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Clinician Profile

Featuring Martin Schwellnus, MBBCh, MSc (Med), MD, FACSM, FFIMS

Current Sports Medicine Reports: 11/12 2017 - Volume 16 - Issue 6 - p 437-438
doi: 10.1249/JSR.0000000000000419
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The International Sports Medicine Federation (FIMS) and the American College of Sports Medicine (ACSM) are proud to feature Martin Schwellnus, MBBCh, MSc (Med), MD, FACSM, FFIMS, in this issue’s Clinician Profile. Professor Schwellnus is a full professor of Sport and Exercise Medicine at the Faculty of Health Sciences, University of Pretoria in South Africa and a specialist sports and exercise medicine physician who consults with athletes of all levels. He holds an MBBCh from the University of the Witwatersrand, and an MSc (Med) and an MD (equivalent to a PhD) degree from the University of Cape Town. He is a fellow of both FIMS and ACSM. Among his many responsibilities, Professor Schwellnus is a director of the newly established Sport, Exercise Medicine and Lifestyle Institute (SEMLI) at the University of Pretoria, director of the International Olympic Committee (IOC) Research Center in South Africa, a longstanding member of the IOC Medical Commission (Medical and Science group), and a member of the editorial boards of several international journals. He is interested in many areas of sport and exercise medicine, notably the health benefits of regular exercise and prescribing safe exercise to all populations to reduce the global burden of noncommunicable disease (NCD), the prevention and management of injuries in active individuals, and the protection of the health of athletes. Professor Schwellnus has published more than 300 scientific journal articles.

What inspired you to pursue a career in sports medicine?

I have always been interested in sport and I led an active lifestyle from childhood. At school, I participated in a variety of sports including athletics (running, sprinting, hurdles), rugby (union), cricket, and squash. Later, in my school career, I developed an interest in medicine and pursued that interest by commencing my medical studies at the age of 17 years. I remained active during my time at medical school but changed my sports activities to distance running and squash. In the latter years of my medical studies, I developed an increasing interest in combining a career in medicine with my interest in sports and exercise. During this time, I also realized that regular physical activity is a key component to health and the prevention and management of chronic disease. Not surprisingly, in the fifth year of my medical studies, I opted to use my “elective” period to conduct a research study on “Changes in pulmonary function after smoking cessation in middle-aged athletes,” resulting in my first publication in this field (3). This study stimulated my interest in combining a research career with clinical service in sports medicine. During my early clinical work as a medical intern, I realized that my medical training and the health systems largely focused on curative medicine and largely ignored the importance of prevention. In contrast to this, I knew that sports participation requires adoption of a lifestyle geared to develop and maintain peak physical, mental, and spiritual performance. I realized there has to be a connection between the lifestyle for optimal health that athletes require and the pursuit of a lifestyle that can play an important role in preventing and treating many chronic diseases in the patients that I looked after as a clinician. This realization led me to pursue a career in Sports Medicine by establishing the first post-graduate training program in Sports Medicine in South Africa at the University of Cape Town in 1990, with the first graduates in 1991. Since then, several more post-graduate Sports Medicine training programs have been established in South Africa and across the world. In the last decade a significant shift in the emphasis of this area of medicine has taken place with a greater focus on “exercise medicine” (1). As a result, in most areas of the world, this profession is now known as “Sport and Exercise Medicine,” and the focus has changed from medical care and injury management of elite athletes to the promotion of exercise, sport, and physical activity as part of a healthy lifestyle for all age groups, including patients with known chronic disease or risk factors for chronic diseases (5,6).

What was it like to be a clinician a decade ago compared with today?

In my experience, a decade ago, the focus of sports medicine was mainly on injury prevention, management, and rehabilitation. In many parts of the world, sports medicine evolved out of the need of athletes to be injury-free and return to sport as rapidly as possible after a musculoskeletal injury. Most sports medicine clinicians I knew spent most of their time on injury prevention and management, and the published research was largely dominated by the studies on sport injuries. However, in the last 10 years, there has been a substantial shift in the scope of practice and the research produced in the field of sports medicine. The first area to grow substantially is the importance of “protecting the health of the athlete,” that is, to increase the focus on preventing illness and medical complications in the exercising individual (from the elite athlete to the recreational exerciser) (4,7). Studies to determine the pattern and risks of illness in active individuals have now been published, and the role of the sports medicine clinician in preventing illness and medical complications in active individuals is increasingly recognized. The second area of change in the clinical practice of the sports medicine clinician, in the last decade, is the focus on exercise prescription as a “medicine” for the prevention and treatment of chronic diseases of lifestyle (5,6).

What is your best advice to other sports medicine clinicians?

If you have not already done so, my advice is to reflect on your current scope of clinical practice in sports medicine. As my friend and colleague Professor Wayne Derman indicated in 2011, the sports and exercise clinician is ideally placed to take a leadership role in making a substantial contribution to managing the greatest threats to health worldwide, which are the NCD (2). What is often not appreciated is the fact that inactive individuals, whom we all should encourage to take the “exercise” drug at a dose of moderate- to high-intensity for 150 min·wk−1, also are at risk of musculoskeletal injury and possible medical complications during exercise. This is even more so in the older individual with underlying chronic diseases. Therefore, the skills and experience that the sports medicine clinician has in injury and illness prevention and management are an integral part of clinical care of these patients with NCD. This may mean that you need to equip yourself with new (or perhaps forgotten) skills, including an understanding of the pathophysiology and pathology of chronic disease, appreciating the complex interaction of exercise intervention with prescribed pharmacological agents, and dealing with medical emergencies that may occur during exercise in high-risk patients (2).

What is the most common question you are asked as a sports medicine physician?

What exactly is sports medicine? I then have to explain that sport and exercise medicine can be broadly defined as the branch of medicine that concerns itself with 1) the role of physical activity and lifestyle factors in the prevention, diagnosis, and treatment of chronic illness and disease; 2) the prevention, diagnosis, management, and rehabilitation of sport and other exercise related injuries; 3) prevention, diagnosis, and treatment of medical conditions related to exercise training and sport participation; and 4) promoting and optimizing sports performance in athletes at all levels (from recreational to elite).

You are a recreational trail runner, mountain biker, and golfer. Can you tell us more about this and your views on exercise as an integral part of a healthy lifestyle?

I have already stated, quite strongly, that the promotion of regular physical activity should become a very important component (and arguably the main component) of the day-to-day work of a sports medicine clinician. I also believe that one of the best ways to get this message across to your patients is to show them that you are doing it. I therefore encourage you as a sports medicine clinician to adopt an active lifestyle, both for your own benefit and for the benefit of motivating your patients.

Would you like to share anything else with the readers of Current Sports Medicine Reports?

As I reflect on the next decade of work in this field, the young sports medicine clinician will, in the next few years, be faced with an entirely new “world” in clinical practice. Emerging fields that are likely to influence the future of sports medicine clinical practice include personalized medical diagnostic and therapeutic decision-making through an understanding of genetics and cell biology, use of wearable technology coupled with “big data science” to influence health behavior, and the use of social media in getting health messages across. My advice to the young sports medicine clinician is to study these trends and embrace them wholeheartedly to make better clinical decisions for your patients.

References

1. Cullen M. Developing a new specialty—sport and exercise medicine in the UK. Open Access J. Sports Med. 2010; 1:11–4.
2. Derman WE. Sport physicians should practice the full gamut of their profession: moving from sports medicine to sports and exercise medicine. Curr. Sports Med. Rep. 2011; 10:316–7.
3. Dowdeswell RJ, Schwellnus MP, Erlank TF. Changes in lung-function after smoking cessation in middle-aged athletes. Am. Rev. Resp. Dis. 1983; 127:186.
4. Engebretsen L, Bahr R, Cook JL, et al. The IOC Centres of Excellence bring prevention to sports medicine. Br. J. Sports Med. 2014; 48:1270–5.
5. Matheson GO, Klugl M, Dvorak J, et al. Responsibility of sport and exercise medicine in preventing and managing chronic disease: applying our knowledge and skill is overdue. Br. J. Sports Med. 2011; 45:1272–82.
6. Matheson GO, Klugl M, Engebretsen L, et al. Prevention and management of non-communicable disease: the IOC consensus statement, Lausanne 2013. Br. J. Sports Med. 2013; 47:1003–11.
7. Rogge J. An ounce of prevention? Br. J. Sports Med. 2009; 43:627.
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