Domhnall MacAuley: Elite performance in endurance sports

Domhnall MacauleyTo meet with the president of the American College of Sports Medicine…you arrange to go for a jog. A family doctor, team doctor, researcher, departmental chair and now a major leader in American health, Tom Best (Ohio State University), has achieved a lot but he took a difficult road and, he and his family, have made many sacrifices along the way. A career in sports medicine doesn’t fit well with the traditional academic route and to follow this dream he had to uproot his family, move practice and change university on a number of occasions. One of his key ambitions is to widen the international appeal of the college and, with a range of international delegates already boosting the overall attendance to 5700 delegates, this should not be too difficult. The new health reforms offer little encouragement, however, to those in sports medicine as there are few overt references to sport, exercise, or physical activity. Nor is it a priority for the Comparative Effectiveness Research Institute (CORI).

Interested in elite performance in endurance sport and how to achieve your potential? Veronique Billat (Centre du Medicine de Sport, Paris), passed on many of the secrets. Top level endurance performance is about sustaining as high a proportion of maximum oxygen uptake (VO2 Max) for as long as possible and she suggests that one can probably perform for about 10 minutes at 87% of maximum. Few races are a constant pace, however, and she charted the variation in pace in top distance runners with frequent periods of acceleration to a pace to 130% VO2 max. How can an athlete do this? The secret is management of ones anaerobic deficit in order to respond towards the end of the race. That means knowing just how hard you can push at any time. Billat’s group have already developed prototype micro systems worn by an athlete that record physiological measurements together with speed and position, feeding back race information to a base station using mobile phone apps. Olympian technology.

Platelet rich plasma injections, and related treatments are another developing field: These spun down homologous blood products are rich in growth factors which act at different times in the healing process. Should they be used as a bolus or sustained, and how do we know at what stage of the healing process to use them? As part of a symposium on performance enhancing agents, Bruce Hamilton (Qatar) summarised the evidence and, asked in particular, if they should be classified as a prohibited product under doping regulations. Accelerated healing after injury is, of course, the aim of all therapeutic management but, the question remains if there could be any systemic performance enhancement from locally injected growth factors. If so, they should be prohibited. Another grey area in doping.

And, there was an unexpected surprise bonus on the final morning when, Doug Altman (Oxford) and Kay Dickersin (John Hopkins), together with Ian Shrier (McGill University, Montreal) discussed evidence based sports medicine in the context of the Cochrane Collaboration. Ian first challenged the sports medicine community in 2002 when, in a radical approach, he questioned the evidence to support stretching. If the audience response is any indication, asking the sports medicine community to think about systematic reviews and reflecting on the evidence to support practice is still quite threatening. They would rather, to use the motto of a well known sports clothing manufacturer, “just do it.”

Domhnall MacAuley is primary care editor, BMJ

  • Prof Mark Batt, Nottingham

    I too attended this very good session to discuss evidence-based medicine. My feelings were that the sports medicine community were not so much threatened by evidence-based medicine but were bold enough to challenge its role in modern health care. Indeed when the panel were asked the simple question by a fellow attendee “what good has evidence-based medicine done for medicine” the panel responses were less than impressive.

    I specifically asked about methodology raising the concern that many of us have that meta-analyses and Cochrane reports give too much weight to RCTs. RCTs, rather than mixed methods analyses, may not be the best methods for assessing many of the complex interventions in Sport and Exercise medicine, particularly those involved with understanding the extent to which a given intervention can help improve uptake of physical activity and thus potentially improve health and wellness. This is critically important as NICE seem to adopt a similar stance which in turn significantly effects commissioning of services.