Physical activity prescription: a critical opportunity to address a modifiable risk factor for the prevention and management of chronic disease: a position statement by the Canadian Academy of Sport and Exercise Medicine.

Non-communicable disease is a leading threat to global health. Physical inactivity is a large contributor to this problem; in fact, the WHO ranks it as the fourth leading risk factor for overall morbidity and mortality worldwide. In Canada, at least 4 of 5 adults do not meet the Canadian Physical Activity Guidelines of 150 min of moderate-to-vigorous physical activity per week. Physicians play an important role in the dissemination of physical activity (PA) recommendations to a broad segment of the population, as over 80% of Canadians visit their doctors every year and prefer to get health information directly from them. Unfortunately, most physicians do not regularly assess or prescribe PA as part of routine care, and even when discussed, few provide specific recommendations. PA prescription has the potential to be an important therapeutic agent for all ages in primary, secondary and tertiary prevention of chronic disease. Sport and exercise medicine (SEM) physicians are particularly well suited for this role and should collaborate with their primary care colleagues for optimal patient care. The purpose of this Canadian Academy and Sport and Exercise Medicine position statement is to provide an evidence-based, best practices summary to better equip SEM and primary care physicians to prescribe PA and exercise, specifically for the prevention and management of non-communicable disease. This will be achieved by addressing common questions and perceived barriers in the field.Author note This position statement has been endorsed by the following nine sport medicine societies: Australasian College of Sports and Exercise Physicians (ACSEP), American Medical Society for Sports Medicine (AMSSM), British Association of Sports and Exercise Medicine (BASEM), European College of Sport & Exercise Physicians (ECOSEP), Norsk forening for idrettsmedisin og fysisk aktivite (NIMF), South African Sports Medicine Association (SASMA), Schweizerische Gesellschaft für Sportmedizin/Swiss Society of Sports Medicine (SGSM/SSSM), Sport Doctors Australia (SDrA), Swedish Society of Exercise and Sports Medicine (SFAIM), and CASEM.

Impact of a surgical screening clinic for patients with knee osteoarthritis: a descriptive study.

OBJECTIVE: To evaluate a surgical screening clinic for patients with knee osteoarthritis (OA) referred for total knee arthroplasty (TKA) and explore management before referral. DESIGN: Descriptive study using retrospective chart review. SETTING: Large Canadian teaching hospital. PARTICIPANTS: Patients with knee OA referred for TKA over a 1-year period. INTERVENTIONS: Patients underwent standardized assessment by physicians who practice sport medicine to determine eligibility for surgical consultation. MAIN OUTCOME MEASURES: Proportion of patients deemed eligible for surgical consultation and undergoing TKA, and conservative management options tried before clinic referral. RESULTS: Of the 327 patients, 172 (52.6%) were referred to the surgeon, of whom 76% underwent TKA. Options used before referral were medications (92.0%), injections (41.3%), and physiotherapy (34.9%). Patients referred to the surgeon, compared with those who were not, were more likely to have met all referral criteria (86.5% vs 33.3%, P < 0.001), tried 3 or more options (70.9% vs 49.7%, P < 0.01), used injections (58.7% vs 32.3%, P < 0.001), scored higher on the Hip-Knee Priority Tool (45 vs 24, P < 0.001), and had been referred by a physician who practices sport medicine (88.2% vs 46.2%, P < 0.001). CONCLUSIONS: Orthopedic surgical screening by trained physicians using standardized tools halved the number of surgical consultations. Few conservative management options were tried before referral, indicating the need to enhance presurgical care for patients with knee OA.

Intra-articular hyaluronic acid in the treatment of knee osteoarthritis: a Canadian evidence-based perspective.

Osteoarthritis (OA) is a chronic condition characterized by a loss of joint cartilage and is a major cause of disability in Canada, with an estimated CN$195 billion annual cost. Knee OA leads to persistent pain and loss of function, and treatment goals primarily focus on symptom relief and retention of function. Intra-articular hyaluronic acid (IAHA) has therapeutic benefits, and numerous recently published meta-analyses (MAs) and commentaries have highlighted new evidence on the role of IAHA therapy for knee OA. A diverse, multidisciplinary group of specialists met independently in closed sessions to review findings from eight MAs with literature search end dates no earlier than 2012 to address controversies surrounding IAHA therapy for mild-to-moderate knee OA within the Canadian treatment context. Outcomes from a total of eight MAs were reviewed, and consistent and statistically significant improvements in pain, function and stiffness up to 26 weeks were found with IAHA therapy compared with IA placebo or controls, regardless of MA size or trial quality. These findings are in line with those of a Cochrane review, another recent systematic review and patient satisfaction survey. Overall, three MAs reported outcomes based on molecular weight (MW), with the two reporting effect sizes showing significantly improved pain outcomes for higher compared with lower MW HAs. Recent evidence suggests that HA therapy is well tolerated with no increased risk of serious adverse events compared with placebo and the full therapeutic effect of IAHA therapy appears to have considerable clinical importance, consisting of the combined IA placebo and HA therapeutic effects. IAHA therapy is a well-tolerated and effective option for patients with mild-to-moderate knee OA failing first-line pharmacological therapy.

Bilateral atraumatic medial meniscal tears in a 17-year-old rower.

Meniscal injury produces disability in a large portion of the population, and sports injuries are a common cause. Atraumatic meniscal tears may occur after repetitive low-energy loading. Rowing is a highly technical sport and very demanding on an athlete's body. There are numerous reports on patellofemoral and iliotibial band friction syndrome in rowers but there is an extremely low incidence of meniscal tears reported in these athletes. This is a unique case report of a young adolescent athlete who suffered bilateral medical meniscal tears during sporting activity. Rowing is a low impact sport making this an unusual occurrence, especially in a young individual. This case report highlights the importance of considering all training activities when trying to isolate the mechanism of injury in an athlete.