Preface

Helping clinicians to help patients has been the clear focus of Clinical Sports Medicine from its inception. In this volume we bring you more authors, more practical tips and more evidence of the work we do as sport and exercise medicine clinicians. If you are a loyal member of the Clinical Sports Medicine community you will already know that we completed Volume 1: Injuries and then dedicated a fresh year of our lives to Volume 2: The Medicine of Exercise. It was a boon for us to be able to concentrate on Volume 2 because historically (pre-2000) the focus of sports medicine had been injuries, and the first four editions of Clinical Sports Medicine really reflected that bias.

As governments began to wrestle with the crippling cost of non-communicable diseases (NCDs) they found there was no magic medication or operation to turn to. Suddenly, sport and exercise clinicians—those erstwhile medical ‘extras’, who had been fighting for specialty status in the 1980s—moved to centre stage, working with the World Health Organization, national and state or provincial governments, and health insurers. Research funding agencies supported various studies of exercise for heart disease, diabetes, cancer and cognitive function. National sports medicine bodies, such as those in Britain, Canada and Australia (BASM, CASM, ACSP), all added an ‘E’ for Exercise in their titles (BASEM, CASEM, ACSEP). It is telling that the shorter versions now seem very dated. Sports Medicine without ‘Exercise’? Weird!

Clinical Sports Medicine clearly needed a dedicated Medicine of Exercise volume to capture a decade of advances. So what’s new in this Volume 2 of the fifth edition?

• Our most comprehensive overview of exercise and physical activity medicine.

• 19 totally new topics. (See new content below.)

• A practical focus and more detail. The focus is one the practical elements of exercise prescription, with more tips, more practical tables and more illustrations.

• Illustrated real-life patient stories. We share lessons from the world’s best athletes—their voices, their challenges and their clinicians’ actions and tips.

• More than 3000 references—the solid foundation. Our chapter authors’ clinical perspective is key, but what they share is founded on increasingly solid science.

Volume 2: The Medicine of Exercise reflects the generosity of the 53 chapter authors and contributors from seven countries. Exercise medicine is arguably more diverse than injury medicine and we are grateful for their expert and enthusiastic contributions throughout chapters 1 to 40.

We feel this is the first true contribution to the field of sport and exercise medicine. The following new authors have shared their clinical experience, anchored in new evidence and gained over many years:

Part A—Exercise for health does precisely what it says on the tin! World Health Organization technical advisor and remarkable medical student (at time of publication) Daniel Friedman takes the helm, steering the reader on a journey from the problem of physical inactivity—and why clinicians need to address non-communicable diseases (Chapter 1), to the clear physiological benefits of activity at the cellular level (Chapter 2), through the how of assessing the patient (Chapter 3) and on to prescribing activity for him or her (Chapter 4). Keeping with our clinical focus, the part closes with tips for the clinician to complement training on motivational interviewing (Chapter 5). The final chapter (Chapter 6, Nutrition for health) reflects the fact that nutrition is now recognised as a vital key to health (in particular with respect to NCDs). Nutrition papers are now published in The Lancet, The BMJ and JAMA—and that was not the case when we launched the first edition of Clinical Sports Medicine.

Part B—Managing medical problems. Six completely new chapters and ten that have been totally revised from the fourth edition are included. There are new chapters on management of obesity (Chapter 7), osteoarthritis (Chapter 16), osteoporosis (Chapter 17), cancer (Chapter 20), depression (Chapter 21) and anxiety (Chapter 22). The other chapters in this part describe and illustrate how to manage critical conditions found in ten other medical specialty areas: diabetes, sports cardiology (two chapters), sports respirology, gastrointestinal, renal and urinary, neurological, rheumatological, infection, and the tired athlete.

Part C—Environment. World leaders, including Professors Mike Tipton and Michael Koehle as well as Drs Sébastien Racinais and Olaf Schumacher, share decades of experience in this domain. Heat (Chapter 23), Cold (Chapter 24), Altitude (Chapter 25) and Underwater (Chapter 26) are substantial upgrades on their fourth edition counterparts. Physical activity and the built environment (Chapter 27) is a completely new chapter; the built environment is one of the World Health Organization’s Seven Investments for Better Health.

Part D—Specific groups. These five chapters focus on the very young (Chapter 28, Associate Professor Carolyn Broderick), girls and women (Chapter 29), older people (Chapter 31) and The person with disability (Chapter 32). Completely new too is the complex issue of transgender and intersex. What endocrine pathways underpin the biology? When is it fair for a transgender athlete to compete? Does hyperandrogenism confer an unfair advantage? Dr Liesel Geertsema provides a very balanced view, as there are no easy answers (Chapter 30).

Part E: Performance and ethics. Four new chapters among five potentially contentious ones: nutrition for performance (new, Chapter 33), drugs in sport (Chapter 34), genetics in sport including genetic testing (new, Chapter 35), legal issues (new, Chapter 36), and harassment and abuse (new, Chapter 37) by Canadian professor and IOC Medical Commission member Dr Margo Mountjoy.

Part F—Practical sports medicine. The new chapter here is on multisport endurance events (Chapter 40), by veteran and international leader Professor Paul Auerbach. Emergency medicine for the sideline clinician is covered in detail and helpfully illustrated (Chapter 38). Professor Timothy Noakes provides the latest from his four-decade experience of endurance event medicine (Chapter 39).

We are delighted with how Volume 2: The Medicine of Exercise has turned out and for that we thank the champion team of multidisciplinary authors who so generously committed to sharing their expertise. They have provided an invaluable resource for our community.