. It is common for an elite young athlete to develop a perfectionist personality due to the constant pursuit of superior performance both at training and competition, which often leads to extra anxiety, stress, depression and fatigue[vi],[vii]. These “optimum” levels of physical activity can improve mental health, however, at an elite level can also compromise mental health due to overtraining, injuries and excessive pressure on the athlete[viii].

Parents and coaches have a fundamental impact on a young athlete’s well-being[ix]. Dunn et al.[x] concludes that parental pressure increased negative stress and decreased motivation for their child athlete. Almost one-third of parents reported to give negative verbal comments to their young athletes, thus increasing the possibility of psychological stress and burnout[xi],[xii]. Alexander et al.[xiii] found that more than one third of young elite athletes reported emotional harm due to their coaches, from actions such as shouting, negative comments about their performance and attempts to intimidate.

Coping strategies

Methods do exist to potentially reduce mental health problems in elite young athletes. For example, athletes should develop a coping mechanism for stress with their coaches and parents. This can include (1) thought control, (2) relaxation, (3) mental development and (4) help seeking— all of which positively improve objective and subjective achievement, whilst decreasing the risk of mental health injury[xiv],[xv]. Parents and coaches are encouraged to comment on the athlete’s attitude and effort, rather than performance[xvi].

Barriers to seeking help

Negative attitude and stigma are two of the biggest barriers faced by young athletes when looking for help. Young people in general are reluctant to admit their mental health issues and studies have shown young athletes have a bigger reluctance than non-athletes when seeking help[xvii],[xviii]. In a survey[xix] of top college athletes, the most common reason for not seeking help was to avoid any ‘personal discomfort’ and others felt there was ‘no need’ for professional help.

In conclusion, mental health issues in elite young athletes are common. Maintaining an athlete’s “super human” identity as well as pressure from parents and coaches are all contributing factors. Steps for the future are to ensure that all young athletes have personalised coping mechanisms to deal with stress and feel confident and comfortable to ask for help.


[i] Caine DJ. Are kids having a rough time of it in sports? Br J Sports Med. 2010;44:1-3.

[ii] Rosenbaum S, Tiedemann A, Sherrington C. Physical Activity Interventions for People with Mental Illness: A Systematic Review and Meta-Analysis. Journal of Clinical Psychiatry. 2014;75(9): 964-974

[iii] Biddle SJ, Asare M. Physical activity and mental health in children and adolescents: a review of reviews. Br J Sports Med. 2011

[iv] Junge A, Feddermann-Demont N Prevalence of depression and anxiety in top-level male and female football players BMJ Open Sport & Exercise Medicine 2016;2:e000087.

[v] Maffulli N, Longo UG, Gougoulias N, Loppini M, Denaro V. Long-term health outcomes of youth sports injuries. Br J Sports Med. 2010;44(1):21–25.

[vi] Appleton PR, Hill AP. Perfectionism and athlete burnout in junior elite athletes: the mediating role of motivation regulations. J Clin Sport Psychol. 2012;6(2):129–145.

[vii] Putukian M. The psychological response to injury in student athletes: a narrative review with a focus on mental health. Br J Sports Med. 2016 Feb 1;50(3):145-8.

[viii] Hamer M, Stamatakis E, Steptoe A. Dose-response relationship between physical activity and mental health: the Scottish health survey. Br J Sports Med. 2009:43(14):1111–1114.

[ix] Mountjoy M, Rhind DJ, Tilvas A, Leglise M. Safeguarding the child athlete in sport: a review, a framework and recommendations for the IOC youth athlete development model. Br J Sports Med. 2015;49(13):883–886.

[x] Dunn JGH, Dunn JC, Gotwals JK, et al. Establishing construct validity evidence for the Sport Multidimensional Perfectionism Scale. Psychol Sport Exerc. 2006;7:57–59.

[xi] Shields DL, Bredemeir BL, LaVoi NM, Power FC. The sport behaviour of youth, parents, and coaches: the good, the bad, and the ugly. J Res Character Educ. 2007;3(1):43–59.

[xii] Gould D, Lauer L, Rolo C, Jannes C, Pennisi N. Understanding the role parents play in tennis success: a national survey of junior tennis coaches. Br J Sports Med. 2006;40(7):632–636.

[xiii] Alexander K, Stafford A, Lewis R. The experiences of children participating in organized sport in the UK, Edinburgh: University of Edinburgh/NSPCC. 2011.

[xiv] Nicolas M, Gaudreau P, Franche V. Perception of coaching behaviors, coping, and achievement in a sport competition. J Sport Exerc Psychol. 2011;33(3):460–468.

[xv] Emery CA, Roy TO, Whittaker JL, Nettel-Aquirre A, van Mechelen W. Neuromuscular training injury prevention strategies in youth sport: a systematic review and meta-analysis. Br J Sports Med. 2015;49:865–870

[xvi] Carter CW, Micheli LJ. Training the child athlete: physical fitness, health and injury. Br J Sports Med.. 2011 Sep 1;45(11):880-5.

[xvii] Schwenk TL. The stigmatisation and denial of mental illness in athletes. Br J Sports Med. 2000 Feb 1;34(1):4-5.

[xviii] Ekeland E, Heian F, Hagen KB. Can exercise improve self-esteem in children and young people? A systematic review of randomised controlled trials. Br J Sports Med. 2005 Nov 1;39(11):792-8.

[xix] Watson J: Student-athletes and counseling: factors influencing the decision to seek counseling services. Coll Stud J 2006, 40(1):35–42.

Johnson Pok-Him Tam (@tamph4) is a Foundation Year 1 Doctor in the West Midlands with an interest in Orthopaedics Surgery and SEM. He was previously the President for University of Bristol Sports & Exercise Medicine society and has written articles for the student BMJ.

Manroy Sahni (@manroysahni) is an Academic Foundation Year 1 Doctor in the West Midlands with a passion for SEM. He also co-coordinates the BJSM Undergraduate Perspective blog series. Please send your blog feedback and ideas to:


Hamstring virtual conference 2.1 Encore edition from 2015…

12 Aug, 17 | by Karim Khan

Because the first few podcast clusters went down a treat – this time we’re back with even more BJSM resources focusing on the hammy, featuring the same podcasts alongside papers from the likes of Reurink, Orchard and Whiteley. So without further ado – here is your one-stop shop for everything hamstring-related, enjoy!

  1. Hamstring Injuries with Carl Askling:

Sweden’s Carl Askling explains new ways to categorise hamstring injuries – all ‘hammy’s are not the same! Listen to tips on how they can be diagnosed, treated, and monitored during the rehabilitation phase. He shares nuggets on how to assess athletes post-hamstring injury for return to sport, an often difficult and confusing process. Club doctors have been sacked for getting this wrong!

Biceps femoris and semitendinosus—teammates or competitors? This study assessed how the different hamstring muscle bellies work together in synergistic coordination patterns and whether changes in neuromuscular coordination patterns are associated with hamstring injuries.

  1. Hamstring Injuries – the American perspective:

A golden overview for the rush-hour traffic with former Olympian and now Professor of Sports Medicine, Tom Best, co-medical director of Ohio State University Sports Medicine. Pearls of wisdom from the injury process to the role of massage and NSAIDs in the rehabilitation process.

  • *New* Platelet-rich plasma does not enhance return to play in hamstring injuries: a randomised controlled trial:

We couldn’t talk about muscle injuries without mentioning the ‘magic bullet.’ Turns out in regard to hamstring injuries, PRP is only indicated if wanting to make a quick buck, with intensive physiotherapy still the gold-standard. #BeautyInTheBasics

  1. Hamstring Injuries in football with Jan Ekstrand:

This goes nicely with the May’s FIFA-edition of BJSM, providing a fantastic overview of SEM in football, from the role of football in global health to injury prevention strategies at the World Cup! One of the most respected researchers in the field, UEFA Champions League Study lead Professor Jan Ekstrand, discusses football-specific issues in hamstring injuries in football players. Are they the same clinical entity or do they need special treatment?

  • *New* MRI does not add value over and above patient history and clinical examination in predicting time to return to sport after acute hamstring injuries: a prospective cohort of 180 male athletes:

Does MRI aid in the prediction of return-to-sport, or should we be more reliant (and trusting) in clinical judgement? Wangensteen and colleagues would argue the latter!

  1. Diagnosing and treating acute hamstring injuries:

Introducing the most popular BJSM podcast EVER! Robert-Jan de Vos speaks to Gustaaf Reurink, author of the already famous 2014 NEJM paper on the role of PRP in acute hamstring injuries. In addition to summarising the results of this game-changing study, the Dutch sports physician discusses the value of clinical tests and MRI in acute hamstring injuries, and whether they can predict return-to-play and re-injury. Great clinical relevance.

In this brilliant editorial, the authors (you may have heard about them…) ask if it is the right moment to say ‘bye–bye MRI’ to the device as a prognostic tool for predicting RTP after hamstring injuries in the individual athlete. A fantastic overview of the evidence.

  1. Eccentric hamstring exercise – they work in practice but not in theory?

Internationally experienced physiotherapist Nicol van Dyk @NicolvanDyk leads the discussion around Nordic hamstring exercises. What’s the role of eccentric strength in hamstring strain injuries as well as in their prevention and rehabilitation. Stellar guest is Dr David Opar, a rapidly emerging voice in this field. They discuss the injury mechanics as well as the revolutionary ‘Nordbord’ Nordic hamstring device, that looks into the potential of this device in prevention, treatment and rehabilitation of hamstring injuries.

Want to learn more?!

Although you might be tempted to keep these resources to yourself, especially if people are wondering where all of this new-found wisdom has come from…remember #SharingIsCaring so please share with your colleagues or interact with us via twitter ( @BJSM_BMJ), Facebook or our Google + SEM Community!  And BJSM has a great mobile app – free on both platforms. Ideal way to follow BJSM podcasts plus way more – blog, YouTube videos ++.

BJSM – Impress your colleagues and live at the forefront of #EvidenceBasedPractice

Isaac Makwala and some thoughts on the challenge of Norovirus at major games.

10 Aug, 17 | by Karim Khan

By Dr Juan-Manuel Alonso  @DrJuanMAlonso

So, what initially looked like a food poisoning turned out to be a Gastroenteritis / Norovirus outbreak . The big evil all sport events medical cover organisers tried to avoid at all costs. Really bad luck! For one reason or another, the Botswana team leader and doctor did not inform the athlete of the measures, or Makwala ignored the instructions, or both, and Makwala, in a classical and predictable attitude, came himself to try to run the 400 m final.

This whole Makwala issue & Norovirus outbreak is terribly unfortunate. An outbreak is difficult to avoid. And any medical organiser needs to take urgent and stringent measures when it happens. I was wondering whether isolation/quarantine is needed or evidence-based for Norovirus outbreak. In the context of a Norovirus outbreak: is stopping a runner from running (or a worker from doing his/her job) appropriate?

I can understand the need to minimize /stop the spread of the virus and isolation /quarantine could have been considered in other settings like a school training camp or a ship’s cruise. I value the debate on the balance of protecting the majority versus individual rights of just one. Still I tend to respectfully disagree with the extreme decision to keep Makwala from racing.

An intermediate, compromise position may have been to allow Makwala to run but to ensure he avoided hand shaking or giving hugs to others. He could have worn a mask and had specific and separate call room procedures (bringing athletes to the track from their room under the stands). Right now the internet does not answer the key questions: no systematic reviews, no metanalysis, no RCT with evidence level A to support the IAAF decision as far as I am awere. In my humble opinion (IMHO) isolation /quarantine is based in level C evidence: expert opinion.

Below are more links to scientific literature.

The communication strategy of the IAAF and Local Organisers was criticised for not providing the facts, but that is difficult to do due to confidential nature of the medical data. …

Norovirus control measures based on general infection control principles treatment mainly supportive & non-specific 

How to prevent the spread of norovirus: Stringent hygiene measures are vital to contain the virus



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