To be healthy you need to be fit; to achieve fitness you need to take part regularly in a sport or some other physical activity. The equation is simple and sensible: hence the ‘importance of sport’. The benefits of sport have been recognized since time immemorial. It seems almost axiomatic to us that fit, able bodies competing with each other in games or excelling in individual sporting achievements are shining examples of health. Today the medical and scientific evidence shows that, generally speaking, this is true, although certain sporting activities bring their own health hazards with them, and approaching sport carelessly can certainly do more harm than good.
Sport in Western society
Of major concern in the Western world today are the so-called diseases of affluence. These include heart disease, cancer, diabetes and many others for which an important precursor is often obesity. Taking up a pleasurable sport is one way of burning off some of the body’s excess calories as well as toning up body muscles, heart and lungs. Using our muscles and exercising our joints keeps them healthy. Sport, as a major influence on fitness, plays an enormously important role in maintaining general health. In the Western world, governments are therefore committed to financing recreational facilities where people can pursue the sport of their choice. Money thus spent is an investment because it is now widely accepted that sport is a positive step in health care, as fundamental as health checks for babies or providing an immunization service against infectious diseases. Large organizations also go to considerable expense to provide employees with sports and recreational facilities because they, too, recognize the practical benefits of having a physically healthy staff, and also understand the psychological advantages of encouraging team and individually competitive sports.
For some of us the sporting achievements of our schooldays are carried into adult life. But for many, sport sinks into oblivion. If any interest persists it is usually no more than that a sport is supported on a passive level – as a spectator sport – either by following a particular team and attending games or matches, or simply by watching broadcasts on television. The choice of sports is enormous, from extremely vigorous activities such as squash and tennis to the comparatively gentle pursuits of country walking and golf. For many adults, however, sportless since school, the disincentive to getting started again is the fear of what might happen if sport is taken up after years of inactivity. Will you collapse with a heart attack midway through your first game of badminton? Will old joint injuries recur? These are genuine and not unreasonable fears. An analogy is that you would be foolish to take your old car, used only occasionally for short trips to the shops, on a long motoring trip around the country without getting the vehicle thoroughly checked first.
If you fancy taking up one of the more vigorous sports and you are in middle age, see your doctor first for a discussion and check-up. If you are obese, whatever your age, it would also be unwise to take up a vigorous sport without seeing your doctor first and also losing some weight. The same should also apply, for safety’s sake, to anyone who has a sedentary occupation and has not taken regular exercise – enough to breathe deeply and sweat a little – for several years.
At the check-up the doctor will examine your heart and lungs, and take your blood pressure. Moderately raised blood pressure is not unusual in older people and can often be successfully dealt with by exercise and diet. Seriously raised blood pressure calls for more radical treatment by drugs, but even in such a case your doctor may not discourage you from participating in more gentle pursuits such as walking or golf. Many health-care clinics now offer a complete health check-up at a price similar to that of an annual vehicle servicing. If you owe it to your car, surely you owe it to your own body?
At a more thorough examination you may have an electrocardiogram (ECG) taken while you are exercising. For this an adjustable running treadmill or cycling machine is used in conjunction with an ECG machine. The treadmill or cycle can be varied to demand different degrees of exercise effort and the ECG machine is then used to determine how your heart responds to the changing workload. The latest generation of these machines determines the efficiency of your heart, and all models measure any arrhythmias (irregularities in heartbeat) that occur during the exercise. This is important because ar-rhythmias are hard to detect at the usual examination, which evaluates the activity of the heart at rest; they tend to show themselves only upon exertion. Arrhythmias are not necessarily harmful (no heart beats absolutely perfectly) but a high percentage of missed or faulty beats during exercise might indicate the need for further cardiac or cardiovascular tests. With a sound heart, the most worrying of your fears will disappear.
At most medical examinations made with a view to assessing your fitness and sporting potential, the doctor would also want to know about any previous sports injuries, and general medical history before he or she could advise you.
Setting your health goals
Armed with a clean bill of health, it is important to realize that you cannot straight away set about run-ning a marathon. Fitness training and warm-up exer-cises are important parts of many sporting activities, and the golden rule is to start at aij easy level and build slowly from there. Do not expect to become a top-class athlete overnight, or even after a year; the best sportsmen and women have certain physiological ‘gifts’ and psychological attitudes which, with coach- ing, enable them to become world-class competition. As the body becomes fitter, obvious changes occur in the muscles, which become more powerful, larger and harder. This also applies to the heart muscle, with the result that the heart rate of a person at rest declines as he or she becomes fitter. There are top athletes in whom the heart weighs over 500 grams (the average is 300 grams), pumps a volume of 140 ml per beat (average 70 ml) and whose heart rate is 40 beats per minute (average 70). When a top athlete pushes himself or herself, the heart rate rises to that of a normal person sitting quietly. An ultra-efficient heart of this kind may be regarded by some doctors as an abnormality. In general, though, the lower the heart rate, the better. A small, weak ‘desk’ or ‘armchair’ heart runs much more risk of failing under strain. It is analogous to the performance difference between a one-litre and a two-litre car engine. Both can propel a car but the smaller engine is likely to fail sooner.
Sports injuries and other problems
Like most things, sport has its drawbacks. Injuries sustained while taking part in sport have to be taken seriously and today sports medicine has become an important discipline in its own right. This is particularly true in the world of professional sport where large amounts of money are at stake. For many everyday injuries such as sprains and strains the most effective treatment is rest, but pain should never be ignored – it is a warning sign that all is not well, and playing on risks serious injury. If you do injure yourself through your sport, it is important to seek proper medical advice about treatment. Similarly, if you have been ill and enter a sports competition, it is important to check with a doctor that you are well enough to participate. Illness, espe-cially mild viral infection, has a deleterious effect on performance because the body temperature is slightly raised. This, plus the added exertion of activity, can make you feel extremely unwell, with the possibility of nausea, vomiting and collapse.
One myth in sport concerns the amount of fluid intake one should have before competitions. It is true that being distended with fluid before a race would hardly improve chances of success, but mild dehydration can be just as bad. The effect of mild dehydration is similar to the ‘under par’ feeling one has for a day or two after severe diarrhoea. So you need not restrict your fluid intake before sports activity and indeed it may be better to increase it and take salt tablets to make up for fluid and salt lost through sweating. A considerable amount of water is lost in physical activity and it is important to replace it quickly. Another source of sporting myths is diet. A normal diet is adequate for most amateur sportsmen and women, though many coaches advocate a high-protein diet for athletes in training and for those building weight and muscle. The idea that taking glucose has a beneficial effect before events like sprinting is largely false: the only thing athletes use in large quantity in such short periods is oxygen. The amount of glucose consumed is comparatively small and blood glucose levels are not affected by sprints. Other myths such as avoiding sex before competitions are viewed somewhat sceptically. Well-prepared, well-rested athletes are likely to do well in their chosen field, but like many performers (actors and musicians included) they have particular routines of behaviour they associate with success. The belief that varying the routine will impair the performance is part of their ‘warm-up psychology’. In practice, the energy that sex may consume is small and relatively unimportant.
There is some truth, however, in another myth: the advice not to swim for some time after a meal. This is also true for other sports besides swimming. Normally the digestive system works independently of body motion, but physical exertion after eating can result in some people feeling nauseous and actually vomiting. There is also some chance of muscular cramp which, if it occurs during swimming, can be very dangerous. Most of us have sufficient blood reserve to cope with this, but it is advisable not to tempt fate.
Drugs and sport
In the 1950s experimenters found that rats of either sex could be made bigger and stronger by giving them male sex hormones. The way was thus opened for the production of substances known as anabolic steroids, compounds chemically similar to male sex hormones but with more effect on stature than sexuality. Their use is banned in international sporting competitions and also at most national levels. However many top-class athletes can still get away with using these drugs in sports where weight is a key factor. The reason is that although the drugs can be detected easily enough by chemical tests of the blood, their effects persist for weeks. If athletes stop taking them a while before a competition, the effects will persist even though they cannot be discovered in the blood during routine tests.
Nobody is sure about the long-term effects of anabolic steroids, so, although it is possible to obtain these drugs from sources other than doctors, for safety they should be avoided.
Amphetamines are stimulants and have also been abused by athletes. These drugs are banned in top-class sport, because athletes have died as a result of their use. There are many other substances which are liable to abuse in the hope of increasing performance. If you take part in professional sport, your coach should be able to give information on drugs banned in national and international competition. If you take any of these for medical reasons your doctor should be able to find acceptable alternatives.