FSEM Joins Academy of Medical Royal Colleges

President's Update

Dr Paul JacksonI am pleased to announce that the FSEM (UK) has been accepted as a member of the Academy of Medical Royal Colleges (AoMRC), this is a big milestone in the development of the Faculty and the specialty. Sport and Exercise Medicine will now have a voice to promote exercise medicine and musculoskeletal medicine directly to those representing all of the other medical specialties in the UK. AoMRC is in a position to collectively influence and shape healthcare across the four nations of the UK and I will keep you up to date with the work we do with the AoMRC on behalf of our membership. 

We have made good progress in raising the profile of the skills that SEM physicians have in MSK Medicine. Our key messages and evidence outlining how effective SEM led MSK services can be in an NHS setting have been communicated in all of our 
recent policy responses. This includes our policy mapping on prevention and supported self-management via the Arthritis and Musculoskeletal Alliance (ARMA). We will also be following developments coming from last week's election results and working on FSEM (UK) policy recommendations for new ministers and returning ministers.

Dr Jo Larkin's blog about the 
MSK care pathway for rehabilitation, also featured on the ARMA website, is a useful tool when sharing and communicating the relevance of SEM in MSK care.

The perception still remains that SEM is all about sport medicine, which is a vital part of what we deliver, however this is beginning to change as we engage more. All of our Members and Fellows have a part to play through the promotion of their skills and training relevant to the Five Year Forward View and its objective 'a radical upgrade in prevention and public health'. I like to add the importance of SEM in the management as well as the prevention of many common conditions, and this is where we can enable a 'radical upgrade' in care pathways and health outcomes for people living with an MSK condition.   
We now have available an excellent Faculty position statement on the complex topic of 
screening for asymptomatic atlanto-axial instability (AAI) in Down Syndrome (DS) athletes. This fully referenced literature review will help doctors in directing athletes with Down Syndrome to the most appropriate sports and activities whilst still encouraging them to take part in exercise which we know brings significant physical and mental health benefits. 

As always, we welcome views from our Fellows and Members on the Faculty and the work it carries out. Our regular Council Meetings provide a platform for our members to get involved via our Council Representatives.

Dr Paul D Jackson, President of the Faculty of Sport and Exercise Medicine UK

Written by Dr Paul D Jackson at 13:10

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Whether you are an elite athlete, weekend warrior or an everyday active person the musculoskeletal care pathway for rehabilitation is the same

Dr Jo LarkinThe knowledge and principles used to treat elite professional athletes in Sport and Exercise Medicine can be used to treat injuries occurring in the rest of the population.

The musculoskeletal (MSK) rehabilitation plan must consider the fact that the objective of the patient is to return to the same activity and environment in which the injury occurred. Functional capacity after rehabilitation, should at the minimum be to the same level, if not better, than before injury. The goal of the rehabilitation process is to limit the extent of the injury, reduce or reverse the impairment and functional loss, and prevent, correct or eliminate the disability.

So why should we do this? Whether you are an elite athlete, weekend warrior or just someone that wants to remain active, the care pathway and rehabilitation in MSK Medicine is the same. Stakeholders such as coaches and corporate bosses, should invest in allowing the time for this to take place because there is evidence to show physical activity has multiple health benefits.

Physical Activity Benefits For Adults CMO

Focusing on the workplace, Business Harvard Review published a document on work effectiveness and performance. It demonstrated that both effectiveness and performance was higher in people that regularly exercise. Exercise has also been show to elevate mood, which has serious implications for workplace performance.

A further study from the Leeds Metropolitan University, demonstrated that on the days that employees visited the gym, their experience at work changed. They reported managing their time more effectively, being more productive, and having smoother interactions with their colleagues. Interestingly this then lead to the individual feeling more satisfied at the end of the day, thus in theory could have a beneficial effect on the individuals’ home life.

Keeping the workforce working is key, no matter if you are an international athlete, office worker or manual worker. Therefore, carefully mapping out the MSK care pathway for the individual is no different. The aim of rehabilitation is to restore function. This is done in very simple steps and starts with a correct and early diagnosis. Once this is established the basic parameters of any rehabilitation programme is to restore the range of movement, strength and then functional progression. The latter phase, is generally sport, exercise and position specific. The goal of the rehabilitation process is to limit the extent of the injury, reduce or reverse the impairment and functional loss, and prevent, correct or eliminate the disability. Within the elite sport setting this is carried out by a multidisciplinary team in order to address all facets of the individuals’ rehabilitation programme and optimise health outcomes, as this is an opportunistic time with the patient.

There are many ways to approach designing a rehabilitation programme and it should occur as soon as the injury takes place. I have provided an example below:

The Acute Phase - there will be some restriction in loading and range to allow for reduction in swelling and pain. However, the practitioner needs to continue to find ways of maintaining cardiovascular fitness.

The Restoration Stage - the programme will focus on range of movement and strength. 

The Reacquisition Stage - where the focus will be progression of strength and initiation of the functional sport and exercise specific tasks.

The Refinement Phase - is to focus on building confidence, developing the complicated skills, progress the cardiovascular drills i.e. graduated return to running or activity. Increase capacity, both endurance and strength of the tissues.

The stages are designed to ensure functions of rehabilitation are systematically undertaken to ensure the patient has best potential return to normal activity.

The government has recently acknowledged the importance of managing MSK issues effectively in the joint green paper “Improving Lives. The Work, Health and Disability Green Paper” with the Department for Work and Pensions and the Department of Health. Therefore, it is imperative we draw on our knowledge from how we rehabilitate the sporting population and utilise our skills for the general population, but instead of using return to sport as our objective end marker, we use the individuals’ goals and link this with occupational return to work goals. Instead of viewing exercise as something we do for ourselves, a personal indulgence that takes us away from our work, it’s time we started considering physical activity as part of the work itself and this is supported within the workplace. In summary, there are many similarities between the care pathway in returning sportspeople to activity and returning working people to their occupation.

Blog first published in Arthritis and Musculoskeletal Alliance (ARMA) members' news May 2017

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Exercise changes the way our bodies work at a molecular level


Even regular walking can drastically change your health Zetar Infinity/Shutterstock Andrew Thomas, Cardiff Metropolitan University

Exercise is good for you, this we know. It helps build muscle, burn fat and make us all into happier, healthier people. But long before you start looking the way you want, there are other hidden, more immediate, molecular and immunological changes taking place inside your cells. Changes which could be responsible for protecting us from heart disease, high blood pressure, type 2 diabetes – and even stave off old age and cancer. The Conversation

You may think that “molecular” changes may not be that much of a big deal. Surely it is fat loss and muscle gain that are the best outcomes of exercise? Actually molecular changes affect the way genes and proteins are controlled inside cells. Genes can become more or less active, while proteins can be rapidly modified to function differently and carry out tasks such as moving glucose into cells more efficiently, or protect cells from harmful toxins.

Type 2 diabetes causes all kinds of health problems, including cardiovascular disease, high blood pressure, blindness, kidney failure and nerve damage, and may lead to limb amputation. The underlying cause is the development of a heightened inflammatory state in the body’s tissue and cells. This damages cells and can eventually lead to insulin resistance and, ultimately, type 2 diabetes.

The main risk factors for type 2 diabetes include obesity, a poor diet and a sedentary lifestyle. However, we have found that even low intensity exercise, such as brisk walking, can increase the body’s insulin sensitivity. This means that people at risk of developing diabetes become less prone because they are able to metabolise glucose more efficiently.

In our study, we asked 20 sedentary people who were at risk of developing diabetes to walk briskly for 45 minutes, three times a week, for eight weeks. Although there was no change in their weight, blood pressure or cholesterol level, on average each participant lost a significant six centimetres from their waist circumference. And, more importantly, there was a reduction in their diabetic risk.

Immune system benefits

Interestingly, there were also exercise-induced changes in the participants’ monocytes – an important immune cell that circulates in the bloodstream. This led to a reduction in the body’s inflammatory state, one of the main risks for type 2 diabetes.

When our body is under attack from foreign invaders such as microbes, immune cells such as monocytes change into “microbe-eating” macrophages. Their main function is to fight infection in our tissues and lungs. There are two main types of macrophages, M1 and M2. M1 macrophages are associated with pro-inflammatory responses and are necessary for aggressively fighting off infections. However, in obese people who do not exercise, these cells become active even in the absence of infection. This can lead to an unwanted, heightened inflammatory condition which may “trigger” diabetes.

On the other hand, M2 macrophages play a role in “switching-off” inflammation and are instrumental in “damping-down” the more aggressive M1s. So a healthy balance of M1 and M2 macrophages is crucial to maintain an optimal immune response for fighting infections – and it may help prevent the heightened inflammatory condition which comes from lack of exercise and obesity too.

Macrophages fight off infectious microbes that infiltrate the body. sciencepics/Shutterstock

Other studies have also shown that exercise has a beneficial impact on tissues’ immune cell function and can reduce unnecessary inflammation. Exercise training in obese individuals has been found to reduce the level of tissue inflammation specifically because there are less macrophage cells present in fat tissue.

In addition, researchers have found a significant link between exercise and the balance of M1 and M2 macrophages. It has been shown that acute exercise in obese rats resulted in a shift from the “aggressive” M1 macrophages to the more “passive” M2 – and that this reduction in the inflammatory state correlated with an improvement in insulin resistance.

Time to move

There is no definitive answer as to how much and what intensity of exercise is necessary to protect us from diabetes. Though some researchers have shown that while higher-intensity exercise improves overall fitness, there is little difference between high and low-intensity exercise in improving insulin sensitivity.

However, a new study has found that all forms of aerobic exercise – in particular high-intensity interval training such as cycling and running – can effectively stop ageing at the cellular level. The exercise caused cells to make more proteins for their energy-producing mitochondria and their protein-building ribosomes. Researchers also observed that these “molecular” changes occurring at the gene and protein levels happened very quickly after exercise and that the effects prevented damage to important proteins in the cells and improve the way in which insulin functions.

Although you might not see the changes you want immediately, even gentle exercise can make a big difference to the way the body’s cells behave. This means that exercise could have far-reaching health benefits for other inflammatory associated diseases and possibly protect us against ageing and cancer too.

Andrew Thomas, Principal Lecturer, Cardiff Metropolitan University

This article was originally published on The Conversation. Read the original article.

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President's Update February

Dr Paul JacksonThe FSEM Diploma in Sport and Exercise Medicine has now become the FSEM Membership Examination. 

We are pleased to be able to offer all doctors working across the spectrum of Sport and Exercise Medicine, the chance to be part of our specialty via a skills and knowledge based qualification.

It is important that the FSEM supports the development of doctors working in musculoskeletal medicine, exercise medicine and team care at all levels. This will maintain standards of excellence and best practice for patients, which range from elite athletes to people recovering from illness and injury or managing a long term condition.

You can read more about the exam name change and changes to our membership criteria in our news item.  

We are also holding elections for new Council members, with a term of office from 2017 to 2021. Members and Fellows will have received a letter and nomination form by email. Our SEM Registrars (or trainees) will also be holding an election for a new Council representative.

Our Education Committee is planning the FSEM session for this year's joint conference with BASEM, in conjunction with the University of Bath 12-13 October. We recently conducted a members survey to find out more about what our members want from this event.  

As always, we welcome views from our Fellows and Members on the Faculty and the work it carries out. Our regular Council Meetings provide a platform for our members to get involved via our Council Representatives.

Written by Dr Paul D Jackson at 11:00

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President's Update December

Dr Paul JacksonAs 2016 draws to a close, I'd like to thank all of our Fellows and Members for their support of the FSEM over the year. It is your continued membership which allows us to represent, develop and lead the specialty of Sport and Exercise Medicine in the UK.

Whilst training and standard setting remaining our core business, engaging with organisations and government bodies to create new opportunities for our doctors, ensuring patients across the healthcare spectrum receive access to the unique medical care our specialty has to offer, will remain an important part of our strategy for 2017. 

With this in mind, the FSEM is now engaging with two more important groups -  Public Health England's Moving Professionals initiative and with the FSEM/British Society of Rheumatology (BSR) Working Party. Through both groups we will offer our expertise in Exercise Medicine and MSK Medicine for public health. 

The FSEM will also be taking part in the open consultation Work, health and disability: improving lives via the Department for Work and Pensions and I would encourage all Fellows and Members with an interest in this to respond or encourage their associated organisations to respond. Find out more about how you can get involved in the news item below.   

As always, we welcome feedback from our Fellows and Members on the Faculty and the work it carries out and our regular Council Meetings provide a platform for our  members to get involved via our Council Representatives.

I wish you all a happy and healthy new year.

Dr Paul D Jackson

Written by Dr Paul D Jackson at 10:30

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