European Society of Athletic Therapy and Training
Déarbhla Gallagher new President of the European Society of Athletic Therapy and Training

We are excited to announce the instatement of our new President: Déarbhla Gallagher, BSc GSR/ARTC.
A certified Athletic Rehabilitation Therapist (Ireland) and Sports Rehabilitator graduate (UK), Dearbhla teaches “Anatomy and Physiology” and “Massage Therapy” at St. Mary’s University College (Twickenham, South West London, UK), Déarbhla’s professional experience is wide:
- Ireland: Club level Gael

ic Football (male and female), private practice
- United States: Volleyball NCAA D1, American Football D1, Wrestling NCAA D1
- United Kingdom: Professional Soccer Academy, Private Practice, Ministry of Defence Medical Rehabilitation Centre.

Confident she will drive ESATT further towards its goals, we look forward to seeing her enthusiasm and vision infecting all of us!

Congratulations Déarbhla, and let’s work hard together.

The Scientific Board and the Editors.
Guidelines for Physiotherapist Professional Entry Level Education

The World Confederation for Physical Therapy, a confederation of national physical therapy associations founded in 1951, has reviewed its set of international guidelines for physiotherapist professional entry-level education.

You can consult them and the relative bibliography following by clicking here


Statutory regulation for Sports Therapy coming to the UK - an interview with Steve Aspinall

Dear readers,

The Health Profession Council agreed last month to make a formal recommendation to the Secretary of State for Health and to Scottish Ministers for the regulation of the professional area of Sports Therapy. 

This is excellent news for all of us, as it is one step forward towards the creation of a statutory governing body, a professional register, and a definition of minimum standards for a BSC hons course. 

I’ve interviewed Steve Aspinall, Chairman of Basrat (British Association of Sport Rehabilitators and Trainers - www.basrat.org) on the topic. I hope you find this interesting!

Salvo Cognetti

1) How important is it to have a professional regulation in the area, and why?

As this field has grown within the UK, it has developed on a number of educational levels, ranging from courses lasting a few weeks up to high quality degree level programmes. As we are talking about a healthcare professional that works with patients and has clear capacity to cause harm, then this obviously raises a great deal of concern about patient safety. Even when we look at University level education, many courses are being ran in this area without appropriate expertise, facilities or resources. BASRaT has always had strong ethical objections about inappropriate, poor quality training for the UK Sports Medicine professional, especially in numbers that are clearly inappropriate for the UK job market. As front line medical professionals, education and training in this area needs to be of an equitable and high standard across the board. This is why all BASRaT accredited institutions undergo a rigorous accreditation process, that covers everything from expertise, facilities and resources to content, assessment, contact hours, staff/student ratios and clinical experience. We hope that professional regulation will help to assure these standards across all the educational institutions delivering programmes in this area.

2) What’s been the decisive factor in your liaising with authorities to make things move forward?

This has been a complicated and extended process with a great deal of history. Essentially, it has been the summation of all the work with the Department of Health, the Health Professions Council and the other bodies with an interest / stake in this area. More recently, we worked towards ensuring that low level Sports Therapy qualifications would not progress onto the national educational frameworks, which in turn limited the ability of non statutory bodies to attempt to regulate this area inappropriately. There have also been a large number of other factors feeding into this process.

3) What will you do now?

We have a lot of hard work to do, with one of the principal tasks being to ensure that any standards of regulation in this area are at a standard commensurate with a safe and effective healthcare professional. We are also continuing to work with the UK Rehabilitaion Council, of which I’m a trustee, and on the UK’s National Exercise Referral Group amongst others.

4) What do you expect from Statutory Regulation?

As above, I would hope it leads to a defined set of minimum standards for the profession and a rationalising of the high number of courses delivered in this area.

6) Does this change anything for gym trainers who deal with a healthy population with ‘average’ needs? How about physiotherapists, doctors, and other professionals involved in the area?


Along with the National Exercise Referral Project, it should give “gym trainers” a much clearer framework to work within and allow them to use their specific skills to better advantage. It will also give Physiotherapists, Doctors and other professionals the confidence that they are working alongside safe and effective healthcare professionals.


7) Are there any potential delays or problems with the proposed regulation being put into place?

The UK coalition government released a white paper on the 16th February 2011 “Enabling Excellence: Autonomy and Accountability for Health and Social Care Staff “, which effectively covers how they want to move away from compulsory regulation for new professions and instead use existing statutory regulators to set up voluntary registers. How this will effect the regulation of our profession at this stage, if at all, remains to be seen.

5) OK, it’ll be done in Scotland. What does that mean for the rest of the UK? Will there be unity or fragmentation?

Although this will cover Scotland as well, that isnt the primary or even the initial focus. Its a UK process, so will be UK wide.

Steve Aspinall

Chairman

BASRaT

Introducing BIOM - A revolutionary bionic leg

Dear readers,

A company called IWalk, from Boston, Massachussets, has developed an amazing novel bionic leg that changes the life of amputees who wear it. BiOM, as it was named, differs from conventional prosthetics in the fact that it provides a high-powered push from the ankle, enabling its users to walk uphill with unprecedented ease and comfort. At the moment, the expected cost of a single prosthesis is about 50,000 US dollars - yet, if healthcare systems such as the NHS and its counterparts around Europe were to offer it to their patients, the life of many amputees could change radically, for the better. 

See the video for yourself  by clicking here

Tot ziens,

Salvo Cognetti

Obesity in Low and Middle-Income countries is rising. An article on Lancet proposes strategies to reverse the trend.

Dear readers,

I’d like to direct your attention to an article that appeared last
November on Lancet – (Lancet 2010; 376: 1775–84) regarding the
increasing prevalence of obesity and its related diseases in low and
middle income countries. As I remember mentioning before, in the
western world we have traded death by infection for death by
atherosclerosis, so to speak. It seems that, however, in poorer
countries, the burden of the latter is being added onto that of the
former. This article explores possible avenues to reverse the trend,
building a comparative model of separate – and joined approaches.

Seven main strategies (Mass-media campaigns, Worksite interventions,
Physician counselling, School-based interventions, Food labelling,
Fiscal measures, and food advertising regulation) are examined, and
the authors conclude that the implementation of several or all of them
would result in cumulative benefits in terms of Disability Adjusted
Life Years, at a very low cost.

While the strategies in this article have been aimed at low and
middle-income countries, there is nothing to say that they wouldn’t
work in the western world, Europe in particular. It falls also upon
us, ESATT, as well as all our colleagues who are in some way involved
in preserving the health of the physically active to raise our voice
on the matter, and advocate for such interventions wherever we can.

Also, as I’m writing this, I received some news I feel can’t wait for
the next post: The Scottish Government is moving towards creating a
regulation of the professional area of Sports Therapy, opening a
register and defining the minimum requirements of a BSC degree. I’ll
interview Steve Aspinall, Chair of BASRaT (British Association Of Sport Rehabilitators and Trainers — http://www.basrat.org/about.asp), and as soon as I learn something more, you’ll
be the first to hear of it. Stay tuned!

Salvo Cognetti

The utility of training diaries - From Guest Editor Siobhan O’Connor

 

 

Dear Readers,

You may have heard of training diaries. But what are they exactly, and what are their benefits?

Training diaries can be an invaluable tool to monitor athletes’ workload, their adherence to training schedules, and their recovery from injuries. Professional athletes all over the world in various fields have begun to use them, and their benefits — both to athletes and their trainers — are quite significant.

I’ve asked our colleague and ESATT co-founder Siobhan O’Connor (see a paragraph about her at the end) to write a piece about it. I was particularly appealed by the different possibilities, such as online and SMS training diaries - even if technology won’t do the training on our behalf (but would it really be fun if it did?), it can still help us to keep an eye on it and make sure we’re doing it correctly…

So here it is!

À Bientôt,

Salvo

 

Training Diaries

At the beginning of this New Year most of us will be attempting to come up with yet another New Year’s Resolution. Instead of the usual ones, such as giving up junk food, and heading to the gym more often, why not try and start up a Training Diary with the Team you’re working with? Training Diaries are mainly used to quantify the training load on an individual or a team. It requires each athlete to record all training and exercise they have completed within a set period of time. It can be an excellent method of allowing the Athletic Therapist, and coaches, to keep an eye on the amount of training done by each team member. 

Analysing physical activity and training load in sporting people is important as optimal levels of training will improve sporting performance and physical well-being, therefore having a beneficial effect on both the individual and the team. However, excessive training could increase the likelihood of injury or cause overtraining.  Therefore, in order to optimise this training effect, it is essential to first quantify exactly what the athlete is doing. (Borresen and Lamber 2009) This is where the Training Diary comes in. Only when the training load has been quantified, it can be decided whether the athlete is adapting positively to the level of training and from this, coaches or athletes can adapt training to optimise the athlete’s performance. (Borresen and Lamber 2009). Another benefit is that the AT themselves could monitor the training diary and help prevent any unnecessary injuries by picking up on any patterns of injuries or predisposing factors before an injury occurs.

Training diaries could also be utilised directly after receiving an injury, until back training and competing in full. The athlete could fill in the training diary daily with information on what type of rehabilitation they are completing. They could also include any fitness work they are doing.  For example, swimming, cycling, and if they have an upper body injury they could fill in any lower body weights they did etc. This would allow the coach and AT to monitor all players including the injured athletes and ensure that they are in fact doing their rehabilitation, keeping up their aerobic fitness if possible and are using this injured time to focus on other issues that may increase their ability as a player or prevent any further injuries in future (for example core work). An immense benefit of the training diary when used effectively at this stage is that it ensures that coaches recognise that injured players aren’t doing “nothing”, that they are doing their rehabilitation and are carrying on with whatever forms of training they can complete within the limitations that their injury imposes.

Just like the majority of tools used by Athletic Therapists, there are many different forms of Training Diaries used. Training Diaries can be handed out each week to players as a sheet that they have to fill in daily, to be returned during the following week’s training session. An innovative idea used more recently is the online Training Diary: this is where the individual must go onto a website, log in via a private username and password and fill in their training diary daily. Another novel approach to Training Diaries is to use SMS messages to fill it in or else ask each player to download a Java Based Training Diary, which they can fill on their mobile phone. Each method has its own pros and cons. However, in my personal experience, the online Training Diary seems to be the easiest to use for the athlete and has the fewest drawbacks.

Most training diaries ask the athlete to fill in the information on training daily. This is because the sooner after exercise the information is filled, the less likely it is to forget aspects of the training, and therefore the description of the training completed is as accurate as possible.

The best and most useful Training Diaries collect information on the type, duration, intensity and frequency of training and you can also ask questions specific to the sport or team for example include questions on footwear, surfaces, environment, injury status etc.

Compliance can be an issue with Training Diaries, and the AT should explain the benefits that the athlete will gain if they complete it properly before they start using it. Reminders that are sent daily through either text messages or emails can help, and the AT should encourage the athletes to develop a routine. Some teams also like to use an incentive or foster some sort of competition within the team e.g. tickets to a match for those who don’t miss a day in completing the Diary.

All in all Training Diaries can be a great tool to help prevent injuries, optimise performance and enhance each athletes own knowledge of the training they are undertaking within a team.

 

Reference

Borresen, J. and Lamber, M. I. 2009. The Quantification of Training Load, the Training Response and the Effect on Performance. Sports Medicine (Auckland). 39 (9), pp779-795. 

 

Siobhan O’Connor is a certified Athletic Rehabilitation Therapist working in Dublin, Ireland. She was one of the first to have graduated in 2009 from the brand new Athletic Therapy and Training degree programme in Dublin City University, where she’s currently in her second year of a research masters on ‘Development, Validity, and Efficacy of different modes of Self Recall Training Diaries in assessing training load on Gaelic Footballers’. She is also a co-founder and current vice president of Athletic Rehabilitation Therapy Ireland, which is a recently set-up professional organization that is responsible for the promotion, regulation, and continued education of Athletic Rehabilitation Therapists in Ireland.


Your nutrition and you. Let’s talk about it with the expert.

Dear Readers,


 

I hope your holidays were good, and that you’ve kept active despite the delicious Christmas dinners and New year’s Parties! As nutrition is something that we always think about, especially this time of the year when we are feeling fresh guilt over that roasted goose, slices of panettone, and the scales that remind us of them, I’ve managed to secure an interview with Dr. Arrigo Cicero, who is an international expert on the topic (see paragraph at end). As fast food has become a daily reality in the lives of many, we are also hearing various things from various sources as for what we should be eating instead. But how much of that is true, and how much of that is simply yet another health-related rumour? Well, we’re about to find out. I hope you find this interesting as much as I did!


 

As the interview was originally undertaken in Italian, I’ve taken the liberty of translating it into English for you. Each question/answer is followed by its english translation.


Until next time,


 

Salvo Cognetti


 

Cari lettori,


 

Spero abbiate fatto buone vacanze, e che vi siate mantenuti in forma nonostante i deliziosi cenoni di natale e le feste di capodanno. Visto che la nutrizione e’ qualcosa a cui pensiamo sempre, e piu che mai in questo periodo dell’anno quando abbiamo dei sensi di colpa freschi riguardo a quell’oca arrosto ed il panettone, e quando la bilancia ce ne rammenta ancora, ho ottenuto un’intervista col Dr. Arrigo Cicero, un esperto internazionale sul campo (Cfr. il paragrafo finale). In un periodo in cui il fast food e’ diventato una realta’ quotidiana per molti, dall’altro lato se ne sentono dire di tutti i colori su quello che dovremmo mangiare invece. Ma quanto di tutto cio’ e’ vero, e quanto invece e’ l’ultima diceria che gira riguardo alla salute? Beh, stiamo per scoprirlo. Spero che lo troviate interessante quanto l’ho trovato io!


 

L’intervista e’ stata fatta originariamente in Italiano, e mi son preso la liberta’ di tradurla in Inglese per Voi :) Sotto ogni domanda/risposta troverete la sua traduzione.

A presto,

Salvo Cognetti
 



Salvatore Cognetti: Oramai, si sente sempre parlare di functional foods, di integratori alimentari per ogni esigenza, di diete basate su presupposti e regole svariate, per non dir balzane a volte. Ma gia’ in passato, sento dire che gli atleti olimpici dell’antica Grecia e i soldati Romani seguivano rigidi codici alimentari, con tanto di una dieta per la marcia e un’altra per la battaglia. In che misura si tratta di innovazione, ed in che misura di una riscoperta trasformata in marketing?


Arrigo Cicero: In realtà dai tempi di Ipocrate si sa che una dieta sana e completa è di per sé sufficiente per mantenere un adeguato stato di salute. Tuttavia quanto vivevano gli atleti olimpici ed i soldati romani? La natura ci ha progettato per vivere “sani” fino a che i nostri figli non siano a loro volta in grado di gestire autonomamente la generazione successiva. Ergo, ad essere ottimisti, la natura ci abbandona dopo i 50 anni: da qui la necessità di combattere il tempo con integratori, alimenti naturali e diete “particolari”. Quindi un razionale esiste, il problema è che il marketing spesso lo cavalca in modo selvaggio e spesso scorretto! 

 

 

Salvatore Cognetti: Nowadays, there’s more and more talk about functional foods, nutritional supplements for any and all needs, of diets based on various assumptions and rules, some of which sound ‘eccentric’ at best. Yet, I hear that Olympic athletes in ancient Greece, as well as ancient Roman soldiers, were following strict dietary rules, such as one diet for marching and one for battling. How much of today’s trend is innovation, and how much of it is a re-discovery that has been transformed into marketing?

 

Arrigo Cicero: In reality, it is known since Hippocrates’ time that a complete and healthy diet is in itself sufficient to maintain adequate health. However, how long did Olympic athletes and Roman soldiers live? Nature has programmed us to live ‘healthy’ until our children are themselves able to deal with the subsequent generation. Ergo, if we’re optimist, nature abandons us after we turn 50. From there onwards, we need to fight time with supplements, natural foods, and ‘special’ diets. So, while the rationale is there, the problem is that marketing strategies tend to jump on the bandwagon in wild and often incorrect ways!

 


SC: La ‘dieta mediterranea’ di cui si sente molto parlare oggi, quanto ha davvero in comune con quella, per esempio, di Creta e della Sicilia di 70 anni fa?

 

AC: La cosa più divertente da ricordare è che la “dieta mediterranea” così come ne parlano la maggior parte degli esperti del settore (compresi italiani e greci!) è stata descritta negli anni ‘50 dall’americanissimo Prof. Angel Keys. In realtà a dieta di Creta (carne di pecora/capra, formaggio, olive intere, pane non lievitato e vino) fondamentalmente non ha quasi nulla a che fare con la dieta siciliana di 70 anni fa ed ancor meno con quella attuale! Anche qua le sperequazioni scientifiche e commerciali si sono sprecate: basti pensare che negli USA esistono integratori di olio d’oliva in perle! 

 

SC: The ‘Mediterranean diet’ we all hear about today: how much does it really have in common with that, for example, of Crete and Sicily 70 years ago?

 

AC: The funniest thing we must remember is that the ‘Mediterranean diet’, as it is talked about today by the most prominent experts (Greeks and Italians included), was described in the ‘50s by the very American Prof. Angel Keys.

In reality, Crete’s diet (sheep/goat meat, cheese, whole olives, unleavened bread and wine), has very little to do with the Sicilian diet of 70 years ago, and even less so with today’s.  Yet, commercial and scientific ‘advancements’ have not been spared: just think that in the USA, there are olive oil supplements in gel caps!

 

SC: Della dieta mediterranea di un tempo, che si basava sui prodotti stagionali e sulla loro raccolta, faceva parte l’attivitá fisica? Quanto della odierna ‘epidemia di obesitá’ pensa che si possa attribuire al cambio della dieta, e quanto alla diminuzione dell’attivitá fisica?


AC: L’attività fisica, più che della dieta, faceva parte della vita di tutti i giorni! Pochi erano quelli che non camminavano sulle proprie gambe! L’epidemia di obesità è indubbiamente legata ad uno squilibrio fra assunzione di cibo e non consumo di calorie. Infatti, se è vero che se non si mangia si cala di peso (anche se si hanno turbe metaboliche gravi o problemi psicologici serissimi!), è anche vero che i maratoneti col loro aspetto ci insegnano che se si consuma si cala di peso! 

 

SC: Was physical activity a part of the mediterranean diet that existed once upon a time, which was based on seasonal products and on their harvest? How much of today’s ‘obesity pandemic’ do you think can be blamed on a change of diet, and how much on a reduction of physical activity?

 

AC: Physical activity was a part of everyday life, more than of diet itself! Few were those who did not walk on their own legs! The obesity pandemic is no doubt linked to an imbalance between food consumption and non-utilisation of calories. Indeed, even though it is true that we lose weight by not eating (even in the presence of severe metabolic diseases or psychological issues), it is also true that the physical appearance of marathon runners teaches us another thing: if we move, we lose weight!

 


SC: Esistono alimenti che possono favorire l’attivitá fisica? (Ad esempio, riducendo il senso di fatica, i tempi di recupero, o migliorando l’umore?) Se si, come andrebbero assunti?

 

AC: In realtà ci sono più alimenti che possono rendere difficile l’attività fisica di quanti non la favoriscano. Comunque si può dire che gli alimenti a basso indice glicemico (gli zuccheri a lento assorbimento), come la pasta di grano duro cotta al dente o un pane tradizionali in crosta possono essere più utili a mantenere la resistenza e ridurre i tempi di recupero rispetto agli alimenti ad alto indice glicemico (tipo dolci, paste, caramelle, etc.). Forse fa eccezione il cioccolato fondente ad alto contenuto di polifenoli che potrebbe avere diversi effetti protettivi per l’organismo, dal miglioramento del tono dell’umore all’azione antiossidante. 


SC: Are there foods that can favour physical activity? (For example, by reducing the feeling of fatigue, recovery times, or improving mood?) If so, how should they be taken?

 

AC: In reality there are more foods that can hamper physical activity than foods that can favour it. Anyhow, it can be said that food with a low glycaemic index (sugars that are absorbed slowly), such as durum wheat pasta cooked ‘al dente’, or traditional crusty bread, can be useful to maintain resistance and reduce recovery times compared to high GI foods (such as sweets and cakes). Perhaps an exception is dark chocolate with a high content of polyphenols, which could have several protective effects for the body, ranging from improvements in mood to antioxidant effects.


SC: Conosco un ragazzo che partecipa in competizioni sportive e, prima di una gara, riduce l’introito diurno di carboidrati nei due giorni di riposo pre-competizione. La sera prima, fa una scorpacciata di pasta, dicendo che questo rifornisce i tessuti di glicogeno e gli da un picco di triptofano (precursore della serotonina) che migliora la qualita’ del sonno e lo rende piú “ottimista” l’indomani… credi che sia solo placebo o c’é qualcosa di vero?


AC: Se ci crede e vince, allora è vero! Scherzo… In realtà le riserve di glicogeno non si ricostituiscono in acuto e la percezione di sonno migliore con la scorpacciata di pasta serale è più l’effetto tipico di “abbiocco” post-prandiale dei grandi consumatori di pasta (al contrario, chi deve restare sveglio di notte dovrebbe fare pasti prevalentemente proteici).  

 

SC: I know a lad who participates in sports competitions. Before one, he reduces his carbs intake in the two days of pre-competition rest. Then, the evening before, he gorges on pasta, saying that this will boost his tissues’ glycogen stores, and gives him a tryptophan peak (precursor of serotonine), that improves the quality of his sleep and makes him more ‘optimist’ the following day. Do you think it’s all placebo, or is there some truth?

 

AC: If he believes in it and wins, then it must be true! Just kidding… In reality, glycogen stores aren’t restored quickly, and the perception of better sleep after such a meal is the typical drowsiness that great pasta eaters experience after a binge (On the contrary, those who need to stay awake at night, should eat predominantly proteins).


SC: In chi invece attivitá fisica non ne fa, in che misura e fino a che punto puo’ la dieta da sola salvaguardare la salute e scongiurare malattie come infarti, ictus, e diabete? Quando, invece, occorre consultare il medico?


AC:In linea di massima, fino a quando l’inattività fisica non si complica con l’aumento di peso e di tutto ciò che ne può conseguire (aumento della pressione, dei trigliceridi, della glicemia, calo del colesterolo HDL - quello “buono” -) la dieta di per sé salvaguarda ampiamente la salute. Alla comparsa però delle complicazioni di cui sopra la consulenza di un medico esperto potrebbe essere utile.   

 

SC: To what extent can diet alone protect health and ward off illnesses such as heart attacks, strokes, and diabetes, in those who do not do any physical activity? When, however, is it time to consult a doctor?

 

AC: Generally speaking, as long as physical inactivity isn’t complicated by an increase in weight and all that it entails (raised blood pressure, high tryglicerides, hypreglycaemia, lowering of HDL (good) cholesterol), diet in itself is enough to preserve health. When the above mentioned complications do occur, however, a consultation with an experienced doctor would be useful.


SC: Facciamo presto a consigliare cibi sani come pesce, frutta e verdura fresche, e quant’altro, ma, almeno qui in UK, la cruda realta’ e’ che molti non se li possono permettere. Quindi, Cosa consiglieresti ad un paziente dismetabolico e povero? Come gli consiglieresti di bilanciare dieta, macro- e micro-nutrienti?


AC: Al paziente dismetabolico e povero direi di mangiare in proporzione ai suoi consumi, dando precedenza alla pasta di grano duro cotta al dente (maggiore è il tempo di cottura riportato sulla scatola e migliore è la pasta!), al pane non condito con la crosta, a qualunque tipo di verdura o legume, latte parzialmente scremato e un po’ di yogurt magro, premiandosi con qualche frutto secco (noci, nocciole, mandorle, pistacchi non salati, ma non arachidi). I soggetti vegetariani elastici (non vegani) sono quelli che hanno la migliore prospettiva di vita, sia per durata che per salute. 

 

SC: It’s easy for us to recommend healthy foods such as fish, fresh fruit and vegetables, and what not. The crude reality, however, is that many can simply not afford them – at least, here in the UK. What would you then recommend to a patient who’s both dysmetabolic and poor? How would you suggest him to balance diet, macro- and micro-nutrients?


AC:I would tell him to eat proportionately to his energy expenditures, with an emphasis on durum wheat pasta cooked ‘al dente’ (the higher the cooking time on the pasta box, the better the pasta!), unseasoned bread with a crust, any type of vegetables, partially skimmed milk and a bit of fat-free yoghurt. He could treat himself with some sundries (walnuts, hazelnuts, almonds, unsalted pistachios, but not peanuts!). Vegetarian individuals (but not vegans!) are those with the best life expectancy, both in terms of length, and of quality.


 

SC: Che domanda farebbe Arrigo ad Arrigo?

AC:Odiandomi abbastanza mi chiederei: “L’alcool a bassa dose, fa veramente tanto bene?”

SC: What question would Arrigo ask Arrigo?

AC: If I hated myself enough, I’d ask: ‘Are low doses of Alcohol really beneficial for health?’

SC: Ottimo! Potresti rispondere?


 

AC: Dati epidemiologici estremamente solidi e credibili ci dicono che il consumo continuativo (= non concentrato nei week-end) di basse dosi di alcolici (= 2 bicchieri di vino da tavola al giorno per un umo e di 1,5 per le donne), non solo di vino (ma anche di birra) sono associati ad una netta riduzione del rischio di sviluppare malattie cardiovascolari e diabete di tipo 2. Da un lato però non so quanto ci si possa fidare del fatto che, suggerendo l’uso di piccole dosi, queste non si trasformino in grandi. Inoltre permane valida la constatazione che l’alcool è neurotossico in modo dose-dipendente, quindi anche piccole dosi intaccano la salute dei nostri neuroni.

SC: Excellent! Could you answer it?

AC: According to some very solid and credible epidemiological data, the sustained consumption (ie, not concentrated during week-ends only) of small doses of alcohol (2 small glasses of wine a day for men, 1.5 for women, or its equivalent units in beer) is associated to a marked reduction of cardiovascular and type 2 diabetes risk. On the other hand, I don’t know whether small doses can be trusted to not become larger and larger over time. Furthermore, alcohol inflicts dose-dependent neurotoxic effects, so even small doses do harm our neurons’ health.
 


SC: Un’ultima domanda: Siamo davvero quello che mangiamo? (Quando leggo le etichette al supermercato, spero di no - Io non mi sento per niente un E308!!)


AC: Non credo che siamo quello che mangiamo, quando che diventiamo quello che ciò mangiamo ci fa diventare. E comunque non abbiamo ancora un’idea chiara di cosa alcuni adittivi potranno determinare dopo 50-60 di assunzione … Chi vivrà vedrà!

 

SC: One last question: are we really what we eat? (When I read labels in a supermarket, I really hope not. I don’t really feel like being an E308!!!)

 

AC: I don’t think we are what we eat, but rather that we become that which what we eat makes us become. And anyway, we still don’t have a clear idea of what some additives can do after 50-60 years of consumption… we’ll just have to live long enough to figure it out!


Arrigo F.G. Cicero (Milano, 03/04/1974), Medico, Specialista in Farmacologia clinica, Diplomato in Terapia e Nutrizione Geriatrica presso l’Università di Parigi, Dottore di Ricerca in Medicina Sperimentale-Aterosclerosi, Responsabile regionale della Società Italiana Nutraceutica, autore di circa 200 articoli scientifici integrali su riviste internazionali su temi per lo più inerenti la prevenzione delle malattie cardiovascolari.

Arrigo F. G. Cicero (Born in Milan, 03/04/1934), Medical doctor, Specialist in Clinical Pharmacology; Diploma in Geriatric therapy and nutrition from the University of Paris, PhD in Experimental Atherosclerosis Medicine; Regional manager of the Italian Nutraceutic Society, author of about 200 scientific articles in international journals, on topics mostly regarding prevention of cardiovascular disease.

About Unicef and Cadbury. - Or - Psst! My soul is for sale too, for the right amount of chocolate!

Dear readers,

Remember how in the double interview, I asked whether we’d take money from a tobacco or junk food company in exchange for permission to use our logo?

It seems that such a happening isn’t too far-fetched. Unicef has just made such an agreement with junk food giant Cadbury, in exchange for 500000 Canadian Dollars. Obviously, this has sparked a controversy: http://www.cmaj.ca/cgi/content/full/182/18/E813

One could argue that, being a charity, Unicef needs to get money from whoever’s willing to give them any. That is, in fact, beyond doubt. But there is a difference between a liberal donation and a business agreement involving permission to use a logo.

To give an example: if the CEO of McDonalds or Philip Morris slipped on the icy pavements and banged his head really hard, and subsequently decided to donate us a million dollars, we’d take them. I’d even write a post on the blog about it saying something along the lines of: we…don’t reeeally like what you do, but thanks for the money - we’ll make it work hard against you!

Yet, two million dollars for our logo? No thanks. (Marco won’t let me, anyway…) It would equate to us saying: we endorse what you do. Does this mean that Unicef endorses child obesity, which is increasingly becoming a problem also in Africa? I hope not.

There may yet be some mitigating circumstances for Unicef, though: their mission is broader than just the health of children, rather focusing on the welfare of children in general. If, with this money, schools, or a well can be built, and the living conditions of a large number of children can be improved, well, it may just be worth the sale of a piece of its soul. In the same logic, there may also be a rational justification as to why the Dutch Red Cross has its logo on the can of coke I’m drinking while typing this — all things considered, it keeps ambulance drivers awake!

However, as it is becoming increasingly clear, investing in development can’t be done without investing in health. As Prof. Julio Frenk, dean of Harvard’s medical school points out in this interview http://www.rahimkanani.com/2010/12/10/an-in-depth-interview-with-dean-julio-frenk-of-harvards-school-of-public-health-on-global-health-international-crises-women-and-girls-and-much-more/, it is a lack of health that is hampering stability and development in the communities that most need it.

Right there, I see a risk. In the western world, we have traded death by infection for death by atherosclerosis, so to speak. But now, are we really sure that we should export the latter to the countries that are still dealing with the former? The cumulative effect scares me. Unfortunately, it didn’t seem to scare Unicef. Is some sort of regulation on advertising and logo-sharing called for? Probably. Let’s ban all unethical or unhealthy businesses from advertising or sponsoring charities? Difficult, but possible. It has been done quite recently for cigarettes, if you remember.

What we, as ESATT and as individual healthcare professionals really should push for, is a change in perception. Junk food now is regarded in pretty much the same way cigarettes were in the 60’s: No doubt harmful to some extent, yet — all things considered — a minor sin. Changing that perception took time and a lot of fighting against the lobbies of big tobacco.

Can the same be done for junk food? I believe so. It will take all of our voices for quite some time, it won’t be easy, but it can be done.

But until then, If I had been unicef, I’d at least have demanded a much higher price for that little piece of my integrity…

Happy new Year!

Salvo Cognetti

'Lifestyle change is the only answer to Cardiovascular Disease'. ESC said it - Let's talk about it with ESATT! (Where's my glass of champagne, by the way?)

Dear Readers,

It is my pleasure to bring to your attention the latest European
Summit of the European Society of Cardiology, which has taken place on
November 30th in Sophia Antipolis, France.

The take-home message was simple, and should definitely please our
readers as much as it has pleased us: ‘lifestyle change is the only
answer to heart disease’. here at ESATT, as you well know, we’re all about the well-being of the physically active. And when it comes to reaching health goals through physical exercise, well, that’s our daily bread!

It is therefore with great delight that we acknowledge and
congratulate this laudable effort from the ESC: the message couldn’t
be any clearer, and the more voices that join in advocating for and
explaining the benefits of lifestyle change and physical activity, the
richer and louder the chorus becomes, the extent to which it’s heard
growing higher with each addition.

An excerpt from their press release, dated January 6th and available
at http://www.escardio.org/about/press/press-releases/pr-10/Pages/European-Summit.aspx?hit=dontmiss
reads: ‘The summit was attended by a broad cross-section of medical
experts, healthcare organisations, national societies, regulators and
representatives from the European Union (EU).  The aim of this
bi-annual event is to encourage concerted action towards a harmonised
strategy for the prevention of cardiovascular disease (CVD) in Europe.
 Much of the debate centred on how the EU and national governments
should respond to overwhelming evidence that shows how lifestyle
factors such as poor diet, lack of exercise, alcohol abuse and smoking
have turned CVD into an epidemic that medical science alone cannot
treat’.

To give a better view of our opinions on the topic of CVD, I took the
liberty of asking a few questions to our Chair of Scientific
Committee, Dr. Marco Manca. You may remember how he managed to disarm
my evil questions during the double interview – but I promise, this
time it won’t be so easy!

But without further ado, let’s see what he had to answer:

Salvatore Cognetti –  The European Summit agrees that lifestyle change
is the only answer to heart disease. Is ESATT involved at all in the
prevention of CVD?
What expertise can we offer in that field?

Marco Manca – ESATT is involved in CVD prevention, of course.
Thousands of athletic trainers and physiotherapists in the EU are
already engaging on a daily basis in cardiovascular rehabilitation
programs and in some pre-conditioning programs, which are done in
preparation of invasive therapeutic interventions. It is easily then
said what our contribution would be:

- Education to training tailoring in secondary prevention, to enhance
the fitness of the patient, to promote his/her return to a healthy
life without stress (and without feelings of being abandoned), and
prevent new events which are peculiarly common in subjects who are
already affected by cardiovascular accidents;

- The design of education programs to grant reciprocity and
consistence of knowledge and practices across the boundaries between
athletic trainers, physiotherapists, nurses, medical doctors and any
other relevant profession. In fact, more and more health systems and
governments advocate for the need to promote physical activity among
the general population (as the European Society of Cardiology has done
today), but to translate this intent from a concept to practice we
need a new education and empowerment of the people standing at the
first line, otherwise everybody has experience with people (often
professionals) generically pushing to move without clear indications;

- The spread of a culture of physical activity, through our blog and
by means of the education that we will offer to our fellow health
professionals, but also through online campaigns, conferences and,
hopefully, public initiatives (such as, for instance, marathons
organized for the world heart day);

- Clarification of misconceptions about exercise and training: what
kind of exercise should or should not be advised? (EG: is strength
conditioning indicated in aged people? What kind of walking accounts
as preventive effective physical activity and in which category of
people? Does leisure time activity protect against cardiovascular
accidents?)
ESATT will seek cooperation with other relevant authorities to reach
this ambitious goal without fragmenting the European landscape.

S. C. – What are we doing on the front of raising awareness among
cardiologists and GPs about our work? What are we planning to do about
that in the future?

M. M. – This question partially overlaps the previous. May I suggest
your readers to take note about our next European meeting to be held
in Lisbon (Portugal) on 3-4 June 2011? I would like to add that we are
negotiating with the Italian Fitness Federation (FIF) to endorse the
journal they have recently founded (Kinesis) as the official journal
of ESATT, which will empower professionals with timely access to
cutting edge research and leading opinion on the subject, tailored for
the EU. We also have a pretty lively blog (credits to the
interviewer), a Twitter account, and we are planning to activate a
LinkedIn network and a Facebook group in the next future to reach the
largest number possible of young colleagues and students, and the
largest audience possible.


S. C. – Journals, Blogs, Scientific meetings, and (Not sure about facebook
groups) have been tried before. Can you really say that they work?
Have they changed something? And what makes you think that our efforts
will do any better than theirs?

M. M. – Your question doesn’t call for just one general, univocal
‘blanket’ answer. I would like to stress here that none of the
previous efforts have really failed; rather they have reached their
goals only partially. In fact, dissemination, and, more generally,
raising public awareness, are extremely complex tasks: the practical
communication plan is a compromise between the “pure idea” shaped by
research and expert opinions and the need to make it usable by people
with different intellectual backgrounds and languages.

In the past strategies were mainly based on the release of “static”
resources (books, webpages, lectures) in which this dynamics were out
of control: you would release a message but its interpretation and,
ultimately, the shape that the information would take in the end were
mainly determined by the audience. Today, thanks to the developments
of the collaborative culture, mainly under the push of internet and
the so called web 2.0, we can design strategies that include
negotiation and co-production of information in the communication
plan. I would also like the reader to notice that any effort should be
evaluated in the light of the forces that were behind it, when
weighting its effectiveness. In fact, culture (also medical culture)
evolves constantly and the strength behind certain messages
(prevention through change of life style is an example) is
proportionally varying: for many years we have thought that aerobic
activity was the only effective training for cardiovascular
prevention, as we have thought that the only way to promote physical
activity would be via campaign, ignoring the impact of other variables
such as the urban architecture and social networks. We are aware that
as our knowledge evolves, our efforts will have to reshape, but we are
confident to be on the right track in the way we think our engagement
with society and our bidirectional communication with public: ESATT is
not an entity, it is a coffee machine (I beg your pardon for the
image, but in any office and lab coffee machine is one of the places
where innovative ideas come up thanks to the informal communication
among peers) offering the opportunity to share and shape information.

S. C. –  Even if the cardiologists and GP’s were to instantly be ‘converted’
and start preaching, proper physical exercise with the aid of a
trainer is still prohibitively expensive for most people. How can you
justify spending 69 pounds a month for a decent gym if you are, like
many, living on 217 (before tax!) a week minimum wage? Not to mention,
the problem’s compounded - Income Inequality has been positively
correlated with obesity, and other studies show that poorer
neighbourhoods are more obese. Can you think of a miracle solution to
disentangle this problem?

M. M. – This is a nice question indeed. I do not blame certain gyms
for having some exclusive, so to say, fees… I am nevertheless aware
that other realities already exist (and can be promoted) where the
economic divide can be more easily bridged: I am thinking of the
enterprise-offered gyms (now more and more common), of the charitable
initiatives during which population is invited to engage in physical
activity under certain reasonable tutoring with the opportunity to ask
questions and suggestions, I am thinking most of all about schools,
where programs including sensible physical education can impact adult
lifestyle, both by educating kids to the joy of activity and by the
second hand “education” that kids will import into their families.
Miracles are not for us to be made, and whilst we can personally
advocate for a fairer economic organization of our societies this, is
not ESATT’s goal for today nor for tomorrow. We can nevertheless
design strategies that can close the gap, and ESATT will support those
choices.

S. C. – What evidence is there, anyway, that physical exercise
actually prevents CVD in a healthy population? How about in people who
are already cardiac patients? Surely you won’t recommend a 77 year old
with cardiac failure to run that marathon on World Heart Day?

M. M. – Nowadays there are more and more evidences supporting the
protective role of physical activity against CVD, in healthy
populations as in patient cohorts. I could suggest the reader to
review the evidences accumulated on childhood prevention as instance
(kindly organized in this website
http://www.familyatheart.org/professionals/scientific_support.asp ).

An exhaustive review of all evidences would be a task far beyond the
scope of this interview (Just to give an idea of the effort we’re
talking about, a search for the keywords “physical activity and
cardiovascular disease” on PubMed gives out almost 17 thousand
abstracts as a result, and then there are all the papers in which
training is associated to risk factors, or specific forms of
cardiovascular disease such as stroke, and so forth… the number can
be much higher). Yet, I can say that much of the indication depends on
the underlying diagnosis (if already cardiac patients or with
familiarity). Facing a patient affected by Marfan syndrome with valve
disease and aortic arch dilatation would suggest a different training
scheme than that which one would prescribe to a diabetes type2 patient
with angina, claudication and past history of NSTEMI. Clinical
evidences are available, which correlate training to better clinical
outcomes of invasive procedures, to better outcomes in prevention of a
second event in people who are already cardiac patients and to a
better response to many drugs, but we have to always relate these
generalized evidences to the specific case to be able to answer each
individual need.

About the 77 year old heart failure patient: what is the clinical
history? What are the likely underlying molecular defects, if any? How
long do we have to train him? I’m not saying he could break the Boston
marathon records, but why would I a priori deny him/her the
possibility to participate in the run with the due preparations if
such is his/her wish?

S. C. – It goes without saying that prevention would be most needed in
the groups with the highest risk factors - eg. obese cheeseburger
addicts who smoke 40 cigarettes in the 12 hours a day they spend in
front of TV. Talking about lifestyle change is a very good thing, they
might even hear it and nod in agreement. But how do you get them
moving? Do we have a strategy to offer?

M. M – I may argue that the profile you are portraying should be
referred to the attention of a medical doctor endowed in preventive
medicine and would gain the most from a concerted therapeutic
approach, life style changes alone being extremely desired (and
urgent) but maybe not enough on their own (it would be to a MD to
judge on a per case basis).

Life style changes alone are critical to that large cluster of our
populations who is living rather reasonable lives, unaware of the risk
connected to what they may consider minor transgressions. Thinking in
terms of society expenses and life years saved, which are not
percentages but raw numbers, being able to tackle CVD among those
unsuspected subjects would have a greater impact than saving those
whom you may already be considering at high risk. The latter is, of
course, a priority for medical and ethical reasons, yet as I have
already suggested they would benefit the most from a medical
intervention, whilst for general population with only ‘venial sins’ on
their record, any medicalization would be considered not really
sensible (both for the psychological burden and for the poor practical
costs/benefits ratio).


Well, he’s bested me again. But not to worry, I will sharpen my
keyboards and round 2 of the Double Interview won’t be as easily
answered! (It’s coming soon onto a blog you may just happen to be
following… stay tuned!)

Your champagne deprived, wannabe evil associate editor

—Salvatore Cognetti

Olympics and Science - Wellcome trust announces awesome project for London’s 2012 Olympics

Dear readers,

It’s so cold here in London that I must type something to keep my fingers warm and moving! 

So it’s quite a fortuitous coincidence that I found something very interesting to bring to your attention: the Wellcome Trust has just announced a massive research experiment in physiology and sports medicine for the 2012 London olympics — Essentially, they will gather a lot of data (reaction time, hand-eye coordination, lung capacity, oxygen consumption, heart rate, lactate threshold, concentration, flexibility, balance etc.) from a pool of school children aged 4 to 19, and from visitors/spectators to the olympics. 

They aim to include 500,000 individuals (!) in each pool, so this will be a massive collection of data - I wonder whether it’s the largest ever made. 

But it doesn’t stop there: In their own words, “Do you have a research question relating to sport, movement or exercise that could benefit from data gathered across the UK population? If so, please get in touch with us to find out if we could work together to gather these data.”

I’m sure that some of our readers do :) As for ESATT - I shall certainly attempt to interview them - so try to keep yourself warm in the meantime (some running on a treadmill would surely help!), do visit their page at http://wellcometrust.wordpress.com/2010/11/26/physiology-research-questions-for-a-mass-participation-experiment/, and stay tuned on these pages!

— The bringer of happy news

Salvatore Cognetti