Olympic Legacy (S&T Report)

Lord Krebs Excerpts

Wednesday 11th December 2013 Grand Committee

Moved by

[Lord Krebs]

That the Grand Committee takes note of the Report of the Science and Technology Committee on Sport and exercise science and medicine: building on the Olympic legacy to improve the nation’s health (1st Report, Session 2012-13, HL Paper 33).

[Lord Krebs (CB)]

My Lords, I start by thanking the members of the Science and Technology Select Committee for their excellent contributions to this report, and our specialist adviser, Professor Ian Macdonald, Professor of Metabolic Physiology at the University of Nottingham. I also thank the Minister for the Government’s response to our report. I am particularly delighted to see that the Minister who will respond to the debate is from the Department of Health as many of the recommendations in our report refer to health as well as to sport and exercise.

We conducted the inquiry, which resulted in the report Sport and Exercise Science and Medicine: Building on the Olympic Legacy to Improve the Nation’s Health, during the run-up to the 2012 Olympics. The inquiry had two purposes. First, we wanted to find out how robust the research and evidence base for improving the performance of our elite athletes is. Secondly, we asked how this knowledge for helping elite athletes might be translated into treatments and preventive interventions that could help improve the nation’s health. Our focus was on biomedical research rather than the engineering science that refined and improved the equipment used by elite athletes and amateur sports men and women alike.

Our inquiry included sport and exercise science, which is about understanding the physiology, nutrition, genetics and biomechanics of the human body in order to improve performance as well as sport and exercise medicine, which is about the treatment and prevention of ill health that might arise from exercise: for instance, muscle strain or joint injury. We did not investigate the important issue of behaviour change—how to encourage people to become more active—because we had already completed an inquiry into this topic in 2010. Although we focused on sport, we recognised that exercise includes a much broader range of activities, such as recreational walking, gardening and housework.

Both of our questions were highly relevant to the Government’s two objectives for the Olympics. These were, first, to ensure top performance of our athletes in winning medals and, secondly, as part of the legacy of the Games, to encourage the nation to be,

“healthier, happier and more active”.

On the first of these two objectives, Team GB surpassed expectation, winning more medals than in any Olympics since 1908. The haul of 65 medals, against a target of between 48 and 70, included 29 gold, placing Britain third in the gold medals table and fourth in the total medals table. This was a stunning success, but might the performance of Team GB have been even better with more systematic appliance of better science? One of Team GB’s greatest Olympic successes was in cycling, winning seven out of 10 track cycling gold medals. While the majority of this remarkable success is down to the athletes themselves, it is thought that some of it is attributable to the meticulous attention to detail of Matt Parker, “head of marginal gains”. He analysed down to the last detail the factors that might make that marginal difference between a medal and no medal: techniques such as spraying tyres with alcohol to remove dirt and increase the friction at the start of a race; heated shorts for the cyclists to keep their muscles warm; and measures to reduce the chance of athletes succumbing to performance-diminishing infections may all have contributed to the fraction of a second difference that is needed to win gold instead of silver.

However, as our inquiry showed, even in the outstanding cycling team, not all the techniques believed to enhance performance of elite athletes are based on sound evidence. For instance, we were told by an expert witness that feeding elite athletes large quantities of antioxidants to help muscle recovery not only does not have a beneficial effect but may even be detrimental. So when we look ahead to the next Olympics, there may be room for even better performance by our athletes by deploying the best scientific knowledge.

Our second question was about using scientific knowledge to help the Government’s objective of getting the population as a whole to become healthier through exercise. The health benefits of exercise are undisputed and affect a wide variety of health outcomes. The Department of Health told us that there was research to show that exercise could help to prevent or manage more than 20 chronic conditions, including coronary heart disease, stroke, cancer, type 2 diabetes and a number of mental health problems. Yesterday’s news story about an article in the British Journal of Sports Medicine lamenting the lack of exercise by children even used the emotive language of “child neglect” to refer to the health problems that will arise because children are not encouraged to do enough exercise.

Scientists do not yet understand the biological mechanisms that give rise to such far-reaching benefits of exercise. One theory is that exercise promotes a process called autophagy, in which worn-out surplus or malformed proteins and other components of our cells are recycled. Perhaps an understanding, through research, of exactly how exercise benefits our bodies would help to improve and enhance the advice to the population at large on exercise, and thereby increase the benefits.

How robust is the research into sport and exercise science and medicine? One fundamental problem of research on elite athletes is that, by definition, there are very few individuals to work on. Furthermore, elite athletes are understandably reluctant to be exposed to invasive measurements that might interfere with their training or become part of a control group in an experiment to test the efficacy of a particular intervention. For this reason, most of the research on elite athletes is observational and anecdotal. That is not to say that all sport science and medicine is weak, but several of our witnesses, including the Physiological Society and the Ministry of Defence, were critical of weak methodologies.

One way to improve the quality of research is to carry out the work on non-elite athletes and the wider public and explore the two-way flow of understanding between those groups and elite athletes. We heard about examples of well known techniques that are supported by good evidence—altitude training to improve stamina, and carbohydrate loading for long-distance runners—as well as those for which there is no evidence of benefit, including taking ice baths after vigorous sport and, as I have already mentioned, taking antioxidant supplements.

UK Sport is the arm’s-length body of DCMS charged with funding research to enhance the performance of elite athletes, with a budget, we were told, of about £20 million over the period between 2009 and 2013. We were surprised that DCMS did not appear to have in place any mechanism to ensure that UK Sport was commissioning science of the highest quality, comparable to that in fields of basic biomedical research. The Government’s response did not specifically address that point, and I would welcome clarification from the Minister about how DCMS carried out that quality assurance.

I now turn again to the relevance of sport and exercise science and medicine to the wider public. Most but not all of our witnesses agreed that the findings from research on elite and non-elite athletes had relevance to the wider population. Examples include the use of exercise and muscle conditioning to improve back and knee pain in osteoarthritis, conditions that affect many people in this country.

Advice to the public on exercise is contained in the Chief Medical Officer’s guidelines on physical activity. These guidelines exist, but how many people are aware of them? I have no doubt that all noble Lords in this Room are acutely aware that the CMO recommends that 19 to 64 year-olds do 150 minutes of moderate exercise or 75 minutes of vigorous activity a week, and that there are specific guidelines for people such as myself who are over 65, but we found in our inquiry no strategy for ensuring that those guidelines were more widely disseminated to the public. Indeed, we were told of one survey of 48 GP practices in 28 London boroughs, which found that none of the GPs was aware of the latest CMO guidelines.

The Government welcomed our recommendation that training at all levels for health professionals should include the need to support the prescription of exercise for both prevention and treatment of ill health. We also suggested that physical activity should be added to the quality outcomes framework for GP practices. I would welcome comment from the Minister on what progress has been made in this area and whether any measurable change in disseminating activity guidelines and encouraging physical activity by health professionals has been achieved.

At the same time, the National Institute for Health and Clinical Excellence—NICE—has a role in ensuring that any prescription of exercise for chronic disease is based on sound evidence. Could the Minister please update us on NICE’s assessments and how they are being translated into recommendations? Many of us who exercise do things that we believe—and are told—are good to do, like stretching before or after exercising, or engaging in muscle-strengthening as well as aerobic exercise. I would be interested to know how robust the evidence is to support these particular pieces of advice and information that are in the general public’s mind.

Finally, I turn to the National Centre for Sport and Exercise Medicine, which the Government established as part of their commitment to a lasting public legacy from the Olympic Games, as well as to improve support for elite and non-elite athletes. The Department of Health’s vision for the centre was for it to be,

“a hub of clinical and research expertise”,

used for the following objectives:

“increase exercise in the community; develop strategies to prevent diseases related to inactivity; and prevent, diagnose and manage injuries for both professional and amateur athletes”.

The centre was established with a £30 million grant to three consortia. However, we were told in our inquiry that no ongoing funding for posts or research was provided and therefore there is a question about the sustainability of the centre. We also suggested that the centre should take the lead in developing a national strategy for sport and exercise science and medicine. Could the Minister please update us on the progress of the national centre and how its sustainability is being established, and also on the production of a national strategy?

No one can doubt the importance of sport and exercise. The health of the population at large would be hugely enhanced if people exercised more. The prestige and entertainment provided by our elite athletes was vividly demonstrated by our national success at the 2012 Olympics and by Andy Murray’s Wimbledon triumph. Science and medicine can make an important contribution to the realisation of these benefits of sport and exercise. The United Kingdom has an absolutely outstanding science base in the biomedical sciences but the evidence that we heard suggested that there is insufficient cross-fertilisation between this excellent science base, carried out in our world-class universities and institutes, and the application of that science to improving the performance of our elite athletes and the health of the nation. I look forward to hearing other noble Lords’ contributions to this debate and the Minister’s reply. I beg to move.

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[Lord Krebs]

I thank all those who have taken part in this debate. It has been a privilege to hear the contributions of all noble Lords, but particularly of those who have first-hand experience of participating in elite sports as Olympians or other forms of competing at a very high level.

One theme has come through repeatedly: the huge importance of the health benefits of sport and exercise in tackling the chronic diseases that plague the population of this country and will cost us huge amounts of money in future. The noble Lord, Lord Addington, raised a very important point when he talked about the enjoyment of sport and exercise. Perhaps the key to encouraging people to be more active is to show them the enjoyment that can be obtained from it. He also referred to the art of coaching elite sports men and women. There may well be an art to it but that does not mean there cannot be science as well working alongside the art. The point made by the noble Lord, Lord Moynihan, and others about learning the lessons of history and from other countries is immensely important. Although we are obviously doing many things very well, we must not forget the possibility of healthy plagiarism from other countries and the history books.

I thank the noble Earl, Lord Howe, for his responses to the questions raised during the debate. I was encouraged to hear about additional investment in sport and exercise science and medicine, the sustainability of the national centre and the e-learning module that will help professionals to disseminate the importance of exercise to patients and the public at large. I also noted and welcome that he said that there was an emphasis on disseminating and publishing the results of work on elite athletes so that it could benefit the wider community. I still very much hope that a national strategy for sport and exercise science and medicine will emerge in the not-too-distant future, but I am very pleased with the responses obtained.

Motion agreed.