Coaches slated for failing the team

Sports minister Richard Caborn is engaged in a tug of war with sport scientists. He says they focus on elite athletes. They insist their research benefits everyone. Matthew Baker reports.

It may be one of Britain's fastest-growing subjects but, according to sports minister Richard Caborn, sport science is being held back by a culture of ivory tower elitism.

In the past, Caborn has criticised the incompetence of the "blazer brigade" who dominate many of Britain's sporting bodies. He has now turned his attention to the country's leading sport science departments, which, he says, are often guilty of failing to use the latest scientific developments to benefit the public.

Caborn acknowledges that sport science has made huge advances in recent years. He has viewed the cutting-edge facilities and research that arguably helped Britain bag a record medal haul at the Sydney Olympics and saw five departments awarded 5* in this year's research assessment exercise. But he argues that unless there is a radical change in the structure of sport science, internationally renowned research by British sport scientists will impact only on elite athletes and not the population as a whole.

"I recently saw some sport scientists at work at Loughborough University," he says. "They were working with slivers of muscle that had been taken from cyclists in the Tour de France and were looking at how to improve recovery rates for elite athletes.

"But why can't their findings on recovery rates for elite athletes not also be used for someone who has been ill or in a car accident to help with their rehabilitation?"

Caborn is also frustrated over what he describes as a failure of sport science institutions to link up with other publicly funded bodies to benefit a wider audience.

"Take my constituency. In Sheffield there are two universities, one of the biggest teaching hospitals in the country and the English Institute of Sport, yet none of them is working together. Surely it's not beyond the wits of man to bring all that lot together?"

He adds that his experiences of sport science institutions abroad is in stark contrast to British universities.

"Before the Winter Olympics I spent some time at a holding camp in Calgary where I viewed some incredible sporting facilities," he says. "But the medics and scientists there seemed equally concerned with the needs of ordinary members of the public as they were with those of elite athletes. An elite athlete was in one bed and granny the next."

Sport scientists up and down the country have been queuing up to criticise Caborn's comments, but a few have admitted there is some justification for his beliefs.

Andy Ramwell, a sport and exercise scientist from Manchester Metropolitan University, was invited to join the National Health Service National Public Health Leadership programme last year and is a firm believer that sport science can play a bigger role in shaping public-health policy.

"Sport science has grown out of a sporting culture, but nowadays there are a lot more joint honours degrees, which include exercise science as well," he says.

"Out of this has emerged a lot of research that is especially relevant to the government's exercise and health agenda. Other countries have long recognised the value of this research. In Canada, for example, they've had integrated programmes for years and recognise that exercise scientists have the tools to face up to some of the biggest health challenges."

He adds that Caborn is right to criticise the slow dissemination of research in areas of public health and says that a combination of funding and research constraints are preventing scientists from being able to serve the public more effectively.

"A lot of the peer-review journals are not interested in practical applied science, which is very discouraging for sport scientists who are working in areas that directly help the public," he says.

"The majority of sport scientists also aren't interested in taking their work down to the level of Joe Public simply because the funding isn't available. Sport science is still a relatively new discipline and has only recently started to get the recognition it deserves."

Others dismiss the minister's comments. Stuart Biddle, head of the department of physical education, sports science and recreation management at Loughborough, says much of his work is geared towards the wider community.

"I showed the sports minister round our facilities earlier this year and he is well aware that we have the British Heart Foundation's national centre here, for example, which is very much focused on the needs of the community.

"The bottom line is that British science is hugely underfunded. The government gives us money to do a certain job and now it is saying that it wants us to do more applied research. It is completely unrealistic."

The recognition within government circles that sport science has a role to play in public health was confirmed last year when several leading sport and exercise scientists were asked to help prepare the first national guidelines for exercise referral programmes.

Designed to help GPs prescribe exercise to patients suffering from conditions such as obesity, diabetes and coronary heart disease, the Department of Health document provides a model of best practice. It has encouraged a rapid growth of programmes.

But as one of the contributors to DoH guidelines points out, sport scientists are involved in a plethora of community-based projects, such as promoting social inclusion through exercise, encouraging physical activity among the elderly and helping monitor the physical and psychological demands of firefighting.

"Through the activities of organisations such as the British Association of Sport and Exercise Sciences, the discipline is making significant contributions to the community, and I for one have not worked with an elite athlete for years," says Andy Smith, head of the School of Sport Science and Psychology at York St John College.

"Far from being in the ivory tower, my experience of working with sport and exercise scientists is that they are very applied people who want to get more people more active more often."

Active lifestyle is ticket to wellbeing

Obesity costs the UK economy an estimated £2.5 billion a year, and cases in England have tripled over the past 20 years.

According to Ken Fox, a leading exercise scientist and head of the department of exercise and health sciences at Bristol University, the only way to beat it is through behavioural interventions that encourage lifestyle changes.

It is a message he has been crying from the rooftops for more than two decades, most recently when he criticised a treatment offered by the National Health Service to children with obesity problems as bordering on the unethical. He is working on the country's first child obesity clinic.

Fox is just one of a number of exercise sport scientists looking at grassroots health issues. He says the government has been slow to address the obesity problem but is at last recognising "that physical activity and diet are critical for good health". He adds, however, that there remains little or no support for obesity sufferers.

"What we've got at the moment is very fat people being told by doctors that they can't help them. Children are often simply measured and told they are obese. We need a network of exercise and diet therapists to support these people."

Courses such as Bristol's MSc in nutrition, physical activity and public health are, however, starting to produce a steady stream of frontline professionals capable of making a significant difference. The focus is on behavioural change.

"We're creating health professionals whose job will be to change patients'

environment," Fox explains. "By studying the psychology of health-related behaviour, we're encouraging students to advance themselves in an area of lifestyle-related disease treatment and prevention."

The degree attracts a wide range of undergraduates - from dietitians and nurses to exercise specialists, psychologists and teachers.

The degree's innovative approach to managing obesity has also seen it win a health initiative best practice award at the recent "Re-energise" national conference after being nominated by more than 700 of the country's leading health, fitness and nutrition professionals.

According to Fox, the discipline-based training of most health professionals seems dated in a world where many diseases are lifestyle-related and environmentally determined.

He says that fewer than one in three dietitians feels that their training has been adequate to help them implement lifestyle change, although evidence shows that adopting a healthier lifestyle can prevent coronary heart disease, type 2 diabetes, cancer, osteoporosis and some forms of mental illness.

He adds that change will be slow without further government support.

"It may be time for the government to consider appointing a lifestyles minister, as is the case in Finland, for example, to work on introducing a radical cultural change."

Although there are few multidisciplinary courses of this kind addressing the problem of obesity and related diseases, Fox believes it is inevitable that others will follow. "We're creating the future health professional," he says.

The work of sport scientists in the field of behavioural medicine has not gone unnoticed by policy-makers. Adrian Taylor, head of physical activity and health at De Montfort University, was one of the co-authors of the Department of Health's recent National Quality Assurance Framework guidelines for exercise referral schemes, which encourage GPs to prescribe exercise to patients.

Taylor plans to launch a physical activity and behavioural medicine degree at De Montfort next year, which, he says, will represent a major departure from traditional academic sport and exercise science degrees.

"We're trying to integrate vocational training, which will include interpersonal, counselling and mentoring skills, into an academic degree to ensure exercise practitioners can deliver preventative and therapeutic interventions to particular populations," he explains.

He adds that the success of exercise referral schemes for patients who suffer from medical conditions such as high blood pressure, combined with an increase in cardiac rehabilitation programmes, is creating new job markets for exercise practitioners.

"It's taken a long time to get exercise referral schemes and phase IV cardiac rehab programmes accepted but there's evidence to show their cost-effectiveness. This is opening the floodgates for a new breed of health professional who can not only add years to patients' lives but also substantially improve their quality of life."