Mags GarganMags Gargan attends a public lecture where medical and health experts discuss both the benefits and risks associated with regular exercise
There is no denying the many of benefits of leading an active lifestyle including physical wellness, reduction in the risk of heart disease, stress management, increased energy levels and improved mental health. However, with exercise also comes the risk of injury and burn out both from a physical and mental health perspective. So, is exercise worth the injury risk? Yes, of course it is, insists Louise Keating from the Royal College of Surgeons in Ireland’s (RCSI) school of physiotherapy.
Ms Keating was one of the speakers at a RCSI MyHealth public lecture in Dublin last week which examined the benefits of staying active and achieving the right level of balance to stay healthy and injury free. She is specialist chartered physiotherapist and she focussed on the injury risks of recreational running, which has become a very popular fitness activity in recent years.
“The best way to describe injury rate in terms of sport is to look at number of injuries per one thousand hours: swimming is about four, basketball is about 10, GAA and soccer are high and rugby is the highest. Running fits in at about 10 per thousand hours so it is not too bad,” she said.
“A big indicator of running related injuries is if you have been injured before, your weekly mileage, interval training and biomechanics,” Ms Keating said. “You need to understand your own profile of risk and how injuries happen. For that we need to understand how overload leads to injury. For runners overuse injuries dominate over acute injuries – 70% of runners over a year develop some kind of overuse injury.”
Ms Keating said that it was important to get to know more about your body if you want to begin running – i.e. how strong and flexible you are.
“We all have different tissue tolerance levels within our body and between us. It also varies with age, and the key thing to think about in terms of age and overload is that our flexibility diminishes. The key thing when you are talking about an overload injury is not necessarily to stop, unless we are talking about a stress fracture. We are talking about you modifying activity, reducing load, for example reducing your training regime and getting to the point where the activity is no longer painful rather than just resting.”
She advised that injury risks could be reduced by warming up, stretching, wearing the correct footwear, biomechanical correction and load modification.
She said her take home message from the lecture was that recreational runners are at risk of injury but not long-term osteoarthritis [joint disease that results from breakdown of joint cartilage and underlying bone]. Runners should consider their own risk profile. Listen to your body and be aware of the warning signs.
Often it is an orthopaedic surgeon who has to “pick up the pieces” when someone suffers a serious injury through sport or exercise, but despite this Prof. John O'Byrne encouraged people to get exercising.
Prof. O’Byrneis an orthopaedic surgeon to the Irish national soccer team and deals with extensive referral for sports injuries. He is also working with the RCSI’s Prof. Fergal O’Brien on the development of novel biomaterials and surgical devices for cartilage and osteochondral repair.
“As an orthopaedic surgeon, by the time you are sitting or standing or lying in front of us the damage has already been done,” he said. “But we hope that while the damage was being done you were having a good time. The question today is active lifestyles, helpful or harmful and I think we would all immediately say helpful, although some people might think that orthopaedic surgeons who sometimes have to pick up the pieces might have a different view.”
He said there are two reasons why you may come to an orthopaedic surgeon, “one is related to sports injuries and the second area is in regard to whether you suffer wear and tear or overuse”.
“High impact sports can lead to high impact injuries. If you are playing contact sports you will sustain a contact injury. It can range from something as simple as a broken collar bone, which may require plating and fixing, to the much more serious type of situation where you have a cervical spinal injury,” he said.
Prof. O’Byrnesaid Ireland has an ageing population who want more active lifestyles and will not accept lifestyle limitations. This means older people are getting injuries associated with exercise more than ever before.
Treatment for older people includes weight reduction and physiotherapy, but Prof. O'Byrne suggests that if an older person has an injury that they continue to exercise within the limits of their injury. However in terms of recovery, it takes a little longer and any cartilage damage takes a lot longer.
“Loss of articular cartilage in a younger sportsperson that can frequently take them out of sport completely because the damage can occur due to disease or due to sporting injury, it can’t really regenerate and can either lead to a requirement for joint replacement or to an inability to participate in sports.”
Over the last few years under the direction of Prof. Fergal O’Brien research had been done to develop bone substitutes. “This has been very successful research and now we are looking into cartilage repair technology.”
He explained that trials of ChondroColl [a plug of bone substitute] have proved to be successful in the cartilage of animals and they will soon to move into clinical human trials.
Prof. O’Byrne’s main message was that he encourages people to get out and be active, and “if you get into trouble we will do whatever we can to get you back out there”.
Peter Connolly, a senior occupational therapist in St John of God’s Hospital discussed active lifestyles and the mental health experience. He focussed on our relationship with exercise and how sometimes exercise is approached in unhelpful ways such as controlling, perfectionism and avoidance, which can affect the choices we make around recovery and then become part of the problem.
“As an occupational therapist I am very much interested in what people do and the meaning and approach to what people do,” he said. “Often I fully recommend and support exercise and if we look at what the evidence proves, it is a combination of the physiological, psychological and social benefits and how they interconnect. Also recent trends suggest that group-based training and outdoor or green gym training would be particularly beneficial for our mental health.”
However, he warned that quite often people “describe a philosophy that ‘it works’, so the more I do, the more benefit I am going to get”, and this is a trap people can fall into “because it can be interconnected with other things going on in people’s lives”.
“If they are doing a lot of training, that’s great if you can balance it with proper recovery,” he said. “Exercise is like any form of stress, there is a certain amount we need. We couldn’t imagine a life without stress or a life without movement. But there is a tipping point where if we continue without recovery we get into diminished returns territory. Sometimes because of a person’s approach to exercise or what’s driving their behaviour they decide to push and push, and then it becomes less helpful, because recovery is the key.”
He said rest and renewal is vital to any person who takes exercise – these include physical, mental, emotional and spiritual aspects. “The elephant in the room is that we don't actually like to rest or sit with our distress and find ways to avoid, supress or numb what we feel. People might use exercise as a way to avoid what they need to do,” he said.
“Exercise is one of the best things we can do for our mental health. If someone could give you a pill for half the things exercise can do, it would probably be a bestseller. It’s about looking at how we relate to exercise. What is its role and is it giving us joy and are we feeling a sense of pleasure and getting the benefits? If we have all those in check then it is working.
“My advice is, if it is working then keep doing it. If you are not doing enough then do a little bit more.”