The Physician and Sportsmedicine
Menubar Home Journal Personal Health Resource Center CME Advertiser Services About Us


Putting Exercise Science to Practice


We physicians recommend exercise to our patients all the time, but do we really know how best to define it, measure it, and prescribe it? This month we're launching a new four-part series to answer those questions. The series, "The Science of Exercise Physiology," coordinated by editorial board member Howard G. (Skip) Knuttgen, PhD, demonstrates how to apply the building blocks of sports science toward everyday clinical practice.

Knuttgen, one of the pioneers of exercise science and a continuing example of excellence in the field, kicks off the series with "What Is Exercise: A Primer for Practitioners" (page 31). Three other articles will run about every other month in 2003: Jack H. Wilmore, PhD, will cover the physiology of aerobic metabolism and training; William J. Kraemer, PhD, will review anaerobic training and muscle strength; and Walter R. Frontera, MD, will integrate the principles of exercise science with disease prevention and rehabilitation for our readers.

Those of you who were in clinical medicine some 20 years ago will recall the excitement at meetings and conferences where sports scientists and clinical practitioners were shaping the field of sports medicine through their research, fascinating presentations, and leadership. Our scientific meetings and learning experiences tend to be a bit more differentiated these days. It was stimulating in the earlier days to hear integrative lectures on exercise physiology, biomechanics, training adaptations, nutrition, motor learning, and sports psychology. And it was inspiring to meet the giants of the field all at one meeting: Ejnar Eriksson, MD, David Costill, MD, William Haskell, PhD, John Sutton, MD, Philip Golnick, PhD, Bengt Saltin, MD, Frank Jobe, MD, and George Sheehan, MD, to mention a few.

I particularly enjoyed those earlier lectures on exercise physiology. Physiologists used exercise as a method of perturbing a resting metabolic or mechanical system in order to understand acute and chronic adaptations in tissues and organ systems. This approach provided a window through which to view the physiologic potential of the human body. For example, muscle blood flow increases 27-fold during acute exercise (from 600 to 16,000 mL/min), while coronary blood flow increases fourfold. Expired ventilation increases from 5 L/min at rest to as high as 200 L/min during intense exercise. Mitochondrial oxidative enzymes increase by 100% after 6 weeks of endurance training. Topics related to fuel utilization shifts, muscle fiber plasticity, and lactate metabolism continue to fascinate.

The really neat thing about the early 1980s was the palpable excitement that existed during the exploration of this new frontier of human performance and the effects of exercise on the human body. The pioneers of that era sought the common goal of advancing our understanding of health, exercise, and sport at all levels of participation.

We know so much more than we used to, thanks to these pioneers. Their work forms the basis of the knowledge and skills we currently use in the practice of clinical medicine.

The four distinguished clinician-scientists writing for this new series have summarized 20 years of advances in exercise science and presented it in a format useful to the practicing physician. I hope you will share my wonder over the marvel of our own human systems and the excitement about our potential to adapt the concepts to a variety of patients. Enjoy! And let me know what you think.

Gordon O. Matheson, MD, PhD