In this issue

Hébert and colleagues describe the difficulties in achieving positive exercise change from within the primary care setting (see page 625). While this is a challenge, it points to the importance of community wide behaviour modification rather than opportunistic counselling when a person sees their doctor for another reason. Needing more than 30 min counselling to achieve good longer-term change in behaviour implies that relying on primary care practitioners alone to change the ills of our societies will fail.

In my practice, I often see excellent outcomes with exercise. I have a patient who had gestational diabetes in her first pregnancy. She looked at her long-term risk of developing type 2 diabetes and commenced a regular exercise programme and healthy weight management. Her second pregnancy was uncomplicated by gestational diabetes. Similarly, a ‘fly-in-fly-out’ mine worker became overweight, and developed impaired glucose tolerance and hypertension. He became focused and exercised regularly in the gym during work rotations and also cycling and running when he lived at his family home. He lost weight, his blood pressure normalised as did his glucose tolerance. The rate of gestational diabetes can be reduced with exercise. There is strong evidence in the article by Barakat and colleagues (see page 656). Older people can reduce all-cause mortality through regular exercise. Read the excellent article by Brown and colleagues. It appears that it is never too late to change behaviour and have a good outcome (see page 664).

While it sounds intuitive (and that is the type of information I like), the article by Bloemers and colleagues (see page 669) linking childhood inactivity with increased sports injury risk sends another important message. No longer should we hear parents saying they don't want their child playing soccer because it is too dangerous, we can now confidently say the reverse is true.

The editorial by Wilson and Whyte (see page 623) concerning long term cardiac risk with life-long ‘excessive’ endurance exercise is pertinent, although it should not deter people from ‘physiological’ levels of exercise. It is, though, food for thought for those ‘baby-boomers’ hooked on endurance sport. There might be a zone too far for their heart's sake.

All in all, primary care doctors can influence the burgeoning epidemic of type 2 diabetes, gestational diabetes, overweight and inactivity1 but we need help. We need to work with individuals who want to change. And we need support in a coordinated attack from the broader medical community (specialists, hospital clinicians), city planners in altering the built environment2, Governments in funding education and exercise programmes.

Sports Doctors Australia – a terrific community for primary care sports doctors

Sports Doctors Australia is an association of doctors who have the aim of providing high level sport and exercise care to all exercising people at all levels of expertise. Therefore, Sports Doctors Australia is part of the upcoming Australian Conference of Science and Medicine in Sport. Our association with Sports Medicine Australia (SMA) is long-standing and invaluable to our members because of the excellent resources that SMA provide as well as the standout evidence based conference each year. This year's conference provides particular value as the 4th International Congress on Physical Activity and Public Health and the National Sports Injury Prevention Conference add to the attraction. Branded as ‘BeActive 2012’ the conference provides Australian clinicians interested in any part of sport and exercise medicine a veritable smorgasbord of clinically relevant lectures, symposia and practical workshops. And we are a social, welcoming bunch! Try us and seek me out if you are shy! Australia's best and the world's best in Sydney – 31 October – 3 November 2012. For information go to http://sma.org.au/be-active/. To learn more about Sports Doctors Australia, visit http://www.sportsdoctors.com.au. And Sports Doctors Australia colleagues – I am sure you will greatly appreciate this newest member benefit – full access to BJSM.