This issue of BJSM – one of the 16 annually – focuses on keeping young people healthy. Many readers are not aware that the IOC and BJSM partner to produce 4 issues of the BJSM annually. These issues focus on the IOC mission of ‘Athlete Protection and Health Promotion’. The special issues, generally appearing in March, June, September and December (issue numbers 3, 7, 11, 15) are tagged as Injury Prevention and Health Promotion (IPHP) issues.

The (IOC) recognises the health and fitness benefits of physical activity (PA) and sport as stated in recommendation #51 from the Olympic Movement in Society Congress  Everyone involved in the Olympic Movement must become more aware of the fundamental importance of Physical Activity and sport for a healthy lifestyle, not least in the growing battle against obesity, and must reach out to parents and schools as part of a strategy to counter the rising inactivity of young people.1

Read the consensus paper from the expert group meeting in Lausanne

The IOC expert group  discussed the role of PA and sport on the health and fitness of young people and to critically evaluate the scientific evidence as a basis for decision making. Specifically, the purpose of this consensus paper is to identify potential solutions through collaboration between sport and existing programmes and to review the research gaps in this field. The ultimate aim of the paper is to provide recommendations for those involved in young people’s sport.

We’ll highlight other papers from the issue this week – check out the table of contents.

Comment via the box below or to karim.khan@ubc.ca. Send us a Guest Blog! You just email the word document and we do the rest! Follow BJSM on Twitter @BJSM_BMJ for updates to the blog and links to other interesting practical sports and exercise medicine for clincians.

We agree with Ian Shrier that the finding of an effect of stretching on risk of muscle, ligament and tendon injuries should be interpreted with caution. That is why we wrote “The finding of an effect of stretching on muscle, ligament and tendon injury risk needs to be considered cautiously because muscle, ligament and tendon injury risk was a secondary outcome, and there was no evidence of an effect of stretching on the primary outcome of all-injury risk. If stretching had reduced the risk of muscle, ligament and tendon injuries without increasing the risk of other injuries, we would expect a reduction in all-injury risk.” Nonetheless, after a prolonged discussion of this issue we decided that the finding could not be totally dismissed. We believe that it was appropriate to report the observed effect on muscle, ligament and tendon injuries with an explicit acknowledgement of the uncertainty associated with this finding.

Regardless of whether one accepts the finding that stretching reduces risk of muscle, tendon and ligament injuries, the implications would appear to be the same. Even if the effect is real, it is quite small in absolute terms (even in this population, at quite a high risk of injury, only “one injury to muscle, ligament or tendon was prevented for every 20 people who stretched for 12 weeks”). For this reason the data from this study do not appear to provide support for the practice of stretching, at least in so far as the aim is to reduce injury risk. The stronger justification for stretching, though still a marginal one in our view, is provided by the clear evidence of a very small effect of stretching on soreness. For other outcomes, such as performance or range of motion our study did not provide any data.

It is not yet known whether stretching is best carried out before exercise, after exercise, or both before and after exercise. We were surprised, when planning this study, to learn that most Australian stretch before exercise but not after, and most Norwegians stretch after exercise but not before! It was for that reason we designed a trial in which participants stretched both before and after exercise. We do not agree with Ian Shrier’s suggestion to conduct an unplanned post-hoc comparison of the non-randomised subgroups that chose to stretch only before, only after, or both before and after exercise. Such an analysis would almost certainly be seriously confounded and would probably be uninterpretable; at any rate it hardly seems consistent with his disapproval of our much more disciplined pre-planned secondary comparison between randomised groups. The only truly satisfactory way to resolve the issue of whether it is better to stretch before or after exercise is to conduct a further randomised trial in which participants are randomised to those two conditions.

Conflict of Interest: None declared

Yes, it’s the sound of a sneeze.

This month BBC news health reporter, Michelle Roberts wrote a feature on the  BJSM article titled,  Upper respiratory tract infection is reduced in physically fit and active adults.

David Nieman at the Human Performance Laboratory in North Carolina shows that exercise can prevent a cold. Their study on more than 1000 adults was undertaken over 12 weeks of fall/winter. During this time period, the odds of having a URTI were significantly reduced in those who exercised more and perceived themselves to be healthier.

For a link to the BBC report (which featured earlier this week  as the most shared article!), click here.

Stretching, or not, has been a controversial issue.

This month’s BJSM helps to unravel (or add to) this puzzle.

In an entirely web-based study (that gained awareness through media coverage), 2377 physically active adults were recruited in an effort to determine whether stretching modifies injury risk and soreness.

The verdict? In the short-medium term stretching reduces the risk of soreness and does not reduce the all-injury risk.

For a link to this article and to make up your own mind, see the November  BJSM.

The following E-letter is a response to Physical activity in the UK: a unique crossroad (Br J Sports Med 2010; 44: 912-914). The original article can be read here.

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I was delighted to read Dr Weilers editorial which eloquently presents many of the issues currently faced in exercise medicine. It is so important to debate this subject-particularly as we are in a unique position in the U.K to effect permanent change.

I was interested in Dr Weilers’ view that the introduction of the GGPAQ into QOF would be a valuable place to start what will have to be a process of cultural change. I would like to debate this opinion further. It has been clearly established in the literature that changes in physical activity levels in the long term are not easy to effect. The most successful interventions involve patient centred, long term, well supported, behaviourally based interventions delivered by highly motivated and well trained medical professionals. I do not agree with your statement that ‘brief interventions (3-10min) can lead to substantial increases in physical activity level (by around 30%)’. I am not aware of any evidence to substantiate this claim, particularly in the long term. The studies which have shown these sorts of results have used of a much more intense intervention, not sustainable within the NHS, and most do not show significant long term results (greater than 3 months).(1,2)

I agree that physical activity promotion to ‘healthy’ populations can only be delivered by primary care. I feel, however, that we are not yet ready for GGPAQ. The effect of creating another ‘box to tick’ in an already target driven culture, I feel, at this stage would be counterproductive. We have a long way to go in the process of educating G.P’s and practice nurses about the evidence base for the benefits of and the delivery of exercise prescription. It will, rightly, take convincing evidence of effectiveness to persuade G.P’s to engage in this process. There is, currently, no evidence that could possibly lead us to suppose that the introduction of GGPAQ would lead to significant and sustained changes in physical activity levels ?1million , to introduce a QOF point does not seem an enormous amount of money until you consider that with that sum, per year, you could employ 10 SEM consultants. I feel this would be a very much more effective way of spending the limited resources available at this stage. A single SEM consultant could provide a comprehensive education programme from medical school to primary and secondary care, could lead good quality, translational research into cost effective ways of delivering exercise interventions and could coordinate existing services for exercise in chronic disease which are often non-existent or ineffective and poorly evaluated. They could assess local needs, building on strengths of existing structures and working on the weaknesses. They could improve links with the fitness industry which in many cases are poorly supported and therefore less effective.

I agree, clinical research is essential at this stage and funding is not easy to come by. The N.H.S needs to address this through its own research organisations. Partnerships with the tremendously powerful fitness industry may also help to fund translational research as might charitable foundations for chronic disease research. Overall, I agree with much of the editorial, but feel that in the current economic climate , we need to think very carefully before rolling out blanket schemes which are open to criticism from the very people we are hoping will deliver them.

Natasha S. Jones
ST6 in SEM
Oxford

References

1.Eakin EG, Glasgow RE, Riley KM. Review of primary care-based
physical activity intervention studies: effectiveness and implications for
practice and future research. J Fam Pract. 2000; 49: 158-168.

2. Lawlor D.A The Effect of physical activity advice given in primary care
consultations-a review. Journal of public Health Medicine.2001; 23:219-226

A recent Vancouver Sun article discusses new findings in the role of diet and exercise in obesity. Click here to read the story.

The sports medicine association formerly known as the Canadian Academy of Sport Medicine (CASM) voted to change their name to the Canadian Academy of Sport and Exercise Medicine (CASEM). This will come into effect on June 9^th 2010. It is interesting that this follows the BASEM name change in the UK. Given the broad mandate of health professionals in our field, and the unfortunate association of the term ‘sports medicine’ with elite athletes in the mind of the general public, is it time for national societies of ‘sports medicine’ to follow the trend set by BASEM, CASEM, and others that preceded them.

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.