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Jerrold Petrofsky, Lee Berk, Gurinder Bains, Iman Akef Khowailed, Haneul Lee, Michael Laymon
Clinical Journal of Sport Medicine, Volume 27, No. 4, July 2017
Delayed-onset muscle soreness (DOMS) is a relatively common phenomenon experienced by people who are new to exercise, or essentially anyone who exceeds their normal workout intensity. DOMS can range from mild irritation to severe pain that can form a significant barrier inhibiting performance, or exercise participation altogether. Furthermore, previous research has shown that DOMS is greater in intensity and duration in older individuals and individuals with diabetes, which is a particularly important patient population within family medicine. This cross-sectional repeated measure design study was performed to assess the impact on DOMS of heat applied for 8 hours immediately or 24 hours after exercise.
60 subjects aged 20-40 who were physically inactive for 6 weeks and had BMI’s less than 40 were divided randomly into 3 groups (control, ThermaCare heat wraps applied immediately after exercise, and ThermaCare heat wraps applied 24 hours after exercise). To provoke DOMS, the subjects completed squats in 3, 5-minute bouts with 3 minutes of rest in-between each bout. Visual analog pain scales, blood myoglobin, muscle strength, range of motion, and stiffness of the quads were the main outcome measures of the study.
The results revealed a significant reduction in soreness in the group that had the heap wraps applied immediately after exercise (P<0.01). This was corroborated by blood myoglobin, algometer and muscle stiffness data. In addition, there was some benefit to applying the heat 24 hours after exercise when compared to control.
In summary, low-level continuous heat wraps left for 8 hours after heavy exercise can reduce the effects of DOMS (assessed by both subjective and objective measures). Although cold therapy is commonly used after heavy exercise to reduce soreness, heat seems to have the added benefit of increasing flexibility of tissue and tissue blood flow. The authors note that for the purposes of reducing joint swelling, it is still probably better to use cold therapy.
Sean Mindra MD, CCFP
PGY3 – Sport and Exercise Medicine, University of Ottawa
Advisor: Dr. Taryn Taylor BKin, MSc, MD, CCFP (SEM), Dip Sport & Exercise Medicine
Physiotherapist-Led Physical Activity Interventions Are Efficacious at Increasing Physical Activity Levels: A Systematic Review and Meta-analysis
Breanne E. Kunstler, MPhty, Jill L. Cook, PhD, Nicole Freene, PhD, Caroline F. Finch, PhD, Joanne L. Kemp, PhD, Paul D. O’Halloran, PhD, and James E. Gaida, PhD
As per the Canadian Institute for Health Information, in 2017, total health expenditures in Canada are expected to represent 11.5% of Canada’s gross domestic product (GDP). Physicians and health care professionals continue to promote preventative care as one way to tackle the ever-growing cost of health care. Primary prevention is generally low cost and has wide-reaching benefits. Specifically, physical activity has been shown to reduce the burden of disease and decrease the progression of many common non-communicable diseases (NCDs). In 2013, just over 2 in 10 adults and 1 in 10 children and youth in Canada met the Canadian Physical Activity Guidelines, which requires adults to achieve 150 to 300 minutes of moderate intensity of physical activity or 75 to 150 minutes of vigorous intensity physical activity, or an equivalent combination of both each week, as well as muscle-strengthening activities on at least 2 days each week. With so many people in Canada being physically inactive and with the rise in preventable diseases, primary care providers, including allied health professionals, have a critical role to promote physical activity and well-being. Physiotherapists are particularly well trained and positioned to promote physical activity in patients as their treatment plans often involve some type of physical activity.
This article did a systematic review of studies that assessed the efficacy of one-on-one, physiotherapist-led physical activity (PLPA) interventions at increasing physical activity levels among adults in clinic-based private practice, primary care, and outpatient settings. The eight studies that met this articles inclusion criteria looked at adults over the age of 18 who either had MSK injuries, risk factors for NCDs or who were suffering from NCDs. The studies either used subjectively (questionnaire) or objectively (accelerometry) quantified change in physically activity. A meta-analysis was conducted to look at the correlation of PLPA interventions at different follow-up times, as well as looking at success rates of PLPA interventions meeting minimum recommended physical activity levels. It also looked at the effect that the length of the therapy session had on the PLPA interventions success.
Looking at 3 out of the 8 studies included in the review, there was a significant finding that PLPA interventions were efficacious at assisting adults achieve the minimum recommended physical activity levels with an OR of 2.15. The other 5 studies included in the review showed a significant finding that PLPA interventions had only a small effect on patient’s physical activity level in short and medium term follow-up which was not seen past 1 year of follow-up. When comparing the length of intervention seen in the different studies there was no difference in efficacy of PLPA interventions on the improvement physical activity level. Overall, the improvement in PA seen by PLPA interventions ranged from increasing vigorous, moderate and low-intensity PA.
In this article, it was highlighted that there was a lack of analysis on the content as opposed to the length of the interventions. There was also no emphasis on the importance of maintaining the level of physical activity achieved over time. As it was shown, the benefits of the PLPA interventions were not seen in the majority of the studies in long-term follow-up. The one study that did use intervention techniques geared towards maintenance of PA improvements resulted in such maintenance. Even though there was improvement of PA in most patients who received PLPA, the benefits of preventative lifestyle changes such as PA is truly seen when maintained over time and integrated into a person’s weekly routine.
In summary, patients ultimately are responsible for the maintenance of their lifestyles. To help them integrate physical activity into their daily lives primary care providers can play an important role. This article shows that training physiotherapists and primary care health care professionals in behavioral changing counseling can help tackle the growing rate of inactivity and ultimately decrease the risks of NCDs.
- Moroz M.D.C.M. CCFP
Sport and Exercise Medicine Fellow, University of Ottawa
Advisor: Dr. Taryn Taylor BKin, MSc, MD, CCFP (CAC SEM), Dip Sport & Exercise Med
Exercise Class Navigation Flow Chart
Encouraging seniors to exercise and to be physically active is an important part of a fall prevention strategy. Exercise programs that promote balance training combined with strength and flexibility have been shown to be effective in significantly reducing falls and the injuries resulting from a fall. LHIN funded exercise and Fall Prevention programs are available across the Champlain region, and different levels of programs for people of different abilities are provided. However, determining which class is the right one is key to ensuring that participants gain maximum benefit from the class. Choosing the wrong level of class can be a lost opportunity to promote increased activity.
To simplify the choices and decisions for older adults, their families and health care providers, the Navigation Working Group of Champlain Fall Prevention Steering Committee has developed a flow chart. Each region has its own flow chart with local class details and contact information, but the descriptions for each level have been standardized across Champlain with consistent wording for each level of class.
List of locations (Renfrew County and District)
On the reverse of the chart is the Staying Independent Checklist and seniors are urged to complete this fall-risk screening tool, although it is not a determinant of exercise and activity levels. This screen is a key first step in the Champlain Fall Prevention Algorithm of Detection, Diagnosis and Intervention. Primary care providers should encourage their older patients to complete the Staying Independent Checklist annually and to bring issues and concerns to the primary care team.
The exercise class flow chart will be launched in November 2016 (Fall Prevention month) and will be distributed to public health units, community support services, primary care providers and other agencies, to encourage seniors to choose an active lifestyle. The flow charts can be found on the www.stopfalls.ca website under the community resources tab, and also on the Champlainhealthline website , under the Exercise Classes for Seniors button, “Which Exercise Class for me?”
For more information contact:
Champlain Falls Prevention Strategy
Regional Geriatric Program of Eastern Ontario
Cell Phone 519 639 3000
As a family physician, you are often faced with the task of counselling women on exercise in pregnancy. This may be for sedentary individuals, recreational athletes and occasionally elite athletes.
In September 2015, at the IOC meeting in Lausanne, a group of 16 experts sat down to review this topic and provide a consensus statement on exercise and pregnancy. Part 1 of the consensus statement was published in the BJSM in May 2016.
Here are some highlights of their conclusions/guidelines to date (Part 1):
1) The pregnant athlete with a past or current eating disorder should be considered high risk and requires close monitoring involving a mutlidisciplinary team emphasising early recognition, treatment of symptoms, meal planning, training regimen adjustments and evaluation for maternal or fetal consequences from malnutrition.
2) Avoid exercising supine due to compression of the IVC.
3) Exposure to increases in temperature above 39 degrees can increase the risk of fetal abnormalities (neural tube defects) during the formation stage which is 35-42 days from the last menstrual period. Of note, exercising in pregnancy at 60-70% VO2 max in a controlled environment for up to 60min does not raise core temp above 38 degrees.
4) Nutritional requirements for a normal pregnancy: 90kcal/day for T1, 287kcal/day for T2, 466kcal/day for T3.
5) Borg ratings of perceived exertion (RPE) scale does not correlate strongly with heart rate in T2 and therefore the elite athlete should use heart rate as a measure.
6) Refrain from high intensity training regimes at altitudes greater than 1500-2000m.
7) The Valsalva Manuevre used during heavy weight training should be avoided.
8) Heavy weight training may cause large increases in intra-abdominal pressure may may harm the pelvic floor support during or after pregnancy.
9) Relaxin increases laxity and joint instability and therefore this should be considered in flexibility exercises.
10) Avoid high risk sports with risk of trauma (from a collision or being hit by something like a hockey stick or from falling) and avoid scuba diving. Examples of high risk sports include bobsledding, luge, equestrian, pole vaulting, hockey, ski racing)
11) As long as symphysis fundal heights are consistent with gestational age, more frequent ultrasound assessments are not required for elite athletes.
12) Exercise may decrease the risk of pre-eclampsia and gestational diabetes.
13) Different types of exercises and acupuncture significantly reduced pelvic girdle/lumbopelvic pain more than usual care alone.
For more in depth on this topic please see Exercise and pregnancy in recreational and elite athletes: 2016 evidence summary from the IOC expert group metting, Lausanne. Part 1 – exercise in woman planning pregnancy and those who are pregnant. Bo, K, Atral R, Barakat R, et al. Br J Sports Med 2016; 50:571-589.
Written by: Jody Murray BPHE/BSc, MD, CCFP (Sport Medicine Fellow)
Advisor: Dr. Taryn Taylor BKin, MSc, MD, CCFP (SEM), Dip Sport & Exercise Med
Patients with heart disease who sit a lot have worse health even if they include exercise in their lives. That is the conclusion of new findings that looked at the activity levels and corresponding health indicators of patients with coronary artery disease.
“Limiting the amount of time we spend sitting may be as important as the amount we exercise,” said lead author Stephanie Prince, PhD, post-doctorate fellow in the Division of Prevention and Rehabilitation at the University of Ottawa Heart Institute. “Sitting, watching TV, working at a computer and driving in a car are all sedentary behaviours and we need to take breaks from them.”
Previous research has shown that being sedentary increases the risk of cardiovascular disease, but until now, its effect on patients with established heart disease was unknown.
The current study, published in November in the European Journal of Cardiovascular Prevention, investigated levels of sedentary behaviour and the effect on health in 278 patients with coronary artery disease. The patients had been through a cardiac rehabilitation programme which taught them how to improve their levels of exercise in the long term.
Patients wore an activity monitor during their waking hours for nine days. The monitors allowed the researchers to measure how long patients spent being sedentary, or doing light, moderate or vigorous levels of physical activity.
The researchers also assessed various markers of health including BMI and cardiorespiratory fitness to determine whether the amount of time a person spent being sedentary (mainly sitting) was related to these markers.
The patients spent an average of eight hours each day being sedentary. “This was surprising given that they had taken classes on how to exercise more,” said Dr. Prince. “We assumed they would be less sedentary but they spent the majority of their day sitting.”
Men spent more time sitting than women—an average of one additional hour each day. This difference was primarily because women tended to do more light-intensity movement—things like light housework, walking to the end of the drive, or running errands.
Dr. Prince said: “Women with coronary artery disease spend less time sitting for long periods, but we need to do more research to understand why. There is some research which suggests that at around the age of 60 men become more sedentary than women and may watch more TV.”
The patients who sat more had a higher BMI and had lower cardiorespiratory fitness. This was assessed using their aerobic capacity. This is the maximum rate at which the heart, lungs and muscles use oxygen during an exercise test.
“These relationships remained even when we controlled for an individual’s age, gender or physical activity levels,” said Dr. Prince. “In other words, people who sat for longer periods were heavier and less fit regardless of how much they exercised.”
Dr. Prince emphasized that sitting less was not a replacement for exercise. “It’s important to limit prolonged bouts of sitting and in addition to be physically active,” she said. “Sedentary time may be another area of focus for cardiac rehabilitation programmes along with exercise.”