In the most traditional sense, physical activity confers a multitude of health-improving and life-saving benefits, including prevention of chronic disease, reduction in all-cause mortality and ...improvement in mental health and well-being.7 Across diverse communities, physical activity may further draw meaning from purposeful movement in ceremony or rehabilitation; for others, it may be the scoring of a golden goal on the world stage, or it may refer to the freedom to wheel or walk in safe, accessible community spaces. Movement equity means addressing barriers and facilitators to physical activity within the healthcare system, built environment, local community and beyond; and improving physical activity resources and recommendations in medical education, clinical, hospital and community settings at scale. While counselling on physical activity is one of our mandates as clinicians and one of the eight Great Investments in Physical Activity for Health,13 appreciate the burden of treatment that such counselling can cause.14 As clinicians, we may believe it is straightforward to encourage walking to work instead of taking the car, but is daily active transport realistic for patients who live long distances from work, have accessibility needs or work multiple jobs? Relationship between physical activity and individual mental health after traumatic events: a systematic review.
Correspondence to Dr Jane S Thornton, Public Health and Family Medicine, University of Western Ontario Schulich School of Medicine and Dentistry, London, Canada; jane.s.thornton@gmail.com Dr Amandev ...Aulakh espouses love of community and representation. Research to practice Having studied physical activity in a multiethnic Canadian population and obesity in Indigenous children and adults, she continues to remain engaged with the lessons learnt through that research. Representation matters Amandev noticed from her early days in her SEM fellowship that there were no female South Asian role models or mentors.
According to Fisher et al’s heuristic model,2 the power differential in sport particularly positions coaches to hurt or help their athletes, and as such coaches are responsible for athlete’s welfare. ...According to self-determination theory, the autonomy-supportive coach emphasises the needs of athletes, encouraging autonomy and involving them in the decision process.3 The higher the stakes, the more coaches tend to adopt a controlling motivation style,4 even though this is when athletes need support the most. Burnout and mental health concerns in medicine are rampant.7 Wellness and resilience programmes achieve little in the face of controlling, stressful and even abusive teaching environments where ‘massive systems change’ is instead required.
Correspondence to Dr Jane S Thornton, Public Health and Family Medicine, University of Western Ontario Schulich School of Medicine and Dentistry, London, Ontario, Canada; jane.s.thornton@gmail.com ...Athletes’ and patients’ perspectives are critical in Sport and Exercise Medicine research1 and the voices of those most impacted by research, policy development and implementation must be actively engaged throughout the process—‘nothing about us, without us’. Since the British Medical Journal’s 2014 launch of its patient partnership strategy, most articles continue to be directed ‘to’, ‘about’ or ‘for’ rather than ‘with’ or ‘by’ patients and the public.2 Reasons for this may include not fully understanding the ‘why’, not knowing where to begin, or logistics such as funding or time limitations. Beyond the Journal’s mandate, Van Mechelen’s classic injury prevention framework has recently been revisited to urge inclusion of the athlete voice and context.3 A conceptual framework for the safe and effective engagement of survivors in safeguarding initiatives in sport has also been advanced.4 One of us lives with rheumatoid arthritis and osteoarthritis, and physical activity is an important tool in her treatment (along with medications, adequate sleep and a healthy diet). Ultimately, engaging athletes and patients can strengthen the research team and improve research outcomes, experience and dissemination.Box 1 Illustrative example on engaging patients and community members on physical activity and health The authors have worked together on the ‘Western Research Hub for Physical Activity and Health’ over the past year, a project that has engaged researchers, clinicians and patients and community members from its start and in different ways.
Antonio Garcia-Hermoso and team studied 3.3 million participants across 31 countries to explore adherence to aerobic and muscle strengthening activities guidelines in their systematic review and ...meta-analysis ( see page 225 ). Results from research with global representation signpost where we can and must begin to effect change. The latest CASEM Position statement is a timely contribution from Michael Koehle and his team to outline personal strategies to mitigate the effects of air pollution exposure during sport and exercise ( see page 193 ).
Abstract
The health benefits of physical activity (PA) are acknowledged and promoted by the scientific community, especially within primary care. However, there is little evidence that such promotion ...is provided in any consistent or comprehensive format. Brief interventions (i.e. discussion, negotiation or encouragement) and exercise referral schemes (i.e. patients being formally referred to a PA professional) are the two dominant approaches within primary care. These cost-effective interventions can generate positive changes in health outcomes and PA levels in inactive patients who are at increased risk for non-communicable diseases. Their success relies on the acceptability and efficiency of primary care professionals to deliver PA counselling. To this end, appropriate training and financial support are crucial. Similarly, human resourcing and synergy between the different stakeholders must be addressed. To obtain maximum adherence, specific populations should be targeted and interventions adapted to their needs. Key enablers include motivational interviewing, social support and multi-disciplinary approaches. Leadership and lines of accountability must be clearly delineated to ensure the success of the initiatives promoting PA in primary care. The synergic and multisectoral action of several stakeholders, especially healthcare professionals, will help overcome physical inactivity in a sustainable way.
Correspondence to Dr Jane S Thornton, Public Health and Family Medicine, University of Western Ontario Schulich School of Medicine and Dentistry, London, ON N6G 2M1, Canada; jane.s.thornton@gmail.com ...Physical Activity is a ‘best buy’ for public health: especially for our youth Physical inactivity is one of the biggest public health threats of this century and greatly increases the risk of non-communicable diseases. Prior to the pandemic, physical inactivity was already a critical issue—a WHO survey of 1.6 million participants in 146 countries revealed that 81% of children and adolescents aged 11–17 were not active enough for optimal health.1 In response, WHO created the global action plan on physical activity, a call to action for policy change and effective implementation, where school-based policy initiatives are an essential component to create a more active society.2 Big challenges demand innovative solutions In a recent large-scale cluster-randomised controlled trial, Danish researcher, Larsen aimed to investigate the effects on health knowledge and enjoyment of the 11-week ‘health education through football’ programme for 10–12 years old, with 3127 Danish schoolchildren (49% girls) taking part.3 This adaptation of the original FIFA ‘11 for Health’ programme aims to increase physical activity and enhance health knowledge at the same time, by coupling health education with football drills and small-sided games. More than one million children have now completed the ‘11 for Health’. programme. Since its European expansion, Danish researchers, led by Krustrup and Krustrup, have discovered wide-ranging positive benefits on health,6 7 health knowledge,8 cognitive function9 and well-being, the latter with even greater effects for girls than for boys10—important as 85% of adolescent girls are inactive vs 78% of boys.1 A springboard for broader implementation To successfully tie in health education with physical activity on a large scale is a major step forward.
Non-communicable disease is a leading threat to global health. Physical inactivity is a large contributor to this problem; in fact, the WHO ranks it as the fourth leading risk factor for overall ...morbidity and mortality worldwide. In Canada, at least 4 of 5 adults do not meet the Canadian Physical Activity Guidelines of 150 min of moderate-to-vigorous physical activity per week. Physicians play an important role in the dissemination of physical activity (PA) recommendations to a broad segment of the population, as over 80% of Canadians visit their doctors every year and prefer to get health information directly from them. Unfortunately, most physicians do not regularly assess or prescribe PA as part of routine care, and even when discussed, few provide specific recommendations. PA prescription has the potential to be an important therapeutic agent for all ages in primary, secondary and tertiary prevention of chronic disease. Sport and exercise medicine (SEM) physicians are particularly well suited for this role and should collaborate with their primary care colleagues for optimal patient care. The purpose of this Canadian Academy and Sport and Exercise Medicine position statement is to provide an evidence-based, best practices summary to better equip SEM and primary care physicians to prescribe PA and exercise, specifically for the prevention and management of non-communicable disease. This will be achieved by addressing common questions and perceived barriers in the field.Author note This position statement has been endorsed by the following nine sport medicine societies: Australasian College of Sports and Exercise Physicians (ACSEP), American Medical Society for Sports Medicine (AMSSM), British Association of Sports and Exercise Medicine (BASEM), European College of Sport & Exercise Physicians (ECOSEP), Norsk forening for idrettsmedisin og fysisk aktivite (NIMF), South African Sports Medicine Association (SASMA), Schweizerische Gesellschaft für Sportmedizin/Swiss Society of Sports Medicine (SGSM/SSSM), Sport Doctors Australia (SDrA), Swedish Society of Exercise and Sports Medicine (SFAIM), and CASEM.
Correspondence to Jenna M Schulz, Family Medicine, Western University Schulich School of Medicine & Dentistry, London, Canada; jschulz2@uwo.ca With increased participation in sport by female ...athletes, there has been a concomitant rise in the number of female athletes aiming to return to activity (RTA) and/or return to sport (RTS) postpartum. ...almost one in two female participants stops exercising/playing sport due to pelvic floor symptoms.1 Additionally, a lack of female athlete-specific research and clinical practice guidelines make it difficult for both athletes and clinicians to navigate a safe and successful RTA/RTS.2 Furthermore, female athletes have specific biological, sociocultural and environmental considerations that could impact sport and health outcomes.3 A recent scoping review was undertaken to evaluate recommendations for RTA/RTS postpartum.4 We concluded that while some recommendations exist,5–7 evidence informed guidelines are needed to improve physical activity levels and RTA/RTS for postpartum females.4 This infographic aims to summarise the results of the scoping review and suggest a framework for RTA/RTS postpartum. Review of the scientific rationale, development and validation of the International Olympic committee relative energy deficiency in sport clinical assessment tool:
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