Domhnall MacAuley: Barefoot runners, Western habits, and GP records – more from ACSM

Domhnall MacauleyShould we abandon running shoes? Running shoes are a relatively new phenomenon – primitive man did not wear shoes when hunting in the savannah and would look in wonder at modern running shoes with their huge wedges, motion support, and cushioned soles. They have changed the way we run and, in spite of all the claims, running injury rates remain the same. Daniel Lieberman (Harvard) presented some anthropological and observational work that form the background to his paper in Nature, and Irene Davis (Harvard) took it a step further by advocating that we should try to run without shoes. Gait analysis and force plate studies are quite convincing: runners wearing shoes have a high impact heel strike and large wedges increase the moment arm accentuating pronation. Although the arguments were persuasive, I am not ready to abandon running shoes just yet. And, Irene did introduce some caveats – don’t run in the cold, where your numb feet will not feel injury, don’t run in the dark, and don’t run on a rough surface – which pretty much excludes most of my running opportunities.

Should we promote physical activity in developing countries? Evidence for the benefits of physical activity are overwhelming and the principles are important across the world. A number of sessions addressed global health and the importance of promoting physical activity. But, in a world where basic living conditions are poor, and the major problems are child health, infectious disease, and poor sanitation, I wonder if physical activity is a priority. Diabetes and cardiovascular disease rates are rising, but I doubt if the developing countries really need a lecture from us. I asked Festus Adams (Ghana) who told me that physical activity is an integral part of the traditional lifestyle – their goal is not so much to promote activity but to avoid introducing the worst habits of an inactive western lifestyle.

Should GPs record physical activity? GPs have a lot to do without adding another tick box to the QoF checklist. But, Kaiser Permanante in Southern California is the first major healthcare system to do  it and I guess it will arrive in the UK soon. Since October 2009 patients are asked two questions 1) “On average how many days do you engage in moderate or greater exercise (like a brisk walk) and 2) “On average how many minutes do you engage in exercise at this level.” Bob Sallis (Kaiser Permanante Medical Centre, Fontana) told me that exercise level is now recorded in 81% of  electronic medical records.

Looking around the convention centre, very few had a BMI greater than 25 and it is the only meeting I have been to where, when they ask for volunteers for clinical examination, there is a rush of guys willing to take their shirts off. Not your average medical conference.

Domhnall MacAuley is primary care editor, BMJ