Today a short link to the Wall Street Journal. [this link is to a free, shorter version of the paper - subscription version highlighted below].
BJSM Senior Associate Editor Jon Drezner is quoted liberally – all good stuff for sports medicine and for his University of Washington. Sports cardiology is a hot topic when it makes the mainstream media. We ran a sports cardiology blog yesterday — interpreting athletes’ ECG/EKG and now WSJ adds interesting new issues! Mandatory exclusion is clearly a tricky issue.

Next thing the editorial team will get accused for making this the BJSC – British Journal of Sports Cardiology!

See the links in yesterday’s guest blog (by Dr Babette Pluim – her PhD was in sports cardiology!). Also, Jon Drezner did a nice job explaining all this in his podcast!
There are key papers Online first and a couple of very interesting ones in the pipeline! Keep an eye out in the BJSC, oops, I mean BJSM for the latest in Sports Cardiology.

BJSM blogs are flagged for you on Twitter (@BJSM_BMJ). We also send other interesting links using that medium (one to two tweets per day).

Don’t forget our current home page – great IOC-supported theme issue on sport in young people and health.

Concussion, concussion, concussion – has dominated the media over the past months. Major injuries to kids, research suggesting long-term problems, even the American Neurology Association updating their guidelines, now Sidney Crosby sits on the sidelines at millions of dollars a day.

BJSM afficionados will be aware but as we get new readers and blog followers daily, I don’t apologize for reminding you of free value in the following links:

The special issue of BJSM that followed the Zurich Concussion Consensus Meeting – this is the meeting that is driving the science – this was the evidence behind all the current change.

Particularly useful is Paul McCrory’s explanation of how to interpret the guidelines – via BJSM’s masterclass podcast.

Here’s the intro that goes with that podcast…

Part 3: You are the expert – you teach concussion to fellows and you can recite the SCAT2 even if you have profound headache and retrograde amnesia. Professor McCrory provides tips from the Consensus Statement that have you on the same page as the 27 experts in Zurich. And maybe you were one of them. Listen anyway, send any additional tips to the BJSM blog (http://blogs.bmj.com/bjsm/) and share the news of this practical podcast.

And then there is consensus statement itself – copublished in about 14 journals – a remarkable achievement in turning knowledge to action or ‘knowledge exchange’

As well as the practical forms to use on the sideline – the unfortunately named ‘SCAT2′ and ‘Pocket SCAT2′

In April, our special issue of BJSM reminds athletes, clinicians, and coaches that prevention of osteoarthritis is important for both younger and older athletes. Check these papers online first if you have BJSM access – otherwise they’ll be up on April 1^st.

Dennis Caine and Yvonne Golightly review  the epidemiology of OA, the effect of acute injury, epiphysial growth plate injury as well as the link between level of sports participation and OA during childhood. They suggest a link between youth sports injuries (most notably in the knee or ankle) and OA. Thus, efforts to prevent sport-related early-onset OA should begin during the childhood years. (Read full article here)

On the other side of the age spectrum, Jiri Dvorak’s review stems from Klunder et al’s seminal investigation that OA of the hip was significantly more frequent in retired football players than controls.  Dvorak assesses FIFA data on injury prevention programs and injury related drug use. The team found a problem of excessive medication use in top-level female and male international football players. “Research into the early onset of osteoarthritis in sports and in particular the most popular sport, football, should include an early diagnosis of small cartilage lesions in the joints which might be treated and reduce the later onset of osteoarthritis.” (Read full article here)

Hideki Takeda et al. offer a review of OA treatments (in both athletes and non-athletes). Unfortunately, surgical or physical rehabilitation does not preclude OA in the knee, and injury prevention is therefore imperative. (Read full article here)

Thanks to Arthritis Research who sponsored the Arthritis in Sport Conference in London in October 2010 (link to BJSM October 2010)

Thanks to the IOC for their support of 4 IPHP Issues annually – see the April 2011 theme issue for the full set of key papers. This issue will be given free to all the attendees of the IOC World Conference on Prevention of Injury and Illness Prevention in Sport (Monaco, 7-9 April).

Just a quick post getting back into the year – highlighting that the issue of managing cardiac risk factors in sports is not easy.

I was reading about various deaths in athletes when I came across this older, but interesting post.

Remember also the September 2009 BJSM which dealt specifically with cardiac issues in the athlete.

Duncan S Buchan 1, Julien S Baker 1, Robert M Malina 2, Non E. Thomas 3

1. University of the West of Scotland

2. The University of Texas at Austin

3. Swansea University

Dear Editor,

We read with interest the recent statement released by BASEM on 26^th November 2010 which criticises the way physical education (PE) is being taught in the United Kingdom.  Previous authors suggest that youth spend less than 50% of PE time in moderate intensity activity and thus fail to procure health related benefits [1].  Interestingly, a recent investigation demonstrated a positive role for brief, interval training as a means of improving the health status of obese and overweight adolescents with unfavourable cardiometabolic profiles [2]. With this in mind we successfully developed and implemented a novel 7 week exercise intervention which aimed to determine the effects of PA programmes of different intensities and duration on three components of physical fitness, namely: cardiorespiratory fitness, muscular fitness and speed/agility [3]. Full details of the protocol can be found elsewhere [4,5].

Briefly, a cohort of adolescent school youth (N = 47 boys and 10 girls, 16.4 ± 0.7 years of age) volunteered to participate in the study. Ethical approval was received from the University of the West of Scotland Ethics committee. Maturation status was obtained prior to experimental data collection. Participants were recruited from two PE classes in years 5 and 6. Year 5 pupils acted as the control group whereas year 6 pupils were randomly assigned to a high intensity training group (HIT) or a moderate (MOD) intensity group. Participants in the HIT group (15 boys, 2 girls) were required to complete a 30 s maximal effort sprint within a 20 m distance separated by cones. Participants were instructed to sprint from the midpoint to the first marker, turn, and then sprint 20 m in the opposite direction to the second marker. Participants repeated the protocol four times with a 30 s recovery period between sprints. This equated to 2 mins of maximal effort sprinting interspersed with 2 min recovery.  The protocol was performed 3 times weekly. Training progression was implemented by increasing the number of repetitions from four during weeks 1 and 2, to five during weeks 3 and 4, to six during weeks 5 and 6. During week 7, participants still performed six repetitions but each was interspersed by only 20 s recovery.

Participants in the MOD group (12 boys and 4 girls) were instructed to exercise at a moderate intensity of 70% VO_2max as utilized in other studies [6], by running steadily for a period of 20 mins. The speed of exercise was determined by each participant’s performance in the 20 metre multistage fitness test (MSFT). Participants were instructed to keep pace with a CD that emitted a continuous audio signal for a period of 20 min. All participants had indices of obesity and blood pressure recorded in addition to four physical performance measures pre and post intervention. These included the 20 MSFT, the counter movement jump (CMJ), agility and the 10m sprint test.

Overall, it was apparent that specific physiological adaptations occurred relative to the stimulus provided. Participants in the MOD group experienced a 26.8% improvement in 20 MSFT and a 7.3% improvement in CMJ performance. Participants in the HIT group experienced an 8.3% and a 5.1% improvement in both the 20 MSFT and CMJ. Participants in the HIT group also experienced a 1.5% and 5% improvement in 10-m sprint and 505-agility performance though no improvements were noted in the MOD group. Though the participants in both groups experienced improvements, it should be noted that these improvements in the HIT group occurred in 85% less exercise time compared to that of the MOD group. Participants in the HIT group also experienced a significant reduction in systolic blood pressure SBP post-intervention (112 ± 10 vs. 106 ± 11 mm Hg) (P=0.017).  Thus, significant improvements in physical fitness were found in both groups after exercising for only seven weeks (3 times per week).

Despite overwhelming evidence supporting the health benefits of regular PA, many youth fail to meet minimal recommendations. This study has demonstrated that HIT is a time efficient means of improving components of health in youth. Given the time constraints of school curricula, incorporating a HIT protocol into the PE curriculum may function to improve PA levels and health status of adolescents. Further research investigating the effects of HIT on markers of health status in youth seems recommended.

References

1. Fairclough SJ, Stratton G (2006) A review of physical activity levels during elementary school physical education. J Teach Phys Educ 25: 239-257

2. Tjonna AE, Stolen TO, Bye A, Volden M, Slordahl SA, Odegard R, Skogvoll E, Wisloff U (2009) Aerobic interval training reduces cardiovascular risk factors more than a multitreatment approach in overweight adolescents. Clin Sci 116: 317-326

3. Ortega FB, Ruiz JR, Castillo MJ, Sjostrom M (2008) Physical fitness in childhood and adolescence: a powerful marker of health. Int J Obes 32: 1-11

4. Buchan, D. S., Ollis, S., Thomas, N. E., & Baker, J. S. (2010). The influence of a high intensity physical activity intervention on a selection of health related outcomes: an ecological approach. BMC Public Health, 10(1), 8.

5. Buchan, D.S. Ollis, S. Thomas, N.E. Cooper, S.M. Malina, R.M and Baker, J.S. Physical Activity Interventions: Effects of Duration and Intensity. Scand J Med Sci Spor (Under Review).

6. Tabata I, Nishimura K, Kouzaki M, Hirai Y, Ogita F, Miyachi M, Yamamoto K (1996) Effects of moderate-intensity endurance and high-intensity intermittent training on anaerobic capacity and VO2max. Med Sci Sports Exerc 28: 1327-1330

Another excellent patient information to download!

Patient Information Sheet 17 – Lateral hip pain

More patient information sheets can be found here.

A special theme issue of BJSM guest edited by Jon Drezner and Babette Pluim on the topic of sudden cardiac death in young athletes is scheduled for June 2009.

A letter from Dr. Thamindu Wedatilake, Hope Hospital, Salford, UK, related to this serious sports medicine condition:

I have read in interest the article by Wilson et al regarding their support for using an ECG in screening for sudden cardiac death in the young. Furthermore I note that there is considerable support from many sporting governing bodies for the above recommendation.

I note the comments of Dr Richard Page where he argued that in the USA alone, mass ECG screening of young athletes would exclude 2000 children from sport for every life saved.

Dr. Page’s comments have concerned me. By trying to save one life in an issue that is highly media motivated for the obvious dramatic nature of sudden cardiac death, we prison a further 2000 children to a potentially life threatening sedentary life style. Hence, ironically we may increase their risk of death from a cardiac cause later in life.

Are we really doing whats best for these children or are we dancing to the tune of the media? Have we thought about the long term repercussions that such a screening programme may have on our childrens’ physical and psychological wellbeing?

Yours/your colleagues thoughts are appreciated.

Jon Drezner replies:

Dr. Wedatilake,

You make an excellent point which was also raised by Dr. Page. Interestingly, I just gave a pro/con ECG screening Grand Rounds with Dr. Page and we looked at this question together.

The number of disqualifications and the downstream effect of limiting exercise in a subset of kids (with identified cardiovascular disease) but who may never suffer SCA is a question that needs to be investigated. I would agree that disqualifying 2000 to save 1 life may not be acceptable. What number of disqualifications is acceptable? 1000? 100? 10? I think the number of disqualifications calculated to save one life is hugely affected by 3 things: the incidence of SCD, prevalence of asymptomatic disease, and total positive (and false positive) rate of ECG screening. If you begin with traditional reported estimates (1:200,000 incidence and 15% false positive) you get about 2000 disqualifications. If you use statistics from more recent studies (1:50,000 incidence and 2-5% total positive rate), you get about 30-50 disqualifications to save a life. Unfortunately, these are all just calculations and until we have large scale studies with follow-up of those disqualified, the long-term effects will just be speculative.

Sudden cardiac death has always been at the apex of ‘serious’ sports medicine conditions. We all agree that one death is one too many. Sports physicians with expertise in cardiac issues — Jon Drezner and Babette Pluim — will guest edit a 2009 Themed Issue that will include, but not be limited to, original data and commentary on the use of automated external defibrillators (AEDs) in the athletic setting, emergency preparedness for sudden cardiac arrest, and the secondary prevention of sudden cardiac death in young athletes.

We look forward to the opportunity to work with authors, groups convening to provide consensus statements, and partner journals to contribute to minimizing sudden cardiac death in the sporting setting.

This special issue will form the June 2009 Issue of BJSM. More details will follow and the deadline for submissions is 11:00 pm, Dec 31. 2008.

Tendinopathy Theme Issue of BJSM

Following the success of the tendinopathy issue in 2007, BJSM will publish ‘Tendinopathy Theme Issue’ in 2009. This edition will concentrate on clinical perspectives of diagnosing and managing tendinopathy.

Specifically, we are looking for papers that have direct or inferred clinical application that will help clinicians manage patients with tendon injury. We encourage you to submit original papers as well as novel opinion pieces based on clinical experience and scientific evidence.

Submissions close August 15th, 2008

Enquiries to Jill Cook: jill.cook@deakin.edu.au

Special The Issue of BJSM – Guest editor – Professor Steven Blair

Leading international authors have agreed to contribute to this issue as part of the battle against physical inactivity. This is a terrific opportunity for you to publish your original research alongside wonderful perspective pieces from these authors. Any questions, feel free to email editor Karim Khan – karim.khan@ubc.ca.

Rationale — Why a special theme issue?

Research on the health benefits of regular physical activity has accumulated rapidly over the past few decades. There is now compelling evidence that physical activity has substantial health benefits for all. Physical activity prevents many of the major chronic diseases, delays loss of functional capacity, and extends longevity. The benefits of physical activity accrue to the young, adults, and older adults; to people with chronic disease and those who are healthy; and to people of all sizes and shapes.

Despite the now overwhelming evidence for the health benefits of physical activity, we have been slow to develop and implement broadly based public health strategies to increase and maintain activity in the population. One notable area of concern is clinical medicine, where, despite lipservice, physical activity interventions are rarely prescribed. To rectify this problem, we encourage clinicians to pay more attention to promoting physical activity during patient consults.This special issue of the BJSM reviews the current state of the science and provides practical recommendations as to how clinicians can implement effective physical activity interventions.Deadline for submissions to this issue: 1st August, 2008.