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SUMMARY: In 1995 the American College of Sports Medicine and the Centers for Disease Control and Prevention published national guidelines on Physical Activity and Public Health. The Committee on Exercise and Cardiac Rehabilitation of the American Heart Association endorsed and supported these recommendations. The purpose of the present report is to update and clarify the 1995 recommendations on the types and amounts of physical activity needed by healthy adults to improve and maintain health. Development of this document was by an expert panel of scientists, including physicians, epidemiologists, exercise scientists, and public health specialists. This panel reviewed advances in pertinent physiologic, epidemiologic, and clinical scientific data, including primary research articles and reviews published since the original recommendation was issued in 1995. Issues considered by the panel included new scientific evidence relating physical activity to health, physical activity recommendations by various organizations in the interim, and communications issues. Key points related to updating the physical activity recommendation were outlined and writing groups were formed. A draft manuscript was prepared and circulated for review to the expert panel as well as to outside experts. Comments were integrated into the final recommendation. PRIMARY RECOMMENDATION: To promote and maintain health, all healthy adults aged 18 to 65 yr need moderate-intensity aerobic (endurance) physical activity for a minimum of 30 min on five days each week or vigorous-intensity aerobic physical activity for a minimum of 20 min on three days each week. [I (A)] Combinations of moderate- and vigorous-intensity activity can be performed to meet this recommendation. [IIa (B)] For example, a person can meet the recommendation by walking briskly for 30 min twice during the week and then jogging for 20 min on two other days. Moderate-intensity aerobic activity, which is generally equivalent to a brisk walk and noticeably accelerates the heart rate, can be accumulated toward the 30-min minimum by performing bouts each lasting 10 or more minutes. [I (B)] Vigorous-intensity activity is exemplified by jogging, and causes rapid breathing and a substantial increase in heart rate. In addition, every adult should perform activities that maintain or increase muscular strength and endurance a minimum of two days each week. [IIa (A)] Because of the dose-response relation between physical activity and health, persons who wish to further improve their personal fitness, reduce their risk for chronic diseases and disabilities or prevent unhealthy weight gain may benefit by exceeding the minimum recommended amounts of physical activity. [I (A)]

OBJECTIVE: To define the causes of injuries to players in English professional football during competition and training. METHOD: Lost time injuries to professional and youth players were prospectively recorded by physiotherapists at four English League clubs over the period 1994 to 1997. Data recorded included information related to the injury, date and place of occurrence, type of activity, and extrinsic Playing factors. RESULTS: In all, 67% of all injuries occurred during competition. The overall injury frequency rate (IFR) was 8.5 injuries/1000 hours, with the IFR during competitions (27.7) being significantly (p < 0.01) higher than that during training (3.5). The IFRs for youth players were found to increase over the second half of the season, whereas they decreased for professional players. There were no significant differences in IFRs for professional and youth players during training. There were significantly (p < 0.01) injuries in competition in the 15 minute periods at the end of each half. Strains (41%), sprains (20%), and contusions (20%) represented the major types of injury. The thigh (23%), the ankle (17%), knee (14%), and lower leg (13%) represented the major locations of injury, with significantly (p < 0.01) more injuries to the dominant body side. Reinjury counted for 22% of all injuries. Only 12% of all injuries were caused by a breach of the rules of football, although player to player contact was involved in 41% of all injuries. CONCLUSIONS: The overall level of injury to professional footballers has been showed to be around 1000 times higher times higher than for industrial occupations generally regarded as high risk. The high level of muscle strains, in particular, indicates possible weakness in fitness training programmes and use of warming up and cooling down procedures by clubs and the need for benchmarking players' levels of fitness and performance. Increasing levels of injury to youth players as a season progresses emphasizes the importance of controlling the exposure of young players to high levels of competition.

The purpose of this paper is to develop a working definition of positive deviance and use the definition in an analysis of behavior among athletes. It is argued that much deviance among athletes involves excessive overconformity to the norms and values embodied in sport itself. When athletes use the “sport ethic”—which emphasizes sacrifice for The Game, seeking distinction, taking risks, and challenging limits—as an exclusive guide for their behavior, sport and sport participation become especially vulnerable to corruption. Although the sport ethic emphasizes positive norms, the ethic itself becomes the vehicle for transforming behaviors that conform to these positive norms into deviant behaviors that are prohibited and negatively sanctioned within society and within sport organizations themselves. Living in conformity to the sport ethic is likely to set one apart as a “real athlete,” but it creates a clear-cut vulnerability to several kinds of deviant behavior. This presents unique problems of social control within sport. The use of performance enhancing drugs in sport is identified as a case in point, and an approach to controlling this form of positive deviance is discussed.

It is widely agreed that overtraining should be employed in order to achieve peak performance but it is also recognised that overtraining can actually produce decrements in performance. The challenge appears to be one of monitoring stress indicators in the athlete in order to titrate the training stimulus and prevent the onset of staleness. The present paper summarises a ten-year research effort in which the mood states of competitive swimmers have been monitored at intervals ranging from 2-4 weeks during individual seasons for the period 1975-1986. The training cycle has always involved the indoor season which extends from September to March and the athletes who served as subjects were 200 female and 200 male competitive swimmers. The results indicate that mood state disturbances increased in a dose-response manner as the training stimulus increased and that these mood disturbances fell to baseline levels with reduction of the training load. Whilst these results have been obtained in a realistic setting devoid of experimental manipulation, it is apparent that monitoring of mood state provides a potential method of preventing staleness.

OBJECTIVES: To determine the rate of ankle injury and examine risk factors of ankle injuries in mainly recreational basketball players. METHODS: Injury observers sat courtside to determine the occurrence of ankle injuries in basketball. Ankle injured players and a group of non-injured basketball players completed a questionnaire. RESULTS: A total of 10 393 basketball participations were observed and 40 ankle injuries documented. A group of non-injured players formed the control group (n = 360). The rate of ankle injury was 3.85 per 1000 participations, with almost half (45.9%) missing one week or more of competition and the most common mechanism being landing (45%). Over half (56.8%) of the ankle injured basketball players did not seek professional treatment. Three risk factors for ankle injury were identified: (1) players with a history of ankle injury were almost five times more likely to sustain an ankle injury (odds ratio (OR) 4.94, 95% confidence interval (CI) 1.95 to 12.48); (2) players wearing shoes with air cells in the heel were 4.3 times more likely to injure an ankle than those wearing shoes without air cells (OR 4.34, 95% CI 1.51 to 12.40); (3) players who did not stretch before the game were 2.6 times more likely to injure an ankle than players who did (OR 2.62, 95% CI 1.01 to 6.34). There was also a trend toward ankle tape decreasing the risk of ankle injury in players with a history of ankle injury (p = 0.06). CONCLUSIONS: Ankle injuries occurred at a rate of 3.85 per 1000 participations. The three identified risk factors, and landing, should all be considered when preventive strategies for ankle injuries in basketball are being formulated.

The primary purpose of this narrative review was to evaluate the current literature and to provide further insight into the role physical inactivity plays in the development of chronic disease and premature death. We confirm that there is irrefutable evidence of the effectiveness of regular physical activity in the primary and secondary prevention of several chronic diseases (e.g., cardiovascular disease, diabetes, cancer, hypertension, obesity, depression and osteoporosis) and premature death. We also reveal that the current Health Canada physical activity guidelines are sufficient to elicit health benefits, especially in previously sedentary people. There appears to be a linear relation between physical activity and health status, such that a further increase in physical activity and fitness will lead to additional improvements in health status.

The relation between physical exercise and psychological health has increasingly come under the spotlight over recent years. While the message emanating from physiological research has extolled the general advantages of exercise in terms of physical health, the equivalent psychological literature has revealed a more complex relation. The paper outlines the research evidence, focusing on the relation between physical exercise and depression, anxiety, stress responsivity, mood state, self esteem, premenstrual syndrome, and body image. Consideration is also given to the phenomena of exercise addiction and withdrawal, and implications for exercise prescription are discussed.

(1984). The Validity of the Astrand and Sjostrand Submaximal Tests. The Physician and Sportsmedicine: Vol. 12, No. 8, pp. 47-54.

"Sports Bras and Briefs." The Physician and Sportsmedicine, 24(12), pp. 99–100 Additional informationNotes on contributorsBryant StamfordDr Stamford is director of the Health Promotion and Wellness Center and professor of exercise physiology in the School of Education at the University of Louisville, Kentucky. He is also an editorial board member of THE PHYSICIAN AND SPORTSMEDICINE.

In brief: In the October issue of THE PHYSICIAN AND SPORTSMEDICINE (page 156), Dr Renneker discussed the surfing life-style and its allure. In this article he concludes with a discussion of the medical aspects of surfing. Ear and eye injuries are common among surfers, as are sprains and strains of the lower back and neck. Not surprisingly, the sun takes its toll on surfers, as it does on many other outdoor sports enthusiasts, and skin cancer can develop. Dr Renneker presents treatment modes for these common problems. He also suggests ways in which surfers can help prevent them, such as using protective eyewear, sunscreen, and a wet-suit hood or special earplugs.

Click to increase image sizeClick to decrease image size Additional informationNotes on contributorsMike MooreMike Moore is an assistant editor of THE PHYSICIAN AND SPORTSMEDICINE.

"Ankle Rehabilitation with Cryotherapy." The Physician and Sportsmedicine, 7(11), p. 133 Additional informationNotes on contributorsKenneth L. KnightDr. Knight is an associate professor in the School of Health, Physical Education, and Recreation and an athletic trainer at Indiana State University in Terre Haute.

A Forum For Our Readers Sportsmedicine Forum is intended to provide a sounding board for our readers. Perhaps you have a special way to treat a common medical problem, or you may want to air your views on a controversial topic. You may object to an article that we have published, or you may want to support one. You may have a new trend to report, identified through an interesting case or a series of patients. Whatever your ideas, we invite you to send them to us. Illustrative figures are welcomed. Address correspondence to Sportsmedicine Forum, THE PHYSICIAN AND SPORTSMEDICINE, 4530 W 77th St, Minneapolis, MN 55435.

"Mall Walking." The Physician and Sportsmedicine, 22(12), pp. 101–102 Additional informationNotes on contributorsBryant StamfordDr Stamford is director of the Health Promotion and Wellness Center and professor of allied health in the School of Medicine at the University of Louisville, Kentucky. He is also an editorial board member of THE PHYSICIAN AND SPORTSMEDICINE.

"Heart Attack Counterattack." The Physician and Sportsmedicine, 24(12), pp. 97–98 Additional informationNotes on contributorsBarry A. FranklinDr Franklin is the director of the Cardiac Rehabilitation Program and Exercise Laboratories at William Beaumont Hospital in Royal Oak, Michigan. He is also a professor of physiology at Wayne State University School of Medicine in Detroit and an editorial board member of THE PHYSICIAN AND SPORTSMEDICINE.

(1975). Hockey Injuries: How, Why, Where, and When? The Physician and Sportsmedicine: Vol. 3, No. 1, pp. 61-65.