70 Years of German Journal of Sports Medicine – Reaching for the Stars on the Shoulders of Giants?

Our Journal represents scientific-clinical translational sports medicine. For 70 years now, there have been regular reports on clinical studies, experimental investigations and clinical case reports, as well as practice-related information from the whole world of sports medicine.

This journal stands on the work of giants, who have laid the foundation for this discipline over the past 300 years. When the Deutsche Zeitschrift für Sportmedizin was re-founded in 1950, it could already look back on a long history. The journal “Der Sportarzt” was founded in 1924. The disastrous affiliation with National-Socialism resulted in an unwillingness to establish continuity. Therefore, although one could speak of the 96th year of publication, we can still be proud of our 70 years of publication as the “Deutsche Zeitschrift für Sportmedizin” – “German Journal of Sports Medicine.” 

The term “prevention” did not exist in antiquity. In medicine, physical activity was esteemed especially in the treatment of disease. The knowledge that a healthy lifestyle promotes long life can be found among Greek and Roman doctors and philosophers, but it was only relevant for the upper classes. The rest of the population performed moderate to heavy physical labor, or were in the military. Even everyday life was a struggle. The first sports-medical care is found predominantly for injured athletes, along with information on nutrition and performance capacity (28).

In the Middle Ages, there was targeted training especially for noblemen and soldiers, which led to athletic competitions. Medical treatises on sports like those of Avicenna are found in the Arab world. Infectious diseases, accidents, war injuries, as well as crop failures, hunger and undernourishment were frequent threats to the population.

A new understanding of the world developed in the Renaissance. In the 17th-19th centuries under the impact of great famines, agricultural reforms - among them the founding of the Agricultural Schools in Hohenheim and Weihenstephan, improved cultivation techniques, introduction and cultivation of higher-yield types of grains, potatoes and orchards - slowly resulted in improvement in the human condition. Important prerequisites for sports, for example in nutrition, were the phosphate fertilizers starting in 1840 and the meat extract created by Justus von Liebig in 1853. In hygiene, developments included the separation of water supply and sewage after the great cholera epidemics in the 19th century in Munich and Hamburg (Max von Pettenkofer and Robert Koch), and a refrigerator constructed by Carl Linde in 1871.

In the Renaissance, science and technology became increasingly important and the body also became an object of interest, first in natural philosophy then in natural science. The bases were the discoveries of circulation by William Harvey in 1628, oxygen by Joseph Priestley in 1771, and the consumption of oxygen in exertion by Antoine de Lavoisier and Armand-Jean-François Séguin in 1789.

Early in the 18th century, Professor Friedrich Hoffmann in Halle was the first doctor to publish on the effects of sports. In 1796, Christoph Wilhelm Hufeland of Jena published “Macrobiotik oder Die Kunst, das menschliche Leben zu verlängern” [Macrobiotics or the Art of Prolonging Human Life] and founded a theory of prevention taking particular note of physical exercise (27). The underlying requisites were the improvements in life in general, mentioned above, and the development of a middle class which proclaimed its right of self-administration during the French Revolution, including gymnastics and other sports activities. The close connection of national leagues and the gymnastics movement becomes clear looking at the Hambacher Festival of 1832. The right of self-administration in sports is based on this middle-class tradition.

Acute diseases still predominated in everyday clinical practice, however. Bringing the patient to a warm hospital room, physical rest and light meals were often the best medicine for undernourished, hypothermic and overworked people. This basic experience characterized medicine up to the 1970s and physical exercise was contraindicated in most internal-medical diseases.

The law of maintaining energy was formulated by JR von Maier in 1845, expanded to include biological beings and nutrition in 1893 by Max Rubner. Max Pettenkofen discovered creatinine in muscles and published metabolic studies with Carl Voit. His student Nathan Zuntz, as Professor of Physiology at the University of Berlin, conducted systematic investigations of gas exchange and physical exercise, as well as the first ambulatory investigations on the treadmill, during a march, or during flight in a balloon. “Pflueger’ Archives”, founded in 1868 by Ernst August Pflueger, is the first journal in which articles on sports and exercise physiology were continuously published. The “Zeitschrift für Arbeitsphysiologie” was founded at the Dortmund Institut für Arbeitsphysiologie by Lehmann in 1928. The journal was continued in 1955 as the „Internationale Zeitschrift für angewandte Physiologie einschließlich Arbeitsphysiologie“, and renamed in 1972 to European Journal of Applied Physiology.

Artur Mallwitz published the first sports-medical Dissertation in 1908 on the exercise capacity of athletes (1). In 1911, a sports laboratory was exhibited in Dresden at an international hygiene exhibition, in which anthropometric, radiological, ergometric and physiological measures were possible. In 1912, the first Sports Medical Congress was held in Oberhof/Thüringen. Sports Medicine and Sports were established as disciplines with the founding of the Deutsche Hochschule für Leibesübungen (DHfL) as an independent college of the sports leagues in 1920, with the surgeon August Bier as Rector and Carl Diem as Prorector. A short while later, in 1924, the journal “Der Sportarzt” was founded by the “Deutsche Ärztebund zur Förderung der Leibesübungen“.
The fundamental developments based on physiology and biochemistry were fascinating for sports medicine, among them studies by A.V. Hill, who demonstrated maximum oxygen uptake as a term for endurance performance and coined the terms oxygen deficit, steady state and O2 debt (6). In 1933, Margaria published for the first time on the relationship between lactate formation and oxygen deficit (12). 

An Extraordinariat für Arbeitsphysiologie und Sportmedizin was established in 1954 under the direction of the Cardiologist and Radiologist Herbert Reindell in Freiburg. The particular focus was on the research which had begun in the 1940s on athlete’s heart for prevention and rehabilitation and a close sports-medical supervision of high-performance sports (22). This clinical orientation bound Freiburg and its later Director Josef Keul and his team to many national teams and successful Olympic teams for a long time.

In 1958, the Institut für Kreislaufforschung und Sportmedizin was founded in Cologne by the Cardiologist and Sports Physician Wildor Hollmann, with a focus on performance-physiological and sports-medical studies.

Wildor Hollman became the Editor-in-Chief of this journal in 1950 and remained in that position for 49 years. As president of the Weltsportärztebundes, he shaped the public image of German sports medicine.

Based on the development of spirogometry by Hugo Wilhelm Knipping and Ludolph Brauer in the 1930s and 1940s, starting in 1949 oxygen uptake could technologically be measured continuously with the closed spiroergometric system designed by Dargatz; measurement in high-performance athletes starting became possible in about 1960. The development of the pneumotachograph by Fleisch and Lilly enabled the development of simpler, semi-open and later open spirogometric systems, which made spiroergometry generally available (2).

Suddenly, the physical performance capacity could be analyzed and differentiated, and the introduction of lactate into performance diagnostics meant that the oxygen situation, training and performance capacity could be better monitored.

Thanks to the 1968 Olympic Games in Mexico, with the unaccustomed altitude conditions, and then the 1972 Games in Munich, there was another spurt which led in the subsequent years to the institution of numerous sports-medical facilities at many German universities.

In addition to the three institutes in Cologne, Freiburg and Berlin (Harald Mellerowicz), other institutes were founded, among them in Saarbrücken in 1978 (Wilfried Kinderman), Heidelberg (Helmut Weicker), Bochum (Horst de Marées), Hannover (Dieter Böning), Tübingen (Hans-Hermann Dickhuth), Munich (Dieter Jeschke), Ulm (Reinhard Wodick and Martin Stauch) and Hamburg (Klaus-Michael Braumann). Jürgen Stegemann expanded the Institut für Physiologie in Cologne to Space Physiology starting in 1968.

Thus a bi- to tripolar world of sports medicine became a broad discipline, which is also reflected in the journal. In 1982, the German Sport Medizin published by Thieme Verlag became the International Journal of Sports Medicine, with Weicker and Jon Karlsson from Stockholm as editors.

In 1953, an “Arbeitsgruppe Sportmedizin” was founded in the DDR in Leipzig, which later became the DDR Society for Sports Medicine. The functional anatomist Kurt Tittel and the sports physicians Stanley Ernest Strauzenberg and Siegfried Israel were internationally known. The Sports Medical Service heralded a state-controlled, state-wide system of sports-medical supervision, and the professional journal “Medizin und Sport” was published starting in March 1969. Noteworthy is also the structured postgraduate education to specialist for Sports Medicine, which was completed by more
than 300 colleagues (1).

In 1950, the Deutsche Hochschule für Körperkultur arose out of the Institut für Leibesübungen, founded in 1925. High-performance sports research was combined in 1969 in the Forschungsinstitut für Körperkultur und Sport (FKS). At the beginning, innovations and paradigms of training – such as replacing intensive interval training with extensive endurance training – were designed in sports medicine and sports sciences in the DDR and attained internationally recognized high quality of training supervision (23, 24). The ubiquitous Stasi dictated to researchers, too, which led Alois Mader, the “Father of the 4-mmol threshold” to flee the country (11), and others to flee in emotional emigration.

The DDR regime placed increasing faith in doping and evasion of international doping controls. In addition to the “clinic’s own” steroid Turinabol, research addressed hormone analogues, central hormonal mechanisms and microdosing, which finally brought delegitimization of the Institute (11, 27). In 1992, 125 colleagues, including a small sports-medical department were taken into the new Institut für Angewandte Trainingswissenschaft (IAT).

Training management with lactate, the lactate threshold concepts and corresponding test forms are innovations which elicited a number of studies and publications and changed sports (1, 25, 26). After all, lactate can be measured anywhere and in practically anyone and the metabolic situation evaluated. This meant that performance diagnostics had left the laboratories and entered the practice as service assistant, a process which is not yet completed.

Training cannot, however, be increased beyond all limits. There are limits to load, which overstepped lead to overload and exhaustion as well as decreased performance. In the 1950s, the high-intensity interval training framed by Emil Zatopek and the German Rowing Eights under Karl Adam, led to sympathicotonic over-training, whereas the introduction of greater training scopes led rather to a vagotonic exhaustion syndrome. Sports endocrinology and biochemistry, founded by Georg Haralambie, Manfred Lehmann and Helmut Weicker delineated the load limits and the broad problematics of overtraining (16). Now the question was how such undesired side effects of training could be prevented. One might consider the decrease in thyroid and sexual hormones as the body’s protective phenomenon against exhaustion, which could be counteracted by more intelligent training, regeneration and nutrition (11, 16, 24). Modern immunological concepts provide better insight into molecular training effects and the considerable influences of micro and macrotraumata (4, 13, 20, 28)
The technocratic side of “anything’s possible” saw an impairment of the body’s homeostasis and an endocrine deficit, which could be overcome by special supplements, targeted measures or substitution hormone deficiencies.

But the balance between the ethically permissible, medically possible and necessity got lost somewhere. Of course, the term “doping” has changed over the last 70 years. But it was clear by the end of the 1970s at the latest that doping essentially endangered not only the legitimation of sports and “scientific doping”, which claimed to control the side effects, the health of the athletes as well. There is an ugly line from the protagonists who still considered “substitution” permissible in 1983 to the “experimental endocrinology” of the Oregon Project in 2019, which must be recognized as doping.

It took a long time for sports medicine to find an unequivocal stand. In this respect, the statement of the German Hochschullehrer für Sportmedizin published 2011 in our journal was definitely an important step: “It is known that doping methods … were sometimes promoted and also financially supported. This situation can, however, in no way justify the cited behavior in our view. … We support the self-evident position that a proven violation of the Anti-Doping Regulations (WADA/Code) by doctors, medical assistants, trainers and functionaries cannot be reconciled with continued activity in high-performance and elite sports nor, when doctors are involved, with continued membership in the DGSP.”

The translation of sports-medical findings to prevention took a long time. Clinicians contributed to differentiated diagnostic and treatment of diseases with the risk factor concept.
Physical activity did not appear in most of the studies, although important data were already available, such as the London Busmen Study by Morris in 1966 and the Harvard Alumni Study by Paffenbarger in 1978 (17, 20).

In the 1970s, the question was slowly formulated in prevention. The study quality was, however, inadequate for a long time, but the evidence continually increased. A meta-analysis of publications in the German Journal of Sports Medicine by the Cochrane Institute reported that in the first 54 years of our journal, there were 490 prospective studies, 182 RCTs (randomized controlled trials), 308 CCTs (controlled clinical trials) which had essentially impacted the understanding of
physical activity (99).

The first Heart Group was started in 1965 by the internist Hartmann in Schorndorf, a movement which has now spread throughout Germany. But proof of effectiveness is still somewhat problematical since there are no prospective studies (28).

The first landmark study on lifestyle and coronary heart disease was published in 1990 by Ornish. Participants were a small group in whom the progression of coronary heart disease could be prevented by means of extreme vegetarian, low-fat diet, exercise, ban on smoking and moderate activity (19). This finding appeared totally unbelievable to clinicians at the time.

Then Belardinelli published a study in 1998, in which he trained patients with chronic coronary heart disease for 8 weeks. He showed that there was a decrease in progression of the coronary heart disease, improved collateralization, improved myocardial perfusion and improvement in cardiac function (3). In Bad Krozingen, Meyer and Roskamm successfully treated heart-failure patients with interval training (1997) (14). The cardiac dilatation due to stress of the weakened heart, feared by clinicians, was not observed in either study.

In 2004, Schuler and Hambrecht published a guidepost study in coronary heart disease, in which patients with single-vessel disease were prospectively randomized to either training or intervention (5). Training had clear advantages over angioplasty: complications, performance, progression, perfusion, costs. In a guidepost prospective study on 6213 men, Meyers showed that the best prediction of coronary mortality over an average 6.4 years was performance capacity and not CHD (18).
Oncology reports that training has a clear survival advantage (16 vs. 38% mortality) in colon carcinoma (15). Training acts on the brain and peripheral nervous system, neuroplasticity is a term which has only been coined in recent years.

The last ten years are characterized by great advances in the recognition of physical exercise therapy. The study quality has continually improved, since physical activity was included in the formulation of the target and not incidentally recorded. Nowadays, we can show that physical activity is effective in numerous diseases, in prevention, secondary prevention and in therapy as well.

We will continue to address new, interesting and relevant topics for the future. The discipline of Sports and Exercise Medicine is in continual flux and its development is dynamic. Chronic inflammation syndromes and the influence of physical exercise, personalized medicine and expression profile, neuroplasticity, wearables, interaction with the socioecological environment are only a few of the topics addressed by our institutions.

The editors see physiological performance optimization as a basic sports-medical task. Athletes have the right to be able to optimally develop the potential attained by talent and training, including from a health point of view.

So if other disciplines have also discovered the specialty, the Journal is of great importance in maintaining, documenting and further developing the core of the discipline. For this, we need the cooperation of all scientists. We are particularly grateful to our editors and to all who have worked on the editing staff over the past 70 years, our junior editors, the Scientific Council and all of the scientific institutes that give
us regular support.