ACSM Annual Meeting in Indianapolis
May 30, 2013
Indianapolis: home of the Indy 500, that just took place last Sunday, and this week home of the 60th Annual Meeting of the American College of Sports Medicine (ACSM).
I’ve already enjoyed a couple of great days here, and I wanted to share some of the high points.
First, I attended a session on exercise therapy and youth, cleverly entitled, “Linking Health Care with Fitness Care in Youth to Prevent Generation XXL.” The session was organized as a series of talks given as part of ACSM 2013 and the concurrently run 4th World Congress on Exercise is Medicine. Among the speakers was Avery Faigenbaum, EdD, a professor of pediatric exercise science whom I have heard speak on several occasions over the years.
He is always a scintillating speaker. Much of his work over the years has involved demonstrating the safety and effectiveness of resistance training in youth. His talk here as part of this session took on a different subject: “Exercise Deficit Disorder in Youth: Challenging Traditional Dogma.” If you have not heard of “Exercise Deficit Disorder” (EDD) before, you will be hearing more about it in the future.
Dr. Faigenbaum has developed the term to acknowledge the well-known but stubbornly persistent observation that kids in America, and around the world, are falling well short of the American Academy of Pediatrics stated goal of 60 minutes of moderate- to vigorous-physical activity per day. In the spirit of primary prevention, he put forth the notion in his talk that we have come to recognize notions such as ‘hypertension,’ ‘impaired fasting glucose,’ and ‘dyslipidemia,’ as treatable–and billable–clinical entities that arguably are truly risk factors more than disease states. There are end stage diseases that we clinicians are attempting to prevent–stroke, cardiovascular disease, renal disease, etc.–when we treat these conditions. In addition, when we treat these antecedent conditions, we can code (ICD-9, soon to be ICD-10 in the USA) and receive reimbursement.
Dr. Faigenbaum extends the logic to the well-known deficit in physical activity in kids that has a clear connection to a variety of disease states later in life–including cardiovascular disease, diabetes, and even osteoarthritis. He shared disturbing data about just how infrequently we clinicians in the U.S. counsel youth and families about exercise. He argues, compellingly, that we need to identify and track EDD as a means for preventing these later stage diseases, and that we are failing our mission as clinicians when we do not use such primary prevention concepts in addressing this public health crisis.
However, rather than have me distill his work second-hand, I’m excited to report I have been able to induce Dr. Faigenbaum to write a guest blog in the next month or so where he can share directly with the readership his thoughts on this important area of sports and exercise medicine. So keep your eyes open here and in the medical literature for more about EDD.
Soon enough, I had to turn attention to my own lecture, which I gave with my good friend Peter Kriz, M.D., a Clinical Assistant Professor of Medicine and Team Physician at Brown University, in Providence, Rhode Island. We delivered an overview of common foot and ankle injuries entitled “Beyond Ankle Sprains: Managing Foot and Ankle Conditions in the Pediatric Athlete.” It’s always great to do this sort of work, as both Peter and I see large volumes of pediatric athletes and enjoy the diagnostic challenges these youngsters can pose.
My only disappointment in giving this talk was that it ran concurrent with a lecture on the BokSmart program, South African Rugby’s injury intervention program. One of the leads in BokSmart is Jon Patricios, President of the South African Sports Medicine Association. I have enjoyed Dr. Patricios’ talks over the year; they are typically delivered with wit and erudition.
My disappointment lasted but a brief moment: though I missed the BokSmart session I found that Dr. Patricios was subsequently chairing a symposia I could attend: “Zealous from Zurich! Collaborative Concussion Consensus–Realising Return to Play,” where a series of panelists including Margot Putukian, Stan Herring, Kevin Guskiewicz, and Dr. Patricios were all sharing different dimensions of the contributions they made to the recent 4th International Concussion Consensus Statement developed in Zurich and published in the March 2013 issue of CJSM.
I walked away from that symposia realizing just how little we know still about this high-profile injury. We have some evidence for instance that certain factors may modify the disease process: for instance, it appears that younger age, female gender, history of multiple concussions, and history of co-morbidities such as migraines all are positively correlated with worse concussion prognosis. But when you get right down to the nitty gritty, we are still in the dark: I think most readers would treat a 25 year old male who just had his first concussion playing rugby differently than a 14 year old girl with a history of ADD and migraines, who has had 3 concussions playing soccer previously and just had her fourth. But precisely how should we treat them differently? Where is the hard evidence that would suggest she may require weeks as opposed to days of a return to play progression?
It’s still really the “Wild West,” where we clinicians are like lone cowboys often making our own rules in the clinic. Oh, it’s getting tamer–I dare say none of us send someone back on to the pitch in the second half if we suspected they suffered a concussion in the first–but I would suspect many of the details of how I might subsequently treat that athlete would vary widely with other clinicians’ approaches. And we just really don’t know right now in any significant detail what is best practice.
Or perhaps I’m being too pessimistic. If you’re reading this blog, share your thoughts. If you have been attending ACSM 2013, what have been your favorite sessions? What are your thoughts about concussions or about the novel concept of Exercise Deficit Disorder. Let me know, or tweet me @cjsmonline.