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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Effects of active video games on children and adolescents: a systematic review with meta-analysis.Scandinavian J Med Sci Sports
To investigate the effectiveness of active video games (AVGs) on obesity-related outcomes and physical activity levels in children and adolescents.
Literature search was performed in five electronic databases, and the main clinical trials registries. Randomized controlled trials investigating the effect of AVGs compared with no/minimal intervention on obesity-related outcomes (body mass index [BMI], body weight, body fat, waist circumference) and physical activity levels of children and adolescents were eligible. Two independent reviewers extracted the data of each included study. PEDro scale was used to assess risk of bias and GRADE approach to evaluate overall quality of evidence. Pooled estimates were obtained using random effect models.
Twelve studies were considered eligible for this review. Included studies mostly reported outcome data at short-term (less or equal than three months) and intermediate-term follow-up (more than three months, but less than 12 months). AVGs were more effective than no/minimal intervention in reducing BMI/zBMI at short-term (SMD = -0.34; 95% CI: -0.62 to -0.05) and intermediate-term follow-up (SMD = -0.36; 95% CI: -0.01 to -0.71). In addition, AVGs were more effective in reducing body weight compared to no/minimal intervention at intermediate-term follow-up (SMD=-0.25; 95%CI: -0.46 to -0.04). Regarding physical activity levels, AVGs were not more effective compared to minimal intervention at short-term and intermediate-term follow-up.
Our review identified that AVGs were better than minimal intervention in reducing BMI and body weight, but not for increasing physical activity in young people. This article is protected by copyright. All rights reserved.
Benzodiazepine abuse among athletes: pain relief or just a weapon against insomnia? A clinical case study.Scandinavian J Med Sci Sports
It is widely recognised that benzodiazepine abuse can potentially induce addiction. Benzodiazepine addiction among athletes is a new and growing ph...
Influence of Risky Pathoanatomy and Demographic Factors on Clinical Outcomes After Isolated Medial Patellofemoral Ligament Reconstruction: A Regression Analysis.Am J Sports Med
Multiple studies have demonstrated that a number of demographic and pathoanatomic characteristics are associated with patellofemoral instability, recurrence of instability, and less satisfactory results following medial patellofemoral ligament reconstruction (MPFL-R). Despite the growing volume of research, the relationship of risk factors to patient-reported outcome after MPFL-R is unclear.
To determine if certain pathoanatomic and demographic factors predict disease-specific quality-of-life outcome after isolated MPFL-R for symptomatic patellofemoral instability.
Cohort study; Level of evidence, 3.
The study analyzed 224 isolated MPFL-Rs. Demographic data were collected, including age at first dislocation, sex, and presence of bilateral instability. Pathoanatomic risk factors included the presence of high-grade trochlear dysplasia, tibial tubercle-trochlear groove (TT-TG) distance, patella alta ratio, Beighton score, and patellar tilt. Other factors included femoral tunnel position accuracy and WARPS/STAID score. Descriptive analyses were conducted, followed by calculation of individual Spearman rank correlation coefficients for the predictor variables versus the Banff Patellofemoral Instability Instrument (BPII) scores. A multivariable regression with stepwise selection was employed to establish the final model predicting BPII score, with all significant variables for alpha ≤ .05 included in the final model.
The cohort of 224 patients included 66 (29.5%) males and 158 (70.5%) females, with a mean age of 24.1 years and a mean body mass index of 23.9 kg/m2. The mean age of first patellar dislocation was 15.7 years, and 41.4% of patients had bilateral instability. Pathoanatomic variables within the cohort included the following: high-grade trochlear dysplasia = 41%; mean TT-TG = 14.6 mm, with 16.8% of patients demonstrating a TT-TG ≥18 mm; mean Caton-Deschamps ratio = 1.09, with 22% of patients demonstrating a ratio ≥1.2; and positive Beighton score = 37.5%. The mean BPII score at postoperative 2 years was 67.1 out of 100. A stepwise elimination in the regression model demonstrated no statistically significant 3- or 2-way relationships. Assessment of individual variables indicated that bilateral symptoms (P = .004), higher age at first dislocation (P = .024), and femoral tunnel position >10 mm from the Schöttle point (P = .042) were statistically significant predictors of lower quality-of-life scores. The R2 value for the regression analysis model was 0.07.
In this large cohort of patients undergoing isolated MPFL-R for symptomatic lateral patellofemoral instability, a multivariable forward stepwise regression demonstrated that bilateral symptoms, femoral tunnel position, and age at first dislocation were statistically significant predictors of lower postoperative BPII scores. No anatomic risk factors were predictive of quality-of-life outcome score 2 years after MPFL-R surgery. The R2 value indicated that there were many other important contributing factors affecting BPII outcome scores than those explored in this study.
Long-term Results of Arthroscopic Rotator Cuff Repair: Initial Tear Size Matters: A Prospective Study on Clinical and Radiological Results at a Minimum Follow-up of 10 Years.Am J Sports Med
Arthroscopic techniques are now considered the gold standard for treatment of most rotator cuff (RC) tears; however, no consensus exists on the maintenance of results over time, and long-term follow-up data have been reported for few cohorts of patients.
To present the long-term results associated with the arthroscopic treatment of RC tears and to evaluate associations between preoperative factors and RC integrity at final follow-up.
Cohort study; Level of evidence, 3.
A total of 169 patients were contacted at least 10 years after arthroscopic RC surgery and were invited to a clinical evaluation. Information on preoperative conditions, tear size, subjective satisfaction, and functional scores was collected; isometric strength and range of motion were also measured; and each patient underwent an ultrasound examination to evaluate supraspinatus integrity and a shoulder radiograph to evaluate osteoarthritis.
A total of 149 patients (88.2% of the eligible patients) were available for a complete telephonic interview, and 102 patients were available for the final evaluation. Ultrasound revealed an intact supraspinatus in 54 patients (53.47%). By adding the 10 patients who underwent revision surgery to the nonintact group, this percentage would drop to 48.65%. Tear size was associated with supraspinatus integrity in univariate analysis (hazard ratio, 3.04; 95% CI, 1.63-5.69; P = .001) and multivariable analysis (hazard ratio, 2.18; 95% CI, 1.03-4.62; P = .04). However, no significant differences were encountered in the subjective and functional scores collected, with the exception of the Constant-Murley Score, which was significantly higher in patients with smaller tears at the index procedure. Strength testing also revealed significantly superior abduction and flexion strength in this group, and radiographs showed a significantly higher acromion-humeral distance and lower grades of osteoarthritis. Patients with an intact supraspinatus at final follow-up showed superior results in all functional scores, greater satisfaction, superior abduction and flexion strength, higher acromion-humeral distance, and lower grades of osteoarthritis.
RC tear size at the time of surgery significantly affects supraspinatus integrity at a minimum follow-up of 10 years. However, a larger tear is not associated with an inferior subjective result, although it negatively influences abduction and flexion strength, range of motion, and osteoarthritis progression. Intraoperative efforts to obtain a durable RC repair are encouraged, since supraspinatus integrity at final follow-up influences clinical and functional outcomes, patient satisfaction, and osteoarthritis progression.
Prevalence and Clinical Implications of Chondral Injuries After Hip Arthroscopic Surgery for Femoroacetabular Impingement Syndrome.Am J Sports Med
Studies on the effect of partial- and full-thickness chondral damage of the hip on outcomes and the ability to achieve meaningful clinical outcomes are limited.
To determine the effect of full- and partial-thickness chondral injuries on 2-year outcomes in patients undergoing hip arthroscopic surgery for femoroacetabular impingement syndrome (FAIS) compared with patients without chondral damage, and to identify significant predictors of achieving the patient acceptable symptomatic state (PASS) and minimal clinically important difference (MCID).
Case-control study; Level of evidence, 3.
Data from consecutive patients with evidence of chondromalacia at the time of primary hip arthroscopic surgery with routine capsular closure for the treatment of FAIS by a single fellowship-trained surgeon between January 2012 and September 2016 were reviewed. Patients were divided into groups with partial-thickness (grade I-III) or full-thickness (grade IV) chondral defects and matched by age and body mass index (BMI) to patients without chondral injuries. Preoperative and postoperative outcomes were compared among the 3 groups, and a binary logistic regression analysis was utilized to identify significant predictors of achieving the MCID and PASS.
There were 634 patients included in the analysis, with a mean age of 34.5 ± 10.9 years and a mean BMI of 25.2 ± 4.7 kg/m2. A total of 493 (77.8%) patients had no evidence of chondral damage, 92 (14.5%) patients had partial-thickness chondral defects, and 49 (7.7%) patients had full-thickness chondral defects. There were statistically significant differences in the Hip Outcome Score (HOS)-Activities of Daily Living, HOS-Sports Subscale, modified Harris Hip Score, pain, and satisfaction (P < .01) among the 3 groups. Patients with grade IV chondromalacia experienced the poorest outcomes and lowest percentage of achieving the PASS. Predictors for achieving any PASS threshold included preoperative alpha angle (odds ratio [OR], 0.96; P = .016), absence of preoperative limping (OR, 7.25; P = .002), absence of preoperative chronic pain (OR, 5.83; P = .019), primary hip arthroscopic surgery (OR, 0.17; P = .050), patients who self-identified as runners (OR, 2.27; P = .037), and Tönnis grade 0 (OR, 2.86; P = .032). Male sex (OR, 2.49; P = .015) was the only predictor of achieving any MCID threshold.
Patients with grade IV chondral defects experienced worse functional outcomes, lower satisfaction, and increased pain when compared with both patients without chondral damage or grade I-III chondromalacia at 2-year follow-up. Several predictors were associated with achieving clinically significant function in patients undergoing hip arthroscopic surgery for FAIS.
Portal Placement and Biomechanical Performance of Endoscopic Proximal Hamstring Repair.Am J Sports Med
Proximal hamstring tendon avulsions are debilitating and commonly cause pain, weakness, and functional limitations. Open surgical repair has been the standard, but improved endoscopic techniques have enabled proximal hamstring fixation with decreased risk of infection and numbness, without the morbidity of a large incision.
To (1) describe pertinent anatomy surrounding the proximal hamstring origin in relation to 4 endoscopic portal sites and (2) test for biomechanical differences between open and endoscopic repair. It was hypothesized that (1) endoscopic proximal hamstring repair is efficacious with respect to commonly used portals and (2) there is no biomechanical difference between open and endoscopic techniques.
Descriptive and controlled laboratory study.
Proximal hamstring ruptures were simulated endoscopically in 10 fresh-frozen human cadaveric pelvis specimens. Endoscopic repair was then completed on 1 limb from each specimen through 4 portals. After repair, each specimen was dissected in layers and measurements from portal tracts to pertinent anatomy were obtained. Open repair was performed on all contralateral limbs, followed by cyclical biomechanical tensile testing to failure of both the open and endoscopically repaired hamstring tendons to assess failure load and local tissue strain.
On average, no portal tract was closer than 2.0 cm to the sciatic nerve or inferior gluteal neurovascular bundle. Anatomic landmarks were identified that could improve the reproducibility and safety of the procedure. Biomechanical testing revealed no differences between the open and endoscopic repair techniques for any measured parameter.
This study supports the safety and efficacy of endoscopic proximal hamstring repair through anatomic and biomechanical analyses and helps establish reproducible and recognizable landmarks that define a safe working zone.
This study maps the anatomic landscape of the proximal hamstring as encountered endoscopically and demonstrates equivalent biomechanical strength of endoscopic proximal hamstring repair, supporting this technique's safety and efficacy.
Nonabsorbable Suture Knot on the Tendon Affects Rotator Cuff Healing: A Comparative Study of the Knots on Tendon and Bone in a Rat Model of Rotator Cuff Tear.Am J Sports Med
Nonabsorbable suture knots are usually used to link the tendon and bone during rotator cuff repair surgery. There are many variations in the arthroscopic knot-tying technique; however, the location of suture knot placement for rotator cuff healing has rarely been studied.
The authors compared the rotator cuff healing between knots tied on tendon and bone in a rotator cuff tear rat model. It has been hypothesized that knots can cause chronic inflammation and create the weakest link between tendon and bone, thus affecting rotator cuff healing.
Controlled laboratory study.
Bilateral supraspinatus tenotomy and rotator cuff repair at the greater tuberosity were performed on 24 Wistar rats. Nonabsorbable surgical suture knots were made on the right supraspinatus tendon tissue and left humerus inferior to the greater tuberosity, respectively. Twelve rats each were sacrificed at 3 and 9 weeks. Six of the 12 rats were used for biomechanical testing and the remaining 6 for histologic evaluation.
The surgical knots placed on the bursal side of the tendon migrated to the articular side, as noted on gross observation in 22 of 24 samples. The knots on the tendon group showed significantly inferior tendon-bone integration and significantly inferior biomechanical results in terms of maximum load to failure and stiffness. An obvious chronic foreign body inflammatory reaction was found in the knots on the tendon group at 3 and 9 weeks. Furthermore, inferior bone-tendon interface regeneration and weakest link formation were obtained in the knots on the tendon group compared with those on the bone group.
Nonabsorbable suture knots placed on the tendon migrate to the articular side, causing chronic inflammation and weakening tendon-bone healing, which may explain some retears after rotator cuff repair.
The present animal study suggests that it is not recommended in clinical practice to make several bulky nonabsorbable suture knots on the rotator cuff tendon during rotator cuff repair surgery. It may be better to tie the knots at the bone side or do knotless repair.
Effectiveness of Aerobic Exercise Programs for Health Promotion in Metabolic Syndrome.Medicine and Science in Sports
Continuous and interval are the two types of aerobic exercise training commonly used for health promotion. We sought to determine which aerobic exercise training program results in larger health improvements in metabolic syndrome (MetS) individuals.
One hundred twenty-one MetS patients (age, 57 ± 8 yr; weight, 92 ± 15 kg; and MetS factors, 3.8 ± 0.8 components) with low initial cardiorespiratory fitness (CRF) (V˙O2peak, 24.0 ± 5.5 mL·kg·min) were randomized to undergo one of the following 16-wk exercise program: (a) 4 × 4-min high-intensity interval training at 90% of HRMAX (4HIIT group; n = 32), (b) 50-min moderate-intensity continuous training at 70% of HRMAX (MICT group; n = 35), (c) 10 × 1-min HIIT at 100% of HRMAX (1HIIT group; n = 32), or (d) no exercise control group (CONT; n = 22). We measured the evolution of all five MetS components (i.e., MetS Z Score) and CRF (assessed by V˙O2peak) before and after intervention.
MetS Z score decreased 41% after 4HIIT (95% confidence interval [CI], 0.25-0.06; P < 0.01) and 52% in MICT (95% CI, 0.24-0.06; P < 0.01), whereas it did not change in 1HIIT (decreased 24%; 95% CI, -0.16 to 0.03; P = 0.21) and CONT (increased 20%; 95% CI, -0.19 to 0.04; P = 0.22). However, the three exercise groups improved similarly their V˙O2peak (4HIIT, 11%; 95% CI, 0.14-0.33; MICT, 12%; 95% CI, 0.18-0.36; and 1HIIT, 14%; 95% CI, 0.21-0.40 L·min; all P < 0.001).
Our findings suggest that in sedentary individuals with MetS and low initial CRF level any aerobic training program of 16 wk with a frequency of three times per week is sufficient stimulus to raise CRF. However, the more intense but shorter 1HIIT training program is not effective on improving MetS Z score, and thus we caution its recommendation for health promotion purposes in this population.
Effect of Muscle-Tendon Unit Length on Child-Adult Difference in Neuromuscular Fatigue.Medicine and Science in Sports
The purpose of this study was to compare the development and etiology of neuromuscular fatigue of the knee extensor muscles at different muscle-tendon unit (MTU) lengths during repeated maximal voluntary isometric contractions (MVIC) between boys and men.
Twenty-two prepubertal boys (9-11 yr) and 22 men (18-30 yr) performed three knee extensor fatigue protocols at short (SHORT), optimal (OPT), and long (LONG) MTU lengths, consisting of repeating 5-s MVIC interspersed with 5-s passive recovery periods until torque reached 60% of the initial MVIC torque. The etiology of neuromuscular fatigue was identified using noninvasive methods such as surface electromyography, near-infrared spectroscopy, magnetic nerve stimulation and twitch interpolation technique.
The number of repetitions was significantly lower in men at OPT (14.8 ± 3.2) and LONG (15.8 ± 5.8) than boys (39.7 ± 18.4 and 29.5 ± 10.2, respectively; P < 0.001), whereas no difference was found at SHORT between both age groups (boys, 33.7 ± 15.4; men, 40.9 ± 14.2). At OPT and LONG boys showed a lower reduction in the single potentiated twitch (Qtwpot) and a greater decrease in the voluntary activation level than men. At SHORT, both populations displayed a moderate Qtwpot decrement and a significant voluntary activation reduction (P < 0.001). The differences in maximal torque between boys and men were almost twice greater at OPT (223.9 N·m) than at SHORT (123.3 N·m) and LONG (136.5 N·m).
The differences in neuromuscular fatigue between children and adults are dependent on MTU length. Differences in maximal torque could underpin differences in neuromuscular fatigue between children and adults at OPT and SHORT. However, at LONG these differences do not seem to be explained by differences in maximal torque. The origins of this specific effect of MTU length remain to be determined.
Plasmalemma Function is Rapidly Restored in Mdx Muscle after Eccentric Contractions.Medicine and Science in Sports
Muscle that lacks dystrophin, as in the mdx mouse, has a heightened sensitivity to eccentric (ECC) contraction-induced strength loss, but an enhanced rate of recovery. However, the timeline and mechanisms underlying why mdx muscle recovers quicker has yet to be determined. We used an electromyographic (EMG) approach to analyze plasmalemma electrophysiological function during and following ECC contraction-induced injury to test the hypothesis that loss of plasmalemmal excitability is a transient event in mdx muscle.
Mice were implanted with stimulating electrodes on the common peroneal nerve and EMG electrodes on the tibialis anterior muscle. Anterior crural muscles of anesthetized mice performed 1 or 2 bouts of 50 injurious ECC contractions, and recovery of maximal isometric torque and M-wave root mean square (M-wave RMS) were assessed following each bout.
Maximal isometric torque and M-wave RMS were equally reduced 62% (P < 0.001) in mdx mice immediately following the initial ECC injury. For these mdx mice, M-wave RMS was still reduced at 2 days post-injury (P = 0.034) but was not different from pre-injury values by 6 days (P = 0.106), while torque took up to 9 days to recover (P = 0.333). M-wave RMS did not change (P = 0.390) in wildtype mice in response to ECC injury while torque decreased 35% (P < 0.001) and recovered by day 2 (P = 0.311). Results from the second bout of ECC contractions were similar to those observed during and after the initial injury.
Functional dystrophin is necessary for excitation to occur at the plasmalemma during ECC contractions but is not essential for complete recovery of plasmalemma electrophysiological function or maximal isometric strength.
A Mobile Application for Exercise Intervention in People Living with HIV.Medicine and Science in Sports
To assess 16-weeks improvements of physical fitness, metabolic and psychologic parameters in people living with HIV (PLWH) exercising with the support of a smartphone application, as compared to a control group exercising without application.
This was a randomized, open-label, pilot study enrolling PLWH in a 16-week protocol consisting of moderate physical activity three times/week, which included an initial coach-supervised period of 4 weeks, followed by 12 weeks where participants trained independently. Participants were allocated to either an experimental group that trained with the use of a smartphone application (APP) or a control group that practiced following a hard copy training program (No-APP). At baseline (BL) and after 16-weeks (W16), patients were assessed for cardiorespiratory fitness, body composition, blood lipid profile, and profile of mood states (POMS).
Forty-eight PLWH were screened and 38 were eligible: 20 were allocated to the APP group and 18 to the No-APP group. Two APP and two No-APP participants were lost to follow-up. Intention-to-treat analysis showed a W16 improvement from BL of ≥15% V[Combining Dot Above]O2peak in 13 of 18 (72%) in APP, but only in 3 of 16 (19%) in No-APP participants (p=0.025). Significant W16 improvements were observed in APP, but not in No-APP participants, in V[Combining Dot Above]O2peak, fat mass and fat-free mass %, total-, LDL-cholesterol and triglycerides, vigour and total mood by POMS. Accordingly, significant % change differences between the APP and the No-APP groups were observed in V[Combining Dot Above]O2peak, fat and fat-free mass %, total-, LDL-cholesterol and triglycerides, and in depression, vigour, anger and total mood by POMS.
Exercising with the use of a smartphone application improved cardiorespiratory fitness, body composition, cholesterol profiles and psychological outcomes in PLWH.
Responsiveness and interpretability of the Animated Activity Questionnaire for assessing activity limitations of patients with hip or knee osteoarthritis.Musculoskeletal care
The aim of the study was to determine the responsiveness and interpretability of the Animated Activity Questionnaire (AAQ), an online questionnaire in which osteoarthritis patients select animations that best match their performance of daily activities.
A longitudinal study was carried out, in which 94 patients with hip or knee osteoarthritis were assessed at baseline, and 3 and 6 months after treatment (conservative and surgical). Responsiveness was assessed by means of testing hypotheses about expected correlations between change in AAQ, a Global Rating Scale of change (GRS) and change in the Activities of Daily Living subscale of the Hip disability or Knee injury and Osteoarthritis Outcome Score (H/KOOS), and a combination of performance-based tests (the 30 s chair-stand test, the timed up-and-go test and the nine-step stair climbing test). The minimal important change (MIC) was estimated by means of the receiving operating characteristics (ROC) method.
The correlations of the AAQ with the H/KOOS were as expected, but other correlations were lower than anticipated. The area under the ROC curve was 0.74 at 6 months. At 3 months' follow-up, the correlations were too low to calculate a MIC. A total of 20% of the results at 3 months and 80% of the results at 6 months were in accordance with the hypotheses. The MIC was 9 points at 6 months.
The AAQ was sufficiently responsive at the six-months follow-up, but not at the three-month follow-up. The MIC at the 6-month follow-up (9 points) was slightly lower than the smallest detectable change of 14 points found in a previous study.