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• Volume 47, Issue 1
• What's hot today? Current topics in sports and exercise medicine
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• David J Berkoff , MD
• UNC Department of Orthopaedics and Emergency Medicine , UNC School of Medicine, UNC Chapel Hill, North Carolina , USA
• Correspondence to Dr David J Berkoff, 3142 bioinformatics bldg. CB 7055, UNC Dept of Orthopaedics, Chapel Hill, NC 27599, USA; david_berkoff{at}med.unc.edu

https://doi.org/10.1136/bjsports-2012-091965

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• Exercise rehabilitation
• Sports rehabilitation programs

This American Medical Society for Sports Medicine (AMSSM)-shaped issue of BJSM highlights ‘hot topics’ in sports medicine. The Merriam-Webster's dictionary defines ‘hot’ as: of intense and immediate interest. I used this simple definition to guide AMSSM's selection of articles for this issue. This issue's selections are clearly ‘hot topics’ but to whom are they considered ‘hot?’

Hot for whom?

What defines a sport and exercise medicine practitioner? Is it the team physician who cares for the professional or elite athlete? Is it the paediatrician who encourages the obese adolescent to put down the Wii controller and get outside? Or is it the cardiologist who dedicates herself to getting a heart failure patient back to tolerating light exercise? How does someone best describe what we do for our patients? We as ‘sports and exercise medicine’ providers have a unique role that encompasses multiple specialties, age groups and patient populations. We are tasked with prescreening athletes prior to activity, preventing and treating all manners of sporting injury. We care for the elderly, the young and those with chronic illness. We follow patients after injuries and are often the experts consulted with difficult and challenging medical cases that are both medical and sports related. We are a diverse group and we meet a wide range of needs. Thus, choosing what is ‘hot’ and relevant to everyone reading this AMSSM-shaped issue was challenging.

The power of placebo

The emerging treatments such as PRP, orthokine and stem cell therapy are not directly represented in this issue. Whereas novel treatments are receiving increased attention in many sports medicine journals, I instead chose to review the power of placebo ( http://dx.doi:10.1136/bjsports-2012-091472 http://dx.doi:10.1136/bjsports-2012-091472). The placebo effect and the need for the double-blind placebo-controlled trial was first described in 1955 by Henry Beecher. 1 This was elaborated on by Shapiro et al 2 and has since become the standard to which we compare all new interventions. A PubMed search today results in 4311 citations highlighted using the search term ‘placebo effect.’ To understand the value of a novel treatment we need to know how these therapies stack up to this powerful standard. Before we adopt a new treatment, we need to understand the influence of what we do and how we measure the persuasive power of placebo in affecting positive change.

The team physician: it only gets more complicated

At the 2012 AMSSM national conference in Atlanta, the presentation by Dr Tracey Viola was a highlight. Team physicians travel around the US providing care to athletes and staff. 3–5 Surely, intranational travel does not involve licensing and malpractice risks. To the surprise, and consternation, of many of us, Dr Viola outlined major licensure and malpractice coverage gaps ( see page 60 ). Having to worry about how to legally perform our duties in other states makes our jobs more difficult. In addition, increasingly difficult is the complicated duty of the team physician to communicate confidential medical information. We are now fully immersed in the social media blogosphere. Facebook, Twitter, LinkedIn and a plethora of other often anonymous sources often leak medical information about our athletes. How do we control this flow of information? What happened to confidentiality and the doctor–patient relationship? Who is leaking these details and who is ultimately responsible for it? The article by Ribbans et al ( see page 40 ) looks at what kind of information is making it to the media, and how this is potentially putting the treating practitioner at risk.

As I continued to narrow down the list of ‘hot topics’, I was left with three topics that were the most pervasive in the past issues: concussion, cardiology and physical activity and health. Each has a uniqueness to it and an international impact that cannot be ignored.

Concussion—an evolution in understanding

The AMSSM has spent the last year collaborating to assemble a society position paper ( http://dx.doi:10.1136/bjsports-2012-091941 ). This document is an outstanding compilation of prior concussion data and research. The clinical experts involved have synthesised reams of information and created this exceptional position statement for our members and clinicians involved in concussion care. This paper will be an influential reference for practitioners worldwide. Equally important is the timing of this concussion statement with the recent 4th Zurich consensus meeting and its consensus paper being published in BJSM 's Concussion Themed Injury Prevention and athlete's Health Protection issue in March 2013. We are confident that the AMSSM position paper will stand along side the 2013 consensus statement as a reference for sports medicine practitioners everywhere.

Long QT syndrome: which athletes are really at risk?

The high-impact research into sudden cardiac death and preparticipation screening by Dr Jonathan Drezner and his colleagues has brought a new level of attention to the quality and breath of research performed by the members of AMSSM. ECG screening is a hot topic worldwide, 6 – 8 and there exists significant debate regarding the precise protocol for preparticipation cardiovascular risk assessment. Dr Michael Ackerman, one of the world's leading experts in long QT syndrome (LQTS), has been studying this high-risk group of athletes for many years. 9 His manuscript published in this issue is truly eye opening ( http://dx.doi:10.1136/bjsports-2012-091751 ). We gather information, do our best to interpret the results, but are we really saving lives or are we merely needlessly excluding young athletes from participation? Dr Ackerman's manuscript sheds new light on this regarding LQTS and restriction from participation. On the subject of sports cardiology, do not forget the special BJSM supplement on this topic in November 2012, 10 and next month's BJSM will have even more on this topic. It is hot and BJSM is the leading sports and exercise medicine journal for sports cardiology.

Physical inactivity is the #4 risk factor for mortality worldwide. What are we doing to change this?

Physical activity saves lives! Physical activity and health is a BJSM focus as evidenced by the volume of articles that are published related to physical activity (PA) and obesity, youth, the elderly and much more. 11 – 14 Salt Lake City sports physician Dr Joy details how we take the next step from identifying physical inactivity as a problem to implementing solutions ( http://dx.doi:10.1136/bjsports-2012-091620 ). Complementing that paper, we have selected an article highlighting a simple single-question method for evaluating PA. If the process of determining PA is onerous, practitioners will not do it. Dr Milton et al ( see page 44 ) show that a single question can be sufficient to determine if a patient's activity level is sufficient to benefit their health.

AMSSM is committed to clinical research and the education of sports medicine providers and has assembled one of the most exciting line ups ever for their upcoming National conference. We invite you to attend the 22nd AMSSM Annual Meeting from 17 to 21 April in sunny San Diego, California. We will highlight hot topics, clinically relevant content and original research submissions. Find out more at www.amssm.org . Also check the BJSM podcast where we discuss this special AMSSM issue and preview the conference in more detail.

See you in San Diego—register today!

• ↵ Shapiro AK. Etiological factors in the placebo effect. JAMA 1964;187:712–4 .
• Whiteside J ,
• Sahebzamani F ,
• Pfister GC ,
• Puffer JC ,
• Johnson JN ,
• Ackerman MJ
• Bennett K ,
• Kujala UM ,
• Andersen LB ,
• McLaughlin D ,

Funding None.

Competing interests None.

Provenance and peer review Commissioned; internally peer reviewed.

Linked Articles

• Original articles Can a single question provide an accurate measure of physical activity? Karen Milton Stacy Clemes Fiona Bull British Journal of Sports Medicine 2012; 47 44-48 Published Online First: 20 Apr 2012. doi: 10.1136/bjsports-2011-090899
• Short report A survey of state medical licensing boards: can the travelling team physician practice in your state? Tracey Viola Chad Carlson Thomas H Trojian Jeffrey Anderson British Journal of Sports Medicine 2012; 47 60-62 Published Online First: 04 Oct 2012. doi: 10.1136/bjsports-2012-091460
• Original articles Sports medicine, confidentiality and the press Bill Ribbans Hannah Ribbans Craig Nightingale Michael McNamee British Journal of Sports Medicine 2012; 47 40-43 Published Online First: 18 Sep 2012. doi: 10.1136/bjsports-2011-090439

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ADOLESCENT AND PEDIATRIC SPORTS MEDICINE

Concussion and mental health disorders in children and adolescents (March 2024)

Ongoing research continues to examine the complex relationship between concussion and mental health disorders. In a recent case-control study of over 18,000 children (≤17 years old) with concussion and over 37,000 matched controls, concussion was associated with an increased risk for a new diagnosis of a behavior disorder at two and four years after injury [ 1 ]. For most diagnoses, the absolute numbers were low. Confidence in a causal relationship is limited by risk of confounding and reliance on an electronic medical record for establishing lack of baseline behavioral problems prior to injury. Whether pediatric concussion is an independent risk factor for new behavioral problems after recovery remains unclear. (See "Concussion in children and adolescents: Management", section on 'Mental health disorders' .)

Overuse injuries, overtraining, and burnout in children and adolescents (February 2024)

Greater numbers of children and adolescents now specialize in a single sport, thereby increasing the risk for overuse injuries, overtraining, and burnout. The American Academy of Pediatrics has issued a new clinical report that reviews the medical literature about these conditions and summarizes key findings pertaining to risk factors, clinical presentation, and prevention [ 2 ]. The report emphasizes the importance of achieving a healthy balance between stress and recovery. Specific recommendations include taking one to two days off from competition and sport-specific training each week and two to three months away from any specific sport each year. Discussions of endurance sports and weekend tournaments are included. (See "Overtraining syndrome in athletes", section on 'Special considerations in the young athlete' .)

Benign acute childhood myositis (January 2024)

Benign acute childhood myositis (BACM) is a self-limited syndrome associated with calf pain and creatinine kinase elevation, often following infection with influenza. In a retrospective study of 65 patients with BACM, the median age was 6.6 years and 66 percent of patients were male [ 3 ]. The most common symptoms were bilateral calf pain, refusal to walk, and diffuse weakness. The median creatinine kinase was 1827 U/L, which normalized after an average of seven days. Early recognition of this syndrome allows the clinician to avoid an unnecessary evaluation for other muscle diseases. (See "Overview of viral myositis", section on 'Benign acute childhood myositis' .)

Avulsion fractures of hip and pelvis in children (October 2023)

There are few large-scale studies of pelvic avulsion fractures in children. A retrospective review of over 700 children with pelvic or hip avulsion fractures from a single tertiary care hospital reported the average patient age was just over 14 years and nearly 80 percent were sustained by males [ 4 ]. The anterior-superior and inferior iliac spines and ischial tuberosity were the most common sites, accounting for over 80 percent of fractures. Most injuries were sustained while the patient was running or kicking during sport, most often football (soccer). The incidence of avulsion fracture rose substantially during the study period, 2005 to 2020. (See "Pelvic trauma: Initial evaluation and management", section on 'Epidemiology and mechanism' .)

MANAGEMENT AND REHABILITATION OF MUSCULOSKELETAL INJURIES

Risk of reinjury following ACL repair (February 2024)

Despite advances in surgical techniques, the risk of reinjury following repair of a ruptured anterior cruciate ligament remains substantial, ranging from 5 to 15 percent depending on the patient's age and activities. According to a systematic review of 71 studies involving over 600,000 patients, factors associated with an increased risk for retear following surgery include male sex, younger age, preoperative high-grade knee laxity, return to a high activity level or sport, and concomitant medial collateral ligament injury [ 5 ]. The modifiable factors identified highlight the importance of following a rigorous rehabilitation program and allowing time for complete healing before returning to sport. (See "Anterior cruciate ligament injury", section on 'Risk of reinjury' .)

Barbotage procedure for calcific tendinopathy of shoulder (January 2024)

To date, few high-quality studies have assessed the effectiveness of barbotage, an ultrasound-guided procedure to remove deposits in patients with calcific tendinopathy of the shoulder. In a recent, multicenter trial, 220 adults with calcific tendinopathy of at least three months duration were randomly assigned to one of three treatment arms: barbotage plus injection with glucocorticoid and analgesic; sham barbotage plus injection with glucocorticoid and analgesic; or, sham barbotage plus injection of analgesic alone [ 6 ]. At four months, patients in all three groups experienced moderate improvement in shoulder symptoms and function, but no significant differences were noted among treatment groups. At 24 months, neither barbotage with glucocorticoid injection nor glucocorticoid injection alone was superior to sham treatment (ie, analgesic injection alone). While barbotage is likely less effective than previously thought, we believe it remains a useful therapy for some patients. (See "Calcific tendinopathy of the shoulder", section on 'Barbotage' .)

Return to sport following stress fracture (November 2023)

Evidence is limited regarding return to sport (RTS) following stress fracture. A new systematic review of 76 studies involving nearly 3000 cases,provides some guidance; most of the studies were retrospective and involved predominately male athletes [ 7 ]. The lowest overall rates for RTS were reported for injuries of the femoral neck (55 percent), talus (69 percent), anterior tibial shaft (76 percent), and tarsal navicular (83 percent). The longest average times for RTS were reported for stress fractures of the tarsal navicular (127 days), femoral neck (107 days), and medial malleolus (106 days). These figures are averages, and healing for individuals may vary substantially given the many factors involved, including location within the bone, radiologic grade, duration of symptoms, compliance with treatment, and underlying bone health. Nevertheless, these findings inform treatment decisions and anticipatory guidance for athletes. (See "Overview of stress fractures", section on 'Return to activity' .)

Heavy load resistance exercise for tendinopathy (November 2023)

Evidence supporting the effectiveness of resistance exercise for the treatment of chronic (overuse) tendinopathy is growing. A recent systematic review and meta-analysis of 110 studies with just under 4000 subjects assessed research primarily involving the rotator cuff, Achilles, lateral elbow, and patellar tendons [ 8 ]. While noting that resistance dose was not well documented in many studies, researchers found consistent evidence that rehabilitation programs using resistance loads in excess of body weight and performed less frequently (ie, less than daily) demonstrated greater efficacy. These findings are consistent with our approach to treatment. (See "Overuse (persistent) tendinopathy: Overview of management", section on 'Heavy-load resistance training' .)

PREVENTION AND BIOMECHANICS OF MUSCULOSKELETAL INJURIES

Running injuries in high school and collegiate athletes (March 2024)

Although running is the most common form of exercise, few high-quality reviews of running-related injuries have been published. A recent systematic review that included 24 prospective cohort studies (nearly 2000 adolescent and young adult competitive runners) found that female runners sustained more injuries than their male counterparts [ 9 ]. All runners, but particularly females, with risk factors for relative energy deficiency in sport (REDS) experienced higher injury rates; athletes with weak hip and thigh muscles were at increased risk of developing anterior knee pain (eg, patellofemoral pain). This study also confirmed known risk factors, such as a history of prior running-related injury. Overall, study quality and certainty of evidence were low to moderate. These findings reinforce the importance of sound nutrition and adjunct strength training to prevent running injuries. (See "Running injuries of the lower extremities: Risk factors and prevention", section on 'Sex and age' .)

• Delmonico RL, Tucker LY, Theodore BR, et al. Mild Traumatic Brain Injuries and Risk for Affective and Behavioral Disorders. Pediatrics 2024; 153.
• Brenner JS, Watson A, COUNCIL ON SPORTS MEDICINE AND FITNESS. Overuse Injuries, Overtraining, and Burnout in Young Athletes. Pediatrics 2024; 153.
• Attaianese F, Costantino A, Benucci C, et al. Benign acute children myositis: 5 years experience in a tertiary care pediatric hospital. Eur J Pediatr 2023; 182:4341.
• Ferraro SL, Batty M, Heyworth BE, et al. Acute Pelvic and Hip Apophyseal Avulsion Fractures in Adolescents: A Summary of 719 Cases. J Pediatr Orthop 2023; 43:204.
• Zhao D, Pan JK, Lin FZ, et al. Risk Factors for Revision or Rerupture After Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis. Am J Sports Med 2023; 51:3053.
• Moosmayer S, Ekeberg OM, Hallgren HB, et al. Ultrasound guided lavage with corticosteroid injection versus sham lavage with and without corticosteroid injection for calcific tendinopathy of shoulder: randomised double blinded multi-arm study. BMJ 2023; 383:e076447.
• Hoenig T, Eissele J, Strahl A, et al. Return to sport following low-risk and high-risk bone stress injuries: a systematic review and meta-analysis. Br J Sports Med 2023; 57:427.
• Pavlova AV, Shim JSC, Moss R, et al. Effect of resistance exercise dose components for tendinopathy management: a systematic review with meta-analysis. Br J Sports Med 2023; 57:1327.
• Joachim MR, Kuik ML, Krabak BJ, et al. Risk Factors for Running-Related Injury in High School and Collegiate Cross-country Runners: A Systematic Review. J Orthop Sports Phys Ther 2024; 54:1.

Osteochondrosis, Apophysitis, Other Bone-related pediatric injuries

Scat 6 – 2023 concussion update, rheumatology serology overview, apophysitis, groin pain in athletes (non-hip joint), cardiac rehabilitation, stress testing and exercise prescription.

Dermatological Conditions in Athletes

ECG Screening in Athletes

Emergency Action Plan

Exertional Rhabdomyolysis

Fracture Management in Primary Care

Iron Deficiency in Athletes

Preparticipation History and Physical

Venous thromoembolism and Return to play

Oct 16, 2019 / Sports Medicine

Hot Topics in Sports Medicine: Modalities and Trends

• There is no evidence, to date, that PRP in acute muscle injuries is superior than placebo or rehabilitation alone.
• PRP is associated with a reduction in patient reported pain (up to one year) for certain conditions.
• Despite widespread usage, little is known on benefits of PRP on the musculoskeletal system.
• Past decade, research showing BFR in combo w/ LL (light load) training → significant muscle strength and size in healthy individuals
• Concerns about adverse effects have not been published in studies, only case reports.
• Promising but not conclusive results for post ACL reconstruction early strengthening and pain for some patellofemoral pain populations.
• Positive results as an adjunct to traditional physical therapy post-knee arthroscopy.
• Clinical applications for BFR training in patients with musculoskeletal conditions are vast.
• Further studies are needed to study the efficacy and safety of BFR in both operative and non-operative orthopedic conditions.
• More effective than low-load training alone but less effective than heavy-load training.
• Limited data is available in the pediatric population.
• Might be appropriate adjunct therapy for knee OA, patellofemoral pain, post op knee arthroscopy, post-ACLR and muscle injuries (hamstrings).
• Lack of standardized protocols for temperature, timing and frequency. 
• Unknown effects on muscle recovery after mechanical overload in athletic populations. 
• Wide variation in study designs. 
• Inability to blind (and unable to eliminate placebo effect).
• Possible benefits include enhanced recovery after injuries, post-exercise and counteract inflammatory symptoms from overuse, post-traumatic recovery, pain and performance.
• NOT FDA regulated, NOT cleared/approved by FDA as a safe and effective device to treat medical conditions.
• Skilled and trained personnel must control procedures to prevent adverse effects (necrosis, skin burning).
• Current contraindications: cryoglobulinaemia, cold intolerance, Raynaud’s disease, hypothyroidism, acute respiratory system disorders, cardiovascular disease, purulent-gangrenous cutaneous lesions, sympathetic nervous system neuropathies, cachexia, hypothermia, claustrophobia, mental disorders hindering cooperation during test, pregnant women, children  under 18 (need parental consent).
• Positive results in studies that include children and adolescents.
• Living sedentary lifestyle or periods of inactivity, obesity, hypertension, diabetes: obtaining medical clearance from physician may be appropriate prior to starting HITT program.
• Can easily be modified for people of all fitness levels and special conditions (i.e. overweight, diabetes).
• Can be performed on all exercise modes: cycle, walk, swim, aqua training or elliptical.
• Time efficiency: similar benefits as to continuous endurance workouts, but in a less time.
• Burns more calories especially post workout due to increased excess post-exercise oxygen consumption (EPOC) after HIIT workouts.

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Mayo Clinic School of Continuous Professional Development

You are here, sports medicine for the clinician online course.

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Course Directors:  George Pujalte, M.D., Daniel Montero, M.D. and Wesley Troyer, D.O.

Access to this online course is available from the date of purchase until the course expires on March 17, 2027. Credit must be claimed within that time period.

The Sports Medicine for the Clinician online course offers learners the confidence to accurately diagnose and treat sports-related conditions, as well as injuries sustained during recreational physical activities. This online course covers appropriate testing and referral criteria, as well as what is on the horizon for diagnosis and treatment. The online course also helps to improve the specific skills in physical exam and imaging interpretation that assist in the diagnosis of conditions that may have implications for participation, performance and recovery in sports and recreational physical activities. The iteration of the lectures also stresses medical conditions and their implications on sports and athletic activities. The selection of topics are our most popular CME talks from the 2023 Mayo Clinic Sports Medicine for the Clinician live course. 

Target Audience

This course is designed for NPs & PAs, sports medicine physicians, family physicians, physiatrists, internists, pediatricians, ER physicians, orthopedists, and medical providers involved in the care and management of athletes and active individuals in clinic or nonoperative/nonsurgical/noninvasive settings.

Learning Objectives

• Identify medications to avoid for athletes and active patients considering sport-specific injuries.
• Identify exercise as a form of management for chronic conditions and various musculoskeletal injuries.
• Recognize various assessment strategies that participants can use in clinic to diagnose difficult to discern orthopedic and sports medicine conditions.

Utilization of this Mayo Clinic online (enduring materials) course does not indicate nor guarantee competence or proficiency in the performance of any procedures which may be in this course.

Additional Information

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The original article was published in Sports Medicine - Open 2023 9 :110

The Original Research Article to this article has been published in Sports Medicine - Open 2023 9 :55

Comment on: Exploring the Low Force-High Velocity Domain of the Force–Velocity Relationship in Acyclic Lower-Limb Extensions

The original article was published in Sports Medicine - Open 2023 9 :55

The Letter to the Editor to this article has been published in Sports Medicine - Open 2023 9 :111

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Sports Medicine and Movement Sciences

Giuseppe musumeci.

a Department of Biomedical and Biotechnological Sciences, Human Anatomy and Histology Section, School of Medicine, University of Catania, Via S. Sofia 87, 95123, Catania, Italy

b Research Center on Motor Activities (CRAM), University of Catania, 95123, Catania, Italy

c Department of Biology, College of Science and Technology, Temple University, Philadelphia, PA, 19122, USA

Sports Medicine is a relatively new topic in medicine and includes a variety of medical and paramedical fields. Although sports medicine is mistakenly thought to be mainly for sports professionals/athletes, it actually encompasses the entire population, including the active and non-active healthy populations, as well as the sick [ 1 ]. Sports medicine also engages amateur sportsmen and strives to promote physical activity and quality of life in the general population. Hence, the field involves all ages from childhood to old age, aiming to preserve and support every person at every age. Sports medicine, which started developing in the 19 th century, is today a medical speciality.

Currently, there exist different technologies applied in the world of sports medicine dedicated to the detection of health problems. Evidence has demonstrated that virtual environments can be useful therapeutic tools with demonstrated positive outcomes. Modern technological advances have led to the implementation of digital devices, such as wearables and smartphones, which have been shown to provide opportunities for healthcare professionals and researchers to monitor physical activity and therefore engage patients in daily exercising. Additionally, the use of digital devices has emerged as a promising tool for improving frequent health data collection, disease monitoring, and supporting public health surveillance. The leveraging of digital data has laid the foundation for the development of a new concept of epidemiological study, known as “Digital Epidemiology”, which could contribute in the future to personalized and precision sports medicine.

The understanding of the importance of physical activity and fitness as part of a healthy lifestyle is increasing all over the world, as well as the number of amateur athletes and the profession of sports medicine takes a big part in this process.

Physical inactivity is the fourth leading cause of morbidity and mortality worldwide [ 2 ]. Regular physical activity is highly beneficial for the primary, secondary and tertiary management of many common chronic conditions. There is considerable evidence for the benefits of physical activity for cardiovascular disease, diabetes, obesity, musculoskeletal conditions, some cancers, mental health and dementia [ 3 ]. Yet there remains a large evidence-practice gap between physicians’ knowledge of the contribution of physical inactivity to chronic disease and routine effective assessment and prescription of physical activity.

The benefits of physical activity for the prevention and treatment of many chronic diseases are well established, including the infection of Sars-CoV-2. Considering the countless positive effects of exercise, planning an adapted physical activity in all phases of recovery (bed rest, rehabilitation, and post-hospitalization) of the patient represents an important strategy to mitigate the decline of cognitive functions and improve the physical and psychological wellbeing of subjects affected by COVID-19. Physical activity, if adapted to the needs of the individual, practiced consistently and regularly, shows a positive influence on the immune system due to its natural protective and anti-inflammatory action. Correct and constant physical exercise, even at home, at all ages and especially in the elderly, is an extra shield against Sars-CoV-2 [ 4 ]. Thanks to the Adapted Physical Activity patients improve the skills: psychological, mental, cardiorespiratory and muscular.

For some chronic conditions, structured exercise interventions are at least as effective as drug therapy. The adapted physical activity should be prescribed in the same way as pharmacological treatment, deciding on the “dosage” and “formulation” for each patient. The “dosage” is calculated to reach a specific level of efficacy that prevents or improves symptoms but does not result in toxic effects [ 3 ]. The exercise regime should always be "adapted" personalized and "tailored" since the level of exercise will depend on the tolerability of the individual, since the body of each of us always responds differently. No do-it-yourself or generalized training/protocols should be allowed, because physical activity if done poorly, can cause more damage than a sedentary lifestyle. As stated by the American College of Sports Medicine, physical activity should be prescribed/administered, alternatively or in association with drug treatment by the Sports and/or Family Physician and/or the Kinesiologist [ 5 ].

With sincere satisfaction and pride, I present to you the Special Issue titled “Sports Medicine and Movement Sciences” . This Special Issue bridging the gap between science and practice in the promotion of exercise and health and in the scientific assessment, study, and understanding of sports performance, sports injury prevention and treatment, exercise for health as non-surgical and non-pharmacological treatments, rehabilitation techniques, adapted physical activity, drugs in sport, and recommendations for training and nutrition.

This Special issue comprises 3 review articles and 16 original research publications from a number of Sports Medicine and Movement Sciences researchers [ 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 ]. Taken together, these articles are geared toward the advancement of our understanding Sports Medicine and Movement Sciences arena, including: Cognitive function; Brain health; Gait analysis; Biomechanics; Health sciences; Physiology; Physical activity; Occupational health; Musculoskeletal system; Evidence-based medicine; Aerobic threshold; Anaerobic threshold; Maximal oxygen uptake; Neuroscience; Exercise; Physical Activity; Balance; Metastability; Neuromuscular control; Prevention; Rehabilitation; Health Promotion; Anatomy; Health Technology; Three-dimensional motion analysis; Reliability; knee injury; Athletic pubalgia; Cardiology; Women's Health; Female athletes; Applied psychology; Clinical psychology; Paralympic sport; Goalball; Soccer; Cognitive psychology; Quality of life; Disability; Regenerative medicine; Osteoarthritis; Virtual reality; Sensorimotor control; Sports injury prevention; Epidemiology; Public health; Psychology; COVID-19; Pandemic; Quarantine; Home based exercise; IPAQ-SF; Psychological well-being; PGWBI; Nerve injury; Nerve regeneration; Therapeutic exercise; Wearable technologies; Sprint initiation; Step technique; Multi-directional movement; Novel training environments and digital devices; Adherence; Breast cancer; Lifestyle; Public Health and Digital Epidemiology.

I hope that readers of Heliyon enjoy reading these significant contributions that remind us of the crucial importance of interdisciplinary collaboration between those working in Sports Medicine and their counterparts in Movement Sciences.

Conflict of interest declaration

The author of this editorial does not have any conflict of interests.

Acknowledgements

The author of this editorial wishes to thank all authors who have contributed to this Special Issue and express his gratitude to Heliyon Clinical Research editorial Team for their assistance and co-operation, in particular Dr. Christian Schulz the Lead Editor of Heliyon and Dr. Lo, On Ching the Editorial Team Leader of Heliyon Clinical Research. Special thanks to the publishing group (Cell Press) who encouraged and made possible the realization of this special issue.

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EMPACT-MI: Empagliflozin Post MI Does Not Lower Risk of First HF Hospitalization, Death

Apr 06, 2024

ACC News Story

The SGLT2 inhibitor empagliflozin did not lower the risk of a first hospitalization for heart failure (HF) or death from any cause among patients with an increased risk for HF following acute myocardial infarction (MI), according to the results of the EMPACT-MI study, presented during a Late-Breaking Clinical Trial session at ACC.24 and published simultaneously in the New England Journal of Medicine .

The event-driven, double-blind trial, conducted from December 2020 to March 2023 at 451 sites in 22 countries, randomly assigned 6,522 patients (median age 63 years, 24.9% women, 83.6% White, 1.4% Black, 12.8% Asian) who had been hospitalized for acute MI and were at risk for HF with newly reduced left ventricular ejection fraction (LVEF) or congestion or both to either 10 mg daily of empagliflozin or a placebo in addition to standard care within 14 days of admission. At baseline, 78.4% of patients had an LVEF ≤45%, and 57.0% had signs or symptoms of congestion that resulted in treatment during the index hospitalization.

Results showed that first hospitalization for HF or death from any cause, the composite primary endpoint, occurred in 267 patients (8.2%) in the empagliflozin group and 298 patients (9.1%) in the placebo group during the median follow-up of 17.9 months. The two groups had incidence rates of 5.9 and 6.6 events, respectively, per 100 patient-years (hazard ratio [HR], 0.90; 95% CI, 0.76-1.06; p=0.21).

For the separate components of the primary endpoint, first hospitalization for HF alone occurred in 118 patients (3.6%) in the empagliflozin group and 153 patients (4.7%) in the placebo group (HR, 0.77; 95% CI, 0.60-0.98) and death from any cause occurred in 169 (5.2%) in the empagliflozin group and 178 (5.5%) in the placebo group (HR, 0.96; 95% CI, 0.78-1.19). Results were similar across all sensitivity analyses for the primary endpoint.

In terms of key secondary endpoints, total number of hospitalizations for HF or death from any cause occurred in 317 cases in the empagliflozin group and 385 in the placebo group (rate ratio [RR], 0.87; 95% CI, 0.68-1.10). Total number of nonelective cardiovascular hospitalizations or death from any cause were 666 and 730, respectively (RR, 0.92; 95% CI, 0.78-1.07). Total number of nonelective hospitalizations for any cause or death from any cause were 998 and 1,138 (RR, 0.87; 95% CI, 0.77-1.0), and total number of hospitalizations for MI or death from any cause were 276 and 274 (RR, 1.06; 95% CI, 0.83-1.35).

The authors noted that an exploratory analysis showed that cardiovascular death occurred in 132 patients (4.0%) in the empagliflozin group and 131 (4.0%) in the placebo group (HR, 1.03; 95% CI, 0.81-1.31). The time to death from cardiovascular causes and time to a first HF hospitalization or cardiovascular death were similar in both groups. Adverse events were similar in the two groups and consistent with the known safety profile of empagliflozin.

Among study limitations the authors noted the lack of central adjudication of endpoint events, which were assessed by site investigators using prespecified definitions, and lack of analysis of outpatient HF events, as well as unsuccessful efforts to improve representation within the trial.

"We found that empagliflozin did not reduce mortality after a heart attack but did reduce the risk of [HF] after heart attack," said Javed Butler, MD, FACC , the study's lead author. "To have a 25% to 30% reduction in [HF] hospitalizations is pretty clinically meaningful, but if you put it together with all-cause mortality, it was not a positive study for our primary endpoint."

In an accompanying editorial comment , Jean Rouleau, MD, FACC , wrote that, "The good news is that the prognosis of patients with left ventricular dysfunction, congestion, or both after an acute [MI] have improved markedly. The challenge is that the identification of additional therapies is increasingly difficult, especially because a large percentage … promptly undergo reperfusion." Moreover, the results of this trial do not support the routine use of SGLT2 inhibitors in this population, but in patients with indications for the drug, such as type 2 diabetes or chronic kidney disease, a recent MI may provide an opportunity to start this treatment and decrease the risk of HF.

Clinical Topics: Heart Failure and Cardiomyopathies, Acute Heart Failure

Keywords: ACC Annual Scientific Session, ACC24, Myocardial Infarction, Heart Failure, Novel Agents, Sodium-Glucose Transporter 2 Inhibitors

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“The Doctor as a Humanist”: The Viewpoint of the Students

Conference Report and Reflection by Poposki Ognen (University Pompeu Fabra); Castillo Gualda Paula (University of Balearic Islands); Barbero Pablos Enrique (University Autonoma de Madrid); Pogosyan Mariam (Sechenov University); Yusupova Diana (Sechenov University); and Ahire Akash (Sechenov University)

The practice of Medicine as a profession has become very technical; doctors rely on fancy investigations, treatment algorithms and standardized guidelines in treating patients. In a lot of universities, medical students and residents are trained without appreciating the importance of art and the humanities in delivering good care to patients and their families. Factual knowledge is imposed on us, as students, from scientific evidence delivered by highly specialized professionals: those who know more and more about niche subjects.

As a result, when someone decides to become a doctor , it seems that scientific training is the sole priority, with most attention being given to the disease-treatment model. As medical students, we are taught very specific subjects, leaving little or no space or time for any cultural enrichment programs. And yet, Personal growth as a doctor and a human being cannot be achieved unless one is exposed to the whole range of human experience. Learning from art and artists can be one such means of gaining these enriching experiences. We can learn from historians, and from eminent painters, sculptors, and writers, as well as from great scientists. How do we achieve these ends? The following essay summarizes and reviews one attempt at providing answers. The 2nd “Doctor as a Humanist” Symposium took place at Sechenov University in Moscow from the 1 st to the 3 rd of April, 2019, to explore the holistic perspective of interpersonal treatment.

To begin our essay, we would like to clarify some key concepts, such as culture, humanism and humanities, as they were employed at the conference. Culture is a complex phenomenon that includes knowledge, beliefs, artistic production, morals, customs and skills acquired by being part of a society, which can be transmitted consciously or unconsciously, by individuals to others and through different generations.

The humanities are academic disciplines that study the cultural aspects and frailties of being human, and use methods that are primarily analytical, critical, or speculative, which distinguish them from the approaches of the natural sciences. Humanism is the practice of making the human story central. Consequently, the studies of humanities, so invested in human stories, is one aspect of practicing humanism.

Technological and practical progress in medicine has been impressive in the past fifty years. Nevertheless, patients still suffer from chronic conditions such as heart failure, chronic lung disease, depression, and many others. These are conditions where technology cannot significantly change the outcomes or reverse the underlying condition. One of the ways to alleviate suffering is through compassion and empathy where the doctor is a professional who listens to, understands and comforts the patient, as well as engaging the patient as a fellow human being. We need arts and humanities as doctors’ tools to comfort and, perhaps, even to heal. We also need them to remind us that we are ‘merely human’ ourselves, and that we share our humanity with our patients, as equals.

Unquestionably, there are fundamental requirements that every physician must internalize; the conference goal was to explain that one such requirement is the humanistic view. Opera, poetry, philosophy, history, the study of dialectics, biographical readings, and even volunteering abroad can be means of engaging the world for positive change. Sometimes called  “soft” skills, these are in fact necessary and valuable qualities to empower ourselves as persons, as well as doctors. The 2nd The Doctor as a Humanist Symposium placed the corner stone in a global project that aims to understand medicine as a multidisciplinary subject, and to establish the concept of humanistic medicine both as a science and an art where the patient and the doctor are human beings working together.

STUDENT PARTICIPATION

The event united experts in Medicine and the Humanities from all over the world. The speakers (doctors, nurses and students) were from Russia, the USA, the UK, Spain, Italy, Germany, Mexico and more. Each day’s program was both intense and diverse, and included plenary lectures and panel sessions. Medical students were highly involved in all parts of the conference, offering us a great chance to introduce our projects, share our opinions on various topics, and discuss our questions connected with the role of the humanities in medicine.We participated in roundtable discussions, which were chaired by experts from different countries. Even though this made us nervous, at the same time it was very important for us, as students, to be a part of it. We discussed the future of medical humanities from various perspectives, and above all our thoughts and ideas were listened to and commented on, on an equal basis with the world’s experts. For once, we could see that our views were being taken into consideration, and we hope that in the future this will be the norm and NOT the exception. We are the future of medicine, and our voices should be heard, too.

At the end of the first day there was a students’ session, where we gave our opinions on the relative importance of the medical humanities from a multicultural viewpoint, and on this particular roundtable there were students from Russia, Spain, Iran, Mexico, Italy, as well as a Nursing resident. One of the students during the session shared her view that “I would like to see medicine through the lens of humanism and empathy, and also implement all its principles in my professional life on a daily basis”. All participants agreed, and although we were representing different countries and cultures there was no disagreement about this. Even though we have not yet faced many of the obstacles of the world of medicine, we can see the role of compassion in clinical practice better perhaps than our seniors. We shared our points of view about this question and its relevance in the different countries. It was an incredible moment, as experts and professors demonstrated a great interest in our ideas.

The program was extremely diverse; however, the main idea that most speakers expressed was how to find, sustain and not lose humanist goals. Brandy Schillace gave an impressive presentation entitled “Medical Humanities today: a publisher’s perspective”, which studied the importance of writing and publishing not only clinical trials, but also papers from historians, literary scholars, sociologists, and patients with personal experiences. The nurses Pilar d’Agosto and Maria Arias made a presentation on the topic of the Nursing Perspective that is one of the main pillars of medical practice. Professor Jacek Mostwin (Johns Hopkins University) shared his thoughts on patients’ memoirs. An Italian student, Benedetta Ronchi presented the results of an interview on medical humanities posed to the participants and speakers during the symposium. The plurality of perspectives made this conference an enriching event and showed us how diverse ideas can help us become better doctors. More importantly, it reminded us of our common humanity.

A significant part of the symposium was dedicated to Medicine and Art. Prof Josep Baños and Irene Canbra Badii spoke about the portrayal of physicians in TV medical dramas during the last fifty years. The book “The role of the humanities in the teaching of medical students” was presented by these authors and then given to participants as gifts. Dr Ourania Varsou showed how Poetry can influence human senses through her own experience in communicating with patients. She believed that many of the opinions and knowledge that we have internalized should be unlearned in order to have a better understanding of the human mind. The stimulus of poetry makes this possible. Poetry allows us to find new ways to express ourselves, and thus increase our emotional intelligence and understanding of other people’s feelings.

One of the most impressive lectures was by Dr Joan.B Soriano, who spoke about “Doctors and Patients in Opera” and showed how the leading roles of physicians in opera have changed over the centuries. People used to consider the doctor as the antihero, but with time this view has transformed into a positive one that plays a huge role in history.

It is important to be professional in your medical career, but also to be passionate about the life surrounding you; for instance, Dr Soriano is also a professional baritone singer. For students, this Symposium was full of obvious and hidden messages, which gave us much lot of food for thought. As Edmund Pellegrino, the founding editor of the Journal of Medicine and Philosophy , said: “Medicine is the most humane of sciences, the most empiric of arts, and the most scientific of humanities.”

CHOOSING ONE WORD

To conclude our summary of the students’ viewpoint each of us chose One word to encapsulate our thoughts about the symposium.

The Doctor as a Humanist is a multicultural event where everyone can learn and contribute to this global necessity to put the heart and soul back into medicine. Of course, we are aware and delighted that other organizations are championing the cause of the Humanities in Medicine, and in some cases, such as https://www.dur.ac.uk/imh/ , they have been doing so for many years.

As medical students, we appreciate how we have been placed at the centre of the symposium, which we believe has made this new initiative rather special. We hope that students of Medicine and from other disciplines come and participate in future symposia.

If you want to learn more, and see how you can participate, please contact the International student representatives, Mariam ( [email protected] ) and David ( [email protected] ).

Acknowledgements

Assistance provided by Jonathan McFarland (c) and Joan B. Soriano (University Autonoma de Madrid) was greatly appreciated during the planning and the development of the article.

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AAIM Moscow – August 2012

Mar 25, 2019

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AAIM Moscow – August 2012. Signature Programs Workshop – AIESEC Alumni First Thursdays ( AAFT). Contents. AAFT Definition What is Good Room for Improvement The Name Issue Opportunities Next Steps. Definition.

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• aiesec alumni
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AAIM Moscow – August 2012 Signature Programs Workshop – AIESEC Alumni First Thursdays (AAFT)

Contents • AAFT Definition • What is Good • Room for Improvement • The Name Issue • Opportunities • Next Steps

Definition • Imagine that no matter where on earth you may be, you can join fellow alumni AIESECers the first Thursday of every month to network, to have fun, and to have impact. • Already today, alumni meet on regular basis in a number of cities around the world, and we know that many more would participate if they knew when and where to go. During a brainstorming session at AAIM 2012 in Hungary, we discussed an idea to elevate these meetings into global program. Peter Mandl and Fabian Tschan, AIESEC alumni leaders in Austria and Switzerland, respectively, demonstrated great initiative and entrepreneurship in launching and growing this effort!

Definition • We invite YOU to get engaged in this global effort in your city on the First Thursday of each month. To find out which cities are already participating and to get more information, visit this Facebook page and ‘Like it!’ Every AIESECer is welcome to join us… alumni, students, trainees and our corporate partners. If there is no event in your city yet, we encourage you to organize one. We will be happy to help. • We are as many as one million strong, and our potential “to the power of AIESEC” is huge! Let us unleash this potential together on the First Thursday of every month in as many cities worldwide as we can. This is a great channel for us to learn from one other, create synergies and have impact.

Definition, in short • When: Monthly meeting • Who: AIESECers (Alumni, students, trainees, partners) • What: Meeting • Where: Every city where Alumni is • Why: Networking (social, business) reconnection, fun, drinks

What is good • 6 months in a row, and growing. August with more than 60 events in 5 continents • Many cities with different approaches: Just social, just business, LC meeting and party, coaching, “Blue Economy”, etc. • In some countries, the event is organized by Alumni and students together • Skype videoconferences among events (same time zone) • Interaction among Alumni, students and trainees

What is Good • Sharing results / best practices • Many reasons to attend: • Friends • Fun / Parties • Contact with AIESEC • Business Networking • Still young

Room for Improvement • If we don’t deliver value, the inititative might die • Set a monthly theme (international, regional, national, local) • Urgent need for regional/national coordinators • Event coordination and responsibilities among Alumni, MC and LC • Timing, the event is set up on a very short time frame, so is not properly communicated • Creation / communication of the events on Facebook

Room for improvement • Many reasons not to attend: • Lack of interest • No proper communication • No one to coordinate it • Not relevant • Same people / few people • To frequent • AIESEC is not any more for me

The Name Issue • “FIRST Thursdays” does not reflect the event it self. In many cities the event is not host on the first week neither / or on Thursdays. • Some cities still use the previous name: “First Thirstday”. • Even though is highly valuable to host the event worldwide on the same day, it is more important to recognize needs and wants of each city.

Opportunities • To attract Alumni from all generations • Worldwide brainstorm for new Signature Programs by AIESEC • Start point for Alumni Associations • To set a common name that suits everyone’s needs

Next steps • Set a suggested 6 month “list of topics”, that should be covered during each AAFT; e.g. : • AAIM / IC results • Alumni Association (creation, development). Regional, National, Local. • Leaders List (End of September; Hugo Preciado, KubaKarlinsky, David Epstein) • Select a new name for the initiative, e.g.: • AIESEC Alumni Monthly Meeting • The Monthly Gathering • Etc. (End of October; Hugo Preciado and all the AAFT coordinators)

Next Steps • Encourage AIESEC students (IC, MCs and LCs) to promote the initiative and to collaborate with the Alumni on this (On going; David Epstein, Andrew Rowe with the IC and each coordinator with their MCs / LCs) • AAFT Homepage improvements: • List of coordinators by cities • Sharing / creating the events (End of September; Hugo Preciado and IT person from AI / AAI)

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