Dietary Ingredients as an Alternative Approach for Mitigating Chronic Musculoskeletal Pain: Evidence-Based Recommendations for Practice and Research in the Military.

OBJECTIVE: Approximately 55-76% of Service members use dietary supplements for various reasons, including pain and related outcomes. This work evaluates current research on dietary ingredients for chronic musculoskeletal pain to inform decisions for practice and self-care, specifically for Special Operations Forces personnel. METHODS: A steering committee convened to develop research questions and factors required for decision-making. Key databases were searched through August 2016. Eligible systematic reviews and randomized controlled trials were assessed for methodological quality. Meta-analysis was applied where feasible. GRADE was used to determine confidence in the effect estimates. The committee made evidence-informed judgments and recommendations for practice and self-care use. RESULTS: Nineteen eligible dietary ingredients were assessed for quality, efficacy, and safety. Avocado soybean unsaponifiables, capsaicin, curcuma, ginger (as a food source), glucosamine, melatonin, polyunsaturated fatty acids, and vitamin D were conditionally recommended as their benefits outweighed risks, but there was still some uncertainty about the trade-offs. No recommendations were made for boswellia, ginger (as a dietary supplement), rose hip, or s-adenosyl-L-methionine. Recommendations were made against the use of collagen, creatine, devil's claw, l-carnitine, methylsulfonylmethane, pycnogenol, willow bark extract, and vitamin E. Research priorities were developed to address gaps precluding stronger recommendations. CONCLUSIONS: Currently the scientific evidence is insufficiently robust to establish definitive clinical practice guidelines, but processes could be established to track the impact of these ingredients. Until then, providers have the evidence needed to make informed decisions about the safe use of these dietary ingredients, and future research can address existing gaps.

Dog walking is associated with a favorable risk profile independent of moderate to high volume of physical activity.

BACKGROUND: An innovative strategy for helping people achieve recommended levels of daily physical activity is dog walking. We assessed differences in physical activity and risk indicators between dog owners who 1) walk their dog (n = 399) and 2) do not walk their dog (n = 137) and compared them with adults who do not own dogs (n = 380). METHODS: Participants (39 ± 13 years) were recruited online and completed an electronic questionnaire. Healthy People 2010 risk indicators included physical activity, overweight status, tobacco use, nutrition behaviors, chronic conditions, depressive symptoms, and social support. RESULTS: Compared with dog walkers, those who did not own or walk their dog reported less physical activity (MET-min·week-1) and a higher body mass index (P < .01). Moreover, after adjusting for age and moderate to high physical activity, those who did not own dogs had significantly greater odds of self-reported diabetes [OR = 2.53; 95%CI (1.17-5.48)], hypertension [OR = 1.71; 95%CI (1.03-2.83)], hypercholesterolemia [OR = 1.72; 95%CI (1.06-2.81)], and depression [OR = 1.49; 95%CI (1.09-2.05)] compared with participants who regularly walked their dogs. CONCLUSIONS: Because of the health benefits associated with dog walking, this activity should be encouraged within communities as a method of promoting and sustaining a healthy lifestyle.