Force instead of self-determination?

Sports medical examinations should give athletes the security of being healthy and being able to pursue their beloved hobby. To this end, Austria's Ministry of Sport is negotiating with the Medical Association about a mandatory certificate in order to be allowed to take part in sporting events. High time to intersperse further thoughts and to warn against negative consequences. First and foremost, however, I am concerned with preventing coercive measures that go hand in hand with the loss of personal responsibility and the restriction of personal freedom.

Runners want to enjoy movement. They pursue their passion, which comes from themselves. No person who is physically active is forced to do anything. Even if the pressure can come from outside due to certain expectations, it is ultimately the intrinsic motives that drive us and encourage us to exercise regularly and to take part in running events.

This conscious decision to jog goes hand in hand with taking responsibility for oneself. This brings a gain in action competence, which means that one's own thinking changes and is restructured towards an actively acting subject. Regular running leads to more mental stability. This is especially important in uncomfortable, difficult situations. You deal with it more relaxed and relaxed and even more intelligent than comparison groups. All runners are concerned with very different achievements that are exclusively provided by themselves. They know that they are responsible for their own running success – regardless of the level and the goal.

However, if the right, individual measure is lost, these intrinsically positive characteristics tip over. Particularly ambitious runners, who are always looking for longer-lasting challenges, are increasingly introverted, mentally unstable and considerably less resilient, and at the same time obsessively dogged. Their way of life shows up as unreasonable, one-sided and unhealthy on several levels. Of course, something like this also has an effect on their competitive behavior, which tends to go as far as extreme situations in ultra runs or multiple triathlons. It's no longer healthy.

Many people today make a conscious effort to lead a healthy lifestyle, be it through more exercise, better nutrition, more social skills or through less stress. There is a parallel here with changing attitudes about the individual's responsibility for living the life they want. Following the concept of self-determination, this means that the more decisions people make themselves, and the more connected they feel to society, the more fulfilled and happier life tends to be. The degree of self-determination is a helpful indicator.

Now, however, exactly this group, which is exemplary in many respects, is to be forced to lose its self-determination and only be allowed to take part in sporting competitions with a current medical certificate. According to the Ministry of Sports, in consultation with the Medical Association, this compulsory examination relates to endurance, starting with New Year's Eve runs, marathons, cross-country races and cycling marathons. This step is also argued by Austrian sports physicians with the situation in Italy. There, after the introduction of mandatory screening examinations for competitive athletes, a reduction in sudden cardiac deaths by 89 % was recorded. What is not mentioned, however, is that after the introduction of these measures, around twenty to twenty-five percent of those who were previously active in sports stayed at home. In addition, many expert opinions are created inadequately or as a courtesy. Through many visits to Italy at major events or as recently at the marathon in Reims (France is similar to Italy), I was able to see exactly how and how often manipulation is taking place. For me, that's not the solution to the real problem.

It's just that anything that involves coercion turns skeptics into adversaries. They don't go to the doctor at all, of course they don't register for any competitions and, in the worst case, drop out of the (desired) health system altogether. The positive motivation is completely missing due to this obligation. As an organizer, I can well imagine granting a “health bonus” if a certificate from a certified sports doctor that is no more than three months old is available when the start number is collected. For acute cases, there is always the Medical Center, where infections or similar problems with starting permission can be clarified.

A residual risk will always remain. Some of the known deaths had been examined by a sports doctor, cared for and stopped in the run-up to the respective event. It should also not go unmentioned that sports medical examinations are often carried out inadequately. A few years ago, for example, a doctor for the Association for Consumer Information incognito tested the quality of sports medical examinations at fourteen providers throughout Austria. The test result was anything but confidence-inspiring. Half of the institutions tested did not even listen to the heart. And only eight out of fourteen performed an exercise ECG and blood pressure measurement.

I don't want to refer to statistics that show that serious incidents simply happen after a certain number. Each individual case affects a personal fate and grieving relatives, who often find it difficult to cope with this situation. It's also sad when experts refer to modest studies and one-sided evaluations that try to whitewash the situation based on the measures they have planned, but ignore the negative effects. Before initiating certain steps, they must be thought through to the end. What are the effects of mandatory examinations on all popular sports in Austria. Do we then check all hikers in the access area to alpine destinations?

This problem can also be compared well with the compulsory vaccination against measles, which is also demanded by parts of the medical profession. In order to prevent larger waves of infection like in 2008, a vaccination rate of at least 95 percent of the entire population is required for measles, the so-called herd protection. France and Italy introduced compulsory vaccination, but Austria is better supplied with measles vaccination without vaccination than the two countries mentioned.

What annoys me personally is the demand of individual doctors for mandatory examinations, who have not yet been particularly behavioral when it comes to activating people to do more sport. Can I also say that this group has good business sense? That wouldn't be fair. But economic considerations often form the basis for such demands. I also don't want to lose any participants due to event-related measures that have not been thought through to the end, like in Italy. But I'm happy to believe the doctors that they only care about the health of the athletes. But then please also with those who do not move at all and cause the real problems and costs to the health system.

A serious preparation should be the goal. Embedded in a reasonable training process, as it is for most runners, the marathon as a training goal does not pose a health problem. The preparation for it optimizes the biological systems, i.e. cardiovascular lungs, metabolism, skeletal muscles and the entire musculoskeletal system. This has a positive effect on health. The marathon itself only rounds off this process.

As a coach, I see myself first and foremost as an educator. That's why I'm trying to offer a wide range of training options, such as our current movement campaign "Salzburg is running!" or the activities of our club RunAustria to provide the necessary impetus. I want to minimize the risk with a positive approach. Some people think that if you train two hours a week, you can successfully run a marathon. This is obviously not painless and is just stupid. Despite such poor preparation, no one dies from it alone. It only becomes dangerous when three factors come together: insufficient training, false ambition and poor health. Even with good performance, a cardiovascular disease can lead to sudden cardiac death. If you are looking for a high sporting challenge, you have to be healthy all round. This requires a qualified medical examination. In the last year, two medical findings - one after a health check-up and a second after a simple sports medical check-up - have additionally motivated me to bring more sporting activity into my life again. That confirmation helps. It is important that the examining doctor expressly certifies the suitability for sports for a longer, intensive effort.

I demand that, but without compulsion! We humans need freedom and self-determination like the air we breathe. What I want to say: Freedom is an elementary, important basic need for us humans. And when we are restricted in our freedom, we become extremely grumpy and insufferable. Self-determination implies that characteristics such as motivation, personality and well-being are basic elements that are needed for the achievement of fulfilling goals.

A marathon is still a fascinating sporting challenge and a fulfilling goal. It motivates many people to do endurance sports in the first place. The health opportunities certainly outweigh the risks, which can also be significantly reduced through a medical preliminary examination and an individually adapted training plan.

Those who are healthy and well trained have little to fear. Move and live your life!

Tip! Here you can and should have yourself checked seriously: sports medicine