Health & Fitness .................................................. 16

Do what you love to do. If you love biking and can’t stand running, why run? Bike instead! Doing what you enjoy will keep you coming back for more.

Set short term, as well as long term goals. A long-term goal to lose 50 lbs. this year can get pretty discouraging because it takes quite a bit of time to get there. Break that goal down to losing 10 lbs. every 5 weeks. Or even 2lbs every week. That way you can see that you really are making progress and you will feel good every time you achieve one of those smaller goals.

Understand that everyone has setbacks. We all mess up and have setbacks in our exercise routines. Instead of getting down on yourself and quitting your program all together, move on. None of us are perfect. Find someone to cheer you on or even better, to do it with you. Having a good support system when you are trying to stick with an exercise routine is a great way to keep yourself on track. Also, if you have a friend who has similar goals, workout with them! You can keep each other going.

Celebrate your successes and set goals that are specific, measurable, attainable, realistic, timely and B-Active For Life!

ANCIENT OLYMPIC MARTIAL ART: PANKRATION

Periodic Health Examination (PHE) or screening in Sport is important at all levels and all ages. Coaches and trainers need to be aware of any risks to their players and athletes, to both prevent injury as well as to ensure they know how to manage any exacerbation of a pre-existing condition should it arise. Additionally, a number of pre-existing conditions can impair fitness and performance; these can usually be treated if they are identified early.

The timing of PHE varies depending up the level of sport being played. Clearly professionals receive constant clinical input and scrutiny, something which is both unrealistic and unnecessary for amateurs. If a single point in the season is to be identified as the most valuable for a PHE,

this would be the pre-season. At this time the athletes’ preparedness for the season ahead can be assessed, medical conditions and fitness issues can be addressed and the individual training schedule adjusted accordingly. Athletes commonly carry over niggling injuries from previous seasons or off-season activity. These need to be identified and managed to prevent them developing into a serious problem.

There are several core elements to the PHE that are relatively standard in elite sports, but are also accessible to athletes at all levels and all ages. These include the medical and injury history, particularly focusing on previous injury and comorbid conditions that may impact fitness and functional capacity; investigations and biochemical parameters, mainly in the form of bloods tests; functional and performance testing to evaluate global and focused preparedness for sport-specific activity. Consensus among medical officers on risk factors for injury rank previous injury as the most important, followed by physical fitness; accumulated fatigue, reduced recovery time between matches and training load.

The first and probably most important element of the PHE is a medical and injury history and relevant examination by a physician. Various sporting bodies provide a useful proforma for this, each geared towards their particular sport; for example the FIFA medical assessment. It is vital for both athlete safety and performance to identify pre-existing conditions that may impact their ability to train and compete. Common conditions such as asthma, diabetes and anaemia need to be identified and optimally managed. Not only do such conditions need to be well-controlled in the medium and longterm, but plans for immediate management of acute exacerbations need to be well-established and the coach and/or trainer need to be able to implement such reactive management plans competently and without delay. Exercise is a common trigger for asthma, for example, and acute exacerbations can be life threatening. Responsible team authorities need to ensure they are aware of the condition, are familiar with the symptoms, and have the ability and confidence to manage such conditions safely until urgent medical intervention arrives.

The other half of the medical history is the identification of previous unresolved injuries, or symptoms that may suggest an as-yetundiagnosed injury. In their enthusiasm to partake and pass selection, sports people often play down injuries or niggling pains. If these are not identified and addressed they are likely to be aggravated and result in longer down-time. Graduated challenge of functional capabilities can bring out telltale symptoms when inactivity have allowed them to go unnoticed.

An extension of the medical assessment are the basic health investigations, such as blood tests and the electrocardiograph. For adults, blood tests are important as a number of conditions that impact performance in sport are common. Anaemia, for example, has several forms, some acquired and some inherited, but all will impair oxygen delivery and therefore overall cardiovascular fitness. An anaemic athlete may well be in good cardiovascular health, but if the anaemia is addressed their fitness will be improved. Similarly, mildly impaired kidney function is not uncommon, but in an

athlete – particularly an endurance athlete – it can be dangerous. Non-steroidal anti-inflammatory medications are commonly used by athletes, and the combination of these and mild renal impairment can lead to significant kidney damage or even failure. And electrolyte disturbance, whether due to impaired renal function or dehydration, can predispose to cardiac arrhythmias and collapse. In our recent screening for a national Bermudian sports team comprising of elite athletes, a number of abnormalities that may affect performance and safety were identified. A periodical screen can identify these and allow them to be addressed or mitigated.

Electrocardiographs (ECGs) demonstrating cardiac function are both necessary but also potentially problematic. Although it is important to identify any gross abnormalities in the heart such as irregular rhythms or abnormal enlargement, the ECGs of elite athletes are as often as 60% of the time abnormal. In the heart of an elite athlete of West African origin, for example, elevated ST waves and early repolarization are common – but by the regular parameters with which ECGs are interpreted, this abnormality might signify an acute myocardial infarction. Similarly, inverted T waves are fairly common in the same group of athletes, however in other populations, they may denote an old myocardial infarct. So although the ECG is important in the health screening of athletes and sports people, familiarity with benign abnormalities is important, and also the ability to follow up genuine abnormalities with a Cardiologist who can reinterpret the ECG and perform an Echocardiogram – a dynamic ultrasound investigation of the heart – to give better identification of any genuine cardiac risks.

The final element of the PHE is the fitness and functional assessment performed by a physiotherapist or other adequately trained musculoskeletal specialist. If done pre-season this will establish the baseline fitness and sport-specific functional condition of an athlete which will then inform the tailored conditioning program for the given individual. If done pre-performance, prior to a tournament for example, it may establish relative preparedness for the demands of the matches ahead. VO2 max remains the gold standard for testing cardiovascular fitness, sometimes augmented by blood lactate testing, but many sports teams do not have access to this. Instead, more functional fitness tests utilizing maximum heart rate, speed, targeted strength and endurance parameters, time to heart rate recovery etc., can be used and most coaches and trainers are very familiar with this form of testing. Where an injury or sub-standard fitness parameter is identified, a sports physiotherapist should be called in for more detailed biomechanical assessment.