Issue 33 Autumn 2012 - Bases

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From national pride to public health – TheLondon legacyWith Team GB’s outstanding performances at the London 2012 Olympic and Paralympic Games still fresh inour minds, Drs Ken van Someren FBASES and Garry Tew discuss the London legacy for sport and exercisescience with a broad view across elite athletic performance to participation and the nation’s health.A world-leading high performance systemThe role and impact of sport science in high performance sporthas seen revolutionary development over the last decade. Withoutdoubt, the increased government and Lottery funding afforded toelite sport since London won the bid in 2005 to host the 2012Games has been critical. But what have we got to show for thisinvestment? An impressive medal tally indeed, but what about thelegacy? Well, the UK now has a high performance sport systemthat is the envy of the world – sport science is now embedded inmost sports programmes, performance is deconstructed, modelled,addressed through science, medicine and technology, and the‘aggregation of marginal gains’ is now the standard for all.London 2012 has afforded an opportunity and focus forcollaboration between high performance sport, academia and thetechnology and engineering industry sector – fields in each of whichthe UK is a world leader. Not only has this resulted in a commonfocus and commitment to enhance sports performance, it has alsoprompted a stepwise development in sport science knowledge andexpertise. Add to this, the growth of professional development andcareer progression pathways for sport scientists working in elitesport, and the future is very promising for applied sports science –particularly with David Cameron’s recent announcement to confirmfunding to elite sport at its current level through to Rio 2016. Thehigh performance sport system we now have, together with theenhanced knowledge and expertise in sports science form a reallegacy and there is much to look forward to over the next 4 yearsand hopefully beyond.A more physically active and healthy nationA key and unprecedented feature of the successful London bidin 2005 was to inspire young people all around the world toparticipate in sport. At the time, this promise was high on ambitionbut low on detail, and so it subsequently fell to Governmentministers to put flesh on the bones. A 2012 legacy policy documentproduced in 2008 by the Department of Culture, Media andSport (DCMS) outlined a headline target of getting one millionmore people playing sport regularly and one million more peoplephysically active by 2012 (DCMS, 2008). This ‘aspirational’ yetarbitrary target became a responsibility shared by the DCMS andthe Department of Health, both of which was meant to inspire onemillion people. So the ensuing political expression of Lord Coe’sSingapore sales pitch was broader than it had been, involving targetsfor increased participation in sport and physical activity, beinginclusive of children, adolescents and adults, and being underscoredby the ambition to be the first Olympic Games that could point toa public health legacy.To achieve these participation targets, much attention hasbeen placed on the achievements and heroism of elite athletesto motivate and inspire (known as the ‘demonstration effect’),and the majority of investment has gone towards increasing thesupply of opportunities to participate in sport or physical activity.As indicated in the Spring 2012 issue (Fox, Biddle & Murphy,2011), there is no recognisable psycho-social mechanism by whichwatching and listening to elite athletes will translate into a broadAbove: What will be the legacy from London 2012?Courtesy Daniel Childand sustained increase in sport or physical activity participation. Infact, elite sportspeople might actually deter participation becauseof a perceived competence gap. That is, people may be put offdoing sport because they cannot imagine being anywhere near asgood at sports as our sporting heroes (Weed et al., 2009). As forinvesting in providing opportunities, a prime example of this is thePlaces People Play ‘mass participation strategy’, which is a £135mNational Lottery funded grassroots sports participation programmethat was launched by Sport England in November 2010. Around£90m of the £135m is designated to providing/transforming sportsfacilities, which will provide more opportunities but not stimulatemore demand. Time will tell if this strategy proves effective, but itis likely that the resulting new facilities will be used predominantlyby existing sports participants rather than those not currentlyparticipating.A potentially important step towards an Olympic public healthlegacy was the establishment of Sport and Exercise Medicine (SEM)as a new medical specialty in 2005, along with the launch of theNational Centre for Sport and Exercise Medicine (NCSEM) inJanuary 2012. The NCSEM has a remit of promoting the nation’shealth and wellbeing by developing SEM services to enable morepeople to be active, and help prevent and treat injuries caused byexercise or conditions associated with lack of exercise. The NCSEMcurrently comprises three collaborating partners: Sheffield, Londonand the East Midlands. The Department of Health has pledged£30 million to support the development of a capital infrastructurenationally, with £10 million going to each partner. However, ongoingrevenue streams are yet to be defined, which has raised questionsabout the Centre’s sustainability (House of Lords Select Committee6 The Sport and Exercise Scientist n Issue 33 n Autumn 2012 n www.bases.org.uk
on Science and Technology, 2012). The specific themes of work willlikely differ between the three centres. In Sheffield, the NCSEM isproviding a vehicle for key stakeholders to come together to createa legacy programme to establish the city as ‘The City of PhysicalActivity’ over the next 20 years and to inform the participationlegacy of future Olympic Games. A brief outline of the workprogramme has been described previously (Tew et al., 2012).A legacy for sports and exercise science?Another area in which the London Games might generate a legacyfor sports and exercise science is that of exercise and health. Theimportance of exercise in preventing and treating many diseases andconditions has been appreciated, at least in our discipline, for manyyears. Exercise is also inexpensive, with a low side-effect profile,and can have a positive environmental impact. Despite all this, therehas generally been reluctance within the medical professions touse exercise as a treatment. This might reflect a lack of knowledgeamong medics of the specific benefits of exercise, a lack of practicalskills in the prescription of exercise in disease and non-diseasestates, a lack of clarity about the best way to deliver exercise (e.g.,lack of confidence in exercise referral schemes), and perhaps apreferential use of pharmacological and surgical interventions.The appointment of London as the host of the 2012 Gameshas helped raise the agenda of ‘exercise as medicine’ in UK medicalcircles through, for example, the NCSEM and the publication ofreports such as Sport and Exercise Medicine: A Fresh Approach (NHS,2012), Exercise for life: Physical activity in health and disease (RoyalCollege of Physicians, 2012), and Sport and exercise science andmedicine: building on the Olympic legacy to improve the nation’s health(House of Lords Select Committee on Science and Technology,2012). Several recommendations were made in these reports,which, if implemented, could benefit the discipline of sports andexercise science markedly. For example, the House of Lords SelectCommittee highlighted the need for funders to facilitate morehigh quality research examining the mechanisms by which exercisebenefits health and identifying the optimal exercise prescription forspecific medical conditions. Exercise scientists have the necessarybackground to support such work, but in the past there have beenfew opportunities because of a lack of funding streams specific tothis area and limited collaboration between sports and exercisescience and medical disciplines. The recent development of thecross-Research Council Lifelong Health and Wellbeing programme(www.mrc.ac.uk/Fundingopportunities/Calls/activity/index.htm),which is offering £5.5 million to support interdisciplinary researchinto the physiological effects and behaviours associated withphysical activity and sedentary behaviour in older adults, mightbe an indication of improving research funding opportunities forexercise scientists.The development of the NCSEM and the above publicationsmight facilitate a better UK-wide infrastructure for providingservices and conducting research relating to exercise and health.For example, part of the capital investment for the NCSEMis for supporting the co-location of SEM specialists, sport andexercise scientists, allied health practitioners, medical researchersand patients to enhance the delivery of SEM across the UK. Theinclusion of sport and exercise scientists in this mix will helpformalise links with medical disciplines and lead to an increasedrecognition of sports and exercise science within the NHS,something that could be further supported if BASES establishesmembership with the Science Council. In the longer term thismight increase the number and type of opportunities for sport andexercise scientists in the area of exercise and health. There havealso been calls for increased coordination and cooperation betweensports and exercise science centres and greater leadership leadingto the development of a National Sports and Exercise Scienceand Medicine strategy, for example, for the translation of researchThe Sport and Exercise Scientist n Issue 33 n Autumn 2012 n www.bases.org.ukfindings into medical treatments and public health interventions(House of Lords Select Committee on Science and Technology,2012). Who better than BASES to lead such an initiative andposition itself as a key player in the ‘exercise as medicine’ agenda?The House of Lords Select Committee inquiry also concludeda lack of scientific evidence-base for the practice of applied sportsscience in elite sport – thought this is perhaps not wholly justifiedgiven the examples provided by a number of the witnesses called.It is certainly true however that what a high-powered randomisedcontrolled trial in non-elite populations concludes will likely havelimited relevance in elite sport where we typically deal with aN of one and any performance gains, however minimal, warrantconsideration.Building on the legacy - So what next?Whilst funding for elite sports has been confirmed until Rio2016, there are clearly challenges ahead to deliver a health legacyfrom London 2012. Further, as the recent House of Lords SelectCommittee inquiry concluded, there is the need for both a greaterfunding of applied sport science and a greater translation ofresearch and knowledge between elite sport and health. Surely thisis the time for BASES to claim this territory and demonstrate justhow critical a role sport and exercise science can play in deliveringon the lofty ambitions of the London 2012 legacy.words: Dr Ken van Someren FBASESKen is the Director of Sport Sciences at the English Institute of Sport.Dr Garry TewGarry is a BASES accredited sport and exercise scientist and a Senior ResearchFellow at the Centre for Sport and Exercise Science at Sheffield Hallam University.ReferencesDepartment of Culture, Media and Sport (2008). Before, during andafter: making the most of the London 2012 Games. [www.culture.gov.uk/reference_library/publications/5161.aspx/].Fox, K., Biddle, S. & Murphy, M. (2012). Creating a legacy for physicalactivity and health from the London 2012 Games. The Sport and Exercise Scientist,31, 22-23.House of Lords Select Committee on Science and Technology(2012). Sport and exercise science and medicine: building on the Olympic legacyto improve the nation’s health. [www.publications.parliament.uk/pa/ld201213/ldselect/ldsctech/33/33.pdf].National Health Service (2012). Sport and Exercise Medicine: A FreshApproach. [www.fsem.co.uk/DesktopModules/Documents/DocumentsView. aspx?tabID=0&ItemID=115345&MId=5288&wversion=Staging].Royal College of Physicians (2012). Exercise for life: Physical activity inhealth and disease. [www.rcplondon.ac.uk/sites/default/files/documents/exercise-forlife-final_0.pdf].Tew, G.A., Copeland, R.J. & Till, S. (2012). Sport and exercise medicineand the Olympic health legacy. BMC Medicine, 10, 74.Weed, M. et al. (2009). A systematic review of the evidence base fordeveloping a physical activity and health legacy from the London 2012 Olympicand Paralympic Games. Department of Health. [www.london.nhs.uk/webfiles/Independent%20inquiries/Developing%20physical%20activity%20and%20health%20legacy%20-%20full%20report.pdf].7
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