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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Do 'pathologic' cardiac murmurs in adolescents identify structural heart disease? An evaluation of 15 141 active adolescents for conditions that put them at risk of sudden cardiac death.

Brit J Sports Med

We assessed whether the presence and character of a cardiac murmur in adolescents were associated with structural heart disease that confers risk of sudden cardiac death (SCD).

We performed a retrospective analysis of 15 141 adolescents age 12-19 who underwent a heart screen with history, physical examination and ECG. Participants with any screening abnormality underwent an echocardiogram for the assessment of structural heart disease. Murmurs were classified as physiological or pathological according to standard clinical criteria, and participants with murmurs were compared with a comparison group without murmurs. The primary outcome was echocardiogram-detected structural heart disease associated with SCD.

905 participants with a cardiac murmur (mean age 15.8; 58% male) and 4333 participants without a murmur (comparison group; mean age 15.8; 55% male) had an echocardiogram to detect structural heart disease. 743 (82%) murmurs were described as physiological and 162 (18%) as pathological. Twenty-five (2.8%) participants with murmurs and 61 (1.4%) participants without murmurs had structural heart disease. Three (0.3%) participants in the murmur group were diagnosed with hypertrophic cardiomyopathy (HCM) which was the only identified condition associated with SCD. Two participants with HCM had physiological murmurs, one had a pathological murmur, and all three had an abnormal ECG. The most common minor structural heart disease was bicuspid aortic valve in both the murmur (7; 0.8%) and comparison (20; 0.5%) groups. The positive predictive value of physiological versus pathological murmurs for identifying any structural heart disease was 2.4% versus 4.3% (p=0.21), respectively. The positive predictive value of having any murmur versus no murmur for identifying structural heart disease was 2.8% versus 1.4% (p=0.003), respectively.

In adolescents, the traditional classification of cardiac murmurs as 'physiologic' or 'pathologic' does not differentiate for structural heart disease that puts individuals at risk for SCD. We recommend ECG evaluation in all patients with a cardiac murmur found during preparticipation screening to increase detection of HCM.

Relationships between incidental physical activity, exercise, and sports with subsequent mood in adolescents.

Scandinavian J Med Sci Sports

Physical activity is beneficial for human physical health and well-being. Accordingly, the association between physical activity and mood in everyd...

Effects of an "Active-Workstation" Cluster RCT on Daily Waking Physical Behaviors.

Medicine and Science in Sports

Evaluate the effects of sit-to-stand and treadmill desks on sedentary behavior during a 12-month, cluster-randomized multi-component intervention with an intent-to-treat design in overweight office workers.

Sixty-six office workers were cluster-randomized into a: control (N=21; clusters=8), sit-to-stand desk (N=23; clusters=9) or treadmill desk (N=22; clusters=7) group. Participants wore an activPALTM accelerometer for 7 days at baseline, month-3, month-6 and month-12 and received periodic feedback on their physical behaviors. The primary outcome was total daily sedentary time. Exploratory outcomes included total daily and workplace sedentary, standing and stepping time, and the number of total daily and workplace sedentary, standing and stepping bouts. Intervention effects were analyzed using random intercept mixed-linear-models accounting for repeated measures and clustering effects.

Total daily sedentary time did not significantly differ between- or within-groups after 12-months. Month-3 gains were observed in total daily and workplace standing time in both intervention groups (sit-to-stand desk: mean Δ±SD= 1.03±1.9 h/day and 1.10±1.87 h at work; treadmill desk: mean Δ±SD= 1.23±2.25 h/day and 1.44±2.54 h at work). At month-3 the treadmill desk users stepped more at the workplace than the control group (mean Δ±SD= 0.69±0.87 h). Month-6 gains in total daily stepping were observed within the sit-to-stand desk group (mean Δ±SD= 0.82±1.62 h/day) and month-3 gains in stepping at the workplace were observed for the treadmill desk group (mean Δ±SD= 0.77±0.83 h). These trends were sustained through month-12 in only the sit-to-stand desk group.

Active-workstation interventions may cause short-term improvements in daily standing and stepping. Treadmill desk users engaged in fewer sedentary bouts but sit-to-stand desks resulted in more frequent transitions to upright physical behaviors.

Sex Differences in Cardiometabolic Health Indicators following HIIT in Patients with Coronary Artery Disease.

Medicine and Science in Sports

Cardiorespiratory fitness (CRF) is an independent predictor of mortality, and females typically achieve smaller improvements in CRF than males following exercise-based cardiac rehabilitation (CR). High-intensity interval training (HIIT) has been shown to produce superior improvements in CRF than traditional CR, but the sex-differences are unknown. The purpose of this systematic review and meta-analysis was to evaluate sex-differences for changes in CRF and cardiometabolic health indicators following HIIT in adults with coronary artery disease (CAD).Methods and ResultsA systemic search of 5 electronic databases for studies examining the effect of HIIT on measured CRF and cardiometabolic health indicators in adults with CAD was performed. Data (published and unpublished) from 14 studies were included in the meta-analyses with ~8-fold greater male than female participation (n=836 vs. n=103). Males with CAD achieved a near significant absolute improvement in CRF (mean difference [MD]: 1.07, 95% CI: -0.08 to 2.23 mL/kg/min, p=0.07) following HIIT when compared to control; there were insufficient data to conduct such an analysis in females. Significantly smaller improvements in CRF were experienced by females than males (MD: -1.10, 95% CI: -2.08 to -0.12 mL/kg/min; p=0.03); there was no sex-difference for the relative (percentage) change in CRF following HIIT. Females achieved significantly smaller reductions in body mass index (MD: -0.25, 95% CI: -0.03 to -0.47 kg/m2; p=0.02) and fasting blood glucose (MD: -0.38, 95% CI: -0.05 to -0.72; p=0.03); no sex-differences were observed for other cardiometabolic health indicators.

There are no sex-differences for relative improvements in CRF following HIIT; however, females are greatly underrepresented in trials. Future studies should increase female participation and perform sex-based analyses to determine sex-specific outcomes with HIIT.

Maximal Oxygen Uptake Is Underestimated during Incremental Testing in Hypertensive Older Adults: Findings from the HAEL Study.

Medicine and Science in Sports

The present cross-sectional study aimed to investigate whether a maximal oxygen uptake (VO2max) verification phase (VER) could improve the accuracy of a previous graded exercise test (GXT) to assess individual VO2max in hypertensive individuals.

Thirty-three older adults with hypertension (24 women) taking part in the Hypertension Approaches in the Elderly Study (NCT03264443) were recruited. Briefly, after performing a treadmill GXT to exhaustion, participants rested for 10 min and underwent a multistage VER to confirm GXT results. Individual VO2max, respiratory exchange ratio (RER), maximal heart rate (HRmax), and rating of perceived exertion (RPE) were measured during both GXT and VER tests. Mean values were compared between bouts using paired sample t-tests and VO2max was also compared between GXT and VER on an individual basis.

Testing was well tolerated by all participants. Both absolute (p=0.011) and relative (p=0.014) VO2max values were higher in VER than in GXT. RER (p<0.001) and RPE (p=0.002) were lower in VER, whereas HRmax (p=0.286) was not different between the two trials. Individual VO2max comparisons revealed that 54.6% of the participants (18/33) achieved a VO2max value that was ≥3% during VER (mean: 13.5%, range: from +3% to +22.1%, ES=0.062), whereas 87.9% (29/33) of the tests would have been validated as a maximal effort if the classic criteria were employed (i.e. VO2 plateau or at least two secondary criteria).

In sedentary older individuals with hypertension, GXT to exhaustion underestimated VO2max in more than half of tested participants, even when established but criticized criteria were used to confirm whether a maximal effort was attained. Employing VER after GXT is a quick approach to assist with the verification of an individual's VO2max.

In Vivo Visualization of Tissue Damage Induced by Percutaneous Muscle Biopsy via Novel High-Resolution MR Imaging.

Medicine and Science in Sports

Percutaneous muscle biopsy is the gold standard for tissue assessment in clinical practice and scientific studies. The aim of this study was to assess and quantify the ensuing tissue damage by in vivo magnetic resonance imaging (MRI).

In this prospective study we enrolled 22 healthy participants, who underwent MRI of the thigh musculature about one week after a percutaneous muscle biopsy of the vastus lateralis muscle. A total of 17 participants also volunteered for a second MR-examination two weeks after biopsy. Volumes of SWI lesions and muscle edema were assessed by susceptibility-weighted imaging (SWI) and T2-weighted MRI, respectively, after manual segmentation by two independent readers. For quantitative in vivo hematoma volume assessment, we additionally determined signal changes induced by experimental hematoma in an ex vivo model.

Mean overall volume of SWI lesions one week after biopsy was 26.5 ± 21.7 μl, accompanied by a mean perifocal edema volume of 790.1 ± 591.4 μl. In participants who underwent two examinations mean volume of SWI lesions slightly decreased from 29.8 ± 23.6 μl to 23.9 ± 16.8 μl within one week (p=0.13). Muscle edema volume decreased from 820.2 ± 632.4 μl to 359.6 ± 207.3 μl at the same time (p=0.006). By calibration with the ex vivo findings, signal alterations on SWI corresponded to a blood volume of approximately 10 - 50 μl.

Intramuscular hematoma and accompanying muscle edema after percutaneous biopsy are small and decrease rapidly within the first two weeks. These in vivo findings underline the limited invasiveness of the procedure.

Outcomes of Open and Endoscopic Repairs of Chronic Partial- and Full-Thickness Proximal Hamstring Tendon Tears: A Multicenter Study With Minimum 2-Year Follow-up.

Am J Sports Med

The preponderance of literature on the repair of proximal hamstring tendon tears focuses on the acute phase (<4 weeks). As such, there is a paucity of data reporting on the outcomes of chronic proximal hamstring tears.

To report minimum 2-year postoperative patient-reported outcome (PRO) scores, visual analog scale (VAS) for pain, and patient satisfaction from patients who underwent open or endoscopic repair of partial- and full-thickness chronic proximal hamstring tendon tears.

Case series study; Level of evidence, 4.

Between April 2002 and May 2017, prospectively collected data from 3 tertiary care institutions were retrospectively reviewed for patients who underwent open and endoscopic repair of partial- and full-thickness chronic proximal hamstring tendon tears. Patients were included only if they had a chronic proximal hamstring tear (defined as ≥4 weeks from symptom onset to surgery). Patients were excluded if they had a tear treated <4 weeks after injury, underwent hamstring reconstruction, or claimed workers' compensation. Patients who reported minimum 2-year follow-up for VAS, patient satisfaction, and the following PROs had their outcomes analyzed: the modified Hip Harris Score, Non-arthritic Hip Score, iHOT-12 (International Hip Outcome Tool), and Hip Outcome Score-Sports Specific Subscale.

Fifty patients (34 females and 16 males) were included in this study. There were 19 endoscopic repairs and 31 open repairs. Within the cohort, 52.0% had a full-thickness tendon tear on magnetic resonance imaging, and 48.0% had a partial tear. Average follow-up time was 58.07 ± 37.27 months (mean ± SD; range, 24-220 months). The mean age and body mass index of the group were 46.13 ± 13 years and 25.43 ± 5.14. The average time from injury to surgery was 66.73 weeks (range, 5.14-215.14 weeks). Average postoperative PROs were as follows: modified Hip Harris Score, 91.94 ± 9.96; Non-arthritic Hip Score, 91.33 ± 9.99; iHOT-12, 87.17 ± 17.54; Hip Outcome Score-Sports Specific Subscale, 87.15 ± 18.10; and VAS, 1.16 ± 1.92. Patient satisfaction was 8.22 ± 1.20.

Patients who underwent open and endoscopic repairs for chronic partial- and full-thickness proximal hamstring tendon tears reported high PROs and satisfaction at a minimum 2-year follow-up with low rates of complications.

The Lateral Femoral Notch Sign Is Correlated With Increased Rotatory Laxity After Anterior Cruciate Ligament Injury: Pivot Shift Quantification With A Surgical Navigation System.

Am J Sports Med

The lateral femoral notch sign (LNS) is a bony impression on the lateral femoral condyle correlated with anterior cruciate ligament (ACL) injury. Its presence is associated with lateral meniscal injury and higher cartilage degradation on the lateral femoral condyle.

The purpose was to investigate the effect of the presence and magnitude of LNS on rotatory instability. The hypothesis was that a positive LNS is correlated with a high-grade pivot shift (PS).

Cross-sectional study; Level of evidence, 3.

A total of 90 consecutive patients with complete ACL tears between 2013 and 2017 underwent intraoperative kinematic evaluation with the surgical navigation system and were included in the present study. The same surgeon performed a standardized PS under anesthesia. The PS was quantified through the acceleration of the lateral compartment during tibial reduction (PS ACC) and the internal-external rotation (PS IE). Presence and depth of LNS were evaluated on sagittal magnetic resonance images (1.5-T).

In 47 patients, the LNS was absent; in 33, the LNS depth was between 1 mm and 2 mm; and in 10 patients, it was deeper than 2 mm. Patients with a notch deeper than 2 mm showed increased PS ACC and PS IE compared with the group without the LNS. However, no significant differences were present between the group with a notch between 1 and 2 mm and the patients without LNS. Receiver operating characteristic curve analysis showed that 2 mm was the most predictive cutoff value to identify the "high-grade rotatory instability" group, with an accuracy of 77.8% and 74.4% and a specificity of 95.5% and 93.9% referred to the PS ACC and PS IE, respectively.

The presence of a lateral LNS deeper than 2 mm could be used for the preoperative identification of patients with a high risk of increased rotatory instability.

School-based interventions modestly increase physical activity and cardiorespiratory fitness but are least effective for youth who need them most: an individual participant pooled analysis of 20 controlled trials.

Brit J Sports Med

To determine if subpopulations of students benefit equally from school-based physical activity interventions in terms of cardiorespiratory fitness and physical activity. To examine if physical activity intensity mediates improvements in cardiorespiratory fitness.

Peak oxygen consumption (VO2Peak mL/kg/min) and minutes of moderate and vigorous physical activity.

Interventions modestly improved students' cardiorespiratory fitness by 0.47 mL/kg/min (95% CI 0.33 to 0.61), but the effects were not distributed equally across subpopulations. Girls and older students benefited less than boys and younger students, respectively. Students with lower levels of initial fitness, and those with higher levels of baseline physical activity benefitted more than those who were initially fitter and less active, respectively. Interventions had a modest positive effect on physical activity with approximately one additional minute per day of both moderate and vigorous physical activity. Changes in vigorous, but not moderate intensity, physical activity explained a small amount (~5%) of the intervention effect on cardiorespiratory fitness.

Future interventions should include targeted strategies to address the needs of girls and older students. Interventions may also be improved by promoting more vigorous intensity physical activity. Interventions could mitigate declining youth cardiorespiratory fitness, increase physical activity and promote cardiovascular health if they can be delivered equitably and their effects sustained at the population level.

Active commuting to school among 36,781 Spanish children and adolescents: A temporal trend study.

Scandinavian J Med Sci Sports

This study examines trends in the rates of active commuting to school (ACS) in Spanish children (n=18,343; 8.93±1.68) and adolescents (n=18,438; 14...

Quantitative 3-T Magnetic Resonance Imaging After Matrix-Associated Autologous Chondrocyte Implantation With Autologous Bone Grafting of the Knee: The Importance of Subchondral Bone Parameters.

Am J Sports Med

Matrix-associated autologous chondrocyte implantation (MACI) with autologous bone grafting (ABG) is an effective surgical treatment for osteochondral defects. Quantitative magnetic resonance imaging (MRI) techniques are increasingly applied as noninvasive biomarkers to assess the biochemical composition of cartilage repair tissue.

To evaluate the association of quantitative MRI parameters of cartilage repair tissue and subchondral bone marrow with magnetic resonance morphologic and clinical outcomes after MACI with ABG of the knee.

Case series; Level of evidence, 4.

Qualitative and quantitative 3 T MRI of the knee was performed in 21 patients (16 male) at 2.5 years after MACI with ABG at the medial (18/21) or lateral (3/21) femoral condyle for the treatment of osteochondral defects. Morphologic MRI sequences were assessed using MOCART (magnetic resonance observation of cartilage repair tissue) 2.0 scores. T2 relaxation time measurements for the assessment of cartilage repair tissue (CRT2) were obtained. Single-voxel magnetic resonance spectroscopy was performed in underlying subchondral bone marrow (BM) and at both central femoral condyles. The presence of pain and Tegner scores were noted. Statistical analyses included Student t tests, correlation analyses, and multivariate regression models.

The mean defect size was 4.9 ± 1.9 cm2. At a follow-up of 2.5 ± 0.3 years, 9 of 21 patients were asymptomatic. Perfect defect filling was achieved in 66.7% (14/21) of patients. MOCART 2.0 scores (74.1 ± 18.4) did not indicate pain (68.3 ± 19.0 [pain] vs 81.7 ± 15.4 [no pain]; P = .102). However, knee pain was present in 85.7% (6/7) of patients with deep bony defects (odds ratio, 8.0; P = .078). Relative CRT2 was higher in hypertrophic cartilage repair tissue than in repair tissue with normal filling (1.54 ± 0.42 vs 1.13 ± 0.21, respectively; P = .022). The underlying BM edema-like lesion (BMEL) volume was larger in patients with underfilling compared with patients with perfect defect filling (1.87 ± 1.32 vs 0.31 ± 0.51 cm3, respectively; P = .002). Patients with severe pain showed a higher BMEL volume (1.2 ± 1.3 vs 0.2 ± 0.4 cm3, respectively; P = .046) and had a higher BM water fraction (26.0% ± 12.3% vs 8.6% ± 8.1%, respectively; P = .026) than did patients without pain.

Qualitative and quantitative MRI parameters including the presence of subchondral defects, CRT2, BMEL volume, and BM water fraction were correlated with cartilage repair tissue quality and clinical symptoms. Therefore, the integrity of subchondral bone was associated with outcomes after osteochondral transplantation.

Retinoic Acid Receptor Agonists Suppress Muscle Fatty Infiltration in Mice.

Am J Sports Med

The infiltration of fat tissue into skeletal muscle, a condition referred to as muscle fatty infiltration or fatty degeneration, is regarded as an irreversible event that significantly compromises the motor function of skeletal muscle.

To investigate the effect of retinoic acid receptor (RAR) agonists in suppressing the adipogenic differentiation of fibroadipogenic progenitors (FAPs) in vitro and fatty infiltration after rotator cuff tear in mice.

Controlled laboratory study.

FAPs isolated from mouse skeletal muscle were cultured in adipogenic differentiation medium in the presence or absence of an RAR agonist. At the end of cell culture, adipogenic differentiation was evaluated by gene expression analysis and oil red O staining. A mouse model of fatty infiltration-which includes the resection of the rotator cuff, removal of the humeral head, and denervation the supraspinatus muscle-was used to induce fatty infiltration in the supraspinatus muscle. The mice were orally or intramuscularly administered with an RAR agonist after the surgery. Muscle fatty infiltration was evaluated by histology and gene expression analysis.

RAR agonists effectively inhibited the adipogenic differentiation of FAPs in vitro. Oral and intramuscular administration of RAR agonists suppressed the development of muscle fatty infiltration in the mice after rotator cuff tear. In accordance, we found a significant decrease in the number of intramuscular fat cells and suppressed expression in adipogenic markers. RAR agonists also increased the expression of the transcripts for collagens; however, an accumulation of collagenous tissues was not histologically evident in the present model.

Muscle fatty infiltration can be alleviated by RAR agonists through suppressing the adipogenic differentiation of FAPs. The results also suggest that RAR agonists are potential therapeutic agents for treating patients who are at risk of developing muscle fatty infiltration. The consequence of the increased expression of collagen transcripts by RAR agonists needs to be clarified.

RAR agonists can be used to prevent the development of muscle fatty infiltration after rotator cuff tear. Nevertheless, further studies are mandatory in a large animal model to examine the safety and efficacy of intramuscular injection of RAR agonists.