The surf was up at ACSEP 2017

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Let the koalas sleep — you won’t be doing much of that if you attend an ACSEP conference

One of the highlights of my 2016 was my first visit to the Australasian College of Sport and Exercise Physicians (ACSEP) annual meeting.  I wrote about the experience in several of these CJSM blog posts.

ACSEP is one of CJSM’s affiliated societies, and we greatly value our relationship with the college.  Two of our Associate Editors are members of the college: Hamish Osborne (NZ) and Steve Reid (AUS).

On a personal note, I also greatly valued the experience of attending the meeting. The venue (Surfer’s Paradise) was stunning — just the ticket for someone muddling through a Northern Hemisphere winter.  And the proceedings themselves — well, they were little short of perfect.  From the educational sessions to the food and social events — first class, all the way.

ACSEP 2016 was, without a doubt, one of the best sports medicine conferences I have ever attended.

I couldn’t make the 2017 edition, which also took place in Surfer’s Paradise. What was my misfortune turned out to have a pleasant side-effect, as Dr. Osborne was in attendance, and he graciously penned this letter giving an overview of the proceedings:

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ACSEP has been and gone and my promised blog post is now a thank you to all those who attended clearly our biggest but also our best-ever annual scientific conference. I arrived early, actually before most registrars as it turned out, to meet and greet and enjoy the excellent presentations from our new intake of trainees. The bar is going up and up. Looking forward to increasing research contributions from this group as they come through.

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Hi hon, really busy at the ACSEP meeting

The first afternoon of the conference was up there with perhaps the best series of 4 keynotes on SEM that I have ever heard. Read more of this post

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A Twitter Journal Club

casemI want to alert you to a very interesting innovation which was instituted at the end of 2016 and will continue into this new year:  the Canadian Academy of Sport and Exercise Medicine (CASEM) Twitter-based journal club.

You read that right — a journal club, on Twitter.

We’re all familiar with journal clubs.  In fact, the fellowship in which I teach (Nationwide Children’s Hospital Sports Medicine) just completed its monthly journal club yesterday, with the fellow (sports medicine physician in training, Jonathan Napolitano) leading the group of doctors through a study published in our January 2017 CJSM: Reliability Testing of the Balance Error Scoring System in Children Between the Ages of 5 and 14.

I recently wrote of the vital, and increasing, importance social media plays in the dissemination of sports medicine research.  A Twitter journal club is an example of that phenomenon.

The CASEM Journal Club just got off the ground at the end of 2016, and had as its first selection another CJSM study: Physical Exam Risk Factors for Lower Extremity Injuries in High School Athletes:  A Systematic Review. Seems like both CASEM and I found this to be particularly intriguing.  To wit, I cajoled the lead author of that study, Jimmy Onate, into recording a podcast with me.  And then he pulled duty on the CASEM Journal Club as the guest author, interacting on Twitter with folks from around the globe.  What a great opportunity — to get to ask the author directly the questions one has after reading his/her study.

The study for this month’s CASEM journal club is the same one we deconstructed in our fellowship yesterday:  the reliability of the BESS in a pediatric population  It hits close to my heart.   Read more of this post

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

Doctor, Doctor — Give Me the News!

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CJSM at CASEM 2014 with Pierre Fremont [L], former CASEM President & one of the authors in the new CASEM Position Statement

CJSM has always had a close relationship with the Canadian Academy of Sport and Exercise Medicine (CASEM).  CASEM is, after all, our mother — we were ‘born’ 25+ years ago as the “Canadian Journal of Sport Medicine.”   In the journal, on the podcasts and on these blog pages, CASEM shows up frequently.

Something else that shows up frequently in CJSM media:  research on the benefits of physical activity.  And so it’s not surprising to see in our current issue that CASEM is taking a hard look at the issue of “Exercise is Medicine” and is publishing with CJSM (and other journals) a position statement on the “Physical Activity Prescription:  A Critical Opportunity to Address a Modifiable Risk Factor for the Prevention and Management of Chronic Disease.”

The list of authors involved is a list of sports medicine heavyweights, including several MD/PhDs who have a presence on social media:  if you are not currently following folks like lead author Jane Thornton MD, PhD and former CASEM President Pierre Frémont MD, PhD and BJSM Editor-in-chief Karim Khan MD, PhD….you should.

These ‘doctor doctors,’ as I like to call my colleagues who have fought the good fight to earn an MD and a PhD, have produced a powerful statement that will have significant influence on how physicians can play a role in addressing the worldwide crisis of sedentary behavior.  The global problem of inactivity especially in children has been an ongoing concern of mine, and it has puzzled me that when I have spoken on this issue I frequently find that physicians feel as if they are on the sideline of this battle.  We collectively throw up our hands and say the problem is too big, or it’s not a clinical medicine problem it’s a public health issue.

But our patients are looking to us for guidance on this issue.  They really do ‘want the news.’ As the authors note in the position statement, “Over 80% of Canadians visit their doctors every year and prefer to get health information directly from their family physician. Unfortunately, most physicians do not regularly assess or prescribe physical activity as part of routine care,  and even when discussed, few provide specific recommendations.

They continue, “Physical activity prescription has the potential to be an important therapeutic agent for all ages in primary, secondary, and tertiary prevention of chronic disease.”  Indeed, Robert Palmer, the singer of “Bad Case of Loving You (Doctor, Doctor)” fame, could not have known how prescient he was when he penned the lyrics, “no pill’s gonna cure my ill…..”  He was talking about love, but he may as well have been talking about the chronic diseases associated with physical inactivity. Prescribing a pill won’t cure this ill: the physical activity prescription, delivered and acted upon, is required.

The beauty of this position statement is that it gives evidence-based tools that primary care physicians as well as sports and exercise medicine physicians can use in their practice to stem the tide of the inactivity epidemic.  I know this statement will be widely read and disseminated; it will be referenced frequently.  I am looking forward even more to seeing its principles put in action by me and my colleagues, around the world–both in our clinics and in the venues where we train future physicians.

Look it over now.  It’s free!  What’s stopping you?

 

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