Exercise therapy - the public health message.

Non-communicable chronic diseases (NCDs), such as cardiovascular disease, diabetes, and cancer, are currently responsible for 65% of all deaths worldwide and are projected to cause over 75% of all deaths by 2030. A substantial accumulation of epidemiological and experimental evidence has established a causal relationship between NCDs and well-known yet preventable risk factors (e.g., physical inactivity and obesity). Given that physical activity has both direct and indirect effects on the mortality and morbidity of NCDs via other risk factors (e.g., obesity, diabetes, and hypertension), it is now undeniable that sedentary lifestyles are one of the most significant public health problems of the 21st century. In 2007, the American College of Sports Medicine (ACSM) and American Medical Association (AMA) launched the Exercise is Medicine® (EIM) initiative in recognition of the fundamental importance of physical activity to health and well-being. EIM is on the forefront of a global movement to reduce sedentary lifestyles, foster implementation of exercise counseling into clinical practice, and disseminate exercise therapy on a global scale. If the devastating human losses and financial burden of inactivity-induced chronic disease are to be ameliorated, the wide-ranging cost-effective health benefits and financial feasibility of physical activity interventions must be appreciated and promoted.

Exercise-induced bronchospasm prevalence in collegiate cross-country runners.

PURPOSE: The purpose of this study was to determine the prevalence of exercise-induced bronchospasm (EIB) in collegiate cross-country runners using a protocol involving an intense exercise challenge conducted in the same environment in which the athletes train and compete. METHODS: One-hundred eighteen collegiate cross-country runners from the Los Angeles, California, metropolitan area participated in the study. All testing took place on a track at the time and location of a normal practice session. The baseline peak expiratory flow rate (PEFR) measurements (best of three) and preexercise heart rate were recorded, after which the athletes ran 2000 m on a track at 85% of maximum heart rate. The postexercise heart rate was recorded and then PEFR measurements at 2, 5, 10, and 30 min after exercise were recorded. The athletes completed a 16-item questionnaire regarding asthma symptoms and health history. Those athletes with a history of asthma and currently taking medications for the asthma were then excluded from statistical analysis of the questionnaire responses. A decrease in PEFR of 15% was considered positive for EIB. RESULTS: Of the 114 athletes not currently taking medications for asthma, at least 14% (16 athletes) were EIB positive. There was a poor correlation between reported symptoms of asthma and testing positive for EIB. CONCLUSION: This study demonstrates a high prevalence of EIB in collegiate cross-country runners (at least 14%) and that reported symptoms are a poor predictor of actual EIB.

Comparing sports injuries in men and women.

OBJECTIVE: To compare the pattern of injury between men and women in seven collegiate sports to determine if gender-specific factors exist which could be modified to reduce the risk of injury to female athletes. DESIGN: Retrospective cohort study of injury reports compiled by certified athletic trainers between Fall 1980 and Spring 1995. SETTING: An NCAA division III College. PARTICIPANTS: Eighteen to 22 year-old male and female college athletes competing in seven like sports (basketball, cross-country running, soccer, swimming, tennis, track and water polo) at the intercollegiate level, playing similar number of contests and using the same facilities. MAIN OUTCOME MEASURES: Analyses of injury patterns, classified by sport and anatomic location, for men and women in seven like sports. RESULTS: A total of 3,767 participants were included in the study, with 1874 sports-related injuries reported among the men and women's teams. Of these injuries, 856 (45.7%) were sustained by female and 1018 (54.3%) by male athletes. Overall, no statistically significant gender difference was found for injuries per 100 participant-years (52.5 for female athlete versus 47.7 for males). A statistically significant gender difference in injury incidence (p < 0.001) was seen for two sports: swimming and water polo. Female swimmers reported more back/neck, shoulder, hip, knee and foot injuries: and female water polo players reported more shoulder injuries. When evaluating all sports concurrently, female athletes reported a higher rate of hip, lower-leg and shoulder injuries, while male athletes reported a higher rate of thigh injuries. CONCLUSION: Except for some minor gender differences in total injuries for two sports and several differences in total injuries by anatomic location, our data suggest very little difference in the pattern of injury between men and women competing in comparable sports. The increased rate of shoulder injury among female swimmers probably resulted from the more rigorous training philosophy of their coach. Thus, no gender-specific recommendations can be suggested for decreasing the incidence of injury to female athletes competing in these sports.

Prevalence of headaches in football players.

BACKGROUND: Football coaches and team physicians rely heavily on players' reports of symptoms in deciding whether a player may return to the game after sustaining head trauma. The decision is made difficult by the wide variety of associated symptoms, some of which (e.g., headache is among the most common) may or may not be associated with serious head injury. More information is needed about the clinical significance of football-related headache. METHODS: To assess the frequency of headache associated with playing football, we analyzed responses to our questionnaire asking about incidence, frequency, and outcome of football-related headache from 443 football players (320 from college, 123 from high school). RESULTS: Eighty-five percent of respondents reported previous headache related to hitting in football. Asked specifically about their most recent game, 21% of respondents reported having had headache during that game. Of players who had headache, only 19% informed the team physician, trainer, or coach, and only 6% were removed from the game. Twenty-seven percent of respondents reported previous diagnosis of cerebral concussion by medical personnel. Defensive backs (25%), defensive linemen (19%), and offensive linemen (18%) were most likely to have headache, related to hitting. CONCLUSIONS: Our data confirm that posttraumatic headache is commonly associated with football participation and often goes unreported. Given that the most serious complications of head injuries (e.g., second-impact syndrome) occur infrequently, headache as an isolated symptom lacks specificity in predicting such complications in football players. Therefore, unless it persists or is accompanied by additional symptoms, headache alone may not reliably suggest the need to remove players from the game.

The painful shoulder. Zeroing in on the most common causes.

Most shoulder problems seen by the primary care physician involve impingement syndrome or problems at the acromioclavicular joint. Despite the complexity of the structures involved, most of these conditions can be diagnosed and treated without difficulty. MRI or other imaging studies are seldom needed but can be used to confirm a questionable diagnosis. Referral to an orthopedic surgeon is appropriate if shoulder problems persist for 3 to 6 months or if there is evidence of a medium or large rotator cuff tear, severe shoulder stiffness, or a complicated fracture.

Achilles tendon rupture. Is casting enough?

Rupture of the Achilles tendon is relatively uncommon, but most primary care physicians are occasionally faced with evaluation and treatment of such an injury. Diagnosis is not difficult and is based almost solely on the history and physical findings. To avoid misdiagnosis, the Thompson test should be performed in any evaluation of ankle pain. The three management options are casting, open surgical repair, and percutaneous surgical repair. Incidence of rerupture is slightly higher with casting, but the greater costs and higher risk of complications with surgical treatment seem to outweigh the benefits. Because there is no conclusive evidence that functional activity is any better with surgical repair, we recommend casting for a minimum of 8 weeks. After this, the patient should wear a heel lift and begin a supervised physical rehabilitation program.

Stress fractures in athletes. How to spot this underdiagnosed injury.

Stress fractures are an increasingly common injury in competitive athletes, especially runners. Amenorrheic athletes are at particularly high risk. A radionuclide bone scan should be considered when the index of suspicion for stress fracture is high. Plain radiographs are of little use in establishing the diagnosis in the early stages of the injury. Early diagnosis and prompt institution of conservative therapy allow for a favorable outcome in most cases. Avoidance of or reduced participation in the inciting activity is important for pain control. Certain stress fractures, such as those involving the femoral neck, should be monitored closely and treated aggressively with internal fixation when conservative measures fail. Runners who have exercise-induced amenorrhea should be advised to decrease their training intensity to a level where menses resume. Cyclic therapy with conjugated estrogens and progesterone should also be considered, as should daily calcium supplementation.

Management of salicylate toxicity.

Salicylate intoxication remains a commonly encountered problem. Early measures to prevent drug absorption, along with alkaline diuresis of the drug, are essential to successful management. If initial therapy fails to produce a response or if the clinical condition rapidly deteriorates, the patient should be treated aggressively with prompt hemodialysis.

Patient compliance and medication perception.

The problem of patient/client noncompliance with regimens of prescribed medication is addressed, with attention to the incidence and illogical nature of this behavior. The psychological theory of cognitive dissonance is suggested as appropriate to an understanding of some aspects of noncompliance because medicinal preparations represent stimuli that are not necessarily neutral. A medication's perceptual properties may have important and specific meanings for patients or clients that may support or detract from compliance. Recent research and empirical evidence that reflects on this concept are reviewed. With further efforts, it may be possible to enhance compliance through perceptual engineering.

Relation of capsule color and perceived potency.

Perceptual properties of medications can elicit specific expectancies and may have implications for patients' compliance. To explore the relationship between capsules' color and perceived potency, 20 participants rank-ordered seven capsules of saturated hue. 10 men showed more agreement than 10 women in ranking strength; red and black capsules were ranked as 'strongest' and white as 'weakest.'