SPORTS MEDICINE (see also physiology of lungs, heart, and skeletal muscles) : the field of medicine concerned with injuries sustained in athletic endeavors, including their prevention, diagnosis, and treatment.

Table of contents :

  • genetic screening
  • training
  • techniques
  • state-of-the-art technology
  • environmental conditions
  • contraindications to agonistic sports
  • recovery
  • doping
  • sport-associated diseases
  • web resources

  • Sports medicine now comprises two main areas: the health benefits of regular physical activity and the health problems associated with sport and physical activity. The first area has become increasingly important now that inactivity and obesity are common. The health problems associated with sport have also assumed increasing importance because of increased participation and professionalism in sport. One of the most important advances in medicine is the documentation that regular physical activity reduces the risk of premature mortality, coronary heart disease, hypertension, colon cancer, obesity, and diabetes mellitusref. Recent studies have shown that inactivity and low cardiorespiratory fitness are as important predictors of mortality and morbidity as overweight, obesity, smoking, and raised cholesterol levels and blood pressureref1, ref2, ref3, ref4, ref5, ref6. Physical activity also protects against breast cancer, and possibly prostate, lung, and endometrial cancerref. Substantial health benefits can be obtained by undertaking a moderate amount of physical activity on most, if not all, days of the weekref. Most recommendations suggest moderately intense exercise with large muscle groupssuch as brisk walkingfor 30 minutes. Recent evidence suggests that exercise sessions may be split into shorter bouts of 5-10 minutes' duration, or even shorter bouts if exercise intensity is high enough.
    Recent advances :

    Most people are capable of this level of physical activity, and expensive training studios, fashionable tights, and even running shoes are not necessary to achieve better health. A recent study in previously sedentary healthy adults showed that a programme incorporating physical activity into the participants' lifestyle was as effective after two years of follow up as a structured programme to improve physical activity, cardiorespiratory fitness, and blood pressureref. Doctors working in primary care are in a key position to promote this level of physical activity; practical tools, such as physician based assessment and counselling for exercise (PACE) (Patrick K, Sallis JF, Long B, Calfas K, Wooten W, Heath G, et al. A new tool for encouraging activity. Physician Sportsmed 1994; 22: 45-55), may help them to advise patients effectively. Body weight has been increasing at an alarming rate worldwide, mainly as a result of decreasing daily energy demands owing to increased mechanisation at home and work and during leisure timeref. Several recent prospective observational studies show that regular physical activity lowers many of the health risks associated with overweight and obesityref1, ref2. Furthermore, obese people who are active have lower mortality and morbidity than people whose weight is normal but who are sedentaryref. This means that for the overweight or obese patient, starting and maintaining a regular exercise programme yields important health benefits, even in the absence of substantial weight lossref1, ref2. This is encouraging, as maintaining regular physical activity of moderate intensity may be perceived as more attainable than reducing body weight. As low functional capacity and a high incidence of chronic disease are common among elderly people, exercise training should be particularly encouraged in this populationref. Advancing age brings progressive loss of muscle strength, muscle mass, and muscle quality, resulting in a condition known as sarcopeniaref. Studies in recent years have shown that strength training can reverse the loss of muscle function and the deterioration of muscle structure associated with advanced ageref1, ref2, ref3. Strength training improves functional ability and health, not only by increasing muscle mass, strength, and power, but also by improving bone mineral densityref1, ref2, ref3. Strength training also improves balanceref. Sarcopenia, osteoporosis, and reduced balance are the main risk factors for falls and osteoporotic fracturesref1, ref2. Strength training may therefore prevent osteoporotic fractures, one of the main sources of physical disability and obstacles to independent living among elderly peopleref1, ref2. Although exercise has not yet been proved to prevent falls and fractures in elderly people, epidemiological studies (case-control and prospective cohort follow up studies) consistently show that both past and current physical activity do protect against hip fracture, reducing the risk by up to 50%ref. Most of the studies on strength training have used high intensity, progressive, resistance training protocols similar to those used by athletes, focusing on large muscle groups (hip and knee extensors). Trial subjects have trained with a resistance of 80% of the maximal load the subject can fully lift once only, and resistance has been increased as strength improves. For maximal effect, strength training should be done 3 days a week for at least 3 months. Each muscle group should be exercised in 3 sets of eight repetitions each session. High intensity strength training can be done at home or in a group but requires skilled instruction at the start. Regular physical activity, especially if started in childhood and adolescence, is a cheap, safe, readily available, and largely acceptable way of improving bone strength and reducing the propensity to fallref. Physical activity, including specific strength training for target groups, should therefore become an essential part of strategies aimed at controlling the alarming increase in osteoporotic fractures. Want to keep your wits about you until a ripe old age? Scientists say that aerobics does more than mental exercise to keep your brain fit. Regularly sweating it out on the squash court is like a fertilizer for brain cells, they say. Exercise for the body helps new brain cells to sprout and make more connections, which in turn helps to preserve the frontal lobes, the area of the brain where ageing is most noticeable. In a review of the past 10 years of research in the field, evidence was found that good nutrition, education, and positive thinking all help to keep your brain young. But the most important factor is aerobics, he concludes. "It has remarkable beneficial effects on the structure and function of the brain. One study in his review looked at a group of over-60s who engaged in "intense walking" for four months, and compared them with another group who stretched instead. The cardio folk were sharper, their memory and attention improved, compared with the stretching group. Exercise helps your brain to make BDNF, which creates brain cells and connections. New capillaries also grow with exercise, nourishing these cells and connections that would otherwise wither away under the pressure of ageing. In the over-50s, exercise is a sort of wonder drug that makes you more mentally agile, less forgetful and delays the loss of sharpness. Some have hypothesized that exercise is helpful because it involves learning new motor skills, a mental challenge that gives your brain a work out. But this would result in growth specifically in the motor areas of the brain, and that people learning new stretches would gain the same benefit as those learning new aerobic routines. Neither seems to be the case. It is true, however, that mental exercise also helps the brain to stay sharp. Use your mind as much as possible and learn to link information to images or sounds in order to strengthen your memory : do not think about yourself with adjectives such as 'grey' and 'old', focusing instead on positive ones such as 'healthy' and 'active'. Studies have shown that simply thinking about these words can affect how someone behaves, changing how quickly they walk, for example. Robertson's team plans to work out an optimum mixture of mental and physical exercises to keep minds sharp. Mrutunjay Padmacharan Mandal a 7 year old boy who was to set an 80 kms marathon record in Mumbai today collapsed before completing the race. The boy began his run at 4:35 am early this morning from Durgadi Fort in Kalyan and was to reach the Gateway of India by 1 pm but the boy collapsed near Kemps Corner in Mumbai and died at the GT hospital. Mandal has already completed a 70-km run from Ujeleshwar to Paschimeshwara temple in Behrampore in 6 hours in April 2006. The boy inspired by long distance runner Budhia Singh has been practicing for the last 1.5 year and was running a distance of 20 kms everyday

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