The Global Sports Medicine Community — the CJSM Summer Podcast

As I write this post, the third round of the US Open Golf tournament is taking place as is Euro2020 (a year after being suspended), and Father’s Day is about to be celebrated in the United States.  That means summer is ‘full on’ in the Northern Hemisphere.

Which also means plenty of folks are taking vacation and it has become hard to track down some authors to join me for a podcast!!!

Lemonade courtesy of Wikimedia

Mixing metaphors:  the old adage has it that you make lemonade out of lemons, and since lemonade is an unofficial drink of summer, you all get a special summer treat with this, the 49th podcast for the journal.

I am using this moment to try out a special podcast format I’ve been toying with in my head.  I’m striking out getting guests for this podcast, and so I’ll serve you up ‘me’ as a guest!

Let me know if you think I’m lemonade….or a lemon!

I’ve been an admirer of the American Journal of Sports Medicine’s ‘5 in 5’ podcast for several years.  The hosts zip through five of the manuscripts in a recent edition of AJSM in approximately five minutes.  It’s a brilliant way to get some snack bite size information and I encourage the readers of CJSM and the listeners of our podcast to check out AJSM’s podcast.

With a tip of a hat to our eminent colleagues at AJSM, I have decided to call today’s podcast “2 in 10”: I’ll walk listeners through two of the studies published in the May 2021 CJSM. The theme for today’s podcast is the truly global nature of CJSM, with the two studies profiled coming from author teams in Israel and Ghana/Germany.

In the spirit of experimentation, I am including the transcript of this podcast at the bottom of this post.

As ever you check out all of our podcast offerings at iTunes  (where you can also subscribe to and comment on the podcasts) and on the main journal’s webpage. 

And finally, as we round the corner toward our 50th podcast, I am more than ever eager to hear from listeners feedback about how we can improve.  Is this new format an enjoyable one? Please be sure again to comment on iTunes or in the comment section here on the blog post.

Cheers to your summer!

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Transcript

Welcome to today’s CJSM podcast – the 49^th in this journal’s history.

With #50 a month or so away, I wanted to try something new this time – I have no guest to interview today.  There’s just yours truly.

I don’t plan on having this as a recurring thing, but I’m open to feedback.  For a long time I have admired the approach taken by a sister journal in the world of sports medicine:  AJSM’s “5 in 5” podcast. 

AJSM offers a mix of podcasts, including some in-depth analyses on their always excellent research offerings.  But on a monthly basis, AJSM does a “5 in 5” podcast, where in five minutes they run down 5 articles in that month’s publication.

I love it. And I encourage you to take a listen.  Today I’ll attempt to do something of the same for the CJSM May 2021 issue.  And I tip the hat to AJSM for the inspiration.  But I won’t be ‘doing’ 5 articles – only two. 

I’d like to start this experiment then with two articles which come from ‘overseas,’ as defined by outside North America, with an acknowledgement of my provincialism.  As an important sidebar, I want to note that it is hard to define geography when one is talking about a journal like CJSM and a publisher like Wolters Kluwer.  Wolters Kluwer is actually trans-Atlantic:  headquartered in the Netherlands and in Philadelphia, in the United States.  And as for CJSM, we were founded by the Canadian Academy of Sport and Exercise Medicine and are the official journal of both CASEM and the American Medical Society for Sports Medicine (AMSSM), with further relationships with affiliated societies in Australiasia (ACSEP) and America (AOASM).  Tricky geography, don’t you think?

But today, I wanted to focus on some work from the broad global community of sports medicine research that informs CJSM.  In 2020, we received manuscripts from 54 countries, and though we did not accept all submissions, contributions from Japan to S. Africa, from Brazil to Sweden, from China to Qatar made it through the various editorial levels to achieve acceptance.  Truly, there is outstanding work being done in sports medicine research across the globe, and I encourage all prospective authors listening to consider CJSM when you are deciding to submit your work. We are a global platform.

The first study I’d like to highlight is a nifty piece of original research from Israel: “The Cardiovascular Reserve Index: A Noninvasive Clinical Insight Into Heat Intolerance.”  Israel has over the years contributed greatly to our understanding of exertional heat illness.  In this study the authors compared 16 male heat intolerant individuals to 79 heat tolerant individuals  using a standard heat-tolerance test (HTT) as their intervention.  They assessed and compared two indices — the dynamic heart rate reserve (dHRR) index and the cardiovascular reserve index (CVRI) – by looking at their ability to predict exercise associated heat intolerance.

The heat tolerance test used is described as walking for a duration of 120 minutes at a rate of 5 km/hour and a gradient of 2% in a climate controlled environment of 40 degrees Celsius and 40% humidity.  Study participants walked with a rectal thermistor in place. HR and BP were measured continuously along with rectal temp. At the conclusion of the test, those individuals with a rectal temperature >38.5 degrees or a heart rate > 150 were defined as having heat intolerance. 

The equations for the dHRR and the CVRI are somewhat complex and interested listeners can go to this podcast’s accompanying blog post at cjsmblog.com for a link to the study to see the equations first hand.

When looking at the two indices’ ability to discriminate between individuals found on this test to be HI or HT, the authors looked at the receiver operating characteristic curve and found the CVRI (with an area under the curve of 93.2%) to be significantly superior to the dHRR (with a value of 76.8). 

I’ll conclude with a borrowing from the authors’own conclusions: “The results suggest that the CVRIA, assessed from noninvasive measurements, can be used as a surrogate index for determining intolerance to heat. More than being a predictor, the CVRI provides a new clinical insight into this condition because it characterizes the efficiency of an individual’s thermoregulatory mechanism and hints that an impaired Cardiovascular reserve may lead to heat intolerance.”

The next study in the May 2021 CJSM I’d like to bring to your attention comes jointly from Ghana and Germany:  “Electrocardiographic and Echocardiographic Findings in Black Athletes:  A General Review.”

We frequently publish reviews – including systematic reviews and meta-analyses – in addition to our regular offerings of individual research studies.  In this General Review the authors used a systematic methodology searching PubMed, Medline and Google Scholar databases through 2017 looking at studies investigating black African/Afro-Caribbean athletes.  Finding 130 studies initially, they winnowed their review down to 16 studies which met pre-selected inclusion/exclusion criteria, including:

• Original articles written in the English language
• Participants were currently competing at levels ranging from amateur to elite levels
• Participants were of black African descent
• Participants were aged 14 to 35 years
• Participants were healthy athletes without any known cardiac disease

Studies involving athletes younger than 14 years and older than 35 years and those involving recreational (non-competitive) athletes were excluded from the review.

As is well known, various ECG and ECHO studies have revealed cardiac morphological adaptations in black athletes that occasionally overlap with phenotypic expression of HCM.  This general review confirms that with the findings

• On ECG that a high proportion (10% to 30%) of black athletes have abnormal ECGs based on standard reading protocols
• On echo, another relatively high proportion (10% to 12%) had borderline abnormal left ventricular wall thickness of 13 to 15 mm.

The authors note that as an increasing # of sporting bodies (including the IOC and FIFA) recommend screening ECG and echo in an attempt to decrease the incidence of sudden cardiac arrest or death during sport that special attention needs to be paid to black athletes in order to avoid unnecessary exclusion from sport.

I want to draw the interested listener’s attention to an open access educational initiative sponsored by the University of Washington and one of our partner societies, ACSEP, where one can learn more about  ECG interpretation, with special attention to the athletes’ heart.  The link to the “e-academy”—uwsportscariology.org/e-academy/ will be found in this podcast’s liner notes in the blog

As I wrap up, I want to remind listeners on our iTunes platform to please rate us and comment on the program.  The feedback is very helpful to us. I hope you’ve enjoyed this experiment today with ‘me’ as guest.  But worry not:  I have some special guests lined up for some upcoming podcasts.

 As we reach something of a milestone with our 50^th podcast, I want to thank you for joining us on our journey.  Remember to go to cjsportmed.com to check out the newest in the journal, cjsmblog.com to check out our blog posts, and @cjsmonline to follow us on twitter.

Any way you engage with CJSM, we hope you join us again, real soon.