This week in BMC Medicine: Sports medicine, physiological changes and improving endurance

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It is well known that exercise is beneficial for health, and this Olympic year has underscored the public health benefits of regular exercise. For instance, a recent study has demonstrated that Olympians live for around 2.8 years longer on average than the general population. However, we needn’t be Olympians to enjoy this longevity; those who partake in the recommended 150 minutes of moderate/vigorous physical activity per week also seem to have a survival advantage compared with the inactive general population.

One specific advantage related to exercise seems to be relevant for those with musculoskeletal conditions. These conditions are the most common cause of severe long-term pain and physical disability. Evidence from an overview of systematic reviews carried out by Kare B Hagen and colleagues from Diakonhjemmet Hospital suggests that exercise therapy is beneficial for most musculoskeletal conditions. However, they found that, with the exception of osteoporosis, there is limited understanding of how exercise therapy affects disease mechanisms.

Although there are obvious benefits of exercise, there should be some considerations. Hugo Olmedillas and colleagues from the University of Zaragoza carried out a systematic review of the literature on the effects that cycling has on bone health. Cycling is a low impact, non-weight bearing sport, meaning that it minimizes trauma to joints. However, bone mass is known to be affected by weight-bearing sports, so that those who participate in such sports tend to have higher bone mass. Olmedillas and colleagues found that although cycling has cardiovascular benefits, it is not effective in improving bone mass, suggesting that cyclists at risk of developing osteoporosis should supplement cycling with osteogenic training. In a commentary on this research, orthopedic surgeon Mike Carmont discusses the effect of both high and low impact sports on bones, noting that the risk of soft tissue injuries should also be considered when choosing an appropriate sport.

Ultramarathons are an example of high impact sports. In a research article, Uwe Schütz and colleagues from the University Hospital of Ulm explored the cerebral physiological changes in ultramarathon runners over the course of this extreme feat of endurance. Here, they found that gray matter volume in the brain is reversibly reduced during the course of an ultramarathon, but no new lesions are detected by MRI. This suggests that short-term adverse brain events do not occur during endurance running when athletes train properly. In an accompanying commentary, Stéphane Perrey and Kevin Mandrick explain how the results of this study can aid understanding of cerebral atrophy in those vulnerable to long-term stress.

As well as the physiological changes that accompany endurance sports, athletes and  researchers are always interested in performance optimization. Nicola Maffulli and colleagues carried out a systematic review and meta-analysis to establish the most effective method of pre-cooling to improve endurance sports performance in hot weather. They conclude that cold water immersion is the most effective method, but highlight that more research is required to establish optimal techniques.

The articles discussed here are the latest additions to our article collection, Advances in Sports Nutrition, Exercise and Medicine.