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Hole in one for consensus statement on golf and health

GolfA systematic review of 342 eligible studies as well as an international working group of experts in public health and health police, had led to an international consensus statement on golf and health.

Amid a growing body of evidence on the health impacts of golf, a consensus aims to help current and would-be players maximise the health pros and minimise the health cons of golf, and to guide policy-makers and industry leaders on how best to make golf more inclusive and accessible and so encourage more people from all walks of life to take up the sport.

The statement by researchers at the University of Edinburgh, La Trobe University, World Golf Foundation, St Augustine, Florida, University of Bristol and the International Society of Physical Activity for Health, London, draws on a systematic review of the available published evidence (342 eligible studies) and discussions among an international working group of 25 experts in public health and health policy, and industry leaders.

Agreement was reached on 79 statements in three areas. These set out what is currently known about golf's associations with health; the factors that may help or hinder take-up of the sport; and a series of recommendations for golfers, industry leaders, and policy makers on how best to maximise its health benefits, promote sustainability, and widen participation.

The evidence shows that playing golf regularly is associated with longevity and reducing the risk factors for heart disease/stroke. And it can boost older people's strength and balance. The sport is also associated with good mental health and improving the overall health of those with disabilities.

Compared with other sports, the risk of injury is moderate, but as it's an outdoor activity, golfers may be more at risk of skin cancer.

Golf is sociable, and gets people outdoors, connecting with nature. It can provide moderate intensity aerobic physical activity, and its health benefits are greatest for players (and spectators) who walk round the course rather than opt for a golf cart.

While around 60m people play golf at least twice every year, the participant profile is quite narrow: players tend to be middle aged to older, male, of white European heritage, relatively well off, and living in North America, Europe and Australasia.

And the sport is often perceived as expensive, male dominated, difficult to learn, and not a game for the young or those on the lower rungs of the social ladder. This can put people off, says the statement. The sport needs to be more inclusive and welcoming of people from all walks of life and ethnic backgrounds, and any such initiatives should be supported, it says.

More people might be keen to take it up if golf were promoted as an enjoyable, lifelong outdoors activity that affords a sense of community and competitive challenge while providing some 'me time' as well as helping to fulfil recommended exercise quotas, says the statement.

And the sport can do its bit for sustainability by "practices that prioritise diversity, healthy societies, connection with, and care of, the environment, environmental integrity and health and wellbeing," the statement suggests.

Among its raft of recommendations, the consensus statement says that golfers should aim to play for 150 minutes/week, or do less, but couple golf with other physical activity, and walk the course rather than ride a golf cart; do warm-up/strengthening exercises to cut the risk of injury and use sun-cream and wear collared shirts/blouses to minimise the risk of skin cancer; and make everyone feel welcome.

Clubs/Industry should build on existing initiatives to promote inclusivity and develop environments and price structures that will be attractive to everyone; develop a culture that will inspire more women and girls to play golf; make every effort to promote equality and diversity, and boost accessibility; promote sustainability through wildlife conservation and by restricting the use of water, energy, and pesticides; and provide additional facilities at clubs, such as a gym, walking routes, crèches and improve the focus on health and safety, with the provision of healthy foods, defibrillators, and speed limiters on golf carts, for example.

Policy makers should promote the benefits of regular physical activity, including golf, for people of all ages, genders, and income brackets; promote the specific health enhancing aspects of golf; support diversity, equality, and sustainability; work with industry and national associations to boost take up of the sport, particularly in groups where physical activity levels are low; and work with industry and regulatory bodies to get golf included in the Paralympics.

"These outputs, if widely shared and adopted, will contribute to an improved understanding of golf and health, and aid these groups in making evidence-informed decisions and to improve health and wellbeing," the consensus statement concludes.

Scientific and public interest relating to golf and health has increased recently. Players, potential players, the golf industry and facilities, and decision makers will benefit from a better understanding of how to realise potential health benefits and minimise health issues related to golf. We outline an International Consensus on Golf and Health. A systematic literature review informed the development of a survey. Utilising modified Delphi methods, an expert panel of 25 persons including public health and golf industry leaders, took part in serial surveys providing feedback on suggested items, and proposing new items. Predefined criteria for agreement determined whether each item was included within each survey round and in the final consensus. The working group identified 79 scientifically supportable statement items from literature review and discussions. Twenty-five experts (100%) completed all three rounds of surveys, rating each item, and suggesting modifications and/or new items for inclusion in subsequent surveys. After three rounds, 83 items achieved consensus with each with >75% agreement and <10% disagreement. These items are included in the final International Consensus on Golf and Health. The final consensus presented here can inform scientific knowledge, and action plans for (1) golfers and potential golfers, (2) golf facilities and the golf industry, and (3) policy and decision makers external to golf. These outputs, if widely adopted, will contribute to an improved understanding of golf and health, and aid these groups in making evidence-informed decisions to improve health and well-being.

Andrew D Murray, Daryll Archibald, Iain Robert Murray, Roger A Hawkes, Charlie Foster, Kevin Barker, Paul Kelly, Liz Grant, Nanette Murtie

[link url=""]BMJ material[/link]
[link url=""]British Journal of Sports Medicine abstract[/link]

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