Kirsten Patrick: Sports medicine and the Olympic legacy

Kirsten PatrickI doubt that this is the first place you’ll read about the 2012 Olympics today as it is 500 days to the start of the games and the tickets go on sale today. It’s also unlikely that this is the first time you are reading that the 2012 Olympics were “sold” to Londoners on the back of the “legacy” that hosting the games will leave. We at the BMJ have wondered about whether that legacy will include an enduring health benefit to the British people, or at least to Londoners, especially if you consider the findings of a systematic review BMJ published last year that examined the health and socio-economic impact of major multi-sports events 1978-2008 and concluded that there wasn’t much of a long term legacy associated with hosting international sporting competitions.

Last week BMJ editors held a brainstorm to decide what the BMJ should publish about sport and exercise medicine in the run up to the 2012 Olympics. We invited 5 experts to advise us: doctors from UK Athletics and the English Institute of Sport, a couple of trainees in sports medicine including one who has competed for Great Britain in the marathon, and a psychiatrist with an interest in the mental health of athletes. We wanted to focus mainly on planning content for the education section of the journal but the discussion kept veering away from the “how to” of preventing and treating various sports related injuries  and towards controversies in sport and how to deliver the elusive Olympic legacy.

It seems that here is a big difference between an elite athlete and the general sporting masses, and an even bigger divide between the physically active and those who don’t currently do much activity, but who would benefit from physical activity to treat chronic illness and maintain health.

Many of us might wonder why super-fit elite athletes need dedicated doctors to look after them. But consider that competing is the elite athlete’s job and if they don’t manage to compete because of injury they’ll lose their job and it begins to make more sense. People who exercise at a very high level may be pushing their bodies beyond what is normal for humans. There are therefore dangers associated with elite athleticism. Paul Dijkstra from UK athletics is interested in how to prevent injuries in elite athletes and in how to get sports managers to care about putting resources into injury prevention. While there’s evidence that exercise is associated with better mental health generally, there’s not much evidence to suggest that elite athletes are more psychologically healthy than the rest of us. In fact you are probably mentally healthier if you are a moderate exerciser than if you are an elite athlete. Alan Currie, psychiatrist in Nottingham, pointed out that while athletes who sustain a physical injury are quickly and intensively treated, those who develop a mental illness are not treated either quickly or intensively with an aim to return them to successful competition. And ultimately mental ill health is not compatible with a successful athletic career. Currently the International Society for Sport Psychiatry among other organisations are campaigning to make sure that sports people have their mental health needs met on a par with their other health needs.

Matthew Stride, a ST5 Sports and Exercise Medicine (SEM) trainee and football team doctor is particularly interested in how the specialty of SEM can help general medicine. There are pockets of interest in exercise-as-treatment among groups of renal specialists, cardiologists, and anaesthetists, but the concept is not as widely appreciated as it ought to be and disseminating information on how exercise can be used as treatment is something that the BMJ should be doing. Exercise can be rehabilitative in many specialties, not only post MI but for patients with renal disease and COPD too. Exercise should be advocated in treatment plans for patients with chronic diseases and co-morbidities and to improve the anaesthetic risk and post op prognosis for people with chronic disease who need to undergo surgery. Although there are problems to overcome when exercising patients with chronic and comorbid diseases who are unused to physical activity the benefits appear to be extraordinary. Exercise is a treatment modality that’s seriously underused but this isn’t because there’s a lack of evidence to support its use. In England there’s no QOF target to make sure that people are meeting the chief medical officer’s guidelines for 5 x 30 minute vigorous exercise sessions per week even though exercise is known to be beneficial in treating and preventing chronic disease.

In the U.S. an initiative called Exercise Is Medicine seeks to “make physical activity and exercise a standard part of a disease prevention and treatment medical paradigm in the United States” and get all health care providers to consider the exercise status of all patients at every patient visit so that patients “are effectively counselled and referred as to their physical activity and health needs, thus leading to overall improvement in the public’s health and long-term reduction in health care cost.” EIM is trademarked. For free you can download what some have called the “BNF of exercise treatment,” the Swedish Institute of Public Health’s guidelines on Physical Activity in the Prevention and Treatment of Disease.

So there’s a whole medical specialty devoted to caring for the health needs of the elite athletic population and a public health interest in getting people who aren’t physically active to get up and go….but I wonder about the “sportspeople in the middle,” those for whom sport is very important but not a career, the many thousands of marathon runners, triathletes, mountain climbers, cyclists, and tennis players, and the countless young people who compete in school sports. Hosting the Olympic Games in the UK may increase the proportion of people who take up a sport seriously or take sport up again after being out of it for a while. Who is interested in their wellbeing and problems related to their amateur sporting interests? My own experience is that musculoskeletal problems in the otherwise healthy person are not a priority in the NHS and it is frustrating because a non-elite athlete wants to get back to a certain level of training/competition as much as an elite one does. The experts at our brainstorm acknowledged that “how (badly) musculoskeletal injuries are managed in primary care in the UK is a big issue.” I would like to see generalists willing and able to recognise and advise properly on musculoskeletal problems in the healthy sporting population.

I look forward to helping to shape educational content for the BMJ that can give our readers tools to support people who choose to use physical activity as a treatment or to maintain their wellbeing.

Kirsten Patrick is clinical reviews editor, BMJ.