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Soap Box20/09/06Physical Activity
Benefits and Hazards
Joanna SwallowSwindon/Bath GP Registrar Day Release Course
Sport and Exercise Medicine
• Personal interest• Elective/providing medical cover
• Uncertain training programme, (4 year post grad course.)• Sports and Exercise doctors 02/06• BASEM
• 2 Main Aims• To promote good health through physical activity
• To provide sports medicine expertise to optimise athletic performance at all levels
Preventative Role of Exercise
• A third of men and more than a quarter of women will be obese by 2010, predicts the "most accurate estimate so far" of the future prevalence of obesity in England.
• More than 12 million adults and one million children will be obese in England within four years if nothing is done to reverse the trend.
• (2003-4 Health Survey for England published by the department of Health.)
The Problem
• Reduced Life Expectancy• Cost to the health service• Heart disease• Stroke• Type 2 diabetes• Some cancers
• July 2004 – Obesity PSA target. • To halt the year-on-year rise in obesity among children aged
under 11 by 2010 in the context of a broader strategy to tackle obesity in the population as a whole.
• Obstacles must be removed to prevent obesity through increased physical activity
Copyright ©2005 BMJ Publishing Group Ltd.
Ogilvie, D. et al. BMJ 2005;331:1545-1548
The rational prescription
Drug Issues in Sport
• Prescribing for athletes: BNF, www.wada-ama.org
• Anabolic steroids
• Human Growth Hormone
• Erythropoietin
• Creatine Monohydrate
• Gene Therapy (synthetic genes expressing IGF1 at high levels)
Anabolic Steroids• Testosterone
• Anabolic Effects – increased muscle size/strength, decreased body fat and recovery time from injury
• Androgenic Effects – increased body hair, deepened voice
• Designer Steroids Androstenedione, Nandrolone
Raised BP, Liver/Renal Damage, Impotence, Cardiovascular disease, Aggression
Creatine Monohydrate
• Nutritional supplement not a drug• Naturally present in muscle, brain and blood cells
• Increases energy content of muscle cells• Recycles ADP to ATP and reduces lactic acidosis
• Daily req 2g, supplements 20g/day• Largest selling sports supplement 200million dollars/year from sales
• No Evidence. 51 day study – GI upset and fluid retention• Lancet paper 1998 – renal failure• FDA recommends consulting a doctor prior to commencing.
EPO
• Peptide hormone• Naturally produced in kidneys• Stimulates RBCs and Hb • Increases oxygen carrying
capacity of blood (aerobic capacity)
• MI, CVA, Clotting
Detection
Naturally occurring substances
Benchmark levels
‘Donations’ –
THG tetrahydrogestrione)
Mass Spectrometry
Testosterone/Epitestosterone
T/E ratio
EPO testing based on haematocrit
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