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Preview: British Journal of Sports Medicine recent issues

British Journal of Sports Medicine recent issues



British Journal of Sports Medicine RSS feed -- recent issues



 



Everyone is an "Athlete"

2018-01-19T05:35:28-08:00

Merrian-Webster defines an athlete as: ‘a. a person who is trained or skilled in exercise, sports or games requiring physical strength, agility, or stamina. b. a person who exhibits dexterity or coordination especially an execution of learning physical tasks.’ The term athlete is often confusing for physicians and patients of all ages. As sports medicine physicians we are asked by young physicians in training: ‘Just how much of your practice is real Sports Medicine?' When we look puzzled, the question is often clarified somewhat sheepishly: ‘How much of your practice is in the care of the elite athlete? ’

Each day as a sports medicine physician, we encounter a patient who has set goals and challenged themselves beyond our perceived boundaries for them. That may be someone who ran his or her first 5 k, or a 65-year-old battling pancreatic cancer, training for an Ironman in between chemotherapy sessions, or a...




Running causes knee osteoarthritis: myth or misunderstanding

2018-01-19T05:35:28-08:00

Jill is a 35-year-old woman who has just nursed her 60-year-old mother through a total knee replacement. She ran 800–5000 m competitively in high school and has continued to run for fitness. She has no knee pain and no history of knee injury. What can we tell her regarding her knee osteoarthritis (OA) risk if she continues to run?

Among the lay public, running is often considered a cause of knee OA, and many people use this as an excuse not to run for fitness, even though knee OA may be more common in sedentary individuals.1 While there is a vast literature addressing knee OA, there is no common conclusion regarding the risk of knee OA from running.

Is running a risk for knee OA?

One cross-sectional study and two systematic reviews have recently addressed this question.

The retrospective study included 2637 men and women aged 45–79...




Preventing fractures in the masters athlete: we can do better

2018-01-19T05:35:28-08:00

Our population is ageing. By 2030, the number of Americans over age 65 years is expected to reach 74.1 million.1 Maintaining physical activity levels will become increasingly important to mitigate the effects of chronic disease in our ageing patient population.

The American College of Sports Medicine recommends 150 min per week of moderate intensity exercise.2 A subset of ageing athletes are meeting and exceeding recommended physical activity levels, with an increasing number of athletes ages 40 years and older participating in Ironman competitions, ultracycling events, ultramarathons and long-distance inline skating.

Age, bone density and fractures: cannot run from the risk

Exercise can reduce many of the negative effects of ageing, and weight-bearing exercise is one of the mainstays of osteoporosis management. However, exercise alone cannot overcome physiological age-related declines in bone density. Bone density peaks in the third decade of life, and then steadily declines,3 4




Physical activity for the ageing athlete: the importance of maintaining musculoskeletal health

2018-01-19T05:35:28-08:00

The term ‘athlete’ has many differing definitions, connotations and stereotypes. For many years, sport and exercise medicine physicians have treated every patient as an athlete to a greater or lesser extent with associated functional, work, sport and social expectations and demands. As we age alongside our patients, we empathise with their changing needs and abilities. People are living longer, but many do so in poor health and with reduced quality of life due to the presence of chronic diseases. Ageing is associated with multi-system decline, including musculoskeletal conditions. In the UK, the greatest cause of pain and disability are musculoskeletal conditions such as osteoarthritis and back pain, and these remain under-recognised as a public health priority.1 The presence of two or more long-term ailments (physical or mental), so called multi-morbidity, is increasingly common in patients from both high-income and low/middle-income economies. Indeed, in the UK, there are...




Evidence-based exercise prescription is facilitated by the Consensus on Exercise Reporting Template (CERT)

2018-01-19T05:35:28-08:00

Exercise interventions are poorly reported

Exercise is effective for the prevention and management of acute and chronic health conditions. Exercise prescription is sensible when supported by high-quality evidence of effectiveness, and it is likely that the design of an exercise programme (eg, how long a person exercises each day, the duration of a programme, the level of intensity of the exercise) influences programme effectiveness. A meta-epidemiological review of 73 systematic reviews (1216 trials) of exercises reported that only 30% of trial reports provided information required to replicate the investigated exercise programme.1

Consequences of poor reporting

This means that researchers would, in most cases, be unable to replicate and validate trial outcomes for exercise programmes that have been reported to be effective. In addition, clinicians would be unable to accurately implement treatment based on the reported intervention.1 Furthermore, when trials of exercise are...




The physical activity paradox: six reasons why occupational physical activity (OPA) does not confer the cardiovascular health benefits that leisure time physical activity does

2018-01-19T05:35:28-08:00

Physical activity (PA) is well documented to improve health. However, this documentation is restricted to leisure time physical activity (LTPA; eg, sports, recreation and transportation). Increasing evidence shows that occupational physical activity (OPA) does not improve health.1 Actually, OPA can be detrimental. These contrasting health effects of LTPA and OPA constitute the so-called PA health paradox.2

For a considerable fraction of the adult population, work constitutes the main setting for PA. Workers in many occupations, such as construction, cleaning, refuse collection, elderly care, farming and manufacturing, are physically active for large parts of their working days, for most of the year. Despite this PA at work, these and other manual workers have relatively poor health.

Many epidemiological studies document that high OPA increases the risk for cardiovascular disease (CVD) and mortality outcomes, even after extensive adjustments for other risk factors including socioeconomic status, LTPA and other health...




The Fat but Fit paradox: what we know and dont know about it

2018-01-19T05:35:28-08:00

What we know about it

In the late 1980s, one of us (SNB) published a study that demonstrated that individuals with a low (below first quintile=20th percentile) cardiorespiratory fitness level had a higher risk of mortality 8 years later, when compared with those who were at least moderately fit.1 Since then, many longitudinal studies have consistently confirmed this notion in men and women, as well as in healthy and diseased individuals, for all-cause mortality, as well as for cardiovascular disease (CVD) mortality.2

Obesity is related to multiple physical and mental comorbidities and it is an incontrovertible risk factor for all-cause and CVD mortality.3 It has been suggested, however, that being fit might attenuate some of the adverse consequences of obesity, independently of some key potential confounders. In this context, in the late 1990s, some studies provided first evidence for what was later...




Exercise interventions for cognitive function in adults older than 50: a systematic review with meta-analysis

2018-01-19T05:35:28-08:00

Background

Physical exercise is seen as a promising intervention to prevent or delay cognitive decline in individuals aged 50 years and older, yet the evidence from reviews is not conclusive.

Objectives

To determine if physical exercise is effective in improving cognitive function in this population.

Design

Systematic review with multilevel meta-analysis.

Data sources

Electronic databases Medline (PubMed), EMBASE (Scopus), PsychINFO and CENTRAL (Cochrane) from inception to November 2016.

Eligibility criteria

Randomised controlled trials of physical exercise interventions in community-dwelling adults older than 50 years, with an outcome measure of cognitive function.

Results

The search returned 12 820 records, of which 39 studies were included in the systematic review. Analysis of 333 dependent effect sizes from 36 studies showed that physical exercise improved cognitive function (0.29; 95% CI 0.17 to 0.41; p<0.01). Interventions of aerobic exercise, resistance training, multicomponent training and tai chi, all had significant point estimates. When exercise prescription was examined, a duration of 45–60 min per session and at least moderate intensity, were associated with benefits to cognition. The results of the meta-analysis were consistent and independent of the cognitive domain tested or the cognitive status of the participants.

Conclusions

Physical exercise improved cognitive function in the over 50s, regardless of the cognitive status of participants. To improve cognitive function, this meta-analysis provides clinicians with evidence to recommend that patients obtain both aerobic and resistance exercise of at least moderate intensity on as many days of the week as feasible, in line with current exercise guidelines.




Concurrent aerobic plus resistance exercise versus aerobic exercise alone to improve health outcomes in paediatric obesity: a systematic review and meta-analysis

2018-01-19T05:35:28-08:00

Objective

To determine if the combination of aerobic and resistance exercise is superior to aerobic exercise alone for the health of obese children and adolescents.

Design

Systematic review with meta-analysis.

Data sources

Computerised search of 3 databases (MEDLINE, EMBASE, and Cochrane Controlled Trials Registry).

Eligibility criteria for selecting studies

Studies that compared the effect of supervised concurrent exercise versus aerobic exercise interventions, with anthropometric and metabolic outcomes in paediatric obesity (6–18 years old). The mean differences (MD) of the parameters from preintervention to postintervention between groups were pooled using a random-effects model.

Results

12 trials with 555 youths were included in the meta-analysis. Compared with aerobic exercise alone, concurrent exercise resulted in greater reductions in body mass (MD=–2.28 kg), fat mass (MD=–3.49%; and MD=–4.34 kg) and low-density lipoprotein cholesterol (MD=–10.20 mg/dL); as well as greater increases in lean body mass (MD=2.20 kg) and adiponectin level (MD=2.59 μg/mL). Differences were larger for longer term programmes (>24 weeks).

Summary

Concurrent aerobic plus resistance exercise improves body composition, metabolic profiles, and inflammatory state in the obese paediatric population.

Trial registration number

CRD42016039807.




Dietary supplements for treating osteoarthritis: a systematic review and meta-analysis

2018-01-19T05:35:28-08:00

Objective

To investigate the efficacy and safety of dietary supplements for patients with osteoarthritis.

Design

An intervention systematic review with random effects meta-analysis and meta-regression.

Data sources

MEDLINE, EMBASE, Cochrane Register of Controlled Trials, Allied and Complementary Medicine and Cumulative Index to Nursing and Allied Health Literature were searched from inception to April 2017.

Study eligibility criteria

Randomised controlled trials comparing oral supplements with placebo for hand, hip or knee osteoarthritis.

Results

Of 20 supplements investigated in 69 eligible studies, 7 (collagen hydrolysate, passion fruit peel extract, Curcuma longa extract, Boswellia serrata extract, curcumin, pycnogenol and L-carnitine) demonstrated large (effect size >0.80) and clinically important effects for pain reduction at short term. Another six (undenatured type II collagen, avocado soybean unsaponifiables, methylsulfonylmethane, diacerein, glucosamine and chondroitin) revealed statistically significant improvements on pain, but were of unclear clinical importance. Only green-lipped mussel extract and undenatured type II collagen had clinically important effects on pain at medium term. No supplements were identified with clinically important effects on pain reduction at long term. Similar results were found for physical function. Chondroitin demonstrated statistically significant, but not clinically important structural improvement (effect size –0.30, –0.42 to –0.17). There were no differences between supplements and placebo for safety outcomes, except for diacerein. The Grading of Recommendations Assessment, Development and Evaluation suggested a wide range of quality evidence from very low to high.

Conclusions

The overall analysis including all trials showed that supplements provided moderate and clinically meaningful treatment effects on pain and function in patients with hand, hip or knee osteoarthritis at short term, although the quality of evidence was very low. Some supplements with a limited number of studies and participants suggested large treatment effects, while widely used supplements such as glucosamine and chondroitin were either ineffective or showed small and arguably clinically unimportant treatment effects. Supplements had no clinically important effects on pain and function at medium-term and long-term follow-ups.




Associations of occupational standing with musculoskeletal symptoms: a systematic review with meta-analysis

2018-01-19T05:35:28-08:00

Objective

Given the high exposure to occupational standing in specific occupations, and recent initiatives to encourage intermittent standing among white-collar workers, a better understanding of the potential health consequences of occupational standing is required. We aimed to review and quantify the epidemiological evidence on associations of occupational standing with musculoskeletal symptoms.

Design

A systematic review was performed. Data from included articles were extracted and described, and meta-analyses conducted when data were sufficiently homogeneous.

Data sources

Electronic databases were systematically searched.

Eligibility criteria

Peer-reviewed articles on occupational standing and musculoskeletal symptoms from epidemiological studies were identified.

Results

Of the 11 750 articles screened, 50 articles reporting 49 studies were included (45 cross-sectional and 5 longitudinal; n=88 158 participants) describing the associations of occupational standing with musculoskeletal symptoms, including low-back (39 articles), lower extremity (14 articles) and upper extremity (18 articles) symptoms. In the meta-analysis, ‘substantial’ (>4 hours/workday) occupational standing was associated with the occurrence of low-back symptoms (pooled OR (95% CI) 1.31 (1.10 to 1.56)). Evidence on lower and upper extremity symptoms was too heterogeneous for meta-analyses. The majority of included studies reported statistically significant detrimental associations of occupational standing with lower extremity, but not with upper extremity symptoms.

Conclusions

The evidence suggests that substantial occupational standing is associated with the occurrence of low-back and (inconclusively) lower extremity symptoms, but there may not be such an association with upper extremity symptoms. However, these conclusions are tentative as only limited evidence was found from high-quality, longitudinal studies with fully adjusted models using objective measures of standing.




Aerobic exercise promotes executive functions and impacts functional neural activity among older adults with vascular cognitive impairment

2018-01-19T05:35:28-08:00

Background

Vascular cognitive impairment (VCI) results from cerebrovascular disease, and worldwide, it is the second most common type of cognitive dysfunction. While targeted aerobic training is a promising approach to delay the progression of VCI by reducing cardiometabolic risk factors, few randomised controlled trials to date have specifically assessed the efficacy of aerobic training on cognitive and brain outcomes in this group at risk for functional decline.

Aim

To examine the effect of moderate-intensity aerobic training on executive functions and functional neural activity among older adults with mild subcortical ischaemic VCI (SIVCI).

Methods

Older adults with mild SIVCI were randomly assigned to: (1) 6-month, 3x/week aerobic training (n=10) or (2) usual care (control; n=11). Participants completed functional MRI (fMRI) at baseline and trial completion. During the fMRI sessions, behavioural performance on the Eriksen flanker task and task-evoked neural activity were assessed.

Results

At trial completion, after adjusting for baseline general cognition, total white matter lesion volume and flanker performance, compared with the control group, the aerobic training group significantly improved flanker task reaction time. Moreover, compared with the controls, the aerobic training group demonstrated reduced activation in the left lateral occipital cortex and right superior temporal gyrus. Reduced activity in these brain regions was significantly associated with improved (ie, faster) flanker task performance at trial completion.

Summary

Aerobic training among older adults with mild SIVCI can improve executive functions and neural efficiency of associated brain areas. Future studies with greater sample size should be completed to replicate and extend these findings.




Genetic polymorphisms associated with the risk of concussion in 1056 college athletes: a multicentre prospective cohort study

2018-01-19T05:35:28-08:00

Background/aim

To evaluate the association of genetic polymorphisms APOE, APOE G-219T promoter, microtubule associated protein(MAPT)/tau exon 6 Ser53Pro, MAPT/tau Hist47Tyr, IL-6572 G/C and IL-6R Asp358Ala with the risk of concussion in college athletes.

Methods

A 23-centre prospective cohort study of 1056 college athletes with genotyping was completed between August 2003 and December 2012. All athletes completed baseline medical and concussion questionnaires, and post-concussion data were collected for athletes with a documented concussion.

Results

The study cohort consisted of 1056 athletes of mean±SD age 19.7±1.5 years, 89.3% male, 59.4% Caucasian, 35.0% African-American, 5.6% other race. The athletes participated in American football, soccer, basketball, softball, men’s wrestling and club rugby. A total of 133 (12.1% prevalence) concussions occurred during an average surveillance of 3 years per athlete. We observed a significant positive association between IL-6R CC (p=0.001) and a negative association between APOE4 (p=0.03) and the risk of concussion. Unadjusted and adjusted logistic regression analysis showed a significant association between IL-6R CC and concussion (OR 3.48; 95% CI 1.58 to 7.65; p=0.002) and between the APOE4 allele and concussion (OR 0.61; 95% CI 0.38 to 0.96; p=0.04), which persisted after adjustment for confounders.

Conclusions

IL-6R CC was associated with a three times greater concussion risk and APOE4 with a 40% lower risk.




Effect of pilates exercise for improving balance in older adults (PEDro synthesis)

2018-01-19T05:35:29-08:00

This section features a recent systematic review that is indexed on PEDro, the Physiotherapy Evidence Database (http://www.pedro.org.au). PEDro is a free, web-based database of evidence relevant to physiotherapy.

 Barker AL, Bird ML, Talevski J. Effect of Pilates exercise for improving balance in older adults: a systematic review with meta-analysis. Arch Phys Med Rehabil 2015;96:715–23.

Background

Falls among older adults are considered an important source of disability, mortality and healthcare use.1 One crucial modifiable risk factor for falls is balance impairment.2 3 Hence, exercises that target balance improvement have been considered an essential component of fall prevention programmes.4 Pilates is a type of mind–body exercise that focuses on improving strength, core stability, flexibility, muscle control, posture and breathing.5 Various pilates exercises challenge balance.

Aim

The primary aim of this systematic review was to evaluate...




Health benefits of tennis

2018-01-19T05:35:29-08:00

Tennis is one of the most popular sports throughout the world, with approximately 75 million participants worldwide. It is a sport that you can play at every age and at every level. Children can start playing from the age of 4, using softer/slower balls and smaller rackets on modified courts (tennis10s, mini-tennis, tenniskids and so on) to make the game easier and more fun, gradually progressing after age 10 to regular rackets, balls and courts. Seniors can come to the sport at any age and can play all their life, with international tournaments up to the age categories of 80+ and even 85+. For the elite player, there are tournaments all over the world. The Association of Tennis Professionals and Women’s Tennis Association offer 62 and 59 tournaments in 31 and 33 countries, respectively, whereas the International Tennis Federation (ITF) Men’s and Women’s Circuit offer 600+ and 500+ tournaments across 77 and 65 countries, respectively. There are over 210 nations affiliated to...







Mobile app user guide: Hipbone to sync personal health data

2018-01-19T05:35:29-08:00

Name of the mobile application

Hipbone.

Category of mobile application

Health and Fitness.

Platform

iOS 8.0 or later. (Updated 15 March 2016: current V.0.2.1; size 19.3 MB. Documented from: https://itunes.apple.com/us/app/hipbone/id994965999?mt=8.)

Cost

Free.

About the app

The Hipbone app is offered by Open mHealth (New York, New York, USA; https://hipboneapp.com/), a non-profit start-up seeking to increase the clinical relevance and usage of self-generated health information.1 Since Apple's release of the iOS 8 operating system in September 2014, iPhone users have been able to collect and curate a variety of their own health data using the native Health application. A signification limitation, however, is that self-generated data, while appreciable in the Health app dashboard, are only stored on the device. Extraction of these data for archiving, conducting analyses or sharing with clinicians is very difficult, limiting...




Queen Mary University London: one of the longest established masters of sport and exercise medicine globally (continuing professional development series)

2018-01-19T05:35:29-08:00

Institution

Sports and Exercise Medicine, William Harvey Research Institute, School of Medicine and Dentistry, Queen Mary University London (QMUL), London, UK.

Course

Master of Science (MSc) in Sports and Exercise Medicine.

Why?

With the continued growth of sports participation, both recreationally and professionally, the expectation for the highest level of health provision is also set to grow. Completion of a Masters in Sports and Exercise Medicine (SEM), to inform evidence-based medicine delivery and demonstrate professional competencies, is increasingly becoming a requirement within these sporting environments.1

Overview

The SEM Masters programme is open to nationally and internationally qualified medical doctors, physiotherapists, osteopaths and podiatrists (table 1). As the longest established SEM MSc in Europe (and possibly the world), the programme has a prestigious history. The vision of Professor John King, as course founder >30 years ago, was to provide the best...




Longer-term quality of life following ACL injury and reconstruction

2018-01-19T05:35:29-08:00

What did I do?

My PhD aimed to generate a detailed picture of longer-term quality of life (QOL) following ACL injury and reconstruction.1 I wanted to summarise everything that was known on the topic before exploring QOL in greater detail and identifying factors related to poor QOL 5–20 years after ACL reconstruction. I also wanted to speak with people who have had an ACL reconstruction to find out from their perspective, how ACL injury has impacted their QOL and whether it continues to do so 5–20 years after ACL reconstruction.

Why did I do it?

When I first ruptured my ACL as a 17-year-old, I (like a majority of people who rupture their ACL) expected to return to sport with minimal difficulties after completing rehabilitation. What I now know is that return-to-sport rates are low, re-injury fears are widespread and many young people develop knee...




Correction: International Olympic Committee consensus statement on pain management in elite athletes

2018-01-19T05:35:29-08:00

Hainline B, Derman W, Vernec A, et al. International Olympic Committee consensus statement on pain management in elite athletes. Br J Sports Med 2017;51:1245–58. 10.1136/bjsports-2017-097884.

Mark Stuart’s affiliation is incorrect. It should be: BPharm FFRPS FRPharmS, BMJ, London, UK.