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Responsibility of sport and exercise medicine in preventing and managing chronic disease: applying our knowledge and skill is overdue
  1. Gordon O Matheson1,
  2. Martin Klügl1,
  3. Jiri Dvorak2,3,
  4. Lars Engebretsen4,
  5. Willem H Meeuwisse5,
  6. Martin Schwellnus6,
  7. Steven N Blair7,
  8. Willem van Mechelen8,
  9. Wayne Derman6,
  10. Mats Börjesson9,10,
  11. Fredrik Bendiksen11,
  12. Richard Weiler12
  1. 1Department of Orthopaedic Surgery, Division of Sports Medicine & Human Performance Laboratory, Stanford University School of Medicine, Stanford, California, USA
  2. 2Schulthess Clinic, Zurich, Switzerland
  3. 3FIFA Medical Assessment & Research Center (F-MARC), Zurich, Switzerland
  4. 4Orthopaedic Center, Ullevål University Hospital, University of Oslo, Norway
  5. 5Sport Injury Prevention Research Centre, University of Calgary, Calgary, Alberta, Canada
  6. 6UCT Research Unit for Exercise Science & Sports Medicine, Department of Human Biology, University of Cape Town, Newlands, South Africa
  7. 7Departments of Exercise Science and Epidemiology & Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
  8. 8Department of Public and Occupational Health and EMGO Institute for Health & Care Research, VU University Medical Center, Amsterdam, The Netherlands
  9. 9Astrands Laboratory, The Swedish School of Sports and Health Sciences and Karolinska University Hospital, Stockholm, Sweden
  10. 10Department of Acute and Cardiovascular Medicine, Sahlgrenska University Hospital/Ostra, Goteborg, Sweden
  11. 11Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway
  12. 12Sport & Exercise Medicine, Homerton University Hospital NHS Trust, London, UK
  1. Correspondence to Dr Gordon O Matheson, Sports Medicine Center, 341 Galvez Street, Stanford, CA 94304, USA; gord{at}


Background The rapidly increasing burden of chronic disease is difficult to reconcile with the large, compelling body of literature that demonstrates the substantial preventive and therapeutic benefits of comprehensive lifestyle intervention, including physical activity, smoking cessation and healthy diet. Physical inactivity is now the fourth leading independent risk factor for death caused by non-communicable chronic disease. Although there have been efforts directed towards research, education and legislation, preventive efforts have been meager relative to the magnitude of the problem. The disparity between our scientific knowledge about chronic disease and practical implementation of preventive approaches now is one of the most urgent concerns in healthcare worldwide and threatens the collapse of our health systems unless extraordinary change takes place.

Findings The authors believe that there are several key factors contributing to the disparity. Reductionism has become the default approach for healthcare delivery, resulting in fragmentation rather than integration of services. This, in turn, has fostered a disease-based rather than a health-based model of care and has produced medical school curricula that no longer accurately reflect the actual burden of disease. Trying to ‘fit’ prevention into a disease-based approach has been largely unsuccessful because the fundamental tenets of preventive medicine are diametrically opposed to those of disease-based healthcare.

Recommendation A clinical discipline within medicine is needed to adopt disease prevention as its own reason for existence. Sport and exercise medicine is well positioned to champion the cause of prevention by promoting physical activity.

Conclusion This article puts forward a strong case for the immediate, increased involvement of clinical sport and exercise medicine in the prevention and treatment of chronic disease and offers specific recommendations for how this may begin.

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  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.