Domhnall MacAuley: Science, shoeless, and a syringe culture. Some highlights from UKSEM

Domhnall MacauleyThe major UK sport and exercise medicine conference (UKSEM) took place this week in Excel. It was huge event that attracted most of the world figures in sport and exercise medicine. We at the BMJ are also keen to address the important issues that link health, sport, and exercise. While the sports media focus on elite athletes, we take a wider view and you will already have noted recent related research and editorial content. The UKSEM conference gave us further insight into some important developments and challenges.

Michael Kjaer (Denmark) listed his top ten papers of the year and, though he favoured biomedical science more than clinical medicine, I was intrigued by a paper quantifying the minimum physical activity required to reduce mortality—90 mins of exercise each week (15 mins per day!)   lowered mortality by 14% (Lancet. 2011 Oct 1;378(9798):1244-53. Epub 2011 Aug 16), and a meta analysis that showed that even two hours per day spent watching television had an increased risk of  type 2 diabetes, cardiovascular disease, and all cause mortality(JAMA. 2011 Jun 15;305(23):2448-55.)

As we age we lose skeletal muscle. We don’t know why but Michael listed a paper on skeletal muscle remodelling and another on calcium transport in the sarcoplasmic reticulum that help our understanding of sarcopaenia.

While we continue to lose muscle tissue as we get older, there is some good news for the brain: physical activity can reduce cognitive decline in women with vascular disease—even a 30 minute brisk walk (Arch Intern Med. 2011 Jul 25;171(14):1244-50. Epub 2011 Jul 19), and an MRI study shows how physical activity (twice weekly resistance training) increases blood flow to the cognitive areas of the brain. (Neurobiol Aging. 2011 Jul 6. [Epub ahead of print]).

One of the mysteries of sports performance is why some athletes’ performance benefits more from training than others. In one training study certain types of microRNA were more common in high responders (J Appl Physiol. 2011 Feb;110(2):309-17. Epub 2010 Oct 28.) But, performance may also be related to the type of training and, perhaps surprisingly, adding strength training to endurance training improved cycling performance in young top level cyclists (Scand J Med Sci Sports. 2011 Mar 1. doi: 10.1111/j.1600-0838.2010.01283.x. [Epub ahead of print]). But, training is as much an art as a science and the gifted coaches achieve the right balance that optimised training load without overtraining. We still don’t fully understand the factors behind underperformance but psychological factors certainly play a part (International Review of Sport and Exercise Psychology Volume 4, Issue 1, 2011 DOI:10.1080/1750984X.2010.541927 Henrik Gustafssonad*, Göran Kenttäb & Peter Hassménc pages 3-24).

A seminar on running barefoot with the world’s leading researchers generated a lot of hot air and some memorable quotes—that running barefoot was as natural as breast feeding and; when walking the dog, the dogs doesn’t wear shoes. The passion of the speakers and the goodwill generated by their catchy sound bites might encourage you to  think that barefoot running may have a place, but my confidence was completely undermined by one speaker’s apparent lack of understanding of the risks of barefoot running in diabetic patients.

David Millar, an international professional cyclist, held us spellbound as he described the syringe culture that that allowed him to inject himself intramuscularly, intravenously, and using a butterfly with various vitamins and minerals before he even considered doping. The lines between what was permitted and what was banned had become so blurred that the decision to inject himself with the tiny syringe containing EPO seemed a very small step—almost easy. He showed pictures of three contemporaries whose deaths he attributed directly to performance enhancing and recreational drug use. He also pointed out that even the most ethical team doctor would have had difficulty controlling drug use, such was the culture at the time. One of the problems is that drugs work. David was already an outstanding cyclist before doping. But, such was the dramatic effect of taking EPO that he said it made him “go like a f**king motorbike”.

Domhnall MacAuley is primary care editor, BMJ