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There is widespread acceptance of the idea that ‘‘sport is good for health.’’ The ideology linking health and sports has a long history and the promotion and maintenance of the health of schoolchildren has long been an area of concern to physical educators in Europe and America.
- Exercise, Sport, and Health
- The Epidemiology of Sports Injuries
The links between physical activity and good health have been endorsed in many official health publications in Britain and North America. In Britain, the Health Education Authority (1997: 2) suggested ‘‘the health benefits of an active lifestyle for adults are well established.’’ In the US, the Surgeon General’s report, Physical Activity and Health (US Department of Health and Human Services 1996: 10), argued ‘‘significant health benefits can be obtained by including a moderate amount of physical activity on most, if not all, days of the week.’’ In Canada, a discussion paper prepared for Health Canada and Active Living Canada (Donnelly & Harvey 1996) noted that a comprehensive examination of Canadian data had similarly identified several significant health benefits of physical activity. Can we conclude, then, that sport is good for one’s health? Let us begin by examining the health benefits associated with physical activity.
Exercise, Sport, and Health
Numerous studies indicate that moderate, rhythmic, and regular exercise has a beneficial impact on health. In the United States, the 1996 report of the US Surgeon General brought together what had been learned about physical activity and health from decades of American research. It concluded that regular physical activity is associated with lower levels of overall mortality for younger and older adults; decreased risk of cardiovascular, and especially coronary, disease; prevention or delay of onset of high blood pressure; reduction of blood pressure in people with hypertension; decreased risk of colon cancer; reduced risk of developing certain forms of diabetes; maintenance of normal muscle strength and joint structure; reduced risk of falling in older adults; lower levels of obesity; and improved mental health.
Five years after the Surgeon General’s report, Britain’s Department of Health (2001:1) stated there was ‘‘compelling evidence that physical activity is important for health’’ and listed health benefits similar to those identified in the American report. Most recently, the National Center for Chronic Disease Prevention and Health Promotion (2004) pointed out that regular physical activity substantially reduces the risk of dying of coronary heart disease (the lead ing cause of death in the USA) and has reiterated all the health benefits identified in the earlier reports in the US and Britain.
At first glance, studies like these might seem to indicate that the health based arguments in favor of sport and exercise are overwhelming. Donnelly and Harvey (1996: 5) have noted, tongue in cheek, that the ‘‘numerous, almost miraculous claims for the benefits of physical activity lead one to wonder why it has not been patented by an innovative company’’; more seriously, they go on to point out that the wide spread nature of these claims should serve as a warning against a too easy and uncritical acceptance, and that the context of the claims needs to be carefully examined. There are indeed some important provisos to be borne in mind when considering studies on the relationship between sport, exercise, and health. In particular, it is important to note that almost all the studies cited to support the idea that sport is good for health refer not to sport, but to physical activity or exercise. Physical activity and sport are not the same thing. Physical activity or exercise might involve lifestyle activities such as walking or cycling to work, dancing, gardening, or walking upstairs instead of taking the elevator. None of these are sport. There are important differences between physical activity and exercise, on the one hand, and sport on the other. Perhaps most importantly, whereas the competitive element is not central to most forms of physical activity, sport, in contrast, is inherently competitive and is becoming increasingly so (Waddington 2000). The increased competitiveness of modern sport, together with the increased emphasis which has come to be placed on winning, mean that, unlike most people who take part in non-competitive physical activities, those who play sport are, particularly at the higher levels, frequently subject to strong constraints to ‘‘play hurt,’’ that is to continue playing while injured, ‘‘for the good of the team,’’ with the associated health risks this behavior entails (Young et al. 1994; Roderick et al. 2000).
It is also important to remember that many sports (not just combat sports) are mock battles in which aggression and the use of physical violence are, to a greater or lesser degree, central characteristics (Dunning 1986: 270). In this context, many sports have, in present day societies, become enclaves for the expression of physical violence, not in the form of unlicensed or uncontrolled violence, but in the form of socially sanctioned violence as expressed in violently aggressive ‘‘body contact’’; indeed, in the relatively highly pacified societies of the modern West, sport is probably the main – for many people, the only – activity in which they are regularly involved in aggressive physical contact with others. As Messner (1990: 203) has noted, in the more violent contact sports, ‘‘the human body is routinely turned into a weapon to be used against other bodies, resulting in pain, serious injury, and even death.’’
The link between sport, aggression, and violence provides a key to understanding why sport is a major context for the inculcation and expression of gender identities and, in particular, for the expression of traditional forms of aggressive masculinity. As Young et al. (1994) have noted, these traditional concepts of masculinity involve the idea that ‘‘real’’ men play sport in an intensely confrontational manner; players are expected to give and to take hard knocks, to hurt and to be hurt and, when injured, to ‘‘take it like a man’’; injury thus becomes a symbol of virility and courage and, for many players and fans alike, relatively violent sports, precisely because of their violent character, are arenas par excellence for young men to demonstrate their masculinity.
Young (1993: 373) has noted that professional sport is a violent and hazardous work place which has its own unique forms of ‘‘industrial disease.’’ He adds: ‘‘No other single milieu, including the risky and labor intensive settings of miners, oil drillers, or construction site workers, can compare with the routine injuries of team sports such as football, ice hockey, soccer, rugby and the like.’’ In this context, one study of injuries in English soccer found that the overall risk of injury to professional footballers is 1,000 times greater than the risk of injury in other occupations normally considered high risk, such as construction and mining (Hawkins & Fuller 1999).
But risks are not confined to elite level sport. There are health costs associated with sports participation even at the mass level.
The Epidemiology of Sports Injuries
A leading British research team has commented that there ‘‘is a reluctance to recognize that increased participation in sports and exercise will also result in an increase in exercise related injuries’’ (Nichol et al. 1995: 232), while Hard man and Stensel (2003: 250) have noted that ‘‘the relationship between the benefits and risks associated with physical activity is not well described.’’
Research indicates that sports injuries are extremely common and have to be taken into account in any attempt to assess the ‘‘health costs’’ and ‘‘benefits’’ of sport and exercise. Community studies in Europe suggest that every sixth unintentional injury is associated with leisure time physical activity, mainly sports, and that around 50 percent of people participating in team sports sustain one or more injuries over a season (Hardman & Stensel 2003: 226). At one university hospital in the Netherlands, sports injuries comprised about one fifth of all injuries treated over a 7-year period, making these the second highest cause of accidental injuries (Dekker et al. 2000). In the US, a prospective study of a physical activity intervention program (Hootman et al. 2002) found that a quarter of all participants reported at least one musculoskeletal injury, and such injuries were more likely to be reported by those participating in sports than those participating in other forms of physical activities.
Large scale, national studies of sports injuries are relatively rare, but a team from Sheffield University Medical School (Nichol et al. 1993, 1995) estimated that in England and Wales there are 19.3 million new injuries and a further 10.4 million recurrent injuries each year. The direct treatment costs of injuries were estimated at L422 million, with costs of lost production (11.5 million working days a year are lost due to sports injuries) estimated at L575 million (Nichol et al. 1993: 25, 31).
The Sheffield University researchers also sought to ascertain the direct economic costs and benefits of sports and exercise related injuries to the health care system. The health benefits of sport and exercise (e.g., avoidance of costs associated with the management of chronic illnesses) were weighed against the costs of treatment of exercise related injuries. It was found that, while there were economic benefits associated with exercise for adults aged 45 and over, for younger adults (15–44 years old), the costs avoided by the disease prevention effects of exercise (less than L5 per person per year) were more than offset by the medical costs resulting from participation in sport and exercise (approximately L30 per person per year). Thus, for every 15–44-year-old adult who regularly participates in sport, there is a net cost to the British taxpayer of L25 per year. The authors conclude ‘‘there are strong economic arguments in favor of exercise in adults aged 45 and over, but not in younger adults’’ (Nichol et al. 1993: 109; emphasis added). A Dutch study that produced similar findings to those of Nicholl et al. noted that this result ‘‘contrasts heavily with statements of people who use the supposed health effect of sport as an economic argument to promote sport’’ (cited in Nichol et al. 1993).
Although the data in these studies relate to injuries from both sport and exercise, the authors did note that injury risks vary markedly from one kind of physical activity to another; unsurprisingly, the highest risks are associated with contact sports and, in line with the analysis presented earlier, the Sheffield study found that the activities with the lowest risks of injury were the non-contact, rhythmic (and largely noncompetitive) activities involved in ‘‘keep fit,’’ swimming, and diving.
The relationship between sport and health is by no means simple. Moderate and regular physical activity has a beneficial impact on health. However, as we move from noncompetitive activity to competitive sport, and from non-contact to contact sports, the health costs, in the form of injuries, increase. Similarly, as we move from mass sport to elite sport, the constraints to train more intensively and to continue competing while injured also increase, with a concomitant increase in the health risks. The health related arguments in favor of regular and moderate physical activity are clear, but they are considerably less persuasive in relation to competitive, and especially contact, sport and very much less persuasive in relation to elite or professional sport.
The injury risks associated with competitive sport are increasingly being recognized by public health specialists. Significantly, almost all the examples of physical activity recommended in the 1996 Surgeon General’s report are either lifestyle activities such as washing a car, gardening, or dancing, or non-contact, rhythmic exercises such as water aerobics, jumping rope, or walking. The only competitive sports which figure in the list of recommended examples of moderate activity are playing basketball for 15–20 minutes and playing volleyball for 45 minutes; all the other major competitive sports in the US, with their associated injury risks, are conspicuous by their absence from this list of recommended healthy activities.
- Department of Health (2001) Exercise Referral Systems: A National Quality Assurance Framework. Department of Health, London.
- Donnelly, P. & Harvey, J. (1996) Overcoming Systematic Barriers to Active Living. Discussion paper prepared for Fitness Branch, Health Canada and Active Living Canada.
- Dekker, R., Kingma, J., Groothoff, J. W., Eisma, W. H., & Ten Duis, H. J. (2000) Measurement of Severity of Sports Injuries: An Epidemiological Study. Clinical Rehabilitation 14: 651-6.
- Dunning, E. (1986) Sport as a Male Preserve: Notes on the Social Sources of Masculine Identity and its Transformation. In: Elias, N. & Dunning, E., Quest for Excitement. Blackwell, Oxford, pp. 267-83.
- Hardman, A. E. & Stensel, D. J. (2003) Physical Activity and Health. Routledge, London.
- Hawkins, R. D. & Fuller, C. W. (1999) A Prospective Epidemiological Study of Injuries in Four English Professional Football Clubs. British Journal of Sports Medicine 33: 196-203.
- Health Education Authority (1997) Young People and Physical Activity: Promoting Better Practice. Health Education Authority, London.
- Hootman, J. K., Macera, C. A., Ainsworth, B. E., Addy, C. L., Martin, M., & Blair, S. N. (2002) Epidemiology of Musculoskeletal Injuries among Sedentary and Physically Active Adults. Medicine and Science in Sport and Exercise 34: 838-44.
- Messner, M. (1990) When Bodies are Weapons: Masculinity and Violence in Sport. International Review for the Sociology of Sport 25(3): 203-18.
- National Centre for Chronic Disease Prevention and Health Promotion (2004) The Benefits of Physical Activity. Online. http://www.cdc.gov/physicalactivity/basics/pa-health/index.htm
- Nichol, J. P., Coleman, P., & Williams, B. T. (1993) Injuries in Sport and Exercise: Main Report. Sports Council, London.
- Nichol, J. P., Coleman, P., & Williams, B. T. (1995) The Epidemiology of Sports and Exercise Related Injury in the United Kingdom. British Journal of Sports Medicine 29(4): 232-8.
- Roderick, M., Waddington, I., & Parker, G. (2000) Playing Hurt: Managing Injuries in English Professional Football. International Review for the Sociology of Sport 35(2): 165-80.
- US Department of Health and Human Services (1996) Physical Activity and Health: A Report of the Surgeon General, Executive Summary. US Department of Health and Human Services, Washington, DC.
- Waddington, I. (2000) Sport, Health and Drugs: A Critical Sociological Perspective. E. & F. N. Spon, London.
- Young, K. (1993) Violence, Risk and Liability in Male Sports Culture. Sociology of Sport Journal 10: 373-96.
- Young, K., White, P., & McTeer, W. (1994) Body Talk: Male Athletes Reflect on Sport, Injury, and Pain. Sociology of Sport Journal 11(2): 175-94.