DEATHS DUE TO STRENUOUS EXERCISES AND LONG DISTANCE RUNS

DEATHS DUE TO STRENUOUS EXERCISES AND LONG DISTANCE RUNS: 13.

Dr Lily Neo asked the Minister for Community Development, Youth and Sports (a) in the past two years, what is the number of incidences of seemingly well individuals whose deaths are due to strenuous exercises; and (b) whether the Minister has information on the causes of death for these cases.

14.

Mr Chiam See Tong asked the Minister for Community Development, Youth and Sports what measures will be taken by his Ministry to improve the safety culture in long distance runs requiring mass participation.

The Minister for Community Development, Youth and Sports (Dr Vivian Balakrishnan): Mr Speaker, Sir, with your permission, I will take the next two Questions, ie, Question Nos. 13 and 14, together as they both relate to sports safety.

Mr Speaker: Yes.

Dr Vivian Balakrishnan: Sir, from the beginning of 2005 to June 2007, the Health Sciences Authority's (HSA) Department of Forensic Medicine reported that there was a total of 21 deaths that occurred during sports - nine of them occurred in 2005, six in 2006, and six in the first half of this year. This represents about 0.05% of total deaths in Singapore. Based on available data, there is no evidence to suggest that there is an upward trend in mortality. The main causes of these sudden deaths are usually related to heart problems such as ischaemic heart disease, cardiomyopathy, myositis or congenital heart abnormalities.

Medical evidence also suggests that the benefits of regular moderate exercise far outweigh the risks of exercise for healthy individuals. In fact, a recent report

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published by the American Heart Association's Council on Nutrition, Physical Activity and Metabolism and the Council on Clinical Cardiology indicated that whilst the relative risk of cardiac arrest was greater during exercise than at rest, nevertheless, the total incidence of cardiac arrest, both at rest and during exercise, decreased with increasing physical activity. The report highlighted that the total incidence of cardiac arrest in the least physically active group was 18 events per million person-hours, whilst the incidence was only five per million person-hours in the most physically active group. In other words, keep on exercising but do it moderately.

Although the incidence of sudden death during sports is low, my Ministry takes sports safety very seriously. The Singapore Sports Council (or SSC) currently provides guidelines on safety measures to all the National Sports Associations and to sports event organisers. These guidelines include the provision of certified first aiders or paramedics, ambulance service with Automated External Defibrillators and other resuscitation equipment as well as ensuring that there are safety briefings for participants. These guidelines and the detailed plans for medical treatment and evacuation are even more crucial when we are having major endurance events such as the upcoming Singapore Marathon.

To enhance our sports safety framework, my Ministry set up the Sports Safety Committee, chaired by Dr Benedict Tan in July this year, to review our current practices and to make specific recommendations to enhance safety. The Committee has completed its report and has submitted recommendations in five key areas. First, in pre-participation screening. Second, public education. Third, having safe sports facilities. Fourth, ensuring proper medical coverage for sports events. And, fifth, a system of

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surveillance and follow up for all matters relating to sports safety.

Let me highlight a few of the recommendations. In the area of pre-participation screening, the Committee has recommended a tiered, risk-based approach, and this ranges from mandatory screening for professional athletes all the way to a self-administered questionnaire for weekend recreational athletes.

In the area of public education, the Committee has recommended that we should have initiatives to ensure that all individuals are aware of sports safety issues, basically learn to recognise danger symptoms and to understand the dangers of over training. And in particular, everyone who is closely associated or has close contact with athletes, that means coaches, volunteers and officials, should be certified in first-aid, cardiopulmonary resuscitation and in the use of the Automated External Defibrillators (AED).

For sports facilities, the Committee's view is that facilities should be both staffed and equipped based on the risk profiles of their clientele. And each facility must have its own respective medical emergency plan.

With respect to medical coverage for sports events, the Committee has developed a risk assessment matrix for the different sports. In other words, sports which have a higher level of cardiovascular activity and higher contact or collision risk are sports which must have more elaborate and more detailed plans to deal with emergencies. Such a classification matrix would enable the event organisers to tailor the appropriate safety equipment, the level of safety personnel as well as the medical arrangements in order to ensure that these sports can be pursued with reasonable safety.

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The Committee has also proposed the establishment of a central repository in order to capture data for sudden deaths and serious adverse events. This would allow more accurate situational analyses with subsequent improvements to our safety systems.

The Committee will be releasing its detailed recommendations within the next day or two. I would like to thank the Committee for coming up with such a comprehensive framework to anchor our nation's sports safety efforts. Some of these recommendations, particularly the ones pertaining to public education, are important and will be implemented as soon as possible. Other recommendations, such as whether to have a central repository, will have to be studied and we will have to see whether that is the efficient and effective way of having such a system.

I would conclude by saying that we must not take sports safety for granted but this is something which all of us are responsible for. Organisers have to make sure that safety measures are taken, medical support is available and equipment is available. Participants need to train, prepare and get themselves screened appropriately before any competition or event that necessitates strenuous exertion. And each one of us, whether a professional or weekend athlete, needs to learn to listen to our body, recognise the danger signs and not push ourselves beyond what we should safely or reasonably do. I therefore urge everyone to play his or her part to ensure that we can continue to enjoy sports, to derive the benefits of sports and to minimise the risks thereof.

Dr Lily Neo (Jalan Besar): Sir, two supplementary questions. May I ask the Minister what measures will his Ministry take to reassure those members of the

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public who are now concerned with exercise induced death? And, secondly, will these concerns of exercise induced death derail our long-term objective of promoting healthy lifestyle through exercise?

Dr Vivian Balakrishnan: Mr Speaker, I thank the Member for those two questions. On reassurance, the key point is education. People need to know that, like many things in life, there is no such thing as zero risk. But you have to take a reasonable approach and you decide whether, on balance, participating in sports is a wise thing or not. And the evidence is clear that for almost everybody, especially if you have no pre-existing disease, participation in sports will reduce the overall mortality and morbidity due to ill health. So, the message needs to be emphasised that we all still need to engage in healthy levels of exercise. But the question then is: how much is enough? What sort of exercises are appropriate and what precautions we need to take? And that is where further public education needs to be put in place. And it is not possible there to give people just generic advice. Our point then will be that if you are just starting out, we will make sure that there are certain questions which you must ask yourself - your family history, your blood pressure, whether you have diabetes, whether you have chest pain or you have breathlessness and other symptoms. This is a self-administered questionnaire. If there is any doubt on any of those points, please consult a doctor and let the doctor perform further examinations in order to stratify your risks and give you specific advice to what you can do or what you should not do.

But the longer term point is what the second question is about, which is that we must not allow these incidents to derail our long-term objective, which is to ensure that our population remains a

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rugged and healthy and, in a sense, optimistic population, a kind of attitude which you get from participating in sports of the physical kind. And I do not believe that Singaporeans, in general, are going to be scared of sports because such incidents have occurred. But what Singaporeans do want to know, and I think have a right to expect, is that sensible precautions are in place. Things which can be done have been done. Tests which should have been done were done. Equipment which is easily available should be made available. That everyone who is involved in sports knows basic first-aid, knows how to make attempts at cardiopulmonary resuscitation and knows how to use the Automated External Defibrillators. Fortunately, we now live in a time where equipment costs have come down and with the built-in intelligence in the defibrillators, a lay person can deliver that. So we are also encouraging more and more people to go for such courses, get themselves certified and to be prepared to use it in the unlikely event that you face such a situation.

So, let me conclude again by saying that we will do everything possible in a rational and sensible way to make sports as safe as possible. But people also have to take responsibility for their health and for their sport activities and be prepared to go for training.

Mr Chiam See Tong (Potong Pasir): The first one is as regards the deaths of two athletes this year, whether they have undergone pre-participation screening. My second question is: what comprises pre-participation screening? The third question - I do not know whether it is suitable for the Minister to answer or the Minister for Defence - I hear that boys, during their NS days, ran beyond the safety limit. Despite the pain, they were supposed to ignore the pain and kept on running until, I suppose, they collapsed. Apparently, they did not give

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up and kept on running. But, in fact, this is a dangerous culture to adopt.

Dr Vivian Balakrishnan: Mr Speaker, Sir, we had two recent tragic incidents when young men collapsed after moderately long distance runs. The Coroner's inquiries have not been conducted and I do not have specific details of the medical problems associated with those two cases and the details of what tests they had undergone before the incident. It would be inappropriate for me to comment on these two specific cases.

On the second question on what constitutes pre-participation screening, as I have explained earlier in my answer, the level of pre-participation screening is one which depends very much on the individual. There is a world of difference between a young person and an older person, between a person with pre-existing disease and a person with no pre-existing disease, between a contact sport and a non-contact sport, between a long distance run and even a short sprint, between weightlifting

and playing netball. So I cannot stand here and say, "This is a complete check list." What I can say is that we will have guidelines in place, so that depending on one's profile, he knows what he should undergo, what questions he should ask himself, in what circumstances he should consult his family doctor, in what circumstances perhaps even a specialist's evaluation is necessary. But underlying and beyond all this is good common sense and moderation in all things, whether we are talking about food or exercise or almost anything else in life, moderation in all things is the most sensible and rational approach.

I am not sure whether the Minister for Defence wants me to answer the last

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question. But what I can say, as a person who has done National Service and as a person who has been a commanding officer of a unit in the SAF, is that we take safety, especially training safety, very, very seriously. Every commanding officer has the lives of his men in his hands. And the purpose of training is to enhance safety. We require people to be operationally proficient, because we want people to be safe, especially during operations. And on this concept of running till you collapse, I feel quite confident to categorically reassure Members that that is not the attitude in which we conduct physical training and, in any case, it does not make sense to do so. If we are training to enhance fitness and to build up strength, we do not run till we collapse. So I do not know where Mr Chiam got that misconception from. But I can reassure him that it does not make medical, scientific or operational sense to do so.