National Strength and Conditioning Association Position Statement on Weightlifting for Sports Performance.

ABSTRACT: Comfort, P, Haff, GG, Suchomel, TJ, Soriano, MA, Pierce, KC, Hornsby, WG, Haff, EE, Sommerfield, LM, Chavda, S, Morris, SJ, Fry, AC, and Stone, MH. National Strength and Conditioning Association position statement on weightlifting for sports performance. J Strength Cond Res 37(6): 1163-1190, 2023-The origins of weightlifting and feats of strength span back to ancient Egypt, China, and Greece, with the introduction of weightlifting into the Olympic Games in 1896. However, it was not until the 1950s that training based on weightlifting was adopted by strength coaches working with team sports and athletics, with weightlifting research in peer-reviewed journals becoming prominent since the 1970s. Over the past few decades, researchers have focused on the use of weightlifting-based training to enhance performance in nonweightlifters because of the biomechanical similarities (e.g., rapid forceful extension of the hips, knees, and ankles) associated with the second pull phase of the clean and snatch, the drive/thrust phase of the jerk and athletic tasks such as jumping and sprinting. The highest force, rate of force development, and power outputs have been reported during such movements, highlighting the potential for such tasks to enhance these key physical qualities in athletes. In addition, the ability to manipulate barbell load across the extensive range of weightlifting exercises and their derivatives permits the strength and conditioning coach the opportunity to emphasize the development of strength-speed and speed-strength, as required for the individual athlete. As such, the results of numerous longitudinal studies and subsequent meta-analyses demonstrate the inclusion of weightlifting exercises into strength and conditioning programs results in greater improvements in force-production characteristics and performance in athletic tasks than general resistance training or plyometric training alone. However, it is essential that such exercises are appropriately programmed adopting a sequential approach across training blocks (including exercise variation, loads, and volumes) to ensure the desired adaptations, whereas strength and conditioning coaches emphasize appropriate technique and skill development of athletes performing such exercises.

Comparison of Weightlifting, Traditional Resistance Training and Plyometrics on Strength, Power and Speed: A Systematic Review with Meta-Analysis.

BACKGROUND: Weightlifting training (WLT) is commonly used to improve strength, power and speed in athletes. However, to date, WLT studies have either not compared training effects against those of other training methods, or been limited by small sample sizes, which are issues that can be resolved by pooling studies in a meta-analysis. Therefore, the objective of this systematic review with meta-analysis was to evaluate the effects of WLT compared with traditional resistance training (TRT), plyometric training (PLYO) and/or control (CON) on strength, power and speed. METHODS: The systematic review included peer-reviewed articles that employed a WLT intervention, a comparison group (i.e. TRT, PLYO, CON), and a measure of strength, power and/or speed. Means and standard deviations of outcomes were converted to Hedges' g effect sizes using an inverse variance random-effects model to generate a weighted mean effect size (ES). RESULTS: Sixteen studies were included in the analysis, comprising 427 participants. Data indicated that when compared with TRT, WLT resulted in greater improvements in weightlifting load lifted (4 studies, p = 0.02, g = 1.35; 95% CI 0.20-2.51) and countermovement jump (CMJ) height (9 studies, p = 0.00, g = 0.95; 95% CI 0.04-1.87). There was also a large effect in terms of linear sprint speed (4 studies, p = 0.13, g = 1.04; 95% CI - 0.03 to 2.39) and change of direction speed (CODS) (2 studies, p = 0.36, g = 1.21; 95% CI - 1.41 to 3.83); however, this was not significant. Interpretation of these findings should acknowledge the high heterogeneity across the included studies and potential risk of bias. WLT and PLYO resulted in similar improvements in speed, power and strength as demonstrated by negligible to moderate, non-significant effects in favour of WLT for improvements in linear sprint speed (4 studies, p = 0.35, g = 0.20; 95% CI - 0.23 to 0.63), CODS (3 studies, p = 0.52, g = 0.17; 95% CI - 0.35 to 0.68), CMJ (6 studies, p = 0.09, g = 0.31; 95% CI - 0.05 to 0.67), squat jump performance (5 studies, p = 0.08, g = 0.34; 95% CI - 0.04 to 0.73) and strength (4 studies, p = 0.20, g = 0.69; 95% CI - 0.37 to 1.75). CONCLUSION: Overall, these findings support the notion that if the training goal is to improve strength, power and speed, supplementary weightlifting training may be advantageous for athletic development. Whilst WLT and PLYO may result in similar improvements, WLT can elicit additional benefits above that of TRT, resulting in greater improvements in weightlifting and jumping performance.

Tumor necrosis factor α inhibitor use and decreased risk for incident coronary events in rheumatoid arthritis.

OBJECTIVE: To determine the association of tumor necrosis factor α (TNFα) inhibitors with risk for cardiovascular disease (CVD) in rheumatoid arthritis (RA) patients. METHODS: A retrospective cohort of 2,101 incident RA patients was established. Medication exposure was categorized into the following groups: TNFα inhibitors alone or in combination with methotrexate (MTX; aTNF group); MTX alone or in combination with other nonbiologic disease-modifying antirheumatic drugs (DMARDs; MTX group); and no MTX, nonbiologic DMARDs (reference group). Primary outcome was adjudicated incident coronary artery disease (CAD), defined as myocardial infarction, unstable angina, or coronary revascularization procedure. Secondary outcome was adjudicated incident CVD, defined as a composite of CAD, stroke, transient ischemic attack, abdominal aortic aneurysm, peripheral arterial disease, or arterial revascularization procedure. Cox regression models were used to calculate the hazard ratio for CAD and CVD for the aTNF and MTX groups compared to the reference group. RESULTS: There were 46 incident CAD and 82 incident CVD events. Adjusting for covariates associated with CAD and CVD, the hazard ratio for incident CAD was 0.45 (95% confidence interval [95% CI] 0.21-0.96) for the aTNF group and 0.54 (95% CI 0.27-1.09) for the MTX group compared to the reference group. Use of TNFα inhibitors for >16.1 months was associated with a relative risk for CAD of 0.18 (95% CI 0.06-0.50) and for CVD of 0.31 (95% CI 0.15-0.65) compared to the reference group. A similar, although not significant, trend was seen with the MTX group. CONCLUSION: Use of TNFα inhibitors is associated with a decreased risk for CAD in RA; the risk decreases further with long-term use. This should be considered when weighing the risks versus benefits of these medications.

Tumor necrosis factor-α inhibitor use is not associated with lipid changes in rheumatoid arthritis.

OBJECTIVE: To determine the association of use of tumor necrosis factor-α (TNF-α) inhibitors with differences in lipid levels in patients with rheumatoid arthritis (RA). METHODS: We studied 807 patients with incident RA to compare differences in lipid levels in TNF-α inhibitor users versus nonusers, with adjustment for relevant covariables. RESULTS: TNF-α inhibitor use was not associated with differences in levels of low-density lipoprotein (LDL), high-density lipoprotein (HDL), total cholesterol (TC), triglycerides, LDL:HDL, or TC:HDL compared to nonusers. CONCLUSION: Use of TNF-α inhibitor was not associated with differences in lipid levels in patients with RA.

Diabetes mellitus risk in rheumatoid arthritis: reduced incidence with anti-tumor necrosis factor α therapy.

OBJECTIVE: To examine the association of tumor necrosis factor α (TNFα) inhibitor use and the risk of developing diabetes mellitus in a rheumatoid arthritis (RA) inception cohort. METHODS: Adults diagnosed with RA between January 1, 2001, and December 31, 2009, were identified (n = 1,881). Prevalent cases of diabetes mellitus (n = 294) were excluded. Information on sociodemographic data, medical history, body mass index (BMI), laboratory measures, and medications was collected from the electronic health record. Incident diabetes mellitus was defined using the 2010 American Diabetes Association criteria or physician-established diagnosis. Time-varying Cox proportional hazards regression models were used to adjust for age, sex, race, BMI, rheumatoid factor (RF) and anti-cyclic citrullinated peptide antibodies (anti-CCP), erythrocyte sedimentation rate (ESR), and use of nonsteroidal antiinflammatory drugs (NSAIDs), glucocorticoids, hydroxychloroquine, and methotrexate. RESULTS: A total of 1,587 incident RA patients without diabetes mellitus were included. The anti-TNFα users (n = 522) had a lower median age but greater baseline BMI; maximum ESR, RF, and anti-CCP positivity; and NSAID, glucocorticoid, or methotrexate use. The median followup time for the ever and never TNFα inhibitor users was 44.9 months (interquartile range [IQR] 23.7-73.0 months) and 37.1 months (IQR 16.3-65.1 months), respectively (P < 0.001). Of the 91 patients developing diabetes mellitus, 16 were ever and 75 were never TNFα inhibitor users, yielding incidence rates of 8.6 and 17.2 per 1,000 person-years (P = 0.048), respectively. Adjusting for covariates, the hazard ratio for incident diabetes mellitus in TNFα inhibitor users was 0.49 (95% confidence interval 0.24-0.99, P = 0.049) compared to the never users. CONCLUSION: In this inception RA cohort, anti-TNFα use was associated with a 51% reduction in risk of developing diabetes mellitus.

Hydroxychloroquine use associated with improvement in lipid profiles in rheumatoid arthritis patients.

OBJECTIVE: Cardiovascular disease (CVD) is the leading cause of death in patients with rheumatoid arthritis (RA). Disease-modifying therapies that improve risk factors for CVD, such as dyslipidemia, are desired. This study used an electronic health record to determine if hydroxychloroquine (HCQ) use was associated with an improvement in lipid levels in an inception RA cohort. METHODS: All adult individuals with the initial diagnosis of RA between January 1, 2001, and March 31, 2008, were identified (n=1,539). Only patients with at least one lipid level post-RA diagnosis were included (n=706). Information on demographics, medical history, body mass index (BMI), laboratory measures, and medications were collected at office visits. Potential risk and protective factors for dyslipidemia were controlled for in linear mixed-effects regression models for low-density lipoprotein (LDL), high-density lipoprotein (HDL), total cholesterol, triglycerides, LDL/HDL, and total cholesterol/HDL. RESULTS: Patients were 69% women and 98% white, with a median age of 65 years and a median BMI of 29.8 kg/m2. In the adjusted regression models, HCQ use was associated with the following average differences in lipids: LDL decrease of 7.55 mg/dl (P<0.001), HDL increase of 1.02 mg/dl (P=0.20), total cholesterol decrease of 7.70 mg/dl (P=0.002), triglycerides decrease of 10.91 mg/dl (P=0.06), LDL/HDL decrease of 0.136 (P=0.008), and total cholesterol/HDL decrease of 0.191 (P=0.006), which were stable over time. CONCLUSION: Use of HCQ in this RA cohort was independently associated with a significant decrease in LDL, total cholesterol, LDL/HDL, and total cholesterol/HDL. Considering these results, its safety profile, and low cost, HCQ remains a valuable initial or adjunct therapy in this patient population at high risk for CVD.

Hydroxychloroquine use and decreased risk of diabetes in rheumatoid arthritis patients.

BACKGROUND/OBJECTIVES: Several studies have associated hydroxychloroquine use with decreased risk of diabetes mellitus (diabetes) or improved glycemic control in rheumatoid arthritis patients, but the studies were small or used data from self-report. The present study sought to replicate this protective relationship in a health system using electronic health records with laboratory data and physician diagnoses. METHODS: This study is a retrospective cohort of 1127 adults with newly diagnosed rheumatoid arthritis and no diabetes within the Geisinger Health System between January 1, 2003, and March 31, 2008. Patients were classified as ever users (n = 333) or never users (n = 794) of hydroxychloroquine. Incident diabetes cases were defined using 2010 American Diabetes Association criteria. RESULTS: The median follow-up times for the ever and never hydroxychloroquine users were 26.0 and 23.0 months, respectively (P = 0.28). The median duration of hydroxychloroquine exposure was 14.0 months. Of the 48 cases developing diabetes during observation, 3 were exposed to hydroxychloroquine at time of development and 45 were nonexposed, yielding incidence rates of 6.2 and 22.0 per 1000 per year (P = 0.03), respectively. In time-varying Cox proportional hazards regression models adjusting for sex, age, body mass index, positive rheumatoid factor and anti-cyclic citrullinated peptide antibodies, erythrocyte sedimentation rate, and nonsteroidal anti-inflammatory drug, glucocorticoid, methotrexate, and tumor necrosis factor α inhibitor use, the hazard ratio for incident diabetes among hydroxychloroquine users was 0.29 (95% confidence interval, 0.09-0.95; P = 0.04) compared with nonusers. CONCLUSIONS: Our findings support the potential benefit of hydroxychloroquine in attenuating the risk of diabetes in rheumatoid arthritis patients. Further work is needed to determine its potential preventive role in other groups at high risk for diabetes.

Pseudoseptic arthritis: a case series and review of the literature.

Purpose. Pseudoseptic arthritis is an acute inflammatory monoarthritis with a sterile synovial gram stain and culture. Pseudoseptic arthritis has been previously described in the literature in a variety of settings including rheumatoid arthritis and microcrystalline disease. Despite pseudoseptic arthritis being a described entity, there is little published data on this topic with no published reports since 1992. Methods. This paper was a retrospective chart review over a 20-year period that identified all rheumatology inpatient consultations at our tertiary rural hospital for pseudoseptic arthritis. Results. We identified 10 patients with pseudoseptic arthritis and presented 5 of those cases in this paper. Majority of these patients had known autoimmune inflammatory arthritis or microcrystalline inflammatory arthritis. Conclusion. Pseudoseptic arthritis is a syndrome that should be in the differential diagnosis with patients with long standing inflammatory condition who present with an acute monoarthritis with no known bacterial source for septic arthritis.