Five Questions with Dr. Nick Peirce: The Role of Physical Activity and Sport in Mental Health

Dr. Nick Peirce, lead on the FSEM team producing recent exercise and mental health position statement.

Reduce depression and cognitive decline by up to 30% with regular exercise?  Can this be so?

For those of us ‘in the know’ in this field of sport and exercise medicine, that statement may seem understood.  But medical research translating to broadly held knowledge which then may lead to meaningful change:  well, we ALL know how rare that situation can be.  The management of recent concussion events in the FIFA World Cup reminds us of the difficulty of knowledge translation: there were instances where it seemed as if we were ‘partying like it’s 1999’ so to speak.

Reviews of the current state of evidence-based knowledge about medically important findings continue to be of vital importance in ‘getting the word out’.  In that spirit, we couldn’t be happier to see the recent position statement released by one of our partner societies, the Faculty of Sport and Exercise Medicine (UK) : The Role of Physical Activity and Sport in Mental Health.

The lead on the team of authors which produced this FSEM UK Position Statement is Dr. Nick Peirce, Chief Medical Officer of the England and Wales Cricket Board.  We wanted to pick his brain to get a bit more of the background work which resulted in this statement.  The summer Cricket season has kept Dr. Peirce occupied above and beyond his usual level of busyness.  During a gap between competitions, CJSM caught up with him — the results of our interview can be found here.

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1. CJSM: We want to discuss the new FSEM statement on the role of physical activity and sport in mental health, but first can you tell us a bit about yourself: your background as a sports medicine clinician and your involvement with FSEM?

NP: I have been involved in Sports and Exercise medicine for over 20 years having worked across a large number of Olympic and Professional sports, including Leading Sports Medicine for English Institute of Sport (EIS) at the busiest site in the country at Loughborough University, the Davis Cup team and the football team Nottingham Forest. I am a Hospital Consultant in Sport and Exercise Medicine in the NHS and have been Chief Medical Officer for the England Cricket for the more than 10 years. I have been involved in many of the Sports Societies and for 3 years have sat on the Faculty (FSEM), although professional sport commitments make this challenging.

2. CJSM: How did you become involved with this particular FSEM project on mental health – was there a large team involved in the production of this project? Was FSEM the only organization involved in the drafting of this document?

NP: The sport of cricket has had high profile players and a reputation for proactive mental health strategy (embedded clinical psychology), increasing openness and perhaps reducing stigma. In addition we established a regular clinical psychology clinic at the EIS more than 15 years ago. As such I was approached to look at a statement and brought together a group of SEM practitioners involved in projects with an interest in this area as well as support from the Royal College of Psychiatry and the leading Mental Health charity MIND.

Dr. Nick Peirce (R) escorts an injured player off the field Photo: PAUL ELLIS/AFP/Getty Images)

3. CJSM: The document on the “Role of Physical Activity and Sport in Mental Health” is readily available on line at https://www.fsem.ac.uk/position_statement/the-role-of-physical-activity-and-sport-in-mental-health/

Would you highlight some of the more important points, found in this position statement, which you and your team would want to see emphasized.

NP: You might argue that the most important overview is that being physically active contributes so significantly to wellbeing in both adults and children. It not only improves established mental health issues, such as anxiety and depression, but helps in their prevention, improves self-esteem, and reduces cognitive decline. Thus, the facilitation of physical activity is vital for all, and where necessary additional resources should be considered by society including public health and sporting bodies, promoting exercise whilst overcoming stigma and vulnerability.

It is also really important to understand that mental health issues are normal in the sports(wo)man and that sports need to recognise their duty of care to athletes,

4. CJSM: We would not want to detract from what may be the major findings in this position statement. However, mindful of the fact that all interventions we clinicians may recommend can come with associated negative side effects, what are some of the potential adverse consequences of sport on an athlete’s mental health?

NP: Sports(wo)men will have the same potential spectrum of mental health issues as the normal population but may be exposed to greater stress and scrutiny of performance.  Moreover, when they retire there is a predictable change in status, self-esteem and removal of normal support systems. In addition certain sports may create pressures that translate into issues such as eating disorders and medication and substance abuse.  Coupled with a delay in seeking help through potential stigma and a lack of understanding in the sporting environment, we have seen some sports develop a reputation for possibly even creating mental health issues. We certainly need to do more research in this area across all sport.

5. CJSM: An awareness of the importance of mental health in sports is in ascendance in our community of sport and exercise medicine. As an American, I am thinking for example of Brian Hainline, the Chief Medical Officer of the NCAA, who has made mental health care for athletes one of his chief priorities.

Why do you think there is this relatively new awareness of the importance of this aspect of our athletes’ health?

NP: We are in an interesting and indeed exciting period, with society  demonstrating an ever strengthening sentiment that sport is not about winning at all costs. This has been born out of some high profile individuals, not just in sport, that have become ambassadors for mental health and helped challenge tradition. As such sports are being challenged to demonstrate they are exercising their Duty of Care appropriately and this has allowed CMOs and other leading lights to push for better support and research in this area.

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Thanks so much Nick for the time you have taken for your busy schedule.

For our readers of this blog, see all of FSEM UK’s position statements here 

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About sportingjim
I work at Nationwide Children's Hospital in Columbus, Ohio USA, where I am a specialist in pediatric sports medicine. My academic appointment as an Associate Professor of Pediatrics is through Ohio State University. I am a public health advocate for kids' health and safety. I am also the Emerging Media Editor for the Clinical Journal of Sport Medicine.

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