you good morning and welcome to this meeting you know that we will talk about sports this morning we will ask our speakers and we will wonder whether sports is really good for your health first of all introductions my name is matsalai dr matsalai i'm actually a journalist and i work for the roy section here in trento we have experts with us this morning they are experts of the world of sport and we are particularly pleased to have a great champion with us mr harry carson who has been a wonderful football player he played for 13 years with the new york football giants here he has been captain team captain for 10 out of 13 seasons he suffered several injuries and also concussions i believe that he concluded his career in 1988 and then starting in the 90s he was diagnosed a the concussion syndrome the post-concussion syndrome and he will explain to us what that means he uses his experience today to talk about the risks in the world of sport and then we have another speaker who is the rules of he is a physician and he is in charge of the trento health monitoring unit he works in the field of health and the factors that determine it and also represents trentino in the world health organization then we have dr paulo crepatz who is a surgeon specialized in sports medicine he's also an expert on physical therapy and rehabilitation and physiatric a physiatrist and a professor so they have all of them a wonderful and very rich curriculum i was very brief of course in summarizing it we know that the best quality of a chairperson as a meeting is that of being brief so i would like without further ado to give the floor to the protagonist and i would like to ask harry carson to tell us about his experience in the world of football and to tell us why today he works and he's so committed in talking about neurological health he will speak in english there is simultaneous translator translation into into italian and i would like to thank the two interpreters mrs germinario and merciless you have the floor mr carson well good morning thank you it's an honor to be a part of this festival to be here and share little bits of my life to perhaps educate or enlighten those of you who are interested in sports and the the health of of sports it's my honor i started playing football when i was a young kid and i think i was doing it because everybody else in my neighborhood was doing it and the way that i got onto really my interest was in playing and just wearing the uniform that was the most important thing because as a kid and i saw these older players wearing the uniform they wore it with such pride and such dignity i wanted to be a part of that and so i went out for the football team when i was in the ninth grade and i didn't make it i quit on the first day because it was just too rough for me and also because i got hit in that first practice and i saw stars and i didn't really know what was going on long story short i came back the next year i made the team i wasn't all that good but i got better and better as i played and went on through high school went was good enough to get a scholarship i went off to college i played four years of college football and i honed my skills in such a way that i was being looked at by the professional teams to play on that level and so i was drafted to play with the new york football giants during my career with the giants i was i became pretty good and i was known throughout the league as one of the hardest hitters when i when you talk about hitters i was playing defense and i had to hit the whether they be wide receivers or running backs or whoever had the ball i had to bring them down and i was very effective in bringing ball carriers down and i enjoyed the experience of playing defensive football but during my career i found that there were times when i would deal with bouts of depression i'm an individual who for the most part i have a happy-go-lucky attitude and as i was playing i would deal with these bouts of concussions and i would wonder why am i why am i dealing with depression and come to find out that the bouts of depression were brought on by the concussions that i had sustained there were times when i would be talking to the media and as captain of the team i had to talk about what was going on with the team and i found myself using fillers like um you know um you know and i'm thinking of what i wanted to say and i couldn't really figure out exactly what words i wanted to use to complete my thoughts and so i dealt with that privately and two years after i left football in 1988 i retired in 1990 i went to my doctor just to get a yearly physical and he said well everything is fine he said is there anything else bothering you and i said no everything is good i wanted to leave his office very quickly i said everything is good and he said are you sure i said well i've been having bouts of depression uh i was dealing with memory loss and so forth and all of these other symptoms that i brought up to him and so he referred me to a specialist i went through two days of of testing and at the end i was diagnosed with a mild post-concussion syndrome and as a result of that diagnosis it was determined that it was due to the hits that i took and gave while i was playing football not just in the national football league or professionally but playing college ball playing high school ball it was the cumulative effects of concussions over the years that had started to take its toll and so i was diagnosed with that condition which for me i was very fortunate because i knew what i was dealing with and i knew the issues that i was dealing with and i asked the doctor before i left his office will i live because i thought i had a brain tumor you know to be dealing with the issues that i was dealing with and he said you'll live but you have you'll have to learn how to manage the condition and so over the years it's been since 1990 so it's been about 27 years now i've dealt with the effects of post-concussion syndrome but i've watched as other players who have played whether it be professionally college ball high school or even young people who play who sustain concussions what they're dealing with from a neurological standpoint there have been some players who have gone so far as to take their own lives because they did not know what they were dealing with i'm very fortunate in that i've always known for 27 years what i've dealt with and i know what triggers migraine headaches that i might be dealing with in any other issues that i might be dealing with and so for me it's important that i do the right things to manage my own health one is i exercise i make sure that i do a lot of cardiovascular exercise to get blood streaming to my brain and throughout my body i try to eat right and i try not to allow anything to bother me i just sort of let it roll off my back and so i don't deal with a lot of stress except for what i'm dealing with my wife so um you know i don't know about here in italy and other places around the world but the issue of traumatic brain injury and concussions in sports is now a very hot button topic in the united states because when you see certain high-profile athletes acknowledge that they're having now neurological issues after they have retired if you look at young people who sustained concussions drought during their athletic career and now when their careers are over they're afraid of what might happen to them down the line when you look at the older players who have played and now they're dealing with the effects of dementia and alzheimer's and a lot of people don't make the connection but i've made the connection that i think there's a correlation between those coaches or players who played 20 30 40 even 50 years ago who are now dealing with the residual effects of traumatic brain injury that they sustained when they were competing and this is something that i think about often when i talk to some of my old coaches who are now dealing with dementia um i i wonder did they know what they were doing when they were playing so this is an issue that i think in the united states a lot of people don't really want to some people want to acknowledge and others don't because they love their sports in the united states they love football they love hockey they love mixed martial arts fighting they love boxing um all of those sports are sports that are contact sports and when you sustain a head injury you don't know how that's going to manifest itself down the line and so uh i've been an individual who i i look at my playing days and i don't see myself as being any different from any other uh player who has played and when i started playing i recognized that you could get hurt physically i recognized that you know i saw people being taken taken off the field on stretchers and i assumed that risk but no one told me about the neurological risk that you put yourself at that that you expose yourself to in playing a contact sport and so that's why i've been talking for more than 25 years about the issue of traumatic brain injury and concussions because no one shared that information with me and i feel that it's important that those of us who have already sustained the damage and are living with the effects and the long-term effects of concussions should share especially with parents to let parents know what risk they are assuming when they allow their kids to play contact sports sports is good certain sports contact sports is not a good proposition for kids who are developing and their brains are developing now if someone wants to play when they are and when they're older i have no problem with it as long as they know the risk that they are assuming in playing a contact sport so whether it be football lacrosse ice hockey even nascar racing dale earnhardt jr who was a famous um racer now he he's the son of dale earnhardt uh he was in an accident in 2012. and then he was in another accident last year and he sustained a traumatic brain injury and now he's retiring from the sport because he's having neurological issues so you have more and more players who are opting to donate their brains to science to find a cure for the traumatic brain injury but the reality is you can look at the equipment that players use and you look at the football helmet or the helmet of a race car driver the helmet protects the skull it does not protect the brain there is no way that you can protect a brain when you're dealing with a contact sport so there are a lot of people who don't want their sports tampered with especially football but i think that the message should go out to any parent who allows his his or her kid to play contact sport the neurological risks thank you very much harry carson sports is a good thing but it entails risks and it is very important to evaluate all the risks now i would like to give the floor to pirus fateh mogadam who is an expert in monitoring health and in his contribution he will tell us about the way by which it is possible to promote health by means of physical exercise thank you it is indeed an honor to to be here i will talk about physical activity and exercise in terms of its capability of promoting health because there is a general consensus in the scientific scenario that those who practice sports and exercise and move on a regular basis have a number of benefits for their health in that there is a strong evidence in terms of reducing mortality for general causes cardiovascular diseases hypertension stroke metabolic syndrome diabetes breast cancer colon cancer depression and falls and there is also strong evidence that there are benefits in terms of bonus strengthening and improvement of cognitive functions improvement of cardiovascular and muscular fitness weight loss if associated with a calorie uh reduction in one's diet so it's a long list and yet i think that there might be things i left out the list could be longer but these are the things that have been particularly investigated and there is a scientific evidence behind these uh these uh things how much do should we exercise though to enjoy the benefits and here we have good news because half an hour a day is sufficient what does that mean it doesn't mean to play sports for half an hour a day in an organized way not necessarily but if you walk at a certain speed or ride a bicycle that's enough it's a 150 minutes a week if you do 300 minutes a benefits increase and that's it because if you increase even further beyond the threshold as you can see from the graph which depicts intensity and duration of physical activity if you do a lot of physical activity you have benefits but you reach a plateau so if you increase intensity beyond a certain point benefits do not actually increase that much and you also have here an indication of how many years you gain in terms of life expectancy and indeed when uh leaving a sedentary lifestyle and starting practicing you have major benefits the gradient of the curve here is a steeper therefore the priority objective in health uh in the health system in health services should not that should not be that of making italians athletes all of them but reducing sedentariness that is bringing those people who do not exercise at all to changing their lifestyle here we have data about the monitoring system that we have in trentino and also in other regions and provinces of italy you see that in trentino they tell the population is more active than in the rest of italy but 17 of people do not exercise it is approximately 60 000 people well as f for its evolution over time in this chart you can see two different aspects in orange we've got the south of italy and the islands in blue the italian average red is central italy and the in green is northern italy the first thing i'd like to highlight is the geographical and equality inequality because people living in the south of italy are at greater risk to be sedentary versus those who live in the north and then there is also an ongoing trend to increasing physical inactivity that's a problem because not only is a physical exercise good for you but it's actually the opposite namely physical inactivity is harmful for you so physical inactivity is considered to be a risk factor just like cigarette smoking it is bad not just for health but also for the economy this is a recent paper published on lancet whereby for 2013 then direct and indirect healthcare costs amounted to 1.4 billion dollars as a result of the italian population being increasingly sedentary and there is also then social inequality even beyond than other inequalities because as you can see the elderly are more risk and the same is true for those with a low education level as well as those who are in financial distress and those who are italian are not italian residents or citizens and this is my short pitch because all of these aspects about health inequality were summarized in this report which was published for this occasion for the trento festival of economics which can be found on this website www in order to prevent i mean if i want to prevent physical inactivity i first need to single out its root causes in order to be more effective is it that we do too little sport and that was uh that's the data that was presented the last february by georgia la leva so italians are a people of sports people and just like physical inactivity also there's positivity seems to be on the rise so there is something wrong there in my opinion the most plausible assumption is that the cause for physical inactivity and for an increase in exercise can be found in the progressive motorization of our daily troubles and movements and i thought i'd just share with you some paintings this one is entitled christina's world by andrew wyatt it was painted in 1948 and then we've got a modern artist who has fun in trying to picture how some famous paintings would be if they were realized today so that's how he sees that famous picture and then this is probably one you know even better so the stern starry night will probably look like that in today's world why is that the one i like best is eduard which should probably be painted like that these are not just impressions or aspects of the american way of life i think there is also more robust than information so we get the information from the italian motor association so as you can see there is increase in the number of cars i mean we're not surprised to see that it first started in the 50s but the amazing thing that it keeps going up even in a present date and this is a number of cons consequences not just for uh physical inactivity but also for an equally important factor namely global warming because the transportation industry contributes by at least a fourth of the co2 global emissions and automotive traffic is indeed one of the main causes why is it so well i mean since many painted his picture up to date and co2 emissions have massively increased thereby causing all the problems we're familiar with in terms of climate change physical activity and environmental pollution are two sets of problems but there might be a single solution addressing them both which looks more promising on paper and which we'd like to support namely the increase in active travel which means the people should leave their car at home because as we heard there's not so much of having a car but the issue is not using it too much we should walk more we should ride bicycles we should public transport more for a number of reasons because it reduces polluted sunset but also then noise then pollution and then also ending a decrease in potential road accidents a decrease is also the consumption of renewable natural sources and it also reduces social inequalities as we will see better later you may think that it's dangerous to ride a bicycle and that's what many people often pull forth on reception but it's even more dangerous and not to ride a bicycle because people who then ride a bicycle to the office have a reduction between 10 and 30 percent of diner vis-a-vis those who ride the car to go to their office the you accord the uk health care system might save 17 billion pounds in 20 years if they were to invest more in active travel thereby also creating new jobs it was actually estimated by the who that about 67 76 000 jobs could be created if the major european cities had the same percentage of urban cyclists you find in copenhagen but how many people do actually use their bicycle for their then daily con commuting so in 13 or 90 which is slightly above the italian average and people who use the bike do it on an average four times a week for about half an hour every day so for daily commuting so that actually is quite close to the recommendation we have of physical exercise and that saves 19 casuses a day because of the connected physical activity and 18 000 tons of co2 will not be then injected into the atmosphere but who are the people who use the bicycle for their daily travel or commuting and that's quite interesting i mean unlike physical inactivity the bicycle is used regardless of age because it's it's a great means to do this exercise also in a more advanced age there is not a gender difference agenda gap because we see that women if anything use a bicycle more than men there is a slight inequality in terms of level of education but there is not there are no inequalities in terms of income there is a difference between italians and foreign citizens but i say the social inequalities or the inequality gap is much smaller so a bicycle is actually a democratic and a gender-neutral means in terms of national healthcare so as to reduce physical inactivity and also to safeguard the environment pedaling is fine but you should not use a static bike energy better they should go outside but obviously such a choice should be promoted should be fostered by public policies as you can see in this front page of the new york magazine you know we've got a very nice bike sharing scheme in trentino in this region where also other activities are carried out in order to encourage active travel such as a trentino padala or another initiative we then highly encourage the esports last year which is an activity together asylum applicants you know scotians by bike and then there was a mixed bike team both italians and refugees which participated in the famous heroica competition a bike race all these initiatives are perfectly consistent with the guidelines the recommendations they are part of the torrentino region healthcare plan whereby you're supposed to carry out a number of activities and physical exercises throughout your your life cycle and that applies both to individuals but also to the workplace so that you know such a choice it should be easier because we've got this sort of metaphoric sisyphus of health care you know this sisyphus who needs to keep pushing up the rock of a healthy lifestyle along that steep rise but then it depends also on the steepness of the curve which is something that can be made softer by a number of common interventions and policies which we hope will soon come thereby making superfluous the action of superheroes like this nice guy called peter nito in mexico city a master superhero trying to defend pedestrian rights because we know that well they're requiring heroes is a poor world thank you thank you very much papyrus for your words speaking in favor of this healthy and democratic vehicle namely bicycle i saw the mayor of trenton nodding and appreciating his words and now we've got paolo crepertz who's a sports physician i know that every day you meet with many people practicing sports at all levels you know either in their leisure time or also competitively so let me ask you do you think that sport is really good for her health and sometimes we even know when we should do some exercise we tend to be than couch potatoes thank you very much for your kind invitation i mean we just heard that when asked whether sport is really good for your health so we the answer will be an affirmative one because the physical inactivity is really bad for your health and i'm not going to repeat what pirates exhaustively explained we equally know that the antidote to this disease is called the regular physical exercise it's a free drug with no side effects it can be taken by everyone but just like any drug he has then apostology so you need to take in certain doses at certain times however in italy there are still sedentary people the sport italians like best is to watch sports on tv i mean tonight there's going to be the match between juventus and real madrid then that seems to be the most practiced sports uh activity in italy i think that if you're here is because you are convinced about the value and importance of regular physical activity or positivity but the real question should be is spot really good for your health or should we rephrase it and say how come the people although being aware that exercise is good for their health and do not practice it it was more effective in convincing people to change their lifestyle fear or gratification or reward when someone goes out a tobacconist with a package of cigarettes they will find a terrible writing a label saying smoking will kill you however i've not seen anyone who after reading that label took the package back to tobacco and he said i'm sorry i wasn't aware they could do that can i have my money back so evidently knowledge is not enough is there an effective way to change people's lifestyle is it a fear terrorism or reward some people speak in favor of the fun theory people's virtuous behaviors may be evoked using rewarding and fun stimuli let me show you one video i think many of you may be familiar with that it was an experiment in a stockholm underground where people were invited to take the stairs as opposed to using the elevator the escalator because the steps had been turned into a huge piano keyboard that could be played and said they stepped on it could you please turn the volume up 66 percent of people decided to use for these fun uh environmentally friendly steps so the promoters showed that you need little to motivate people in a pleasant way which is also advantageous for your health in that case people's response was purely emotion and and he might not always say usher then better and more healthy lifestyles but it may be suggestive over the next few months then you will be then hit by this new app that will be released by the local council for health so with the clear goal of convincing couch potatoes to stand up and do some exercise but which are the things that tying us to the couch is our culture really promoting sports activity economies and others explain the global crisis of our times has its roots in the extended the well-being we had for the past few decades with an evident awakening of our mental and motivational factors psychologists in terms explain that the factors facilitate this growing lack of responsibility and many such as the pressure to fragment individual will so as to have better consumers the insistence on proposing mass image is weak and frail and able to face up to difficulties the erosion of the relationship with reality which is results of the digital culture the ongoing devaluation of personal engagement trying to achieve a short term personal goals as we heard yesterday from michael marmot the root cause is not so much that we don't know about the potential damage of a certain lifestyle but rather the disempowerment because we know that we cannot manage our life and health styles and mama said that the people have little control of their life and that's why they cannot make healthy choices and that's why there are many people i can tell you in my daily experience as a physician who actually praise highly the couch starting from some prestigious italian journalists but this praise of the culture has a truth in history such as cicero you know being idol and be totally inactive is a source of faith lately nothing but the habit to have a rest before growing tired lazy people always feel like doing something and hairy food physical exercise is a fib is a lie if you're healthy you don't need it if you're sick you cannot do it the other automotive manufacturer and so ferrari said all people are like antique furniture and the less you move them around the longer the last luckily no other people think like that gino barter the famous cyclist said italians are a people of sedentary people then people who have a career will eventually get a chair you know the inaudible the first person then stepping on the moon so his temper became quite famous however he said i'm convinced that every human being has a finite number of heartbeats i don't intend to waste mine running out running around doing exercise and that's why as you can see they've placed elevators even near fitness centers so somebody commenting this lifestyle stated that something cannot work in a society where you drive your car to go to the to drive to the gym where you will pedal on a static bicycle so the question again is does really sport make your life longer mark twain said that the only sport he practiced was to go to the funerals of his sports friends and this was echoed by the italian politician julian royalty who said my friends who practice sport died a long time ago economists too investigated this matter and leonardo wrote that the man spent half of his life to ruin his health and the second half to get cured or men use their health to reach a certain wealth and then they use all the money they gained to go back to a healthy condition why why should we uh avoid the pleasure of sitting down and make exercise instead well if you are here you are wondering about that peers talked about all the benefits and advantages of practicing a physical activity i would not go back to that but i would mention who that stated that health is not simply the absence of disease but it's a general physical psychological and social well-being and hippocrates stated that all parts of the body with a function if used in a continuous way and moderately develop and age slowly their known use entails that you will develop a disease or you will not develop properly and you will age prematurely if we managed to give everybody the right diet and physical exercise we would have found that we would find a way to be healthy we talked about physical health but there are also scientific studies that tend to promote a positive lifestyle and some are very interesting the promise always being that of living longer and healthier a study was published last uh a couple of days ago and stating that if you quit the smoking you uh gain in terms of years of life and thousands of euros that you can not use in buying cigarettes and you can go instead 10 times to the caribbean islands and then health is also a social issue if you have a university degree for instance you live five years longer and that is due to your cultural uh situation and also to the wealth that you can achieve if you have a university degree there is another study i would like to mention even for 15 years thousands of people were investigated one hour over running a day gives us seven years of extra life and i would like to make a calculation two hours of running per week for 40 years means an extra three years of life three years of life so six months of physical exercise means that we gain this amount of life based on the study if you have seven extra hours of life by running one hour of course at a certain point you will not get immortal but you will have a benefit so in this conditions we have guarantees in terms of health and in terms of life expectancy we will live better we will live longer and yet i would also mention what woody allen said i quit smoking i will live an extra week and during that week it will rain like hell so walking is the first thing we think of when talking about physical activity and hippocrates wrote and said that walking is the best medicine of course you have to have the will to do so thinking walking go at the same speed rousseau said i cannot meditate unless i walk the moment i stop walking i stop also thinking and this perhaps applies to other people as well there is a profound relationship between the history of walking the history of human thought man has walked for several reasons political economic social aesthetic reasons and also for fun think of the exodus of the jews or think of the pilgrimage of santiago the way of saint james i think of the long marcher by mao zedong think of chagavara think of armstrong on the moon and the 100 steps between the house of pepino and pastato and the mafia boss that lived nearby so walking also means a fleeing from something from someone eskimos maintain that you can stop getting hungry and sorry not hungry but angry if you walk long enough and we could perhaps try that walking comes her from africa it is the outcome of evolution and it has a widespread everywhere it is the art of looking for something or looking for someone looking for ourselves pilgrimage is a special form of walking it means looking for something which is intangible walking helps as understanding who we are a proverb by native americans states that you have to walk two moons in your neighbor's shoes before being able to judge your neighbor and sometimes people say that if you look at people who walk you can judge what they are those who have an ideal work on their tiptoes and those who are a pessimist and to down to earth that work on their heels i i will speed even further even though i know that i'm creating trouble uh for interpreters so we talked about walking let's now talk about sport i will use running as a an emblematic activity but of course i could mention other sports disciplines why should we run well snoopy tell says running is very healthy is good for your body and is very good also for of the earth because the earth and the soil will feel useful if you run on them and then confucius said when i run all my thoughts fly away and i can overcome myself and that means being strong those are who do marathons so of course there are many on our planet if you want to leave you have to walk if you want to live longer you have to run in the 70s in the 80s running and also cross-country skiing or riding have widespread sports and this has become a must phenomenon and yet also a number of questions arose and one of the questions is why should i run why after finishing my uh day at work should i go running or why should i get up early five o'clock in the morning and run i did it a fortnight ago and we run the breakfast to run at five o'clock in the morning why do we do that well we have to find the reason in ourselves and for an african proverb says that if there is a will there is a way if you don't want something you will find an excuse so we all have our own excuses and we all have our motivations we have to work on that and then uh sportsman zanardi said life is like coffee you can put as much sugar as you want in your coffee but if you want your coffee to be to be sweet you have also to steer it if you simply keep still you will not have anything out of life and rashkin said the best acknowledgement after uh doing something is what you have become thanks to the efforts that you made and a very special motivation is that that drives people aged over 50 to become obsessed with the need to practice at uh in the morning or in the evening they go running they ride the bike we are members of a tribe um over the middle uh middle aged men in lycra that you see there why because these sports equipment is fundamental for these experiences so we are the mammals and we get so tired together with other people who are fanatic as fanatic as we are and we take the challenge our daily life can be highly monotonous and you see finding some time that we can devote to ourselves can be really a healthy practice the emotions coming from a physical effort um are good for your mind the endorphins which flow in your veins when you are an amateur sports person makes a and make life a nicer thing and the world a nice a nicer place to live so we have people who try and avoid the midlife crisis by running but self irony you see is so important in this and a very significant contribution and i'm about to conclude comes from rugby in that in rugby there is one rule which of course is anglo-saxon and it is under statement understatement is a word that does not translate actually into italian we use the english word understatement but that means avoiding excess avoiding an excessive emphasis because you know that in the gym and also in american football why not playing is playing that is what it is and that is the best way to grasp the beauty and the importance of playing in sports and in life the rugby italian players per game said life is more than playing and playing is a nice way to try and live better and learn how to live and then marco lo olmo from ultra tale trail said in when racing and running those uh who rank last are as good as those who were among the first to to reach the finish line and they take extra hours to get to the finish line and they manage to get to the end even though they know that they will never get a medal for that so they are even better if you want to know how you will be in 10 years says jeff scaff look at yourself in the mirror after a marathon so you judge please whether my face here at the end of the marathon in rome 10 years ago resembles what i look like today before concluding i would like to mention something about this lack of responsibility do you become a champion or are you born a champion is is sufficient to make an effort to become excellent what does it mean to be talented well today in all fields in all domains excellence is combined to inborn talent and this conviction has devastating effect on real behaviors this is at least what i think because if you are born with little talent it seems that there is nothing to do you should simply accept that and perhaps you are also relieved because that means that you will not have to make many efforts in practicing sports but this mentality is a wrong result of a wrong interpretation of genetics because there is epigenetics as well epigenetics abandons the idea that genes completely govern our life and environment is given the geo importance a gene in our dna can become manifest or not it can express itself partially only and behavior here of the gene depends on regulatory proteins which are influenced by the environment by the diet and by lifestyles as well as physical activity which means that making an effort is a key in bringing to light what nature has given us and we owe this discovery to anders ericsson from the university of florida he developed the theory of the 10 000 hours he said that you do not become excellent simply because you have the genes to do so but because there is a voluntary process which is an intentional practice what is it it is the conscious practice of performing a task which is a different thing than simply repeating a gesture this is something which is intentional and which entails posing new objectives and challenges and this favors a cerebral neuroplasticity which means that you can master an activity and a task ericsson has investigated for instance how many hours people spend to develop a talent in their field and the average he says is 10 000 hours 3 hours a day for 10 years perhaps if you're not talented you will not become excellent but if you are talented anyway you have to make an effort so you might think of that i'm a dreamer but you know yesterday professor marmot spoke so much about the importance of being a dreamer and i would like to mention in the end eduardo galeano who is a writer italian writer and he also wrote about sports and he explained what utopia is utopia is something that may makes us move a utopia is there on the horizon i get two steps closer and it it gets two steps more distant and then ten steps and the horizon is more distance by stem steps the longer i walk i will never get there anyway but what is utopia is what makes me walk thank you very much paulo made us feel like going home wearing some liquor like equipment and garments and start walking and running thank you so much we have a 15 minutes left so i would say that we can accept questions from the uh audience if you have questions to our speakers so this is the right moment to ask them and kindly use a microphone for the purpose of translation so we have the first question good morning my name is stefan i have a question from mr carlson since you are great a formal sports champion and now you are trying to disseminate the thoughts you have developed in your activity uh i mean since you know the relationship between the traumatic injuries in contact uh with our injury i mean in light of what you know now if you were to go back would you do exactly the same you know considering all the substantial economic benefits or instead would you then practice your sport in a different way or perhaps do something else altogether you know many people have asked me that question but i i i came to this conclusion myself given what i know now if i had to do it all over again i would not have done it because as i said earlier i understood the physical risks that i was putting myself into and i assumed that risk i knew i could hurt my knee i knew i could hurt my shoulder i knew i could hurt my back i knew i could possibly be paralyzed playing the sport because i'd seen it but i i assumed those risks no one told me about the neurological risks and so as a result of that knowing what i know i know my knee can be replaced if i hurt my knee my shoulder my hip those joints can be replaced you cannot replace your brain you've only got one and once your brain is damaged there is no telling or understanding of what is going to happen to you once your brain is damaged so i'm not a doctor i got a degree in education and while i was certified to teach i went into sports i went into football but i've used my degree as an educator to share what i've dealt with as an athlete to those who really are wanting the information i know there are some people who i can say until i'm blue in the face and they don't care they want their kids to play football or they want to play football because they look at the monetary rewards of playing the game but what good are the monetary rewards if you're dealing with traumatic brain injury and you can't enjoy uh living life because you're dealing with these these issues so um i'm a little different than most other players that i mean they're they're players who i played with who are football players and they would say emphatically i would do it all over again in a heartbeat for me i just sort of happened into football i started playing football because of girls you know just wearing the uniform it was like a chick magnet you know but there's a risk that comes with playing the game and and uh that neurological risk is one that given what i know now i would not have done it in my family i'm the i'm the tyrant and i don't care but my grandson is never going to play the game of football because i value him so much and i know that the neurological risk is too great and so i've made that decision that my grandson is not going to play he knows he's not going to play and so you know given what i know i've shared that with my family they understand where i'm coming from and and that's it so good afternoon my name is valerio vecchiarelli professionally i have been following then high level sports such as olympics in the field and sometimes i was faced with a weird situation i mean before the final 10 000 meter the olympics i was in the courtroom and i saw the more than 10 athletes were presenting then a medical certificate because they were using ventilating a drug against asthma i played rugby for many years and i saw that in the recent years in rugby a very strange protocol was adopted for people who have a head injury and so they need immediately to go back to the changing rooms to be examined as if they continue playing hence my question do you think the high level performance board is good for you i mean i'm addressing you physicians if a parent were to come to you uh to say i'm the father of a boy who could make a living out of it to becoming a professional player or athlete to go to the olympics what would you do would you then uh advise them to follow their career i think that question is addressed to paulo's crepe who's a sports doctor because i suppose he often deals with similar questions i started working as a sports uh doctor with francesco mozaire the cyclist in the national aberdeen for 20 years i worked with the italian kayak team i'm telling you because i've got a direct knowledge about performance or high performance sports in the abstract of this session mention is made of limits i mean performance sport does entail risks as you pointed out and as harry carlson pointed out for these limits it's important to abide by certain rules which may help us first of all to survive and second off to make sports a more positive environment are you aware of the limits i mean first you've got a physical and then you need to have a filled the supported and also first aid expertise but you also need to abide by the rules you need to follow a coaching program depending on the athletes age and fitness i mean for children you don't do exactly through the same coaching sessions as you would for a grown-up because a child's characteristics are totally different among the rules i consider for sport to be conducive to health is obviously doping prevention doping is a legal forensic economic problem and i think it's mainly about respecting your opponent it originates from someone feel unable to compete with the opponent with the same rules so why is he so well they're affected by many factors they're also pressurized by media or even by the authorities whereby people who are weaker fall prey to these temptations in cycling there is a widespread use of respiratory drugs so that's what we say as a joke either all asthmatic ride the bicycles or older than cyclists are asthmatic so because ventolin which is a drug you mentioned is supposed to be an asthma drug but it's a spray formulation it was a taking off doping drug list i mean it can no longer be taken as an injectable or in oral form but it can be taken as a nebulizer first of all because it's widely popular and also because there is no reason to think that it may improve athlete's performance especially since it's allowed and everybody may use it i think sport should actually set its own rules because i think it's one of the nicest things you know in our heritage we should protect its beauty it's not just about law enforcement but it's also about cleaning up what's wrong so i said to safeguard all the beauty that lies in a sports experience good afternoon we just heard about the the big difference between a physical activity in northern italy and southern italy so i was wondering about the main causes that may be identified is it about culture is about the lack of infrastructure such as bicycle lanes in north and south of italy so in these terms when we talk about inequality in terms of the supply of health services i think you've just seen rodin on the topic of this festival namely then inequality in health can we talk about social inequalities or differences in the ability to practice sports which as we heard is so important for us to remain healthy and also economically available payroll fate will answer this question thank you very much for your question in terms of the data we have i cannot give you an answer because we are just monitoring monitoring this issue but i suppose everybody will be wondering about the reasons but we cannot find an answer in the data or if we can it's only up to a point and the reasons you outline are indeed among the most plausible ones in order to practice in order to do physical exercise in addition to practicing sport the infrastructure is essential i mean we are lucky we live in this province so there is so much sports facilities and infrastructure it would be almost difficult not to do any exercise you just need to go for a hike for a walk it's so nice and that could be one reason another reason might be of caterer type you know because even when to go even a short distance you take the car because everybody else does it you know you would sound weird if you were to walk to your destination i mean together with some colleagues on mine we work on the eighth floor we tend to take to climb the stairs and many people look at us as if we were a bit weird you know why don't you take the lift or sometimes when you ride the bicycle when it's raining people think that you are a bit obsessed and that it's a bit of a cultural issue that needs to be overcome because as we've seen in other countries where there is a great rainfall i mean you're not strange if you decided to walk or to ride your bicycle even if it's raining talking about sports and there is also a social economic aspect to it i mean people in financial distress as we've seen are more risk for physical inactivity and that is also related to the fact that you need to spend money to do some sports and there i think the public policy should be more supportive and if i may i'd like to add one final comment in terms of uh safety or physical exercise as you know in italy you need a medical certificate to practice export ecg and the number of blood tests and this obligation has been extended also to non-competitive activities and i must say that there has been some scientific evidence of it being equity effective but it's once again about equality because these tests are expensive and i mean our province therefore boys and girls under 18 will give a reimbursement if you decide to go through that but not all promises do that whilst the grown-ups and even elderly people have to pay you know to uh food to the build themselves i mean we work together with the union italiana sport for tutti and they offer them walks for the elderly and now they're forced to ask for a medical certification and then they will have a fewer people because actually you'd have to pay more for the physical examination than you would for the uh this enrollment and there is no real benefit in terms of greater safety we are heading towards the end we still have time for one final question good afternoon thank you very much for this very interesting session i heard you mentioning the data for trentino i come from roll from bozen and i can actually share some service with you in sports made by young people and up to 14 in the province of boston almost 50 percent of young people going to school are enrolled in some sports association when you go up to 18 years of age then that gets half the so from 50 to 25 percent and here we are talking about you know about a success story for this province and region in italy so what sort of public policy should be pursued because we should not forget there is also a social gap i mean i work in uh then vocational training in less than twenty percent of our students a practical spirit otherwise if you go to a high school you find higher percentages so what sort of active public policies should we envisage because we should take a direct and more aggressive approach and then we should turn it into a best practice to disseminate to harry carlson who would like to thank her for his comments my question since you are here to uh you know as a testimonial which tools instruments rules would you recommend what do you think should be then necessarily enforced by either the state or institutions so as to prevent that there is a huge business behind high level performance ports will in any case ensure the athletes health thank you for your questions we only have a very few minutes left so we'll have a very short answer from harry thank you get the bulk of that question uh could you re rephrase it for me please see you're here to bear witness to your past experience i think that you know the state institutions or authorities which govern the whole sports procedure should actually embrace what you said so as a suggestion you know what sort of rules and policies that would ensure a better health for professional athletes so as to prevent you know someone like you than suffering permanent damage i i think that anyone who wants to play the sport should be able to play the sport in the manner in which they'd like to play the sport but they should be advised beforehand of the risks and i think that when you're looking at a young person understand that their brain development is not fully completed until they are between the ages of 20 and 25 any damage that they sustained that damage they will probably take with them for the rest of their lives i've seen this personally in the united states where i've been a very strong advocate of alerting people of traumatic brain injury i see a lot of tbi or traumatic brain injury in athletes who have played contact sports but i've also seen quite a bit in those in the military who have been subjected to bomb blasts and so forth so in terms of protecting people when you look at a cigarette carton and it it tells you that you could develop cancer if you smoke i think the same thing should be done in regards to sports parents should when they sign a consent form to allow their kid to play they should be warned that their child could possibly sustain some kind of traumatic brain injury so that they know ahead of time and if they want to go ahead and proceed in doing so then fine but again i feel that every parent should understand exactly what they're signing their kids up for and so that is uh one of the reasons why i've been really an outspoken advocate in regards to this issue people within the national football league don't necessarily like me talking about this because their main appeal is to young people into parents and they want parents to feel free and and about allowing their kids to play but there is a risk that is there so i don't think the government can do much i think that it's about the parents making the a decision as to whether they will want their child to play football or any other contact sport where you might sustain some kind of traumatic brain injury responsibility so responsibility and being aware of things if i understood well uh the point now is what can we do to improve sports practice also in areas such as trentino and south tyrol these two provinces here where sports is well nurtured well perhaps dr crappats might comment on that but i think that really we should focus on the problem of people not practicing sports it might be that paulo and i disagree on that but you see my position is the following much has to do with not only sports but agonistic sports professional sports this has a number of consequences and there are other aspects that pertain to the health sector of course but what i think is that from the viewpoint of health itself purely per se perhaps a sport is not that good because it has to select talent it's not so that everybody can continue practicing sports uh playing in teams it is impossible to have an organization that can include everybody it is the those who are better who will find a place and we all want to see athletes play and compete but it is the talented ones that we see so it is obvious that people will not all become athletes until they leave sports the point is also trying to help people who stop practicing sport continue practicing a physical activity in their daily life i think that sports organizations associations have a major role to play here so that people uh continue practicing sports and they also have a lot to do in terms of educating their athletes in about the importance of for instance walking to the gym or walking walking to the stadium instead of driving a car thank you very much we have to draw this to a close and i would like to thank really the speakers for their wonderful contributions i thank the audience too for attending this meeting we conclude this appointment but of course there are going to be several additional appointments here at the festival that are very interesting and we have to go there walking or riding a bicycle thank you very much you