18th FINA World Sports Medicine Congress

Important milestone in Windsor

By Dr Kevin Boyd & Dr Saul Marks
FINA Sports Medicine Committee and World Sports Medicine Congress Scientific Organising Committee

The Aquatics Sports Medicine community held its quadrennial meeting in Windsor, Canada on 3-4 December 2016 in advance of the World Swimming Championships (25m). For the first time, the FINA Sports Medicine Congress was integrated within the FINA World Aquatics Convention and alongside the FINA Swimming Coaches Golden Clinic. This provided an ideal opportunity for interaction and cross fertilisation of ideas amongst the aquatics family and opportunities for coaches to attend the medical and scientific presentations. The Congress benefitted from administrative support from FINA and our Canadian hosts, and the convention website and ‘app’ devised for the event. Local Sports Medicine Physician, Dr Lee Schofield (CAN) acted as Chair of Local and Scientific Organising Committee, supported ably by compatriots Dr Saul Marks, Honorary Secretary FINA Sports Medicine Committee, and Dr Margo Mountjoy, FINA Bureau – Sports Medicine Liaison and delivered a wide-ranging and contemporary programme.

The Congress theme was Swimming for Gold, Swimming for Life, and brought together leading world speakers to share their knowledge with the aquatics community. FINA continued its commitment to physician development and engagement by sponsoring the attendance of one sports doctor from each National Federation to attend the Congress. Around 80 countries availed themselves of the opportunity and this was particularly popular amongst some smaller, developing nations.

Following a welcome and introduction from Dr Julio Maglione, FINA President, the congress opened in keeping with tradition with the invitational Bleasdale Lecture. This year, it was delivered by Dr Alan Vernec, Medical Director for WADA (CAN). He reviewed some of the anti-doping issues around the Rio Olympic Games 2016. Putting in to context the history of doping, he was able to offer some reassurance as to the positive impact of current anti-doping practices on our sport. He outlined the strategic direction of anti-doping efforts of WADA with greater focus on intelligent testing and the expansion of the individual profiles within the Athlete Biological Passport.

The importance of nutrition

Professor Ron Maughan, Visiting Professor at the University of St Andrews (GBR), presented the first of two talks on nutrition. He stressed the importance of matching diet to the demands of training and the nutritional goals, and how this should vary the intensity of training, taper and competition phases. Micronutrient requirements can be achieved by a mixed diet and should only be actively replaced if deficiencies can be demonstrated. He highlighted the launch of a new publication Nutrition for Aquatic Athletes, a practical guide to eating for heath and performance. This encapsulates the scientific outcomes of the Aquatic Nutrition Consensus meeting held at the end of 2013, sponsored by FINA and Yakult. This will become the go-to resource for nutritional information for athletes, coaches and parents across all the aquatics disciplines.

Aquatics injuries and illness informed by the findings from FINA projects at the Rome, Barcelona and Kazan World Championships were presented by Professor Astrid Junge, Medical School of Hamburg (GER) and Dr Saul Marks, FINA Sports Medicine Committee (CAN). They were able to demonstrate the improved understanding of injury and illness rates and which problems tend to affect which athlete groups. This knowledge has suggested a focus on a number of areas within our sports to reduce the incidence and consequences of such problems. Further educational videos addressing problems in aquatics regarding the spine, knee and concussion have been completed and will be released in the near future to complement the popoular Shoulder injury prevention video already available. Dr Margo Mountjoy (CAN) presented information from a further FINA initiative supporting athlete health and well-being. Asthma rates across sports were determined from anti-doping information highlighting the high incidence of asthma within our sport and the influence of endurance-based exercise as a risk factor for airway dysfunction.

Water temperature

FINA, along with the IOC and the International Triathlon Union (ITU) have invested in research studies to provide some basic science around the upper and lower water temperature limits for Open Water Swimming. Research teams from University of Otago (NZL) and the University of Portsmouth (GBR) were invited to present their data to the aquatics community. Both studies have provided new insights into high intensity exercise in warm and cool water. It is recognised that there is variability between athletes and that water temperature is only one demand on the open water swimmer. Both studies were academically robust and appeared to support the safety of the current upper water temperature limit, however for the lower water temperature, the science has produced concerns in developing hypothermia particularly over longer events.  Those involved in our sport will be aware of the discussions over the use of wetsuits at lower temperatures and the proposals for rule change. This have involved discussions within the sport and the stakeholders to find the best way forward and we are likely to see the introduction of wetsuits under defined conditions in 2017.

The Science and Medicine of Anti-doping session saw presentations from Prof Anne Snowden, University of Windsor’s Odette School of Business (CAN), Prof David Gerrard, Chair WADA TUE Experts Committee (NZL) and Dr Jordi Segura, new Chair of the FINA Doping Review Control Board (ESP). Prof Snowden suggested that technology would allow for international tracking systems that could monitor the prescription of medications. Prof Gerrard explained the process of obtaining a TUE (Therapeutic Use Exemption) and why this is appropriate in specific circumstances to ensure that athlete well-being is not compromised. National anti-doping agencies must now have systems in place that will permit a standardised appraisal of such applications. Dr Segura reviewed FINA’s anti-doping programme over recent years and reported the increasing number of tests, particularly out of competition, that are performed in the FINA registered testing pool of the top 700 aquatic athletes worldwide.

Improving athlete performances

The session, Improving Aquatic Athlete Performance, saw a number of excellent, relevant presentations. Dr Nathan Riding, Aspetar Post-doctoral Researcher (QAT), reviewed the current issues around cardiac screening for athletes and how this needs to be more sensitive for aquatic athletes. The FINA Athlete Heart project ongoing at the Windsor 2016 Championships will continue to inform this work. Prof Koji Kaneoka, Sports Medicine at Wasada University (JPN), reviewed lumbar spine problems in divers and swimmers and advised how exercises can prevent injury and improve performance. Prof Wayne Derman, Director of the Institute of Sport and Exercise Medicine, University of Stellenbosch (RSA) outlined the additional and unique challenges facing Paraswim athletes. Dr Margo Mountjoy (CAN) highlighted the up to date concepts around RED-S (Relative Energy Deficiency in Sport) and the relevance across the aquatic disciplines. Dr Suzanne Leclerc, Medical Director, Institut national du sport du Quebec (CAN), offered recommendations on aquatic specific return to play following concussion.

A combined session with Swimming Coaches Golden Clinic offered presentations geared towards the practical application of knowledge. Professor Ron Maughan presented Eating to win. Not underestimating the importance of athlete talent in performance, the skills of a nutritionist are relevant and success can depend on small margins. Supplements may only have a role for some though there are concerns and consequences with their use. On overview of Safe Open Water Swimming by Professor David Gerrard (NZL) and Dr Kevin Boyd (GBR), FINA Sports Medicine Committee members, identified the roles coaches and organisers have, focussed on safety during these events. A comprehensive risk assessment of the anticipated conditions along with a robust safety plan to ensure adequate support is available for the athletes. Coaches have roles in individual athlete preparation before and in monitoring during completion. Team travel issues with helpful practical recommendations were presented by Professor Wayne Derman (RSA). Preparation in advance, during and on return home can reduce the risk of illness and loss of training time or performance. For example, introduction of team-based hand hygiene measures has significantly reduced the risk of upper respiratory and gastrointestinal illness.

Mental preparation

Further collaboration with the FINA Swimming Coaches Golden Clinic focussed on mental preparation for winning delivered by Mr Peter Jensen, Sports Psychologist at Queen’s Smith School of Business (CAN). Professor Jean Cote, Sports Scientist at Queens University, Kingston (CAN), reviewed the IOC Youth Athlete development model and the requirements of the young athlete. Dr Inigo Mujika, Sports Physiologist at the University of the Basque County (ESP), outlined how coaches might get the most out of the pre-competition taper phase. A parallel session saw members of the faculty offer workshops based in and around the pool covering practical medical and scientific presentations relevant to the audience.

Cutting edge Sports Science highlights included Prof Ricardo Fernandes, Professor of Biomechanics at the University of Porto (POR), and his evaluation of start techniques using the new backstroke start facilities. Dr Inigo Mujika, reviewed the difficulties in peaking in team sports where individual variation must match the overall team needs. The inherent problems in reducing subjectively in synchronised swimming judging were covered by Dr Mickael Begon, Associate Professor of Biomechanics at the University of Montreal (CAN).

Cameron Award

Free scientific paper presentations where invited and the best 8 papers were presented in person at the Congress from countries around the world, including Slovenia, Iran, Great Britain, Germany and Canada.  The Cameron Award is presented at each Congress for the best scientific presentation. Selection criteria include relevance to aquatics, relevance to athlete health, academic rigour, practical application and quality of presentation. A committee comprising of members of the FINA Sports Medicine Committee recommended the 2016 Cameron award be presented to Dr Emily Pattinson, University Of Winchester (GBR) for her work Sources of Self-efficacy in a Competitive Diving Sample. Dr Pattinson and colleagues have developed a tool applied to competitive divers across a range of countries that provides insight into limitations in athlete psychology and opportunity to improve performance.

As part of FINA’s commitment to development and education, proceedings of the World Sports Medicine congress will be made available on FINA’s website through the Sports Medicine pages. Colleagues interested in aquatic sport medicine and science should be aware of the next Congress and we welcome you to join us then.