VOLUME 22 – ISSUE 4 • S U M M E R 2 0 0 5

Incorporating The Bulletin

Opinions expressed throughout this journal are the Contents contributor’s own and do not necessarily reflect the views or policy of Sports Medicine Australia (SMA). Members and readers are advised that SMA cannot be held responsible for the accuracy of statements made in advertisements nor the quality of the goods or services advertised. All materials copyright. FROM THE CEO ______2 On-acceptance of an article for publication, copyright passes to the publisher. Wrestling the heat demon Publisher Sports Medicine Australia PO Box 237 Dickson ACT 2602 Tel: (02) 6230 4650 DR J ______4 Fax: (02) 6230 5908 Email: [email protected] A safe and level playing field should be the goal of drugs in sport policy Web: www.sma.org.au Circulation: 5000 ISSN No. 1032-5662 Editors DRUGS AND SPORT ______8 John Orchard Kerry Mummery Government discussion paper: investigating doping in sport Managing Editor Options for “independent and transparent” way to investigate doping Dominic Nagle Chief Executive Officer allegations Gary Moorhead Alcohol and sport: same again? Subscription Manager Joyce McClune Maurie O’Connor Design/Typesetting Levitate Graphic Design, Canberra. SMA STATE BRANCHES UNCOVERING THE SECRET OF THE DON: BRADMAN RE-ASSESSED ______16 ACT ACT Sports House Paul Glazier, Keith Davids, Ian Renshaw, Chris Button 100 Maitland St Hackett ACT 2602 Tel: (02) 6247 5115 New South Wales PO Box 724, Glebe NSW 2037 SPORTS INJURY, SPORTS SAFETY 1997 TO 2002 ______22 Tel: (02) 9660 4333 Northern Territory “Sport safety in Australia: an update – July 2003” PO Box 2331, Darwin NT 0801 Tel: (08) 8981 5362 New Department of Health and Ageing report Queensland Sports House, 150 Caxton St, Milton QLD 4064 Tel: (07) 3367 2700 South Australia VIETNAM VETERANS: THE “HEARTMOVES” EXERCISE PROGRAM ______25 PO Box 219, Brooklyn Park SA 5025 Tel: (08) 8234 6369 Mike Climstein, Janet Currie, Leanne Otter, Mark Debeliso, Kent J Adams Victoria and Tasmania 1st Floor, 120 Jolimont Rd Jolimont VIC 3002 Tel: (03) 9654 7733 THE BULLETIN ______29 Western Australia PO Box 57, Claremont WA 6010 Cover photograph: Australian Sports Commission Tel: (08) 9285 8033 SUBSCRIPTION RATES 2003 Australia A$35 Overseas A$50 SMA members receive Sport Health as part of their membership fee Single copies and back copies A$15 (includes-postage) PP No. 226480/00028 For subscriptions contact Joyce McClune Phone: (02) 6230 4650 Email: [email protected] F R O M T H E CEO Wrestling the Heat Demon

By Gary Moorhead

Over the last couple of months, the • Sport is infinitely variable – both responses for the whole state of Australian media have been full between sports and within different Queensland, failed to turn up any of horror stories involving adverse levels of competition of the same cases of heat illness relating to outcomes from playing sport and sport. children2. exercising in hot weather. Recent • Weather conditions are one of the • Medical coverage data and headlines have included: great variables of life – especially information from the Medical • “Six runners hospitalized and 60 if you live in Melbourne. “Weather Director of the Alice Springs others treated for dehydration forecast” is probably the world’s Masters Games showed no during the Melbourne Marathon.” greatest lie; “unseasonable incidences of heat illness • “Soldier Dies from Heat During weather” is the one thing you can experienced by athletes at the other 3 Exercises” rely on. end of the age spectrum . • “Man Who Melted: we pulled him • Australia is a continent that has • Scientific studies, and research out of the grave”. weather conditions ranging from carried out by the Australian tropical to cool temperate – and Bureau of Meteorology (BOM), But at the same time as these sometimes this can be on the same began to cast doubt on the “horrors” are occurring, Sports day in the same place! reliability and validity of the Medicine Australia is changing its WBGT readings. In fact, the BOM In 2001, SMA issued revised “Guidelines for Preventing Heat WBGT is derived not from a single Illness in Sport” to remove mandatory Guidelines for Preventing Heat measuring device (a wet bulb cancellation recommendations. Illness in Sport, which were based globe thermometre) but from an Does this make sense? From SMA’s on new Guidelines issued by the algorithm that takes into account perspective it makes complete sense. American College of Sports Medicine a range of atmospheric variables. (ACSM). For the first time, SMA also With the Heat Guidelines, SMA is Industries where heat is an issue published a specific cancellation/ being asked to reduce a very complex use a measure called the Thermal postponement policy: 28 degrees Wet issue to a series of simple solutions to Work Limit (TWL) and this may Bulb Globe Temperature (WBGT) fit the needs of a very diverse range give a more accurate reading if for adults and 34 degrees ambient of interests: adapted for sport4. temperature for children. The year • Sporting organisations want clear 2001 was at the height of medical Fundamentally, the major problem direction on when it is safe – and indemnity controversy in Australia with any guideline is the impossibility when it is not – to play sport in hot and the new Guidelines took an ultra of creating a “one size fits all” weather. safety-first stance. The cancellation recommendation. recommendations were based on • Parents want to know that their The greatest fear with heat illness is worst case scenarios – responses by children will not be in any danger the condition known as “heat stroke”. athletes in endurance running. when they play sport. Heat stroke is a killer. The mortality • Public health promoters (and Over the next three years, these rate is 20% to 75% if cooling is not sporting organisations) want to Guidelines – and the cancellation effective and survivors usually have minimise any disruption to people recommendation – began to seem an some permanent damage. over-reaction to the problem: engaging in sport and physical While heat stroke occurs most activity. • Detailed evidence was produced to commonly in conditions of high • Politicians want to be seen to be show that a literal interpretation of ambient temperature and high acting to solve problems and deal the Guidelines would see no sport humidity (the conditions we try to with issues. played in the northern half of the measure with WBGT), heat stroke can country for a large part of the year1. occur in the absence of both5. Further, At the same time, we have to factor in British army medical staff attending a mass of variables: • A detailed study over 10 years the 2004 Australian Conference of presentations to Cairns Base • People are different – physically, of Science and Medicine in Sport Hospital, of recalled events of physiologically, psychologically, reported incidences of heat illness in Cairns doctors and of ambulance genetically. cool weather where the precipitating

2 Sport Health F R O M T H E CEO

factor was apparently exertion and/or indicator. (This will be developed the natural inclination is to stop what gear and clothing related rather than in conjunction with BOM to we are doing. In many cases, ceasing hot weather and hydration6. give readings in a wide range of activity is the first and best step to locations around Australia and preventing heat illness occurring. The task of those charged with displayed on SMA websites) the care of the health of athletes is made even harder by problems with 3. Promoting effective 1. Dr Mark Young, sports physician, Brisbane Orthopaedic and Sports Medicine Centre. diagnosing the seriousness of heat countermeasures. These will Temperature data supplied by mail to SMA 1 illness and whether or not it is likely include options such as shorter October 2002. 2. Brun S. The incidence of heat related illness in the to develop into heat stroke. Initial playing periods, longer breaks, child athlete in Cairns, Far North Queensland, symptoms of both are similar. moving activity from the hottest and the associated environment variables. Journal of Science and Medicine in Sport parts of the day, being sensitive to 2004;7:4Supplement);110. The most reliable predictor is needs of players to self-regulate, 3. Dr Geoff Thompson, sports physician, Territory core temperature7. Following the provision of shaded rest areas and Sports Medicine. Symposium transcript: “Preventing Heat Symposium at the Australian injury from exercise in hot weather”. Australian fans for cooling. Conference of Science and Medicine in Sport, Alice Conference of Science and Medicine Springs, 6-9 October 2004. in Sport in Alice Springs in October 4. Reminding people that heat illness 4. Brake D. The application of a rational heat stress index (Thermal Work Limit) to sports medicine. 2004, the President of the AFL Medical is not always about dehydration. Journal of Science and Medicine in Sport 2004;7:4(S Officers recommended to the AFL that Adequate fluids are essential, but upplement);102. 5. Barker TA, Motz HA, Gersoff WK. Environmental rectal thermometers be added to the heat illness can occur despite factors in Athletic Performance” in Sports Injuries: “Emergency Management Bag” at AFL adequate hydration. Mechanisms, Prevention, Treatment (p67). Philadelphia. Lippincott Williams & Wilkins. 2001. games and training8. 5. Distinguishing elite sport as a 6. Edwards S and Nicol A. Symposium transcript: “Preventing injury from exercise in hot weather”. While the incidence of heat injury is separate category. Most heat Australian Conference of Science and Medicine in probably much lower than has been illness seems to occur when Sport, Alice Springs, 6-9 October 2004. accepted anecdotally, especially in athletes “push themselves” beyond 7. Barker et al (p68). 8. Seward H. “Heat symposium. SMA Conference the northern parts of Australia, it is the body’s natural limits. Those October 2004. Report to AFL.” (Draft supplied to obvious that heat illness and heat in charge of elite athletes must author.) stroke do exist and steps must be recognise this danger and be taken to prevent their occurrence. prepared for its consequences. However, SMA believes the way The Australian Football League to reduce the incidence is through elite level guidelines are a good education of participants and example for other sports to follow administrators, rather than arbitrary in this area. cancellation recommendations. 6. Warning about specific one-off SMA is in the process of developing style events, like fun runs and new Guidelines and advice that marathons. This type of event also will assist sporting organisations to encourages individuals to push develop their own heat policies that themselves beyond the body’s are appropriate to their type and level natural warning signs and limits. of sport. Unfortunately, SMA cannot Similar conditions can occur when provide a quick fix, easy answer people are worked in tightly to the question “when should we disciplined groups that prevent cancel?”. Ultimately, the final decision opportunities for individual self- regarding cancellation will be up to regulation – such as with military individual sports on a case by case or other squad-style training. basis. What we can do is to try and Sporting organisations need to make sure those decisions are well- realise also that heat illness can be informed. an issue for officials, sports trainers, The new guidelines will probably take coaches (ask Kevin Sheedy), and even on some of the following points: spectators. 1. Recommended fixed cancellation Finally, if sports administrators and temperatures will be removed or sports participants remember that significantly modified. sport is supposed to be fun and they “listen to their bodies”, they will rarely 2. The reliance on WBGT readings get into trouble with heat illness. The may be reduced and an attempt body is an excellent self regulator will be made to develop some form and when we feel hot and bothered, of alternative “participant comfort”

VOLUME 22 – ISSUE 4 • SUMMER 2005 3 D R J

A safe and level playing field should be the goal of drugs in

sport policy By Dr J

In case you are sick of the subject, and forth from the list of prohibited can stop rogue countries from failing this is another (lengthy) drugs in sport substances (eg, pseudoephedrine). to enforce doping criteria as well as piece. Fortunately it won’t fall into And they become almost impossible other countries. The big disadvantages either category of clichéd article along to fathom when certain performance- from where I see it at the moment the lines of: (1) Guess what, lots of enhancing drugs are approved for are: Olympic medal winners are taking some competitors in an event or 1) due to over-officiousness of WADA, drugs and getting away with it? (I competition but not for others, to excessive resources are now wrote one of these in a Dr J. during which I will return later. going to be spent complying with the 1990s and have read similar My personal view on the criteria for Therapeutic Use Exemption (TUE) articles 100s of times since) or (2) permitting drug use is as follows: Guidelines for drugs that shouldn’t because of (1) this is all too difficult, even be on the banned list (eg, let’s just make drugs open slather and, 1) a drug should either be banned or cortisone injections and creams, at the cost of a few athletes dying legal in a certain sport, not banned salbutamol); here and there, at least we can end for some athletes and legal for the hypocrisy of applauding athletes others; 2) the TUE process may become as who are only up on the podium much of a rort in certain countries 2) there is no point banning a drug because they have beaten the system. as the previous system, with if it isn’t performance enhancing athletes trying to invent proof of I am a big supporter that sport in a particular sport or if you can’t suffering from as many conditions needed a World Anti-Doping Agency enforce the ban (ie, there is no test as possible to allow access to (WADA) because at least we now for detection); as many ‘banned’ performance- have a common standard that we can 3) given that a drug helps enhancing drugs as possible; criticise and lobby to have changed, performance and can be tested where appropriate. It is unfortunate 3) because of testing limitations we for, the criteria for banning should but realistic that performance- are often shooting small offenders be based on whether or not the enhancing drug use in professional with a cruise missile (ie, stripping potential for health damage by athletes seems to be heading the Olympic Golds off someone who overuse/abuse outweighs the same way as paying tax is treated tests positive for pseudoephedrine) potential for inadvertent use or by business – that is, an area where whilst we are firing a paper plane need for genuine medical use in everyone tries to get away with as into the big offenders (those who some athletes; much as they legally can. use high doses of EPO and HGH). 4) for drugs where detection of the In one way we are developing a more Anabolic steroids are the prime actual drug is problematic but mature attitude to drugs in sport, category of drugs that should be cited detection of its net effects is easy where it is appreciated by the majority to show why use of certain drugs in (and the classic here is EPO and that there is no black and white with sport should be illegal. packed red cell volume), it is much respect to performance-enhancing more sensible to ban the effect The stories of East German female substances. If a performance- rather than the drug itself (ie, ban athletes who have suffered from enhancing drug is on the banned list, excessive blood thickness, which is infertility in the years after their an athlete who takes it or a doctor what presents the health problem athletic careers are exhibit A in the or conditioner who prescribes it is anyway, rather than banning argument against the use of anabolic considered to be a cheat (eg, anabolic EPO). I agree with this section of steroids. Like all drug categories, steroids). Yet, if a performance- the argument of Savulescu et al, there are grey areas, but at least with enhancing drug is considered ‘legal’, published recently in BJSM, but steroids we are more united in being an athlete who declines to use it or not the rest of the open-slather hard across the board in this category. a doctor who doesn’t prescribe it is approach1. not on the cutting edge (eg, creatine). An exception exists in some circles The boundaries get blurred more The big advantage of WADA is that for the so-called ‘soft’ anabolic when there are drugs that move back there is now a system in place that steroid precursors, like DHEA

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and androstenedione, which are use. Caffeine is almost ubiquitous, and status in order to be able to take prohibited in most sports, but have is a good drug to think about if anyone salbutamol, but why not just make been legal recently in US Major tells you that stimulants don’t have the drug legal? Even if salbutamol is League Baseball. Mark McGwire, addictive properties. Caffeine makes a major performance-enhancer (and who broke the MLB season record you do your job better, perform better I am not convinced it is), would it for most home runs in 1998, admitted in IQ tests, probably run faster and, be fair that only asthmatics could to the use of androstenedione as fortunately, if you can manage to keep access these properties of the drug? It a performance-enhancer, and why your heart beating in sinus rhythm, definitely wouldn’t be fair to ban all wouldn’t he when it was legal in that doesn’t have too many side effects. asthmatic athletes from competition sport at the time he broke the record? Pseudoephedrine has been studied for using salbutamol and, since quite extensively in recent years and excessive use isn’t likely to lead to Although MLB has tended to be none of the published papers has any major harm (because salbutamol an exception, most sports have a shown any great performance effects has minimal cardiac effects, a bit zero tolerance on anabolic steroid from a standard dose. like caffeine), why not just make use amongst athletes, which I fully salbutamol a legal drug? Does anyone support. The days of doctors making However, the way that so many seriously believe that non-asthmatic exceptions for athletes recovering football players seem to love gobbling Olympics athletes who are inspired from (say) knee reconstructions them down before games suggests to cheat, and who apparently have are past us, and for good reasons. to me that there may be a slight no problems finding doctors and Yes, there is no doubt that, if your performance effect from higher-than- physiologists who can get them EPO quads have wasted after a knee standard doses. The fact that so much and HGH on the quiet, would have reconstruction, anabolic steroids will money can be made from buying any problem finding doctors and help you regain some of the bulk, Sudafed and melting it down to form physiologists who can help them and this was the reason why some heavier speed to resell at nightclubs fudge the results of an exercise of these drugs were prescribed by also casts this drug in a bad light. Even challenge test so they can be declared respected sports physicians in the late despite my suspicions, the fact that asthmatic? 1980s and early 1990s. every second over-the-counter cold medication contains pseudoephedrine The over-officiousness of the A fairly fortunate side effect might means that I would support keeping it authorities to regulate an important be that your other muscles will off the ‘banned’ list. and pretty harmless drug like hypertrophy as well, as Rodney salbutamol arises, in my opinion, Howe discovered in 1998. In The risk that a heavy user might be from their impotence in being unable his rehabilitation from a knee gaining a performance advantage to regulate the heavy drugs that are reconstruction he took anabolic and/or will suffer health problems commonly being abused, such as steroids (perhaps with a semi- is outweighed by the injustice that HGH and EPO. Make salbutamol legitimate intent of building his occurs if an athlete is disqualified and cortisone puffers completely quadriceps strength back up) and, after inadvertent use (which is legal, make insulin legal, make anti- rather than have a mediocre year unfortunately what happened with epileptics legal etc, etc, as these drugs which tends to follow major knee Andrea Raducan, who lost her Gold have a much greater therapeutic surgery, he temporarily became the in the gymnastics at the Sydney importance than potential to lead to best forward in the NRL competition. Olympics). athlete death through abuse. When he failed a drug test for The stimulant which seems to give anabolic steroids, he was given a If you accept the arguments that rise to the most flagellation in WADA hefty suspension, which I feel was the ‘soft’ stimulants such as caffeine, circles is salbutamol, which is an correct decision, despite the fact that salbutamol and pseudoephedrine important (and potentially life- he cited his knee problems as being should all be legal, then what about saving) drug for the 10%-20% of the rationale for using steroids. the amphetamine-type drugs? athletes who are asthmatics. There is It still angers other countries that some evidence that salbutamol has A line has to be drawn somewhere, the USA track and field medical performance-enhancing effects2, and because these stimulants are definitely officials, until only a year or two history has shown that more Olympic very performance-enhancing in most ago, apparently turned a blind eye medallists have had salbutamol in sports. The heavier you travel up to positive anabolic steroid samples their system than there should be the stimulant pathway, the more if the athlete could cite a ‘legitimate asthmatic athletes, which has led likely that cardiac arrhythmias and reason’ for using the drugs. to the suspicion that some athletes even arrest can occur, and of course may have been taking salbutamol for the more potential performance- Stimulants are harder to cast in the reasons other than asthma attacks. enhancement you can get. Horses, same light as anabolic steroids, as greyhounds and humans all run there are and always will be ‘soft’ The new WADA guidelines want faster and have more endurance after stimulants that the majority of people athletes to show ‘proof’ of asthmatic using amphetamines, but there have

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probably been quite a few deaths in longer and I’m equally sure that it football, long team meetings are now the past (particularly in cyclists) from helps you run faster. Is it fair that necessary. their use. some athletes are given this privilege There isn’t a blood test or a scan that but others are not? I don’t have any problem with you can have which diagnoses ADD inclusion of amphetamines on ADD, whether or not you believe – it is all about context, and whether ‘banned’ lists of drugs, but then I do it is overdiagnosed, is a disease of you can behave in a manner that is have a big problem with these drugs context. So, for example, is ‘low sex considered appropriate by those around being banned and then exceptions drive’. If a couple is happily married you during your everyday duties. made for certain athletes. and both partners want sex once or Unfortunately, due to the combined twice a fortnight, then they are both The common and now-obvious failings of our school system and our considered ‘normal’. If people who loophole for being granted ‘approval’ pharmaceutical industry, we have only want to have sex once or twice a to use amphetamines is the use of reached a situation where a large fortnight are unfortunate enough to be Ritalin for the condition known as proportion of our male schoolkids married to partners who want sex once ADD (Attention Deficit Disorder). need to be treated for ADD in order or twice a day, they might genuinely Even though other experts are to fit in with the system in which they be diagnosed as having an arousal particularly cynical about the use of find themselves. disorder. Of interest, a psychiatrist Ritalin for ADD, I am happy to listen might prescribe someone testosterone As the worst behaved kid in the to expert psychiatrists who claim in this context, to treat the arousal class gets put on Ritalin for ADD, the (with plenty of experience) that Ritalin disorder (and believe me, if TUEs keep pressure then falls on the next worst is very helpful in a clinical setting for going the way they are, some athletes behaved kid to take the same drug. ADD patients. will come up with this as a reason for Apparently he can usually buy it from The three big questions I have over wanting anabolic steroids). his mate sitting next to him in the back Ritalin are: row of the class for the going rate of $1 If you have a job of a certain type, per tablet. In the truck driving industry, 1) Is denying an ADD patient his/her such as a rock musician, actor, artist, the fact that many of your competitor Ritalin more similar to denying a chef, advertising executive, opinion truck drivers are taking amphetamines diabetic his/her insulin or more journalist, stand-up comic etc, etc, you and can therefore do the Sydney to similar to denying the post-knee may only ever rarely be required to sit Melbourne drive in seven and a half reconstruction patient the anabolic at attention listening to a person who hours puts pressure on other truck steroids to regain quadriceps you consider boring, and therefore drivers to do the same. The expectation strength? it would be highly unlikely that you that badly-behaved boys will take might be diagnosed with ADD (just 2) How much performance- Ritalin is now as ingrained as the as someone who was married to enhancement does Ritalin really expectation that long-haul truck drivers a partner who wanted sex once a give in strength and power sports will take it (or something similar) to stay fortnight would be unlikely ever to be and, whatever it is, is it fair awake longer. diagnosed with an arousal disorder). that only ADD-sufferers get this If you are a schoolkid, your life is all Although Ritalin is a banned drug, advantage? about sitting at a desk and listening there is a perceived need for medical 3) Most importantly, since there is to someone give instructions, and authorities to grant ‘exemptions’ for no objective test for how much you might be much more likely to be athletes to take it under the TUE Attention Deficit one really has, considered to have ADD if you don’t system, based on medical need. how the hell do you stop an athlete like listening. I don’t have any experience with ‘faking’ the symptoms and signs these panels, but apparently it is not A professional football player a few of ADD in order to steal a march uncommon for TUEs to be granted for decades ago would never have been on the field by getting access to a Ritalin for ADD, based on the opinion told he had ADD, partially because strong stimulant? of two independent psychiatrists (who the condition wasn’t recognised are diagnosing this condition entirely As far as I am aware, there is only and partially because the average on symptoms and signs rather than one trial showing the effects of Ritalin team preparation meeting went for any investigations). in ADD patients3 (which showed it 10 minutes rather than three hours. helped some aspects of performance, It is quite legitimate to diagnose a In the USA, Mark McGwire and of course doesn’t answer the player with having a mild variety inadvertently opened up the debate question of whether it helped by of a psychiatric condition (ADD) if on androstenedione in MLB by ‘curing’ the condition or whether it he (the player) always snaps at the being one of the very top players just helped performance, because coach when he tries to explain a in the sport who had his use of the stimulants just ‘help’). I’m sure Ritalin complicated play for the fifteenth drug made public. In Australia we helps you stay concentrating for time and, in the context of modern now have a similar case with Willie

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Mason, who is one of the very best talkback radio), is whether or not convinced that stimulants help you players in the NRL and who it has Ritalin should be a drug for which after they have watched Willie Mason been widely reported has been given ADD-athletes can get TUEs. Actually win the man-of-the-match award a TUE to take Ritalin. I don’t want that shouldn’t just be ADD – Ritalin two weeks in a row in the 2004 NRL to comment on the appropriateness is also approved for the condition of Preliminary and Grand Finals. of the diagnosis (as some media narcolepsy so, if you have enough late It shouldn’t surprise us that, when commentators in Sydney have at nights and keep falling asleep during drug authorities made a soft-stimulant length) other than to say that Willie team meetings (as opposed to getting like salbutamol ‘banned’ in sport, is being looked after by an excellent up and wandering around the room), except for asthmatics, suddenly there sports physician Hugh Hazard, who there would be an opportunity for were a whole lot more asthmatics has the respect of the sports medicine Ritalin to help you in this situation as cropping up at the Olympics. What community. well. worries me is that if we keep the I am fully prepared to accept that, if The ‘recommended’ uses for current status quo going on TUEs for this diagnosis (ADD) has been made amphetamine-type drugs don’t end just Ritalin, football players might become by expert psychiatrists, it is correct. there – it is a popular class of weight like truck drivers or, I hate to say I do however think that we should loss drug. How are we to say that a it, eight-year-old boys in Australian question whether an expert panel javelin thrower who has a prescription schools. Are classrooms less disruptive should be granting approval for any for Duromine for weight loss deserves now and the trucking industry safer particularly players, with ADD or it any less than a javelin thrower in the because large percentages of people anything else to take amphetamine- same competition who got a Ritalin in them are taking stimulants? type medications (which are strong prescription for ADD from the same Some psychiatrists may argue that, enough to be on the banned list for psychiatrist? How do we draw the line if we give Ritalin to a quarter of the other players). here and not allow another javelin population of disruptive NRL and AFL thrower in the same competition an Willie Mason, for those in the players, we will have a better-behaved anabolic steroid prescription for sexual southern states who haven’t caught group of professional footballers. The arousal disorder, as long as there are up in the soap operas surrounding problem is that, if keeping up with two respected psychiatrists who write his Rugby League career, is a bit like the competition in sport means getting that the athlete definitely has the your Shane Warne or Jason Akermanis diagnosed with ADD by a psychiatrist, condition? figure of the NRL. He is a bloody players are going to have an incentive good player and a character who Willie Mason’s performance history for to behave badly in order to get the (when not on media ban) speaks the year in 2004 (broken into pre- and ADD-diagnosis to be given the legal candidly and, some would say, post- Ritalin periods, according to the imprimatur to take speed. sometimes without thinking enough time the Daily Telegraph reported If speed infests professional football before pressing the play button on his that he gained a TUE for the use of like it has the schoolyard and the mouth (a bit like this writer, so I have Ritalin4) is detailed in Figure 1. It trucking industry, then the battle to some sympathy towards him). shows an apparently impressive rise stop football players from behaving in metres gained per match once he His ADD details were made public badly is going to be a losing one, not gained the TUE. It is notable that this during a relentless barrage of to mention the battle to create a level rise was not statistically significant (so criticism that was aimed at Willie’s playing field in sport. it could have been due to chance that direction in the Rugby League silly his performance was better towards References season, and I would like to refrain 1. Savulescu J, Foddy B and Clayton M. Why we the end of the year). should allow performance enhancing drugs in from commenting on any of the sport. Br J Sports Med 2004; 38:666-670. http://bjsm. controversies in which he was There is very little evidence to fall bmjjournals.com/cgi/content/full/38/6/666 2. van Baak M, de Hon O, Hartgens F, Kuipers involved earlier this year other than back on to work out if Ritalin is H. Inhaled salbutamol and endurance cycling the TUE issue. Despite that Willie going to be a performance-enhancing performance in non-asthmatic athletes. Int J Sports has copped more than his share of stimulant in football players or Med 2004; 25: 533-38. 3. Pelham W, et al. Methylphenidate and baseball criticism, he is, unfortunately from the sprinters, with or without ADD playing in ADHD children: who’s on first? J Consul viewpoint of not wanting to single or narcolepsy. I know we need a Clin Psychol 1990; 58: 130-133. 4. Willie Mason on drugs for ADHD. Daily Telegraph, him out, the only NRL player whose double-blind crossover trial to see August 31, 2004. Ritalin use is in the public domain whether you can sprint faster on Figure 1 – Willie Mason’s metres gained per game in 2004, grouped to periods for which, as reported in (apparently there are others but we speed versus placebo, but I think I the Daily Telegraph [4] were prior to or after he had don’t know who they are due to already know the answer. Football been given a TUE for Ritalin [source of statistics, NRL stats]. medical confidentiality). players think that pseudo-speed p7 Investigating doping in sport: Federal Government (Sudafed) makes them go faster, so proposes new “independent and transparent” What should be debated in medical they wouldn’t need convincing about process circles (not hysterically à la Sydney the real stuff. They won’t be any less p10 Alcohol and sport: same again?

VOLUME 22 – ISSUE 4 • SUMMER 2005 7 DRUGS IN SPORT Investigating Doping in Sport Federal Government proposes new “independent and transparent” process

Senator Kemp, the Federal Minister for the Arts and Sport, issued a discussion paper on 18 November on options for independent investigation of sport doping allegations. Recent allegations concerning elite Australian cyclists, he said, highlighted the need for an “independent and transparent process” to investigate such allegations. Senator Kemp urged that key stakeholders and other interested people provide comment on the discussion paper, titled Discussion paper about proposed legislation affecting Australian arrangements for the investigation and hearing of sports doping allegations. Sport Health presents this edited version of the paper for interested members of Sports Medicine Australia.

Recent cases of suspected prohibited Current arrangements process, including failure to comply activities and doping allegations made with a request to provide a sample, in relation to elite Australian athletes Australian sport is presently managed tampering in relation to a sample, have highlighted the need for an on a ‘sport runs sport’ basis, with evading the testing process and failure independent and transparent process government involvement occurring to meet whereabouts notification to investigate doping in sport, the largely through sports funding. The requirements. discussion paper says. Australian Government, through The Code provides for other anti- the Australian Sports Commission The credibility and legitimacy doping rule violations including use (ASC), provides national leadership, of Australia’s anti-doping efforts of, possession of and trafficking in a professional services and advice to is closely linked to the level of prohibited substance or method. In the sports industry and recognition confidence athletes, sport officials Australia allegations relating to those and/or funding to national sporting and the Australian public have in violations are presently dealt with organisations (NSOs), subject to processes undertaken to investigate on a case-by-case basis. Normally, certain conditions which are intended and hear all doping allegations so that an allegation is investigated by an to promote the development of correct decisions are made, including independent investigator appointed those sports in the interest of the any decision not to proceed with a by the sporting organisation community at large and members of case. concerned, sometimes jointly with the sporting organisations themselves. the ASC, for example where an AIS There are three broad options to Each sport receiving Australian scholarship holder is involved. There address these concerns: leave it Government funding through the is no Australian Government body entirely to the sports bodies to ASC must satisfy a number of funding with the overall responsibility for the conduct investigations and hearings criteria including having an approved investigation of such allegations. into alleged doping violations; provide anti-doping policy that is consistent funding to sports bodies to employ with the World Anti-doping Code accredited investigators to conduct (the Code), ASC Core Anti-Doping Reasons for government investigations and to present the case provisions and, if applicable, its at subsequent hearings; or establish involvement International Sporting Federation. an independent doping investigation Australia is currently seen as an board to perform these functions. Through the Australian Sports Drug example of good practice in the Agency (ASDA), the Australian The discussion paper sets out world anti-doping community. The Government provides an independent, a possible legislative proposal Australian public also needs to be accountable, high-standard drug to implement the latter option. confident that proper processes are testing regime on which sports can Comments are sought on the broad undertaken to investigate and hear all rely. ASDA is also responsible for options outlined above, as well as doping allegations and that correct examining possible anti-doping rule on the issues raised in the attached decisions are made, including any violations that relate to the testing legislative proposal. decision not to proceed with a case.

8 Sport Health DRUGS IN SPORT

Investigation of a doping allegation Conduct of hearings continue to work with sports to and taking a case to hearing can be ensure the Code provisions in regard difficult and expensive. Some sports Arrangements for the hearing of to hearing and appeals mechanisms may not be in a position to obtain doping cases vary. The Australian are identified in a sport’s anti-doping legal expertise to assist them. There Olympic Committee (AOC) anti- policy. is also a risk that individuals or doping by-laws require all Olympic It is proposed that sports will organisations may be sued by people sports (and those seeking to become be required, under their funding being investigated. Olympic sports) to use CAS as the agreement with the ASC, to include hearing body for doping cases. There is a potential for real or in their approved anti-doping policy perceived conflict of interest for sports Some sports, notably the National either agreement to use CAS or in investigating possible breaches of Rugby League and Australian Football provision for an independent tribunal codes and allegations of wrongdoing. League, have established independent mechanism. The ASC would, as part A real or perceived conflict of tribunals to deal with a wide range of of approving a sport’s anti-doping interest can arise in respect of issues, including doping cases. Other policy, approve a fully independent athletes at all levels but may present sports have no specific arrangements tribunal arrangement (for example, particular issues in relation to high in place. If a doping case were to ARL and NRL), or require a sport that profile athletes, whose presence is arise in one of these sports, the under its anti-doping policy elects not important to a sport’s ability to attract governing body would deal with the to use CAS to establish sport specific sponsorship, spectator support and matter in accordance with its anti- arrangements, which should include other participants. In addition, the doping policy. the use of accredited arbitrators. reputation of a sport may, to a large The World Anti-doping Code contains » to page 10 degree, depend on the reputation of basic principles to ensure a fair its outstanding performers. hearing for people alleged to have Doping allegations of evidence of violated anti-doping rules. The Code prohibited practices are rare and requires all appeals for ‘international’ office holders of individual sporting athletes to be heard by CAS (Article bodies may change frequently. In 13.2.1) but it does not set out any these circumstances it is likely to requirements or procedures for other be difficult for individuals within a hearings. particular sport to be able to build The Australian Government does up expertise in handling such matters not propose, at the present time, to or to take advantage of experience establish a government-run tribunal gained by other sports. or hearing body as many sports Australian Government involvement are required to use CAS and others in the investigation of allegations of have well established arrangements use, possession and trafficking in in place. However, the ASC will prohibited substances or methods could help sports to manage conflicts of interest and ensure that the tribunal hearing a case had all the relevant information to enable it to make a fair decision. In the same manner that ASDA provides its independent testing program, a body to investigate such allegations would provide an independent, fair and impartial service to sports. One option is to establish a Sports Doping Investigation Board (Board) by legislation, with members appointed by the Commonwealth Minister with responsibility for sport.

VOLUME 22 – ISSUE 4 • SUMMER 2005 9 DRUGS IN SPORT

Sports Doping Investigation Board Government’s proposed model

Functions The Board would operate is of the opinion that: independently and would not be • the complaint is frivolous, vexatious The functions of the Board would be subject to Ministerial direction in or not made in good faith, to: relation to the handling of specific cases. • the subject matter of the complaint a) investigate: is trivial, It is intended that the Board, in (i) the possible use, possession, investigating, providing evidence or • the complaint does not relate to a trafficking or administration by a presenting a case, could make use ‘relevant person’, ‘relevant person’1 of a scheduled of information obtained from other drug or doping method (as • the complaint does not relate to a sources, such as information supplied defined in the Australian Sport matter referred to in paragraph (a) by the Australian Customs Service Drug Agency Act 1990 (ASDA of the Board’s functions, (Customs), sporting organisations, Act)2 ASDA or the ASC. • the subject matter of the complaint (ii) a ‘relevant person’ tampering could be more conveniently or It is intended that if prima-facie with a sports drug matter (as effectively dealt with by ASDA, or evidence of criminal activity were defined in the ASDA Act3) uncovered by the Board, the matter • an investigation of the complaint is (iii) a ‘relevant person’ attempting would be referred to the police. not warranted having regard to all to engage in the conduct Police and Board investigations the circumstances. referred to in paragraphs (i) may be able to occur concurrently. The criterion relating to matters and (ii) above However, this would depend upon that could be more conveniently any arrangements agreed between (iv) a ‘relevant person’ aiding, or effectively dealt with by ASDA the Board and police to ensure abetting, covering up, or is proposed because there is the integrity of evidence gathering being otherwise complicit some potential overlap between processes. Similarly, Customs may in the conduct referred to in the functions of ASDA and the undertake an investigation and paragraphs (i), (ii) and (iii) Board; for example where there prosecution under its legislation at the above is a complaint by a person that an same time as a Board investigation, athlete is providing false whereabouts b) provide any evidence obtained in and with arrangements agreed information. It is expected that the the course of such an investigation between the Board and Customs to Board and ASDA would have agreed to a sporting organisation, sporting ensure the integrity of the processes. protocols about the circumstances in tribunal, committee or other which each agency would deal with hearing body When should investigations a particular matter or refer it to the c) where it considered it desirable to other agency. do so, present a case to a sporting occur? The Board should also have the tribunal, committee or other The legislation would allow a person power to investigate a doping hearing body against: to make a written complaint to the allegation of its own motion to deal (i) a person who has been Board about the use, possession, with circumstances where there investigated by the Board trafficking or administration by a has been no formal complaint, but ‘relevant person’ of a prohibited relevant information has been referred or substance or method, or other matters to it by another source, such as the (ii) a competitor whose name has referred to in paragraph (a) of the Australian Customs Service, the ASC, been entered on the Register of Board’s functions above. ASDA, the Minister or a member of Notifiable Events by ASDA the public. The Board would be empowered to d) advise the Minister on matters investigate such a complaint. It should As a condition of receiving Australian falling within the above functions have a discretion to not investigate, or Government funding and/or ASC and any related matters. cease to investigate, a complaint if it recognition, sports and the ASC

10 Sport Health DRUGS IN SPORT

would be required to agree that organisation or international ask questions of employees of those the Board would investigate all sporting federation to obtain a organisations. As the circumstances allegations of use, possession or sample for testing, will differ from case to case, it is trafficking of prohibited substances proposed to allow the Board to • a person whose name is entered on or methods. In some cases, a determine at what point, if any, those the Register of Notifiable Events, particular NSO may have its own well other organisations should be notified established independent investigations or any coach, trainer, manager, agent, of the investigation. procedures. team staff, official, medical or para- However, where those organisations medical personnel working with or were notified, the legislation would treating a competitor, as defined in an require them not to further disclose Who should be subject to applicable anti-doping policy or under that information, except for the the Code. investigation? purposes of taking any action in The last category is ‘athlete support accordance with the anti-doping For the purposes of the Board’s personnel’ as defined in Appendix policy of the organisation. powers, a ‘relevant person’ would be 1 to the World Anti-doping Code. a ‘competitor’, as defined in section The Board would have the power Article 2.6.2 of the World Anti-doping 2A of the ASDA Act, that is: to conduct the investigation in such Code makes it an anti-doping rule manner as it thinks fit. It could for the • an Australian citizen or permanent violation for athlete support personnel purposes of the investigation obtain resident competing in international to possess prohibited substances and information from such persons, and sporting competition, methods. It also appears appropriate make such inquiries, as it thinks fit. to subject athlete support personnel to • an Australian citizen or permanent investigation in relation to at least the If it decides not to investigate or to resident assessed by a NSO as anti-doping rule violations referred to stop investigating a matter, it would having the potential to represent in Articles 2.5, 2.7 and 2.8 of the Code be required to inform the person Australia in international sporting which deal with tampering, trafficking being investigated, the complainant competition, and administration of prohibited (if there has been a complaint) and (if • a member of a team in an drugs. another organisation has been notified international sporting competition of the investigation) that organisation in which teams representing of the reasons for the decision. Australia or teams representing Investigation process Its investigations would be conducted Australian organisations that The Board would be required, before by its delegates, who would make a contain members assessed by beginning an investigation of a matter, formal report to the Board. It would a NSO as potential Australian to notify the person being investigated be required, if it is to make a finding representatives take part, of the investigation. that is adverse to any person as a • a sporting competitor who receives However, it would have a discretion result of the investigation, to give Commonwealth or ASC support to not notify the person being the person an opportunity to make or whose sporting organisation is investigated if it had reasonable submissions about the matter. recognised and or funded by the grounds to suspect that such a If the Board approves the report and ASC, notification could result in the loss of, the report finds that the person under • a competitor in international or tampering with, potential evidence investigation has no case to answer, a sporting competition in Australia, or where there were ongoing copy of the report would be provided investigations by other Agencies. • a competitor in sporting to the person under investigation, competition at a level assessed by It would have discretion to notify the complainant (if there has been a NSO as being a level at which the ASC, ADSA and any relevant a complaint) and -- if another Australian representatives would be NSO or sporting organisation of organisation has been notified of the expected to compete, the investigation. In some cases, a investigation -- that organisation. complaint may amount to nothing • a person assessed by a foreign If the Board approves the report and more than an unsubstantiated sporting organisation to be the report finds that the person under allegation. In such cases, it international standard and whom investigation has a case to answer, a is probably inappropriate to ASDA is required to obtain a copy of the report would be provided notify other organisations of the sample for testing, to the person under investigation, investigation. However, at some the complainant (if there has been a • a non-Australian in respect point in the investigation it may complaint) and the relevant sporting of whom ASDA is requested, become necessary; for example, if organisation(s), the ASC, ASDA and permitted or required under a the investigator will need to seek WADA. contract with a foreign sporting documentary information from or

VOLUME 22 – ISSUE 4 • SUMMER 2005 11 DRUGS IN SPORT

Provision of the reports once inquiries would normally be necessary private, but the person would be completed to these people or to establish whether a person had a entitled to have an adviser present at organisations is in line with the Code. case to answer. the examination. Occasionally there are calls for Accordingly, it is proposed that A record would be required to be public release of details about Customs information would be passed kept of any examination and the doping allegations and investigations initially to the Board, which would person would be entitled to be given conducted into those allegations. have discretion as to whether to pass a written copy of the record. This can include calls for release of that information on to the ASC or a The legislation would also provide information before an investigation sporting organisation. that civil proceedings do not lie is completed. However, public In some cases, the Board may decide against a person in respect of loss, disclosure of information about to investigate the matter first and damage or injury of any kind suffered investigations raises difficult questions decide to only pass on information by another person because of any of balancing the need to protect the in the event that the competitor is such acts done in good faith as privacy and reputation of individuals found to have a case to answer. This the making of a complaint or the in the face of unsubstantiated procedure would be designed to making of a statement to, or the allegations and the need for ensure that raw Customs information, giving of a document or information transparency to maintain public which can cause substantial to, the Board in connection with an confidence in the investigations damage to a person’s reputation, investigation. system. It is proposed to give the is not released while inquiries are Board some discretion to release Under section 137.1 of the Criminal undertaken. information publicly. Code Act 1995, penalties (including Relevant Customs information would imprisonment) would apply to the still be supplied to ASDA to assist it in provision of false or misleading Disclosure of Customs deciding who to request to provide a information to the Board. information between sample. bodies Delegates Board powers There are many cases each year The Board could act through delegates, where prohibited substances or It is proposed that the Board would who could be its members, its staff or methods are either sent to people have some powers to compel accredited investigators who have been in Australia through the mail from witnesses to attend and answer contracted by the Board. overseas or where people are in questions or produce documents It would manage an accreditation possession of such material on arrival where there are reasonable grounds process for investigators, including in Australia. Current information to believe that information will assist the development and publication of disclosure provisions enable Customs in the investigation. These could guidelines and rules for investigation information to be passed to the include the power to give a notice of doping allegations and criteria for ASC, which, in certain circumstances summoning a person to attend before accreditation. Potential investigators can then pass that information to a delegate to produce documents or would be required to demonstrate sporting organisations (Part VIIA of to answer questions; and examine the their skills and qualifications the Australian Sports Commission Act person on oath or affirmation. to achieve accreditation and 1989). Customs information can also It would be an offence with a maintain them in order to maintain be passed to ASDA for the purpose of maximum penalty of one year’s accreditation. Further details are set deciding who to request to provide imprisonment for a person required out below. a sample (section 67AA of the ASDA to answer a question or to produce Act). This process is separate from documents to refuse or fail to take an any decision by Customs to prosecute oath or make an affirmation, answer Accreditation a person. a question that the person is required The Board would be required to Information received from Customs is to answer or produce a document that formulate an accreditation scheme for important in the fight against doping the person is required to produce. the accreditation of investigators. in sport as it may be evidence of The offence would not apply if the anti-doping rule violations. However, The accreditation scheme would person has a reasonable excuse; for the information of itself is often not empower the Board to make decisions example if the answer to the question enough to establish a violation; for accrediting and varying or cancelling or the production of the document example, a parcel from overseas the accreditation of investigators. would tend to incriminate the person. addressed to an athlete does not The accreditation scheme would prove that the athlete knows of The examination of a person would make provision for an investigator to the contents of the parcel. Further be required to be conducted in surrender the accreditation. It would

12 Sport Health DRUGS IN SPORT

make provision for the keeping of If the person decided to proceed However, it is proposed that the a register of investigators accredited to hearing, the Board would be Board would take forward to hearing under the scheme. In particular, it responsible for presenting the case to all cases where a doping infraction would make provision for: the hearing body and ensuring that all notice has been issued, including relevant evidence was made available RNE cases. This would ensure that • the register to be kept in such form to the panel, including obtaining all doping hearings are handled and manner as the Board directs further evidence if that became consistently and remove the need for • persons to inspect the register necessary during the hearing process. sports to bring evidence against their athletes in any doping hearings. • persons to obtain information Fresh allegations against the person contained in the register in question or others arising in the Footnotes 1 Broadly, a competitor or any coach, trainer, course of the hearing would be • fees to be charged by the Board for manager, agent, team staff, official, medical or subject to separate investigation by para-medical personnel working with or treating a such an inspection or for providing competitor. For further detail see ‘Who should be the Board. subject to investigation?’ in this paper. such information. 2 Under subsection 2(1) of the ASDA Act, a Decisions of the Board would be ‘scheduled drug or doping method’ means a drug, The accreditation scheme would be subject to judicial review under the or a doping method, included in a schedule set a disallowable instrument subject to out in a drug testing scheme. Details of the drug Administrative Decisions (Judicial testing schemes are set out in the Australian Sports tabling in, and disallowance by, each Drug Agency Regulations 1999. A ‘doping method’ Review) Act 1977 in the same House of the Parliament. is defined in subsection 2(1) of the ASDA Act as way as decisions made under any the manipulation or substitution of any human biological fluid or tissue or breath or the use of a It would empower the Board to Commonwealth legislation. substance in a manner that is capable of concealing accredit an investigator, subject to one the use of a drug by the person concerned. Doping infraction notices in the cases 3 Tampering with a sports drug matter is defined in or more conditions specified in the of positive tests or failure to comply section 4A of the ASDA Act. A sports drug matter instrument of accreditation. It would includes the requesting, collection or handling of violations are currently issued by samples or information under drug testing schemes also empower the Board to impose and arrangements. the relevant sporting organisation, further conditions to which the once ASDA has listed the violation accreditation is subject and revoke or on the Register of Notifiable Events vary any condition. (RNE). The Australian Government A condition of an accreditation could does not propose to change these make provision for or in relation to a arrangements. matter by conferring a power on the Board. For example, a condition could require that an investigator comply with certain protocols approved by the Board. The Board would be required to formulate rules of conduct relating to investigations and the legislation would provide that compliance with the rules of conduct is a condition of Human Kinetics ad accreditation. The rules of conduct would be a disallowable instrument subject to tabling and disallowance by each House of the Parliament.

Enforcement

The current system in relation to enforcement and hearings would be retained. After the sporting organisation receives a Board report which finds that a person has a case to answer, the organisation would act to issue an infraction notice and the person could either accept the infraction or seek to proceed to hearing.

VOLUME 22 – ISSUE 4 • SUMMER 2005 13 DRUGS IN SPORT

Alcohol and sport: Same again?

by Maurie O’Connor

When it comes to dealing with issues alcohol industry. Alcohol promotes between sport and alcohol have never relating to alcohol and sport, we seem sport and sport promotes alcohol. really been fully debated in the same to just keep going for the same old way that they were for the connection things over and over again. The only between sport and tobacco. As we thing that changes is the price - the “Drugs” and Sport know, the debate with tobacco price of our inability to make some Much of the research and focus on and sport resulted in the banning significant and sustainable changes drugs in sport has concentrated on of tobacco advertising in sport and that may contribute to culture change the use and problems of performance similarly the call to do likewise with and have enough meaning and enhancing drugs. There is no doubt alcohol has come from many sources, relevance for sportspeople to initiate that this issue captures the headlines, particularly those within the public any behaviour change. This article stirs emotions and creates righteous health area. examines the connection between indignation. This is particularly so However, the case against alcohol alcohol and sport, its implications leading up to and during Olympic advertising in sport is much more and some of the latest responses, Games and the last Games in equivocal. The reasons for this have including a new initiative by Sports Athens were a good example. In to do with exactly those strong Medicine Australia. fact, however most of the problems sporting and cultural traditions and much of the adverse publicity relating to alcohol that we have Fermentation surrounding athletes that has been talking about. Also there is a continued to occur over the years difference in the health effects, which Alcohol is part of Australian history has been with the use of recreational makes alcohol consumption low risk and culture. It is an established part drugs, mainly alcohol. at certain levels low risk, compared of our socialisation and an indicator There is a long history chronicled in to tobacco smoking, which presents of our rites of passage. For nearly our press of embarrassing, illegal and significant risk at any level. These and every social occasion or celebration, abusive behaviours by sportspeople other factors give alcohol that much alcohol is an important ingredient. relating to excessive alcohol use. more acceptability. It is not surprising then that alcohol Despite that history we still continue Alcohol advertising has always been is also a major part of our sporting to have footballers of all codes able to hit some receptive chords in culture and sporting heritage. Having behaving badly, cricketers making a population that is only too willing a beer and watching the footy or bad calls and individual athletes being to believe that “they’ve earned a cricket is an established Australian “tired and emotional” on a regular thirst”. The use of alcohol as a social pasttime. Alcohol has always had basis. Not much has changed. lubricant, a “bonding agent” and a a close association with sport in facilitator of engagement with the Australia at all levels — spectator, opposite sex are some of the aspects player, administration and promotion. The party goes on of alcohol use that advertisers use Alcohol features heavily in post-sport to tap prime psychological needs. celebrations and has particularly Alcohol advertising in sport is still When portrayed in an amusing way, strong links to team sports. going strong and there are few governments that are considering these ‘aspects’ of alcohol use, along Breweries and distillers have always any limitations. The industry would with a sporting link, have many of been major sponsors of teams and argue that the use of their logos and the ingredients that appeal to young significant sporting events. A whole brands is not intended to recruit new Australians — a winning formula. range of products are now available customers, especially young ones, but Consequently the main debate around that promote various forms of alcohol on the other hand their opponents alcohol advertising is occurring with and brand names along with sporting would argue that sponsorship is under-age drinking and new forms teams, codes and events. Billions of all about making people associate of alcohol that are more appealing to dollars are tied up in this connection, alcohol with fitness and success. young people. The important issue which is usually regarded as having a here is that many of those young mutual benefit for both sport and the The implications for this association

14 Sport Health DRUGS IN SPORT people also play sport. The effects of One More? “What’s the Score” is the Australian alcohol on sporting performance have Institute of Sport’s alcohol and drug never become part of that debate, Many of the responses to this problem education program for elite athletes. but are crucial in initiating behaviour have tended to be reactionary to say The program targets both athletes change with young people who do the least. They have often tended and coaches and is supported by a play sport. to simply place all the responsibility booklet aimed at the athletes and a with individual athletes, rather than manual for presenters. accepting that cultural change is also Tip The Balance - Alcohol Here’s to the game the responsibility of sporting bodies, Management in Sport is a new coaches and administrators. Unfortunately there has not been a initiative by Sports Medicine lot of research dealing with the use of Those responses have mainly lacked Australia which is aimed at athletes alcohol by athletes in Australia and its a more comprehensive approach that at the sub-elite level. It includes an effects on their sporting performance. targets the concerns of sportspeople education program for sportspeople Some of the research from the United as well as their behaviours in social as well as training for coaches and States has found higher levels of settings. Providing alcohol and drug administrators. The education is alcohol consumption among American information to athletes is simply not supported by a Tip The Balance college athletes than their non-athlete enough unless it is presented in a brochure. A training manual, CD-ROM peers. At least two studies in Australia sporting context with meaning for and other web-based material are in the 1990s with AFL and Rugby their personal situations. If education now in development. League footballers have found binge is supported by a policy process and drinking rates of up to 30 standard administrative endorsement in sport, drinks in a session. then change is possible. Last Drinks The evidence seems to suggest A comprehensive approach should Despite these recent developments that, while being involved in sport involve a prevention element there is still a long way home may promote healthier behaviours including policies, codes of conduct and very few designated drivers. and attitudes in early adolescence, or contracts, as well as a multi- Comprehensive approaches still need it may not necessarily provide level educational approach using champions at all levels. SMA can an environment for developing both formal and informal methods. now be said to have taken on that responsible drinking practices in late It should also involve an element mantle with Tip The Balance, and its adolescence and young adulthood. of early intervention, which trains development will be worth watching. The surveys with athletes have coaches and administrators to Cultural change is a slow process but indicated that their knowledge recognise and respond appropriately the groundwork has been laid in 10 regarding the effects of alcohol on to warning signs and relate problems previous years of work with athletes the body was poor and that their before they result in crises. that has informed the Tip The Balance consumption of alcohol in winning development. celebrations tends to be risky. Something Different? What we have learnt in those years is A recent study by Shelly Rowe at the a few simple facts. For sportspeople Australian National University found Some recent initiatives have sought to be interested in messages about that 60% of male and 50% of female to take a different approach. All are alcohol they must be in a context athletes reported binge drinking on aimed at different sporting groups that relates to their own experiences at least one of their last two drinking and have different intervention and which relates to their sporting occasions. She also found that 96% approaches. performance. It’s not rocket science, of females competing at national and but it could be rocket fuel. The Good Sports Program state representative levels reported conducted through the Australian Maurie O’Connor is Senior Project binge drinking on either of their last Drug Foundation has been working Officer, Alcohol Management two drinking occasions. with community sporting clubs Project, Commonwealth The only thing that seems to have which serve alcohol. The program, Department of Veterans’ Affairs changed in the last 10 years is the conducted mainly in Victoria, uses a form of alcohol that many young ‘responsible service of alcohol’ and people are now drinking. The policy approach within the licensed consumption levels and patterns, the sporting clubs. It also seeks to raise lack of knowledge and awareness, awareness of the issues relating to and the behaviours that often make alcohol and sport. the papers are still there.

VOLUME 22 – ISSUE 4 • SUMMER 2005 15 BRADMAN REASSESSED

Uncovering the secrets of The Don Bradman reassessed

By Paul Glazier, Keith Davids, Ian Renshaw and & Chris Button

Across the world, sport science Recently, statisticians have attempted littered with examples of punctuated support programmes have been set cross-generational performance equilibrium from Fosbury’s flop up to help world-class sportsmen comparisons of legendary sportsmen technique in the high jump, to Bjorn and women develop their skills and women and, in cricket, Dickson Borg’s heavy top-spin forehand drive and surpass the performances of et al(1) undertook a statistical analysis and the double-hitch kick long jump. their peers. But how did athletes of of all Test batsmen over a 120- In the context of this article, these bygone generations cope without year period between 1877-1997. By ideas lead to key questions such as: this support? What can modern-day plotting the coefficient of variation Why was Bradman so much more athletes, and their coaches, learn of batting averages across eras (eg, successful than anyone else? What from the early experiences and pre-World War I, pre-World War II, was his secret? Was he simply a activities of past greats? In this article, 1946-65, 1965-1979, the 1980s and ‘one-off genius’ or is it possible that a we consider whether or not sport the 1990s), Dickson et al1 showed cricketer of a future generation could science can provide some answers that variability had decreased over emulate his amazing achievements? to these questions by examining time and that a modern player would the factors underpinning the unique need to average approximately 77 The modelling of Dickson et al1 batting ability of one of the truly runs per innings to match Bradman’s raises the question whether or not great performers of relatively modern career batting average statistically. An another Bradman will ever emerge times, Sir Donald Bradman. We analysis of modern players, however, in the modern era, but reference to also consider some of the training shows that no current Test batsman the theory of punctuated equilibrium equipment and practice strategies is able to boast this figure, with the suggests that this possibility is used by today’s leading cricketers, highest averages currently belonging likely to occur as a result of sudden and question whether they are to Matthew Hayden (Australia) 58.14, technical innovations produced by more advantageous than those of Rahul Dravid (India) 58.09 and Sachin an individual performer. For this Bradman’s era. In attempting to piece Tendulkar (India) 57.39. reason, it may be useful to gain an together understanding of the iconic insight into Bradman’s own technical Dickson et al(1) invoked the ideas of Australian’s cricketing development, development and practice strategies to the eminent evolutionary biologist, we blend a mix of theoretical ascertain what innovative, perturbing Stephen Jay Gould, for interpreting principles, experimental data and forces were at work. their modelling work. Gould(2) anecdotal evidence from the sport developed the evolutionary theory of science and coaching literatures. punctuated equilibrium to describe What made Bradman how long periods of evolutionary great? Contextualising Bradman’s stability for biological organisms are broken by sudden, shorter spurts record-breaking career Since his retirement from the game, of dramatic evolutionary change, many explanations for the Don’s the latter resulting from external Bradman finished his international expert batting and vast statistical perturbing forces. Gould’s2 theory career with a batting average of superiority have been posited in the contrasts with Darwin’s traditional 99.94 runs per innings, a record that ‘popular’ press, media and coaching perspective that portrays evolution is still at least 40-50% better than literature, but science is revealing that as a slow, steady process occurring any other batsman in the history many of these claims are erroneous at a relatively constant rate and, as of the game. Comparing player or unsubstantiated. For example, we note below, is precisely the sort performances across eras, however, is it has often been suggested that of framework that may be able to fraught with difficulty and answering Bradman had better eyesight and explain sudden jumps of 40-50% in questions like: ‘How do current Test faster reactions than his nearest cricket batting performance. Indeed, batsmen measure up to the legends rivals. However, he was discharged Gould(2) alluded to the baseball of yesteryear?’ and ‘Can there ever prematurely from the Australian hitting average of 0.400 to exemplify be another Don Bradman?’ provides Army during World War II for having these theoretical ideas and sport is science with a complex challenge. defective eyesight – according to

16 Sport Health BRADMAN REASSESSED

Hutchins3, his release was due to formed by the thumb and forefinger practiced a similar game during his fibrositis – and when he submitted of each hand are in line with each formative years7. Thus, although the himself for psychophysical tests at the other, pointing between the splice old adage ‘practice makes perfect’ University of Adelaide, it was found and the outside edge of the bat. carries some weight in the quest to that he had a slightly slower reaction During the stance, the bat should be acquire skill, it seems that what you time than the average University placed just behind the back foot. The do during practice counts for far more student4. These facts are unsurprising conventional back-lift should enable than merely time serving the long given the well-documented findings the bat to be taken back in a line hours needed. that top-class athletes do not have from wicket to wicket with the top Why did this type of unorthodox exceptional perceptual systems and hand taking control. The front arm practice regime lead to such visual reaction times compared to should be extended backwards to outstanding success and can talent their less accomplished counterparts5. give a wide sweep with minimum flex development programs across the Moreover, it has been reported that of the elbow8. world learn anything from these high-calibre athletes have the same experiences in developing the incidence of visual defects as the future world-class stars of sports? It normal population; about 10% suffer Bradman adopted a grip that was not seems that creating the right type of from problems of short- and long- practice environment is important sightedness and other weaknesses6. consistent with the coaching manual, for developing the Bradmans of the Other psychological factors have been having the ‘vee’ of his left hand in line future. What does the scientific sub- implicated in Bradman’s success, discipline of motor learning tell us such as his supreme powers of with the splice of the bat. about how to structure and organise concentration and mental toughness, practice environments for efficient and but, although clearly important, these effective learning? factors alone are unlikely to explain In comparison, the key differences the large gulf between him and other It seems that dynamical systems between these basics and Bradman’s batsmen. theory, allied to the insights of batting technique are highlighted by the Russian physiologist and Bradman in his coaching book, The biomechanist, Nicolai Bernstein, Art of Cricket(4). Bradman adopted a Bradman’s ‘rotary’ whose research accounts and grip that was not consistent with the stimulating ideas were translated technique coaching manual, having the ‘vee’ of into English in 1967, are proving his left hand in line with the splice of Perhaps a more likely explanation for invaluable9. His ideas, combined the bat. Bradman’s stance was also Bradman’s success, gaining favour with powerful theoretical paradigms unconventional, involving closure of with top coaches, resides in his in science such as chaos theory and the face of the bat and positioning it ‘unorthodox’ batting technique – a the sciences of complexity, have between his feet. Similar differences possible disequilibrating perturbation been integrated with concepts and were observed in his back-lift as in the sport. Indeed, on the basis tools from dynamical systems theory he levered the bat up by pushing of the insights of Bradman himself to re-shape our understanding of down with the top hand, whilst and eyewitness accounts of keen movement behaviour10. using the bottom hand as a fulcrum. observers, combined with original As it neared the top of the back-lift, Dynamical systems are examples of film and video footage, and a study Bradman manoeuvred the bat through nonlinear systems operating in regions conducted by sport scientists at a continuous arc and back towards of state space far from equilibrium, Liverpool John Moores University the plane of the ball during the providing them with an appropriate in the UK, Shillinglaw7 concluded downswing in preparation for impact. amount of metastability. Dynamical that the single most important factor systems theory has been successfully underlying Bradman’s outstanding run According to Shillinglaw(7), this applied to the study of coordination scoring record was his unique ‘rotary’ technique, which was putatively in nervous systems and movement technique. developed through long hours control11,12, movement development13, practicing his childhood game of Most coaches emphasise the 14 and skill acquisition15. In particular, striking a fast-moving golf ball with importance of grip, stance and the dynamical systems framework a cricket stump, afforded Bradman back-lift as being the foundations has influenced the way that superior balance, shorter movement for successful batting. Traditional movement scientists view inter- and times and enhanced bat speed coaching emphasises that the standard intra-individual variability in motor through the striking zone than more grip is one where the bat handle is performance, as a function of learning conventional batting techniques. held with the hands together, with and development across the lifespan. the firmer top hand about 25 mm It is also interesting to note that Sir Bernstein9 focused attention on from the top of the handle. The Jack Hobbs, arguably the greatest processes of movement coordination hands are positioned so that the ‘vees’ English batsman ever, extensively and also noted the incredible

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amount of variability exhibited over environments so that functional adjustments; for example, as required performance repetitions as individuals movement solutions may be found. during cricket batting strokes17. engaged in even the most repetitive of Even under the most severe spatio- For example, Bradman has reported tasks such as hammering a nail. temporal constraints, the formation adapting his technique when playing of perception-movement couplings defensive strokes from outside enables batsmen to get the bat in the line of ball flight to lessen The role of constraints the right place at the right time to the chances of edging the ball to intercept the flight path of the ball. in structuring technique the slips against swing and seam Acquiring these functional perception- bowlers4. Furthermore, there is variability movement couplings also enables grip growing evidence that the nature of forces to be modulated right up to the Traditionally, the study of motor movement variability is driven by the point of bat-ball impact, thus ensuring behaviour has seen a tendency interaction of the various sources of that the ball is struck at the right to operationalise variability with constraint on action, and this leads to speed into gaps in the field18. measures of variance in motor output the uniqueness of system dynamics (eg, standard deviation around the for a particular performer under a distribution mean of a dependent specific set of task constraints. This Past vs. present: Bradman variable measured over repeated task-specific view may provide a trials). From a cognitive science better framework for understanding v. Tendulkar perspective, scientists seeking support the role of inter- and intra-individual From this theoretical backdrop, for the concept of motor invariance variability in the provision of it becomes clear that the specific provided a narrow interpretation of feedback, diagnoses and treatment constraints of his childhood game variability in movement as evidence interventions in human movement by encouraged Bradman to adopt a of noise or random fluctuations at sport medicine specialists16. technique that enabled the bat different levels of the movement to remain highly manoeuvrable, system (eg, anatomical, mechanical, therefore minimising lags in the way physiological). Both Bradman and Tendulkar shared that his perceptual-motor system dealt This traditional emphasis led to the with rapid environmental changes and two important commonalities that idealising of the notion of ‘common ensuring that the ball could be played optimal movement patterns’ towards may account for their tremendous as late as possible. which all athletes should aspire, With this in mind, it may be more typically a performance model achievements. useful to compare the technique provided by a leading performer of and style of Bradman with those of the day. For example, the search modern players. Bradman himself for motor invariance implies that Movement scientists have also identified Tendulkar as the batsman all cricketers should adopt a single revealed the important role of who resembled him most in technique optimal batting stance and technique, perception in shaping and guiding (ie, his compactness, technique, with the distinct possibility that the sports techniques. In achieving stroke production). Bradman was precious individualised practice successful coordination solutions, renowned for his efficiency of solution of Bradman would have been it is clear that various sources of play and was said to pay particular ‘coached out’ of his repertoire at an perceptual information can act as attention to the balance of risk and early age. degrees of constraint on the many reward in his shot selection. Given the motor system degrees of freedom. Rather than being undesirable, perceived similarities in the play of Obviously, the relationship between variability of technique can be viewed Bradman and Tendulkar, it would be perceptual degrees of constraint and as exemplifying functional adaptive of interest to examine the cricketing the motor system degrees of freedom behaviours of athletes, since a development of these two so-called can change quite dramatically in consistent outcome can be achieved ‘child prodigies’. by different patterns of joint relations dynamic sports environments, Despite the generally-held view that owing to the dynamics of the joint emphasising how the coupling of both players were great players due biomechanical degrees of freedom. information and movement needs to vary functionally during performance. to ‘natural talent’, a common feature Ideas from chaos theory indicate that of both players’ development is their Owing to the mutually dependent a defining feature of a chaotic system extraordinary emphasis on practice. relationship between the perceptual is that deterministic processes can Although great store is given to the fact and motor sub-systems, unambiguous drive fluctuations in system output that Bradman developed his hand-eye task-specific perceptual variables such that apparently seems random. coordination by famously practising as time-to-contact and place-of-contact With such a view, noise may have a with a golf ball and cricket stump can act as degrees of constraint and positive role in preventing a system against a water tank, he also undertook can be used to make fine-grained from becoming too stable in complex much realistic cricket practice.

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Although he is said to have received This level of commitment could Implications for practice no ‘formal’ coaching, Bradman was explain why Tendulkar’s relative brought up in a family and community development was much faster than a nonlinear pedagogical that loved cricket. For example, that of Bradman. Although they approach his parents, particularly his mother, both scored their first centuries at bowled at him from about the age of 9 12 years, Tendulkar scored his initial The qualitative data on personal or 10. Bradman also engaged in other first-class century at 1421 and his first experiences of skill acquisition makeshift games as a child, such as Test century at 17. By the age of 21, and development in world-class playing tennis or soccer against the Tendulkar had scored seven Test cricketers, allied to recent theoretical garage door. He scored his first 100 in centuries, compared with two from developments in science, have strong a school match aged 12. Interestingly, Bradman at the same age. implications for sports pedagogists from age 15 to 17 Bradman played and coaches, providing a new almost no cricket, concentrating on Chappell expressed little enthusiasm approach steeped in ‘nonlinear tennis19. At 17, he became a regular pedagogy’. for the contribution of sport science player in the local Bowral Cricket Club, Nonlinear pedagogy advocates that and his first full season was notable to the development of the next a key aim is to provide practice for the 300 he scored in the last game environments that enable individual of the season. At 18, the final stage generation of Australian cricketers athletes to couple together key and perhaps the most critical(3) of and suggested that a “mafia” of sub-systems of the movement Bradman’s initial development was system (perceptual and motor completed when he joined St. Georges academics and sport scientists sub-systems) during functional, Cricket Club in Sydney and began to goal-directed practice. Nonlinear play in a high standard of cricket on with little playing experience had pedagogical approaches encourage turf pitches. over-complicated training, creating discovery learning, a more positive Similar to Bradman, Tendulkar was view of movement variability, and steeped in cricket from a very early regimented coaching structures, an emphasis on varying the task age. At two-and-a-half years of age, he leading to the development of constraints of practice. insisted that his nanny throw a plastic Such an approach may signal bad ball at him, which he attempted to cricketers with little understanding news for any strategy that attempts strike with a dhoka or washing stick20. to focus on the practice and Interestingly, during these early years of the game. acquisition of a ‘common optimal Tendulkar only played cricket with a movement pattern’. For example, hard rubber ball. Both Bradman and Tendulkar shared ball projection machines or bowling two important commonalities that At age 11, probably the most notable machines are often used to perfect may account for their tremendous difference in the development of an ideal batting technique in highly achievements. First, both players Bradman and Tendulkar took place: replicable conditions since coaches gripped their bat in an unorthodox Tendulkar was provided with quality can control the speed, trajectory manner. In Bradman’s case, there coaching from a well-respected coach. and direction of deliveries projected was no coach to interfere or change The great strength of his coach was at batsmen. However, the use of his preferred style. In Tendulkar’s that equal emphasis was placed on bowling machines prevents learners case, his coach was sensible enough net practice and match play. Under his from picking up relevant information to follow the old adage: “If it ain’t guidance Tendulkar was exposed to during the bowler’s run-up, bound broke, don’t try to fix it!” The very a quite remarkable level of intensity and delivery stride, and therefore the low grip of Tendulkar enabled him in his cricketing activities. On a daily timing of their introduction needs to to select as his first bat one that his basis Tendulkar undertook net practice be carefully considered. coach considered far too heavy (he between 7.30 am and 10 am. The rest still uses a 3lb 2 oz bat when most A recent study23 showed that using of the day was spent in playing up to players use approximately 2lb 8oz- a bowling machine results in 13 different games across Mumbai, as 2lb 10oz). Second, and possibly the batsmen adopting different timing the coach shifted him to the adjacent most important common factor, is the and coordination patterns for pitch as soon as he got out in one importance attached to demanding deliveries bowled by a real bowler of game3. Even this was not enough and practice by both men. They both comparative speed. on the occasions when Tendulkar was support the view that natural talent not playing in an organised match, Against a bowling machine projecting alone is not enough, but that you he could often be seen practicing his cricket balls at 26.76 m.s-1, batsmen need to work incredibly hard to fulfil strokes inside his house with a ball attempted to couple the backswing any inherent potential4,22. hung from a small net. to the moment the ball emerged from

VOLUME 22 – ISSUE 4 • SUMMER 2005 19 BRADMAN REASSESSED

the projection mechanism (0.02 ± 0.10 the front foot for the bowling machine Interestingly, these ideas are being s) whereas, against the real bowler, (0.53 ± 0.05 s) was similar to the real promoted from within high-level the backswing started later (0.12 ± bowler (0.55 ± 0.05 s). sport, too. Greg Chappell, one of 0.04 s). Even though the timing of the greatest cricketers of all time and When these differences are combined backswing initiation was different, now a highly respected coach, has to the finding that the stride length results from other research on bi- criticised the use of bowling machines was longer when facing the bowler phasic striking activities24 suggests during practice. When interviewed by (0.59 ± 0.06 m vs. 0.55 ± 0.07 m), it that the batsmen may have attempted the Trinidad & Tobago Express and is clear that speed of foot movement to standardize the initiation of the subsequently reported on cricinfo.com is also affected by batting against downswing effectively to control the (22 June 2004), Chappell expressed bowling machines. It is important temporal duration of this phase of little enthusiasm for the contribution for batters to co-ordinate the bat technique. However, the downswing of sport science to the development swing movements to their footwork commenced earlier when facing the of the next generation of Australian and coaching advice for batters bowling machine (0.32 ± 0.04 s) cricketers and suggested that a “mafia” suggests that backswing should be compared to the bowler (0.41 ± 0.03 of academics and sport scientists coupled to the movement of the s) showing that bat speed differed in with little playing experience had front foot. However, these data the two conditions. over-complicated training, creating revealed a greater correlation between regimented coaching structures, These differences led to a different initiation of backswing and front foot ratio of time spent during the movement when batting against the backswing and downswing when bowler (r = 0.88) than the bowling Bradman showed that the best batting against the bowling machine machine (r = 0.65). In summary, these players are those who can overcome (47:53 %) compared to the real results suggest that coaches should bowler (54:46 %). Moreover, initiation think very carefully before using problems by coming up with of the front foot movement occurred bowling machines in practice with 0.16 ± 0.04 s after ball release from expert players who gain a perceptual specific solutions, often “breaking” the bowling machine and 0.14 ± 0.03 advantage from being able to utilise conventional, technical rules. s after ball release by the bowler. important information from bowling Finally, the timing of the placement of actions.

Figure 1: Differences in timing and coordination of the phases of the forward defensive shot when batting against a bowler and bowling machine from the point of ball release to bat-ball impact. When batting against the bowling machine, the backswing was initiated virtually at ball release, with the front foot movement being initiated later. Against the bowler, the initiation of backswing and front foot movement occurred synchronously. Initiation of the downswing against the bowling machine was earlier and the downswing was slower than against the bowler. Front foot placement was temporally similar in the two conditions, but the stride was shorter and faster for the bowling machine condition. Smaller elbow angles when batting against the bowling machine led to different bat angles at impact. (NB. Figures are not to scale).

20 Sport Health BRADMAN REASSESSED

leading to the development of In sport, it seems that the saying 15. Newell KM. Change in movement and skill: learning, retention and transfer. In Dexterity and its cricketers with little understanding of ‘nothing is more practical than Development (Ed: Latash ML & Turvey MT, pp. 393- the game. He was particularly critical a good theory’ warrants greater 430). Mahwah, NJ. Erlbaum. 1996. 16. Davids K, Glazier P, Araújo D et al. Movement of the role of bowling machines attention from scientists attempting systems as dynamical systems: The functional during cricket batting practice, to understand how to support the role of variability and its implications for sports medicine. Sports Med 2003;33:245-260. emphasising the importance of development of the highly skilled 17. Savelsbergh GJP & Bootsma RJ. Perception-action the batter adapting movements to performers of the future. The sciences coupling in hitting and catching. Int J Sport Psychol 1994;25:331-343. key task information sources from of chaos, complexity and dynamical 18. Glazier P, Davids K & Bartlett RM. Grip force bowlers. He argued that giving players systems theory may well hold the dynamics in cricket batting. In Interceptive Actions in Sport: Information and Movement (Ed: Davids too much technical information key to understanding the secrets of K, Savelsbergh G, Bennett SJ et al, pp. 311-325). may only confuse them and cited a the Don in providing the theoretical London. Routledge. 2002. number of West Indian greats of the rationale for structuring sports practice past, who could not explain “how” programs and using artificial aids such they played great shots, but were able as ball projection machines to good to just “do” them. effect. On teaching players, he said: “To try Paul Glazier is at the School of Sport, to explain to them the biomechanics Physical Education & Recreation at of it all would just confuse them. The the, University of Wales Institute, more structure you get at an early age, Cardiff; Keith Davids and Chris Button the more it messes you up.” Chappell at the School of Physical Education concluded thus: “We should not lose at the University of Otago; and Ian sight of the old fashioned methods of Renshaw at the Division of Sport & learning to play cricket by dismissing Recreation at Auckland University of them out of hand, to replace them Technology. with unproven approaches like References biomechanics that are not yet proven 1. Dickson G, Mummery K, Arnold T et al. Legends at to be workable and that, in other the crease: changes to the performance variation of Test cricket batting performances 1877-1997. Sport sports like swimming and athletics, Management Association of Australia and New Zealand Conference. Gold Coast. Griffith University. have been tried and discarded”. 1998. Over-structured coaching to provide 2. Gould SJ. The Structure of Evolutionary Theory. Cambridge, MA. Harvard University Press. 2002. off-the-shelf coordination solutions 3. Hutchins B. Don Bradman: Challenging the Myth. may have limited value, since Cambridge. Cambridge University Press. 2002. 4. Bradman D. The Art of Cricket. London. Hodder & Bradman showed that the best Stoughton. 1958. players are those who can overcome 5. Williams AM, Davids K & Williams JG. Visual problems by coming up with Perception and Action in Sport. London. E & FN Spon. 1999. specific solutions, often “breaking” 6. Beckerman SA & Hitzeman S. The ocular and visual conventional, technical rules. In characteristics of an athletic population. Optometry 2001;72:498-509. developing practice programs, sport 7. Shillinglaw AL. Bradman Revisited: The Legacy of scientists need to understand that Sir Donald Bradman. Manchester. The Parrs Wood variability is not error or noise to be Press. 2003. 8. Andrew K. The Skills of Cricket. Marlborough. The eradicated but can be functional to Crowood Press. 1992. successful performance. 9. Bernstein NA. The Coordination and Regulation of Movements. Oxford. Pergamon Press. 1967. The underlying science suggests 10. Beek PJ & Meijer OG. On the nature of ‘the’ motor-action controversy. In Complex Movement that the feats of the Don are likely Behaviour: The Motor-Action Controversy (Ed: to be approximated, perhaps by an Meijer OG & Roth K, pp. 157-185). Amsterdam. Elsevier. 1988. individual like Tendulkar, as long as 11. Kelso JAS. Dynamic Patterns: The Self-Organization coaches learn to respect individual of Brain and Behavior. Cambridge, MA. MIT Press. differences by providing plenty of 1995. 12. Davids K, Williams AM, Button C et al. An opportunities for young learners to integrative modelling approach to the study of discover their own fitting coordination intentional movement behaviour. In Handbook of Sport Psychology, 2nd Edition (Ed: Singer RN, solutions. Inter-individual variability Hausenblas H & Jannelle C, pp. 144-173). New needs to be better understood and York. John Wiley. 2001. 13. Thelen E & Smith LB. A Dynamic Systems Approach player development programs should to the Development of Cognition and Action. focus on manipulating the key Cambridge, MA. MIT Press. 1994. 14. Newell KM, Liu Y-T & Mayer-Kress G. Time scales constraints on each athlete, since each in motor learning and development. Psychol Rev, athlete should be considered as a 2002;108:57-82. unique individual.

VOLUME 22 – ISSUE 4 • SUMMER 2005 21 SPORT SAFETY Sport Safety Sports injury, sports safety 1997 to 2002 Department of Health and Ageing report

The Commonwealth Department of Health and Ageing has released Sport Safety in Australia: an update – July 2003, its update of sports safety activities and related issues from 1997 to 2002. The report was prepared by Professor Caroline Finch, Director of the NSW Injury Risk Management Research Centre at the University of New South Wales. It contains 11 chapters (and a large number of tables) dealing with a range of factors: from an overview of policy developments since 1997, through descriptions of the incidence and costs of injuries, to discussion of prevention and risk management strategies. Its appendices include a valuable bibliography of published sports injury prevention resources. Sport Health presents this overview of the Report into an issue of deep interest to SMA members. The full version of the report is available from the Department of Health and Ageing’s website at http://www.health.gov.au/internet/wcms/ publishing.nsf/Content/phd-pub-injury-sportssafety-cnt.htm.

Injury prevention and control is ASIPT released SportSafe Australia: A sports injuries were not included in recognised as one of Australia’s six National Sports Safety Framework. the report. national health priority areas in 1994, Sport safety in Australia “provides Similarly, information relating to the report says, and sports injuries an overview of the sports injury recreational beach and water safety are one of the particular contexts prevention initiatives that have (for example, surf life saving or recommended for the targeting of occurred in Australia since the diving) or playground falls had also prevention and control strategies. release of the National Sports Safety been excluded because they were “Since the mid to late 1990s, sports Framework. It focuses only on related to the water safety or child injuries have increasingly been research into sports injuries and their fall prevention strategies, rather than recognised as a significant public prevention published since 1997, prevention in the context of organised health issue and one that needs on the premise that earlier work sport. a strong preventive approach. informed the development of the Accordingly, sports injury prevention National Sports Safety Framework.” has become an issue of concern to No federally-funded Its focus is on broad-based many government agencies. community-level participation in national lead agency “Since the early 1990s, there has sport in either formal (ie, organised been increasing attention given to the sport) or informal (ie, social sport) The report says that there was no problem of sports injuries in Australia. settings, it says, because “this context federally funded national lead agency Such injuries occur across a range of is where the major public health in Australia to guide sports safety participation settings including formal burden of sports injuries, and the policy and to consider provision of sport, informal sport, school sport, vast amount of participation, occurs”. infrastructure. active recreation, fitness activities It brings together the findings of “This means that there is no and general physical activity. Sports recent published research and other national group with the authority or injuries have now been clearly information on injuries sustained representativeness to enable sustained identified as a public health priority by non-elite participants in sport action at this level. in Australia, though limitations of activity and the evidence for measures the available data have been well introduced to prevent or minimise “Many of the efforts to guide or direct documented.” injuries in this context. sports primary prevention actions at the grass roots level of sports In 1995, the then Minister for Human As the focus was only on information participation have largely come from, Services and Health and the Minister that was directly related, or potentially or been coordinated by, the health for Environment, Sport and Territories related, to sports injury prevention or sector.” established the Australian Sports an understanding of the mechanisms Injury Prevention Taskforce (ASIPT) of injury to inform the development of The ASC (through the AIS’s Sports to promote a national perspective prevention strategies, projects related Science and Sports Medicine on sports injury prevention. In 1997, to the treatment or management of departments) had made a significant

22 Sport Health SPORT SAFETY

contribution to understanding and work had resulted in the release of a in Australia and had demonstrated a addressing sports injury prevention working data dictionary, which had gradation of injury risk from highest and treatment issues at the higher helped to inform coding schemes for in Australian football to lowest in and more competitive levels of ICD-10 AM and had assisted with a netball (field hockey and basketball participation through its support for number of other surveillance projects. have intermediary rates of injury). the SportSafe program and funding of Different patterns of injury, in terms research projects. of body region and nature of injury Collecting information: distributions, were evident when data National sporting organisations from different sources were combined. (through funding from the ASC) little incentive, little Data collected in hospital settings and national, state and territory coordination corresponded to more severe injuries departments of sport and recreation than information collected through recognised and played a key role “However, its value beyond these general population surveys. in addressing sport safety issues. contexts is unknown. At present, Partnerships between health and there is little incentive to collect sports Generally, soft tissue injuries such as sport agencies had shown that they injury information and no specific sprains and strains and injuries to the were successful ways to address some body has the responsibility for doing lower limb were the most common. sports safety issues. Some states had so, or for coordinating such activity. Sports injury risk appeared to be higher developed infrastructure to support This adversely affects both the quality in males and younger persons, which local level sports safety initiatives, and of the data collected and its analysis. was likely to be related to participation some research activities, but a full levels and the types of activities that impact assessment of these schemes “The large number of local level males undertook (eg, competitive had not been undertaken, the report projects with their own data football) compared to females. said. collection forms and unstandardised methodologies compounds the Epidemiological studies had started to “Dissemination of injury prevention problem. provide evidence for potential sports information and other health injury risk factors. education strategies has become a “Limited time data collection exercises The WASIS had provided the best popular strategy in Australia. There are being promoted as injury information about risk factors is no doubt that health and safety surveillance activities but they rarely for sports injury in community education is important. include an ongoing monitoring and recording function. It is laudable that participants of four sports. Identified “However, the effectiveness of sports bodies and community groups risk factors included previous injury, sports-related injury prevention now see the collection of sports injury particularly a back injury, and certain education strategies, either alone or data as an important activity (and this psychological profiles. Protective in conjunction with other activities, in is a major change since 1997) but factors were being adequately this country is largely unknown.” ad-hoc data collections add little to prepared for the game by participating our knowledge about sports injuries, in formal training, having experience except for at the local level. in a sport, being generally healthy and SmartPlay having high physical endurance. “There is currently no lead agency The SmartPlay message, delivered to oversee or guide the future Injury history was consistently through the SMA’s networks, had development of an Australia-wide identified as an injury risk factor, been adopted by most States and approach to sports injury surveillance. suggesting that poor/inadequate territories and appeared to have rehabilitation or injury susceptibility some brand recognition. A key factor “Until such a body is established, (for reasons unknown) needed to in prioritising injury areas was the injury surveillance activities in this be addressed. It had been suggested existence or identification of key country are likely to remain ad-hoc,” that lower limb injuries, particularly injury indicators. Such indicators were the report says. in elite football, were related to needed to demonstrate that policy It was not possible with the current ground conditions and surfaces or the and other changes had actually led to available data, to compare sports pace of the game. However, specific changes in health status over time. injury rates across different States or examination of these factors in community-level sport had yet to be “The sports injury area is seriously other regions of Australia, nor was it undertaken. hindered in this aspect, as the quality generally possible to compare injury of the data sources leading to key risk across sports. This limited the “There is a need to combine indicators is very poor. ability to rank sporting activities for epidemiological, biomechanical and priority setting. Furthermore, there medical approaches to take sports injury “The major injury surveillance was no baseline against which injury prevention forward,” the report says. initiative since 1997 has been the prevention gains could be monitored. establishment of the Australian The available estimates of the costs of Sports Injury Data Working Party to The Western Australian Sports Injury sports injury were only, at best, very draw up guidelines for sports injury Study (WASIS) was the first prospective general indicators of the size of the surveillance, the report says. This cohort study of sports participants problem.

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“The figures are not comparable Safety strategies Summing up, the report provides an because of the different factors they update of sports safety initiatives that consider and the different costs they Sport safety plans at the sports club, have been conducted in Australia include and exclude. organisation and facility level had since the launch of the National Sports received attention over the past Safety Framework in 1997. “They are not accurate because of the five years. There was also quite a limitations of the existing data sources “Because of the recent activities in considerable amount of descriptive used to derive the figures but they do the sports injury area, we now have information, with recommendations nevertheless indicate the size of the a much better understanding of some on personnel, training and education problem and the potential cost benefits aspects of sports injury and sports for several sports at this level. to be gained from reducing it.” safety than at the time of National But sporting clubs in Australia varied Health Goals and Targets Initiative in The estimate by Egger in 19901 considerably in the extent to which 1994 and the setting of this national remained the only available figure for they considered or implemented risk Framework.” the cost of sports injuries in Australia, management policies, even in the few the report said. The report said that there were still sports in which this had been formally many aspects of sports safety where “The lack of a more accurate and up- investigated. knowledge is still quite limited and to-date estimate of the cost of sports “Furthermore, the proportion of clubs other areas where it was practically injuries hampers efforts to determine applying risk management policies, non-existent. cost-benefit ratios for the introduction as compared to emergency action of sports injury prevention measures. It provided in table form a summary policies or head injury management of the current status of sports injury “Furthermore, it limits the leverage policies, is low.” knowledge, as at the end of 2002, that can be applied to government There were various barriers to the comparing it to the earlier assessment and other organisations to address the development, implementation and of the National Injury Prevention significant sports injury problem in monitoring of these plans. Advisory Committee (NIPAC) in 1999. this country.” The table shows that, since the late The collaborative, volunteer nature of 1990s, “there has been an increase in sports clubs management had several knowledge about: Prevention associated barriers to risk management policies in these clubs. The issue • the burden/cost of sports injuries, The recognition of longer-term injury of volunteers was even more of a effects had implications for both • some potential risk factors(though problem in rural areas. Many clubs injury prevention and promoting this knowledge is still quite also lacked the knowledge and abilities physical activity. There had been very limited), to be able to perform the duties that few studies evaluating sports injury a risk management policy would • implementation of interventions, countermeasures both nationally and demand. Committees and personnel and internationally. The report points out had designated roles in a specific that this was one of the major gaps in • barriers and motivators associated sporting organisation, and at most current sports injury knowledge. with the uptake of interventions. clubs no personnel is assigned to ‘risk “This lack of information seriously management’ duties. “The only area where there is limits the provision of evidence-based good evidence available is in the On the question of protective injury prevention guidelines for sports description of the nature of sports equipment, the report points out that bodies, participants and parents. injuries. the use of, and factors relating to the “Considerable effort will need to be use of protective equipment in most “There continues to be no evidence given towards addressing this major Australian sports was not known. about what interventions have been information gap if significant gains formally trialled, the effectiveness “Furthermore, whether the equipment in sports injury prevention are to be of such interventions or the cost- being used in sports is suitably reached over the next decade.” benefit analyses associated with their protective, fits accordingly, and implementation.” International studies were beginning maintained properly is largely 1. Egger G. Sports injuries in Australia: causes, cost and to provide strong evidence for the unknown. Before efforts to promote prevention. Health Promotion Journal of Australia. effectiveness of ankle supports and protective eyewear, for example, 1991;1(2):28-33. balance board training for preventing can be effectively developed, it is ankle injuries. Protective equipment important to determine players’ current was a popular strategy but its behaviours, knowledge and attitudes effectiveness had largely not been associated with protective equipment demonstrated in the field. Some major and injury risk. Negative attitudes and trials of the effectiveness of protective beliefs towards the use of protective equipment were now taking place in equipment need to be addressed. Australia.

24 Sport Health SPORT SAFETY

Vietnam veterans: effectiveness of the “Heartmoves” exercise program by Mike Climstein, Janet Currie, Leanne Otter, Mark DeBeliso and Kent J Adams

More than 59,000 Australians served exercise program on primary resting systolic (SBP) and diastolic in the Army, Navy or Air Force cardiovascular risk factors, exercise blood pressure (DBP) were assessed branches of the Australian military capacity and flexibility in Australian via auscultation by an experienced during the Vietnam war (1962 to VVs. clinical exercise physiologist. Resting 1973). Australian Vietnam veterans heart rate was assessed via palpitation (VV) cohort health studies conducted of the radial artery over a 60-second in 19961 and 19972 involving more Methods period. Flexibility was assessed by than 41,000 Australian VVs found a standard sit and reach test and a significantly higher prevalence Subjects measured to the nearest 0.5 cm. The of hypertension, cancers, diabetes Vietnam veterans (n=19; Army, n=17, subjects were allowed three trials and ischaemic heart disease than in Navy, n=2) residing in metropolitan in succession with the best score other Australian men of similar age. Sydney volunteered to participate in recorded. Recommendations from the findings this study. Subjects were recruited in these surveys included developing by advertisements placed by the Submaximal exercise or amending standard operating NHF and the VVCS. Subjects were procedures relating to prevention fully informed of all procedures capacity and management of significant health and inherent risks involved, and disorders in VVs. Despite numerous provided written informed consent The HeartMoves exercise program investigations studying post-traumatic prior to participation. Additionally, stipulated that exercise was limited stress disorder, suicide and cancer, a subjects were required to provide to submaximal intensities; therefore review of the literature failed to find medical clearance from their general assessment of exercise capacity a single published article pertaining practitioner as stipulated by the was assessed via the steady state to either the HeartMoves exercise HeartMoves program. submaximal exercise criteria as program or exercise training and described by Jones and Campbell4. Prior to participating in the exercise, Australian VVs. Subjects completed a three-stage subjects completed a pre-exercise continuous exercise test on both a The HeartMoves program was assessment form which asked cycle ergometer at 60 rpms (Monark, initially designed as a safe low- respondents to report on their current model 828 E) at 25 W, 50 W, and to moderate-intensity exercise level of physical activity and medical 75 W and on a LifeFitness (model program for the general community history. 9500HR) motorised treadmill at which could also be utilised by 4.5 km.h-1, 5.5 km.h-1 and 6.5km. individuals with risk factors for Physiological assessments h-1. A cycle ergometer and treadmill cardiovascular disease or type II Height was measured to the 0.1 m were utilised, as the cycle ergometer diabetes. The Australian Vietnam using a standard medical scale (model tends to discriminate against leg Veterans Counselling Service (VVCS) Health O Meter, Bridgeview, IL) with strength and, for those subjects who of the Commonwealth Department body mass assessed on the same suffer from either knee and/or hip of Veterans Affairs contracted the device via the balance scale to the disorders that cause problems with National Heart Foundation (NHF) closest 0.1 kg. gait, the cycle ergometer allowed of Australia (Newcastle branch) to us the opportunity to investigate provide the HeartMoves program The sum of five skinfold thicknesses changes in their submax exercise to Australian Vietnam veterans. (biceps, triceps, subscapularis, capacity. The order in which subjects HeartMoves is intended to improve suprailiac and abdominal) using 3 performed the cycle or treadmill test the heart health of Australian VVs by methods described by Telford et al was randomised. Submaximal heart improving their cardiac risk factors were assessed with a Harpenden rate was assessed by telemetry and and exercise capacity. Therefore, the calliper to estimate body fat on all determined as the steady state heart purpose of this study was to evaluate subjects. Next, following a five-minute rate during the last minute of each the effectiveness of 10 weeks of quiescent period, subjects assumed five-minute stage of exercise. Subjects’ participation in the NHF’s HeartMoves an upright sitting position where RPE was also determined at that time

VOLUME 22 – ISSUE 4 • SUMMER 2005 25 SPORTFROM THE SAFETY CEO AFL INJURY REPORT

using the Borg scale of 0 to 10. At the However, as a group the VVs Table 2 depicts the resting conclusion of their peak stage of cycle reported being physically active haemodynamics, sum of 5 skinfolds ergometry, subjects were asked to (prior to the HeartMoves program) and flexibility results. Significant cycle at 50 rpms at an output of 12.5 at 3.39d/wk (range 0 to 7d/wk) at improvements (p<0.05) over time W for one minute. Recovery heart rate an average intensity of 3.1 (RPE were found in resting systolic blood was assessed at the completion of this scale 1 to 10). The pre-exercise pressure (6.9%), resting diastolic 60-second period. health assessment identified a high blood pressure (7.0%) and mean percentage of subjects reported arterial blood pressure (7.0%). There Exercise training suffering from hypercholesterolemia was however a non-significant The HeartMoves exercise program (68%) and hypertension (53%), improvement (6.5%) in pulse pressure consisted of four components: warm- which are primary risk factors for which is an independent risk factor up (10 mins), muscular strengthening heart disease. Other common health for all cause and cardiovascular using light hand weights (20 mins), disorders reported in the survey mortality. A significant improvement rhythmic endurance activities (20 included arthritis (58%), asthma (47%), of 12.9% was also found in resting mins) and a cool-down (10 mins). general heart problems — ie, heart heart rate. The sum of five skinfolds Each session lasted 60 mins and was attack, angina, palpitations, bypass, also significantly improved over supervised by the same accredited pacemaker, valves or angioplasty the 10-week period with the total HeartMoves instructor who advised — (26%), diabetes (16%) or kidney/ skinfolds decreasing by 8.2% and the participants to exercise at an intensity liver condition (16%). The pre- abdominal skinfolds decreasing by of a rating of perceived exertion of exercise health assessment reported 4.8%. Flexibility, assessed via sit-and- three to five (equating to 50% to 70% no instances of heart attack or stroke; reach, also improved significantly by HRmax). Static flexibility exercises however, two subjects did report 68.8% (approximately 2.8cm). suffering from chest pain/discomfort for the calf, quadriceps, hamstrings, Table 3 depicts the changes over prior to initiating the HeartMoves lower back and shoulder muscle time in the submaximal exercise exercise program but were allowed to groups were conducted during heart rates and rating of perceived participate by their doctors. both the warm-up and cool-down exertion. Significant improvements in periods. Group exercise sessions During the HeartMoves exercise submaximal heart rates were found were conducted in an indoor, program, two subjects had to be with the treadmill evaluations at air-conditioned facility two days withdrawn from the exercise (and 4.5km.h-1 (7.5%), 5.5km.h-1 (6.3%) per week for 10 weeks. Subjects study) due to complaints of exertional and 6.5km.h-1 (5.4%). However, participated in the HeartMoves angina. One has undergone coronary there were no significant differences exercise two days per week with all stenting, the other subject is pending in RPE at these stages. Significant subjects requested not to undertake further evaluation. differences in submaximal heart any additional exercise outside of the rates were found at 25 W, 50 W and The average subject compliance to training program and to maintain their 75 W on the cycle ergometer (7.5%, the HeartMoves exercise program “normal” daily activities. Additionally, 7.4% and 4.5% respectively), with a was 65.0% (range 24% to 86%). there were no make-up exercise significant change in RPE at the 50 Reasons (when provided) for non- sessions available to participants. W (13.9%) and 75 W (23.7%) power compliance included illness (28%), outputs. There was also a significant illness requiring hospitalisation (3%), improvement of 8.5% in the 60-second Statistical analysis holidays (52%), VVCS programs recovery heart rate. 5 for PTSD (7%) and “other” (9%). A two-tailed T-test was used to There were no make up exercise determine statistically significant sessions available in the HeartMoves Discussion differences over time (Pre vs Post). program. Table 1 depicts the Alpha was set (a priori) at 0.05 subjects’ characteristics. Subjects at The results of this study demonstrate for determination of statistical the completion of the study had a that 10 weeks of participation in the significance. non-significant decrease in mass HeartMoves exercise program improved by 1.5 kilograms (1.7% decrease). cardiovascular risk factors, exercise Results Given the decrease in the subjects’ capacity and flexibility in Australian mass, there was a non-significant VVs. These results are similar to the In the pre-exercise health assessment, 2.2% improvement in BMI with the results of Morey and colleagues6 who nine subjects (47%) reported group pre-test average of 30.32 found improvements in submaximal inadequate (ie, <3d/wk x <30mins) kg–m-2 (classified as obesity class 1) heart rate (7%), resting heart rate (8%) physical activity on a weekly basis improving to 29.66 kg–m-2 (classified and flexibility (11%) following a two- (according to the American College of as overweight). year supervised exercise program in Sports Medicine recommendations). older (65-74yrs) veterans.

26 Sport Health AFL INJURYSPORTFROM THE REPORTSAFETY CEO

Table 1. Subjects physical characteristics*

PARAMETER PRE POST P VALUE (T-TEST) Mass (kg) 87.82 (+ 13.08) 86.31 (+ 12.66) NS BMI (kg–m-2) 30.32 (+ 4.54) 29.66 (+ 4.39) NS

Note: *Values expressed as mean +S.D., NS = Non significant

Table 2. Subjects haemodynamics, skinfold and flexibility results*

PARAMETER PRE POST P VALUE (T-TEST) Blood pressure (mmHg) Systolic 136.63 (+ 11.12) 127.11 (+ 10.09) < 0.05 Diastolic 87.16 (+ 7.03) 81.00 (+ 6.94) < 0.05 MAP 103.64 (+ 7.25) 96.37 (+ 7.16) < 0.05

Heart Rate resting 80.37 (+ 9.11) 70.00 (+ 8.89) < 0.05 Skinfolds (mm) Sum of 5 108.01 (+ 25.20) 99.14 (+ 17.91) < 0.01 Flexibility (cm) - 4.11 (+ 6.70) - 1.28 (+ 6.66) < 0.01

Note: *Values expressed as mean +S.D., NS = Non significant

Table 3. Subjects submaximal exercise results*

PARAMETER PRE POST P VALUE (T-TEST) Treadmill .5km.h-1 eart rate (bpm) PE 99.67 (+ 2.91) 92.17 + 11.58) < 0.05 .72 (+ .32) 1.28 (+ .57) NS Treadmill .5km.h-1 eart rate (bpm) PE 107.06 (+ 3.21) 100.22 + 12.63) < 0.05 2.71 (+ .72) 1.94 (+ .90) NS Treadmill .5km.h-1 (n=15) eart rate (bpm) 116.27 (+ 2.88) 110.00 + 13.31) < 0.05 PE 3.47 (+ .30) 2.80 (+ .32) NS Cycle ergometer 25W eart rate (bpm) 96.44 (+ 3.24) 89.12 + 11.63) < 0.01 PE .83 (+ .04) 1.53 (+ .87) NS Cycle ergometer 50W eart rate (bpm) 107.00 (+ 4.48) 99.00 + 12.33) .53 (+ .01) < 0.01 PE 2.94 (+ .00) .05 Cycle ergometer 75W n=14) eart rate (bpm) 113.21 (+ 6.40) 108.07 + 13.88) < 0.01 PE 4.21 (+ .19) 3.21 + .19) < 0.01 60sec recovery HR (bpm) 101.67 (+ 2.01) 93.00 (+ 1.29) < 0.01

Note: Values expressed as mean +S.D., NS = Non significant

Although there are only two studies6, was of limited duration with no colleagues8 found a compliance rate 7 conducted involving exercise and opportunities for make-up sessions. of 71% in VVs who were prescribed VVs, the reported compliance of Anecdotal information provided by a naltrexone for the treatment of veterans participating in supervised number of the subjects pertained to alcoholism while Schectman et al9 exercise programs is quite poor the perception that the HeartMoves found a similar compliance rate of at 47%6, and 53%7, which is not program would be continued on a 73% in VVs prescribed bile acid dissimilar to our findings (65%). It long-term basis and there was no sequestrants. was surprising that more than 50% of concern of limited opportunity. The The significant improvements in the non-compliance was attributed remaining studies available pertaining resting blood pressure (~9mmHg to holidays, despite the VVs being to VVs and compliance involved SBP and ~6mmHg DBP) and resting aware that the HeartMoves program prescribed medications. Cramer and

VOLUME 22 – ISSUE 4 • SUMMER 2005 27 SPORT SAFETY

HR (10bpm) may dramatically affect the risk of these VVs of developing hypertension and related cardiovascular problems. The benefits of improvements in skinfolds (particularly abdominal) is further supported by Yusuf and colleagues10 who have recently reported in the INTERHEART study that abdominal obesity was found to be a strong risk factor (greater than BMI) as a predictor for acute myocardial infarctions. Our findings suggest that the HeartMoves exercise program offers a cost-effective, non-drug therapy which positively influences the overall cardiovascular risk of VVs. Additionally, the significant reduction in exercise heart rate, combined with the enhanced recovery time from aerobic exercise, enhances morbidities. This is in agreement with References 1. O’Toole BI, Marshall RP, Grayson DA, Schureck RJ, the ability of these VVs to perform other studies that have demonstrated Dobson M, French M, Pulvertaft B, Meldrum L activities of daily living (ADLs), work and Bolton J, Vennard J. The Australian Vietnam the positive health benefits of Veterans Health Study: II. self-reported health of and recreational tasks at a lower moderate activity. veterans compared with the Australian population. cardiovascular risk. Since a majority of Int J Epidemiol. 1996; Apr;25(2):319-30. Based upon these preliminary results, 2. Crane PJ, Barnard DL, Horsley KD and Adena MA. these VVs suffer from risk factors for we conclude that the HeartMoves Mortality of Vietnam veterans: the veteran cohort heart disease, lowering the potential study. A report of the 1996 retrospective cohort program is an appropriate exercise study of Australian Vietnam veterans. Canberra: for a cardiac event due to stress from Department of Veterans’ Affairs, 1997. program which is beneficial to the ADLs, work or recreational tasks is 3. Telford R, Egerton W, Hahn A and Wang P. Skinfold overall heart health of Australian VVs measures and weight controls in elite athletes. important. and warrants continued participation Excel. 5(2):21-25. 1988. 11 4. Jones N and Campbell EJ. Clinical exercise testing Qualitative analysis of our subjects despite the long-term benefits yet to (2nd edition). WB Saunders Company. Sydney, revealed increased socialisation be determined. AUSTRALIA. 1982. and reported levels of social 5. Hinkle DE, Wiersma W and Jurs SG. Applied statistics Acknowledgements for the behavioral sciences. Houghton Mifflin support associated with HeartMoves Company, Boston MA USA. 1987. participation. Participants revealed The authors would like to thank the NHF 6. Morey MC, Cowper PA, Fesssner JR, et al. Two-year trends in physical performance following supervised that they had been able to reduce (Newcastle branch) and the Harbord exercise among community-dwelling older veterans. levels of prescribed antidepressant Diggers Memorial Club for their financial American Geriatrics Society. 1991; 39(10): 986-992. support of this project. We would also like 7. Cowper PA, Morey MC, Bearon LB, et al. The impact medications and felt better able to of supervised exercise on the psychological well- to express our gratitude to Melissa Lowe for deal with experience of post-traumatic being and health status of older veterans. Journal of her assistance with the preparation of this Applied Gerontology. 1991; 19(4): 469-485. stress disorder. These qualitative manuscript. 8. Cramer J, Rosenheck R, Kirk G, et al. Medication findings(11) support this study’s compliance feedback and monitoring in a clinical Associate Professor Mike Climstein is with trial: predictors and outcomes. Value Health. 2003; physiologic results. The participants 6(5):566-573. the School of Exercise Science at Australian stated that over the course of the 9. Schectman G, Hiatt J, and Hartz A. Evaluation of the HeartMoves program, they felt more Catholic University and Director of effectiveness of lipid-lowering therapy (bile acid Rehabilitation at Harbord Diggers Memorial sequestrants, niacin, psyllium and lovastatin) for energetic, physically fit and less treating hypercholesterolemia in veterans. American Club in Sydney. Dr Janet Currie is Head Journal of Cardiology. 1993; 71(10): 759-765. “overweight”. Participation in the of the School of Exercise Science at ACU, 10. Yusuf S, Hawkin S, and Ounpuu. Effect of program was reported as offering the where Leanne Otter is an Honours student. potentially modifiable risk factors associated with myocardial infarction in 52 countries (The VVs a valuable way to access exercise Associate Professor Kent Adams is with the INTERHEART study): Case-control study. Lancet. and be able to relate to and bond Department of Health and Sport Sciences 2004; 364: 937-952. 11. Otter L and Currie J. A long time getting home: with a group of men who shared at the University of Louisville (US) and Vietnam Veterans’ experiences in a community similar backgrounds. Assistant Professor Mark DeBeliso is with exercise rehabilitation program . Disability the Department of Kinesiology at Boise State Rehabilitation. 2004; 26(1):27-34. It is also important to note that these University (US) physiological improvements were attained with a moderate-intensity exercise program that can be safely performed by previously sedentary subjects with a variety of co-

28 Sport Health BULLETIN

SDrA Sports Doctors Australia Newsletter

From the President that constructive practical ideas It is an opportunity not to be missed. and information were able to I urge you to mark this in your diary This is the first time my Committee be exchanged, future ongoing now and make the effort to attend. colleagues and I have had the connections were able to be made You will not be disappointed. opportunity to update SDrA members and the value of a multidisciplinary SDrA once again will be very of our activities through the pages of approach in providing the most much involved (through Dr Neville Sports Health. We hope to contribute effective form of advice and treatment Blomeley who is our representative regularly in this way in future issues. could be emphasised. It was also a on the 2005 Conference Committee) great opportunity to catch up with in the planning of the medical colleagues and friends. ACSMS2004 component of the conference and I The Alice Springs Convention Centre would take this opportunity to invite SDrA members contributed quite proved to be an excellent venue you to contact either Neville or myself significantly to the medical component of international standard and the if there are any topics you would like of the recent 2004 Australian social side of the conference was to see included. We are considering Conference of Science and Medicine in equally outstanding. The Conference having several three-minute Sport that was held in Alice Springs. Committee, SMA Board and SMA case presentations for interactive staff need to be congratulated for discussion. Please advise us if you Dr Anita Green was the Conference their organisation, implementation have suitable cases that you would Co-Chair and Dr Neville Blomeley was and smooth running of such a like to present. our representative on the Conference comprehensive program. Committee. * * * * * SDrA activities centred on the Please note that the members’ provision of very practical workshops 2005 Conference discussion forum is now accessible involving team travel, bracing through the SDrA website at www. Planning is well underway for next principles and indications, on-field sportsdoctors.com.au to provide year’s Conference which is to be held emergency medicine situations,and easy communication and discussion in Melbourne from 13 to 16 October soft tissue and joint injection between members. 2005 and will incorporate the Third techniques where models were National Physical Activity Conference * * * * * available to test and refine skills. and the Fourth National Sports Injury The Emergency Medicine workshop, Membership of FIMS will be available Prevention Conference. which was fully booked, was quite at no additional cost to all financial a highlight. Four groups of five There is so much to be gained by members of SDrA from the beginning participants rotated through four attending the National Conference. of 2005. stations, and each station was set It is a once a year conference * * * * * up with life-sized sophisticated where there will be interaction with interactive models and emergency It is with great sadness that I note the medical colleagues who have wide lifesaving equipment that addressed unexpected and sudden death of Dr and varied areas of expertise and emergency scenarios and allowed Bill Webb following his attending the experience as well as our discipline each participant a hands-on approach. 2004 Conference in Alice Springs. group colleagues with whom we I would like to acknowledge and work in our practices, where new Bill was a totally committed sports thank Laerdal Pty Ltd and St Andrews and practical approaches to injury medicine practitioner and a highly Hospital in Brisbane for providing the prevention and management will respected colleague. Both at home necessary components that made this be discussed, where the most up- and internationally, he will be such a spectacular success. to-date research will be presented, remembered for his contributions to where practical skills will be able many different sporting organisations The conference itself was well to be upgraded and where for a but more particularly for his attended by 270 delegates and the concentrated few days there will be outstanding services to rowing. very full program offered something access to world authorities in most for everyone. The boutique nature aspects of science and medicine in of this conference encouraged sport. interdisciplinary involvement so » to page 31

VOLUME 22 – ISSUE 4 • SUMMER 2005 29 BULLETIN The team behind the teams at Melbourne 2006

The Melbourne Commonwealth Games don’t take place until 2006, but preparing for them has already been well underway. A central part of the largely unsung background to the Games is looking after the athletes taking part. Gary Moorhead, CEO of SMA, talks here with Dr Peter Harcourt, Chief Medical Officer of the 2006 Commonwealth Games, about what the medical coverage of the Games entails.

GM: Can you provide us an overview PH: Based on experience from large GM: Are there any events or athletes of Melbourne 2006 Commonwealth sporting events, and the opportunities that you are particularly looking Games? available, we will be implementing forward to seeing in action at the some new initiatives for the Melbourne Melbourne Games? PH: The Melbourne 2006 2006 Commonwealth Games. Commonwealth Games will be the PH: While I am looking forward to a biggest sporting event in Victoria’s We are also investigating a new range of events and individual clashes history. About 4500 elite athletes, element to the sports medicine at the Melbourne 2006 Commonwealth representing 71 nations -- or about one program that utilises Australian Games, I will be particularly keen to third of the world’s population--will sports medicine staff, especially see the Opals and Boomers in their descend on Melbourne for 12 days of physiotherapists and masseurs, and first Commonwealth Games. I won’t sporting competition from 15-26 March places them with visiting teams. This be able to sit on the bench with 2006. initiative will provide an improved the Boomers but I will be courtside level of service for the athletes and watching -- loudly! The athletes will be competing in 16 a unique experience for those sports sports across 24 disciplines across 31 GM: Can the sports medicine medicine professionals involved. competition venues. community get involved with the In Melbourne, sports trainers will Games? GM: What is the role of the medical be included in our sports medicine services? PH: Yes, they can definitely get volunteer program for the first time. involved and there will be a variety PH: The medical services play an Sports trainers will be an important of opportunities. It is important to important part in the success of the part of the sports medicine teams at understand that a large number Games. By giving athletes prompt venues and will assist in ensuring and range of medical and health and efficient treatment we will be initial injury management for all professionals are required to volunteer able to allow them to focus on their athletes. for the sports medicine program. competition. You can see we are keen to make Details are still being finalised and will As part of the Commonwealth the Melbourne Games a worthwhile be released as part of the Volunteer Games medical services, a Polyclinic medical experience – not just Program Launch in the first part of will be established at the Games participation in a major, high profile 2005. Village in Parkville. This clinic will sporting event but also professionally Those medical professionals from all provide a range of services including stimulating. discipline areas who would like to general practice, sports medicine, GM: What about drug testing? Have register their interest in volunteering physiotherapy, podiatry, optometry, we learnt anything from the Athens can do so at the Games website: go dental care, imaging, massage, Olympics? to www.melbourne2006.com.au and psychology and some specialist follow the link – ‘Getting Involved’. medicine: the works – all that is PH: The Athens Olympics raised the needed to support the athletes in their standard of drug testing with the The joy of working in a large team competition. introduction of blood testing and other should be experienced by all those technological advances. As can be who are interested and involved in Each competition venue will also have seen by the large number of positive sports medicine – it is great fun and an appropriately staffed medical centre tests, including higher profile athletes extremely gratifying. to ensure that athletes can get attention and gold medallists, the drug testing when they require it. Being a part of the Melbourne Games programs are gaining strength and are will be a once in a lifetime experience GM: Will there be any new or different winning the battle against drug cheats. medical services available at the The Melbourne Games will add to not to be missed. Melbourne Games? this battle with a rigorous drug testing program.

30 Sport Health BULLETIN JSMS: Major expansion of the Editorial Board

The Editorial Board of the Journal of In alphabetical order, the new members are: Science and Medicine in Sport has Associate Professor Shona Bass of Deakin University been expanded with 17 new members Dr Tim Carroll of The University of New South Wales to broaden the Journal’s coverage of injury epidemiology, physical activity Dr Marijke Chin A Paw of the Free University of Amsterdam epidemiology, sports physiology, Dr Jill Cook of La Trobe University sports psychology, biomechanics, Dr Aaron Coutts of the University of Technology, Sydney exercise physiology, pulmonary Dr Peter Eastwood of The University of Western Australia physiology, motor control and skill acquisition. Dr Damian Farrow of the Australian Institute of Sport Dr Belinda Gabbe of Monash University Their appointment to the Board confirms the Editors’ desire to confirm Dr Stephanie Hanrahan of The University of Queensland and extend the multidisciplinary Dr Paul Laursen of Edith Cowan University and applied nature of the Journal, Dr Anthony Leicht of James Cook University as well as add to its international Associate Professor Frank Marino of Charles Sturt University representation. Associate Professor Ken Nosaka of Edith Cowan University Dr Mireille van Poppel of the Free University of Amsterdam Dr Jo Salmon of Deakin University Dr Ian Shrier of McGill University Professor Peter Terry of the University of Southern Queensland In addition, some long-standing members have decided to retire from the Board. They are Professor Bruce Abernethy Professor Louise Burke Professor Bruce Elliott Mr Michael Kinchington Professor Willem van Mechelen Professor Lawrence Spriet Associate Professor Julie Steele.

» from page 29 Bill shared a vision with the late Dr Bill’s knowledge, experience, practical President David Garlick to improve medical and commonsense approach to Dr Bill Straughan practitioner education and skills sporting issueswill be missed. Vice President and Secretary: in sports medicine practice. They * * * * * Dr Neville Blomeley produced at the University of NSW Treasurer the annual two-week course that The SDrA Annual General Meeting Dr Trevor Law ultimately resulted in them organising was held on 8 October 2004. the Graduate Diploma and Masters Members of the Committee for the Committee Members courses in Sports Medicine. From next year are Dr Shane Brun, Dr Brendan de those courses, SDrA evolved. Morton, Dr John Estell, Dr Maddy Martin, Dr Tom Mittiga. Bill Straughan President SDrA

VOLUME 22 – ISSUE 4 • SUMMER 2005 31 FOR YOUR LIBRARY For your Library

From Breakpoint to Running: Sports Injuries: Year Book of Sports Advantage: Biomechanics and Diagnosis and Medicine 2004

A practical exercise physiology management Roy J Shephard et al (Eds) guide to optimal applied in practice Christopher Norris Published by Mosby in cooperation with ACSM, tennis health and Frans Bosch and Published by Butterworth distributed by Elsevier Ronald Klomp Heinemann, distributed by Australia performance Elsevier Australia Published by Churchill ISBN 0323020577 ISBN 0-7506-5223-3 Babette Pluim and Livingstone/Elsevier This year’s selection of Marc Safran Australia This the third edition of abstracts contains the (www.elsevier.com.au) this well-known handbook, Published by Racquet Tech customary huge range of completely updated and Publishing ISBN 0-443-07441-0 interests. Some tantalising (www.raquettech.com) extended, providing scientifi c Running presents the latest discoveries: information and clinical ISBN 0-9722759-1-6 insights on practical training guidance for all involved techniques based on recent This “ultimate guide to sports in treating injured sports research on biomechanics medicine and physical training people. This addition has and exercise physiology for in tennis” (in the words of more than 440 line drawings runners and their medical Todd S Ellenbecker) provides and 146 photographs and support. Chapter subjects go information on description, plenty of format changes, the all the way from discussing treatment and prevention objective being to make it basic anatomical and of all types of tennis injury more visually and clinically biomechanical principles and for players well as sports informative. Its 20 chapters the physiology of exercise medicine professionals and cover the biomechanics to close analysis of running coaches. It has a 6-part of injury, tissue healing, technique and strength structure: Principles of injury sports massage, taping, training for athletes. The prevention and rehabilitation; exercise therapy, fi rst contact authors are well known Complete inventory of tennis management, gait, and injury coaches in The Netherlands. injuries; Medical issues; to trunk and upper and lower Special issues; Special tennis limb. groups (juniors, wheelchair players, etc); and Managing and delivering tennis medicine SMA regrets to announce the death of Dr Bill Webb, Secretary and President of programs. Topical subjects the then ASMF in the late 1970s and early 1980s, one of the architects of the covered include heat stress, development of a full-time secretariat for the federation, and a pioneer with the sports drinks, supplements, late Dr David Garlick of ways to improve sports medicine practice by general over-training, playing surfaces practitioners. and doping. Sport Health will publish an obituary of Dr Webb in its Autumn issue.

32 Sport Health BULLETIN The Alice Springs “friendly”

Masters Games by Amanda Shipway

You will often hear it said “There’s coverage of the event through the coordinated the sports coverage at all something different about the Alice week providing more than 2000 hours 10 Masters Games; Pippa Tessmann, Springs Masters Games”. Perhaps it of volunteer services to the Games! Physiotherapy Co-ordinator; Paul is the size of the town (27,000), the Dixon and Cliff Smith, Alice Springs The majority of trainers were from friendliness of the locals, or the sheer Masters Contacts; Annie Davis, the Alice Springs which is fantastic and numbers of visitors who converge on sports trainer co-ordinator and all the demonstrates a strong commitment Alice Springs for the bi-annual games. sports trainers who volunteered over to sports medicine in the Centre. A My belief is that it is hospitality, the week. Their efforts are greatly smaller number of trainers traveled friendliness and assistance of more appreciated. to Alice from Darwin, South Australia than 500 volunteers at the Games, and Western Australia to participate SMA NT Branch is currently 60 of whom are sports medicine as volunteers and their assistance was negotiating with the Northern volunteers. appreciated. Territory Government to provide Sports Medicine Australia NT Branch sports first aid coverage at the (SMA NT) under the stewardship of upcoming Arafura Games (14 – 21 Dr Geoff Thompson, sports physician Injury rates May 2005). To register your interest, and Alice Springs Masters Games In 2004 more than 4,500 competitors or to find out more about the Alice Medical Director, has been providing competed in the Games across 33 Springs Masters Games or upcoming sports first aid coverage at the Alice sports ranging from athletics to International Arafura Games ring SMA Springs Masters Games for the past volleyball. in the Darwin Office on telephone: 10 games! 89815362 or email: [email protected]. An average of 90 patients per day au. The sports medicine coverage were seen by the sports medicine model developed over this time, clinic, with return to competition rate, Amanda Shipway is Executive and perfected at other key sporting after treatment, in the range of 65% Officer of SMA NT. events such as the Arafura Games, has – 70%! proven to be extremely successful. The model includes the construction “The injury rates were exactly as we of a 15-bed medical sports clinic have come to expect over the past constructed in the Traeger Park nice games with approximately 650 Swimming Centre and a 2-bed clinic injuries assessed in the clinic,” Dr at the netball and basketball stadiums. Thompson said. “By far the majority The clinics are staffed on a 10-hour of the injuries reported were muscle rotational basis by a range of sports injuries. In particular there were a medical professionals. high incidence of hamstring and calf muscle tears”. In 2004, the sports medicine team consisted of a sports physician, Dr The whole event from the Sports Thompson and Medicine perspective was a great four sports medicine registrars: Dr success. Greg Harris, Dr Kylie Sellwood, Dr This success would not have been Sandra Mejak, possible without all the sports Dr Karen Soo and Dr Corey trainer volunteers, sports registrars Cunningham. In addition, there were and physiotherapists who worked nine physiotherapists from across tirelessly to provide the competitors Australia, led by sports physiotherapist with the best possible care. co-ordinator Pippa Tessmann. In particular, I would like to mention A further 60 sports medicine-trained Dr Geoff Thompson who has sports trainers were involved in the

VOLUME 22 – ISSUE 4 • SUMMER 2005 33 BULLETIN

Australian Conference of Science and Medicine in Sport 2004 Conference Awards By Andrew Fulford Sport Health congratulates the winners of the Australian Sports Medicine Federation Fellows Awards at ACSMS, Alice Springs, 2004

Asics Medal (Best Paper Asics Best Paper John Sutton Award for (Injury Prevention and Health Overall) Promotion) Best Young Investigator Dr Tim Olds Ms Christine Armit – Basic Science (K. Ridley) (W.Brown, C.Ritchie, A.Marshall, Mr Fang Wang University of South Australia S.Trust, A.Green) (G.Murrell, M.Wang) Activity styles: A cluster analysis of School of Human Movement Studies, Orthopaedic Research Institute children’s activity patterns The University of Queensland Involvement Of C-Jun N-Terminal Promoting Physical Activity To Older Kinase (Jnk) In The Oxidative Stress- Best Paper Awards: Adults In General Practice Induced Tendon Cell Apoptosis And Matrix Degradation Asics Best Paper Asics Best Paper (Clinically Relevant Conditions) (Lower Limb) Asics Award for Best Young Mr Steve Saunders Dr Kate Webster Investigator – Lower Limb (M.Coppieters, M.Magarey and (R.Siebold, J.Elliot, J.Feller) Mr Adam Bryant P.Hodges) Musculoskeletal Research Centre, La (E.Eiling, A.Murphy, W.Peterson, Saunders Sports and Spinal Trobe University J.Kelly, E.Hohmann) The University of Queensland Graft Selection For Anterior Cruciate Central Queensland University Ligament Reconstruction In The Low back pain and associated Effects Of Menstrual-Cycle Hormone Female Athlete changes in deep abdominal muscle Fluctuations On Musculotendinous activation during human locomotion Stiffness And Knee Joint Laxity: Young Investigator Implications For Acl Injuries Asics Best Paper (Performance Enhancement and Awards: NSW Sporting Injuries Committee Basic Science) Award – Best Young Investigator Ken Maguire Award for Best Young – Injury Prevention Mr Aaron Petersen Investigator – Clinical Miss Ebony Scase (K.Murphy, M.McKenna, R.Snow, Mr Nick Potter D.Cameron-Smith, A.Garnham, R. (J.Cook, M.Makdissi, B.Gabbe) (P.Brukner, M.Makdissi and Aughey and G. Leppik) K.Crossley) La Trobe University Victoria University of Technology Centre for Health, Exercise and Physical training programs reduce Increased Na+, K+-Atpase Gene Sports Medicine, The University of injuries in elite junior Australian Rules Transcription Is Related To Depressed Melbourne Football? Evaluation of an injury Na+, K+-Atpase Activity Following prevention strategy Navicular Stress Fractures: Outcomes Acute Intense Exercise. Of Conservative And Surgical Management

34 Sport Health BULLETIN ACSMS National Conference Report

by Angela Cox, SMA Conference Manager

On behalf of the 2004 Organising Committee, my thanks to all sponsors, speakers, trade exhibitors and delegates who supported the inaugural “boutique” Australian Conference of Science and Medicine in Sport in Alice Springs last October. Women in Sport Award We have had extremely positive feedback, all attendees enjoying an excellent Wendy Ey Women in Sport Award scientific program featuring keynote presentations from Dr Peter Brukner, Professor Mark Hargreaves and Professor Bruce Abernethy. Delegates were able Ms Deirdre McGhee to complement the science with a relaxing social program and a variety of pre and (B.Power, J.Steele) post touring options. Guest speaker Dr Geoff Thompson was one of the bonus University of Wollongong highlights of the conference as he entertained diners at the annual Fellows Dinner. Bouyancy and breast bounce: Does A special thank you to Mark Doherty and ASICS who were once again the Major deep water running reduce exercise- Conference Sponsor and whose support ensures that 14 prestigious Australian induced breast discomfort? Sports Medicine Federation Fellows Awards valued at more than $28,000 are available each year to support new research. I would also like to thank John Poster Awards Anderson from the NSW Sporting Injuries Committee and the Australian Sports Commission for their continued support. Best Poster Clinical The 2005 Organising Committee has been working tirelessly in recent months to Prof George Murrell ensure that all preliminary details for next year’s conference have been finalised (M.Sein, J.Walton, J.Linklater, earlier than ever. R.Appleyard, D.Kuah, B.Kirkbride) They are therefore able to announce that ACSMS2005 will be held from 13-16 St George Hospital, Sydney October at the Melbourne Convention Centre in Melbourne and that for the first time it will be held in conjunction with the Fifth National Physical Activity Supraspinatus tendinosis and elite Conference (13-15 October) and the Fourth National Sports Injury Prevention swimming training Conference (15-16 October). AOK Health Best Poster This unique mix of conferences will ensure that the Conference theme “Promoting (Performance Enhancement and innovation, measuring success” will be explored across the areas of sports science, Basic Science) sports medicine, physical activity promotion and sports injury prevention. The Prof Rabindarjeet Singh conferences will provide you with an excellent opportunity to keep abreast of the latest findings and developments in research and interventions across all areas. (J.Singh, G.Khanna) Universiti Sains Malaysia An outstanding scientific program will bring together leading international and Australian speakers whose innovative research is helping shape the future of sports Effects of coconut water ingestion medicine and science here in Australia and throughout the world. on cycling performance in heat and humidity Confirmed speakers include Professor Roald Bahr, Oslo Sports Trauma Centre & University of Sport and Physical Education, Dr Shona Bass, Deakin University, Journal of Science and Medicine in Professor Irene Davies, University of Delaware, Dr Billie Giles-Corti, The University Sport Best Poster (Injury Prevention of Western Australia, Dr Karim Khan, University of British Columbia, Dr Kevin and Health Promotion) Kirby, California School of Podiatric Medicine, Dr Willem van Mechelen, VU Mr Nathan Johnson University Medical Centre, Amsterdam and Dr Jill Cook, Latrobe University delivering the 2005 Refshauge Lecture. (S.Stannard) Other 2005 highlights include bringing together more than 700 key stake holders The School of Exercise and Sports and sports medicine professionals from all sectors of sports science, sports Science, The University of Sydney medicine, physical activity promotion and sports injury prevention and the largest Insulin resistance, muscle triglyceride trade ever assembled for the Australian Conference of Science and Medicine in and inactivity: From survival to diabetes? Sport. We are accepting papers and taking registrations for 2005. Please visit the conference website at www.sma.org.au/acsms/2005/ for further information or alternatively contact the Conference Secretariat at [email protected].

VOLUME 22 – ISSUE 4 • SUMMER 2005 35 MEMBER BENEFITS SMA Member Benefits

The SMA Member Benefits team has selected four benefits • Win a free website package for September/October that we believe will be of special • Reduce your telephone spend with corporate priced plans interest to members. • Fleet like discounts and more on purchasing a new vehicle • Get more rewards out of your credit card

Win a FREE Website for • Full suite of DSL products Special Offer – your Business • Lease or purchase phone systems September 2004 • Dedicated account manager We are keen to help our small ABFS Protection Pack^ included business members to increase their • Award winning customer service with every new car bought during profile and potentially their revenue. • Full account analysis September/October If you do not currently have a website • Headlight protectors presence, why not go into a draw • One convenient account to win a free total website package • Bonnet protectors to get you on line at nil cost. This Take the pain out of buying • Mud flaps package will include: a new or used vehicle * Industry standard warranty periods apply • A 5 page website designed to suit ^ Offer ends 29th October 2004 your business The Automotive Buying and Finance • Your own “.com” domain name Service will save you valuable time and Are your credit card money by organising the purchase of • Hosting of your site for 6 months your new or used car. All you need rewards still rewarding? To enter this draw, please email your to decide on is the make, model and In recent months a number of details to us by Friday 29 October. colour. They will also: organisations have reduced the value of The winning member will be notified • Arrange finance: fleet level their Gold Credit Card Rewards Programs on Monday 1 November. discounts available on new vehicles including the value of the Qantas and customised finance at bank Frequent Flyer points. Through your Let us help you rates. benefits program you still have access to one of the most rewarding cards in the reduce your business • Take care of your trade in market - the Citibank Gold Card. telecommunication costs • Deliver your new car to door to Benefit from: test drive in peace • $ for $ Rewards points People Telecom will provide you • Make sure your used car is with corporate pricing plans to suit mechanically checked, detailed, • $ for $ Qantas Frequent Flyer points your business needs. Members with roadworthied and comes with a • Low interest rate of 6.9% p.a.* for small to medium sized businesses warranty* will benefit from call plans normally the first 9 months reserved for larger corporates and • Not charge you for using this • No annual fee in the first year corporates will benefit from extremely service • Bonus Rewards points on balance competitive plans. An additional 5% • Clearly show your member transfers at a low 6.9% p.a.* discount has been arranged for all discount on order forms * Fees and charges apply. Terms and Conditions new members. apply and are available upon request or see the Citibank brochure for further details. All Citibank People Telecom will also provide you standard credit card Annual Percentage Rates are with: variable and subject to change. • Full suite of voice products (including capped calls)

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36 Sport Health