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FSEM (UK) and BASEM Working Together for Sport and Exercise Medicine

Relay BAton Small Shutterstock _110153336The Faculty of Sport and Exercise Medicine will join BASEM in celebrating its 65th Anniversary when we come together for the 4th joint BASEM/FSEM Annual Conference in Bath later this year.

FSEM is a relatively young organisation which celebrated its 10th anniversary last year and over the 10 years we have come a long way, we now have 119 doctors on the GMC specialist register for SEM plus many more Members and Fellows who work in SEM as part of their portfolio careers.

Our Membership examination (MFSEM) has been transformed from the old Diploma Examination and may now be taken by any doctor wishing to test their knowledge and clinical skills in the specialty. We anticipate that this will become the benchmark for doctors from other areas of medicine spending some of their time working in SEM. For those choosing a career in Sport & Exercise Medicine we continue to have high application rates for places on our higher specialist training programme.

The Executive Committees of FSEM (UK) and BASEM meet each year to agree which organisation will lead on various areas of mutual interest. The current agreement is that BASEM will deliver all education apart from higher specialist training, and FSEM (UK) will fulfil its statutory duty to deliver higher specialist training, to set standards, and to organise examinations. Over the last couple of years, FSEM (UK) and BASEM have worked together to ensure mutual recognition of Faculty of Pre-Hospital Care approved immediate care courses, regardless of the organisation delivering the training. This has been very helpful for doctors working in more than one sport. We have also released joint statements to clarify that doctors have a primary responsibility to their patient when there has been a lack of clarity about this in the media. The Faculty has also produced an updated version of the Professional Code in which the duties and responsibilities of an SEM doctor are mapped against the GMC document Good Medical Practice.

In addition to the respective roles in education and training the greatest challenge for both FSEM (UK) and BASEM in coming years is to work with the Departments of Health in the four Home Countries to bring more Musculoskeletal Medicine delivered by SEM doctors into the NHS, to promote the benefits of increased physical activity, and to introduce Exercise Medicine as a highly effective management option, particularly in those with multi-morbidity. The Faculty keeps a database of those already delivering MSK services and Exercise Medicine to the NHS. If you are working for the NHS or with an independent provider contracted to the NHS, the Faculty office would like to hear from you.

In writing this I realise that have been a member of BASEM for exactly half of its existence and more than half of my life. I have attended most of the Annual Conferences over the past 30 years, the most memorable of which was the one held in Bruges in the early 1990s. I look forward to this year’s BASEM/FSEM (UK) conference in Bath October 12-13 both for the academic content and the opportunity to catch up with many friends and colleagues.

This article appeared in BASEM Today September 2017

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President's Update August

Dr Paul JacksonWHO is hosting an open web-based consultation to develop a draft global action plan to promote physical activity. This consultation and its resulting action plan is a welcome move by the World Health Organisation and, on behalf of its membership, the FSEM (UK) will be responding. In our key policy priorities, we continue to call for a national approach to the application of physical activity in disease prevention:

  • Address the treatment and prevention of non-communicable diseases with a new focus on a national preventative strategy including the therapeutic use of physical activity and exercise

This message, backed up with our recommendation to increase Exercise Medicine and physical activity assessment in the NHS, has been an important part of our consultation responses for the UK and devolved governments. Addressing the promotion of physical activity is a global problem, which will ultimately be addressed on a national level and delivered via local partnerships and services. 'Think globally act locally', a saying contributed to the Scots town planner Sir Patrick Geddes, has never been more relevant and could be the key to achieving the Five Year Forward View's 'radical upgrade in prevention and public health'.

The Faculty is looking forward to hosting the second phase of the American Medical Society for Sports Medicine (AMSSM) and FSEM (UK) Travelling Fellowship Programme. Our visiting fellows from the U.S. will be Dr Lee Rice, Dr Ken Barnes and Dr Mederic Hall and they will join us at on the 30th of September until the 14th October. We have a packed programme lined up for our three visiting fellows which will conclude with all three speaking at our joint annual conference with BASEM on the 12 and 13 October. Further details are in our Travelling Fellowship news item.

Written by Dr Paul D Jackson at 10:26

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Ten reasons why we should all love cyclists

Ten reasons why we should all love cyclists

Cycling Shutterstock The Conversation BlogKeep rollin’. Shutterstock Seamus Allison, Nottingham Trent University

Cyclists globally are much maligned by drivers who may never have thought about the many benefits they provide. In fact, cycling as a form of truly sustainable transport is increasingly the focus of attention by governments seeking solutions to multiple societal problems.

In April 2017, the UK government finally announced its Cycling and Walking Investment Strategy allocating £1.2 billion to support initiatives aimed at making cycling and walking the norm. Hard on its heels was a study in the British Medical Journal of Sports Medicine showing that moderate exercise performed several times a week can protect against dementia and boost mental health, adding to what we already know about the many physical health benefits of exercise.

The potential benefits to us all of greater levels of commuter cycling are manifold and go well beyond health. Here are ten of the ways cyclists help everyone:

1) They help improve air quality. At a time when air quality and how it can be improved is increasingly a talking point, cycling offers a low cost, virtually emission-free solution that has been staring us in the face for years.

2) They help reduce congestion. Bicycles take up less space than motor vehicles, it’s as simple as that. So if there were more bikes and fewer cars congestion would drop. Besides, have you ever seen an ambulance held up by cycle traffic?

3) They ease the burden on the NHS. Research shows that exercise improves our health and makes us less prone to serious long-term health problems. It has also been shown that on average cyclists have the health of people ten years younger than them. As a result, cyclists help to reduce waiting times and the burden on the NHS.

4) Cyclists boost the economy. The Department for Transport’s own figures suggest that for every £1 invested in cycling there is a return in the range of £5.10 to £10. It has also been shown that car journeys cost the economy six times more than journeys by bike and that gap is widening Both these impacts are due to the multiple societal costs of driving, such as the cost of poor health, the cost of congestion and so on.

Lights Shutterstock The Conversation Blog File -20170516-11937-wgwgwiGreen transport. Shutterstock

5) Cycling boosts everyone’s quality of life. Studies have shown that where cycling and walking are the predominant modes of transport, people report a positive impact on their well-being.

6) Cyclists help to combat climate change. While walking is probably the only truly sustainable mode of transport, cycling comes a close second and allows us to cover greater distances than walking. While much debate surrounds the true impact of electric vehicles, it is increasingly clear that they are not actually the sustainable solution we require.

7) They improve road safety. While the safety in numbers effect for cyclists is well understood, it is not so clear what impact higher cycling numbers have on overall road safety. However, it appears that more people are killed and injured by motor vehicles than by cyclists even after correcting for the difference in road miles covered by the two. A 100kg cycle with rider travelling at 12mph just doesn’t have the same potential to cause harm as a 1,500kg vehicle travelling at 30mph

8) Cycling improves mental health. Cycling as a form of moderate exercise positively impacts cyclists’ mental health and there is now evidence to suggest that it can also reduce the impact of dementia.

9) Cyclists help lower the cost of car insurance. In advanced economies, most cyclists are also car owners and pay insurance accordingly. However, because they use their vehicles less frequently they present a lower insurance risk. Cyclists do not receive a reduction in their insurance bill as a result of this reduced risk. Consequently, they help to subsidise the insurance costs of other drivers assuming insurance companies seek to protect revenue.

10) They help reduce the tax burden for road maintenance. In the UK, motoring receipts from vehicle duty are considerably lower than the cost of road maintenance. Since most cyclists pay vehicle duty but place a lower burden on the road infrastructure, they contribute more than they take out and so subsidise the costs for other road users.

The ConversationCycling is increasingly seen as a solution capable of addressing multiple societal problems. It will take a shift in how the public thinks about how we travel and our relationship with vehicles, transport infrastructures, tax systems and each other before we start to realise that this has been obvious for some time. But if that happens, perhaps even the most ardent car lover might be prepared to give a second thought to what could be achieved if they just got on their bike.

Seamus Allison, Senior Lecturer, Nottingham Trent University

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

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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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