The 'hard' martial arts and health benefits systematically reviewed

Shotokan karate is a hobby of mine. I say 'hobby' but for me it's become so much more than that. It's not just that I find myself practising my age-uke (pronounced 'aggey-uki') or various favourite kata whenever I have some space free around me; it's more in relation to how it's been a route for me to live a lot more healthier [active] lifestyle more generally. I am indeed at one with myself...

A recent paper by Sandra Origua Rios and colleagues [1] provides some good evidence that practising the martial arts - the 'hard martial arts such as karate, taekwondo or kung fu - carries quite a few health benefits for adults. Based on their searching the collected peer-reviewed research literature and use of the Effective Public Health Practice Project tool, authors concluded that most studies on such training carried positive effects "showing some improvement and maintenance of balance, cognitive function and psychological health" when practised by adults. Studies like this one from Witte and colleagues [2] tell you quite a lot about what you need to know. All this is good news indeed to the many, many practitioners of such martial arts. Also an added boost to the masses that will undoubtedly take up one or more of the arts when they watch the very best demonstrate their skills at the 2020 Olympics...

Of course it's not necessarily all 'positive' when it comes to the use of martial arts and health and wellbeing. The authors note that 'risk of injury' is always going to be a concern when engaging in disciplines that rely on strikes, blocks and throws and 'confrontation of force by force'. In the context that risk of injury is a risk carried by most, if not all sporting activities, the authors add that the majority of injuries sustained in the hard martial arts tend to be minor; particularly when practising at less than elite competitive level (as most people do). Indeed, on the specific point of injury risk, I can add a few things: (a) developing 'control' when sparring (we call it 'kumite') is a key point that comes from practice and more practice, and (b) protective equipment such as mitts and on occasion, gum shields and various, ahem, parts-of-body protectors, are available and sometimes used. Other injuries such as bruising, blistering and some occasional joint pain/stiffness are typically short-lived and clear up after a few days of rest. I might also mention that actually facing an opponent and 'not fearing getting hit' is something else important that comes from such training, given that most people aren't used to being in such an atypical situation and tend to panic (and that's when injuries can happen).

Origua Rios et al also suggest that more research is required on the risk-benefit profile of the hard martial arts including evidence based on randomised controlled trials (RCTs) tracking "morbidity and mortality in the long term." I would agree; but with the proviso that looking at hard martial arts vs. no martial arts training is not necessarily going to be the only methodological way forward in light of other, more general evidence talking about sedentary behaviour and health-related quality of life for example. Indeed, when one talks about 'cognitive functions' potentially being positively affected by martial arts training, it would be useful to see comparisons with the more 'soft' martial arts such as Tai Chi for example, to see how and why such as effect might originate and perhaps generalise. I have my ideas about where any maintenance/improvement to cognitive abilities may originate from in karate terms (try learning and retaining knowledge of all those kata!) but more scientifically-derived information is required.

I know that the hard martial arts probably won't be everyone's cup of tea. I know some people might think it's a bit too rough or challenging or something for those with sprightly athleticism who can 'do a really good high kick'. I would however caution against such preconceptions. As my instructor(s) often say: quality of movement is better than speed or height of said movement (or words to that effect).

And with physical activity (PA) and cognitive functions in mind, it's perhaps also timely that a recent meta-analysis from Celia Álvarez-Bueno and colleagues [3] has also been published talking about how: "PA, especially physical education, improves classroom behaviors and benefits several aspects of academic achievement, especially mathematics-related skills, reading, and composite scores in youth." I daresay that getting more children and young people involved in the martial arts might have a similar effect; although ensuring that due care and attention is paid to 'enjoyment' as being a big part of why someone does or does not stick to a particular sport (see here).

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[1] Origua Rios S. et al. Health benefits of hard martial arts in adults: a systematic review. J Sports Sci. 2017 Nov 21:1-9.

[2] Witte K. et al. Comparing the effectiveness of karate and fitness training on cognitive functioning in older adults—A randomized controlled trial. Journal of Sport and Health Science. 2016; 5: 484-490.

[3] Álvarez-Bueno C. et al. Academic Achievement and Physical Activity: A Meta-analysis. Pediatrics. 2017. Nov 22.

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Sickness and disability benefit and mental illness in the UK

"Mental disorders have become the most common cause of receiving benefits, with the number of claimants rising by 103% from 1995 to 1.1 million in 2014. Claimants with other conditions fell by 35%."

The findings reported by Sebastião Viola & Joanna Moncrieff [1] (open-access) provide stark evidence of both how prevalent mental illness is these days, and the financial implications of such illness to both the individual and more generally society.

Set within the context of some pretty inflammatory language being used to describe those claiming benefits (see here) and the continued saga that is austerity in the UK (see here), I would hope that the Viola/Moncrieff results might serve to further illustrate the increasing parity (of esteem) between physical illness and mental illness insofar as the burden they can both inflict. For too long now, the focus on physical health has perhaps been at the expense of mental health (see here). I'd also hope that such findings might also serve to help 'de-stigmatise' some of the circumstances leading someone to claim for such benefits.

Drawing on data "from the Department for Work and Pensions [DWP] regarding numbers of claimants of all sickness and disability-related benefits in England, Scotland and Wales" (UK), researchers looked at the 'significant' causes for claims recorded. For those not familiar with the UK welfare system, some background can be found here. Taking into account how the benefits system has changed somewhat over recent years, researchers reported on various trends noted from the data including those related to long-term benefit claims (more than 5 years) and claims according to age, gender and regional distribution.

Results: the general trend in claiming sickness benefit was one of a decline between 1995 and 2014. When however, breaking down the statistics according to "causal categories of medical condition" the authors reported that 'mental disorders' were by far, the most common cause of claims awarded: "rising by 103.4% over the period examined to over a million in 2014 (from 571 600 in 1995 to 1 136 360 in 2014)." Claims based on the previous most common category - musculoskeletal disorders - dropped by about 40% over the same period. The authors note: "By 2014, almost half of claimants were claiming benefits for a mental disorder, up from 21.4% in 1995 to 46.5%."

Analysis of long-term claimants also showed a similar trend insofar as the impact of mental illness. So: "Numbers of long-term claimants for mental disorders rose by 87.4% from 346 770 in 2000 to 649 990 in 2011 and numbers with all other conditions rose by only 0.79% (from 826 910 to 833 480)." Trends by gender (sex) suggested an equalisation between males and females. The authors also noted some geographic changes in the data: "The proportion of mental disorder claims was highest in London and southern regions in 1995, and in Scotland in 2014." Interestingly too: "areas traditionally associated with industrial decline, such as Wales, the North East and the North West, did not show particularly high proportions of mental disorder claims compared with other areas."

Drilling down into the details of what constituted a 'mental illness', the authors reveal some interesting trends in relation to claims. Depression or depressive disorder is consistently shown to be the most frequent 'category of disorder' (circling around the 40% mark of total mental illness claimants for 1999 and 2014). Anxiety and related conditions is the second most frequently cited category; between them and depression capturing 65-75% of the total claims with mental disorders mentioned. The authors also make an interesting point about claims appearing under the category of 'learning disability' including "Pervasive Developmental Disorder" (PDD). Although the total number of claims increased in this category - ~87,000 in 1999 and ~125,000 in 2014 - there was only a small change registered as a percentage of the 'total mental disorder claimants' between the years. I know some people might um-and-ah about the descriptors used to code PDD and other developmental disorders (including use of the words 'mental retardation' in the same category) but those are the codings specifically used by the DWP not my own.

Viola & Moncrieff provide some important discussions about their findings and the context they are presented in. The ideas, for example, that "regions of high unemployment and economic inactivity" or "the recent economic recession" somehow correlate with claims for state benefits as a result of mental illness don't generally hold true on the basis of the presented data. I would however soften those words by pointing out that austerity may very well exert a psychiatric toll on a person if one accepts that the quite alarming suicide statistics we've seen recently (see here) are not solely down to just social factors.

"Evidence from the UK suggests a modest increase in the reported prevalence of common mental disorders since the early 1990s, but this is not large enough to account for the increase in disability claims, and may represent increasing recognition and identification of such disorders as much as their actual occurrence." With this statement, the authors tap into how stigma associated with mental health problems might be decreasing, as more people feel comfortable talking to others about their issues and how this might be reflected in the claimant figures. They also take a bit of a jab at the 'effectiveness' of pharmacotherapy used to treat/manage such mental health issues: "The increasing use of all types of drugs for mental disorders, and especially antidepressants, in England since the 1990s does not appear to have ameliorated the rising trends in disability claims for these conditions." I'll say nothing more on this point.

The final words of this rather long post are reserved for what potentially might impact on disability benefit claims in the context of mental health issues, specifically with employment in mind. The authors note that "the provision of suitable employment opportunities where health and mental health-related limitations are accommodated" might be one model to look to with further research required. I'd agree that a caring workplace should be an important part of the strategy to reduce the numbers of claimants and provide the various positive opportunities that accompany work. I am however a little cautious about any 'one-size-fits-all' approach to accomplishing this, as lessons from specific labels covered by the Viola/Moncrieff paper come to mind (see here). And on the topic of employment and autism, I might also divert your attention to a much needed piece on why we perhaps shouldn't get too excited about 'autism employment initiatives' just yet (see here)...

Finally, although not wishing to mix science and politics too much, the recent news that a certain gentleman (quiet man?) has quit his post here in Blighty because of "pressure to make cuts to disability benefits" seems to be oddly relevant to discussions today.

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[1] Viola S. & Moncrieff J. Claims for sickness and disability benefits owing to mental disorders in the UK: trends from 1995 to 2014. British Journal of Psychiatry Open. 2016; 2: 18-24.

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Viola, S., & Moncrieff, J. (2016). Claims for sickness and disability benefits owing to mental disorders in the UK: trends from 1995 to 2014 British Journal of Psychiatry Open, 2 (1), 18-24 DOI: 10.1192/bjpo.bp.115.002246