Dear Editor,

I read with interest the article written by Dr. G.J. Buse entitled, No holds barred sport fighting: a 10 year review of mixed martial arts competition published in the 6 February 2006 edition of your journal. As a researcher focused on injury prevention, I have recently been part of a research group reviewing data from both mixed martial arts competitions and professional boxing and enjoyed reading the information presented by Dr. Buse.

In an article published in October 2005 in the Southern Medical Journal, our research group attempted to define the overall injury rate of athletes participating in professional boxing.[1] We reviewed data from the fight cards published by the Nevada State Athletic Commission and noted any injury comments recorded by the ringside physicians. Our research demonstrated an overall injury rate of 17.[1] injuries per 100 boxer-matches with 11.3% of those matches ending in knockout.

In an attempt to compare boxing injuries to mixed martial arts (MMA) injuries, we did a review of the fight cards for MMA matches using the same protocol as for the professional boxing matches. Our data—to be published soon by The Journal of Sports Science and Medicine—indicate that the overall injury rate for MMA matches is similar to professional boxing and the knockout rate is almost half that of professional boxing.[2]

In reviewing Dr. Buse’s data, I would have liked to have seen a comparison of injury rates before and after the sanctioning of the sport in September 2001. Though MMA began in the United States in 1993, these first fights only superficially resemble MMA matches today and were really very different competitions. Sanctioning brought about many rule changes that mandated weight classes, time limits for rounds and matches, and eliminated many of the most dangerous techniques including stomps, head butts, and groin attacks. Combining MMA matches prior to sanctioning with the sanctioned matches of today is confusing and is not helpful in attempting to determine the true injury risk for participants in these competitions.

It should also be noted that although there were five deaths in the boxing ring in the United States during 2005, there has never been an MMA death in the United States. The death cited by Dr. Buse occurred in an unregulated event during 1998 in the Ukraine.[3] MMA fighters in the United States now must pass all the prefight screening tests of professional boxers and are supervised by referees and ringside physicians. It is important not to lump MMA competitions with the infamous “Toughman” competitions—a “sport” that matches amateur participants against trained fighters using “one size fits all” protective gear and often supervised by chiropractors and other untrained medical staff—when comparing MMA to other combat sports. While MMA has never had a casualty in the United States, at least 12 deaths have resulted from Toughman competitions.[4]

MMA also has some rules that seem to be an improvement over professional boxing. The fact that MMA has no “standing eight count” enabling a concussed participant time to recover and continue fighting is a tremendous step toward diminishing traumatic brain injury. Furthermore, by allowing leg and arm attacks opponents have a more diverse target area and do not focus solely on attacking the head, and if in trouble, a participant can “tap out” to signify his desire to end the match. In our study, the “tap out” was the second most common means of ending a bout and ended approximately 30% of matches.2 Last, most MMA matches are far shorter than boxing matches. Sanctioned MMA events usually consist of three 5 minute rounds as compared to the usual ten to twelve rounds of boxing.

In sum, mixed martial arts competitions are a controversial subject in today’s sporting world and while no one would argue that these events are safe, it is important that we in the medical and research communities stay disciplined in our response to these subjects. I am thankful that your journal has taken an active role in seeking to determine the inherent risks of MMA competitions, and I hope that it will continue giving balanced and constructive suggestions regarding MMA and other such controversial subjects.

Sincerely,

Gregory H. Bledsoe MD, MPH
Assistant Professor
Department of Emergency Medicine
The Johns Hopkins University School of Medicine Baltimore, Maryland

References

1. Bledsoe GH, Li G, Levy, F. Injury risk in professional boxing. Southern Med J 2005; 98:994-998.

2. Bledsoe GH, Hsu EB, Grabowski JG, Brill JD, Li G. Incidence of injury in professional mixed martial arts competitions. The Journal of Sports Science and Medicine (in press).

3. Porter K. Chipley man dies from injuries suffered in “ultimate fighting” match [news article online]. Panama City, FL: The News Herald, 1998, http://ap.emeraldcoast.com/nharchive/index.php (accessed 6 Feb 2006).

4. Branch, G. Toughman Competition Faces Its Own Battle. USA Today, 3C, 20 May 2003.

Dear Editor,

The influence of a regular physical exercise on health and fitness is well-established, as physically active subjects are characterized by a consistently decreased risk of cardiovascular disease, diabetes, cancer, osteoporosis, obesity, fractures and mental health problems. Accordingly, the current guidelines recommend 30 minutes or more of moderate-intensity activity on most days of the week, and that people already achieving this would benefit further from participation in more vigorous activity.[1]

However, there is still an open debate regarding the intensity and the type of physical activity required to achieve most favourable health changes in the general population without overwhelming the relative benefits or eliciting osteoarthritis and cardiovascular abnormalities not present at rest.[2] It was recently observed that the volume of lifestyle activities of moderate intensity in leisure time was inversely associated with all cause mortality in women but not in men and. Therefore, with regard to the health enhancing physical activity recommendation as a threshold, there were favourable findings only in women.[3]

In recent investigations on male professional athletes, we demonstrated that a vigorous and regular endurance aerobic training regimen does not influence markers of hemostatic or endothelial activation,[4] does not induce any persistent phlogistic reaction,[5] nor it is associated with biochemical signs of significant and irreversible chronic cardiac involvement, as reflected by normal concentrations of the NT-pro-brain natriuretic peptide.[6]

Therefore, as a substantial intensification in leisure-time physical activity within the population does not apparently produces any acute increase of the risk of adverse cardiovascular events[4-6] and it is likely to be more effective for eliciting supplemental gains in health,[2] we suggest that higher intensities and amounts of aerobic training may be safely implemented in free-living sedentary individuals as a preventive or therapeutic measure to increase the health benefits, especially in individuals who are most at risk of developing health problems.

References

1. Willett W. Harvesting the fruits of research: new guidelines on nutrition and physical activity. Cancer J Clin 2002; 52: 66-67.

2. Lee, IM, Sesso, HD, Oguma, Y, Paffenbarger, RS Jr Relative intensity of physical activity and risk of coronary heart disease. Circulation 2003; 107: 1110-1116.

3. Bucksch J. Physical activity of moderate intensity in leisure time and the risk of all cause mortality. Br J Sports Med 2005;39:632-8.

4. Lippi, G, Salvagno, GL, Montagna, M, Guidi, GC Chronic influence of vigorous aerobic training on hemostasis. Blood Coagul Fibrinolysis 2005; 16: 533-534.

5. Lippi, G, Salvagno, GL, Guidi, GC Other advantages to aerobic exercise. CMAJ 2005;173:1066.

6. Lippi, G, Salvagno, GL, Montagnana, M, Schena, F, Balestrieri, F, Guidi, GC Influence of physical exercise and relationship with biochemical variables of NT-pro-brain natriuretic peptide and ischemia modified albumin. Clin Chim Acta (in press).