Sport, Exercise and Physical Activity Medicine
Exercise is the medicine
Know the public health dose: 150–300 minutes per week of moderate aerobic activity, or 75–150 minutes of vigorous activity, plus muscle-strengthening work twice weekly, and reduced sedentary time. The same message applies across most chronic disease and in pregnancy, with individual adjustment. Exercise capacity behaves like a vital sign; measure it where feasible.
Athlete-specific concepts
- Pre-participation screening: history and examination have the highest yield; ECG reduces sudden cardiac death in athletes only within a systematic programme, at the cost of false positives.
- Load management: sudden spikes in load relative to recent baseline are associated with injury; the acute:chronic workload ratio is a useful heuristic, not a law.
- Concussion: SCAT6 assessment, no same-day return to play, graduated return with at least 24 hours symptom-free at each step.
- Relative energy deficiency in sport: low energy availability impairs bone, menstrual and immune function; screen for it after stress fracture or unexplained underperformance.
- Doping: check WADA status; therapeutic use exemptions must be obtained in advance for prohibited substances.
Traps
Clearing an athlete on fitness alone without sport-specific criteria; returning a concussed player once symptoms settle at rest; missing cardiac warning signs (exertional syncope, family history of sudden death); and assuming rest treats overuse injury.
Worked example
Return to sport after hamstring strain requires pain-free full range, at least 90% strength symmetry, a completed near-maximal sprint progression and sport-specific drills before reintegration. Time since injury alone does not clear the athlete.