Elsevier

The Lancet

Volume 380, Issue 9836, 7–13 July 2012, Pages 59-64
The Lancet

Series
Sport and exercise as contributors to the health of nations

https://doi.org/10.1016/S0140-6736(12)60865-4Get rights and content

Summary

Self-reported rates of participation in sport vary by country. In the UK, about 40% of men and women aged 16 years or older participate in at least one sport every week. Although few data exist to assess trends for participation in sport, there is little evidence of change in the past decade among adults. Large cohort studies suggest that such participation in sport is associated with a 20–40% reduction in all-cause mortality compared with non-participation. Randomised trials and crossover clinical studies suggest that playing sport is associated with specific health benefits. Some sports have relatively high injury risk although neuromuscular training programmes can prevent various lower extremity injuries. Clinicians can influence a large number of patients through brief interventions that promote physical activity, and encouragement toward participation in sport for some physically inactive patients qualifies as evidence-based therapy. Exercise might also be considered as a fifth vital sign and should be recorded in patients' electronic medical records and routine histories.

Introduction

Nations bidding to host the Olympic Games usually claim that the event will promote public health. Organisers suggest that global events such as the Olympics or the Fédération Internationale de Football Association (FIFA) World Cup might inspire onlookers to be physically active, and thus obtain health benefits. Whether these events lead to an upsurge in physical activity is uncertain and has been reviewed elsewhere.1 In this report, we examine the broader question of whether sport and exercise specifically contribute to the health of nations.

Section snippets

Sport and exercise versus physical activity

Because we aim to assess the contribution of sport and exercise to the health of nations, a distinction needs to be made between sport and exercise and physical activity. Physical activity is “any bodily movement produced by skeletal muscles that results in energy expenditure” and is positively correlated with physical fitness.2 The broad components of physical activity are occupational, transport, domestic, and leisure time, which consists of exercise, sport, and unstructured recreation. Most

Rates of participation in sports and exercise

To estimate the potential influence of sport and exercise, we need to assess rates of participation in those activities at a population level and information about the associations between sport, exercise, and health outcomes. Accurate, cross-sectional, population-wide data for participation in sports are rare. For example, details of participation in sport cannot be extracted from the largest physical activity questionnaire in the USA—the Behavioural Risk Factor Surveillance System.7

Health benefits of sport

What evidence is there for direct health benefits of sport? The Physical Activity Guidelines Advisory Committee state that: “The volume of regular physical activity has been frequently and consistently related to health benefits”.20 The relation is curvilinear with the exact parameters of the curve varying for different health benefits (figure 2).19 Physical activity inherent in sport contributes to health benefits commensurate with the proportion of total physical activity that the sport makes

Health promotion through sport

In addition to the direct health benefits derived from physical activity of sport, sport can provide indirect benefits through campaigns for health promotion. Sporting celebrities can act as spokespeople for health, especially for targeted audiences such as schoolchildren. FIFA disseminated a health education programme branded 11 for Health,29 which used football to engage primary school students by linking each of 11 health messages with a well-known football player. For example, in one of the

Injury risk in sport

In addition to health benefits, physical activity is associated with health risks, mainly musculoskeletal injuries. Injury risk is greatest when individuals perform at the highest levels of relative intensity, which is common in competitive sports. Sports injuries are not routinely reported at a national level in the way motor vehicle accidents are, but insurance data suggest that costs from sports injury are substantial. In Switzerland, 42 000 football players generated 145 million Swiss

Clinicians in promotion of sport and exercise

Physicians and other health professionals can contribute substantially to patients' adoption of exercise behaviours, just as they have provided smoking cessation advice and contributed to smoking reduction in many countries. A straightforward but influential step forward would be measurement of the exercise vital sign43 in every consultation. Patients ought to report how many minutes of physical activity they undertake in an average day and how many days a week such activity takes place. This

Conclusion

The evidence for physical activity as a major public health preventive approach and a potent medical therapy has increased exponentially in the 64 years since London, UK, last hosted the Olympic Games. Recent major national and international guidelines provide consistent recommendations and policy advice (eg, the Toronto Charter49 and Physical Activity Guidelines from WHO50 and the USA34). Sport is one sector that can improve the health of a nation through increased physical activity, but

Search strategy and selection criteria

We searched Medline, CINAHL, Embase, SPORTDiscus, and the Cochrane Library databases between Oct 1, 2010, and Jan 31, 2012, for articles published in English without date restriction with the search terms “Sport*[MeSH Terms]”, “exercis*[Title/Abstract]”, “jog*[Title/Abstract]”, “run*[Title/Abstract]”, “aerobic train*[Title/Abstract]”, “physical* fit*[Title/Abstract]”, “Sports[MeSH Terms]”, “Exercise therapy[MeSH Terms]”, “physical* activ*[Title/Abstract]”, “randomized controlled

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