Debating transversus abdominis, the “exercise pill” and whether flying limits athletes’ performance on arrival
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* Karim M Khan

In this issue of *BJSM*, Allison and Morris (***see page [930](http://bjsm.bmj.com/lookup/doi/10.1136/bjsm.2008.048637)***)1 question some fundamental beliefs regarding core stability. Whether or not you agree with them, the paper raises an important issue. It is difficult to move research into practice but sometimes practice behaviours do seem to take off ahead of the clinical evidence. Is this the case here or not? Make up your own mind. Associate Editor Professor Paul Hodges responds in December's *BJSM*.

Jill Cook (***see page [863](http://bjsm.bmj.com/lookup/doi/10.1136/bjsm.2008.048629)***)2 takes this issue and considers it more broadly. Are all those patients who worked diligently on the Cybex machine in the 1980s better off for that? (I can see the younger reader yelling out: “Hey Mum, what’s a Cybex?”). But I digress. The editorial reminds both clinicians and scientists that close communication is essential. As one of the worlds leading clinician-scientists, Jill Cook is well placed to make us think about this for the ultimate benefit of our patients.

## RESPONSE TO THE *CELL* PAPER: “EXERCISE PILL”

*BJSM* is renowned for being a tad contrarian and this month we benefit from having Indiana’s Stu Warden and Robyn Fuchs comment on the recent report of a pill3 that provides all the benefits of exercise without you actually having to go to the trouble (***see page [862](http://bjsm.bmj.com/lookup/doi/10.1136/bjsm.2008.053512)***).4 What will “Big Pharma” think of next? A pill that provides all the benefits of sex without having to go to the trouble? But ignore me, and enjoy their provocative commentary. What do you think of the concept of an exercise pill? Should we promote exercise as a “polypill”? Comment on the *BJSM* Blog ([http://blogs.bmj.com/BJSM](http://blogs.bmj.com/BJSM))

In this issue, Andrew Nichols (***see page [909](http://bjsm.bmj.com/lookup/doi/10.1136/bjsm.2007.037861)***)5 argues that sports medicine research methodology is improving and we can be confident that our field has an increasingly scientific basis. Good thing! He also found that *BJSM* authors span more countries than do those of other sports medicine journals. For example, please see the papers on (1) the metabolic cost of assisting walking patterns from Japan (***see page [922](http://bjsm.bmj.com/lookup/doi/10.1136/bjsm.2007.039453)***)6 and (2) from Brazil, the effect of high-intensity prolonged exercise on muscle.7 An interesting note comes in from New Zealand: flying for 10-13 hours reduces oxygen saturation and is like being at altitude (***see page [877](http://bjsm.bmj.com/lookup/doi/10.1136/bjsm.2007.042960)***).8 This has immediate application for personal travellers and teams, as it may not make sense for a team to arrive on the day of competition.

## UK HEALTH STUDY: WATCHING A NATION PLAY SPORT!

On the subject of super science, you’ll also find the results of the UK Health Study (***see page [901](http://bjsm.bmj.com/lookup/doi/10.1136/bjsm.2008.048082)***).9 These novel data provide a temporal trend for 60 000 participants! Without giving away the ending here, it looks moderately hopeful that physical activity can be improved in some segments but not in others. We still have a lot of work to do to narrow the gap in physical activity adoption between lower and higher socioeconomic strata and between white and ethnic minority groups. Please visit relevant linked papers in *BJSM*. See April’s meta-analysis of walking10 and the “walking issue” (May, 2008) in which Williams11 analysed 7000 men in the US and found that walking had profound effects on BMI and waist circumference in those with the highest BMI. This is great news. Show me the pill that will do that without side-effects.

And before I leave this issue don’t forget to check out “Online First”. You’ll find gems from authors such as Frank Booth, Stephen Blair, Kay Crossley and the aforementioned Paul Hodges, to name just a few. *BJSM* gains terrific support from sports medicine luminaries – our challenge is to help you find their papers fast! The downside is that it is difficult to get papers into *BJSM* – we can accept only 10% of submissions. I will save my explanation of that – and how to defy the odds – on the BJSM Blog, ([http://blogs.bmj.com/BJSM](http://blogs.bmj.com/BJSM)) rather than on this page, which comes out in the print version of the journal. If you are reading this in the print form, remember that “the e-version is the version”, so please visit on the web as well. We’ve enlarged the cover graphic a bit to help you read the titles and you can find the free articles right there on the home page. Click on the cover icon and you are in!

## Footnotes

*   **Competing interests:** None.

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1.  Allison GT, Morris SL. Transversus abdominis and core stability – has the pendulum swung? Br J Sports Med 2008;42:630–1.
    
    

2.  Cook J. Jumping on bandwagons: Taking the right clinical message from research Br J Sports Med 2008;42:563.
    
    

3.  Narkar VA, Downes M, Yu RT, et al. AMPK and PPARdelta agonists are exercise mimetics. Cell 2008;134:405–15.
    
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4.  Warden SJ, Fuchs RK. Are ‘exercise pills’ the answer to the growing problem of physical inactivity? Br J Sports Med 2008;42:562–3.
    
    [FREE Full Text](http://bjsm.bmj.com/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6ODoiYmpzcG9ydHMiO3M6NToicmVzaWQiO3M6OToiNDIvMTEvODYyIjtzOjQ6ImF0b20iO3M6MjQ6Ii9ianNwb3J0cy80Mi8xMS84NjEuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9) 

5.  Nichols AW. Sports medicine clinical trial research publications in academic medical journals between 1996 and 2005—an audit of the PubMed MEDLINE database. Br J Sports Med 2008;42:609–21.
    
    [Abstract/FREE Full Text](http://bjsm.bmj.com/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6ODoiYmpzcG9ydHMiO3M6NToicmVzaWQiO3M6ODoiNDIvNy82MDkiO3M6NDoiYXRvbSI7czoyNDoiL2Jqc3BvcnRzLzQyLzExLzg2MS5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=) 

6.  Shimada H, Suzuki T, Kimura Y, et al. Effects of an automated stride assistance system on walking parameters and muscular glucose metabolism in elderly adults. Br J Sports Med 2008;42:622–9.
    
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7.  Bessa B, Nissembaum M, Monteiro AN, et al. High intensity ultraendurance promotes early release of muscle injury markers. Br J Sports Med 2008;42:589–93.
    
    

8.  Geertsema C, Williams AB, Dzendrowskyj P, et al. Effect of commercial airline travel on oxygen saturation in athletes.  Br J Sports Med 2008;42:577–81.
    
    

9.  Stamatakis E, Chaudhury M. Temporal trends in adults' sports participation patterns in England between 1997 and 2006: The Health Survey for England. Br J Sports Med 2008;42:601–8.
    
    

10. Hamer M, Chida Y. Walking and primary prevention: a meta-analysis of prospective cohort studies. Br J Sports Med 2008; 42: 238–43.
    
    [Abstract/FREE Full Text](http://bjsm.bmj.com/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6ODoiYmpzcG9ydHMiO3M6NToicmVzaWQiO3M6ODoiNDIvNC8yMzgiO3M6NDoiYXRvbSI7czoyNDoiL2Jqc3BvcnRzLzQyLzExLzg2MS5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=) 

11. Williams PT. Association between walking distance and percentiles of body mass index in older and younger men. Br J Sports Med 2008;42:352–6.
    
    [Abstract/FREE Full Text](http://bjsm.bmj.com/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6ODoiYmpzcG9ydHMiO3M6NToicmVzaWQiO3M6ODoiNDIvNS8zNTIiO3M6NDoiYXRvbSI7czoyNDoiL2Jqc3BvcnRzLzQyLzExLzg2MS5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=)