Hot child in the city

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Tamara Hew-Butler on TruTV’s “Adam Ruins Everything”

My topic for today is not that glorious piece of 70’s bubble gum pop from Nick Gilder — no, it is a topic much more directly related to sports medicine.

It’s August and it is hot indeed, with a day here in Ohio set to be one of those classic 90/90 days (>90 F and > 90% humidity).  And it’s the first day of high school Friday night football, with middle school and Pop Warner following this weekend.   These are days we need to do all we can to prevent exertional heat illness (EHI), most especially in our children and adolescents.

In our zeal to prevent EHI, we must be careful not to overhydrate.  A year ago CJSM published the Third International Consensus Statement on Exercise Associated Hyponatremia and followed this up with a blog post and a podcast where we discussed the risks of overhydration with lead author, Tamara Hew-Butler.

The hashtag that came out of those discussions — #Drink2Thirst — spread over social media last year.  The concept is an important one, and one which remains controversial.  There are still many proponents of mandatory water breaks, or of drinking to a certain color of urine.  Others argue that while both are potentially life-threatening, the risk of EHI outweighs the risks of the much rarer condition of EAH — better to err on the side of overhydration they say.  On the other side, some note that hydration is pushed on athletes as something of a panacea, touted as helping to prevent exercise associated muscle cramping (EAMC) when the science argues against that concept.

Now, Adam Ruins Everything, on TruTV, has weighed in on the issue of overhydration in sports, with hilarious effect. And I see Adam has recruited Dr. Hew-Butler herself to debunk some of the hydration mythology and spread the mantra of #Drink2Thirst

Watch the video, and laugh.  Then check out some of the links in this post that will take you to the consensus statement and podcast and you’ll get more of the hard science from Dr. Hew-Butler.  It might change your thinking, and you may start translating some of this science to how you approach the athletes you manage.

Stay cool out there and #Drink2Thirst!

Fitspo and the Olympics

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With one of my superstar athletes, softball player SB!

I was struck by two newspaper articles I read in the last two days.  I hope with this post mostly to share these articles, and that most of this blog’s readers will read them.  I do not want to provide a lot of my own commentary. I will explain in due course.

The first was published in the New York Times: “For those keeping score, American women dominated in Rio.” The second was shared with me by a friend in the UK, who sent me a Manchester Guardian piece: “Why has women’s fitness become a beauty contest?”

The Times article I am sharing not so much as a proud American* but as a fan of women’s sports and the power of sport to promote health in all its forms, mind, body and spirit.  The medal count for the USA Women’s Team would have seen it rank third in the overall standings (61)  if it had been its own country. The article explores some of the phenomena behind that remarkable performance, among which are the structural supports that empower large numbers of women in the USA to play sport from childhood on through elite sport.  As one of the commentators notes, however, the American dominance largely reflects the relative lack of such structural support throughout much of the rest of  the world: Donna Lopiano, a former executive director of the Women’s Sports Foundation, states, “We have the largest base of athletic development. Our women are going to dominate, not only because of their legal rights but because women in other parts of the world are discriminated against.”

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With another superstar, volleyball player BR.

The Guardian article makes for powerful reading.  This opinion piece also reflects on the positive power of women’s sport, as it quotes the American civil rights leader Susan B. Anthony, who wrote in 1896:  “Let me tell you what I think of bicycling. I think it has done more to emancipate women than any one thing in the world. I rejoice every time I see a woman ride by on a bike. It gives her a feeling of self-reliance and independence the moment she takes her seat; and away she goes, the picture of untrammeled womanhood.”

However, Anna Kessel, the author of the piece, spends most of the article exploring the connections between the Olympics we just saw and the rising #Fitspo movement, a social media phenomenon potentially reducing much of sport to a new body image obsession, one which, typically, disproportionately affects women.  She bemoans the many Olympic moments she saw where commentary about a woman’s sporting performance seemed overshadowed by her appearance or the outfit she wore.

Some of the musings I heard or read during the Olympic fortnight reminded me of Sepp Blatter’s infamous comment about what would make women’s soccer more interesting — ‘tighter shorts’.

As I wrote earlier, that’s the ‘share’. Two articles, well worth reading.  Check them out if you can, and let us know here what you think. Check out the #Fitspo movement on Twitter or Instagram and let us know what you think.

Writing for this blog, I always hope to stimulate a virtual conversation.  As I type these last few words, I am, of course, engaged in a written monologue–in front of my laptop, alone.  And I am painfully aware of my limitations as a straight man in commenting on these issues. When I read these articles, I mostly find myself nodding and, essentially, trying to listen to what the authors have to say.

I would love to hear what you have to say, as well.

*Up North, they are duly proud as well: a colleague from Canada reminds me that that country brought in 22 medals, 16 of which were earned by women.

Boxing in the Olympics

 

Rio de Janeiro - Robson Conceição derrotou na tarde deste domingo o cubano Lázaro Álvarez e vai a final do boxe categoria peso ligeiro. (Fernando Frazão/Agência Brasil)

The new look to Olympic Men’s Boxing  (photo: Fernando Frazão/Agência Brasil)

With summer holidays and work, I will be honest — I have not been watching too much of the Olympics on the television.  I have made a point to watch Michael Phelps’ last (possibly?) Olympic swim and Usain Bolt’s historic 100m gold medal performance.  I am a former track and field athlete myself, and so I also have witnessed Jamaica’s Elaine Thompson win the women’s 100m and South Africa’s Wade van Niekerk set the 400m world record.  I catch up on news in the newspaper when I wake up (for instance, the story of Anna Sofia Botha is possibly the most heartwarming of these Games).  But watching live TV?  Not so much.

Between the track events, I have caught some of the men’s boxing and I, like possibly many of you CJSM blog readers, have been struck by the absence of head protection.  Our world of sports medicine is big, and I’ll confess I had not been aware of the rules changes going into these Olympics regarding the non-use of this protective equipment for men’s boxing:  since the 1984 Los Angeles Olympics, mandatory headgear has been in place for boxers until now, in Rio.

There has been some controversy over this issue — both when it was introduced as a safety measure, and now in 2016 when it has been removed, also for stated safety reasons:  the incidence of concussions is expected to decline without the headgear in place.  The International Boxing Association (AIBA) made this rule change since the Beijing Olympics, and International Olympic Committee (IOC) spokesman Mark Adams is quoted as saying, “AIBA provided medical and technical data that showed the number of concussions is lower without headgear. They have done a lot of research in the last three years. The rule will go ahead for Rio.”

Some of that research has been published in our journal, including this cross-sectional observational study on the use of head guards in AIBA boxing tournaments.   The results of this study show that referees had to stop matches for head injuries more often when boxers were wearing head gear than when they weren’t.  At the end of the day, after integrating all the available current evidence, it was understood that the headgear was not sufficiently protective to prevent concussions (no surprise there: the holy grail of contact sports may be effective, ‘concussion proof’ head protection), and, instead, promoted more frequent hits to the head — a good example of ‘risk compensation’ in injury prevention.

The CJSM study, authored by a group including lead author Michael Loosemore and senior author Julian Bailes, has already generated a fair amount of debate on social media and commentary in the media, including the New York Times.  We have been receiving a fair number of ‘letters to the editor’ regarding the study since these Olympics have begun, and we will be publishing both the letters and the authors’ responses soon.  A robust debate looking at the evidence, and pointing toward where research must head to resolve this issue — that is a ‘contest’ that will extend beyond Rio and into Tokyo, site of the 2020 summer games.  Stay tuned to the blog and to CJSM to stay abreast of this issue.

5 Questions with Dr. Jane Thornton — what is the physical activity prescription?

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Jane Thornton MD, PhD (2nd from left) — Canadian Olympian and Lead Author of CASEM Position Statement

We are having a sit down with Jane Thornton, MD PhD today as part of our recurring  blog offering, ‘5 Questions with CJSM.’  Among many other things, Dr. Thornton is the lead author of the new Canadian Academy of Sport and Exercise Medicine (CASEM) Position Statement on the ‘Physical Activity Prescription.’  This article, published in our July 2016 issue, has already drawn an immense amount of interest — it is currently free, so do not hesitate to check it out and print out/download the PDF to fully appreciate its contents.

Dr. Thornton is an extraordinarily accomplished individual who is finishing up her family medicine/sport medicine training at the University of Western Ontario.  Besides a medical degree, she has earned a Masters and PhD, doing her studies CJSM Associate Editor Connie Lebrun while at the Fowler Kennedy Sports Medicine Clinic.

With the Rio Olympics set to begin in a few days, it is perfect timing to conduct this interview with Dr. Thornton.  While doing all of that academic work noted previously, she was also training for the Canadian national rowing team. She rowed in the 2008 Olympics in Beijing with the Canadian women’s eight.  She knows a thing or two about physical activity, no doubt. In addition to her authorship of the CJSM manuscript, Dr. Thornton has co-created along with Dr. Mike Evans a website about how to #MakeYourDayHarder, advancing the notion that our every day activities offer abundant opportunity to get in meaningful levels of physical activity.

At CJSM, we have had an abiding interest in research on various aspects of physical activity (e.g. check out our recent post on #PEPA16 and Ann Gates, another mentor of Dr. Thornton’s), and so it is with great pleasure that we share with you our ‘chat’ with Jane Thornton.

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1) CJSM: How effective is an ‘exercise prescription’?  What is the evidence for this intervention?

JT: It may sound like common sense that physical activity is good for us, but it has taken us a long time to understand just how important it really is as a component of treatment. When we understand that it can lead to improved clinical outcomes in over 30 different chronic diseases, and can be as effective as medication in many instances (hypertension, stroke, and mild-to-moderate depression, to name a few), then we can’t ignore the fact that it should be something we talk about with our patients.

To best illustrate its effectiveness, though, let’s compare exercise prescription with smoking cessation counseling.  When we examine the number needed to treat (NNT), studies tell us that we need to counsel 50-120 patients to see one patient successfully quit smoking. When it comes to getting one patient to meet the globally agreed upon physical activity guidelines (150 minutes per week of moderate-to-vigorous physical activity), however, that number drops to 12 – meaning we have an incredible opportunity to help patients make a life-changing adjustment in their lives. No one, including me, would argue that smoking cessation counseling is not incredibly important. But given the recent findings that being inactive is almost as bad for you as smoking, we really should be expanding the conversation at each clinical encounter to include exercise.

2) CJSM: What are the barriers to its use?  Why aren’t more physicians actively engaged in giving their patients an exercise prescription?

JT: The most oft-cited barriers are time constraints, lack of education and training, complex comorbidities… and the most honest among us will also bring up the point that we just don’t think patients are motivated enough or willing to change. Interestingly, if we demonstrate a belief in patients, they will usually rise to the challenge. It may also come as no surprise that doctors who are active themselves are also more likely to counsel their patients to be active. A big obstacle in many countries is, of course, remuneration. It’s hard for some to justify time spent counseling on exercise if there is no billing code they can tack on. That one is a tougher nut to crack. Policy makers should take comfort in the fact that the practice of exercise prescription is also cost-effective.

3) CJSM: You are active on Twitter – if you could compose a 140 character Tweet for the CASEM position statement, what would it be?  Read more of this post

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