MEDICAL MATTERS

Why do we do that?

FIA Chief Medical Officer John Searle looks at keeping up with the times

When I was a medical student 50 years ago, we were often told by distinguished doctors they did operations or prescribed certain drugs because, ‘in my experience it works’. No doctor would get away with this now because medicine has to be ‘evidence-based’. There has not only to be sound reasoning behind how patients are treated but also good scientific evidence. Increasingly such an evidence-based approach is expected of us in the fitness sector too.

What does that mean? Well there are different levels of evidence. Something might obviously work for a particular client. In that case we need to try and measure or assess it objectively. It is all too easy to think something is working just because we believe it is working. A better line of evidence are controlled studies where two groups of people are compared. One has a particular intervention and the other does not. The same measurements are done under the same conditions in each group and the results compared. Sometimes when the same study is done by different researchers they get conflicting results. So the best levels of evidence are where many studies are grouped together and subjected to rigorous statistical analysis. The evidence obtained in this way makes it much more certain that a particular intervention does or does not work.

Like many PTs I always taught clients to do static stretches after the warm up and before higher intensity training started. Now I know it’s not only a waste of time, it actually reduces performance and does not reduce the incidence of injury during exercise. The key thing is to warm up adequately. So I now teach people to stretch at the end of a session, not to decrease DOMS (because it does not) but to maintain an optimum range of joint movement.

One supplement I regularly advised for older people particularly (and indeed took myself), is glucosamine. Given that glucosamine plays an important role in maintaining joint cartilage health it made good sense to use it. But as more studies have been analysed there is less evidence that glucosamine supplements make any measurable difference to the condition of our joints. So I have stopped using it myself and stopped advising clients and patients to take it too!

Our responsibility for our clients is always to advise what is best for them according to the results they want from training. And that means our advice and training programmes should be evidence- based and we should keep questioning why we do things.

26 The rePs Journal 2011;21(June):26