Published 9 July 2008, doi:10.1136/bmj.a739
Cite this as: BMJ 2008;337:a739

Editor's Choice

Olympic dreams

Many enjoy sport, yet few achieve sporting excellence: most are ordinary people doing ordinary things on local playing fields on a wet Saturday. In this issue we focus on the health risks and benefits of exercise. No glamour, excitement, glorious triumphs, or multimillion pound endorsements—just some simple messages for your patients and mine. And there’s more to follow in the BMJ in coming weeks.

Sudden cardiac death in sport is a headline grabber. Pressure groups seek screening, distraught parents look for solutions, but science struggles to find evidence. Most of what we know of mass testing comes from Italy, where medical examination before participation in organised sport is mandatory. We already know that physical examination alone is ineffective; now Sofi and colleagues in Florence find in a large cross sectional study of all ages that, of those ultimately excluded from competitive sport, 79% had normal resting electrocardiographs (doi: 10.1136/bmj.a346). Drezner and Khan (doi: 10.1136/bmj.a309) say the evidence supports systematic screening before participation. The study was preliminary and cross sectional, with no data on later outcomes, harms (such as unnecessary anxiety), or cost effectiveness, so it may be too early to say that. Does sport for all mean exercise electrocardiographs for all? What do you think?

Much of current knowledge on the benefits of exercise comes from major epidemiological studies of endurance-type aerobic activity. Using a database built over years at the Cooper Clinic in Dallas, Jonatan Ruiz and colleagues find that muscular strength is associated with reduced all cause and cancer mortality even after adjustment for cardiovascular fitness (doi: 10.1136/bmj.a439). Whatever exercise you do, do something.

Sport and the randomised controlled trial are unlikely bedfellows. Calls for intervention studies are often met with excuses and pleading for special circumstances from the sporting community. Pasanen and colleagues (doi: 10.1136/bmj.a295) show that a neuromuscular training programme in Finland prevented non-contact leg injuries in women playing floorball (a hockey-like sport). The unwritten message is that it is possible to do randomised trials with large sporting organisations, teams, and individual athletes. No more excuses.

Elite sport has an unpleasant truth lurking in the background: on the brink of another Olympic games, the world holds its breath for the next doping scandal. Bengt Kayser and Aaron Smith (and the many signatories who agree with them) take a new and realistic look at the problem (doi: 10.1136/bmj.a584). Anti-doping policy has failed, they believe; our current approach is flawed and we need a more pragmatic approach. Dominic Wells raises the spectre of genetic engineering in athletes, suggesting that some athletes may be tempted to experiment with genetic modification (doi: 10.1136/bmj.a607). And in the Student BMJ Richard Brixey and David Gould explain the evidence and say that, while gene doping is unlikely at Beijing 2008, it could be a problem in London 2012 (student.bmj.com/issues/08/07/education/282.php).

No Olympic dreams for Ruth Booker: just to climb again her beloved mountains (doi: 10.1136/bmj.a61) and enjoy the wonder of nature, the exhilaration of achievement, and the beauty of sport.

Cite this as: BMJ 2008;337:a739

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