Q: What is a MOOC?

A:  A “Massive Open On-line Course.”

Have you ever taken one?

I’m enrolled in one right now:  “Exercise Physiology:  Understanding the Athlete Within,”   taught by Professor Mark Hargreaves from the University of Melbourne.  I think it is the fourth MOOC I’ve ever taken, and it is the first one that has any direct relation to my profession.  The course began last week, and I was able to do most of my lecture viewing this past weekend.  While my kids are enjoying their summer vacation at an overnight camp, I’m back in school!

Before I get much further, I suppose I should spend a moment describing, at least in my terms, what a MOOC is, most especially for those folks that ticked “No” in the poll above.

Massive Open On-line Courses (MOOCs) have been around now for a few years.  I believe there are several providers, the largest ones being Coursera and edX.   One can better understand the nature of a MOOC by deconstructing the phrase itself:  MOOCs are typically ‘massive’ (they have large enrollments);  ‘open’ (they are typically free, and enrolling is a matter of  simply ‘signing up’); ‘on line’  (you’ll need internet access); courses (they are educational sessions which last for several weeks, and include syllabi, lectures, assignments).

edX describes itself on its twitter home page thus: “A global community committed to bringing quality education to everyone across the globe through an innovative MOOC platform–founded by Harvard and MIT.” Read more of this post

National Council on Youth Sports Safety


Strained metaphor?
Like the Washington Monument,
our approach to concussions is
under revision

I am in Washington D.C. Thursday and Friday as a participant in the National Council on Youth Sports Safety (NCYSS), being put on by the Protecting Athletes and Sports Safety (PASS) Initiative.  Our host and keynote speaker is Dr. David Satcher, the former Surgeon General who has devoted his life to issues of public health, and has recognized that the concussion ‘epidemic’ has become a game changer in the field.

I’ve met a variety of high profile leaders, in addition to Dr. Satcher, in the world of youth sport concussion during my 24+ hours on the ground in D.C.

I don’t suppose it’s surprising,  but I think one of the most important components of these sorts of meetings is the networking:  I am coming out of this conference with at least three rather solid collaborative research ideas, not to mention commitments to work on other projects with several of the conference attendees.


Physicians from Nationwide Children’s Hospital and
Dr. David Satcher, former United States Surgeon General

On a ‘meta’ level, what I was struck by in this conference was the theme that was consistently struck:  we need more scientific research on youth sport concussion, and the urgency behind this need derives fundamentally from two areas–1) the often undervalued but critical importance of mental health and 2) the risk of children in being inactive.

In other words,  as concerned as we need to be about reducing the risk of concussion, about reducing possible long-term mental health issues consequent to this injury, we need to balance this concern with he equally strong demand that we promote physically active children.

In fact, it’s not simply the effect of sport and exercise on obesity, but also their positive effect on mental health:  for instance, physically active kids are less prone to depression.  And so, if one were concerned solely with mental health, he would need to navigate the twin perils of traumatic brain injury and physical activity.

At CJSM, we are on the frontline in these issues.  We publish original research on concussion in almost every one of our journal editions.  The November issue for  instance has an excellent study on predicting clinical concussion markers at baseline.   In the same issue we published the Canadian Academy of Sports and Exercise Medicine Position Statement on the mandatory use of bicycle helmets:  an issue of keeping youth and others safe while they are physically active.


@cjsmonline (attached to laptop)
tweeting from #NCYSS before
catching that plane

I am leaving D.C. struck….by the sight of the Washington Monument under scaffolding!  In truth, I am more than ever struck by how big of an issue concussion has become, and how it will remain central to primary care sports medicine research for years to come.  There are lots of questions that need answers.  We’ll be working on this continuously here at CJSM.

Exercise-associated hyponatremia; drinking oneself to death….. Guest blog by Dr Jonathan Williams

A 22 year old male fitness instructor finished the 2007 London Marathon, collapsed, and despite immediate emergency medical care, died. His serum sodium was markedly low, and the cause of death was found to be hyponatremia. Subsequent investigations established that he had been concerned about becoming dehydrated, and had therefore drunk a large volume of fluid en route. Several other athletes have died from hyponatremia due to drinking excessively, and many others have required hospital care. Studies from the 2002 Boston Marathon and 2006 London Marathon found that 13% and 12.5% of finishers, respectively, had asymptomatic hyponatremia. Our paper in this month’s CJSM explored the 2010 London Marathon runners’ knowledge about fluid intake, their drinking strategies and knowledge about exercise-associated hyponatremia (EAH).

City marathons were established around the world in the 1970s and 1980s. Elite marathon runners of the time rarely drank much during races; when Mike Gratton won London Marathon in 1983, he drank nothing. However, in 1975, the American College of Sports Medicine published a position statement advocating regular fluid intake during endurance events, suggesting this would reduce the risk of heat stroke. During the 1980s and 1990s, increasing numbers of endurance athletes experienced EAH.  International EAH Consensus Development Conferences of 2005 and 2007 reviewed the available evidence about EAH, and advocated drinking “to thirst” rather than the higher volumes recommended by ACSM. In 2007, ACSM revised its position statement advising that fluid intake during exercise should not exceed sweat loss.

In our study, a representative sample of 217 runners was questioned. More than 93% of the runners had read or been told about drinking fluid on marathon day. However, 12% planned to drink a volume large enough to put them at higher risk of EAH, and only 25.3% planned to drink according to their thirst. Although 68% had heard of hyponatremia or low sodium, only 35.5% had a basic understanding of its cause and effects. These findings suggest that runners lack knowledge about appropriate fluid intake on race day. Effective education is needed to prevent overdrinking during marathons.

Professor Tim Noakes has researched EAH for almost thirty years. He is due to publish a book in May 2012 called ‘Waterlogged’ in which he explores the influence sports drink manufacturers have on the science of hydration, and on runners’ drinking habits. ‘Waterlogged’ is likely to be thought-provoking, controversial and fascinating.

The cause of EAH is firmly established and it is entirely preventable. It is now the responsibility of race organizers, drinks manufacturers, running publications and us as sports physicians to educate runners effectively about safe drinking strategies.

Dr Jonathan Williams is a Sports Medicine Doctor and General Practitioner, as well as an avid runner.

The photograph is of the author having just completed a London Marathon

References :

1) Williams J et al. 2012. Hydration Strategies of Runners in the London Marathon. Clin J Sport Med 22 (2): 152-156

2) Hew-Butler et al. 2008. Statement of the Second International Exercise-Associated Hyponatremia Consensus Development Conference, New Zealand, 2007. Clin J Sport Med 18(2): 111-121

3) Hew-Butler et al. 2005. Consensus Statement of the First International Exercise-Associated Hyponatremia Consensus Development Conference, Cape Town, South Africa 2005. Clin J Sport Med 15(4): 208-213

4) Sawka MN et al. 2007. ACSM Position stand – Exercise and Fluid Replacement. Med Sci Sports Ex 39 (2): 377-390

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From Scotland to the Sahara – Guest Blog by the new Scottish Government Champion for physical activity, Dr Andrew Murray

What does running 2660 miles from Scotland to the Sahara teach you?

I learned a load of things running to the Sahara. Donkeys have a top speed of 25kms/hr, road signs hurt if you run into them, and the desert is extremely hot. I ate 7000 Kcalories per day, got through 16 pairs of socks, and averaged 34.5 miles per day for 77 days.  I also thought plenty about what I’d do as a General Practitioner and Sports and Exercise Medicine doctor when I got home.

I firmly believe that physical inactivity is the fundamental health challenge of our age.  Dr Mike Evans in his video 23 and a half hours  asks the question- ‘What is the single best thing we can do for our health?’ For its benefits both to physical and mental health, as well as to quality of life he concludes that taking regular physical activity comes out on top. Please do watch this video and forward it on.

One of the most satisfying parts of my journey south was that over 1300 people came and jogged part of the route with me.  My oldest companion was 81, and the youngest (being pushed by his mum) was 5 months, going to show that physical activity is achievable by all.

Steven Blair’s research proves that low fitness is equivalent in risk to smoking, diabetes, and obesity combined. This statistic is all the more frightening given that government figures show that only 39% of Scots hit minimum activity guidelines.This is too big a problem to ignore, and action is required. Many health care professionals recognise the health problems associated with physical inactivity, but feel that the solutions lie with public health rather than with grass roots professionals.

I was delighted to accept a role as Scottish Government Physical Activity Champion working with health professionals, and advocating that “Exercise is Medicine” on the back of a BBC documentary about my run, and my medical background.  A little background to the role is here. This role was created partially as a legacy to the 2014 Commenwealth Games that are coming to Scotland.  The government have stated that raising an awareness of the benefits of activity, and getting the nation on the move is just as important as the medals.

Preventative medicine is great medicine. The benefits are clear. The message is simple.


Blair, SN. 2009. Physical inactivity: the biggest public health problem of the 21st century. BJSM 43:1-2

Evans, Mike. Video ’23 and a half hours’

Follow Dr Andrew Murray on Twitter at @docandrewmurray ,  and on Facebook at Sports and Exercise Medicine Scotland.

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