Specialty spotlight – sport and exercise medicine

Dr Jo Larkin, sport and exercise medicine (SEM) sonsultant, and Dr George Bownes, StR in sport and exercise medicine, discuss the specialty and why they pursued it as a career. They explore the variety involved in training and working in the specialty, and the role SEM can play in engaging in issues of public health.

Introduction to sport and exercise medicine

Sport and exercise medicine (SEM) involves the delivery of expert care in injury management and illness, physical activity and sport. It also has a large scale application in improving the musculoskeletal (MSK) and physical health of the general public and in treating and preventing disease through exercise advice and prescription.

SEM consultants work in a variety of MSK and exercise medicine services across NHS primary and secondary care. They also work within sports medicine from the 'grass roots' level up, including individuals who participate in sport, clubs, non-professional and professional teams and athletes.

Our consultants lead and work with multidisciplinary teams in many different settings. In sport, they aim to improve individual and team performance, prevent and rehabilitate injury. With exercise medicine they use the ‘prescription’ of exercise to prevent and treat many chronic conditions seen in primary and secondary care settings.

This is an exciting time for the specialty; as modern healthcare moves towards a radical upgrade in prevention and public health, SEM has a unique skills base to offer. Exercise prescription is ideally positioned to play a key part in the future healthcare landscape.

What skills are most important for sport and exercise medicine?

Sport and exercise medicine consultants work in a variety of MSK, chronic disease and exercise medicine services. The skill-set of SEM physicians traverses the traditional boundaries of primary and secondary care, often providing cheaper pathways and models of care.

Which specialties do sport and exercise medicine specialists work most closely with?

MSK medicine is a vital component of our skill set, therefore SEM doctors will work closely with rheumatology, orthopaedics and rehabilitation. For care pathways, including SEM, to be effective it is vital that our consultants work as part of a multi-disciplinary team and you will see SEM specialists also work alongside cardiology, surgery, oncology and endocrinology.

What is most rewarding about working in sport and exercise medicine?

The variety of work in a specialty that has a broad based application, not only for sport but for public health; from enabling peak performance in athletes and sportspeople to rehabilitation in chronic disease, workplace wellness and the management of diabetes.

What challenges are involved in sports and exercise medicine?

The specialty of sport and exercise medicine with its unique skills in exercise medicine has one big challenge ahead of it - delivering physical activity and using a more evidence-based approach to promote preventative health measures alongside a culture of wellness within the NHS.

How has sport and exercise medicine changed in recent years?

The specialty is a fairly new one with the Faculty of Sport and Exercise medicine launching in 2006. Although sport doctors have been in existence for the last few decades, the specialty has really expanded in recent years to include MSK medicine, exercise medicine, rehabilitation and workplace wellness all areas that need investment for future public health.

What are there opportunities for teaching and research in sport and exercise medicine?

There is an enormous opportunity for further research into the effectiveness and cost effectiveness of exercise medicine in the NHS. We are opening up dialogues with both Health Education England and NHS Scotland in order to protect current teaching posts and training places and to create new ones for a specialty which has an enormous application for public health.

Dr Roderick Jaques, president of the Faculty of Sport and Exercise Medicine UK

Why choose SEM?

Few specialties can offer the variation that training in SEM provides. Core placements within MSK clinics, emergency medicine departments, rehabilitation centres, general practice, cardiology, and public health are supplemented with opportunities to experience medical provision within elite-level sport. Alongside this, there is an enormous opportunity for tomorrow’s consultants to make a real difference to the healthcare landscape through using unique skills the specialty can bring in MSK medicine, rehabilitation and exercise medicine.

Currently the specialty is reviewing how it can contribute to the NHS 5-year forward view and support the need to provide a radical upgrade in prevention and public health. Our consultants continue to complete research on the effectiveness of exercise medicine, proving that the specialty can offer value in a broad range of conditions to improve clinical outcomes.

Dr Jo Larkin, SEM consultant, clinical lead for the Centre of Spines Rehabilitation at DMRC Headley Court, England Sevens rugby football union team physician and consultant for London Sports Orthopaedics

Dr David White, StR in SEM (Scotland)

Training and working in SEM

Specialty training in SEM covers a uniquely broad range of topics, including: MSK medicine, exercise physiology, rehabilitation medicine, public health, emergency medicine, primary care, cardiology and team sports. Involvement with research and teaching is encouraged through the programme. Trainees must work towards and pass the diploma in SEM as they proceed through the programme. This exam is run by the FSEM and RCSED.

SEM training will particularly suit proactive and dynamic trainees, who enjoy working as part of a multidisciplinary team and in a range of clinical environments.

For information on the training pathway, see the Joint Royal Colleges of Physicians Training Board. You can learn more about the recruitment and interview process through ST3 recruitment.

For information on the MRCP (UK) exam, including PACES, see their website.

Sport and exercise medicine resources

RCP resources

Historical highlights from the library, archive and museum collection

Richard Mead (1673–1754), physician and philanthropist, was involved in the founding of the Foundling Hospital, a home for abandoned children, in 1741. He actively encouraged movement and exercise and ensured a courtyard was built so that the children could run freely and get fresh air daily. The RCP holds many fascinating artefacts related to Richard Mead, including several portraits, his gold-headed cane, university diploma, printed works and even his own pocket watch.

The RCP holds a portrait print of Sir Herbert Atkinson Barker (1869–1950). Sir Herbert was an English manipulative surgeon who developed a highly successful osteopathic technique, specialising in knee and other damaged joints, both in top sportsmen and the general public. However, his methods were never formally approved by the medical establishment.

In his book Diet and food considered in relation to strength and power of endurance, training and athletics Alexander Haig (1853–1924) examined the impact of uric acid on exercise and physical activity. His investigations led him to believe that migraines, which he suffered from throughout his life, and many other medical issues, were caused by excessive amounts of uric acid in the body. He said uric acid caused fatigue, and to counter this he recommended a meat-and-caffeine free diet with plenty of dairy products, pulses and vegetables consumed throughout the day. Diet and food is packed with tips about what athletes should and should not do to improve their stamina, such as sucking lemons and drinking milk during exercise. For illustration, Haig drew on a wealth of anecdotes including descriptions of cyclists who had to cut their journey short as they attempted to subsist on blackberries alone and a meat-eater versus vegetarian 70-mile walking race.

Haig was a physician to the Metropolitan Hospital and Royal Hospital for Children and Women. His ideas around uric acid were quite popular with the public, especially his recommendations around diet. However he faced criticism from others in the medical profession who did not accept that uric acid was the cause of so many different types of illnesses.

Sir Adolphe Andrews (1883–1967) was a general physician who was deeply interested in athletics and the training of athletes, and was consulting medical officer to the British Olympic team on numerous occasions between 1912 and 1948. His written work included the topics of exercise, physical fitness, and the training of athletes. The brother of Harold Maurice Abrahams, the Olympic athlete, he was no mean performer himself and was often seen in middle age running round Regent’s Park.

Our archives hold the minutes of the RCP’s SEM committee 1998–2006 (accessible to fellows after 10 years, and to others after 20 years.)

Contemporary library items include The ethics of sports medicine edited by Claudio M. Tamburrini and Torbjörn Tännsjö, which cover areas such as genetic and performance enhancement, ‘the concept of competition and equality’, and ‘the promises of cyborg athletes’.  ‘Medicine, sport and the body: a historical perspective’ by Neil Carter looks at the history of the relationship between sport, medicine and health from the mid-19th century to today, including ideas of health, sport and exercise; injuries; pioneers in the specialty; drugs, anti-doping efforts and ethics; and medicine, sport and the female body. There is also a special chapter focusing on the history of boxing.