The latest medical research on Sports & Exercise Medicine

The research magnet gathers the latest research from around the web, based on your specialty area. Below you will find a sample of some of the most recent articles from reputable medical journals about sports & exercise medicine gathered by our medical AI research bot.

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Small Steps in Fitness, Major Leaps in Health for Adults with Intellectual Disabilities.

Exercise and Sport Sciences Reviews

Physical fitness is positively related to health outcomes like morbidity and all-cause mortality, with minimally required cut-off values to generat...

Location of Intra- and Extra-articular Hip Impingement Is Different in Patients With Pincer-Type and Mixed-Type Femoroacetabular Impingement Due to Acetabular Retroversion or Protrusio Acetabuli on 3D CT-Based Impingement Simulation.

Am J Sports Med

Diagnosis and surgical treatment of hips with different types of pincer femoroacetabular impingement (FAI), such as protrusio acetabuli and acetabular retroversion, remain controversial because actual 3-dimensional (3D) acetabular coverage and location of impingement cannot be studied via standard 2-dimensional imaging. It remains unclear whether pincer hips exhibit intra- or extra-articular FAI.

(1) To determine the 3D femoral head coverage in these subgroups of pincer FAI, (2) determine the impingement-free range of motion (ROM) through use of osseous models based on 3D-computed tomography (CT) scans, and (3) determine the osseous intra-and extra-articular 3D impingement zones by use of 3D impingement simulation.

Cross-sectional study; Level of evidence, 3.

This is a retrospective, comparative, controlled study involving 70 hips in 50 patients. There were 24 patients (44 hips) with symptomatic pincer-type or mixed-type FAI and 26 patients (26 hips) with normal hips. Surface models based on 3D-CT scans were reconstructed and compared for hips with acetabular retroversion (30 hips), hips with protrusio acetabuli (14 hips), and normal asymptomatic hips (26 hips). Impingement-free ROM and location of impingement were determined for all hips through use of validated 3D collision detection software based on CT-based 3D models. No abnormal morphologic features of the anterior iliac inferior spine were detected.

(1) Mean total femoral head coverage was significantly (P < .001) increased in hips with protrusio acetabuli (92% ± 7%) and acetabular retroversion (71% ± 5%) compared with normal hips (66% ± 6%). (2) Mean flexion was significantly (P < .001) decreased in hips with protrusio acetabuli (104°± 9°) and acetabular retroversion (116°± 6°) compared with normal hips (125°± 13°). Mean internal rotation in 90° of flexion was significantly (P < .001) decreased in hips with protrusio acetabuli (16°± 12°) compared with normal hips (35°± 13°). (3) The prevalence of extra-articular subspine impingement was significantly (P < .001) higher in hips with acetabular retroversion (87%) compared with hips with protrusio acetabuli (14%) and normal hips (0%) and was combined with intra-articular impingement. The location of anterior impingement differed significantly (P < .001) between hips with protrusio acetabuli and normal hips.

Using CT-based 3D hip models, we found that hips with pincer-type and mixed-type FAI have significantly larger femoral head coverage and different osseous ROM and location of impingement compared with normal hips. Additionally, intra- and extra-articular subspine impingement was detected predominantly in hips with acetabular retroversion. Acetabular rim trimming during hip arthroscopy or open surgical hip dislocation should be performed with caution for these hips. Patient-specific analysis of location of impingement using 3D-CT could theoretically improve diagnosis and planning of surgical treatment.

The Concept of Sport Sampling Versus Sport Specialization: Preventing Youth Athlete Injury: A Systematic Review and Meta-analysis.

Am J Sports Med

The prevalence of youth athletes specializing in 1 sport has been increasing over the past decade. Subsequently, the rate of youth athlete injury has also been increasing. It is possible that an association exists between youth specialization and sports injury rate.

To determine if sport sampling is associated with a lower sports injury rate in youths compared with youths who specialize in 1 sport.

Systematic review and meta-analysis.

A systematic review was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using PubMed, Embase, and the Cochrane library. Inclusion criteria included studies written in the English language, studies with athletes between 7 and 18 years of age, studies that report injury rates, and studies that specify if athletes were sport samplers or specialized in a sport. Data relevant to this study, including injuries and patient characteristics, were extracted and statistically analyzed.

The initial search identified 324 studies, 6 of which met inclusion criteria. From these 6 studies, the total participant number was 5736. Of those, 2451 (42.7%) were "sport samplers," 1628 (28.4%) were "sport specializers," and 1657 (28.9%) were considered "others" (ie, could not be classified as true samplers or true specializers). The average age of all the athletes was 14.6 years (range, 7-18 years). Sport specializers had a significantly higher injury risk than the sport samplers (RR, 1.37; 95% CI, 1.19-1.57; P < .0001). There was a higher risk of injury in the "others" group when compared with the "sport sampler" group (RR, 1.21; 95% CI, 1.14-1.29; P < .0001). There was a higher risk of injury in the "sport specializer" group over the "others" group (RR, 1.09; 95% CI, 1.04-1.14; P < .005).

Sport sampling is associated with a decreased risk of sports injury in youth athletes when compared with those who specialize in 1 sport. Injury rates increase as a youth athlete becomes increasingly specialized. Youth athletes would benefit substantially from participating in sport sampling.

Repair of a Meniscal Defect in a Rabbit Model Through Use of a Thermosensitive, Injectable, In Situ Crosslinked Hydrogel With Encapsulated Bone Mesenchymal Stromal Cells and Transforming Growth Factor β1.

Am J Sports Med

Meniscal injury repair with tissue engineering technique is promising. Among various scaffolds, the thermosensitive injectable hydrogel has recently attracted much attention.

(1) Evaluate the biocompatibility of thermosensitive, injectable, in situ crosslinked hydrogel and (2) determine whether the hydrogel with or without transforming growth factor β1 (TGF-β1) could support the fibrochondrogenic differentiation of bone mesenchymal stromal cells (BMSCs) and promote the repair of a critical-sized defect in rabbit meniscus.

Controlled laboratory study.

The rheological and sustained release properties of the hydrogel were demonstrated. BMSCs were isolated and cultured. Cell viability, quantitative polymerase chain reaction (qPCR), and Western blot were tested in vitro. In vivo, a critical-sized defect was introduced into the meniscus of 30 rabbits. Each defect was randomly assigned to be implanted with either phosphate-buffered saline (PBS); BMSC-laden hydrogel; or BMSC-laden, TGF-β1-incorporated hydrogel. Histological and immunohistochemical analyses were performed at 8 weeks after surgery. The Ishida scoring system was adopted to evaluate the healing quantitatively.

The elastic modulus of the hydrogel was about 1000 Pa. The hydrogel demonstrated a sustained-release property and could promote proliferation and induce fibrochondrogenic differentiation of BMSCs after the incorporation of TGF-β1 (P < .001). At 8 weeks after surgery, a large amount of fibrocartilaginous tissue, which was positive on safranin-O staining and expressed strong type II collagen intermingled with weak type I collagen, was observed in the defect region of the BMSC-laden, TGF-β1-incorporated hydrogel group. In the BMSC-laden hydrogel group, the defect was filled with fibrous tissue together with a small amount of fibrocartilage. The mean ± SD quantitative scores obtained for the 3 groups-PBS; BMSC-laden hydrogel; and BMSC-laden, TGF-β1-incorporated hydrogel-were 1.00, 3.20 ± 0.84, and 5.00 ± 0.71, respectively (P < .001).

The hydrogel was biocompatible and could stimulate strong fibrochondrogenic differentiation of BMSCs after the incorporation of TGF-β1. The local administration of the BMSC-laden, TGF-β1-incorporated hydrogel could promote the healing of rabbit meniscal injury.

This hydrogel is an alternative scaffold for meniscus tissue engineering.

Morphological Changes of the Femoral Tunnel and Their Correlation With Hamstring Tendon Autograft Maturation up to 2 Years After Anterior Cruciate Ligament Reconstruction Using Femoral Cortical Suspension.

Am J Sports Med

Graft healing within the femoral tunnel after anterior cruciate ligament reconstruction (ACLR) using suspensory fixation could be reflected in graft maturation and tunnel morphological changes. However, the correlation between graft maturation and femoral tunnel changes remains unclear.

To quantitatively evaluate femoral tunnel morphological changes and graft maturation and to analyze their correlation after ACLR using femoral cortical suspension.

Case series; Level of evidence, 4.

Patients who underwent single-bundle ACLR with a hamstring tendon autograft using femoral cortical suspension were included. Preoperative and postoperative (at 6, 12, and 24 months) knee function were evaluated using KT-1000 arthrometer testing, the Lysholm knee scoring scale, and the International Knee Documentation Committee (IKDC) questionnaire. At 1 day, 6 months, 12 months, and 24 months after ACLR, 3-dimensional magnetic resonance imaging was performed to observe the morphology of the femoral tunnel and to evaluate graft maturation using the graft signal/noise quotient (SNQ). The Pearson product moment correlation coefficients (r) of femoral tunnel radii versus clinical outcomes and graft SNQs at last follow-up were analyzed.

A total of 22 patients completed full follow-up. KT-1000 arthrometer, Lysholm, and IKDC scores improved over time postoperatively, but no significant improvement was seen after 12 months (P < .05). The radius of the tunnel containing the graft and the SNQs of the femoral intraosseous graft and intra-articular graft were the highest at 6 months, and they decreased by 24 months but remained higher than their 1-day postoperative values (P < .05). Expansion mainly occurred at the anteroinferior wall of the femoral tunnel. The tunnel aperture radius was positively correlated with SNQs of the intraosseous graft (r = 0.591; P < .05) and intra-articular graft (r = 0.359; P < .05) but not with clinical outcomes.

After ACLR using suspensory fixation, morphological changes of the femoral tunnel were mainly observed in the part of the tunnel containing the graft, which expanded at 6 months and reduced by 24 months. Expansion mainly occurred at the anteroinferior wall of the femoral tunnel. Femoral tunnel expansion was correlated with inferior graft maturation but not with clinical outcomes.

Improving access to digital ulcer care through nurse-led clinic: a service evaluation.

Musculoskeletal care

Digital ulcers (DU) remain one of the most burdensome co-morbidities in systemic sclerosis. The objectives of the study were to describe patient-level stratification and to evaluate a nurse-led DU clinic service development.

A nurse-led digital ulcer clinic was established to identify patients with DU and manage them. Patients were recruited through scleroderma clinics, GP referrals, and self-referrals. The clinic involved patients being treated with appropriate treatment. Patients were stratified according to their DU risk level based on number and severity of ulcers. Among these, 22 patients were asked to complete a patient satisfaction survey. Data were analyzed descriptively.

Seventy-five patients were seen in the clinic, 46 (61%) were 56 years of age and above. Patients were identified as high (23%), medium (51%) or low risk (26%) for development of DU. The duration of DU history was from 7 months to 40 years. Prior to attending the nurse-led DU clinic, 90% of patients had received up to six courses of antibiotics for their DU, 76% had attended A&amp;E, and 90% had unscheduled appointments. 90% had been seen by the GP due to DU and subsequently required hospital admissions. During the nurse-led clinic follow-up, only two patients had emergency admission. All patients reported that their needs in personal care of DU were met.

There are a significant number of people with SSc who have DUs affecting their quality of life as well as needing more healthcare services. A dedicated specialist nurse-led DU clinic may improve overall care of patients.

Recovery despite everyday pain: Women's experiences of living with whiplash-associated disorder.

Musculoskeletal care

Living with whiplash-associated disorders (WAD) means living every day under the influence of pain and limitations. As the incidence of WAD and the related intensity of pain are somewhat higher among women than men, the aim of the present study was to describe women's experiences of living with WAD.

A purposive sample of seven women participated in individual in-depth qualitative interviews, the transcripts of which were subjected to qualitative content analysis.

The results of the analysis suggested six themes of women's experiences with WAD: living with unpredictable pain; trying to manage the pain; living with limitations; being unable to work as before; needing support and understanding; and learning to live with limitations. The findings showed that unpredictable pain limited women's strength to engage in activities of daily life and be as active as before. Support and understanding were important for their ability to manage changes in their daily lives.

Pain considerably affects the daily lives of women with WAD, particularly by limiting their ability to perform activities and to enjoy their professional and social lives. As women with WAD need support with managing their daily lives, nurses and other healthcare personnel should adopt a person-centred approach, in order to support such women according to their individual needs and circumstances.

An exploration of physiotherapists' perceived benefits and barriers towards using psychosocial strategies in their practice.

Musculoskeletal care

This study aimed to determine what physiotherapists perceive are the benefits of using psychosocial strategies in their own practice, and whether perceived barriers extend beyond practitioner and contextual barriers.

Content analysis of two open-ended questions was conducted. Australian physiotherapists (n = 206) provided written comments.

Three key categories of benefits emerged: patient benefits, shared patient and physiotherapist benefits, and physiotherapist benefits. Patient benefits included improved rehabilitation experience, improved patient wellbeing and improvement of psychosocial responses. Specifically, increased patient enjoyment, improved self-management and improved understanding of the links between their physical and psychological health. Therapeutic alliance appeared as a shared patient and physiotherapist benefit, with specific reference to enhanced partnerships and improved patient-centred practice. Physiotherapist benefits comprised of improved needs assessment and occupational benefits such as reduced load. Three key categories of physiotherapist barriers, contextual barriers, and patient barriers emerged. Time, knowledge, confidence, lack of expertise, and limited formal training, were the main barriers, specifically a lack of practical training, and for more complex strategies. Physiotherapists acknowledged patient barriers such as patient resistance, lack of understanding, and complex mental health needs.

These findings contribute novel information with regard to the benefits and barriers of psychosocial approaches from a physiotherapist perspective. Physiotherapists may benefit from further support in their use of psychosocial approaches, to emphasize the benefits for their own practice. Furthermore, to potentially reduce patient barriers and improve outcomes, patient education concerning a biopsychosocial model of care could be valuable.

Ability of the Bristol Impact of Hypermobility questionnaire to discriminate between people with and without Joint Hypermobility Syndrome: a known-group validity study.

Musculoskeletal care

A number of psychometric properties of the Bristol Impact of Hypermobility (BIoH) questionnaire have previously been demonstrated, including strong concurrent validity and test-retest reliability. This study aimed to identify whether it can discriminate between those with and without Joint Hypermobility Syndrome (JHS).

The wording of a small number of BIoH questionnaire items was adapted to create a generic version that asked about 'general health' rather than 'hypermobility'. The generic questionnaire was distributed online to university students and staff. A sampling frame was used to create age and sex-matched samples from the non-JHS respondents in the current study and a pre-existing JHS cohort. Questionnaire scores were then compared between samples.

790 responses were received. 414 were excluded, mainly due to self-reported generalized joint hypermobility or a JHS diagnosis. The sampling frame was applied to the remaining non-JHS responders (n = 376) and the pre-existing JHS cohort (n = 448), resulting in 206 age and sex-matched participants in each sample. The median (IQR) BIoH scores (out of a maximum 360) were 81 (57.25) and 231.5 (74.25) in the non-JHS and JHS samples respectively (p < 0.001). There was a very strong correlation between BIoH score and the number of painful areas (r = 0.867, p < 0.001).

The BIoH questionnaire discriminates between those with and without JHS. The median difference (151.5 points) far exceeds the smallest detectable change of 42 points previously identified. The results provide further evidence of the psychometric properties of the BIoH questionnaire and its potential to support research and clinical practice.

A Randomized Community-based Exercise Training Trial in African American Men: Aerobic Plus Resistance Training and Insulin Sensitivity in African American Men.

Medicine and Science in Sports

To examine the impact of a community-based exercise training intervention on cardiometabolic outcomes in African American men who have a family history of type 2 diabetes.

The Aerobic Plus Resistance Training and Insulin Sensitivity in African American Men (ARTIIS) study randomized participants into either an exercise training intervention or an information only control group for 5 months. The exercise training intervention consisted of 150 min of moderate intensity aerobic activity and 2 d of resistance training per week, consistent with the current federal physical activity guidelines. Participants in the control group received monthly newsletters featuring topics focused heavily on type 2 diabetes education and prevention. Outcome data were analyzed using repeated-measures ANCOVA models and incorporating both intention-to-treat and per-protocol principles.

Adherence to the aerobic and resistance training prescriptions were between 77% and 79%. Despite significant within group improvements in glucose and insulin levels (fasting, 2 h, 2 h minus baseline) and Homeostatic Model 2-Insulin Resistance, there were not significant between group differences. There was a marginally significant between group difference for Homeostatic Model 2-Beta (P < 0.06), and significant between group differences in peak cardiorespiratory fitness (P < 0.001) and waist circumference (P = 0.03).

These findings suggest that exercise training in accordance with the current national recommendations is effective in improving some health parameters in middle-age African American men who have a family history of type 2 diabetes, but did not have a significant impact on glycemic status.

Feasibility and Effects on Muscle Function of an Exercise Program for Older Adults.

Medicine and Science in Sports

Study objective was to determine feasibility and compliance with a 3-month exercise intervention in older adults, and if peripheral quantitative computed tomography muscle measures and jumping mechanography could detect changes in muscle mass and function.

A parallel group, nonblinded, pilot trial with individuals 70 yr or older randomized to control group of walking-only (WALK) or an intervention group of walking combined with exercises to improve balance and strength (W + EX). Both groups attended similar weekly nutrition education sessions. Body composition, muscle density, intramuscular adipose tissue area, and muscle function were assessed before and after the intervention using dual-energy x-ray, peripheral quantitative computed tomography, functional tests, and mechanography.

Eighty-five (90%) of 94 individuals enrolled completed (41WALK, 44W + EX). Eighty-six percent of participants attended seven or more nutrition sessions, and log sheets, used to assess exercise compliance, were returned by 66% of participants, and of those, 88% logged activity on 50%+ days. Sixty-seven percent of participants stated that they increased activity levels, and 82% stated that they felt better overall. Both groups increased lean and lost fat mass, resulting in decreases in fat percentage (all, P < 0.05). Intramuscular adipose tissue area decreased and muscle density increased among WALK (P < 0.05 and P = 0.056, respectively) but were not different between groups. Improvement in force efficiency and chair-rise power were greater among W + EX group than WALK (5.9% ± 1.8% vs -1.2% ± 2.0% [P = 0.01] and 0.25 ± 0.19 W·kg and -0.37 ± 0.23 W·kg [P = 0.04], respectively). Differences in mechanography results became greater in a per-protocol analysis.

A larger trial is feasible, and the program was well accepted. Both groups showed improvements, the program that included strength and balance lead to greater jump force efficiency and power than walking only. Whether these differences lead to differences in fall rates need to be determined in a larger trial.

Body Composition as a Mediator between Cardiorespiratory Fitness and Bone Mass during Growth.

Medicine and Science in Sports

To examine the effect of cardiorespiratory fitness (CRF) and muscle power output (MPO) on bone mass of prepubertal and pubertal children using lean mass (LM) and percentage of fat mass (%FM) as mediator variables. The hypothesis was that both LM and %FM would be independent mediators of the relationships during the sexual maturation period.

We analyzed 200 children (88 boys and 112 girls [11.5 ± 2.0 yr]). Body composition was analyzed by bone densitometry, and indirect calorimetry and cycle ergometer were used to calculate V˙O2peak (mL·kg·min) and MPO (W) during an incremental exercise test. Sample was divided by pubertal status.

In the prepubertal group, LM and %FM acted independently as mediators in the relationship between bone mass and CRF or MPO (22%-25% for LM and 37%-50% for %FM, respectively). In pubertal children, LM acted as mediator at 37%.

Although the independent mediator role of LM and %FM in the associations between CRF or MPO and bone mass was present during the prepubertal stage, only LM remain its mediator role in these associations during the postpubertal period. Therefore, with growth and sexual maturation, the full effect of LM seems to increase, whereas the influence of %FM seems to disappear.