Tag Archives: exercise

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Domhnall_MacDomhnall MacAuley is a CMAJ Associate Editor and a professor of primary care in Northern Ireland, UK.

 

We publishing the wrong research and funding too many of the wrong studies. This was the general message from Adrian Bauman’s keynote address - "What gets published in physical activity research and why it seldom has an influence on policy" - at the Health Advancing Physical Activity (HEPA) conference.

The talk might have been about physical activity research but the message has resonance across medicine. If we really want to change medicine we really need to understand how researchers produce evidence and how policy makers interpret, or misinterpret, what is published. There is a significant mismatch between researchers’ objectives and policy makers’ needs. And, rarely heard in a medical context, Adrian was quite sympathetic to the needs of policymakers. ...continue reading

DMacA_3Domhnall MacAuley is a CMAJ Associate Editor and a professor of primary care in Northern Ireland, UK

 

Couch potatoes say that you never see a happy jogger, and they might be right. Too many runners train too hard, think “no-pain-no-gain” and don’t take time to step back.  Intelligent middle aged high achievers (like us doctors) often make the same mistakes.  Forget the Sports Guru nonsense. Your body is not a highly tuned Grand Prix racing machine.  Most of us just chug along like a four-door family saloon. So, here are a few suggestions to help you avoid injury, burn out, and boredom. Basic, simple and obvious, they won’t sell many running magazines but they might be of some use to middle of the road athletes expecting miracles, underachievers who mismatch training loads and life circumstance, and obsessives who feel rest and relaxation should be avoided at all costs. ...continue reading

DMacA_3Domhnall MacAuley is a CMAJ Associate Editor and a professor of primary care in Northern Ireland, UK

 

The newspaper story about our research focused on the proportion of older people without sufficient leg strength to stand up unaided from sitting in a chair. At the time, it irritated me. We had just completed a major country wide health and activity survey with superb data on fitness at all ages....and they picked this one component. It was a huge piece of work. Our team had interviewed 1800 adults up to the age of 70 years old, measured VO2max together with ECGs on a treadmill, undertaken various strength tests in a mobile exercise laboratory that we transported to 14 different hospital sites, and taken fasting blood tests in peoples’ homes. My main interest in sport and exercise medicine was in promoting physical activity and - at the time - I thought I was a bit of an exercise guru. It wasn’t the headline I had hoped for and, furthermore, I was teased for weeks by friends and relatives. Everyone wanted to show me how they could all stand up unaided from sitting in their armchairs!

But, with a bit of hindsight, I can now say that perhaps the journalists were right. ...continue reading

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DMacA_ski_resizeDomhnall MacAuley is a CMAJ Associate Editor and a professor of primary care in Northern Ireland, UK

 

Some years ago, out walking along the river, I met an ex-athlete friend . “I gave up running at 50,” he told me. "Too many of my friends were having heart problems”. This didn’t fit with what I believed about the benefits of exercise, so I didn’t give it a lot of thought.

More recently, however, when preparing a talk on sudden cardiac death, I came across a research paper from Sweden that followed up 52, 755 athletes who had completed the Vasaloppet a long distance cross country ski race (90k) and, curiously, showed that those who raced more often and faster, were more likely to have hospital admissions for cardiac arrhythmia. This seemed counter-intuitive. ...continue reading

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Martin Burtscher is Professor at the Department of Sport Science, Medical Section, at the University of Innsbruck, Austria

Gerhard Ruedl is Assistant Professor at the Department of Sport Science at the University of Innsbruck, Austria

 

Daily news reports on skiing injuries during the winter season may convey the impression of downhill skiing as being a most dangerous activity. In fact, these reports have to be interpreted in the light of the very large participation rates. Worldwide, there are more than 2,000 downhill ski areas spread across 80 countries with an estimated 400 million skier days annually.

Assuming a death rate of 1 per 1 million skier days and an injury rate of 1-2 per 1,000 skier days a total of 400 fatalities and 400,000 to 800,000 injured skiers would result. That may be enough to fill newspapers daily but they actually represent a relatively low death and injury risk.

Put another way, for the individual who skis for 20 days per winter season on average ...continue reading

Domhnall MacAuleyDomhnall MacAuley is a CMAJ Associate Editor and a professor of primary care in Northern Ireland, UK, and recently in Edinburgh for the British Association of Sport and Exercise Medicine conference 2014

 

Why are the Jamaicans so dominant in world sprinting? And, it’s not just Jamaicans, but those of Jamaican origin representing other countries such as Canada and the UK. Is there a genetic component? Yannis Pitsiladis, a world expert with access to the world’s largest biobank, found no unique genetic trait. Jamaicans’ believe that this dominance is from the eugenic effects of the slave trade - only the fittest and strongest survived ...continue reading

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Kirsten Patrick is a Deputy Editor at CMAJ

I’ve come back to competitive swimming in the last couple of years, as a Master. Although I enjoyed a youth spent in the water, I can't fully identify with the T-shirt slogan I've seen this week, “I used to be faster; now I’m a Master!” I didn't find myself motivated to set competition goals when I was 14, sadly. Having had a pretty good 2013/14 training season I am about as fast as I was when I last competed as a teen. Last week I had the opportunity to compete in the 15th FINA World Masters Swimming Champs in Montreal, Canada, which someone told me is the largest aquatic event to be held in the Americas, ever.

While some things do not change – e.g. familiar anxiety, with its negative consequences – aches and pains are more worrisome than they were 25 years ago, ‘recovery’ is slower, and, since improving as you age is pretty unlikely, my main (and realistic) aim is to slow the rate of decline rather than to ride a trajectory of gradual improvement.

That said, this week, I’ve seen some truly inspiring swims, and also some nigh-unbelievable race times achieved by swimmers who are a lot older than me. The oldest participant in the 3km open water event was an incredible 87. The oldest participant in the pool swimming division was a 97 year old lady who had traveled from New Zealand! She looked 75. There were women in the 90+ category in all the swimming events INCLUDING the 400m individual medley and the 200m butterfly (in which one aged 90 set a new world record of 8min 52sec ....I couldn’t swim 200m fly NOW so the thought of swimming fly for nearly nine minutes at the age of 90 boggles the mind!). There were two 95-year-old men and there were men in the 90+ categories in most events. A lovely 87 year old man from my club competed and won a pair of silver medals. There were some pretty old participants in the diving category too. Scary to watch.

Looking at the results I can dream that if I work really hard at slowing the decline (to a rate of zero…okay who am I kidding?) I could, for example, swim the 200m individual medley in my current time at this meet in 20 years time – and medal!

Clearly these inspiring seniors are a healthy lot, enjoying the benefits of partaking in regular aerobic and strength-building exercise over many years. Yet it seemed to me that there are benefits of competitive/club exercise, aside from direct cardiovascular health related ones, when you are growing older. If you are introverted like me, being in a sports club helps you to connect with people in a less-stressful way than regular socializing. I see the power of the swim club in the way that the older members of my own swim club care for and encourage each other. I’ve seen it at the Masters Champs. Most people are not there to win, or to medal. Most are team mates who have made a journey half way around the world together. They have fun with each other and support each other, cheer each other on, say ‘Good job!’ even if a swimmer comes in way off their PB. At other, more accessible, events I have seen swimmers in the over-80-&-90 years age categories that are in wheelchairs on poolside, who can still swim a race and may hope to set a new record.

Heavy picOn the last weekend of #FINAMasters2014, we shared Parc Jean Drapeau with festival-goers attending the Heavy Montreal event. It made for an interesting contrast. Hundreds of lean, older, healthy, lightly clad athletes drinking fruit smoothies, alongside thousands of heavy metal fans wearing heavy jackets in the hot sun, arriving on Harleys, drinking mainly copious alcohol and filling the air with tobacco and marijuana smoke. Populations drawn from different demographics.

That got me thinking about the older competitive swimmer demographic, or at least the crowd that managed to get themselves to the World Champs. We’re looking at a privileged bunch – that much is clear. They have enough money to travel a long way to compete. They have enough leisure to put in hours and hours of training; many can afford to hire personal trainers to help them with land training as well as pay fees that come with Masters swim club membership (registration with a Masters club was a requirement for entry). Some could afford to bring their spouses and kids along too. I noticed that the only competitors who came from Africa were from South Africa and Egypt. The majority came from Canada (‘home country’) and the United States, with large contingents from wealthier European countries, Japan and Australia. South American countries were quite well represented. I didn’t see a single black person competing (although I’m not saying I saw every competitor), which seemed odd.

Kirsten competing in a relay event (centre)

Kirsten competing in a relay event (centre)

So when admiring the obviously superior health and wellbeing of Masters Swimmers, it is prudent to remember what’s known about the associations between socio-economic advantage, good health and longevity. I’m still in awe of the 80+ and 90+ year old swimmers who came to compete at Worlds this year. They are an inspiration. I hope to be a 90-year-old competitor myself someday. That’s a good intention to have. “If you can’t beat ‘em outlive ‘em,” they say 😉 Yet I recognize that alongside all effort of training hard and eating healthily, the long term health of my body depends on other factors, too, like my income, many childhood advantages, education, genetic factors, and luck. I’d like to develop another intention, too – to encourage people who don’t think swimming is ‘for them’ to try it. Hopefully, by the time I’m competing in the 80+ age groups, Masters swimming will represent a broader demographic.

Domhnall MacAuleyIts not just the football. Sports docs watch the World Cup medical stories with great interest—which players are injured, what happened and how they are managed. Luis Suárez, suddenly infamous, scored two goals, effectively eliminating England, just weeks after an arthroscopy. And, with the current controversy over concussion and possible long term chronic traumatic encephalopathy, we are especially aware of head injuries. In 2010, team doctors of the 32 finalist teams reported 125 injuries in 64 matches with 104 injuries during training. Most of these injuries were not serious and the incidence of match injuries was lower than in the three preceding World Cups. So far, this year looks even better. The World Cup only offers a short window on acute soccer injuries, however, and it may be more important to look at the long term sequelae and, in particular, if soccer might lead to long term osteoarthritis. There is some evidence that it does but we await the findings of what may be the definitive study, Osteoarthritis Risk of Professional Footballers, undertaken by the Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis—a major UK and international collaboration. The World Cup is also likely to generate other tangential papers such as to how it might influence the number of ER admissions or myocardial infarctions.

Exercise in treating arthritis initially seemed counter intuitive. Rob Petrella, now at University of Western Ontario, first brought this to my attention in a poster at a medical conference, and it led to his systematic review in 2000 asking if exercise was an effective treatment for osteoarthritis of the knee. At that time there were few sufficiently powered randomised controlled trials but, overall, the evidence seemed in favour. Last year, a similar systematic review showed overwhelming evidence in favour of exercise for lower limb osteoarthritis. This was a sequential meta analysis and, what was particularly important, was that there was sufficient evidence to show physical activity was beneficial as early as 2002. It can take a long time to change our minds and integrate evidence into practice.

Evidence in treating arthritis is not always what one might expect. Just a few weeks ago, Kim Bennell and her colleagues published a high quality randomized controlled trial on the effect of physical therapy in hip osteoarthritis. Patients had 10 treatments over 12 weeks comprising education and advice, manual therapy, home exercise, and gait aid if appropriate. There was, perhaps unexpectedly, no difference in pain or function compared with sham treatment. I cannot imagine that the findings of this study were welcomed by Kim’s physiotherapy colleagues. Its not just in football where the results can be surprising, unexpected and disappointing for the supporters.

DMacA_3Domhnall MacAuley is a CMAJ Associate Editor and a professor of primary care in Northern Ireland, UK

The photograph in the Globe and Mail was impressive. Thousands on the Ride to Conquer Cancer bike ride in Toronto reflects both the current popularity of cycling and people's willingness to support cancer charities. According to the photo caption, it had raised over $119 million; 20 million dollars this year alone. An immense achievement. Cycling has of course, been long linked with cancer fundraising through Lance Armstrong, long time champion for cancer sufferers who gave so many people hope and inspiration and raised millions for his cancer charity. Sadly, his doping admission destroyed his personal reputation and popularity, did untold damage to his cancer work, and disappointed millions of cancer patients.

Doping seems inextricably linked with cycling and will be once again in Canadian consciousness with the release on Friday June 13th of “La Petite Reine”, a biographical film about Genèvieve Jeanson. Its timely release will reprise the pressure on athletes to perform, the role of parents and coaches, and our own expectations of top athletes. The doping story in cycling doesn’t seem to have dimmed public interest however and, as the Tour de France begins in a few weeks, cycling fans will look forward once again to watching the pain, suffering, and glory of the heroes and villains of the cycling world and still hoping to believe.

Cycling is more popular than ever, in spite of the seemingly relentless adverse publicity—even if we allow ourselves a quiet smile at the modern cycling phenomenon, the MAMILs (middle-aged men in lycra). Doctors are not immune and, if coffee room chat is an accurate measure, may be particularly vulnerable to the MAMIL phenomenon. It is easy to forget the risks, however, when thinking of the considerable health benefits. To give this a medical context, do read this Australian newspaper article based on the crash injuring Sydney Medical School Professor Paul Haber when a 4x4 vehicle ploughed into their group of seven cyclists.

What can we do? We need to keep in perspective the public health benefits of physical activity and the wider benefits of this cycling movement. Serious road crashes are relatively rare, but they are preventable. There is no medical solution, its about the environment, the law, and society. Doctors may not have a direct part to play in changing government transport policy, the legal system, nor road design but they can give leadership, highlight the risk of injury and advocate for change.