Monday, 24 January 2011

Dr Bhavesh Kumar SEM Registrars reports from UKSEM 2010

Impressions from UKSEM 2010

London hosted the inaugural UKSEM conference over 4 days from 24 – 27 October 2010. It was billed as Europe’s largest Sport and Exercise Medicine (SEM) conference, a world class multidisciplinary meeting for professionals with an interest or working directly in sports medicine, sports science, physical activity promotion and conditioning, and rehabilitation. It aimed to re-invigorate and re-position the BASEM conferences on the global map, and provide an occasion to demonstrate the growth of SEM in the UK, both in quality and quantity.

The word on the ground was one of massive approval. There was a genuine feel of a high quality international conference.  Everything this year was ‘big’!

The Venue

The gigantic ExCel International Exhibition and Conference Centre played host, in London, the largest and most accessible city for national and international delegates. It felt like we had the whole arena to ourselves, though the Capital Suite was an intimate part of it, with ample space for a the 42 carefully chosen and relevant exhibitors, a decent quality spread of lunch and refreshments, and multiple break-away rooms surrounding the two main partitioned lecture halls.   

The Delegates

Over 600 delegates from a variety of sports and exercise health related backgrounds in the NHS, military, elite sport and private sectors attended over the course of the 4-day program. In addition to many senior, experienced and well-recognised figures, it was fantastic to see a notable presence from undergraduates, some of whom submitted posters or gave oral presentations of their research. The majority of the SEM Registrars from around the country and many recently qualified SEM specialists saw this as an important forum to meet, network, learn, present, and be inspired. Some trainees took the opportunity to chair seminars and sessions on oral presentations of research.

The Format

Vying for attention were two main steams of parallel sessions in large lecture halls, a ‘GP Masterclass’ Day, oral presentations of research, as well as almost a hundred poster presentations, and a surprisingly interesting selection of exhibitors and sponsors. Essentially, there was something for everyone at every moment.

In between keynote lectures, many delegates were found jumping between adjacent parallel sessions to miss as little as possible, and it was almost impossible to choose only 2 from a superb selection of 9 workshops. The breadth of topics included ones on exercise physiology, immunology and metabolism, biomechanics, rehabilitation, complimentary therapies, rheumatology, sports medicine, and the role of certain technologies.

The 44 abstract presentations across two mornings each provided 10-minute résumés of their work. Categories covered the widest possible cross-section of basic science research, sport science and human strength and conditioning, sports medicine, exercise medicine and population health. This complimented almost a hundred posters on display. There were many contributions from young researchers as well as experienced consultants and full-time researchers, and prizes were given for the best ones in their categories. Thus there was ample encouragement for delegates to make a submission for next year!

With the risk of pulling delegates in too many directions, thus spreading them thinly in parts, it may be a consideration to take one leaf from the American conference (ACSM) model, and perhaps have an earlier start to the day, thereby giving an opportunity for interested delegates to attend the abstract presentation sessions without missing out on the main speakers.

If one felt tempted to take some physical exercise amongst all the cerebral overload, then there were offerings of running style analysis with video motion capture and tailored advice on footwear, as well as trials of anti-gravity treadmills, used to assist in gradual weight bearing rehabilitation, which are popular among the military and premier league clubs.

The Keynote Speakers

There’s no doubt that the most important ingredient in making UKSEM a world-class conference was the A-list speakers, with many of them being world leaders in their fields of special interest.

Professor Eddie Coyle from Texas gave the opening keynote lecture on the limits of human performance, based on his 3 decades of research and 125 publications. He talked about genetic and trainable factors, and gave us all hope, after declaring the likes of Lance Armstrong and Paula Radcliffe, having started with average physiological efficiency, have been able to develop this by around 1% per year. We can apparently expect a 1 hour 45 minute marathon in the next decade or two! 

It was inspiring to have a high profile speaker like Lord Coe, who chaired the Olympic Bid Company that successfully brought London the 2012 Games, and with it subsequent funding for our Specialty training programmes. He spoke with fluency of his journey from being inspired to take to the track after watching the Olympic Games in 1968 at the age of 13, to his vision of the 2012 Olympics providing similar impetus to our children, thereby improving both physical and mental well-being, while empowering the youth “to make better life-decisions” generally. Perhaps an invitation to next years conference will provide an opportunity for him to divulge a little more about the Olympic legacy, as the 2012 Games draw closer and the economic state of the nation moves forward.

Professor Micheal Kjaer from Denmark attracted a large audience despite speaking just prior to the evening drinks reception at the close of the first day. He enlightened us with some of his cutting-edge work and ideas on tendinopathy, and key areas of future development.

We were provided insight into how Australia and America are each tackling their own physical inactivity epidemic, and lessons the UK could take note of. Professor Paul McCrory spoke of Australia’s ‘Life, be in it’ campaign and their use of ‘lifescripts’ to prescribe exercise in primary care. He alluded to the need to provide a core message to a clear market using a multimedia approach to reach out and achieve sustained physical activity and behaviour change. Professor William Haskel, who has been chairman of the Physical activity guidelines committee in the US, informed us of the vision of ‘Exercise is Medicine’, and their drive to make the details of the physical activity each patient takes per week a ‘Vital Sign’, which can provide a basis for monitoring and prescribing appropriate exercise.  

Respected figures from the world of sports performance and training attracted most attention on the UKSEM twitter page! Mr Kelvin Giles came fresh from an Interview on BBC radio to give an energetic presentation of his concerns regarding the paltry amounts of heart rate-increasing activity being performed by children during each PE lesson. He argued passionately that current focus is too sport specific, and does not reach out to children of all abilities, address cardiovascular fitness nor movement efficiency. He suggested ‘five-in-five’ routines daily that involve a minute each of squatting, lunging, pushing, bracing and rotating for example, to produce functional gains in strength, stability, flexibility and posture that children can use as they get older, and reduce the risk of comorbidities setting in in middle age. Mr Vern Gambetta continued the theme of the need to incorporate functional training movements in Return to Sport Programmes after injury, as well as addressing risk factors for injury, and principals of prevention.

Edzard Ernst, professor of complimentary therapy, ran through an informative and comprehensive summery of decades years of research into the effectiveness of all manner of alternative therapies from homeopathy and hypnosis, to acupuncture and chiropractice. Despite being frequently sought by sportsmen and women of all abilities, he explained that there is little good quality evidence proving that many of these modalities work, and of course the curabo effect is difficult to account for in many cases, particularly where appropriate sham or placebo is difficult to produce.     

Defence Rehabilitation

One parallel session on the entire third day held in one of the two main lecture halls was dedicated entirely to Defence Rehabilitation. Sessions covered clinical problems that are commonly encountered in the Army, their management and rehabilitation. Topics included injuries to nerves and the musculoskeletal system, rheumatologic disorders, imaging, the physical thermal demands of parachute training, and conflict rehabilitation in Afghanistan. There were also prizes given for abstract presentations.

GP Masterclass

This full day event was held in a separate seminar room on the second day, and was designed as a fairly comprehensive, highly relevant and enticing stand-alone event, attracting its own subscription fee. There seemed to be 50 or more delegates present at most times, though some of these were people from the main event who chose to sneak in to hear talks on interesting clinical and practical topics from senior figures.

For example, Dr Richard Budgett spoke about the medical preparations for London 2012. BASEM president Sir Malcolm Read answered the topic of ‘Doctor, am I fit to start an exercise class or run a marathon?’ The senior Irish Rugby team doctor Eanna Falvey gave his triangle approach to musculoskeletal anatomy, whilst the equivalent for the English RFU discussed ‘when can a patient return to sport after concussion?’ The CMO to the European PGA Golf Tour, Dr Roger Hawkes, covered upper limb problems in Golfers. Dr Phil Batty, who works with Blackburn Rovers FC as well as a local school, talked about sports injuries in children.

There were also talks on How to prescribe exercise, Managing common upper and lower limb complaints in primary care, Imaging sports injuries, and The perils of providing touchline, racing or pitch side cover.  

Screening, Physical competence, rehabilitation and performance workshop

The final half-day on Saturday morning was primarily aimed at physiotherapists, strength and conditioning, and performance coaches, again attracting a separate fee. A world-renowned trio of coaches hosted. Mr Kelvin Giles delivered a practical guide to physical competency assessment and screening for injury prevention, and Mr Frans Bosch applied these principals to the example of running.  Mr Vern Gambetta talked about high-level training and athletic development.

What was new?

Research-based presentations from leaders in their field brought us up to date on a number of topics, from The Science Behind Tendon Pathology (Prof. Michael Kjaer), The Role of Fascia in Injury, Proprioception and Soft Tissue Pain (Dr Robert Schleip), and Muscle Injury and Repair (Prof. Gordon Lynch), to exercise immunology and the impact of nutrition (Dr Neil Walsh) and sleep disruption (Mr Adam Harper-Smith). 

The Chief Medical Officer to UK Athletics, Dr Paul Dijkstra, updated us on the approach and experiences of using Platelet-rich-plasma with UK Athletes, and gave us greater understanding of the factors that clinicians should take heed of when considering this novel therapy as a treatment option.

Professor Philip Conaghan talked about recent advances in the elusive cure for osteoarthritis, with mention of stem cells, and new biologic medications currently undergoing clinical trails that we hope will talk us forward.

Dr Eanna Falvey took us through a novel ‘triangle’ approach to assessing groin injures, ensuring that we consider the plethora of differential diagnoses when assessing this particular complex area.

There was also a session on cutting-edge frontiers and technological innovations, with Sponsors covering the potential of regenerative medicine for the treatment of sports injuries, and role of video technology in assessing movement.

Research

Good quality research underpins the evidence base and stature of all established medical specialties, and this message was emphasised with regularity at the conference.

The inspiration was provided by eye-opening talks from the multitude of Professors in showing what can be achieved and the directions we can take. 

Encouragement to undertake research was given in unambiguous terms, most explicitly from Professor Greg Whyte of the Institute of Sports and Exercise Medicine, and Professor Alan Silman from Arthritis Research Campaign, who talked about Osteoarthritis and made us aware of funds available to support more cutting edge research ideas and grant applications for Arthritis.

An overview of current Hot topics in SEM was covered very neatly and succinctly by Professor Domhnall Macauley, by presenting his verdict of the top ten SEM publications in 2010. His selection drew little dispute, though a few nominations to add to the list. His top ten can be found at http://blogs.bmj.com/bmj/2010/11/25/domhnall-macauley-on-sports-medicines-top-ten/

The controversies

There were a couple of notable lectures that attracted spirited debate!

Professor of culture, media and sport, Ellis Cashmore spoke of the reasons why he believes that we should Stop testing and Start Legalising drugs in sport! His arguments included respecting sportsmen’s autonomy, and made parallels with vision correction measures and cash incentives in sport as being performance enhancing. Dr Mike Loosemore led the counter arguments as chairperson in a heated debate that could have gone on all day! In the end, the feeling was that Loosemore beat Cashmore on points at the very least!

Less heated, though stimulating well-founded discussion, was neurologist and sports physician Professor Paul McCrory’s lecture on Cognitive assessment of concussion. This focussed on the merits of different neurocognitive assessment tools for use at the pitch side and pre-event, treatment options in concussion, and the recommendations for time away from sport following concussion.


Prizes and Awards

If the quality of the conference itself wasn’t enough to entice the most reluctant, then the prizes on offer may have!

There were four prizes of £1000 to each of the best abstract presentations in their category. Congratulations go to the overall winner Mr Russ Coppack from DMRC Headley Court, who won an invitation to participate in the American College of Sports Medicine Conference in 2011.

Past winners of the UKADIS Malcolm Read Scholarship in SEM had an opportunity to present the findings of their proposals that landed them their prizes. The funds enabled travel abroad to centres of excellence and subsequent relay of their findings to interested parties in the UK. Dr Rick Seah spoke of his research proposal into novel injection therapies in the management of tendinopathy, and the challenges in attaining adequate power to conduct high quality research.

Perhaps less within most of our reach at this stage is the Sir Roger Bannister Medal. The winner this year was one of the forefathers of Sports Medicine in Britain, Professor Peter Sperryn. His achievements and services to SEM include organising the first BASM meeting in 1964, holding the roles of BASM Secretary, vice-chairman and vice-president, presidency of FIMS educational committee, being editor of the BJSM, and CMO of Track and Field Athletics.

The Social Events

There were two main social events in the evenings. The drinks reception with entertainment from the Chris Allard Band directly followed the close of play on day one. The vast majority of delegates stayed on to unwind and catch up following a fantastic educational day. The Conference Black tie dinner was a more formal affair on the evening of the second day, with around 150 delegates of all ages and backgrounds enjoying a quality 4-course meal with ample champagne and wine. I’ll always remember Sir Malcolm Read, our president, not wasting a moment in showing his encouragement and support for SEM whilst in the Gents! Whilst discussing Lord Coe’s speech, and how I would have liked to hear more about his vision beyond 2012, he replied “the future of the specialty is in your hands, take it and run with it!”

The Inspiration and Future

There is no doubt that this inaugural conference has inspired and provided a vision for all delegates, in particular the many students and junior health professionals, providing a benchmark on what the specialty does now, and how it can be furthered by us from now onwards.

It was great to see an abundance of both undergraduates, who show eagerness and desire to submerge themselves in SEM from a far earlier stage than many current BASEM members were able to, as well as many established SEM faces, some of whom are retired, though nevertheless still enthusiastic to learn. Their presence also provides considerable strength and support for our specialty, as well as inspiration.

As the specialty grows year on year, there will be an even greater presence and sense of community, more research will be conducted and ideas shared, and more avenues open for expansion. UKSEM 2011 is guaranteed to be even bigger and better. See you at the ExCel from 23rd -26th November 2011! 

We pass our thanks to the BASEM committee and staff for their vision, and months of hard work in making UKSEM 2010 a big success.

Bhavesh Kumar
ST3 SEM, London Deanery

(Additional comments: I can only describe the aspects of the conference that I myself was able to experience.  Regrettably it was not possible to mention all the speakers and sessions that helped make UKSEM the success it was.)

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