Opetusministeriö Undervisningsministeriet Opetusministeriön työryhmämuistioita ja selvityksiä Undervisningsministeriets arbetsgruppspromemorior och utredningar Evaluation of sports and exercise Reports of the Ministry of Education, Finland 2003:3 Sport medicine and biology research in Finland KUVAILULEHTI Julkaisija OPETUSMINISTERIÖ Julkaisun päivämäärä 7.2.2003 Julkaisun laji Työryhmämuistio Toimeksiantaja Opetusministeriö Tekijät (toimielimestä: toimielimen nimi, puheenjohtaja, sihteeri) Liikunnan biolääketieteellisen tutkimuksen arviointityöryhmä Hilkka Riihimäki, puheenjohtaja Ulla Silventoinen, sihteeri Toimielimen asettamispvm 4.9.2000 Dnro 20/043/2000 Julkaisun nimi Liikunnan biolääketieteellisen tutkimuksen arviointityöryhmän raportti Tiivistelmä Tutkimuksen tieteellinen taso Arviointityöryhmä pitää suomalaisen biolääketieteellisen liikuntatutkimuksen yleistä tasoa erittäin hyvänä ja kansainväliset mitat täyttävänä. • Epidemiologisen tutkimuksen vahvuutena olivat hyvin organisoidut, pitkän seuranta-ajan omaavat kohorttitutkimukset, huolellisesti suunnitellut ja toteutetut interventiotutkimukset (sisältäen vaativia randomoituja kontrolloituja kokeita) sekä tehokas kansallisten rekisteritietojen käyttö. Alan tutkijoiden tulisi edelleen tehostaa yhteistyötä perustieteiden tutkijoiden kanssa. • Kuntoutustutkimuksen vahvuutena olivat hyvin organisoidut tuki- ja liikuntaelimistön vammojen hoitoon keskittyneet tutkimukset. • Biomekaanisen tutkimuksen tieteellistä tasoa pidettiin erinomaisena ja sen tuottama tieto täydentää hyvin kliinisiä tutkimusohjelmia. Tutkimusalue tuottaa myös erittäin relevanttia tietoa niin urheilijoille, aktiiviliikkujille kuin ikääntyvälle väestölle. • Liikuntafysiologisen tutkimuksen tason arviointiin olevan hyvä suhteessa kansainväliseen tutkimukseen. Tutkimus tuottaa käyttökelpoista tietoa kliinisen hoitotyön ja kuntoutuksen tarpeisiin. • Perustutkimuksen laatu ja laajuus arvioitiin yleisesti vain kohtuullisen hyväksi. Tämä on uusi alue liikuntalääketieteellisessä tutkimuksessa ja tästä näkökulmasta on ymmärrettävää, ettei tutkimusryhmillä ole pitkää perustutkimuksen traditiota. • Korkean viittauskertoimen (impact factori) lehdissä julkaistujen vertaisarvioitujen artikkelien määrä osoittaa, että alan suomalaisen tutkimuksen yleinen taso on hyvä. Eräät tutkimusryhmät julkaisevat töitään lehdissä joiden impact factor on huomattavasti alhaisempi kuin mitä tutkimuksen tieteellisen taso antaisi odottaa. Kaikkia tutkimusryhmiä kehotetaankin mahdollisimman kunnianhimoiseen julkaisupolitiikkaan. • Julkaistujen artikkelien viittausten määrä kuvastaa tutkimuksen vaikuttavuutta tutkimusyhteisössä. Viittausanalyysistä saatu viittausten keskiarvo oli 6,9 ja parhaan tutkimusyksikön keskiarvo oli 15,8. Näiden lukujen pohjalta tutkimuksen vaikuttavuus arvioitiin hyväksi. Kansallinen ja kansainvälinen yhteistyö Kansallinen verkostoituminen ja yhteistyö vaikuttivat toimivan hyvin. Yhteistyötahoina olivat sekä yliopistojen eri laitokset että tutkimuskeskukset. Tutkimusryhmien kansanväliset yhteydet olivat laajat ja joissain tapauksissa yhteistyö myös tuotti yhteisiä tutkimusprojekteja ja julkaisuja. Vain muutamat tutkijaryhmät ovat saaneet rahoitusta EU:lta tai muista ulkomaisista läheteistä. Kansainvälistä yhteistyötä tulee edelleen kehittää ja siihen tulee sisällyttää yhteistyötä eurooppalaisten tutkijaryhmien kanssa. Tämä voisi edesauttaa EU -rahoituksen hankintaa. Tutkijakoulutuksen määrä ja laatu Tutkijakoulutuksen määrä arvioitiin hyväksi. Arviointi osoitti, että valtaosa tutkijoista väittelee suhteellisen nuorena, joka on kansallisen tutkimuspolitiikan mukaista. Jatko-opiskelijoiden rekrytoiminen vaikutti olevan joillain alueilla ongelmallista. Toinen ajankohtainen ongelma on post- doc tutkijapaikkojen vähyys. Tutkijakoulutuksen laatu vaihteli suuresti. Koulutuksen laatu oli yleisesti parempaa suurissa kuin pienissä yksiköissä. Työryhmä suosittelee, että jatko-opiskelijat olisivat alansa tutkijakoulussa. Muita huomioita Lyhytaikaiset, vuoden rahoitusjaksot luovat epävarmuutta ja tekevät tutkimusprojektien pitkän tähtäimen suunnittelun vaikeaksi. Tämä tekee nuorten tutkijoiden työllisyyden epävarmaksi ja vähentävät tutkijan uran kiinnostavuutta. Sama vaikutus on myös avustusten maksamisella henkilökohtaisina apurahoina ilman sosiaaliturvaa. Useat tutkimusryhmät vaikuttavat erittäin riippuvaisilta opetusministeriön rahoituksesta. Työryhmä kannustaa tutkimusryhmiä ja -yksiköitä hakemaan rahoitusta entistä enemmän muista lähteistä. Erityisesti perustutkimuksen alueella työskenteleviä kehotetaan hakemaan avustusta Suomen Akatemiasta. Organisatorisesti, liikunnan biolääketieteellinen tutkimus on jakaantunut liian moniin yksiköhin, joista monet ovat liian pieniä saavuttaakseen vaadittavan kriittisen massan. Työryhmä suosittelee liikuntalääketieteen yksiköiden erillisarviointia. Tämä arviointi on kohdistunut vain yksiköissä tehtävään tieteelliseen tutkimukseen, eikä toiminnan muihin osa-alueisiin oteta kantaa. Tutkimuksen näkökulmasta olisi parempi jos alueella olisi vähemmän mutta vahvempia yksiköitä, joilla on riittävä kriittinen massa korkeatasoisten tieteellisten tutkimusten onnistuneeseen toteuttamiseen ja jotka pystyvät vakaampien tutkimusolosuhteiden ylläpitoon. Avainsanat (asiasanat) Liikunta, biolääketieteellinen tutkimus, arviointi Muut tiedot Sarjan nimi ja numero Opetusministeriön työryhmämuistio 2003:3 ISSN 1458-8102 ISBN 952-442-177-1 Kokonaissivumäärä 84 Kieli Englanti Hinta Luottamuksellisuus Julkinen Jakaja Yliopistopaino Kustantaja Opetusministeriö PRESENTATIONSBLAD Utgivare UNDERVISNINGSMINISTERIET Utgivningsdatum 7.2.2003 Typ av publikation Arbetsgruppspromemoria Uppdragsgivare Undervisningsministeriet Författare (uppgifter om organet: organets namn, ordförande, sekreterare) Arbetsgruppen för utvärdering av den biomedicinska idrottsforskningen Hilkka Riihimäki, ordförande Ulla Silventoinen, sekreterare Datum för tillsättandet av organet 4.9.2000 Dnr 20/043/2000 Publikation Rapport av arbetsgruppen för utvärdering av den biomedicinska idrottsforskningen Sammandrag Forskningens vetenskapliga nivå Utvärderingsarbetsgruppen finner allmänt taget nivån på den biomedicinska idrottsforskningen i Finland mycket hög och bedömer att forskningen väl motsvarar internationell standard. • Styrkeområdena inom den epidemiologiska forskningen var välorganiserade kohortstudier med lång uppföljning, omsorgsfullt planerade och genomförda interventionsstudier (inklusive krävande randomiserade kontrollerade prov) samt ett effektivt utnyttjande av nationella registeruppgifter. Forskarna inom branschen borde ytterligare förstärka samarbetet med forskarna inom grundforskningen. • Styrkeområdena inom rehabiliteringsforskningen var välorganiserade undersökningar inriktade på vården av rörelseorganen. • Den vetenskapliga nivån på den biomekaniska forskningen ansågs vara utmärkt och den kunskap den producerar ett välkommet komplement till de kliniska forskningsprogrammen. Forskningsområdet ger också ytterst relevant kunskap för såväl idrottsmän, aktiva motionärer som den åldrande befolkningen. • Nivån på den idrottsfysiologiska forskningen bedömdes som god i förhållande till den internationella forskningen. Forskningen producerar användbar kunskap för det kliniska vårdarbetet och rehabiliteringen. • Grundforskningens kvalitet och omfattning bedömdes allmänt endast som förhållandevis god. Detta är ett nytt område inom den idrottsmedicinska forskningen och ur den synvinkeln är det förståeligt att forskningsgrupperna saknar en lång tradition inom grundforskningen. • Antalet vetenskapligt granskade artiklar som publicerats i tidskrifter med ett högt inverkanstal (impact factor) visar att den finländska forskningens nivå på området allmänt taget är god. Vissa forskningsgrupper har publicerat sina arbeten i tidskrifter med en impact factor som inte motsvarar forskningens höga vetenskapliga nivå. Alla forskningsgrupper uppmanas därför att bedriva en så ambitiös publiceringspolitik som möjligt. • Antalet citeringar för de publicerade artiklarna reflekterar forskningens inflytande inom forskningssamfundet. Medeltalet för antalet citeringar var 6,9 och den bästa forskningsenhetens medeltal var 15,8. Utgående från dessa siffror bedömdes verkningsfullheten som god. Det nationella och internationella samarbetet Det nationella nätverksbildandet och samarbetet föreföll att fungera väl. Samarbetsparter var såväl universitetens olika institutioner som forskningsinstituten. Forskargrupperna har haft omfattande internationella kontakter och i vissa fall gav samarbetet också upphov till gemensamma forskningsprojekt och publikationer. Endast några få forskargrupper har fått finansiering från EU eller andra utländska finansieringskällor. Det internationella samarbetet borde ytterligare utvecklas och även omfatta samarbete med europeiska forskargrupper. Detta kunde förbättra möjligheterna till EU-finansiering. Forskarutbildningens omfattning och kvalitet Omfattningen på forskarutbildningen bedömdes vara god. Utvärderingen visade att största delen av forskarna disputerar som relativt unga, vilket överensstämmer med den nationella forskningspolitiken. Inom vissa områden föreföll rekryteringen av forskarstuderande problematisk. Ett annat aktuellt problem är det låga antalet post-doktorala forskarplatser. Kvaliteten på forskarutbildningen varierade kraftigt. Kvaliteten var i allmänhet bättre i större enheter än i mindre. Arbetsgruppen rekommenderar att forskarstuderandena är inskrivna vid en forskarskola inom branschen. Andra observationer Kortvariga finansieringsperioder på ett år skapar osäkerhet och försvårar en långsiktig planering av framtida forskningsprojekt. Detta medför också en osäker sysselsättningssituation för unga forskare och gör forskarkarriären mindre attraktiv. Samma verkan har också det faktum att understöden betalas som personliga stipendier utan någon social trygghet. Många forskningsgrupper förefaller mycket beroende av finansieringen från undervisningsministeriet. Arbetsgruppen uppmuntrar forskningsgrupperna och -enheterna att aktivare ansöka om finansiering också hos andra finansieringskällor. I synnerhet de som arbetar inom grundforskningen uppmanas söka understöd hos Finlands Akademi. Organisatoriskt är den biomedicinska idrottsforskningen uppdelad på alltför många enheter, av vilka flera är alltför små för att nå upp till den kritiska massa som behövs. Arbetsgruppen rekommenderar att de idrottsmedicinska enheterna utvärderas separat. Denna utvärdering har endast gällt den vetenskapliga forskning som bedrivs i enheterna och arbetsgruppen tar inte ställning till de övriga delområdena i verksamheten. Ur forskningens synvinkel skulle det vara bättre om det fanns färre men starkare enheter med tillräcklig kritisk massa för att de med framgång skall kunna bedriva vetenskaplig forskning på hög nivå och upprätthålla stabila forskningsförhållanden. Nyckelord Biomedicinsk forskning, utvärdering Seriens namn och nummer Undervisningsministeriets arbetsgruppspromemorior 2003:3 ISSN 1458-8102 ISBN 952-442-177-1 Sidoantal 84 språk Engelska Pris Sekretessgrad Offentlig Distribution Universitetstrycket Förlag Undervisningsministeriet DESCRIPTION Publisher Ministry of education Date of publication 7.2.2003 Type of publication Committee report Contracted by Ministry of Education Authors (If a committee: name of organ, chair, secretary) Team for the evaluation of sports and exercise medicine and biology research in Finland Chair: Hilkka Riihimäki Secretary: Ulla Silventoinen Committee appointed on 4.9.2000 Dno 20/043/2000 Name of publication Report of the evaluation of sports and exercise medicine and biology research in Finland Abstract Scientific quality In general, the scientific quality of research was evaluated as very high in many areas of biomedical and biological sports research, and it was judged to comply well with the international standard in the field. • In epidemiology, the strengths were well-conducted cohort studies with long follow-up times, carefully planned and conducted intervention studies (including demanding randomized controlled trials), and efficient use of national register data. Collaboration with scientists in basic research needs to be continually strengthened. • In rehabilitation research, the strengths were found to be well-conducted studies that were focused on the treatment of musculoskeletal injuries associated with activity in children, middle-aged subjects and the elderly • The scientific quality of research that has focused on biomechanics was found to be excellent and a welcome complement to outstanding clinical research programs. Research in this area was found to be highly relevant to athletes, active individuals and the elderly. • In exercise physiology in general, the scientific quality of research was considered to be good compared to international standards. Exercise physiology has much to offer for purposes of clinical treatment and rehabilitation. • The quality and quantity of basic research was, in general, considered to be only rather good. This is a new field of research in sports medicine, and in this light it is understandable that, for the most part, research groups have no long-term basic research tradition. • The number of peer-reviewed papers published in high-impact journals reflects the generally good international standard of Finnish research. Some of the units had published their work in low-impact journals that were incompatible with the high scientific quality. All research groups are encouraged to keep their ambition level in publishing as high as possible. • The number of citations for the published papers reflects the impact of studies within the scientific community. The mean number of citations was 6.9; and for the highest-ranking research unit this mean was 15.8. Based on these figures, the impact was considered good. National and international collaboration National networking seemed to function well and was found to involve many universities and research institutes. The research groups have wide international contacts that in some cases have resulted in productive joint research projects and publications. Only a few groups have received funding from the EU or other foreign sources. International collaboration should be enhanced and include collaboration with European research groups. This could facilitate obtaining research funding from the EU. The quantity and quality of researcher training The quantity of researcher training was considered good. The review found that most students completed their doctoral training at a relatively young age. It was noted that it was not always easy to recruit graduate students. Another current problem is the shortage of posts for post-doctoral researchers. The quality of researcher training varied substantially from one unit to another, the general tendency being that big units performed better than smaller ones. It is recommended that graduate students be registered in an appropriate graduate school. Additional observations Short-term, one-year funding cycles create an insecure research environment, and make the long-term planning of future research programs difficult. They also influence security of employment for young researchers, and make the choice of research as a career less attractive. The same is true for the practice of awarding personal grants without paying any social security contributions. Many of the research groups seem to be very dependent on funding from the MoE. In general, the research units/groups are encouraged to actively apply for funds also from other sources besides the MoE and the scientist in the basic research from the Academy of Finland, in particularly. Organizationally, sports and exercise research is split into too many units, many of which were considered to be too small to reach the desired critical mass. A separate overall evaluation of sports medicine centers is recommended - the evaluation group could not take into account any functions of the centers other than research. From the research point of view, it would be better to have fewer but stronger units with sufficient critical mass to successfully conduct high quality research programs and ensure sustainability. Other information Name and number of series Ministry of Education committee reports 2003:3 ISSN 1458-8102 ISBN 952-442-177-1 Number of pages Language English Price Degree of confidentiality Public Distributed by Helsinki University Press Published by Ministry of Education 84 Contents 1. Introduction 1 2. Evaluation 1 2.1. Evaluation Criteria 1 2.2. Evaluation group 2 2.3. The evaluation process 3 3. Research in sports sciences in Finland 5 4. Administration and financing of sports sciences 6 5. Summary information of own reports 11 5.1. Human resources 11 5.2. Funding 12 5.3. Reported role of funding by the Ministry of Education (MoE) 12 5.4. Researcher training 13 5.5. Publications 14 5.6. Collaboration 16 5.7. SWOT -analysis 17 6. Evaluation of sport and exercise medicine and biology research in Finland 18 6.1. General evaluation of sport and exercise medicine and biology research 18 6.2. Discipline-specific evaluations 23 6.2.1. Epidemiological research of the relationship between physical activity, fitness and health 23 6.2.2. Biomechanics, rehabilitation, traumatology 25 6.2.3. Exercise physiology 31 6.2.4. Molecular biology/basic science 34 6.3. Evaluation of research groups/units 36 6.3.1. UKK Institute 36 6.3.2. Department of Health Sciences (DHS), University of Jyväskylä 40 6.3.3. Department of Biology of Physical Activity (DBPA), University of Jyväskylä 44 6.3.4. LIKES Research Center for Sport and Health Sciences 48 6.3.5. Unit for Sports and Exercise Medicine, Helsinki, (USEM) The Finnish Foundation of Sports Medicine 52 6.3.6. Tampere Research Center of Sports Medicine, TRCSM 55 6.3.7. Foundation for Research in Health Exercise and Nutrition, Kuopio Research Institute of Exercise Medicine (KRIEM) 58 6.3.8. Paavo Nurmi Center (PNC) 61 6.3.9. Oulu Deaconess Institute, Department of Sports Medicine (DSM) 64 6.3.10. Research Institute for Olympic Sports (RIOS) 66 6.3.11. Research group on Articular Cartilage and Chondrocytes in Normal and Ostearthritic Joints. Prof. Heikki Helminen, Department of Anatomy, University of Kuopio 71 6.3.12. Orthopedic Sports Medicine research group of Markku Järvinen, University of Tampere 74 Appendix 1-3 1 1. Introduction The Ministry of Education's Department for Cultural and Sports and Youth Policy allocate funds to research projects in sports sciences and research institutes from pools and lottery funds. The funding, planning and development of sports sciences proceeds according to 5- year plans made and carried out by the Ministries' expert committee, the Sports Science Subcommittee. In the most recent plan, the subcommittee recommended a general evaluation of sports research. An overall evaluation was last carried out during 1989-90. It was decided that the next evaluation would be done in two parts: first behavioral research and then biomedical research. An evaluation of behavioral research in the field of sports was carried out during 1998-99. The task of this committee was to evaluate Finnish research in sports biology and sports medicine. The evaluation covered sports related research in physiology, biomechanics, health sciences and medicine, including traumatology, epidemiology and experimental research. The Sports Science Subcommittee prepared the evaluation process and recruited the evaluation group. The Ministry of Education officially appointed the evaluation group proposed by the subcommittee in September 2000. 2. Evaluation The evaluation concerned all the research institutes, research groups and individual researchers that had received state subsidy for research in the field of sports biology and sports medicine during the period under review (Appendix 1). In this context, research in the field of sports biology and sports medicine meant research primarily focusing on the impact of sport on health and on functional capacity. The evaluation was expected to establish the current status of research in the field of sports biology and sports medicine and review its plans for the future. The specific goals were described in the decision of the Ministry of Education on the appointment of the evaluation group as follows: The evaluation group will evaluate: 1) Scientific quality of research by selected research teams and their productivity 2) Standard of Finnish biomedical sports research compared to international research. 3) National and international contacts between researchers in the field 4) Quantity and quality of research training in the field. In addition, the evaluation group will put forward proposals for the development of the discipline. 2.1. Evaluation Criteria The evaluation group set the following evaluation criteria. 1) Scientific quality While evaluating the scientific quality of research, the evaluation group considered quality in reference to international research (ranking of journals, citation analysis, panelists’ judgment), originality, profoundness, extensiveness, timeliness, significance and multi/interdisciplinarity. 2 The following scale was used to evaluate scientific quality: • Excellent • Very good • Good • Fair • Poor 2) Relevance to the needs of sports culture and society 3) Productivity An attempt was made to obtain comparable data on productivity from different groups/units. It turned out to be difficult to get reliable estimates of person years allocated to relevant research for evaluation purposes, and the evaluation scale was limited to: • Acceptable • Unacceptable 4) National and international collaboration While evaluating national and international collaboration, the evaluation group considered joint publications with national and international collaborators, individually reported collaboration and network analysis for the groups/units. 5) Quantity and quality of researcher training A) Quantity To rate research productivity, the evaluation group considered the number of licentiate and doctoral examinations, age at the time, and the number of post-doctoral researchers in training B) Quality To rate research productivity, the evaluation group considered individual reports about organizing researcher training, and interviewed graduate students/young doctors. The scale used to rate the quantity and quality of researcher training was the same as that used for scientific quality in 1) above. 2.2. Evaluation group Chair: Professor Hilkka Riihimäki Current position(s): Director of Department of Epidemiology and Biostatistics, Finnish Institute of Occupational Health, Helsinki, Finland. Docent (Public Health, especially epidemiology), Department of Public Health, University of Helsinki, Helsinki, Finland. Education: MD, DMedSc, MSc Main field(s) of scientific expertise: Epidemiology of musculoskeletal disorders and work- related diseases 3 Members: Professor Leena Ala-Kokko Current position(s): Professor of Medicine, Center for Gene Therapy, Tulane University, New Orleans, LA, USA Education: MD, DMedSc, Docent (Department of Medical Biochemisty, University of Oulu, Oulu, Finland) Main field(s) of scientific expertise: Molecular biology of extracellular matrix proteins and Genetics of musculoskeletal diseases. Professor Bruce Beynnon Current position(s): Professor of Orthopaedics and Rehabilitation and Director of Research Education: BS, MS and PhD Biomechanical Engineering Main field(s) of scientific expertise: Soft tissue biology and joint biomechanics. This includes shoulder, knee and ankle joint biomechanics, cartilage biomechanics, total hip and knee replacement biomechanics, clinical research focused on knee ligament reconstruction and rehabilitation, and clinical studies of knee and ankle injury risk factors. Docent Juhani Smolander Current position(s): Senior Research Fellow, ORTON Research Institute, Foundation For The Disabled, Helsinki; Finland, Docent (Department of Physiology, University of Kuopio, Finland) Education: PhD Main field(s) of scientific expertise: Applied physiology involving exercise, environmental and work physiology. Professor Bengt Saltin Current position(s): Director of the Copenhagen Muscle Research Centre, Docent in exercise physiology, KI, Stockholm, Education: MD, PhD Main field(s) of scientific expertise: Exercise physiology, using unique human experimental models to elucidate roles of heart and skeletal muscle in limiting the human maximal aerobic power and to what extent phenotype expression is modulated by physical activity and training. Secretary: Planning officer Ulla Silventoinen Ministry of Education, National Sports Council, Sports Science Subcommittee, Finland 2.3. The evaluation process Data collection At the start of March 2001 a questionnaire was sent to the research groups/units asking them to report their research activities during the years 1995-2000. The groups/units were asked to report their resources and to evaluate the role of Ministry of Education funding. The groups/units also reported their postgraduate and doctoral training, national and international collaboration and main areas of research, the main results in these areas and 4 articles published during the years 1995-2000. They also made a SWOT analysis concerning the work of the whole group. The groups/units were also asked to briefly describe future plans. Agreement on the evaluation process and criteria The evaluation group held a meeting in Helsinki on Monday, June 4th, 2001. At this meeting, it discussed the evaluation goals set by the Ministry of Education, agreed on the process and criteria, and finalized the program of site visits. Site-visits The evaluation group made site visits during the first week of June 2001. The directors of the research groups/units and responsible researchers in the main fields of research were asked to be present during these visits. At the start, the chairperson of the evaluation group introduced the process; the members of the group, and the evaluation goals and criteria . Representatives of each group/unit presented the work done by them, their personnel, research facilities and future plans etc. Questions and discussion followed the presentations. The chairperson summarized the visit and explained how the evaluation process would continue. The evaluation group toured the premises of the research group/unit. It also discussed individually with one or two postgraduate students in every group/unit. Preparation of the evaluation report The first drafts of evaluations were discussed and written each evening after the site visits . Afterwards, the chairperson and secretary edited a draft of the evaluation as a whole. The members of the evaluation group commented on the draft via email. After several drafts, the final evaluation report was completed at the end of December, 2003. During the writing process, Professor Saltin withdrew and Docent Smolander took his place in the evaluation group. Feedback seminar The evaluation group is going to organize a feedback seminar for the research groups/units, the aim of which is to present the results to the groups/units and give them a chance to comment on them and the evaluation process as a whole. 5 3. Research in sports sciences in Finland Up to the 1950s, research into sports sciences in Finland was fairly sporadic and mainly depended on the interest shown by representatives of other disciplines. The Finnish Society for Research into Sports and Physical Education was established as early as 1933 and the Finnish Society of Sports Medicine in 1939. More systematic research into sports sciences has been carried out since the 1950s. The Faculty of Sports Sciences was established at the University of Jyväskylä in 1968 as the unit responsible for research and higher education in sports science. At the moment, sports researchers work in universities, research institutes and as independent researchers. Higher education in sports sciences is given at the Faculty of Sport and Health Sciences of the University of Jyväskylä. The Faculty is still the only university level institute in this field in Finland. Along with education, the Faculty, due to its unique status, is chiefly responsible for research into sports sciences in Finland. It also has a significant role in developing research in the field of health sciences. The Faculty's research activities take place in its four departments: the Department of Biology of Physical Activity, the Department of Physical Education, the Department of Social Sciences of Sport, and the Department of Health Sciences. Both basic and applied research directed toward practical professional fields are carried out in cooperation with various research bodies. The Faculty's permanent teaching and research staff consists of approximately 70 employees, including 19 professors. When taking into account part-time lecturers and teachers, research support and administrative personnel, the workforce of the Faculty totals over 100 employees. The number of students enrolled in the Faculty is approximately 1,000. In addition to the Jyväskylä faculty, there are three multidisciplinary research institutes in the field: The Research Center for Sport and Health Sciences (LIKES, 1970) in Jyväskylä seeks to promote sports and public health, and research into these sectors. The UKK Institute for Health Promotion Research in Tampere (1980) works in the social and health services sector to promote healthy lifestyles, especially physical exercise, by means of research, education and information. The Research Institute for Olympic Sports (KIHU, 1989) in Jyväskylä carries out multidisciplinary research in support of competitive and top-level sports and provides relevant services. Some sports research is also conducted by the National Public Health Institute, the Finnish Institute of Occupational Health, and the R&D department of the Social Insurance Institution (reorganized in 2001), as well as in different universities. In the field of sports medicine, there are six research centers: 1) In the Turku Faculty of Medicine, sports medicine research was started as early as 1956. Since 1987 the sports medicine center has operated under the name of Paavo Nurmi Center (PNC). 2) The Unit for Sports and Excercise Medicine, Helsinki (USEM) began to operate in 1965. It has been attached to the Finnish Foundation of Sports Medicine since 1973. 3) The Research Center for Sport and Health Sciences (LIKES) in Jyväskylä also has a unit for sports medicine. 6 4) The Department of Sports Medicine (DMS) was established at the Oulu Deaconess Institute in 1972. 5) The Kuopio Research Institute for Exercise Medicine (KRIEM) was founded in 1976. Since 1991, it has operated under the auspices of the Foundation for Research in Health Exercise and Nutrition. 6) The Tampere Research Center of Sports Medicine (TRCSM) started at the Varala Sports Institute but has been an administratively independent department of the UKK Institute since 1984. The missions of the sports medicine centers are threefold. First of all, they provide education and information. Their educational mission is very important because they are responsible for specialist training in sports medicine. Secondly, the centers carry out research. Medical and testing services constitute the third main task, and in this they have a regional role. All these sports medicine centers are fairly small in size, which restricts the scope of their research. The centers pay special attention to strengthening their research activities by deepening their cooperation and creating links to basic research in the field. The Association for the Promotion of Sports Medicine and Physiological Testing (LIITE, 1990) has an overall responsibility for coordinating and developing sports medicine in Finland. 4. Administration and financing of sports sciences Administration Research into sports sciences is primarily administered by the Ministry of Education. Public funding mainly comes from three sources: the Ministry's Department for Education and Science Policy, its Department for Cultural Policy and Sports and Youth Divisions, and the Academy of Finland (Table 1) Table 1. The public funding of sports sciences in Finland Organization Ministry of Education: Department for Education and Science Policy Ministry of Education: Department for Cultural, Sport and Youth Policy Academy of Finland Source State budget Pools and lottery proceeds State budget / Pools and lottery proceeds Target University core funding (e.g. Jyväskylä Faculty of Sport and Health Sciences) Graduate schools Research projects Research centers (sports medicine) centers) Research projects Research programs Posts for researchers Centers of Excellence 7 The Department for Education and Science Policy is responsible for university core funding, part of which is allocated to basic research. These funds come from the State budget. This is how the Jyväskylä Faculty of Sport and Health Sciences get its basic funding. The Academy of Finland is an expert organization for research funding. The Academy that is subordinate to the Ministry of Education, is financed through the State budget and concludes an agreement on target outcome and relevant resources with the Ministry. The Academy promotes high-quality research by granting long-term funding based on scientific merits, providing science policy expertise and strengthening the status of science, scholarship and research. The Academy of Finland finances all disciplines and primarily allocates funds for high-quality basic research. At the Academy, sports sciences come under the Research Council for Health. The Academy finances sports research projects every year. In addition, there are sports scientists at graduate schools financed by the Ministry of Education. The Ministry of Education's Department for Cultural, Sport and Youth Policy allocate funds from pools and lottery funds to research projects in sports sciences and research institutes. The administration of this funding differs from other science administration in the Ministry of Education sector. The expert body corresponding to the Academy is the Sports Science Subcommittee of the National Sports Council appointed by the Ministry of Education for a single parliamentary term. The Ministry of Education allocates funds for the following purposes: • Researcher and other staff salaries and fees • Purchase of research instruments and equipment • Lease of the necessary premises • Travel in Finland and abroad and travel to international conferences relating to research • Other expenses qualifying for government aid • Research programs. The Sports Science Subcommittee is responsible for supporting, coordinating and developing applied sports science research, sectoral research in the field, sports medicine research and for disseminating sports science information. This long-standing practice in research funding was reconfirmed in the Sports Act (and the relevant Decree) of 1999. According to the Decree, the Sports Science Subcommittee of the National Sports Council submits a proposal to the Ministry of Education concerning the allocation of lottery funds to sports research and information and to sports medicine. The final decision is made by the Minister. A question raised from time to time in discussions on sports sciences is whether or not administration and financing should be transferred to the Academy of Finland. Since sports science research is applied and relatively narrow in scope, this would involve the risk of not getting sufficient funding from the Academy. On the other hand, close contacts with the Academy and with its funding and quality criteria would guarantee the same high level as in other sciences. 8 Financing General research financing In Finland, research and development (R&D) financing has been growing very rapidly in recent years. In 1999 it represented 3.1% of GDP. Public funding grew by nearly 45% from 1995 to 2001 (from FIM 5.5 billion to 8.0 billion), and the Academy of Finland's financing more than doubled over this period from FIM 493 million to FIM 1099 million. All in all, the government allocated a total of FIM 8.025 billion to R&D in 2001. The distribution of these funds is given in Figure 1. 26 % 14 % 30 % 16 % 4 % 10 % Institutions of higher education Academy of Finland National Technology Agency Government research institutes University hospitals Other R&D funding Figure 1. Distribution of government research funding in 2001. The Department for Education and Science Policy allocated some FIM 2,080 million in core funding to the universities. This mainly covered the cost of the basic structures (premises, salaries etc.) and tuition. The Academy of Finland financed research carried out in universities and research institutes with over FIM 1 billion (€180 million) in 2001. Most of these funds were allocated to high- quality research projects and to centers of excellence in research. The projects financed by the Academy amount to some 3, 000 researcher years. The Ministry of Education's Department for Cultural, Sport and Youth Policy granted FIM 22 million to sports science research in 2001. In Figure 1, this funding is included in Other R&D funding. Sports research funding The growth in sports science research has not equaled that in R&D overall. The real value change in government funding to sports research shows a 6.8% fall from 1991 to 2000 (Table 2). 9 Table 2. Government funding to sports research during the years 1991-2000. 0 1 000 2 000 3 000 4 000 5 000 6 000 7 000 8 000 9 000 10 000 19 88 19 89 19 90 19 91 19 92 19 93 19 94 19 95 19 96 19 97 19 98 19 99 20 00 2 0 01 1 00 0 FI M research proj. total research institutes RIOS travelling grants instruments etc Figure 2. Distribution of government funding of research in sports sciences 1988-01. Most government funding, FIM 13 million, is allocated to research institutes (Figure 2). The sports medicine centers and the Research Institute for Olympic Sports RIOS together receive some 80% of this funding. Research projects receive around FIM 8 million. Some funding is also allocated to travelling grants and research instruments, etc. Year Government funding Index Real value Real value change 1991 19 000 000 93,0 21 880 645 1992 20 000 000 95,5 22 429 319 2,5 % 1993 19 500 000 97,3 21 464 029 -4,3 % 1994 17 923 000 98,5 19 487 851 -9,2 % 1995 19 150 000 100,0 20 509 650 5,2 % 1996 18 300 000 101,9 19 233 857 -6,2 % 1997 19 300 000 102,9 20 087 755 4,4 % 1998 20 300 000 105,2 20 666 635 2,9 % 1999 20 300 000 107,1 20 300 000 -1,8 % 2000 20 400 000 107,1 20 400 000 0,5 % 90-00 -6,8 % 10 0% 20% 40% 60% 80% 100% 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2 001 Behav. and social sci. Medical sci. Figure 3. Distribution of government funding of sports science research projects 1988-99 About 60% of research project funding has been allotted to sports medicine and the biology of physical activity (Figure 3). During the period 1995- 2000, the average sum per research project was around FIM 150,000. Research projects mainly receive grants. During the period under review, 70-90% of the sports medicine and biology of physical activity research grants were awarded to researchers with degrees in either medicine or health science and an average of 25% to sports scientists. The sports medicine centers receive yearly government funding of about FIM 1 million each. This covers some 75% of their overall expenditure. The distribution of government funding to sports medicine centers is given in Figure 4. 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 1993 1994 1995 1996 1997 1998 1999 2000 2001 Helsinki Kuopio Tampere Turku Oulu Jyväskylä Figure 4. Government funding of sports medicine centers 1993-2001 11 5. Summary information of own reports The research groups/units were asked to report their research activities during 1995-2000 by completing a questionnaire. The evaluation group got an extensive amount of information from each unit/group. A brief summary of the reports is presented here. 5.1. Human resources The human resources of the research groups/units vary considerably. The biggest units employ from 50 to 75 persons and the smallest 5 to 10 persons. Table 3 shows the total number of staff in different units. Table 3. Number of full time staff in research units and groups. Unit Number of staff UKK Institute 53 Department of Health Sciences, University of Jyväskylä, DHS 75 Department of Biology of Physical Activity, University of Jyväskylä, DBPA 33 LIKES, Research Center 15 Unit for Sports and Exercise Medicine, Helsinki, USEM 10 Tampere Research Center of Sports Medicine, TRCSM 5 Kuopio Research Institute of Exercise Medicine, KRIEM 17 Paavo Nurmi Center, PNC 10 Oulu Deaconess Institute, Department of Sports Medicine, DSM 9 Research Institute for Olympic Sports, RIOS 22 Helminen et al. 16 Järvinen et al. 17 Kalimo et al. 8 Research groups/units were asked to estimate the person years used to research work during the years 1995-2000 in the context of this evaluation. It turned out to be very difficult to make these estimates and the numbers shown in Table 4 are not fully commensurable. Table 4. Estimates of person years used for research in sports biology and medicine 1995- 2000. Unit Person years UKK Institute 154.0 Department of Health Sciences, University of Jyväskylä, DHS 91.8 Department of Biology of Physical Activity, University of Jyväskylä, DBPA 22.5 LIKES, Research Center 29.9 Unit for Sports and Exercise Medicine, Helsinki, USEM 10.0 Tampere Research Center of Sports Medicine, TRCSM 12.6 Kuopio Research Institute of Exercise Medicine, KRIEM 13.6 Paavo Nurmi Center, PNC ? Oulu Deaconess Institute, Department of Sports Medicine, DSM 11.4 Research Institute for Olympic Sports, RIOS 40.0 Helminen et al. 18.0 Järvinen et al. 22.5 Kalimo et al. ? 12 5.2. Funding Figure 5 shows the main sources of funding of the groups/units. The UKK Institute's strong basic funding from Finland's Slot Machine Association increases the ratio of the research institute's own funding to 45 % of total funding. If the UKK Institute is excluded, the share of units' own funding is only 21 %. 45,38 9,27 2,38 2,35 0,85 13,54 3,14 23,08 0 5 10 15 20 25 30 35 40 45 50 University/ research Institute Ministry of Education, research projects Ministry of Education, institution Academy of Finland Foundations Industry EU Others % Figure 5. Sources of funding of research groups/units (%) The role of the Ministry of Education's funding seems to be most important to the sports medicine centers and RIOS, being 56 % and 75 % of total funding respectively. The sports medicine centers get also a considerable amount of funding from the cities where they are located. Funding from the Academy of Finland accounts for 21 % of total research funding of departments at the University of Jyväskylä. The role of the Academy's funding seems to be quite modest for the other units. On the average less than one percent comes from this source. Co-operation with industry is just starting. Department of Health Sciences, RIOS and the UKK Institute seem to have the best relations to industrial companies. The amount of funding from the companies is still modest. The research units have not been able get funding from the European Union, except the UKK Institute. The more detailed figures of funding are shown in Appendix 2. 5.3. Reported role of funding by the Ministry of Education (MoE) The small research groups report that the role of funding by the Ministry of Education has been crucial. To some of these groups this has been practically the only source of funding and it has given an opportunity to researchers to concentrate full-time on research work. 13 Sports medicine centers get both institutional funding and research project funding from the Ministry. The role of institutional funding seems to be crucial for the existence as well as the scientific work of these Centers. It is a cornerstone for the operations and it ensures continuity. Contributions to the specialization program of sports physicians would not be possible without funding from the Ministry of Education. The research projects rely on it to a very great extent. This funding makes many self-initated and co-operative projects possible and it was said to have a positive impact on other sources of funding. For the University departments and the UKK Institute, the share of funding from the Ministry of Education in absolute terms is rather modest and it varies significantly between the research groups/units. Still, other sources of funding could not replace the support for doctoral studies received from the Ministry of Education. Institutional and project funding from the Ministry of Education constitutes the main source of funding for research at the Research Institute for Olympic Sports. 5.4. Researcher training The total number of licentiate examinations during years 1995-2000 was two and doctoral examinations 50. Of these examinations 19 were completed by female and 31 by male students. The yearly numbers of dissertations is shown in figure 6. 0 2 4 6 8 10 12 14 1995 1996 1997 1998 1999 2000 Female Male Figure 6. Number of doctoral theses 1995-2000 The average age at the time of earning a doctorate was 32 years (range 25 to 54 years) and there was no significant difference between male and female students. 14 0 1 2 3 4 5 6 7 8 9 10 UKK -in st. Dep HSci Dep BPA LIK ES Hels inki, USEM Tam pe re, TRCSM Kuo pio , K RIEM Turk u, PNC Oulu , D SM RIO S Helm ine n et al . Jä rvi ne n e t a l. Kali mo e t a l. Female Male Figure 7. Number of doctoral examinations in research units/groups 1995-2000. 5.5. Publications The number of publications is highly dependent on the resources of the research unit and the nature of the research. The highest number of international peer-reviewed publications during this five-year period was produced in one of the largest research units, the UKK Institute. The productivity rate of the sports medicine centers varied from 27 to 88 publications during years 1995-2000. RIOS seems to be at the same level as the average productivity rate of sports medicine centers. 0 20 40 60 80 100 120 140 160 180 200 UKK-in st. Univ.o f J KL,DHS Univ.o f J KL,DBPA LIK ES Helsin ki, USEM Tam pe re TRCSM Kuo pio , K RIEM Turk u, PNC Oulu DSM RIO S, J yvä sky lä Helmine n e t a l. Jä rvin en et al. Kalim o e t a l. To ta l n um be r o f p ub lic at ion s Figure 8. Number of international peer-reviewed publications 1995-2000. 15 0% 5% 10% 15% 20% 25% 30% 35% UKK-inst. Univ.of JKL,DHS Univ.of JKL,DBPA LIKES Helsinki, USEM Tampere TRCSM Kuopio, KRIEM Turku, PNC Oulu DSM RIOS, Jyväskylä Helminen et al. Järvinen et al. Kalimo et al. Figure 9. Percentage of high impact publications. Articles published in general journals with an impact factor over 5, or in the 10 highest impact factor sports science journals. It is well understood that it is difficult to compare different fields of research using impact factors. Yet this classification takes into account high quality sports science and general science aspects. The percentage of high impact publications along with the average impact factor of the publications express the quality of the publications and partly the ambition level of the groups. The average percentage of high impact publications was 21.7. The highest percentages were found at the Kuopio Research Institute for Exercise Medicine, Tampere Research Center for Sports Medicine and the Kalimo research group. 0,0 0,5 1,0 1,5 2,0 2,5 3,0 3,5 4,0 UKK-inst. Univ.of JKL,DHS Univ.of JKL,DBPA LIKES Helsinki, USEM Tampere TRCSM Kuopio, KRIEM Turku, PNC Oulu DSM RIOS, Jyväskylä Helminen et al. Järvinen et al. Kalimo et al. Figure 10. Average impact factors of the publications. 16 The average impact factor of all publications of the units/groups was 2.2. The impact factors of the publications varied from 0.023 to 28.857. The Tampere Research Center for Sports Medicine, the UKK Institute, the Kuopio Research Institute of Exercise Medicine and the Kalimo and Järvinen groups had highest mean impact factors. The research groups were asked to name the 5 most important publications in the main fields of their research work. Their sets of articles may not have been their most cited ones, but probably the most relevant ones in view of this evaluation. A citation analysis of these articles was made. This analysis showed that a high impact factor does not necessarily guarantee a high citation rate. The results of the citation analysis and the impact factors are shown in Table 5. Table 5. Results of citation analysis and impact factors of the 5 most important articles listed by groups/units. Unit / group Citations Impact factor Total Averag e of all Sum of 5 best Average of 5 best Total Averag e of all Sum of 5 best Average of 5 best UKK Institute 575 11.5 283 56.6 181.125 3.623 39.953 7.991 Univ. of Jyväskylä, DHS 155 7.05 108 21.6 52.848 2.402 28.773 5.755 Univ. of Jyväskylä, DBPA 95 3.8 61 12.2 36.131 1.455 12.025 2.405 Jyväskylä, LIKES 66 4.13 49 9.8 30.291 1.893 19.531 3.906 Helsinki, USEM 120 10.91 105 21 54.952 4.996 45.144 9.029 Tampere, TRCSM 160 8.89 117 23.4 37.493 2.083 19.053 3.81 Kuopio, KRIEM 51 10.2 51 10.2 24.954 4.991 24.954 4.991 Turku, PNC 40 3.64 36 7.2 27.927 2.539 18.829 3.77 Oulu, ODI 15 5 15 5 9.986 3.329 9.986 3.329 Jyväskylä, RIOS 90 2.5 44 8.8 62.502 1.736 24.585 4.917 Helminen group 38 4.75 35 7 8.813 1.102 7.183 1.437 Järvinen group 74 5.29 48 9.6 78.112 5.579 54.765 10.953 Kalimo group 62 12.4 62 12.4 22.64 4.528 22.64 4.528 5.6. Collaboration The research groups and units were asked to report the national and international collaboration of the research unit/group as a whole. They gave a list of major collaborators and joint activities (e.g. joint research programs, exchange of researchers, joint publications, etc.). The information obtained might not be comprehensive, but it is indicative of the extent of collaboration. Along with the UKK Institute, the Department of Biology of Physical Activity and the Department of Health Sciences enjoy the widest collaboration both nationally and internationally. As can be expected, LIKES actively collaborates on a national scale with universities and research units. It turned out that almost all the units collaborate with the University of Turku. Besides universities and hospitals, the key collaborator was the National Public Health Institute, Helsinki. The network analysis of the groups/units is shown in Appendix 3. 17 5.7. SWOT -analysis The research units and groups were asked to make a SWOT analysis concerning the work of the whole unit /group. The most important and most often mentioned strengths, weaknesses, threats and opportunities of the research units and groups were as follows: Strengths • Long research tradition • Excellent national and international collaboration • Multidisciplinarity of the research unit/group • Competence and education of personnel • Public and governmental interest in the area. Unlike the other units, the UKK Institute views its basic funding as being stable and thus as a strength. This may be because the UKK Institute gets it's basic funding from a different source than the other units, The Finnish Slot Machine Association. The RIOS concentrates quite strongly on research of top sports and thus sees support from the National Olympic Committee to be one of its strengths. Weaknesses • Insufficient resources: - funding, needs to be applied for annually - staff - facilities - equipment • Problems related to small size: - lack of critical mass - vulnerability The Department of Health Sciences at the University of Jyväskylä (DHS) also mentions the inability to create joint research plans at the department / faculty level as one of their most important weakness. The potential for benefits from synergy are not fully used. The DHS also mentioned that it finds it hard to recruit young doctoral students (due to the background of the students Master's programs). Opportunities • New funding opportunities: - Graduate Schools, EU funds, industry • Expansion of collaboration both nationally and internationally. • Easy recruitment of young PhD students • Physical exercise is perceived as an essential factor in health promotion Threats • Uncertainty of the continuation of funding • Brain drain due to lack of senior researcher positions • Insufficient collaboration with basic research 18 6. Evaluation of sports and exercise medicine and biology research in Finland 6.1. General evaluation of sports and exercise medicine and biology research Confining research activities to what is relevant to the context of this evaluation was not always a straightforward matter. This was due to the fact that many groups were organized on an interisciplinary basis. Also, the principal focus in many projects was not on the effects of physical exercise or sports. Networking between different units was recognized as important, but this also made it difficult to allocate the research projects to the respective units. At times, these matters rendered the evaluation of the research units or groups, particularly rating their productivity, difficult. The evaluation group tried to base its evaluation on projects for which the groups/units were primary responsible. Scientific quality of research and productivity In general, the scientific quality of research was evaluated as very high in many areas of biomedical and biological sports research, and it was judged to comply well with the international standard in the field. In epidemiology, the strengths were well-conducted cohort studies with long follow-up times, carefully planned and conducted intervention studies (including demanding randomized controlled trials), and efficient use of national register data. Epidemiological research has provided nationally and internationally recognized important findings on the relationships between sports and exercise and health. This most demanding research must be done within dependable research institutes with experienced research staff and a well-functioning infrastructure. The strongest units have excellent epidemiological research programs. These include the UKK Institute, the Department of Health Sciences of the University of Jyväskylä, and the Kuopio Research Institute of Exercise Medicine. The review also revealed that very good epidemiological research was done in other units that participated as collaborators in studies administered by a university department or research institute. These collaborations were considered to be an efficient way to obtain information about the health effect of sports and exercise. It is not advisable for small research units to take an independent role in conducting extensive epidemiological studies. The conduct of epidemiological studies often requires multidisciplinary researcher groups. Collaboration with scientists in basic research needs to be continually strengthened. This was evident, for instance, for the groups involved in genetic epidemiology. Development of methods is important for future research, specifically with regard to the assessment of physical activity, sports activity, health-related physical fitness, and functional performance capacity. The review found that much is known in qualitative terms about the associations between physical activity and health outcomes, and progress has been made in studies that have focused on dose-response relationships. Also, controlled interventions have either been completed or are under way. A future challenge is posed by community level interventions. They should be planned so that the impact can be evaluated in a scientifically valid way. In addition, the evaluation group recognized that future research efforts should focus on understanding the relationship between a combination of physical activity and diet, and how they affect health outcomes. In rehabilitation research, the strengths were found to be well-conducted studies that were focused on the treatment of musculoskeletal injuries associated with activity in children, middle-aged subjects and the elderly. Not only has rehabilitation research focused on what are commonly assumed to be the sports injuries of young athletes alone, but also on those of older 19 individuals. This is very important because rehabilitation research serves the needs of all of society, and has had a key impact on the entire population. From this perspective, the research was considered to be broad enough in scope while remaining of a high scientific quality. This comprehensive approach is outstanding – it includes all those at risk for injury in society, it has led to important advances that have been recognized on national and international fronts, and was considered to be a very good use of MoE funds. This approach should continue to be encouraged. The evaluation group also found that rehabilitation research was comprehensive from the perspective that both soft and hard tissue injuries have been studied. This should be pursued further. In biomechanics, the strengths were found to be the high scientific quality of the work, the welcome complement it provided to rehabilitation research programs, and the direct linking of the research findings to the clinical environment. Sports trauma research, although somewhat smaller in scope, was also found to be of a high scientific quality, and focused on the most common injuries associated with sports. In general, the scientific quality of research into exercise physiology was considered to be good compared to international standards. To a large extent, research was descriptive and, in future, a mechanistic approach (for example, one that focuses on specific disease mechanisms) could open the way to higher quality research with a significant impact. This would mean deepening the methodology and establishing successful collaboration with researchers who are at the cutting edge of currently evolving methods. It could be beneficial to shift the priority from health effects to the effects on pathological processes. Exercise physiology has much to offer for purposes of clinical treatment and rehabilitation. Broader basic knowledge of physiology is needed for the assessment of functional capacity, which should not be restricted to measuring only muscle strength, body fat content and oxygen intake capacity. The quality and quantity of basic research was, in general, considered to be only rather good. This is a new field of research in sports medicine, and in this light it is understandable that, for the most part, research groups have no long-term basic research tradition. The facilities are not adequately equipped for basic research, and the scientists in these groups are not sufficiently well trained to do basic research. In most instances, however, the groups have established excellent collaboration to overcome these limitations. Because basic science is a growing sector in sports medicine, more attention should be focused on recruiting basic scientists, training students, and obtaining reasonable funding for this type of research. Many groups in basic research are almost totally dependent on funding from the Ministry of Education (which means that they do not apply for funding from the other sources). Funding from the Ministry is rather limited. Instead of splitting the funding, the Ministry should direct it towards groups with a good record and that have high potential. This would mean reducing the number of research units/groups. In general, a good proportion (22 %) of all international peer-reviewed papers were published in high-impact journals (the 10 highest-impact-factor journals in sports science or general journals with an impact factor ≥ 5). For the highest-ranking units, the proportion exceeded 30 %. This reflects the generally good international standard of Finnish research. Some of the units had published their work in low-impact journals that were incompatible with the high scientific quality of their work, as judged by the evaluation group. All research groups are encouraged to keep their ambition level as high as possible, because even key findings can go unnoticed in low-ranking journals that are underestimated by the scientific community. 20 The number of citations for the published papers reflects the impact of studies within the scientific community. Based on the set of papers that the units/groups had selected as their most important, the mean number of citations was 6.9; and for the highest-ranking research unit this mean was 15.8. Based on these figures, the impact was considered good. When scrutinizing these figures, it should be kept in mind that the citation rates are not necessarily directly comparable across various fields of research. An attempt was made to obtain comparable data on productivity from different groups/units. It turned out to be difficult to get reliable estimates of person years allocated to research relevant to the context of this evaluation, and thus the evaluation scale was limited to acceptable/unacceptable. The productivity rate was considered acceptable for all groups in general, but unacceptable for some single projects. The evaluation group wanted to acknowledge the exceptionally high productivity of the Unit of Sports and Exercise Medicine, Helsinki, due to the Unit's excellent and productive collaborative networking. National and international collaboration National networking seemed to function well and was found to involve many universities and research institutes. The Faculty of Health Sciences at the University of Jyväskylä and the UKK Institute form the core structure for biomedical sports and exercise research in Finland. In the Tampere area, networking between the UKK Institute, university researchers and the Tampere Research Center of Sports Medicine seemed to function well - to the extent that at times it was difficult to identify the unit primarily responsible for the studies. Unfortunately, the same does not seem to be true in Jyväskylä. Collaboration between the research units/groups does not function in an optimal way - not even across the departmental divisions in the Faculty. The Department of Health Sciences, the Department of Biology of Physical Activity, the LIKES Institute and the Research Institute of Olympic Sports should form a strong core for scientific work and researcher training in sports and exercise research in Finland. Therefore, every effort should be taken to enhance collaboration and coordination of the activities of these units. The research groups have wide international contacts that in some cases have resulted in productive joint research projects and publications. Only a few groups have received funding from the EU or other foreign sources. International collaboration should be enhanced and include collaboration with European research groups. This could facilitate obtaining research funding from the EU. The quantity and quality of researcher training The quantity of researcher training was considered good. The review found that most students completed their doctoral training at a relatively young age, which has been one of the goals of research policy in Finland. It was noted that it was not always easy to recruit graduate students. Another current problem is the shortage of posts for post-doctoral researchers. Foreign exchange of post-graduate and post-doctoral level trainees was quite infrequent. Mobility among young scientists needs to be encouraged – particularly within the EU where the funding potential for this purpose is underutilized. The quality of researcher training varied substantially from one unit to another, the general tendency being that big units performed better than smaller ones. It is recommended that 21 graduate students be registered in an appropriate graduate school. This would help to secure proper tutoring and appropriate planning of their formal training. All graduate students should be actively linked to a university department. Attending international scientific conferences is an important form of training, and this should be offered to all doctoral students. Additional observations Many of the research groups seem to be very dependent on funding from the MoE. Research funding from the MoE is meant to be directed towards applied research into sports and exercise, and research that provides reliable information for public decision-making and planning. However, progress in basic science is a prerequisite for progress in applied research. Sometimes, the relevance of basic science research, for instance on the musculoskeletal system, can be rather remote from its applications. The Academy of Finland should be the primary financier for such basic science research. The research groups should have no excuse for not reaching a high enough scientific level to succeed in the competition for funding from the Academy. In general, the research units/groups are encouraged to actively apply for funds also from other sources besides the MoE and the Academy. A serious threat to the future success of research is the shortage of funds to replace outdated or malfunctioning equipment. This problem was obvious in the university departments and the UKK Institute. University core funding has decreased over recent years while the proportion of external research funding has increased. Adequate overhead allowance in research funding could help to alleviate this problem. In the sports medicine centers, the equipment primarily serves for testing and clinical work, and secondarily for research. It does not seem appropriate to supply these small units with sophisticated equipment without sufficient technical support. Research requiring sophisticated technical equipment is best done in larger units that have adequate resources and facilities. Short-term, one-year funding cycles create an insecure research environment, and make the long-term planning of future research programs difficult. They also influences security of employment for young researchers, and make the choice of research as a career less attractive. The same is true for the practice of awarding personal grants without paying any social security contributions. Organizationally, sports and exercise research are split into too many units, many of which were considered to be too small to reach the desired critical mass. It was quite obvious that in all respects the established big units do better than the small ones. The major centers in this field of research are the UKK Institute, the Department of Health Sciences and the Department of Biology of Physical Activity of the University of Jyväskylä. Each of these centers has well defined strategy and research programs, good leadership, a sufficient critical mass with multidisciplinary expertise and the necessary infrastructure. These units also have a good environment for graduate students to learn research skills. Most of the smaller units plan their research activities in an opportunistic manner on a "study-to-study" basis. Their research directions are fully dependent on the interest and skills of the persons involved in research, which makes the unit's research very vulnerable. This is proved by the fact that during the evaluation period two of the centers, the Paavo Nurmi Center and Department of Sports Medicine of the Oulu Deaconess Institute went through a transition that had a major impact on the performance of units. Sports medicine centers receive their core funding from the MoE. This funding is classified as part of research support. The role of the centers is multifaceted and includes research, 22 specialist training in sports medicine, and local services. Research profiles vary substantially between the centers. At one extreme, the Kuopio Research Institute of Exercise Medicine has a high profile with a clear research strategy while at the other some centers act on a "study-to- study basis". In many cases, the centers seem to have provided facilities for data collection in support of epidemiological studies. Splitting resources into many small units is not the most efficient way to allocate resources to research. At the time of its evaluation, one of the units was led by an inexperienced junior scientist - all research units should be led by senior scientists. A separate overall evaluation of sports medicine centers is recommended - the evaluation group could not take into account any functions of the centers other than research. From the research point of view, it would be better to have fewer but stronger units with sufficient critical mass to successfully conduct high quality research programs and ensure sustainability. 23 6.2. Discipline-specific evaluations 6.2.1. Epidemiological research of the relationship between physical activity, fitness and health The scientific quality of epidemiological research into physical activity, fitness and health is excellent and its relevance is also very appropriate. This is proved by the respectable number of publications in the highest-ranking journals and also by high citation rates. Research in this area has provided new information on the effects on health of a physically active lifestyle and sports on chronic diseases, such as coronary heart disease, diabetes, cancer and musculoskeletal disorders (osteoporosis, disc degeneration, osteoarthritis). It has also provided evidence of the adverse effects on health of low level physical activity and poor physical fitness as well as excessive physical stress from sports. The results concerning the benefits of moderate-intensity physical activity and dose-response relationships are of the utmost importance from a health promotion and public health perspective. Scientifically valid methods of assessing physical activity and health-related fitness in different age groups have been and are still being developed. Resources have been allocated to design “products” that can be used in health care and community interventions. This developmental work has contributed also to European collaborative research and surveillance programs. Injury rates at home, in leisure time and in different sports have been estimated. Several projects have addressed the question of genetic influences on physical fitness and the relation between physical exercise and health, based on twin studies or the analysis of DNA polymorphisms. Some interesting results have already been obtained. The significance of the information on genetic susceptibility remains to be seen in health promotion and the prevention of adverse health effects. Laboratory methods to assess r health outcomes and their determinants are up- to-date, but very little funding has been available for the renovation of facilities and new equipment. This situation, if it continues, can threaten the future development of high-quality research. In observational epidemiology, several unique cohort studies with long-term follow-ups are going on. Many of the cohort studies have been designed specifically to study health-related physical activity as one of the primary objectives (e.g. the Kainuu Study, the Evergreen Study, the Kuopio Ischemic Heart Disease Study, the Finnish Athlete Cohort Study). Some other research programs, designed for more general purposes, have provided an excellent base to study the determinants of physical activity and the health effects of physical activity (e.g. the Finnish Twin Cohort, the Finnish Young Twin Cohort, the 1966 Birth Cohort of Oulu). A prerequisite for the successful execution of these large cohort studies with long-term follow- ups has been that the units in charge, primarily the UKK Institute and university departments, are big enough and stable enough to secure the continuity and know-how necessary for the management of these demanding studies. In some observational studies innovative study designs have been used. As an example, a study of the effect of unilateral training on growing and mature bones among tennis and squash players may be mentioned. Well-conducted cohort studies provide the best evidence that can be found from observational epidemiology, and therefore they are very valuable. They are time-consuming, require a lot of resources and as such they are a challenge also for the funding organizations. Many of the cohort studies have succeeded in obtaining funding from the Academy of Finland and some also from international sources. The current policy of the Ministry of Education, 24 one of the major funding organizations, only awards funds on an annual basis. This renders the long-term planning of large research programs difficult. In experimental epidemiology several successful randomized controlled trials to test the effectiveness of physical exercise interventions on various fitness and health outcomes have been completed and some are ongoing. Intervention research is obviously one of the strengths in the area of sports and exercise medicine research in Finland. The intervention research has provided evidence of the health effects of aerobic training, the dose-response of the effect of moderate to low intensity exercise that approaches the minimal beneficial dose, the effects of walking training on weight maintenance after weight reduction, the effect of high-impact exercise on bone mineral density, and the effects of physical training on skeletal muscles and strength in old age. The evidence stems from strictly controlled settings and hence a future challenge will be to test the effectiveness of the interventions in community trials. These trials should be evaluated using a sound scientific approach, which is not the case, for instance, for the ongoing Fit for Life Program. National collaboration is extensive; it seems to function well and is productive. Epidemiological projects mostly require a multidisciplinary team of research scientists, and therefore networking is often a prerequisite for successful research. Most of the sports and exercise medicine groups/units are too small to be independent actors in large-scale epidemiological research, but they have successfully built up collaboration with academia, the UKK Institute and other research institutes, as well as with each other. The groups/units often provide facilities for collecting data on clinical and laboratory tests. In many cases, this networking has made it possible to include aspects of health-related physical activity in research primarily targeting other goals. Productive international collaboration, resulting in joint publications, has not been very common. The reason may be the nature of the research; in which case international collaboration may not produce any significant added value. The research groups have, however, active contacts with their international peers. In the future, particularly, evolving European collaboration should be utilized to create new opportunities in this field of research as well. Training of a new generation of researchers, competent in epidemiology, has been successful. Currently, a major problem is the small number of post-doctoral positions. Conclusions and recommendations The general level of epidemiological research was very good with some excellent achievements of both international and national significance from both the scientific and practical point of view. Continuation of valuable high-quality cohort studies is encouraged. Also, further studies focusing on the dose-response relationship between physical exercise and its beneficial and also potentially harmful (trauma) health effects are needed in all age groups from childhood to old age. Such research will improve the knowledge base for health promotion and preventive programs for many chronic diseases. Community interventions with valid evaluation of their impact are a future challenge. Large-scale epidemiological studies need to be conducted by stable institutes (that are also big enough) and research groups with sufficient experience and infrastructure. It is highly recommended that experts in sports exercise biology, physiology and medicine collaborate 25 with epidemiologists in various research institutes and universities, and include research questions in their studies that are of interest to sports and exercise research. The benefits of physical exercise in the treatment and rehabilitation of patients with various diseases or injuries warrant further research. It is also considered important to carry out national descriptive surveys to have reliable information on the status of physical exercise among the population. Methods development for valid assessment of functional capacity as well as health-related fitness needs further research. National networking has been efficient, although in many cases international networking has not been necessary. Building an international network particularly at the EU level can open new opportunities. 6.2.2. Biomechanics, rehabilitation, traumatology Biomechanics The scientific quality of Finnish research that has focused on biomechanics was found to be excellent and a welcome complement to outstanding clinical research programs. Research in this area was found to be highly relevant to athletes, active individuals and the elderly. Overall, the review revealed that Finnish biomechanics research was based on innovative hypotheses that were matched with well thought-out experimental designs and proper statistical methods. For the most part, the researchers used state-of-the-art instrumentation and methods to evaluate biomechanics and this led to publications in widely respected journals that have good impact factors. The availability of biomechanics training was considered to be limited at most institutions, the course work was of a fair quality or at times unavailable, and the level of mentoring was fair. The review of the Järvinen group found that the scientific quality ranged between very good and excellent. Some of the most important biomechanics research has focused on osteoporosis and this has been recognized at national and international levels. Osteoporosis research has characterized the basic processes related to the interaction of the shape, material properties and strength of bones, and the key external stimulus, mechanical loading. This group was the first to demonstrate that recovery of bone loss produced by the lack of mechanical stimuli is both dose-dependent and bone-site specific. This has become an important consideration for the treatment and rehabilitation of hip and spine fractures. Another unique contribution has been the observation that the maintenance of mechanical loading-induced bone gain requires higher than normal levels of physical activity. This has led to the recommendation of new types of exercises for individuals interested in treating subjects with decreased bone mineral density, and for maintaining bone density levels in the elderly. Investigators also developed some of the key methods for studying bone biomechanics. For example, they have shown that bones are capable of adapting to their mechanical characteristics without necessarily simultaneously adding additional mineral to their structure. This is a key finding because it has implications with regard to how we quantify the outcome of investigations designed to increase bone health. Most of the tools used by the investigators have been thoroughly evaluated and this has led to an improved understanding of the inherent inaccuracies associated with dual X-ray absorptiometry measurements of bone mineral density in vivo. The research group also leads the field with 26 regard to the development and use of biodegradable materials for the fixation of anterior cruciate ligament grafts. The group introduced biodegradables for the treatment of sports injuries, and this has resulted in benefits such as permitting magnetic resonance imaging and revision surgery. Productivity by this group was considered acceptable. The review of the Tampere research groups/units revealed that the scientific quality was excellent. Innovative and novel contributions have also been made with regard to treatment of hip fractures –soon to become a modern day epidemic for the elderly. This was considered highly relevant work that has had an important national and international impact. The research performed at the Tampere Research Center of Sports Medicine focused on several studies of energy shunting external hip protectors for the elderly. This group made significant advances with regard to our understanding of how hip fractures occur, and how to prevent them with passive protective equipment. This represents an important advance with regard to our understanding of the effect of physical activity and impact on the elderly who are at the greatest risk for hip fracture. In addition, the group also evaluated the biomechanical strength of a new fixation device for the treatment of anterior cruciate ligament disruptions. This work combined an innovative design with a new biodegradable material that eliminates the need for a permanent implant for the fixation of anterior cruciate grafts. This approach allows re- operations when necessary, and prevents contamination from magnetic resonance imaging of the knee. This advance has revolutionized the way in which cruciate ligament surgery is performed throughout the world. Productivity by this group was considered acceptable. The review of the Jyväskylä Department of Biology and Physical Activity revealed that the scientific quality was good to very good. Research by this group has been quite impressive with regard to studies of the biological and biomechanical behavior of muscle and tendon. Specifically, this research group has developed innovative tools for the measurement of tendon and muscle forces in vivo. This has led to several studies of the force-length and force- velocity relationship of muscle at a basic science level. The investigators have developed the tools necessary to measure neuromuscular function, as well as stiffness of individual muscles and joints. Investigators at both national and international level much appreciate these advances. The research done by this group of investigators is unique, and represents the best work in the world with regard to understanding the loads developed during the triple jump, plantar pressure distributions during ski jumping, and aerodynamics during ski jumping. No other group is performing this type of research and all the work done here is truly unique and represents a significant contribution to enhancing athletic and human performance. Productivity by this group was considered acceptable. The review of the Institute for Olympic Sports found that the scientific quality was good with regard to their studies of sports biomechanics and enhancement of human performance. This work has focused on javelin throwing, shot-put, ski jumping, cross country skiing, and kayaking, and has led to advances with regard to the best way in which athletes should train and compete in these athletic events. Biomechanics research at the Research Center for Sport and Health Sciences (LIKES) was at the basic science level, and the scientific quality of this work ranged between poor and good. The scientific quality of research into biomechanics ranged from poor to good. The work has provided important input parameters for the development of future biomechanical models of human performance. Of particular note were biomechanical studies focusing on the effect of exercise on bone metabolism. This work was found to be sound science and an exciting investigation because of its unique contribution to the understanding of how loading affects the biological response of bone. This is important with regard to understanding how stress 27 fractures occur in athletes, particularly amongst young females at increased risk for this injury. Productivity of this unit was considered poor. In conclusion, the scientific quality of the biomechanics research performed in Finland ranged between good and excellent. For the most part, biomechanics was founded on testable hypotheses that were matched with proper experimental designs and statistical methods. The design of the research was descriptive where appropriate, and mechanistic when needed. The review also revealed that the investigators understood the rationale for their research programs, and only pursued investigations that were novel and produced innovative and significant contributions for literature produced. It was also noted that, in most cases, biomechanics research was directly linked to the clinical environment. Productivity was found to be acceptable and for some of the groups it was quite impressive. Researchers involved with biomechanics have established collaboration at national, and international level when necessary, and this has led to important discoveries with regard to the development of devices such as new soft tissue fixation systems and hip protectors to diminish the incidence of hip fractures. Perhaps the most impressive aspect of Finnish biomechanics research was its wide scope and diversity with regard to the diagnosis and treatment of sports and activity related injuries. Biomechanics research included investigations of both hard tissue (bone) and soft tissues (muscles, ligaments, tendons, etc.). There were, however, several concerns. First, and perhaps foremost, biomechanics research done by the clinical groups/units should involve closer collaboration with basic scientists located in university settings. This approach would provide important opportunities for students who are working toward their doctoral degrees, and insight into the planning and execution of research. Although there were isolated cases where this occurred, there were many situations in which it appeared as if clinicians were involved in basic science research that was beyond their expertise. These individuals would benefit from the input of a basic science program, and clearly this is important for students. The second concern was the training given to students in biomechanics. It appears that most trainees obtained very little experience in didactic coursework. This is a very important component which most students should obtain, and it is important if they plan to continue with research after earning their degree. One way to accomplish this would be to establish collaboration with other institutions in Finland. With regard to the direction of biomechanics programs, there appeared to be very little research focused on the biomechanics of articular cartilage in both normal and diseased conditions. This will become an important issue for sports medicine research over the next decade. Rehabilitation Research The review of sports medicine rehabilitation research performed at institutions throughout Finland revealed that innovative work has been performed that has led to novel contributions and important advances with regard to the most serious injuries affecting athletes and active individuals. For the most part, the groups/units involved applied appropriate scientific methodology. The most impressive observation that the evaluation group made was that almost all of the research was based on testable hypotheses that were matched with appropriate experimental designs and statistical methods. Most of the institutions used state- of-the-art equipment and measurement techniques, and this resulted in impressive advances 28 with regard to the treatment of injuries to soft and hard tissue. From this perspective, the scientific quality of rehabilitation research was considered excellent. Several of the research investigations reviewed involved an immense amount of work and intense commitment by the institutions over long time periods. This represents one of the biggest strengths of the Finnish sports medicine research program. It is obvious that both institutions and investigators are committed to performing properly thought-out and planned rehabilitation research. Advances have been made with regard to the treatment of musculoskeletal injuries associated with activity. These have focused on children, middle-aged and elderly subjects, and were considered broad in scope. Rehabilitation research in Finland has not focused only on elite athletes, but included those involved with physical activity in general. This comprehensive approach is outstanding and has led to national and international impacts. Rehabilitation research at the UKK Institute was considered excellent. The research focused on the effects of musculoskeletal injuries and disorders in the bone mineral density of growing and mature bones, and studied the importance of the functional recovery of the injured extremity for the recovery of bone. This research made an important advance by demonstrating that knee ligament tears can create considerable bone loss to the affected limb, and has shown that the loss occurs quite rapidly. Further, recovery of this post-traumatic osteoporosis was found to be slow and incomplete. This research is important because it not only demonstrates that severe knee ligament trauma alters the biomechanics of the knee; it also alters the biological response of bone, and emphasizes the importance of rehabilitation in treating deficiencies in bone mineral density. Another avenue of research that is quite unique with regard to its contribution to the field of sports medicine rehabilitation has been the study of the long-term effect of rotator cuff tendon ruptures on bone mineral density. As with knee ligament injuries, rotator cuff tendon rupture not only alters the biomechanics of the joint, it also produces substantial reductions in the bone mineral density of an injured limb. The investigators demonstrated that, in this non-weight-bearing joint, there is considerable post- traumatic osteoporosis that occurs following a rotator cuff tendon injury. This work emphasized that controlled mobilization and rehabilitation is critical for minimizing bone loss. The investigators also demonstrated that the age of an athlete, or active individual, has a dramatic affect on their ability to remodel bone and heal fractures. Insight was gained with regard to understanding why developing bones have an improved capacity to respond to exercise and physical loading in comparison to mature bones. This work is truly innovative, and has opened a new avenue of research with regard to understanding the management and rehabilitation of fractures in children and adults. Productivity by this unit was found to be outstanding. Very impressive work was performed at the Tampere Research Center for Sports Medicine with regard to the rehabilitation of chronic and acute knee ligament tears, and ankle ligament tears. These are amongst the most common and severe injuries to affect athletes, and this group performed some of the most impressive rehabilitation research in this field. The scientific quality was found to be excellent and resulted in important contributions at the national and international levels. Specifically, clinical studies that focused on chronic and acute anterior cruciate ligament tears revealed that it is important to reconstruct these ligament tears and use appropriate rehabilitation in an effort to restore normal joint biomechanics and muscle function to knees with these severe injuries. Research also focused on surgical versus functional treatment of ankle ligament tears and revealed that surgery is not necessary to treat these disabling injuries. Instead, a well-controlled rehabilitation program focused on restoring 29 motion and strength is associated with an improved outcome. This work is important because it has eliminated the need for surgery on disrupted ankle ligaments. This has decreased the pain and morbidity associated with treatment of these injuries. Research also focused on the treatment of patients who have suffered severe tendonopathy, the most important of which focused on tears of the Achilles tendon. This work provided important insight into the mechanisms in which tendons degenerate and rupture. Research done by the Järvinen group provided important insight into the effect of immobilization (both long- and short-term) on the healing response of skeletal muscle and was considered to be of very good scientific quality. It has provided the scientific basis for treating muscle strains, the most common sport related complaint, and has allowed quantification of the magnitude and duration of the motion needed to ensure formation of a sufficiently strong scar to withstand the biomechanical loading environment induced by the rehabilitation of muscle strains. Further, this work focused on the biological response of healing muscle tears, and shows that non-steroid anti-inflammatory drugs are beneficial in comparison to cortical steroids for regenerating skeletal muscle. Novel research has been done using unique models that have developed an understanding of the interaction between alpha 7 integrin and dystrophin associated complexes during the regeneration of injured skeletal muscle, and the effects of altered biomechanical loading during these processes. This work has facilitated a basic science understanding of the rehabilitation of severe muscle tears and strains. The group also made significant advances with regard to the treatment of tendon injuries. They described the effect of rotator cuff rupture on the skeleton, and defined factors in the treatment of these injures that contribute to the development of osteoporosis. They also described the long-term prognosis of Achilles tendonopathy, showing that the etiology has to do with intrinsic factors because patients initially complaining of unilateral symptoms are prone to problems in the contralateral, uninvolved Achilles tendon. The Järvinen group also studied the most common graft material used to reconstruct the ACL, bone-patellar tendon-bone preparations. Important advances made here are the identification of the various surgical factors related to long-term success, including the development of patellofemoral arthrosis. The investigators identified the best means of treating patellofemoral arthrosis; which is physical therapy. One of the more important research investigations that the evaluation group reviewed was the DNASCO randomized clinical trial carried out by the Kuopio Research Institute for Exercise Medicine. This work revealed that genetic factors modify the effect of physical activity on risk factors for atherosclerosis. Although this research does not fit within the framework of classic sports medicine rehabilitation research, it is important for the rehabilitation of middle- aged individuals who are either involved with sports or need to become involved with physical activity to improve their health. This research was well designed, founded on a novel hypothesis and included a comprehensive approach. This group of researchers should be encouraged to continue work. It will have an important impact on both national and international communities. Similar to the above-mentioned approach, research at Oulu Deaconess Institute was founded on solid experimental design and appropriate scientific methodology. Specifically, the investigators focused on the effect of exercise on bone mineral density and geometry, balance, muscle strength and the likelihood of falls amongst elderly women with severe osteopenia. This work represents a new and innovative contribution to the literature that has both national and international impact. The researchers at this institute also focused on the efficacy of exercise and diet in preventing Type II diabetes in individuals with impaired glucose 30 tolerance. Although this may not have a direct impact on physically fit athletes, it certainly affects those who are not fit and need to become more active. From this perspective the work represents a considerable advance towards rehabilitating individuals at risk for adverse health outcomes. Rehabilitation research in Finland was found to be important because it focused on the rehabilitation of individuals who suffer from the most common disabling musculoskeletal disorder, low back pain. For example, work done at the Department of Health Sciences at the University of Jyväskylä focused on the effect of a three-month active rehabilitation program on impairment and disability, and their permanence in subjects with low back pain. This was found to be a key contribution because of the high prevalence of this disease, coupled