Responsibility of sport and exercise medicine in preventing and managing chronic disease: applying our knowledge and skill is overdue
Identifieur interne : 004186 ( Istex/Corpus ); précédent : 004185; suivant : 004187Responsibility of sport and exercise medicine in preventing and managing chronic disease: applying our knowledge and skill is overdue
Auteurs : Gordon O. Matheson ; Martin Klügl ; Jiri Dvorak ; Lars Engebretsen ; Willem H. Meeuwisse ; Martin Schwellnus ; Steven N. Blair ; Willem Van Mechelen ; Wayne Derman ; Mats Börjesson ; Fredrik Bendiksen ; Richard WeilerSource :
- British Journal of Sports Medicine [ 0306-3674 ] ; 2011-12.
Abstract
Background The rapidly increasing burden of chronic disease is difficult to reconcile with the large, compelling body of literature that demonstrates the substantial preventive and therapeutic benefits of comprehensive lifestyle intervention, including physical activity, smoking cessation and healthy diet. Physical inactivity is now the fourth leading independent risk factor for death caused by non-communicable chronic disease. Although there have been efforts directed towards research, education and legislation, preventive efforts have been meager relative to the magnitude of the problem. The disparity between our scientific knowledge about chronic disease and practical implementation of preventive approaches now is one of the most urgent concerns in healthcare worldwide and threatens the collapse of our health systems unless extraordinary change takes place. Findings The authors believe that there are several key factors contributing to the disparity. Reductionism has become the default approach for healthcare delivery, resulting in fragmentation rather than integration of services. This, in turn, has fostered a disease-based rather than a health-based model of care and has produced medical school curricula that no longer accurately reflect the actual burden of disease. Trying to ‘fit’ prevention into a disease-based approach has been largely unsuccessful because the fundamental tenets of preventive medicine are diametrically opposed to those of disease-based healthcare. Recommendation A clinical discipline within medicine is needed to adopt disease prevention as its own reason for existence. Sport and exercise medicine is well positioned to champion the cause of prevention by promoting physical activity. Conclusion This article puts forward a strong case for the immediate, increased involvement of clinical sport and exercise medicine in the prevention and treatment of chronic disease and offers specific recommendations for how this may begin.
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DOI: 10.1136/bjsports-2011-090328
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Matheson</name><affiliation><mods:affiliation>Department of Orthopaedic Surgery, Division of Sports Medicine & Human Performance Laboratory, Stanford University School of Medicine, Stanford, California, USA</mods:affiliation></affiliation></author><author><name sortKey="Klugl, Martin" sort="Klugl, Martin" uniqKey="Klugl M" first="Martin" last="Klügl">Martin Klügl</name><affiliation><mods:affiliation>Department of Orthopaedic Surgery, Division of Sports Medicine & Human Performance Laboratory, Stanford University School of Medicine, Stanford, California, USA</mods:affiliation></affiliation></author><author><name sortKey="Dvorak, Jiri" sort="Dvorak, Jiri" uniqKey="Dvorak J" first="Jiri" last="Dvorak">Jiri Dvorak</name><affiliation><mods:affiliation>Schulthess Clinic, Zurich, Switzerland</mods:affiliation></affiliation><affiliation><mods:affiliation>FIFA Medical Assessment & Research Center (F-MARC), Zurich, Switzerland</mods:affiliation></affiliation></author><author><name sortKey="Engebretsen, Lars" sort="Engebretsen, Lars" uniqKey="Engebretsen L" first="Lars" last="Engebretsen">Lars Engebretsen</name><affiliation><mods:affiliation>Orthopaedic Center, Ullevål University Hospital, University of Oslo, Norway</mods:affiliation></affiliation></author><author><name sortKey="Meeuwisse, Willem H" sort="Meeuwisse, Willem H" uniqKey="Meeuwisse W" first="Willem H" last="Meeuwisse">Willem H. 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Matheson</name><affiliation><mods:affiliation>Department of Orthopaedic Surgery, Division of Sports Medicine & Human Performance Laboratory, Stanford University School of Medicine, Stanford, California, USA</mods:affiliation></affiliation></author><author><name sortKey="Klugl, Martin" sort="Klugl, Martin" uniqKey="Klugl M" first="Martin" last="Klügl">Martin Klügl</name><affiliation><mods:affiliation>Department of Orthopaedic Surgery, Division of Sports Medicine & Human Performance Laboratory, Stanford University School of Medicine, Stanford, California, USA</mods:affiliation></affiliation></author><author><name sortKey="Dvorak, Jiri" sort="Dvorak, Jiri" uniqKey="Dvorak J" first="Jiri" last="Dvorak">Jiri Dvorak</name><affiliation><mods:affiliation>Schulthess Clinic, Zurich, Switzerland</mods:affiliation></affiliation><affiliation><mods:affiliation>FIFA Medical Assessment & Research Center (F-MARC), Zurich, Switzerland</mods:affiliation></affiliation></author><author><name sortKey="Engebretsen, Lars" sort="Engebretsen, Lars" uniqKey="Engebretsen L" first="Lars" last="Engebretsen">Lars Engebretsen</name><affiliation><mods:affiliation>Orthopaedic Center, Ullevål University Hospital, University of Oslo, Norway</mods:affiliation></affiliation></author><author><name sortKey="Meeuwisse, Willem H" sort="Meeuwisse, Willem H" uniqKey="Meeuwisse W" first="Willem H" last="Meeuwisse">Willem H. Meeuwisse</name><affiliation><mods:affiliation>Sport Injury Prevention Research Centre, University of Calgary, Calgary, Alberta, Canada</mods:affiliation></affiliation></author><author><name sortKey="Schwellnus, Martin" sort="Schwellnus, Martin" uniqKey="Schwellnus M" first="Martin" last="Schwellnus">Martin Schwellnus</name><affiliation><mods:affiliation>UCT Research Unit for Exercise Science & Sports Medicine, Department of Human Biology, University of Cape Town, Newlands, South Africa</mods:affiliation></affiliation></author><author><name sortKey="Blair, Steven N" sort="Blair, Steven N" uniqKey="Blair S" first="Steven N" last="Blair">Steven N. Blair</name><affiliation><mods:affiliation>Departments of Exercise Science and Epidemiology & Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA</mods:affiliation></affiliation></author><author><name sortKey="Van Mechelen, Willem" sort="Van Mechelen, Willem" uniqKey="Van Mechelen W" first="Willem" last="Van Mechelen">Willem Van Mechelen</name><affiliation><mods:affiliation>Department of Public and Occupational Health and EMGO Institute for Health & Care Research, VU University Medical Center, Amsterdam, The Netherlands</mods:affiliation></affiliation></author><author><name sortKey="Derman, Wayne" sort="Derman, Wayne" uniqKey="Derman W" first="Wayne" last="Derman">Wayne Derman</name><affiliation><mods:affiliation>UCT Research Unit for Exercise Science & Sports Medicine, Department of Human Biology, University of Cape Town, Newlands, South Africa</mods:affiliation></affiliation></author><author><name sortKey="Borjesson, Mats" sort="Borjesson, Mats" uniqKey="Borjesson M" first="Mats" last="Börjesson">Mats Börjesson</name><affiliation><mods:affiliation>Astrands Laboratory, The Swedish School of Sports and Health Sciences and Karolinska University Hospital, Stockholm, Sweden</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Acute and Cardiovascular Medicine, Sahlgrenska University Hospital/Ostra, Goteborg, Sweden</mods:affiliation></affiliation></author><author><name sortKey="Bendiksen, Fredrik" sort="Bendiksen, Fredrik" uniqKey="Bendiksen F" first="Fredrik" last="Bendiksen">Fredrik Bendiksen</name><affiliation><mods:affiliation>Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway</mods:affiliation></affiliation></author><author><name sortKey="Weiler, Richard" sort="Weiler, Richard" uniqKey="Weiler R" first="Richard" last="Weiler">Richard Weiler</name><affiliation><mods:affiliation>Sport & Exercise Medicine, Homerton University Hospital NHS Trust, London, UK</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">British Journal of Sports Medicine</title><title level="j" type="abbrev">Br J Sports Med</title><idno type="ISSN">0306-3674</idno><idno type="eISSN">1473-0480</idno><imprint><publisher>BMJ Publishing Group Ltd and British Association of Sport and Exercise Medicine</publisher><date type="published" when="2011-12">2011-12</date><biblScope unit="volume">45</biblScope><biblScope unit="issue">16</biblScope><biblScope unit="page" from="1272">1272</biblScope></imprint><idno type="ISSN">0306-3674</idno></series><idno type="istex">8BDF363381F54899B93770210B4AE12D4148B73C</idno><idno type="DOI">10.1136/bjsports-2011-090328</idno><idno type="href">bjsports-45-1272.pdf</idno><idno type="ArticleID">bjsports-2011-090328</idno><idno type="PMID">21948123</idno><idno type="local">bjsports;45/16/1272</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0306-3674</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract">Background The rapidly increasing burden of chronic disease is difficult to reconcile with the large, compelling body of literature that demonstrates the substantial preventive and therapeutic benefits of comprehensive lifestyle intervention, including physical activity, smoking cessation and healthy diet. Physical inactivity is now the fourth leading independent risk factor for death caused by non-communicable chronic disease. Although there have been efforts directed towards research, education and legislation, preventive efforts have been meager relative to the magnitude of the problem. The disparity between our scientific knowledge about chronic disease and practical implementation of preventive approaches now is one of the most urgent concerns in healthcare worldwide and threatens the collapse of our health systems unless extraordinary change takes place. Findings The authors believe that there are several key factors contributing to the disparity. Reductionism has become the default approach for healthcare delivery, resulting in fragmentation rather than integration of services. This, in turn, has fostered a disease-based rather than a health-based model of care and has produced medical school curricula that no longer accurately reflect the actual burden of disease. Trying to ‘fit’ prevention into a disease-based approach has been largely unsuccessful because the fundamental tenets of preventive medicine are diametrically opposed to those of disease-based healthcare. Recommendation A clinical discipline within medicine is needed to adopt disease prevention as its own reason for existence. Sport and exercise medicine is well positioned to champion the cause of prevention by promoting physical activity. 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behaviour</json:string><json:string>prevention</json:string></teeft></keywords><author><json:item><name>Gordon O Matheson</name><affiliations><json:string>Department of Orthopaedic Surgery, Division of Sports Medicine & Human Performance Laboratory, Stanford University School of Medicine, Stanford, California, USA</json:string></affiliations></json:item><json:item><name>Martin Klügl</name><affiliations><json:string>Department of Orthopaedic Surgery, Division of Sports Medicine & Human Performance Laboratory, Stanford University School of Medicine, Stanford, California, USA</json:string></affiliations></json:item><json:item><name>Jiri Dvorak</name><affiliations><json:string>Schulthess Clinic, Zurich, Switzerland</json:string><json:string>FIFA Medical Assessment & Research Center (F-MARC), Zurich, Switzerland</json:string></affiliations></json:item><json:item><name>Lars Engebretsen</name><affiliations><json:string>Orthopaedic Center, Ullevål University Hospital, University of Oslo, Norway</json:string></affiliations></json:item><json:item><name>Willem H Meeuwisse</name><affiliations><json:string>Sport Injury Prevention Research Centre, University of Calgary, Calgary, Alberta, Canada</json:string></affiliations></json:item><json:item><name>Martin Schwellnus</name><affiliations><json:string>UCT Research Unit for Exercise Science & Sports Medicine, Department of Human Biology, University of Cape Town, Newlands, South Africa</json:string></affiliations></json:item><json:item><name>Steven N Blair</name><affiliations><json:string>Departments of Exercise Science and Epidemiology & Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA</json:string></affiliations></json:item><json:item><name>Willem van Mechelen</name><affiliations><json:string>Department of Public and Occupational Health and EMGO Institute for Health & Care Research, VU University Medical Center, Amsterdam, The Netherlands</json:string></affiliations></json:item><json:item><name>Wayne Derman</name><affiliations><json:string>UCT Research Unit for Exercise Science & Sports Medicine, Department of Human Biology, University of Cape Town, Newlands, South Africa</json:string></affiliations></json:item><json:item><name>Mats Börjesson</name><affiliations><json:string>Astrands Laboratory, The Swedish School of Sports and Health Sciences and Karolinska University Hospital, Stockholm, Sweden</json:string><json:string>Department of Acute and Cardiovascular Medicine, Sahlgrenska University Hospital/Ostra, Goteborg, Sweden</json:string></affiliations></json:item><json:item><name>Fredrik Bendiksen</name><affiliations><json:string>Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway</json:string></affiliations></json:item><json:item><name>Richard Weiler</name><affiliations><json:string>Sport & Exercise Medicine, Homerton University Hospital NHS Trust, London, UK</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>Editor's choice</value></json:item></subject><articleId><json:string>bjsports-2011-090328</json:string></articleId><language><json:string>eng</json:string></language><originalGenre><json:string>review-article</json:string></originalGenre><abstract>Background The rapidly increasing burden of chronic disease is difficult to reconcile with the large, compelling body of literature that demonstrates the substantial preventive and therapeutic benefits of comprehensive lifestyle intervention, including physical activity, smoking cessation and healthy diet. Physical inactivity is now the fourth leading independent risk factor for death caused by non-communicable chronic disease. Although there have been efforts directed towards research, education and legislation, preventive efforts have been meager relative to the magnitude of the problem. The disparity between our scientific knowledge about chronic disease and practical implementation of preventive approaches now is one of the most urgent concerns in healthcare worldwide and threatens the collapse of our health systems unless extraordinary change takes place. Findings The authors believe that there are several key factors contributing to the disparity. Reductionism has become the default approach for healthcare delivery, resulting in fragmentation rather than integration of services. This, in turn, has fostered a disease-based rather than a health-based model of care and has produced medical school curricula that no longer accurately reflect the actual burden of disease. Trying to ‘fit’ prevention into a disease-based approach has been largely unsuccessful because the fundamental tenets of preventive medicine are diametrically opposed to those of disease-based healthcare. Recommendation A clinical discipline within medicine is needed to adopt disease prevention as its own reason for existence. Sport and exercise medicine is well positioned to champion the cause of prevention by promoting physical activity. Conclusion This article puts forward a strong case for the immediate, increased involvement of clinical sport and exercise medicine in the prevention and treatment of chronic disease and offers specific recommendations for how this may begin.</abstract><qualityIndicators><score>9.5</score><pdfVersion>1.6</pdfVersion><pdfPageSize>595.277 x 793.702 pts</pdfPageSize><refBibsNative>true</refBibsNative><keywordCount>1</keywordCount><abstractCharCount>1979</abstractCharCount><pdfWordCount>9773</pdfWordCount><pdfCharCount>66014</pdfCharCount><pdfPageCount>11</pdfPageCount><abstractWordCount>277</abstractWordCount></qualityIndicators><title>Responsibility of sport and exercise medicine in preventing and managing chronic disease: applying our knowledge and skill is overdue</title><pmid><json:string>21948123</json:string></pmid><genre><json:string>review-article</json:string></genre><host><title>British Journal of Sports Medicine</title><language><json:string>unknown</json:string></language><issn><json:string>0306-3674</json:string></issn><eissn><json:string>1473-0480</json:string></eissn><publisherId><json:string>bjsm</json:string></publisherId><volume>45</volume><issue>16</issue><pages><first>1272</first></pages><genre><json:string>journal</json:string></genre></host><categories><wos><json:string>science</json:string><json:string>sport sciences</json:string></wos><scienceMetrix><json:string>health sciences</json:string><json:string>clinical medicine</json:string><json:string>sport sciences</json:string></scienceMetrix><inist><json:string>sciences humaines et sociales</json:string></inist></categories><publicationDate>2011</publicationDate><copyrightDate>2011</copyrightDate><doi><json:string>10.1136/bjsports-2011-090328</json:string></doi><id>8BDF363381F54899B93770210B4AE12D4148B73C</id><score>1</score><fulltext><json:item><extension>pdf</extension><original>true</original><mimetype>application/pdf</mimetype><uri>https://api.istex.fr/document/8BDF363381F54899B93770210B4AE12D4148B73C/fulltext/pdf</uri></json:item><json:item><extension>zip</extension><original>false</original><mimetype>application/zip</mimetype><uri>https://api.istex.fr/document/8BDF363381F54899B93770210B4AE12D4148B73C/fulltext/zip</uri></json:item><istex:fulltextTEI uri="https://api.istex.fr/document/8BDF363381F54899B93770210B4AE12D4148B73C/fulltext/tei"><teiHeader><fileDesc><titleStmt><title level="a">Responsibility of sport and exercise medicine in preventing and managing chronic disease: applying our knowledge and skill is overdue</title></titleStmt><publicationStmt><authority>ISTEX</authority><publisher>BMJ Publishing Group Ltd and British Association of Sport and Exercise Medicine</publisher><availability><p>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions</p></availability><date>2011-09-26</date></publicationStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a">Responsibility of sport and exercise medicine in preventing and managing chronic disease: applying our knowledge and skill is overdue</title><author xml:id="author-1"><persName><forename type="first">Gordon O</forename><surname>Matheson</surname></persName><affiliation>Department of Orthopaedic Surgery, Division of Sports Medicine & Human Performance Laboratory, Stanford University School of Medicine, Stanford, California, USA</affiliation></author><author xml:id="author-2"><persName><forename type="first">Martin</forename><surname>Klügl</surname></persName><affiliation>Department of Orthopaedic Surgery, Division of Sports Medicine & Human Performance Laboratory, Stanford University School of Medicine, Stanford, California, USA</affiliation></author><author xml:id="author-3"><persName><forename type="first">Jiri</forename><surname>Dvorak</surname></persName><affiliation>Schulthess Clinic, Zurich, Switzerland</affiliation><affiliation>FIFA Medical Assessment & Research Center (F-MARC), Zurich, Switzerland</affiliation></author><author xml:id="author-4"><persName><forename type="first">Lars</forename><surname>Engebretsen</surname></persName><affiliation>Orthopaedic Center, Ullevål University Hospital, University of Oslo, Norway</affiliation></author><author xml:id="author-5"><persName><forename type="first">Willem H</forename><surname>Meeuwisse</surname></persName><affiliation>Sport Injury Prevention Research Centre, University of Calgary, Calgary, Alberta, Canada</affiliation></author><author xml:id="author-6"><persName><forename type="first">Martin</forename><surname>Schwellnus</surname></persName><affiliation>UCT Research Unit for Exercise Science & Sports Medicine, Department of Human Biology, University of Cape Town, Newlands, South Africa</affiliation></author><author xml:id="author-7"><persName><forename type="first">Steven N</forename><surname>Blair</surname></persName><affiliation>Departments of Exercise Science and Epidemiology & Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA</affiliation></author><author xml:id="author-8"><persName><forename type="first">Willem</forename><surname>van Mechelen</surname></persName><affiliation>Department of Public and Occupational Health and EMGO Institute for Health & Care Research, VU University Medical Center, Amsterdam, The Netherlands</affiliation></author><author xml:id="author-9"><persName><forename type="first">Wayne</forename><surname>Derman</surname></persName><affiliation>UCT Research Unit for Exercise Science & Sports Medicine, Department of Human Biology, University of Cape Town, Newlands, South Africa</affiliation></author><author xml:id="author-10"><persName><forename type="first">Mats</forename><surname>Börjesson</surname></persName><affiliation>Astrands Laboratory, The Swedish School of Sports and Health Sciences and Karolinska University Hospital, Stockholm, Sweden</affiliation><affiliation>Department of Acute and Cardiovascular Medicine, Sahlgrenska University Hospital/Ostra, Goteborg, Sweden</affiliation></author><author xml:id="author-11"><persName><forename type="first">Fredrik</forename><surname>Bendiksen</surname></persName><affiliation>Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway</affiliation></author><author xml:id="author-12"><persName><forename type="first">Richard</forename><surname>Weiler</surname></persName><affiliation>Sport & Exercise Medicine, Homerton University Hospital NHS Trust, London, UK</affiliation></author></analytic><monogr><title level="j">British Journal of Sports Medicine</title><title level="j" type="abbrev">Br J Sports Med</title><idno type="pISSN">0306-3674</idno><idno type="eISSN">1473-0480</idno><imprint><publisher>BMJ Publishing Group Ltd and British Association of Sport and Exercise Medicine</publisher><date type="published" when="2011-12"></date><biblScope unit="volume">45</biblScope><biblScope unit="issue">16</biblScope><biblScope unit="page" from="1272">1272</biblScope></imprint></monogr><idno type="istex">8BDF363381F54899B93770210B4AE12D4148B73C</idno><idno type="DOI">10.1136/bjsports-2011-090328</idno><idno type="href">bjsports-45-1272.pdf</idno><idno type="ArticleID">bjsports-2011-090328</idno><idno type="PMID">21948123</idno><idno type="local">bjsports;45/16/1272</idno></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2011-09-26</date></creation><langUsage><language ident="en">en</language></langUsage><abstract><p>Background The rapidly increasing burden of chronic disease is difficult to reconcile with the large, compelling body of literature that demonstrates the substantial preventive and therapeutic benefits of comprehensive lifestyle intervention, including physical activity, smoking cessation and healthy diet. Physical inactivity is now the fourth leading independent risk factor for death caused by non-communicable chronic disease. Although there have been efforts directed towards research, education and legislation, preventive efforts have been meager relative to the magnitude of the problem. The disparity between our scientific knowledge about chronic disease and practical implementation of preventive approaches now is one of the most urgent concerns in healthcare worldwide and threatens the collapse of our health systems unless extraordinary change takes place. Findings The authors believe that there are several key factors contributing to the disparity. Reductionism has become the default approach for healthcare delivery, resulting in fragmentation rather than integration of services. This, in turn, has fostered a disease-based rather than a health-based model of care and has produced medical school curricula that no longer accurately reflect the actual burden of disease. Trying to ‘fit’ prevention into a disease-based approach has been largely unsuccessful because the fundamental tenets of preventive medicine are diametrically opposed to those of disease-based healthcare. Recommendation A clinical discipline within medicine is needed to adopt disease prevention as its own reason for existence. Sport and exercise medicine is well positioned to champion the cause of prevention by promoting physical activity. Conclusion This article puts forward a strong case for the immediate, increased involvement of clinical sport and exercise medicine in the prevention and treatment of chronic disease and offers specific recommendations for how this may begin.</p></abstract><textClass><keywords scheme="keyword"><list><head>hwp-journal-coll</head><item><term>Editor's choice</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="2011-09-26">Created</change><change when="2011-12">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><extension>txt</extension><original>false</original><mimetype>text/plain</mimetype><uri>https://api.istex.fr/document/8BDF363381F54899B93770210B4AE12D4148B73C/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="corpus bmj" wicri:toSee="no header"><istex:xmlDeclaration>version="1.0" encoding="UTF-8" standalone="no"</istex:xmlDeclaration><istex:docType PUBLIC="-//NLM//DTD Journal Archiving and Interchange DTD v2.3 20070202//EN" URI="archivearticle.dtd" name="istex:docType"></istex:docType><istex:document><article article-type="review-article"><front><journal-meta><journal-id journal-id-type="hwp">bjsports</journal-id><journal-id journal-id-type="nlm-ta">Br J Sports Med</journal-id><journal-id journal-id-type="publisher-id">bjsm</journal-id><journal-title>British Journal of Sports Medicine</journal-title><abbrev-journal-title abbrev-type="publisher">Br J Sports Med</abbrev-journal-title><abbrev-journal-title>Br J Sports Med</abbrev-journal-title><issn pub-type="ppub">0306-3674</issn><issn pub-type="epub">1473-0480</issn><publisher><publisher-name>BMJ Publishing Group Ltd and British Association of Sport and Exercise Medicine</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="publisher-id">bjsports-2011-090328</article-id><article-id pub-id-type="doi">10.1136/bjsports-2011-090328</article-id><article-id pub-id-type="other">bjsports;45/16/1272</article-id><article-id pub-id-type="other">bjsports;bjsports-2011-090328</article-id><article-id pub-id-type="pmid">21948123</article-id><article-id pub-id-type="other">1272</article-id><article-id pub-id-type="other">bjsports-2011-090328</article-id><article-categories><subj-group subj-group-type="heading"><subject>Reviews</subject></subj-group><subj-group subj-group-type="hwp-journal-coll"><subject>Editor's choice</subject></subj-group></article-categories><title-group><article-title>Responsibility of sport and exercise medicine in preventing and managing chronic disease: applying our knowledge and skill is overdue</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Matheson</surname><given-names>Gordon O</given-names></name><xref ref-type="aff" rid="A1">1</xref></contrib><contrib contrib-type="author"><name><surname>Klügl</surname><given-names>Martin</given-names></name><xref ref-type="aff" rid="A1">1</xref></contrib><contrib contrib-type="author"><name><surname>Dvorak</surname><given-names>Jiri</given-names></name><xref ref-type="aff" rid="A2">2</xref><xref ref-type="aff" rid="A3">3</xref></contrib><contrib contrib-type="author"><name><surname>Engebretsen</surname><given-names>Lars</given-names></name><xref ref-type="aff" rid="A4">4</xref></contrib><contrib contrib-type="author"><name><surname>Meeuwisse</surname><given-names>Willem H</given-names></name><xref ref-type="aff" rid="A5">5</xref></contrib><contrib contrib-type="author"><name><surname>Schwellnus</surname><given-names>Martin</given-names></name><xref ref-type="aff" rid="A6">6</xref></contrib><contrib contrib-type="author"><name><surname>Blair</surname><given-names>Steven N</given-names></name><xref ref-type="aff" rid="A7">7</xref></contrib><contrib contrib-type="author"><name><surname>van Mechelen</surname><given-names>Willem</given-names></name><xref ref-type="aff" rid="A8">8</xref></contrib><contrib contrib-type="author"><name><surname>Derman</surname><given-names>Wayne</given-names></name><xref ref-type="aff" rid="A6">6</xref></contrib><contrib contrib-type="author"><name><surname>Börjesson</surname><given-names>Mats</given-names></name><xref ref-type="aff" rid="A9">9</xref><xref ref-type="aff" rid="A10">10</xref></contrib><contrib contrib-type="author"><name><surname>Bendiksen</surname><given-names>Fredrik</given-names></name><xref ref-type="aff" rid="A11">11</xref></contrib><contrib contrib-type="author"><name><surname>Weiler</surname><given-names>Richard</given-names></name><xref ref-type="aff" rid="A12">12</xref></contrib></contrib-group><aff id="A1"><label>1</label>Department of Orthopaedic Surgery, Division of Sports Medicine & Human Performance Laboratory, Stanford University School of Medicine, Stanford, California, USA</aff><aff id="A2"><label>2</label>Schulthess Clinic, Zurich, Switzerland</aff><aff id="A3"><label>3</label>FIFA Medical Assessment & Research Center (F-MARC), Zurich, Switzerland</aff><aff id="A4"><label>4</label>Orthopaedic Center, Ullevål University Hospital, University of Oslo, Norway</aff><aff id="A5"><label>5</label>Sport Injury Prevention Research Centre, University of Calgary, Calgary, Alberta, Canada</aff><aff id="A6"><label>6</label>UCT Research Unit for Exercise Science & Sports Medicine, Department of Human Biology, University of Cape Town, Newlands, South Africa</aff><aff id="A7"><label>7</label>Departments of Exercise Science and Epidemiology & Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA</aff><aff id="A8"><label>8</label>Department of Public and Occupational Health and EMGO Institute for Health & Care Research, VU University Medical Center, Amsterdam, The Netherlands</aff><aff id="A9"><label>9</label>Astrands Laboratory, The Swedish School of Sports and Health Sciences and Karolinska University Hospital, Stockholm, Sweden</aff><aff id="A10"><label>10</label>Department of Acute and Cardiovascular Medicine, Sahlgrenska University Hospital/Ostra, Goteborg, Sweden</aff><aff id="A11"><label>11</label>Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway</aff><aff id="A12"><label>12</label>Sport & Exercise Medicine, Homerton University Hospital NHS Trust, London, UK</aff><author-notes><corresp><label>Correspondence to</label> Dr Gordon O Matheson, Sports Medicine Center, 341 Galvez Street, Stanford, CA 94304, USA; <email xlink:type="simple">gord@stanford.edu</email></corresp></author-notes><pub-date pub-type="ppub"><month>12</month><year>2011</year></pub-date><pub-date pub-type="epub-original"><day>26</day><month>9</month><year>2011</year></pub-date><pub-date pub-type="epub"><day>26</day><month>9</month><year>2011</year></pub-date><volume>45</volume><volume-id pub-id-type="other">45</volume-id><volume-id pub-id-type="other">45</volume-id><issue>16</issue><issue-id pub-id-type="other">bjsports;45/16</issue-id><issue-id pub-id-type="other">16</issue-id><issue-id pub-id-type="other">45/16</issue-id><fpage>1272</fpage><history><date date-type="accepted"><day>25</day><month>8</month><year>2011</year></date></history><permissions><copyright-statement>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions</copyright-statement><copyright-year>2011</copyright-year></permissions><self-uri content-type="pdf" xlink:role="full-text" xlink:href="bjsports-45-1272.pdf"></self-uri><abstract><sec><title>Background</title><p>The rapidly increasing burden of chronic disease is difficult to reconcile with the large, compelling body of literature that demonstrates the substantial preventive and therapeutic benefits of comprehensive lifestyle intervention, including physical activity, smoking cessation and healthy diet. Physical inactivity is now the fourth leading independent risk factor for death caused by non-communicable chronic disease. Although there have been efforts directed towards research, education and legislation, preventive efforts have been meager relative to the magnitude of the problem. The disparity between our scientific knowledge about chronic disease and practical implementation of preventive approaches now is one of the most urgent concerns in healthcare worldwide and threatens the collapse of our health systems unless extraordinary change takes place.</p></sec><sec><title>Findings</title><p>The authors believe that there are several key factors contributing to the disparity. Reductionism has become the default approach for healthcare delivery, resulting in fragmentation rather than integration of services. This, in turn, has fostered a disease-based rather than a health-based model of care and has produced medical school curricula that no longer accurately reflect the actual burden of disease. Trying to ‘fit’ prevention into a disease-based approach has been largely unsuccessful because the fundamental tenets of preventive medicine are diametrically opposed to those of disease-based healthcare.</p></sec><sec><title>Recommendation</title><p>A clinical discipline within medicine is needed to adopt disease prevention as its own reason for existence. Sport and exercise medicine is well positioned to champion the cause of prevention by promoting physical activity.</p></sec><sec><title>Conclusion</title><p>This article puts forward a strong case for the immediate, increased involvement of clinical sport and exercise medicine in the prevention and treatment of chronic disease and offers specific recommendations for how this may begin.</p></sec></abstract></article-meta></front></article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo><title>Responsibility of sport and exercise medicine in preventing and managing chronic disease: applying our knowledge and skill is overdue</title></titleInfo><titleInfo type="alternative" contentType="CDATA"><title>Responsibility of sport and exercise medicine in preventing and managing chronic disease: applying our knowledge and skill is overdue</title></titleInfo><name type="personal"><namePart type="given">Gordon O</namePart><namePart type="family">Matheson</namePart><affiliation>Department of Orthopaedic Surgery, Division of Sports Medicine & Human Performance Laboratory, Stanford University School of Medicine, Stanford, California, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Martin</namePart><namePart type="family">Klügl</namePart><affiliation>Department of Orthopaedic Surgery, Division of Sports Medicine & Human Performance Laboratory, Stanford University School of Medicine, Stanford, California, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Jiri</namePart><namePart type="family">Dvorak</namePart><affiliation>Schulthess Clinic, Zurich, Switzerland</affiliation><affiliation>FIFA Medical Assessment & Research Center (F-MARC), Zurich, Switzerland</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Lars</namePart><namePart type="family">Engebretsen</namePart><affiliation>Orthopaedic Center, Ullevål University Hospital, University of Oslo, Norway</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Willem H</namePart><namePart type="family">Meeuwisse</namePart><affiliation>Sport Injury Prevention Research Centre, University of Calgary, Calgary, Alberta, Canada</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Martin</namePart><namePart type="family">Schwellnus</namePart><affiliation>UCT Research Unit for Exercise Science & Sports Medicine, Department of Human Biology, University of Cape Town, Newlands, South Africa</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Steven N</namePart><namePart type="family">Blair</namePart><affiliation>Departments of Exercise Science and Epidemiology & Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Willem</namePart><namePart type="family">van Mechelen</namePart><affiliation>Department of Public and Occupational Health and EMGO Institute for Health & Care Research, VU University Medical Center, Amsterdam, The Netherlands</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Wayne</namePart><namePart type="family">Derman</namePart><affiliation>UCT Research Unit for Exercise Science & Sports Medicine, Department of Human Biology, University of Cape Town, Newlands, South Africa</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Mats</namePart><namePart type="family">Börjesson</namePart><affiliation>Astrands Laboratory, The Swedish School of Sports and Health Sciences and Karolinska University Hospital, Stockholm, Sweden</affiliation><affiliation>Department of Acute and Cardiovascular Medicine, Sahlgrenska University Hospital/Ostra, Goteborg, Sweden</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Fredrik</namePart><namePart type="family">Bendiksen</namePart><affiliation>Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Richard</namePart><namePart type="family">Weiler</namePart><affiliation>Sport & Exercise Medicine, Homerton University Hospital NHS Trust, London, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="review-article" displayLabel="review-article"></genre><subject><genre>hwp-journal-coll</genre><topic>Editor's choice</topic></subject><originInfo><publisher>BMJ Publishing Group Ltd and British Association of Sport and Exercise Medicine</publisher><dateIssued encoding="w3cdtf">2011-12</dateIssued><dateCreated encoding="w3cdtf">2011-09-26</dateCreated><copyrightDate encoding="w3cdtf">2011</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType></physicalDescription><abstract>Background The rapidly increasing burden of chronic disease is difficult to reconcile with the large, compelling body of literature that demonstrates the substantial preventive and therapeutic benefits of comprehensive lifestyle intervention, including physical activity, smoking cessation and healthy diet. Physical inactivity is now the fourth leading independent risk factor for death caused by non-communicable chronic disease. Although there have been efforts directed towards research, education and legislation, preventive efforts have been meager relative to the magnitude of the problem. The disparity between our scientific knowledge about chronic disease and practical implementation of preventive approaches now is one of the most urgent concerns in healthcare worldwide and threatens the collapse of our health systems unless extraordinary change takes place. Findings The authors believe that there are several key factors contributing to the disparity. Reductionism has become the default approach for healthcare delivery, resulting in fragmentation rather than integration of services. This, in turn, has fostered a disease-based rather than a health-based model of care and has produced medical school curricula that no longer accurately reflect the actual burden of disease. Trying to ‘fit’ prevention into a disease-based approach has been largely unsuccessful because the fundamental tenets of preventive medicine are diametrically opposed to those of disease-based healthcare. Recommendation A clinical discipline within medicine is needed to adopt disease prevention as its own reason for existence. Sport and exercise medicine is well positioned to champion the cause of prevention by promoting physical activity. Conclusion This article puts forward a strong case for the immediate, increased involvement of clinical sport and exercise medicine in the prevention and treatment of chronic disease and offers specific recommendations for how this may begin.</abstract><relatedItem type="host"><titleInfo><title>British Journal of Sports Medicine</title></titleInfo><titleInfo type="abbreviated"><title>Br J Sports Med</title></titleInfo><genre type="journal">journal</genre><identifier type="ISSN">0306-3674</identifier><identifier type="eISSN">1473-0480</identifier><identifier type="PublisherID">bjsm</identifier><identifier type="PublisherID-hwp">bjsports</identifier><identifier type="PublisherID-nlm-ta">Br J Sports Med</identifier><part><date>2011</date><detail type="volume"><caption>vol.</caption><number>45</number></detail><detail type="issue"><caption>no.</caption><number>16</number></detail><extent unit="pages"><start>1272</start></extent></part></relatedItem><identifier type="istex">8BDF363381F54899B93770210B4AE12D4148B73C</identifier><identifier type="DOI">10.1136/bjsports-2011-090328</identifier><identifier type="href">bjsports-45-1272.pdf</identifier><identifier type="ArticleID">bjsports-2011-090328</identifier><identifier type="PMID">21948123</identifier><identifier type="local">bjsports;45/16/1272</identifier><accessCondition type="use and reproduction" contentType="copyright">Published by the BMJ Publishing Group Limited. 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