THE LANCET SPORT AND EXERCISE MEDICINE SERIES: Special Release

As the UK gears up for the 2012 Olympic and Paralympic games, scientists writing in The Lancet call for doctors to recognise exercise as a “fifth vital sign”, joining temperature, blood pressure, pulse and respiratory rate as one of the key indicators of health used by health professionals.

The call appears in a paper published as part of a new Series on sports and exercise medicine, which examines how sport and exercise contribute to the health of a nation. The second Series paper surveys the challenges and rewards of Paralympic medicine, while a Comment highlights the lack of specialised sports and exercise medicine training provided for medical undergraduates.

Doctors should consider exercise a fifth “vital sign”

In the first Series paper, Sport and exercise as contributors to the health of nations, an international team of researchers set out to examine whether sport and exercise contribute to the health of nations. They argue that although country-wide data on participation in sports are too scarce to draw any firm conclusions in this respect, the existing evidence suggests that regular participation in sports and / or exercise has clear benefits for physical and mental health, and that health professionals need to pay more attention to their patients’ fitness.

“Low fitness is a better predictor of mortality than obesity or hypertension, which are health risk factors afforded far greater emphasis than fitness by the media and most health professionals,” according to Professor Karim Khan of the University of British Columbia, Canada, one of the paper’s authors.

The researchers suggest that if health professionals were to consider exercise levels as a “vital sign”, they could provide more help for patients to adopt exercise regimes. This could result in dramatic improvements in the number of people who regularly exercise, in the same way that smoking cessation advice has resulted in reductions in the number of people who smoke in many countries.

Despite the lack of high-quality data on nationwide sport participation levels, existing studies appear to show clear health benefits associated with regular participation in sport and / or exercise. For instance, a series of small randomised clinical trials published in 2010 showed that people who started playing football two or three times a week, having formerly never played the game, experienced reduced risk factors for cardiovascular disease, diabetes and osteoporosis.

Sport can also have a positive effect on health awareness, with the authors mentioning FIFA’s 11 for Health education programme in which football superstars such as Cameroon’s Samuel Eto’o provide educational messages about health issues for young people. This programme resulted in an 18% improvement in health knowledge in schools in Zimbabwe and Mauritius.

According to the authors, “The evidence for physical activity as a major public health preventative approach and a potent medical therapy has increased exponentially in the 64 years since London, UK, last hosted the Olympic Games…We believe that small changes at the community level and large, nationwide policies and initiatives are needed to improve health at a country level.”

The challenges and rewards of Paralympic medicine

In the second Series paper, Paralympic medicine, Nick Webborn of the British Paralympic Association and Peter Van de Vliet of the International Paralympic Committee Medical and Scientific Department, outline some of the issues that arise for health-care professionals when maintaining health in elite athletes with a variety of impairments.

They point out that the complex mix of medical issues among Paralympic athletes can be challenging for health-care providers and event medical staff, and call for increased awareness of Paralympians’ health needs among medical staff. They also call for more research into the long-term potential for injuries afforded by the latest prosthetic technologies, with very little scientific understanding of the types of injuries and stresses that these technologies may cause currently available. The authors also examine the issue of performance enhancement in Paralympic athletes, with some practices – such as Botulinum toxin being used to control spasticity in athletes with Cerebral palsy – resulting in athletes’ classification altering. The danger of voluntary inducement of autonomic dysreflexia – where athletes with spinal injuries give themselves a painful stimulus to trigger a reaction that results in performance-enhancing high blood pressure – is also highlighted.

“Provision of health care for Paralympic athletes is probably the most challenging and rewarding area of sports medicine,” say the authors. “The complex mix of medical issues can be challenging for health-care providers and medical staff at the events, and the medical needs of the athlete group need to be understood and medical staff trained appropriately.”

Training in sport and exercise medicine is insufficient in most UK undergraduate medical degrees

In a Comment published alongside The Lancet Series on sport and exercise medicine, Rod Jaques of the Faculty of Sport and Exercise Medicine UK, and Mike Loosemore of University College London, UK, highlight the lack of specialised training in sports medicine in undergraduate medical training.

Despite the fact that up to 20% of consultations in UK general practice involve musculoskeletal complaints – often caused by sports or exercise injuries – there is little or no specific teaching on sports and exercise medicine in the undergraduate curriculum. Furthermore, despite the well-established positive effects of exercise on so-called “lifestyle” diseases such as cardiac disease and diabetes, fewer than half of the UK’s medical schools teach the Chief Medical Officer’s guidance on physical activity.

According to the authors, “Large cohort studies from the USA have shown that low cardiorespiratory fitness is the single biggest risk factor for all-cause mortality. The importance of sports and exercise medicine, in particular the benefits of physical activity in non-communicable disease prevention and chronic disease management, should be incorporated in the core undergraduate medical programme.”