• Prevention

We have just returned from the 5th IOC World Conference on Prevention of Illness and Injuries in Sport in Monaco. As always, it was great to meet old and new colleagues in sport and exercise medicine, listen to interesting talks, and participate in the workshops. The new sessions on Paralympic sports medicine were highlights for many of us.

The extra challenges of taking care of paralympic athletes are highlighted by Melbourne’s Liam West et al ( see page 1050 ) in their editorial on how to manage concussion in disability sport. In another editorial, Tweedy et al ( see page 1048 ) discuss how enabling technology can improve the performance of paralympic athletes, to such an extent that take-off velocity of a unilateral below-knee amputee with a long jump-specific prosthesis is higher than that of able-bodied athletes. Strikingly, the athlete with a disability has a personal best that would have won Gold at the London Olympics.

Many athletes with disability are born with, or suffer from, serious chronic diseases. One is inflammatory rheumatic disease, and traditional dogma was that exercise would exacerbate disease activity—both athletic activity and health promoting exercise were discouraged. Good that Sveaas et al ( see page 1065 ) showed in a systematic review that both cardiorespiratory and strength exercises limit disease activity, and that the athlete can take advantage of the numerous health effects of increased physical fitness, such as better cardiovascular health. This study is not the only one to reveal that old recommendations, given with the best purposes, might fall.

That brings us to the editorial by Rome’s Providência et al ( see page 1056) who report that very few athletes who continue to compete despite cardiac disorders, experience sudden cardiac arrest. These incidents are thought the most severe in sports, and important to include in injury-and illness surveillance systems in a better way than today, as highlighted by Fortington et al ( see page 1052 ) in their editorial. Providência and colleagues also challenge the paternalistic way that medicine decided peoples’ fate. Far too many athletes might have been deprived an active life due to overcautious recommendations. Enlightened by new research showing increased survival after sports-related sudden cardiac arrest, it is easier to discuss options for a further career with the athlete patient. Shared decision making is also encouraged in the editorial by Drew et al ( see page 1054). They also support that the principles of system thinking should be extended into research fields of health and coaching to integrate these parts to improve performance.