May Day

Unisphere-cc

CJSM: bringing you clinical sports and exercise medicine research, from around the globe

Whether you are celebrating today as International Workers’ Day, running around a May pole, or watching Leicester City try to complete the 5000:1 shot of winning the Premiership, we are sure that today, May 1, can only be a good day:  our third issue of the year has just published.  And this May Day CJSM is full of offerings we’re sure will be of  interest to you.

Two of the articles have a special focus on physical activity as an intervention for medical conditions — one is a meta-analysis from Chinese colleagues finding a protective effect for physical activity against lung cancer, and the other is a prospective, single-blinded, randomized clinical trial looking at rock climbing as an intervention in the treatment of low back pain. This study is from Austria, and had positive findings for dependent measures of disability (the Oswestry Disability Index), a physical examination maneuver, and even the extent of disc protrusion on MRI.  We’re proud to publish these high quality studies from across the globe.

We are also proud to contribute to the growing body of literature on the effectiveness of “Exercise is Medicine.” Read more of this post

Osteoarthritis: Part I

I’ve been an Associate Editor for CJSM now for six months, and so some of you in the blog world may already know a little bit of my background as it has come out over time in my various posts.

For those of you who may be new readers of this blog, I thought for today’s post it was important for me to let you know that I work at Nationwide Children’s Hospital, the pediatric hospital affiliate of Ohio State University, and my specialty is pediatric sports medicine.

So……I don’t manage a lot of osteoarthritis (OA) in my current practice.

ocd of knee jpeg

Adult OCD of the knee,
unstable lesion: destined for osteoarthritis?

However, I didn’t narrow my clinical scope of practice to the younger crowd until 2010, and I have managed my fair share of OA in my career, injecting plenty of knees with hyaluronic acid derivatives, encouraging weight management and low impact exercise…….Now, I suppose I’m more on the end of the spectrum of primary prevention of the disease: if I manage my young patients’ knee osteochondritis dissecans properly, perhaps I can spare them from degenerative joint disease later in life.

I’m not telling anyone reading this something they don’t know already when I write that career paths are varied in modern medicine.  There’ s no telling if I’ll be taking care of kids exclusively in 10 years.  We all have mandates from Certification Boards requiring us to stay abreast of the current medical literature; we’re tested on it every few years now, as Maintenance of Certification is a phenomenon here to stay.  Forces like these make it incumbent that I read and ‘stay on top of’ developments in the world of OA diagnosis and management, even if I am not seeing much of this disease in my current practice.

After all, OA is the leading cause of chronic disability among older adults in the United States.  That’s a disease worth knowing about.

I thought, therefore, that I would share with you a couple of interesting studies that have come out recently on major issues in the world of osteoarthritis.  Both studies were just published within the last month:  the first, “Shared Decision Making in Patients with Osteoarthritis of the Hip and Knee,”  published in the Journal of Bone and Joint Surgery (JBJS), I will discuss in my next blog post.  And the second, “Effects of Intensive Diet and Exercise on Knee Joint Loads, Inflammation, and Clinical Outcomes Among Overweight and Obese Adults with Knee Osteoarthritis,” published in the Journal of the American Medical Association (JAMA), I will review now.   They are both large, high quality evidence (Level 1) studies which focus on low tech, low cost interventions that have the potential of having major clinical impact.  They are both studies primary care sports/MSK clinicians like myself might be expected to be aware of. Read more of this post

ACSM Annual Meeting in Indianapolis

Dan_Gurney_&_Crosthwaite

Vintage Indy 500: Dan Gurney

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.

Read more of this post

Sport and Exercise Medicine – A Fresh Approach. Guest blog by Dr Richard Weiler

Sport and Exercise Medicine (SEM) has been evolving rapidly around the globe and is gaining mainstream recognition. In the United Kingdom it formally began life in 2005, when the Chief Medical Officer at the time, Liam Donaldson, pledged to develop the specialty as a commitment to the London 2012 Olympics. 2012 has arrived and the specialty of Sport & Exercise Medicine is slowly gaining a foothold in the publicly funded UK National Health Service (NHS).

In the UK, we now have an established Faculty of Sport & Exercise Medicine and a fairly comprehensive and evolving 4-year specialist training programme . There are currently about 50 specialist trainees in training across the country and about 10 doctors have become specialists in SEM in the last couple of years.

Challenging economic climates have resulted in new measures being implemented by the Government. ‘Market forces’ have been suggested as a means to ensure that funds are targeted locally and efficiently for patient needs. This has resulted in an urgent need for the fledgling SEM specialty to justify its existence and demonstrate patient benefit and cost effectiveness in order to establish new SEM services and maintain existing services. This is not easy for a specialty that has existed for only a few years. A major obstacle when speaking to those holding the funds is the lack of understanding about what SEM specialists can offer the NHS. Is it about elite sport, athletes and the Olympics or is it about exercise, gyms and running?

The truth is mostly ‘none of the above’ for the general population, so late in 2011 we published an NHS Information Document explaining what an SEM specialist offers the NHS and NHS patients. This is broadly based on education, research, musculoskeletal, sports medicine, physical activity for prevention of chronic disease and physical activity prescribed in the treatment of chronic disease (exercise medicine).

We hope that this peer reviewed NHS Information Document, endorsed by all the key UK organisations in the SEM field, will be helpful to our colleagues and fellow multidisciplinary team members both in the UK and around the world.

The rest as they say is history, or in the wise words of Master Yoda “Always in motion is the future.”

The publication involved the collaboration of too many people to thank individually, but the co-authors, whom were all SEM trainees at the time of writing, all deserve individual mention (in no particular order). Natasha Jones, Kate Hutchings, Matt Stride, Ademola Adejuwon, Polly Baker, Jo Larkin and Stephen Chew.

Dr Richard Weiler is an Honorary Consultant in Sport and Exercise Medicine based at  University College London Hospitals Foundation Trust, London, UK

Leave a Comment

Leave a Comment

%d bloggers like this: