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

Olympic Incentive

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

Triathlon

• 1500m Swim

• 40km Bike

• 10km Run

• Aquathlon

• 1km Swim

• 5km Run

Bike

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2nd world aquathlon champs

SummaryPhysical Activity is fundamental to the Health of the Nation and therefore to general practice

We should encourage sport at all levels and support the consequences of this.

References: www.dh.gov.ukwww.wada-ama.orgwww.bmjjournals.comwww.science.org.au

Any Questions?