Correspondence to Jenna M Schulz, Family Medicine, Western University Schulich School of Medicine & Dentistry, London, Canada; jschulz2@uwo.ca With increased participation in sport by female ...athletes, there has been a concomitant rise in the number of female athletes aiming to return to activity (RTA) and/or return to sport (RTS) postpartum. ...almost one in two female participants stops exercising/playing sport due to pelvic floor symptoms.1 Additionally, a lack of female athlete-specific research and clinical practice guidelines make it difficult for both athletes and clinicians to navigate a safe and successful RTA/RTS.2 Furthermore, female athletes have specific biological, sociocultural and environmental considerations that could impact sport and health outcomes.3 A recent scoping review was undertaken to evaluate recommendations for RTA/RTS postpartum.4 We concluded that while some recommendations exist,5–7 evidence informed guidelines are needed to improve physical activity levels and RTA/RTS for postpartum females.4 This infographic aims to summarise the results of the scoping review and suggest a framework for RTA/RTS postpartum. Review of the scientific rationale, development and validation of the International Olympic committee relative energy deficiency in sport clinical assessment tool:
ObjectiveWomen are often advised to return to activity (RTA) as early as 6 weeks postpartum, despite undergoing significant physical, physiological and psychological changes. Our objective was to ...examine existing evidence and clinical practice guidelines to navigate a safe and successful RTA or return to sport (RTS) postpartum.MethodsWe searched CINAHL, Embase, Medline, PsycINFO and SPORTDiscus and included any secondary studies with recommendations or guidelines for RTA or RTS postpartum. Grey literature and primary sources were excluded. Four reviewers independently screened titles and abstracts, followed by full-text review for eligibility, with conflicts resolved by a third-party reviewer. One reviewer extracted data, which was cross-referenced by another reviewer.Results5851 studies were screened, and 33 were included in this scoping review. Most studies stated that RTS postpartum can begin once ‘medically safe’, around 6 weeks postpartum, but this term was generally left undefined. In addition, most studies recommended engaging in 150 min of moderate-vigorous physical activity per week after 6 weeks postpartum, but the type of exercise recommended was often non-specific.ConclusionA lack of consistent, evidence-based guidelines exist for RTA or RTS postpartum. Multiple evidence gaps require additional research to inform patient and activity specific guidelines for a safe and successful RTA or RTS postpartum.
PURPOSELow back pain is the most frequently reported musculoskeletal disorder and represents one of the highest patient burdens in healthcare. This systematic review and meta-analysis aimed to ...investigate the effectiveness of Pilates exercise on pain intensity and functional disability caused by low back pain (LBP). MATERIALS AND METHODSA Systematic review with meta-analysis was conducted. Data sources: MEDLINE-NLM and MEDLINE-EBSCO. We also searched on Scopus Elsevier, Cochrane, DOAJ, SciELO, PEDro, and PLOS ONE databases. Eligibility criteria: randomized controlled trials (RCTs) evaluating LBP in which the primary treatment was based on Pilates exercise compared with no exercise, or non-specific exercise. RESULTSThe search returned 1566 records of which 36 articles were included in the systematic review and 19 in the meta-analysis. Twenty-two studies compared the effects of Pilates exercise vs no exercise and 13 studies examined the effects of Pilates exercise vs non-specific exercise. Analysis showed that Pilates had a positive effect on the perception of LBP vs no exercise. A similar trend occurred with non-specific exercise. CONCLUSIONSPilates exercise can decrease LBP compared to no exercise and non-specific exercise. General practitioners should consider Pilates exercise as an effective strategy to manage LBP and counteract the growing health. TRIAL REGISTRATIONPROSPERO registration number: CRD42022308387.IMPLICATIONS FOR REHABILITATIONPilates is a good strategy for improving low back pain and is more effective than other exercise programs or no exercise.Pilates is a safe tool to apply to most of the population with low back pain.Pilates is a non-pharmacological strategy useful for counteracting low back pain.
New Findings
What is the central question of this study?
Nitric oxide causes dilatation in peripheral vessels; however, whether nitric oxide affects basal cerebral artery dilatation has not been ...explored.
What is the main finding and its importance?
This study demonstrated that vasodilatation occurs in the right middle cerebral artery in response to exogenous nitric oxide. However, blood velocity decreased and, therefore, overall cerebral blood flow remained unchanged. This study provides new insight into the role of nitric oxide in cerebral blood flow control.
Recent evidence indicates that basal cerebral conduit vessels dilate with hypercapnia, with a nitric oxide (NO) mechanism explaining one way in which parenchymal cerebral arterioles dilate. However, whether NO affects basal cerebral artery dilatation remains unknown. This study quantified the effect of an exogenous NO donor sodium nitroglycerin (NTG); 0.4 mg sublingual spray on the right middle cerebral artery (rMCA) cross‐sectional area (CSA), blood velocity and overall blood flow. Measures of vessel CSA (7 T magnetic resonance imaging) and MCA blood velocity (transcranial Doppler ultrasound) were made at baseline (BL) and after exogenous NTG or placebo (PLO) administration in young, healthy individuals (n = 10, two males, age range 20–23 years). The CSA increased in the rMCA BL, 5.2 ± 1.2 mm2; PLO, 5.4 ± 1.5 mm2; NTG, 6.6 ± 1.5 mm2, P < 0.05; mean ± SD. Concurrently, rMCA blood velocity decreased from BL during NTG compared with PLO (BL, 67 ± 10 cm s−1; PLO, 62 ± 10 cm s−1; NTG, 59 ± 9.3 cm s−1, P < 0.05; mean ± SD. However, total MCA blood flow did not change with NTG or PLO BL, 221 ± 37.4 ml min−1; PLO, 218 ± 35.0 ml min−1; NTG, 213 ± 46.4 ml min−1). Therefore, exogenous NO mediates a dilatory response in the rMCA, but not in its downstream vascular bed.
Purpose
The purpose of this study was to: (1) test the hypothesis that HTO improves articular cartilage composition in the medial compartment without adversely affecting the lateral compartment and ...patella, and; (2) explore associations between knee alignment and cartilage composition after surgery.
Methods
3T MRI and standing radiographs were obtained from 34 patients before and 1-year after HTO. Articular cartilage was segmented from T2 maps. Mechanical axis angle (MAA), posterior tibial slope, and patellar height were measured from radiographs. Changes in T2 and radiographic measures were assessed using paired
t
tests, and associations were assessed using Pearson correlation coefficients.
Results
The mean (SD) MAA before and after HTO was − 6.5° (2.4) and 0.6° (3.0), respectively. There was statistically significant shortening mean (95%CI) of T2 in the medial femur − 2.8 ms (− 4.2; − 1.3),
p
< 0.001 and medial tibia − 2.2 ms (− 3.3; − 1.0),
p
< 0.001, without changes in the lateral femur − 0.5 ms (− 1.6; 0.6),
p
= 0.3, lateral tibia 0.2 ms (− 0.8; 1.1),
p
= NS, or patella 0.5 ms (− 1.0; 2.1),
p
= NS). Associations between radiographic measures and T2 were low. 23% of the increase in lateral femur T2 was explained by postoperative posterior tibial slope (
r
= 0.48).
Conclusion
Performing medial opening wedge HTO without overcorrection improves articular cartilage composition in the medial compartment of the knee without compromising the lateral compartment or the patella. Although further research is required, these results suggest HTO is a disease structure-modifying treatment for knee OA.
ObjectivesWe systemically reviewed published studies that evaluated aerobic exercise interventions in patients with knee osteoarthritis (OA) to: (1) report the frequency, intensity, type and time ...(FITT) of exercise prescriptions and (2) quantify the changes in markers of cardiovascular health and systemic inflammation.Data sourcesPubMed, CINAHL, Scopus; inception to January 2019.Eligibility criteriaRandomised clinical trials (RCT), cohort studies, case series.DesignWe summarised exercise prescriptions for all studies and calculated effect sizes with 95% CIs for between-group (RCTs that compared exercise and control groups) and within-group (pre-post exercise) differences in aerobic capacity (VO2), heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and inflammatory markers (interleukin-6 (IL-6), tumour necrosis factor-alpha). We pooled results where possible using random effects models.ResultsInterventions from 49 studies were summarised; 8% (4/49) met all FITT guidelines; 16% (8/49) met all or most FITT guidelines. Fourteen studies (10 RCTs) reported at least one marker of cardiovascular health or systemic inflammation. Mean differences (95% CI) indicated a small to moderate increase in VO2 (0.84 mL/min/kg; 95% CI 0.37 to 1.31), decrease in HR (−3.56 beats per minute; 95% CI −5.60 to −1.52) and DBP (−4.10 mm Hg; 95% CI −4.82 to −3.38) and no change in SBP (−0.36 mm Hg; 95% CI −3.88 to 3.16) and IL-6 (0.37 pg/mL; 95% CI −0.11 to 0.85). Within-group differences were also small to moderate.ConclusionsIn studies of aerobic exercise in patients with knee OA, very few interventions met guideline-recommended dose; there were small to moderate changes in markers of cardiovascular health and no decrease in markers of systemic inflammation. These findings question whether aerobic exercise is being used to its full potential in patients with knee OA.PROSPERO registration numberCRD42018087859.
Correspondence to Dr Jenna M Schulz, Family Medicine, Western University Schulich School of Medicine & Dentistry, London, Canada; jschulz2@uwo.ca Health equity, as defined by the WHO, ensures that ...all participants, regardless of background or ability can access and benefit from the essential elements of health and well-being.1 For physical activity and sport, equity often involves breaking down barriers to participation, whether they be financial, cultural or physical. Using an intervention component analysis design, Dawson et al (see page 641) evaluate the effectiveness of fall prevention programmes in residential aged care and conclude that to prevent falls, delivering the right exercise that is sufficiently resourced and tailored to the individual is critical. ...in a systematic review and meta-analysis conducted by Zhang et al (see page 674) , they seek to determine the efficacy of exercise-based sport injury prevention programmes in community settings.
•Pola-DA-EPCH-R has an acceptable safety profile that is similar to that of previously published results of the standard DA-EPOCH-R regimen.•Substituting vincristine with Pola did not appear to ...affect the ability to escalate chemotherapy dosing beyond dose level 1.
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The POLARIX trial demonstrated the superiority of polatuzumab vedotin (Pola) over vincristine in the rituximab-cyclophosphamide-doxorubicin-vincristine-prednisone (R-CHOP) regimen for large B-cell lymphomas, but it is unknown whether Pola can be safely incorporated into intensified regimens (eg, dose-adjusted DA–EPOCH-R etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab) typically used for the highest risk histologies. This was a single-center, open-label, prospective clinical trial of 6 cycles of Pola-DA-EPCH-R (vincristine omitted) in aggressive large B-cell lymphomas. The primary end point was to estimate the safety of Pola-DA-EPCH-R as measured by the rate of dose-limiting toxicities (DLTs) in the first 2 cycles with prespecified suspension rules. Secondary and exploratory end points included efficacy and correlation with circulating tumor DNA (ctDNA) levels. We enrolled 18 patients on study, and with only 3 DLTs observed, the study met its primary end point for safety. There were 5 serious adverse events, including grade 3 febrile neutropenia (3, 17%), grade 3 colonic perforation in the setting of diverticulitis, and grade 5 sepsis/typhlitis. Among 17 evaluable patients, the best overall response rate was 100%, and the complete response rate was 76%. With a median follow-up of 12.9 months, 12-month event-free survival was 72%, and 12-month overall survival was 94%. No patient with undetectable ctDNA at the end of treatment has relapsed to date. Using Pola to replace vincristine in the DA-EPOCH-R regimen met its primary safety end point. These data support the further evaluation and use of this approach in histologies where the potential benefit of both an intensified regimen and Pola may be desired. This trial was registered at www.clinicaltrials.gov as #NCT04231877.
Aging patients with ischemic heart disease (IHD) have impaired cerebrovascular vasodilation in response to hypercapnia, but whether this is due to endothelial dysfunction or impairment in the ...vascular smooth muscle remains unknown. Further, despite being a standard drug given to patients with cardiovascular disease, the role of an exogenous nitric oxide donor (sodium nitroglycerin – NTG, which acts independently of the endothelium) in the cerebrovasculature in these patients is not known. This study tested the hypothesis that age and IHD impair nitric oxide‐mediated dilation (sodium nitric oxide, 0.4 mg spray) of the nine larger cerebral arteries in the Circle of Willis (3 Tesla MRI), as well as mean flow velocity transcranial Doppler ultrasound; right middle cerebral artery (MCA) and calculated MCA cerebral blood flow. These measures were made in groups of IHD (n=10, 49–77 years), older controls (CTL; n=5, 51–78 years) and young healthy (YH; n=10, 20–26 years) individuals. Compared to baseline, right MCA velocity V (cm/s) decreased similarly in all three groups ΔIHD: −5.8 ± 5.0 cm/s; ΔCTL: −5.8 ± 3.2 cm/s; ΔYH: −6.3 ± 4.4: all p<0.05 versus baseline; mean ± S.D.. However, a main effect of drug indicated that NTG induced artery dilation in all six basal and the three extracranial arteries average range of cross sectional area values for all vessels provided here: BL: 3.3 – 16.5 mm2; NTG: 3.9 – 17.9 mm2, p<0.05, mean, and this dilation was similar across all 3 groups e.g. right MCA CSA – ΔIHD: 1.3 ± 1.4 mm2; ΔCTL: 0.7 ± 1.2 mm2; ΔYH: 1.3 ± 0.9 mm2, p>0.05 versus baseline; mean ± S.D.. As a result, NTG exerted no change in MCA blood flow versus baseline. These results demonstrate that age and IHD have little impact on vascular smooth muscle responses to exogenous nitric oxide.
Support or Funding Information
Supported by Canadian Institute for Health Research (201503MOP‐342412‐MOV‐CEEA)
This is from the Experimental Biology 2018 Meeting. There is no full text article associated with this published in The FASEB Journal.
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