Sports Medicine in Transition

The title of this Editorial resonates with awakening, innovation and consciousness of the strengths of Sports Medicine. And that is really necessary, if Sports Medicine is to exist in the future at the highest scientific level.

On the dark side of the process are the threatened closure of university sports-medical faculties in Germany on the one hand, but the positive development of expansion of Sports Medicine on the other, if we look at the entire German-speaking region. Thus a second sports-medical professorship for Preventive Sports Medicine was recently created at the University of Basel in addition to the Professorship for Sports Medicine which was only established in 2009. A similar situation applies at the University of Lausanne. In order to reverse the negative development in Germany, it is necessary to formulate clear concepts to convince those responsible at the universities of the value of Sports Medicine has in the Canon of other specialist disciplines. The question spontaneously arises: what are the actual strengths of Sports Medicine? And these are at the core the assessment of performance capacity and stressability of the human body, and the dosed application of exercise and sports in the sense of prevention and therapy of chronic diseases, along with improvement of performance.

The extremes of elite athletes with genetically-determined performance capacity and maximal trainability and participants in so-called “bed rest” studies, which demonstrate the effects of chronic inactivity can be used as the physiological model for the way physical activity and inactivity act. The specialty of Sports Medicine lies within these borders, over the entire age span from the small child to the elderly, from healthy to sick, covering all diseases. The sports doctor is a specialist for physical health and exercise, usually coming from the initial discipline of Internal Medicine or Orthopedics, rarely from other disciplines like Neurology. The doctor should be able to apply methods for the evaluation of performance capacity and stressability and the components endurance, strength, coordination and flexibility as tools better than doctors of other disciplines and in this cooperate closely and equally with sports and training scientists, sports psychologists and experts in sports nutrition. After all, in addition to precise diagnosis, successful transfer of exercise recommendations to the everyday life of healthy and sick persons is needed.

Successful implementation of exercise interventions is apparently covered by the words “every step counts” to oppose physical inactivity. This probably is true in the sense that even mini-interventions or periods of standing to interrupt sitting on the job reduce the risk of cardiovascular diseases (1). But this common banality, which is voiced even by many sports doctors, is basically a devaluing of competence in the application of exercise and sports in prevention and therapy. As an analogy, would a Diabetologist ever think of telling his patient that „every unit counts” in his insulin medication?

In the age of personalized medicine and Precision Medicine, as promulgated by former US-President Obama and the NIH (5), Sports Medicine must take completely different paths. The differentiation in Responders and Non-Responders is basically the right thought to individualize exercise interventions. This is seen by Sports Medicine research in nearly every intervention study. Unfortunately, we only insufficiently approach the reasons for the effect or non-effect of exercise as medication because the number of cases and the individual characterization of the person are inadequate for the required precision. For this, further development of Sports Medicine in several aspects is essential if there is to be no further loss of meaningfulness.

First, we need well-characterized, population-based, large databases which present the functioning of the body with the components endurance, strength, coordination and flexibility.  I emphasize especially these components in addition to characterization using questionnaires, blood and genetic analyses, imaging and other in-depth description of the personalized health, because these performance characteristics of the body are usually not given adequate attention considering their importance for the quality of life, morbidity and life span (3, 7). One reason is certainly that Sports Medicine has too weak a voice in planning cohorts. In this, the greatest disadvantage of existing cohorts is the lack of normal values or super-normal values to enable delineation between “really healthy” from “starting to be sick“. To achieve this, the sports-medical-research and research-interested facilities of Sports Medicine should get together and regain their important position in medicine and contribute to the health of the general population with such „Cohorts of physical function”. Which parameters determine good physical function can be much better recognized than before and interventions based thereon can be designed earlier and be more targeted.

Secondly, Sports Medicine should use the nearly boundless chances of mobile sensors for recording physical activity by type, scope, intensity, frequency and time of day along with other parameters like pulse, respiration, temperature as well as localization, recognition of construction and social barriers, air pollution and numerous other factors (4). The possibilities increase nearly every month with newly-developed health and activity trackers which nowadays can be implanted subcutaneously for long-term monitoring. These monitors, also termed gadgets, enable recognition of personalized risk patterns with the core element exercise, which like a fingerprint of health are unique and could enable highly-individualized recommendations for a healthy lifestyle. If we additionally create a link between laboratory-based physical function data and mobile data and the hemodynamic parameters cited, Sports Medicine would considerably strengthen its role in health prevention and therapy. A large number of cases would be needed for this, too.

Third, implementation of sports-medical recommendations by the affected person is a great challenge and chance at the same time. Suitable communicative means are much too infrequently used to improve health behavior. Despite initial approaches in studies, coaching of patients and healthy persons is still in a very early stage. The “Stages of Change” are unsystematically taken into account, or the knowledge of them anchored only in a rudimentary fashion. Smartphones and virtual reality could be used much more often to support motivation, compliance, adherence and maintenance, even playfully (2). The use of electronic aids for “Self-Training” in combination with supervised training is still completely in square one. Time, mediation competence and a broad network of exercise therapy are needed on the path to successful and widespread implementation of exercise therapy.

The perspectives just mentioned for personalized Sports Medicine require responsible handling of personal data. These data, which are often thoughtlessly revealed by Smartphone users to the internet providers, belong, following Denmark’s lead (6) in the hands, or only in the hands of institutions that can be trusted. These should be allowed to use the data for the benefit of the data-giver to improve health and the quality of life. The digital network must be made safer and the individual benefit to health more accessible for the individual.

Sports Medicine could as a unity enter into personalized medicine, recall its strengths and thus experience renewal. As no other specialty, it can characterize the functioning of the human body with its classical performance-diagnostic methods and draw individualized recommendations for a healthy lifestyle from a “Function Cohort”. But it must really want this transition.