Global Alliance for the Promotion of Physical Activity: the Hamburg Declaration.

Non-communicable diseases (NCDs), including coronary heart disease, stroke, hypertension, type 2 diabetes, dementia, depression and cancers, are on the rise worldwide and are often associated with a lack of physical activity (PA). Globally, the levels of PA among individuals are below WHO recommendations. A lack of PA can increase morbidity and mortality, worsen the quality of life and increase the economic burden on individuals and society. In response to this trend, numerous organisations came together under one umbrella in Hamburg, Germany, in April 2021 and signed the 'Hamburg Declaration'. This represented an international commitment to take all necessary actions to increase PA and improve the health of individuals to entire communities. Individuals and organisations are working together as the 'Global Alliance for the Promotion of Physical Activity' to drive long-term individual and population-wide behaviour change by collaborating with all stakeholders in the community: active hospitals, physical activity specialists, community services and healthcare providers, all achieving sustainable health goals for their patients/clients. The 'Hamburg Declaration' calls on national and international policymakers to take concrete action to promote daily PA and exercise at a population level and in healthcare settings.

[The athlete's shoulder : overview of the typical clinical presentations]. / L'épaule du sportif : tour d'horizon des tableaux cliniques typiques.

Shoulder injuries are common in athlete population. They can be due to trauma or overuse. Traumatic lesions are roughly the same in the non-athlete population. On the other hand, overuse lesions are specific to the sport, depending on the movements performed by the athlete. The majority of the early literature studied baseball pitchers. Pathophysiological theories have been applied to other overhead sport. In this article, we discuss briefly the main specificities and conditions of the painful athlete's shoulder.

Les blessures de l'épaule sont fréquentes chez le sportif. Elles peuvent être secondaires à un traumatisme ou liées à une surcharge mécanique. Les lésions traumatiques diffèrent peu des lésions que l'on peut retrouver dans la population non sportive. Par contre, concernant les lésions de surcharge, on constate des blessures spécifiques du sportif, en lien avec la gestuelle du sport pratiqué. Une grande partie de la littérature vient des États-Unis à travers l'étude du lanceur au baseball (pitcher). Les concepts physiopathologiques ont largement été appliqués à d'autres sports nécessitant une gestuelle au-dessus des épaules (overhead athlete). Nous parcourons brièvement les principales spécificités et tableaux cliniques de l'épaule douloureuse chez le sportif.

[Avoiding cognitive bias : example of quantified assessment of muscle strength]. / Éviter les biais cognitifs : exemple lors de l'évaluation quantifiée de la force musculaire.

Optimizing treatments requires the prevention of diagnostic errors. The use of shortcuts, cognitive biases, may lead to errors of judgement that can impair clinical reasoning and distort decision-making. Objective, quantifiable and comparable assessment is a safeguard against this, and for instance force quantification is used for this purpose. We will present here the use of hand-held dynamometers with recommendations for best practice as well as simple but essential tools for interpreting the results. Indeed, the use of these easy-to-use dynamometers requires rigour to ensure the quality of measurements and data analysis by/for the clinician. The use of this equipment should be widely promoted and democratized in informed clinical practice.

L'optimisation des traitements passe par la prévention des erreurs de diagnostic. L'utilisation de raccourcis et les biais cognitifs peuvent engendrer des erreurs de jugement nuisant au raisonnement clinique et risquant de pervertir les prises de décision. L'évaluation objective, quantifiable et comparable en est un rempart et la quantification de la force est, par exemple, utilisée à cette fin. Nous présentons ici l'utilisation des dynamomètres à main avec des recommandations de bonne pratique ainsi que des outils d'interprétation des résultats simples mais indispensables. En effet, l'emploi de ces dynamomètres d'utilisation aisée nécessite de la rigueur pour assurer la qualité des mesures et l'analyse des données par/pour le clinicien. Le recours à ce matériel doit être largement promu et démocratisé en pratique clinique éclairée.

[Covid 19 : return to sport criteria for elite athletes]. / Covid-19 : critères de retour au sport chez les athlètes d'élite.

The SARS-CoV-2 pandemic raised concerns about potential cardiac damage when infected athletes returned to sport. Swiss sports medicine and cardiology quickly published guidelines to manage this risk, proposing appropriate investigations and a gradual return to sport protocol. Although these guidelines have been adapted as new knowledge emerged in 2021 and 2022, they were introduced at a time of overestimation of the rate of cardiac complications in pauci-/asymptomatic elite athletes. Updated guidelines should be issued shortly, in accordance with the current state of research. In the meantime, the investigations and process suggested by Sport & Exercise Medicine Switzerland and Swiss Olympic remain valid and should be applied.

La pandémie de SARS-CoV-2 a suscité des préoccupations sur de potentielles atteintes cardiaques lors du retour au sport chez les athlètes infectés. Des recommandations de la médecine et cardiologie du sport suisses ont rapidement vu le jour pour gérer ce risque en proposant des investigations adaptées et un protocole de retour au sport graduel. Bien que ces recommandations aient été adaptées avec l'avancée des nouvelles connaissances en 2021 et 2022, elles ont été introduites dans une phase de surestimation du taux de complications cardiaques chez les athlètes d'élite pauci/asymptomatiques. Une mise à jour devrait être prochainement établie en accord avec les données actuelles. Dans l'attente, les investigations et le processus suggéré par Sport & Exercise Medicine Switzerland et Swiss Olympic restent valables et devraient être appliquées.

Effects of a Single Electrical Stimulation Session on Foot Force Production, Foot Dome Stability, and Dynamic Postural Control.

CONTEXT: Mounting evidence suggests neuromuscular electrical stimulation (NMES) as a promising modality for enhancing lower limb muscle strength, yet the functional effects of a single electrical stimulation session for improving the function of the intrinsic foot muscles (IFM) has not been evaluated. OBJECTIVE: To investigate the immediate effects of an NMES session compared with a sham stimulation session on foot force production, foot dome stability, and dynamic postural control in participants with static foot pronation. DESIGN: Randomized controlled clinical trial. SETTING: Laboratory. PATIENTS OR OTHER PARTICIPANTS: A total of 46 participants (23 males, 23 females) with static foot pronation according to their Foot Posture Index (score ≥ 6) were randomly assigned to an NMES (n = 23) or control (n = 23) group. INTERVENTION(S): The NMES group received a single 15-minute NMES session on the dominant foot across the IFM. The control group received a 15-minute sham electrical stimulation session. MAIN OUTCOME MEASURE(S): All outcome measurements were assessed before and after the intervention and consisted of foot force production on a pressure platform, foot dome stability, and dynamic postural control. Statistical analysis was based on the responsiveness of the outcome measures and responder analysis using the minimum detectable change scores for each outcome measure. RESULTS: In the NMES group, 78% of participants were classified as responders for at least 2 of the 3 outcomes, compared with only 22% in the control group. The relative risk of being a responder in the NMES group compared with the control group was 3.6 (95% CI = 1.6, 8.1]. Interestingly, we found that all participants who concomitantly responded to foot strength and navicular drop (n = 8) were also responders in dynamic postural control. CONCLUSIONS: Compared with a sham stimulation session, a single NMES session was effective in immediately improving foot function and dynamic postural control in participants with static foot pronation. These findings support the role of NMES for improving IFM function in this population.

Period prevalence of SARS-CoV-2 infections and willingness to vaccinate in Swiss elite athletes.

Objectives: (1) To assess the period prevalence of SARS-CoV-2 infections and willingness to vaccinate in Swiss elite athletes and (2) to evaluate whether sociodemographic and sport-related characteristics were associated with infection of SARS-CoV-2 in athletes. Methods: A total of 1037 elite athletes (Mage=27.09) were surveyed in this cross-sectional study. They were asked whether they had been infected with SARS-CoV-2 and whether they would like to be vaccinated. Characteristics of a possible COVID-19 illness were also recorded. Results: During the first year of the pandemic, 14.6% of all Swiss elite athletes were found to be infected with SARS-CoV-2, and 5.4% suspected that they had been infected. Male athletes, young athletes and team sports athletes had an increased likelihood of being infected with SARS-CoV-2. There was considerable heterogeneity in the duration and severity of a COVID-19 illness in athletes. Overall, 68% of respondents indicated a willingness to be vaccinated if they were offered an opportunity to do so. Conclusion: In the first year of the pandemic, Swiss elite athletes were tested more often positive for SARS-CoV-2 than the general Swiss population. Because COVID-19 illness can impair health for a relatively long time, sports federations are advised to motivate athletes to be vaccinated.

Exercise Science Graduates in the Healthcare System: A Comparison Between Australia and Switzerland.

Physical inactivity (PI) is a leading risk factor for global mortality worldwide, a major preventable cause of non-communicable diseases (NCDs) and a socioeconomic burden for healthcare systems. Fortunately, evidence shows that exercise interventions delivered by qualified exercise science graduates is an effective way to reduce PI, prevent and treat NCDs. This study compares the integration of exercise science graduates, defined as university graduates with degrees in sport and exercise science, in the healthcare systems of Australia, a commonly cited model in this regard, and Switzerland, a country considered to have an effective but costly healthcare system. For both countries, three domains were reviewed: healthcare system, exercise science graduates' education, and roles played by exercise science graduates in healthcare system. Australia formally recognizes specifically trained exercise science graduates (referred to as Accredited Exercise Physiologists) as healthcare professionals. The exercise interventions they deliver, which were shown to be cost-effective and lead to positive health outcomes, are covered by Medicare, the Australian universal health insurance. However, Medicare covers only a maximum of 5 yearly sessions of all allied-health services taken together. Conversely, Switzerland, despite offering university master's degrees that focus on physical activity delivery to clinical populations, does not recognize the respective graduates as healthcare providers. As a result, their services are not covered by the Swiss health insurances. The latter do, however, cover a generous number of services (not formally limited) delivered by other allied-health professionals. In conclusion, Australia makes a better use of exercise science graduates than Switzerland does. Switzerland would benefit from establishing a clinical profession for exercise science graduates, defining competencies that they should acquire and setting their scope of practice. The very restricted number of therapy sessions covered by Medicare might limit the positive impact exercise science graduates have on the Australian healthcare system. Overall, mutual learning between countries can promote development and global recognition of clinical positions for exercise science graduates.

Paediatric and adolescent athletes in Switzerland: age-adapted proposals for pre-participation cardiovascular evaluation.

High-level sports competition is popular among Swiss youth. Even though preparticipation evaluation for competitive athletes is widespread, screening strategies for diseases responsible for sudden death during sport are highly variable. Hence, we sought to develop age-specific preparticipation cardiovascular evaluation (PPCE) proposals for Swiss paediatric and adolescent athletes (under 18 years of age). We recommend that all athletes practising in a squad with a training load of at least 6 hours per week should undergo PPCE based on medical history and physical examination from the age of 12 years on. Prior to 12 years, individual judgement of athletic performance is required. We suggest the inclusion of a standard 12-lead electrocardiogram (ECG) evaluation for all post-pubertal athletes (or older than 15 years) with analysis in accordance with the International Criteria for ECG Interpretation in Athletes. Echocardiography should not be a first-line screening tool but rather serve for the investigation of abnormalities detected by the above strategies. We recommend regular follow-up examinations, even for those having normal history, physical examination and ECG findings. Athletes with an abnormal history (including family history), physical examination and/or ECG should be further investigated and pathological findings discussed with a paediatric cardiologist. Importantly, the recommendations provided in this document are not intended for use among patients with congenital heart disease who require individualised care according to current guidelines.

Successful Return to Performance After COVID-19 Infection in an Elite Athlete.

PURPOSE: To present training load (TL) and heart-rate variability (HRV) in an elite sprinter monitored before, during, and after a COVID-19 infection until successful return to performance. METHODS: TL, subjective morning fatigue (MF), and supine HRV were monitored during a 12-week period. RESULTS: During a high-TL period (training camp), MF and heart rate increased and vagally mediated HRV variables decreased. MF increased and stayed high 3 days after the camp despite decrease in TL. In contrast, 4 days after the camp, heart rate decreased and vagally mediated HRV variables increased, reflecting parasympathetic hyperactivity. Elevated MF and suboptimal training performance led to a PCR test decision, which returned positive. After a 10-day training suspension, TL was progressively increased with low MF and high vagal tone. The athlete was able to return to competition 17 days after medical clearance for return to participation and 1 week later beat his indoor 60-m personal best. CONCLUSIONS: In this athlete, COVID-19 infection induced parasympathetic hyperactivity with subjective fatigue. This case report presents how performance capacity was only negatively influenced by a COVID-19 infection in the short term, with a quick and successful return to performance, thanks to state-of-the-art medical management. This highlights the importance of TL and HRV monitoring in return-to-participation and return-to-competition decisions.

Cognitive biases cloud our clinical decisions and patient expectations: A narrative review to help bridge the gap between evidence-based and personalized medicine.

In sports medicine and rehabilitation of musculoskeletal conditions, training, knowledge and expertise of clinicians are the guarantors of good clinical practice. But are they really? Since the 1970s, a growing body of sociological and behavioral science has developed the concepts of cognitive biases and thinking errors. In a nutshell, it tries to explain how we approach decision-making using shortcuts, or heuristics. Our brains will alternatively use 2 systems to think and decide: system 1 is fast, intuitive and emotional, whereas system 2 is slow, logical and conscious. We may think clinicians use the latter systematically, but they actually use system 1 in many situations. Whether due to intrinsic thinking errors or external forces that cloud our judgment, we are under unconscious influences and so are all the stakeholders in the rehabilitation setting, including the patient/athlete. We present some of the most prevalent biases that pervade clinical decision-making and attempt to give a bit of background context starting from the typical tension between academic authority and personal experience. The field of sports performance is also riddled with beliefs, egocentrism and a general tendency to search for magic bullets that will bring the marginal gains and edge over the competition. This plays into the rehabilitation of patient-athletes in different ways. Finally, there are ways to mitigate the effect of cognitive biases to improve decision-making. This must include better communication, shared decisions and ultimately the understanding that we should drive our profession to deliver high-value care tailored to the patients, in line with the best evidence at the best possible cost. Hopefully, we can shed some light without too many of our own biases on the complexities of thinking in sports medicine and rehabilitation.

Reframing how we care for people with persistent non-traumatic musculoskeletal pain. Suggestions for the rehabilitation community.

There have been repeated calls to re-evaluate how clinicians provide care for people presenting with persistent non-traumatic musculoskeletal conditions. One suggestion is to move away from the 'we can fix and cure you' model to adopting an approach that is more consistent with approaches used when managing other persistent non-communicable diseases; education, advice, a major focus on self-management including lifestyle behavioural change, physical activity and medications as required. Currently the global delivery of musculoskeletal care has many of the elements of a 'super wicked problem', namely conflict of interest from stake-holders due to the consequences of change, prevailing expectation of a structural diagnosis and concomitant fix for musculoskeletal pain, persistent funding of high risk, more expensive care when low risk more economic viable options that don't impact on the quality of outcome exist, and an unquestionable need to find a solution now with the failure resulting in a growing social and economic burden for future generations. To address these issues, 100 participants included clinicians, educators and researchers from low-, middle- and high-income countries, eight presenters representing the physiotherapy, sport medicine and the orthopaedic professions and the insurance industry, together with three people who shared their lived experiences of persistent musculoskeletal pain, discussed the benefits and barriers of implementing change to address this problem. This paper presents the results from the stakeholders' contextual analysis and forms the basis for the proposed next steps from an action and advocacy perspective.

Delphi developed syllabus for the medical specialty of sport and exercise medicine: part 2.

Training in the medical specialty of sport and exercise medicine (SEM) is available in many, but not all countries. In 2015, an independent Delphi group, the International Syllabus in Sport and Exercise Medicine Group (ISSEMG), was formed to create a basic syllabus for this medical specialty. The group provided the first part of this syllabus, by identifying 11 domains and a total of 80 general learning areas for the specialty, in December 2017. The next step in this process, and the aim of this paper was to determine the specific learning areas for each of the 80 general learning areas. A group of 26 physicians with a range of primary medical specialty qualifications including, Sport and Exercise Medicine, Family Medicine, Internal Medicine, Cardiology, Rheumatology and Anaesthetics were invited to participate in a multiple round online Delphi study to develop specific learning areas for each of the previously published general learning areas. All invitees have extensive clinical experience in the broader sports medicine field, and in one or more components of sports medicine governance at national and/or international level. SEM, Family Medicine, Internal Medicine, Cardiology, Rheumatology and Anaesthetics were invited to participate in a multiple round online Delphi study to develop specific learning areas for each of the previously published general learning areas. All invitees have extensive clinical experience in the broader sports medicine field, and in one or more components of sports medicine governance at national and/or international level. The hierarchical syllabus developed by the ISSEMG provides a useful resource in the planning, development and delivery of specialist training programmes in the medical specialty of SEM.

Fat Oxidation Kinetics Is Related to Muscle Deoxygenation Kinetics During Exercise.

PURPOSE: The present study aimed to determine whether whole-body fat oxidation and muscle deoxygenation kinetics parameters during exercise were related in individuals with different aerobic fitness levels. METHODS: Eleven cyclists [peak oxygen uptake ( V . O 2 ⁢ p ⁢ e ⁢ a ⁢ k ): 64.9 ± 3.9 mL⋅kg-1⋅min-1] and 11 active individuals ( V . O 2 ⁢ p ⁢ e ⁢ a ⁢ k : 49.1 ± 7.4 mL⋅kg-1⋅min-1) performed a maximal incremental cycling test to determine V . O 2 ⁢ p ⁢ e ⁢ a ⁢ k and a submaximal incremental cycling test to assess whole-body fat oxidation using indirect calorimetry and muscle deoxygenation kinetics of the vastus lateralis (VL) using near-infrared spectroscopy (NIRS). A sinusoidal (SIN) model was used to characterize fat oxidation kinetics and to determine the intensity (Fatmax) eliciting maximal fat oxidation (MFO). The muscle deoxygenation response was fitted with a double linear model. The slope of the first parts of the kinetics (a 1) and the breakpoint ([HHb]BP) were determined. RESULTS: MFO (p = 0.01) and absolute fat oxidation rates between 20 and 65% V . O 2 ⁢ p ⁢ e ⁢ a ⁢ k were higher in cyclists than in active participants (p < 0.05), while Fatmax occurred at a higher absolute exercise intensity (p = 0.01). a 1 was lower in cyclists (p = 0.02) and [HHb]BP occurred at a higher absolute intensity (p < 0.001) than in active individuals. V . O 2 ⁢ p ⁢ e ⁢ a ⁢ k was strongly correlated with MFO, Fatmax, and [HHb]BP (r = 0.65-0.88, p ≤ 0.001). MFO and Fatmax were both correlated with [HHb]BP (r = 0.66, p = 0.01 and r = 0.68, p < 0.001, respectively) and tended to be negatively correlated with a 1 (r = -0.41, p = 0.06 for both). CONCLUSION: This study showed that whole-body fat oxidation and muscle deoxygenation kinetics were both related to aerobic fitness and that a relationship between the two kinetics exists. Individuals with greater aerobic fitness may have a delayed reliance on glycolytic metabolism at higher exercise intensities because of a longer maintained balance between O2 delivery and consumption supporting higher fat oxidation rates.

[Physical activity†: under-used therapeutic option in the treatment of metabolic diseases]. / Activité physique†: une thérapie trop peu utilisée dans la prise en charge des maladies métaboliques.

It is well demonstrated that physical activity can improve the control of diseases such as diabetes, or dyslipidemia. Introduction of regular and frequent physical activity is also part of the useful measures in the management of excess weight. It is therefore surprising that the prescription of physical activity for the treatment of these diseases is still not part of the curriculum of medical studies, and that reimbursement remains very scarce. This article summarizes the state of scientific knowledge in the field and outlines their clinical application.

Il est bien démontré que l'activité physique (AP) peut participer à l'amélioration du contrôle de maladies telles que le diabète ou l'hyperlipidémie. La reprise d'une AP régulière et fréquente fait également partie des mesures reconnues utiles dans la gestion de l'excès de poids. Il est dès lors étonnant que la prescription d'AP dans le cadre du traitement de ces maladies soit peu enseignée, et sa prise en charge très mal remboursée. Cet article fait le point sur les connaissances dans le domaine, et la manière de les appliquer cliniquement.

Patient-reported outcome measures for hip-related pain: a review of the available evidence and a consensus statement from the International Hip-related Pain Research Network, Zurich 2018.

Hip-related pain is a well-recognised complaint among active young and middle-aged active adults. People experiencing hip-related disorders commonly report pain and reduced functional capacity, including difficulties in executing activities of daily living. Patient-reported outcome measures (PROMs) are essential to accurately examine and compare the effects of different treatments on disability in those with hip pain. In November 2018, 38 researchers and clinicians working in the field of hip-related pain met in Zurich, Switzerland for the first International Hip-related Pain Research Network meeting. Prior to the meeting, evidence summaries were developed relating to four prioritised themes. This paper discusses the available evidence and consensus process from which recommendations were made regarding the appropriate use of PROMs to assess disability in young and middle-aged active adults with hip-related pain. Our process to gain consensus had five steps: (1) systematic review of systematic reviews; (2) preliminary discussion within the working group; (3) update of the more recent high-quality systematic review and examination of the psychometric properties of PROMs according to established guidelines; (4) formulation of the recommendations considering the limitations of the PROMs derived from the examination of their quality; and (5) voting and consensus. Out of 102 articles retrieved, 6 systematic reviews were selected and assessed for quality according to AMSTAR 2 (A MeaSurement Tool to Assess systematic Reviews). Two showed moderate quality. We then updated the most recent review. The updated literature search resulted in 10 additional studies that were included in the qualitative synthesis. The recommendations based on evidence summary and PROMs limitations were presented at the consensus meeting. The group makes the following recommendations: (1) the Hip and Groin Outcome Score (HAGOS) and the International Hip Outcome Tool (iHOT) instruments (long and reduced versions) are the most appropriate PROMs to use in young and middle-aged active adults with hip-related pain; (2) more research is needed into the utility of the HAGOS and the iHOT instruments in a non-surgical treatment context; and (3) generic quality of life measures such as the EuroQoL-5 Dimension Questionnaire and the Short Form Health Survey-36 may add value for researchers and clinicians in this field. We conclude that as none of the instruments shows acceptable quality across various psychometric properties, more methods studies are needed to further evaluate the validity of these PROMS-the HAGOS and iHOT-as well as the other (currently not recommended) PROMS.