Facts of Life:
Issue Briefings for Health Reporters
Vol. 7, No. 4
April 2002

Sport for Life:
Avoiding Pitfalls, Attaining Benefits

The Issue
The Facts
Interview: Sport for Life: Enhancing Health and Well-being at Any Age
Going the Distance: Access to Sport for People with Disabilities
Interview #2: Healthy Attitudes, Healthy Policy
Practicing Safe Sport
Unsporting Behavior
The Research

The Issue:

Participation in sports at all ages and stages of life enhances health and enjoyment, yet it also carries risks. Both underexercising and overexercising can be harmful. Injury can be caused through carelessness, pressure to perform or simple wear and tear on the body. People with disabilities, the elderly and the poor often have insufficient access to facilities, exercise and instruction. (1) Overemphasis on competition may contribute to the phenomenon of overzealous “soccer moms” and “hockey dads” and to the increased use of performance-enhancing drugs. (2) However, many of the risks can be managed and minimized with the correct approach and preparation.

The Facts:

• About one-quarter of American adults do not engage in any leisure-time physical activity. Inactivity is more common among women, blacks and Hispanics, older adults and those with lower incomes. (3)
• Close to 6 million high school students play team sports and another 20 million take part in recreational or competitive activities outside school. (4)
• Snowboarding and skateboarding were two of the fastest-growing sport in the United States during 2000. Other nontraditional sports also gained popularity, including wall-climbing, surfing, paintball, mountain biking, in-line skating and snowshoeing. Many participants are “Generation Y” males born between 1979 and 1994. (5)

• In traditional sports, baseball participation declined by 10 percent during 2000. Basketball also declined as a sport, down 17 percent from its 1997 peak. Softball and volleyball declined by 36 percent and 37 percent respectively, while soccer popularity remained level. (5)

• Fishing remained the third most popular recreational activity in the United States in 2000, with 54.8 million adherents, just behind recreational walking and swimming. However, due to a 15 percent increase in the U.S. population between 1987 and 2000, the actual incidence of fishing has declined by over 20 percent. (5)
• Pressure to perform and win in various sports inside and outside the educational setting can lead to physical and psychological damage. A survey in 1993 by the Minnesota Amateur Sports Commission found that almost half the young athletes who participated said they had been insulted or yelled at; 17.5 percent said they were hit, kicked, or slapped and 8.2 percent reported being pressured into harming other players. (6)

• In basketball, one player is injured every 100 hours. Running accidents occur at the rate of one every 200 to 400 hours and tennis yields an injury every 1400 hours. Weight training accidents occur only every 8000 hours or less. (7) At the other end of the scale, martial arts injure a participant once every 48 hours, with women experiencing roughly twice as many injuries as men. (8)

• Each year, more than 775,000 children under age 15 are treated in hospital emergency rooms for sports injuries. About 80 percent of these injuries are from playing football, basketball, baseball or soccer. (4) Among children age 5 to 14, boys account for nearly 75 percent of all sports-related injuries. (9)

• During the 1990s, anabolic steroid use among 12th graders-- both boys and girls -- rose to an all-time high with more than 500,000 adolescents having cycled (an episode of use lasting 6 to 12 weeks) an anabolic steroid during their lifetime. (10)

Sport for Life: Enhancing Health and Well-being at Any Age

Richard E. Killingsworth, M.P.H., is director of the Active Living by Design National Program Office at the University of North Carolina School of Public Health. Sponsored by the Robert Wood Johnson Foundation, the program will promote physical activity through community design and transportation alternatives. Previously, Mr. Killingsworth was a health scientist with the Centers for Disease Control and Prevention. He currently serves on several national boards and committees.

Q. What factors add up to an exercise-friendly neighborhood?

A. You need to look at how "walkable" the community is as a whole. It's based on factors like land use and connectivity. Is the commercial center too far to walk or cycle from surrounding homes? Are streets and sidewalks laid out so that walkers and cyclists have a choice of routes to places of business or interest?

Proximity of routes to work or home is a key factor. Too often, a walkable street ends in a cul-de-sac. One way to assess a community for exercise-friendliness is to observe how many young children are playing outside, or how many elderly people are walking to a destination of interest or utility. If these two groups are nowhere to be seen, you can assume the community is not functioning properly for all its residents.

Q. Given the well-established benefits of sport and activity on the nation's health, why isn't more being done to create access for all? Is the problem mainly a budgetary one?

A. The problem really isn't budgetary - the money is there. Transportation commands the second biggest federal budget right now. Currently, though, as much as 99 percent of the road transportation budget is earmarked for automobile use, for building and maintaining roads. Over the next couple of years, health campaigners will be trying to integrate provisions for non-car alternatives into upcoming legislation. Proposals will be based on factors such as easing motor vehicle congestion during high-traffic times.

The problem is really that the need for better planning and policy has been largely overlooked. There's a general assumption that people are completely responsible for making the right choices for themselves and then acting on those choices.

Increasingly, studies show that isn’t true. The social, physical and policy environment have to support those choices. Look at tobacco. It’s taken more than 40 years of changing policies, banning smoking in many workplaces and public spaces, to motivate people to give up smoking and stay off cigarettes permanently.

Q. Isn't it more important to tackle unhealthy lifestyle habits, such as excessive drinking, smoking and unhealthy diets, before creating facilities people may not want to use?

A. One influences the other. It is vital to put the facilities in place while promoting lifestyle changes, otherwise there is nowhere to act on good intentions.

You're asking: "If we build it, will they come?" Not if a trail or cycle path isn't going anywhere that people want to be - taking the children to school, buying groceries, going to places of exercise. Nearly 75 percent of car trips are to destinations less than a mile away. Many of these trips could be done on foot. But the roads may not be safe or efficiently connected, so people take their cars.

For example, only 28 percent of children who live within a mile of school walk there. In fact, some schools don't allow children to walk, because their transport subsidies are calculated according to how many children will use the bus service.

A number of health-related organizations are trying to enact policy changes with a campaign called "Safe Routes to School." It's aimed at getting children back on their feet by providing safe walking and cycling routes as an alternative to getting a ride.

Q. What can churches, hospitals, universities and other institutions do to provide sports and exercise facilities?

A. These institutions could play a very useful role in augmenting community exercise facilities. However, all too often, they are not at the table when initiatives are launched. Currently, the Robert Wood Johnson Foundation is allocating $100 million to faith-based organizations nationwide to start their own healthy living initiatives.

The problem many larger institutions have is that their facilities are already over-subscribed. For example, at the University of North Carolina, only faculty and staff can use the facilities. However, schools and churches could make a great difference by coordinating their promotional efforts and suitable venues. For example, a church could promote healthy habits and exercise and motivate its members to take part, while the local schools could make space, equipment and staff available, perhaps in return for a nominal charge or membership fee. Right now, thousands of taxpayer-funded, local elementary and middle schools are sitting empty every evening.

Q. Are there special challenges related to sport and exercise facilities in inner-city settings? How are they being overcome?

A. Crime and lack of safety are key concerns. People will avoid walking or cycling on unsafe streets. Decaying facilities are another problem. As taxpayers migrate from the city, there is less money to maintain existing green spaces and trails, much less create new ones. Meanwhile, poor diet, pollution and stress continue to intensify the need.

Government cannot really be effective because it doesn't know the grass-roots issues. Instead, the communities themselves need to come together to identify problems and solutions. Our team is involved in a new initiative called Active Living by Design, funded by the Robert Wood Johnson Foundation. As part of this initiative, 25 communities all over America are receiving funding to develop resource partnerships and create healthier environments.

Q. What about mobility and access to exercise for people with disabilities?

A. The Americans with Disabilities Act of 1990 provides guidance for building more accessibility into existing environments. Slowly, the situation is improving, although the great majority of metropolitan centers do not offer sufficient access.

For example, Boston is a city where walking is possible, but its narrow sidewalks and lack of sloping curbs make it difficult to get from Point A to Point B if a person is not fully mobile. Yet there is not enough money to make the recommended changes for what is a relatively small proportion of residents with disabilities.

Q. How interested are developers of residential property in designing sports and exercise facilities into their developments?

A. Developers are seeing a growing demand for activity areas and facilities in new properties, and they are keen to meet that demand. Purchasers will pay a considerable premium to have tennis courts and a pool within strolling distance. However, zoning can be an obstacle. Builders stick to the building code, no more, no less. They will build in sport and activity areas if they possibly can.

Q. What is your vision for the activity-friendly community of thefuture?

A. I'd like to see communities where you can walk out of your front door and walk or cycle to an exercise location without getting into your car; where walking is part of everyday life because your route links you to places you need or want to get to. This kind of access is also a vital element in the village concept, promoting sociability and safety as more people use more public routes. We're at the beginning of a long journey. To reach this vision, we need to adopt new standards for the way we design our communities and slowly change what already exists.

Going the Distance: Access to Sport for People with Disabilities

Intended to end discrimination against people with disabilities and to bring them into the mainstream of American life, the Americans with Disabilities Act (ADA) became law in 1990. One of its provisions requires that "places of exercise may not discriminate against persons with a disability." This means that people with disabilities should have access to school, university and community sports programs, suitable transportation to get to and from exercise venues and be considered for employment at places of exercise if suitably qualified. (18) While the law has certainly opened doors to sport and exercise for many disabled people, considerable barriers still need to be overcome to take full advantage of its provisions.

On the positive side, according to James F. Sallis, Ph.D., at San Diego State University, access to sporting activities for children with disabilities is surprisingly good. Legal pressure and advocacy for inclusion have created a favorable environment for them to participate in a range of activities. In addition, HMOs list many diagnosed conditions for which they will pay for physical therapy.

"In my view, there are more resources for children who have special needs than for some groups who don't," says Sallis, who views physical activity as equally important for all young people, whether they are disabled or not. Adults also have a better choice of specialized sports programs. In addition, the law has upheld their right to demand integration into regular sports programs, where they can often take advantage of better coaching, better facilities and more intensive training.

Yet this very integration raises a number of special concerns. Should a child or adult who is blind compete in skating? Should a wheelchair user be allowed to coach third base? When sports organizations are assessing such safety requirements, ADA mandated that they be based on individual assessment and actual risks, rather than speculation, prejudice, stereotypes or unfounded fears. However, changing attitudes can take time and determination.

Other barriers are self-imposed, such as individuals' belief in their own ability to perform. To strengthen this belief, acceptance by teammates, coaches, officials and administrators is vital; team leaders can do much to achieve this by setting a positive example. However, negative attitudes toward athletes with disabilities are still common within this influential group. They may have concerns about neglecting other team members in order to focus on the different needs of one member with a disability. They may worry about safety or about accommodating special gear or equipment.

Financial considerations also figure for athletes with disabilities. Special equipment such as motorized wheelchairs can cost thousands of dollars. Insurance costs, already high for athletic events, are higher still for those with disabilities. And often, they must pay more and travel greater distances to take part. (18)

While people with disabilities will continue to face challenges in order to claim their right to sport and exercise, the proven physical, mental and social benefits provide them with a strong incentive to go the distance.

Interview #2: : Healthy Attitudes, Healthy Policy

David Buchner, M.D., Ph.D., is chief, Physical Activity and Health Branch, in the National Center for Chronic Disease Prevention and Health Promotion in Atlanta. Previously, he was selected to be a fellow in the Robert Wood Johnson Clinical Scholars Program at the University of Washington, where he received his M.P.H. degree. He was subsequently director of community medicine and codirector, University of Washington Center for Cost and Outcomes Research. Dr. Buchner has published extensively in the areas of physical activity in older adults and the role of physical activity in preventing fall injuries.

Q. How early should parents introduce children to structured physical activity, such as organized sports or exercise classes?

A. The main structured activities for school age children are physical education classes, which should be part of every school day, after school sports and activities with parents. Preschool children as young as toddlers should also have structured physical activity that develops basic movement skills such as walking, jumping and running, and motor skills such as kicking and throwing.

Q. How can parents encourage physical activity in their children?

A. Games for young children should be noncompetitive and promote the development of kicking, throwing, catching and body movements such as skipping, rolling and jumping. Supervised aquatic instruction is fun and appropriate for preschool children. Walking or biking with your child to school is healthy and fun for both parents and children. When a child does not have access to daily physical education in school, and does not walk or bike to school, it is especially important to provide and encourage after-school opportunities in sports and other physical activities. Parents should model a physically active lifestyle for their children. Its important to allow children to participate in activities they enjoy, to encourage them to try new activities and never to use physical activity as punishment.

Q. What role do team sports play in children developing good exercise habits and healthy attitudes towards competition?

A. Team sports can help children develop a physically active lifestyle that persists into adulthood. However, a realistic appraisal of youth sports acknowledges both the benefits and the potential for harm. As children grow older and stronger, they are more capable of causing injury to themselves and to others. Success in team sports need to be measured in terms of personal growth and development of the children, not in win-loss records or parental self-esteem. Some children do better in sports where there is more emphasis on “competing with yourself” such as cross-country, swimming or skiing.

Q. How well does physical education in schools provide for the activity needs of children?

A. The situation with physical education in schools can and should be improved. There are currently three national objectives that should guide this improvement. First, we should increase the proportion of the schools that require daily PE. Second, we should increase the proportion of adolescents who participate in daily PE. This is particularly important for girls who show a dropoff in level of physical activity during adolescence. Third, we need to increase the proportion of PE class time that is spent being physically active.

Q. Why isn’t this being done already?

A. There are two well recognized barriers to these improvements. One is that schools lack the funds to hire qualified PE teachers and provide quality, daily PE classes. The second is that increasing emphasis on academic success, such as performance on standardized tests, makes the curriculum less flexible to changes of any type. Of course, it makes sense that children that are fit and healthy are, in fact, more ready to learn. However, children in this country are becoming more overweight, which increases their risk for a variety of health problems. We need to seriously look at options such as improved physical education to counteract the increase in unhealthy weight gain among children.

Q. What measures are being taken to provide more effective physical education in schools?

A. There are a growing number of structured programs that can be adapted and implemented to suit the needs and budgets of individual schools.

SPARK (Sports, Play and Active Recreation for Kids) is one example of a successful program being taken up by schools. It addresses both the physical and emotional needs of children. Initial results show an improvement in physical education teaching, with higher activity and fitness levels and better coordination demonstrated by pupils in the scheme.

In addition, the time spent on physical education rose by 200 to 300 percent, without adversely affecting academic performance. (11)

Q. How should physical education change to help children continue activity into adult life?

A. Sports should be a source of enjoyment as well as fitness. Children should be shown that practicing a skill does lead to individual improvement, whatever their starting ability; classes should allow for all children to experience that improvement, with a much wider choice of activities during and after school.

Q. How does the level and choice of activity differ at different ages and in different groups?

A. Girls show a marked decline in physical activity from the beginning of middle school and through high school. While sporting activity for both sexes (as distinct from exercise, running, swimming and walking) declines with age, men remain more active than women overall, most notably at the highest income levels. At lower income levels, less leisure sport and exercise is sometimes balanced by a higher component of physical labor, although this doesn’t carry the benefits of taking part in an enjoyable sporting activity.

Pregnancy is one time of adult life where exercise should be modified. The joints loosen so women should avoid activities that put stress on them. In midlife and older age, walking becomes the most common, because it is an appropriate activity over a wide range of fitness and ability levels.

Q. What prevents adults from including more sport and physical activity in their lives?

A. Lack of time is cited as the main barrier. However, people generally find time for activities that they consider a high priority and enjoyable. When the enjoyment factor is diminished, perhaps because of a minor medical problem, that can lead to avoiding activity.

Attitudes can also be a barrier to finding time for exercise. Exercise and sport is seen by many as a leisure activity and a form of relaxation rather than a purposeful use of time. An individual taking a smoking-cessation class in her lunchtime may be praised for taking action to improve her health. But if she went running or took a dance class during that time, she might be seen as having fun or wasting time. Yet physical activity is just as essential to health as a smoking cessation class.

Q. How are expectations and experience of fitness and exercise changing for older adults?

A. People increasingly understand that physical activity is essential for quality of life and maintaining active living in old age. Young adults who are physically active reduce their future risk of chronic disease, while older adults experience more immediate benefits. For example, older adults with low fitness who begin a strength training program will typically show improvements over a few months in their ability to do tasks of everyday life.

Together with improvements in understanding and treating disease, diet and exercise can prolong middle age potentially into the upper 70s, raising expectations of what and how much older people can do. Recent research suggests regular physical activity prevents cognitive impairment in older adults. While its true some decline in fitness occurs in everyone with age, it is possible for older adults to maintain remarkable levels of fitness, such as running in marathons.

Q. What provisions are being made to improve sport and exercise facilities for older adults?

A. Most older adults prefer doing activities on their own, such as walking on a treadmill at home, gardening, jogging in the park or going to a health club and lifting weights. But a sizable minority want exercise classes, and more and more classes are becoming available in the community in places such as senior centers. Some health and fitness facilities are also increasing programming appropriate for older adults. Walking, however, remains probably the single most popular activity among older adults. Having communities that are walkable is quite important for them.

Q. What kind of physical activity is recommended for older people?

A. Strength training should be part of all training programs for older people. It sustains function and has the motivating advantage of showing fairly rapid results. Yoga and T’ai Chi are also beneficial and growing more popular. T’ai chi carries a low risk of injury and can improve balance, preventing falls. It’s a good example of a nontraditional activity fitting in well with present health guidelines. Whatever the activity, it is important to make gradual changes in intensity. There is a much higher risk of sudden death when a sedentary older person graduates too quickly to high levels of activity. The risk can be managed by stepping up activity in 5 percent to 10 percent increments; for example, 10 miles a week, then 12 miles, and so on.

Practicing Safe Sport

Risks of sports injury are present to varying degrees at all ages, but, children are more susceptible. Still growing and developing, they are less coordinated and have slower reaction times than adults. In addition, the risk of injury increases when children of different heights and weights, are competing or playing together. Such risks can be minimized by matching children to sports according to their skill level, size and physical maturity. (12)

Overuse injuries, in which repetitive actions put too much stress on the musculoskeletal system, present another risk factor. They can occur in adults as well as children but are more serious in children as they may affect growth and development. Common overuse injuries include Little League elbow, swimmer’s shoulder, shin splints and spondylosis (fracture of the lower back). These injuries can be avoided by warming up properly, avoiding excessive activity (playing too long or too intensely), learning proper techniques for the sport, and wearing and using the correct equipment. (12)

Competition and pressure from parents and coaches can also be a factor in sports injuries, so these two groups play an important role in encouraging safer attitudes. Parents should monitor children’s fitness to return to play after an injury and should teach children not to play through pain. Coaches should enforce all the rules of the game, encourage safe play and be aware of the special risks young players face. First aid should be available at all games and practices. Above all, the focus should be on fun rather than on winning. (4)

The number of girls and women taking part in sport has risen significantly in recent years. The style of play has evolved to fast and aggressive. With this change has come more injuries. Women athletes have higher rates of injury than males in many sports, particularly basketball, alpine skiing, volleyball and apparatus gymnastics. (13), (14)

Women are particularly prone to injuries of the knee, especially to the anterior cruciate ligament (ACL), a band of connective tissue that helps stabilize the knee. National Collegiate Athletic Association data shows that female basketball and soccer players have a significantly higher incidence of knee injuries in general and ACL injuries in particular than their male counterparts. (24)

Learning how to jump and land differently can reduce the risk of damage. Strengthening surrounding muscle groups, increasing calcium intake and seeking out training shoes designed for women will help to reduce risk further.(25) Aging brings new challenges to fitness and greater risk of injury for both men and women. As muscles age they begin to shrink and lose mass, responding more slowly to the body’s demands. The water content of tendons decreases, making tissues stiffer and less tolerant of stress. Fatigue sets in more quickly and recovery slower. Aging bones are more fragile. Joint motion becomes more restricted and joints can become inflamed and arthritic. (17)

Yet exercise is even more important as we age, and steps can be taken to counteract many of these symptoms. Gentle stretching helps to maintain joint flexibility, while weight training increases muscle mass and strength.(17) Even in old age, injury can be prevented by modifying activity to accommodate the body’s needs.

Unsporting Behavior

The approximately 30 million American children aged 4 to 14 involved in organized sport, are facing a growing climate of hostility pervading youth sports programs. (21)

The National Federation of State High School Associations lists several unacceptable behaviors for players, fans, coaches and educators. These include "disrespectful or derogatory yells, chants, songs or gestures; distracting opponents; blaming losses on officials, judges, coaches or participants, and displays of temper with an official's call." (20)

Such behavior is by no means confined to young people. In a recent online article, clinical and sports psychologist Darrell Burnett, Ph.D., says that parents today are too invested, emotionally and financially, in their children's games. However unlikely, dreams of sports scholarships, or even professional contracts, can ride on their children's performance, and a wrong move or "bad decision" by an umpire or referree can seem to destroy that dream.(21) Headlines support this notion, recording incidents from weekend soccer scuffles to the Texas cheerleader murder plot to the tragic beating death of a hockey dad.

In many sports, the drive to improve performance can lead competitive athletes at all levels to supplement their diet and training with a growing range of banned substances, from steroids, supplements and sports drinks to caffeine and blood doping. Drugs include anabolic steroids for bursts of strength and speed; beta blockers to lower blood pressure and create steadier aim for archery and shooting; and diuretics to remove excess water from the body, lowering weight to meet rowing and boxing classifications. (22)

Blood doping involves intravenous administration of blood, red blood cells and related blood products to raise oxygen-carrying capacity in the blood. (22) Even for athletes who do not use such measures as drugs or blood doping, the pressure to win is a risk factor in some sports injuries, encouraging athletes to train or play too hard.(4) Increasingly, young athletes of both sexes are taking illegal steroids to achieve low body weight and muscular build, both for performance and appearance.(2)

The Research

The Research Bibliography 1. Centers for Disease Control and Prevention. (1999). Neighborhood safety and the prevalence of physical inactivity: Selected states. Morbidity and Mortality Weekly Report, 48(7):143-6

2. Penn State University News. (2000). [Muscular body images pressure girls, boys into misuse of anabolic steroids.] www.psu.edu

3. Centers for Disease Control and Prevention, National Center for Chronic Disease. (1996). Prevention and Health Promotion, President's Council on Physical Fitness and Sports. Physical Activity and Health: A Report of the Surgeon General. Atlanta, GA. www.cdc.gov

4. Centers for Disease Control and Prevention. (2002). [Sports injury prevention in children and adolescents.] www.cdc.gov

5. American Sports Data, Inc. (2001). [Trends in U.S. sports/fitness participation 1999-2000. Superstudy® of Sports Participation.] www.americansportsdata.com

6. Anderson, C. M.A. (1993) Minnesota Amateur Sports Commission Survey. [Keeping youth sports safe and fun.] www.masc.state.mn.us

7. Sports Injury Bulletin. (2002). [When males and females take up martial arts, who gets hurt?] www.sportsinjurybulletin.com

8. A comparison of male and female injury incidence in martial arts training. (1994). Medicine and Science in Sports and Exercise, vol. 26(5), Supplement, p. S14.

9. National Safe Kids Campaign: [Promoting child safety: Recreation, why children are at risk.] www.safekids.org

10. Penn State News. (2000). [Muscular body images pressure girls, boys into misuse of anabolic steroids.] www.psu.edu

11. Sallis JF, McKenzie TL, et al. (1997). The effects of a 2-year physical education program (SPARK) on physical activity and fitness in elementary school students. Sports, play and active recreation for kids. American Journal of Public Health, 87 (8): 1328-34.

12. The Nemours Foundation. (2002). [Preventing children's sports injuries.] www.kidshealth.org

13. De Loes M(1995). Epidemiology of sports injuries in the Swiss organization, Youth and Sports, 1987-1989: injuries, exposure, and risks of main diagnoses. International Journal of Sports Medicine; 16(2):134-138

14. Zelisko JA, Noble HB, Porter M. (1982). A comparison of men's and women's professional basketball injuries. American Journal of Sports Medicine; 10(5): 297-299

15. Arendt E, Dick R. (1995). [Knee injury patterns among men and women in collegiate basketball and soccer]. NCAA data and review of literature. American Journal of Sports Medicine; 23(6): 694-701

16. Rauch, C. (2001). American Academy of Orthopaedic Surgeons. Online Service Academy News. [Females suffer more knee injuries than males.] www.aaos.org

17. American Academy of Orthopaedic Surgeons. (2000). Online Service Fact Sheet: Effects of Aging. orthoinfo.aaos.org

18. Michigan State University. (2001). Disability Sports. Americans with Disabilities Act. ed-web3.educ.msu)

19. Minnesota Amateur Sports Commission. (MASC). [Keeping youth sports safe and fun.] www.masc.state.mn.us

20. National Federation of State High School Associations (NFHS). (2000). [The case for sportsmanship, ethics and integrity in high school activities.] www.nfhs.org

21. WebMD Medical News. (2001). [Angry grownups are real spoilsports.] mywebmd.com

> 22. World Anti-Doping Agency. (WADA). FAQ on Doping. www.wada-ama.org

23. Burke, L.M. (2000). Australian Institute of Sport, Department of Sports Nutrition. Positive drug tests from supplements. Sportscience 4(3). www.sportsci.org

24. The Physician and Sportsmedicine. (1997). [Anterior cruciate ligament injuries in female athletes.] www.physsportsmed.com

The Center for the Advancement of Health is an independent nonprofit organization that promotes greater recognition of how psychological, social, behavioral, economic and environmental factors influence health and illness. The Center advocates the highest quality research and communicates it to the medical community and the public. The fundamental aim of the Center is to translate into policy and practice the growing body of evidence that can lead to the improvement and maintenance of the health of individuals and the public. The Center was founded by the John D. and Catherine T. MacArthur Foundation and the Nathan Cummings Foundation, which continue to provide core funding. Funding for this series was provided by the Robert Wood Johnson Foundation.

For Information Contact:
Ira R. Allen
Director of Public Affairs
Center for the Advancement of Health
2000 Florida Ave., NW, Suite 210
Washington, DC 20009
p. 202.387.2829 / f. 202.387-2857
press@cfah.org
http://www.cfah.org

© Copyright 2001, Center for the Advancement of Health

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