Soap Box 20/09/06 Physical Activity Benefits and Hazards Joanna Swallow Swindon/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. ( 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: The rational prescription

Olympic Incentive

Drug Issues in Sport Prescribing for athletes: BNF, 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

2 nd world aquathlon champs

Summary Physical 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: Any Questions?