Sport and exercise science and medicine: building on the Olympic legacy to improve the nation's health - Science and Technology Committee Contents


CHAPTER 2: The quality of science underpinning sport and exercise science and medicine

Sport and exercise science and medicine

11.  Sport and exercise science (SES) is the application of fundamental and applied sciences to the sport and exercise environment;[16] and findings from a variety of different areas of science, including physiology, biomechanics, nutrition, genetics and psychology, are applied to the study of sport and exercise.[17] In 2001-07, research income for "sports-related studies" was £31.2 million.[18]

12.  Sport and exercise medicine (SEM) has been recognised recently as a specialty by the National Health Service (NHS).[19] It is concerned with "all aspects of health and illness that may prevent a person from engaging in, or returning to, sporting or physical activity".[20] The NHS define SEM as "the management of medical conditions and injury in those who participate in physical activity".[21] The specialty also includes expertise in exercise advice, prescription and promotion for general health, and for those with chronic medical problems.[22] The research subjects of both SES and SEM include elite athletes, non-elite athletes and the wider public. There is some overlap between the two fields.

13.  In this chapter, we consider the use of science to improve the performance of elite and non-elite athletes, and the scientific study of physical activity in the wider population. We also explore the relevance of findings from research in SES and SEM to the wider public.

Quality of SES and SEM research

14.  Before considering whether SES and SEM research can be translated into public health benefits, it is necessary to consider whether the research is sufficiently robust—in the sense that it is based on accepted scientific methodology—to justify translation. The scientific method involves systematic observation, measurement, and experiment, and the formulation, testing, and modification of hypotheses.[23] Replication of research results and appropriate statistical analysis are necessary before a result is widely accepted.

15.  Several witnesses referred to the difficulties of conducting good quality research with elite athletes. A principal difficulty was the limited number of elite athletes to test and, therefore, small sample sizes.[24] Furthermore, many elite athletes are reluctant to allow invasive procedures, such as blood sampling and tissue biopsies, for fear they would interfere with performance.[25] We were told that another common difficulty was creating control groups, because athletes, and their support staff (such as coaches), were seeking a "competitive edge" and so would not consent to such arrangements.[26] As a consequence, research on elite athletes tends to be descriptive or anecdotal rather than systematic. Given that some of these difficulties are intractable because of the very nature of elite performance, using non-elite athletes offers a more effective alternative subject for research in these fields.

16.  A number of witnesses were positive about the quality of research. For example, Professor Myra Nimmo, Head of School of Sport, Exercise and Health Sciences and Professor of Exercise Physiology of Sport, Loughborough University, argued that the quality of SES research, on the whole, was excellent.[27] Colonel John Etherington, Vice-President, Faculty of Sport and Exercise Medicine (UK), and Director, Defence of Rehabilitation and Consultant in Rheumatology and Rehabilitation at the Defence Medical Rehabilitation Centre, Headley Court, said that "the model of the science is very good" in SES.[28] Professor Tim Cable, Director of the School of Sport and Exercise Sciences and Professor of Exercise Physiology, Liverpool John Moores University, was confident of the rigour of science in SES, and gave the examples of the physiological adaptations that can be provoked by certain training regimens, brain behaviour adaptations seen in learning skills, and biomechanical adaptations. He argued these were are all based on sound scientific evidence.[29]

17.  Other witnesses, however, suggested that the quality of sport science research was generally weak. The Physiological Society said that an "increased amount of robust research" was being undertaken, but were critical of the quality of research both in SES and SEM.[30] Much of the research presented in our sport science seminar was observational and anecdotal, so the results of such research must be viewed as no more than provisional.[31] Observational research needs to be followed up with rigorous testing of hypotheses in controlled experiments with sufficient sample sizes for statistical analysis. There are voluntary guidelines promoting good quality SES research but it is not clear how widely they are followed.[32] The RCP and Ministry of Defence (MOD) were critical of weak methodologies employed in SEM, and suggested that there was a "focus on more esoteric areas".[33] They pointed to a lack of good quality, large-scale trials, with appropriate outcome measures,[34] which Colonel Etherington summarised as a lack of "rigour in approach to clinical trials in sport and exercise medicine".[35]

18.  UK Sport argued that measuring quality of research by its methodology risked ignoring the "end user". UK Sport suggested that other factors had to be considered such as performance impact, adoption of findings, and behaviour change.[36] Professor Greg Atkinson, Professor in Exercise and Human Health Research, Teesside University, and Professor David Patterson, Chair, Institute of Sport and Exercise Medicine and Professor of Cardiovascular Medicine, Centre for Health Informatics and Multiprofessional Education, University College London (UCL), made the case for the value of observational studies.[37]

19.  We accept the importance of outcomes, and the merits of observational research as the first step to full scientific investigation. However, if the research in this field is to be of value, it must be rigorous. For example, it should be able to stand-up to the widely used test of peer-review and be of comparable quality to research in fundamental disciplines such as physiology.

20.  During the course of this short inquiry we were presented with little evidence to suggest that the enhancement of the performance of elite athletes is generally based on strong biomedical science. Given the difficulties associated with conducting research with elite athletes, it is important to develop a two-way flow between, on the one hand, observations on elite athletes and, on the other hand, rigorous research on non-elite athletes and the wider public.

Improving the performance of elite athletes

21.  The examples in Box 1 illustrate the quality of science underpinning attempts to improve elite performance.

BOX 1

Examples of use of science to improve elite sporting performance
  • Training at altitude has become increasingly popular amongst elite athletes. Exercising at altitude leads to increased ventilation, increased heart rate, decreased stroke volume, reduced plasma volume, and lower maximal aerobic power. This enables athletes to push their limits in training. It is also claimed that the technique, known as hypoxic training, increases the level of haemoglobin and thus the oxygen carrying capacity of the blood. This will help to reverse the effect of altitude to reduce exercise performance. When athletes then return from altitude, they experience performance benefits at sea level.[38] Professor Hugh Montgomery of University College London, who has pioneered much of this work, explained that whilst "we know that it does work", what is less clear are "the reasons why and how to manipulate it".[39]
  • Ice baths are increasingly used by elite athletes to accelerate recovery from training. There is limited scientific evidence to support this technique, with no evidence from controlled trials that post-exercise cooling with an ice bath enhances recovery and improves subsequent performance.[40]
  • The increase in metabolism during high intensity exercise can generate free radicals which can damage mitochondria and other organelles inside muscle cells. In an attempt to counteract this potential free-radical damage there is substantial consumption of antioxidants by athletes. However, evidence from Professor Jose Viña shows clearly that antioxidant supplementation does not have such protective effects and may, in fact, prevent the benefits normally seen with exercise training.[41]
  • One aspect of nutritional manipulation which has been shown to be beneficial in terms of performance during prolonged endurance exercise (such as marathon running) is carbohydrate loading. This technique was originally developed in experimental studies in non-elite athletes, and showed that continuing training while on a low carbohydrate diet would deplete the muscle carbohydrate (glycogen) stores, but when followed immediately by 2-3 days of a high carbohydrate diet this would lead to an overshoot of recovery of glycogen (supercompensation) which led to enhanced muscle glycogen levels at the start of an endurance event. This, in turn, ensured a sustained supply of carbohydrate fuel for the muscles and better endurance performance and was subsequently adopted by elite athletes. The specific detail of this regime has been modified over the years with subsequent research on non-elite athletes then applied to the elite, in order to ensure sustained improvement in performance with less extreme dietary manipulations.[42]

USE OF THE LATEST DEVELOPMENTS IN SCIENCE TO IMPROVE ELITE PERFORMANCE

22.  The UK has internationally recognised expertise in many fields relevant to SES and SEM. For example, Professor Jose Viña, Department of Physiology, University of Valencia, referred to the UK's leading research in fields relating to the improvement of performance, such as metabolic research applied to the physiology of muscle.[43] In this context, we considered whether SES and SEM for elite athletes were being informed by the latest developments in, for example, physiology, biomechanics, genetics and nutrition. Professor Gerta Vrbova, Emeritus Professor of Developmental Neuroscience, UCL, suggested not. She told us that SEM departments are "often poorly equipped" to apply advances in science to problems in their field.[44] The Physiological Society said that although there was significant potential for fundamental scientific research to "feed into" performance enhancement of elite (and non-elite) athletes, that potential was often not fulfilled.[45] The evidence we received has led us to the view that the latest advances in relevant areas of biomedical research are not being consistently applied to improving the performance of elite athletes. Robust methodologies must be applied to SEM and SES for them to have maximum effect, and to enable a two-way flow of research between the fundamental and applied disciplines.

USE OF SCIENCE BY UK SPORT

23.  UK Sport is a DCMS arm's length body. They have a research and innovation budget of £7.5 million (for the period 2009-13) from a combination of Government and National Lottery funding,[46] and attract over £12 million in "external funding".[47] We asked Liz Nicholl, Chief Executive of UK Sport, about their approach to science relevant to their remit. She told us that the agency's primary objective was to win more medals in competitions. As a result, their focus was on outcomes stemming from the application of science rather than scientific methodologies used.[48] UK Sport said they relied on the providers of science to do the quality assurance.[49] We were surprised by this since ensuring that robust science is used would increase the likelihood that interventions to improve competitive performance are effective. We note that UK Sport has a science research advisory group to provide "advice on research and development projects" and to evaluate "the effectiveness of projects annually",[50] but, if the science used by UK Sport is to be as effective as possible in improving performance, it must be consistently robust and verified as such. A review in 2005 by the Office of Science and Technology concluded that DCMS needed to satisfy itself of the quality assurance of science by its arm's length bodies, such as UK Sport.[51] Neither DCMS officials nor Hugh Robertson MP, Minister for Sport and the Olympics at DCMS, convinced us that the department has the capacity to undertake this task.[52] We recommend that DCMS and UK Sport take steps to ensure that the biomedical science UK Sport applies to improving the performance of elite athletes is of the highest quality and meets international peer-review standards that would be applicable in other areas of science.

24.  We were also disappointed by the approach of UK Sport to sharing the findings of research. Little of the agency's work is published in peer-reviewed journals, and many of its results are not publicised in order to protect a competitive edge.[53] We heard one good example of findings being shared: the publication of the findings of a UK Sport workshop on early treatment of muscle strains.[54] But we did not receive evidence to suggest that this type of work is undertaken often. We recommend that UK Sport should, as a matter of principle, undertake to share its research findings more widely, especially where the research is publicly funded.

HEALTH BENEFITS OF PHYSICAL ACTIVITY

25.  There is a significant body of evidence regarding the health benefits of physical activity and the use of exercise to manage chronic disease. For example, DH referred to research demonstrating that physical activity can be effective in the prevention and management of over 20 chronic conditions, including coronary heart disease, stroke, type two diabetes, cancer, obesity, mental health problems and musculoskeletal conditions.[55] They argued that the research on disease management is robust because it is supported by randomised controlled trials.[56] Professor David Jones, Emeritus Professor of Muscle Physiology, Manchester Metropolitan University, told us about research into the role exercise can play in preventing the development of obesity, diabetes and cardiovascular disease.[57]

26.  The Chief Medical Officers' Physical Activity Guidelines are based on a literature review of the latest research into physical activity. Most involves population-level studies that show correlations between physical activity and health outcomes.[58] What is less well understood are the underpinning mechanisms which would explain these effects.[59] Research into increasing our understanding of these underpinning mechanisms could unlock benefits for athletic performance and for public health, in relation to managing illness and disease prevention. For instance, understanding the cellular or molecular processes that underpin changes in muscle mass have applications for both. There seems to be sufficient evidence to demonstrate a causal link between physical activity and health benefits for a very wide range of diseases. However, the reasons for this link are not well understood. Research to understand these underpinning mechanisms could be of benefit to elite athletes, non-elite athletes and the wider public.

Relevance of findings from the study of elite and non-elite athletes to the wider public

27.  Where there is good quality evidence from the study of elite and non-elite athletes, we considered whether findings from such research in SES and SEM were relevant to the wider public. Some witnesses challenged the relevance of studies of elite athletes to the general population. Professor Sir Steve Bloom, Head of Division for Diabetes, Endocrinology and Metabolism, and Chair of the Academic Section of Investigative Medicine, Imperial College London and Chief of Service for Pathology at Imperial College Healthcare NHS Trust, said: "I cannot see any area of research that has come out of competitive training that is actually helpful to the general population",[60] and Dame Sally Davies, Chief Medical Officer (England) and Chief Scientific Adviser, DH, was "not convinced there is vast transferability".[61] These views were, however, the exception.

28.  Colonel Etherington argued that the principles of exercise to produce a physiological adaptation were applicable to the wider public:

"whereas the minutiae of the physiological enhancement to get that last 2% to win a gold medal may not be so relevant to the elderly patient with osteoarthritis of the knee, the principles of strength training and general conditioning are".[62]

The RCP provided two examples of research "pulled-through" to benefits for the general population: they suggested that the management of the diabetes of elite sportsmen has begun to inform the principles of diabetic care in the exercising population; and that work with athletes had informed the use of exercise and muscle conditioning to improve back and knee pain in osteoarthritis. They concluded that, whilst there was potential for lessons learnt from the study of athletes to be applied to general population, this was not always happening.[63]

29.  Professor Alison McConnell, Professor of Applied Physiology at Brunel University, argued that:

"by understanding the limits of human performance (for example, cardiac output, muscle blood flow) and by gaining an understanding of how to optimise interventions to achieve specific goals, exercise science can contribute to the development of exercise-related interventions for patients".[64]

The Physiological Society made a similar argument:

"understanding of elite performance physiology, being located on one extreme of a continuum of human states (from elite, through the normal range to various disease states), can provide unique insight into physiological mechanisms of relevance to heart disease, respiratory disease, ageing, muscle wasting, obesity, diabetes". [65]

Professor David Mullineaux, Professor in Sports Science, School of Sport, Coaching and Exercise Science, Faculty of Health and Life Sciences, University of Lincoln, suggested that, although there was great potential to transfer understanding of elite athletes to improve the health of the wider public, this avenue of research was underexplored.[66]

30.  Where there is a good scientific basis, lessons could be learnt from the study of elite and non-elite athletes that have relevance to the wider public. This "trickle down" of research from athletes to public health benefits will be even more valuable where underpinning mechanisms are better understood.

31.  This is a potentially valuable area of research which could have a variety of applications: preventative measures and treatments for members of the public who exercise infrequently (for example, weekly rather than daily); providing underpinning knowledge for more detailed exercise guidance; and developing new interventions based on knowledge of physiological responses. We would hope that research and innovation to support Paralympians also filters through to benefit the wider public. In the next chapter, we consider the barriers to translation and how they can be reduced so as to enable greater "trickle-down" of research to benefits for the wider population.


16   Based on the definition by the British Association of Sport and Exercise Sciences (BASES) at http://www.bases.org.uk/About. Back

17   IbidBack

18   RAE 2008: Subject Overview Report: Unit of Assessment 46 Sport-Related Studies, January 2009. Back

19   DH. Back

20   http://www.medicalcareers.nhs.uk/specialty_pages/medicine/sport_and_exercise_medicine.aspx.  Back

21   Ibid. Back

22   Ibid. Back

23   Oxford University Press: Oxford English Dictionary, 2010. Back

24   Q 90. Back

25   Q 11, RCP. Back

26   Professor Atkinson, Professor Mullineaux, The Physiological Society. Back

27   See Appendix 5. Back

28   Q 7. Back

29   Q 4. Back

30   The Physiological Society. Back

31   See Appendix 5. Back

32   Professor Atkinson, BASES. Back

33   RCP, MOD. Back

34   IbidBack

35   Q 8. Back

36   UK Sport. Back

37   Professor Atkinson, Q 90. Back

38   See Appendix 5, RL Wilber: 'Application of altitude/hypoxic training by elite athletes', Medicine and Science in Sports and Exercise, 2007, M Vogt and H Hoppeler: 'Is hypoxia training good for muscles and exercise performance?', Progress in Cardiovascular Disease, 2010. Back

39   Q 11. Back

40   KL Sellwood, P Brukner, D Williams, A Nicol and R Hinman: 'Ice-water immersion and delayed-onset muscle soreness: a randomised controlled trial', British Journal of Sports Medicine, 2007, M Yamane, H Teruya, M Nakano, R Ogai, N Ohnish and M Kosaka M: 'Post-exercise leg and forearm flexor muscle cooling in humans attenuates endurance and resistance training effects on muscle performance and on circulatory adaptation', European Journal of Applied Physiology, 2006, Appendix 4. Back

41   MC Gomez-Cabrera, E Domenech, M Romagnoli, A Arduini, C Borras, FV Pallardo, J Sastre and J Viña: 'Oral administration of vitamin C decreases muscle mitochondrial biogenesis and hampers training-induced adaptations in endurance performance', American Journal of Clinical Nutrition, 2008, MC Gomez-Cabrera, M Ristow and J Viña: 'Antioxidant supplements in exercise: worse than useless?', American Journal of Physiology, 2010. Back

42   E Hultman, and J Bergström: 'Muscle glycogen synthesis in relation to diet studied in normal subjects', Acta Medica Scandinavica, 1967, LM Burke: Sports nutrition in JW Erdman, IA Macdonald, SH Zeisel (eds): Present Knowledge in Nutrition, 10th Edition, 2012. Back

43   Professor Viña. Back

44   Professor Vrbova. Back

45   The Physiological Society. Back

46   Supplementary evidence from UK Sport. Back

47   http://www.uksport.gov.uk/pages/research-innovation/.  Back

48   Q 89. Back

49   Q 70. Back

50   UK Sport. Back

51   Office of Science and Technology: Science review of DCMS, 2005.  Back

52   QQ 41-42, QQ 135-136. Back

53   Q 134. Back

54   http://www.uksport.gov.uk/news/muscle_strain_think_tank/. Back

55   DH. Back

56   Op. cit. Sport and Exercise Medicine: A Fresh ApproachBack

57   Professor Jones. Back

58   DH, see Appendix 5. Back

59   See Appendix 5. Back

60   Q 14. Back

61   Q 44. Back

62   Q 7. Back

63   RCP. Back

64   Professor McConnell. Back

65   The Physiological Society. Back

66   Professor Mullineaux. Back


 
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