BJSM Podcast

Managing concussion: a 2019 update with Prof Kim Harmon. Episode #366

Did you know that up to 3.8 million sports-related concussions occur in the USA annually?
As the largest membership organisation representing sports medicine physicians in North America, the AMSSM is perfectly placed to provide advice and guidance to clinicians who are expected to manage every stage of the concussion spectrum.
On this week’s episode, Prof Kimberly Harmon (T: @DrKimHarmon) returns for another podcast and joins BJSM’s Daniel Friedman (T: @ddfriedman) to discuss the upcoming updated 2019 AMSSM position statement on managing concussion in sport.
Prof Harmon is a Professor in the Department of Family Practice and Departments of Family Medicine and Orthopaedics and Sports Medicine at the University of Washington, as well as a past president of the AMSSM. She has over 20 years of experience as a team physician for the University of Washington, and is currently the head physician for the university’s American football team.
In this 20 minute conversation, Prof Harmon discusses:
· Our current understanding of concussion
· The 2019 updated AMSSM Concussion in Sport position statement vs the 2013 statement
· Managing concussed athletes and return to play at the collegiate level
· Efforts to prevent concussion and reduce its severity in college football
Prof Harmon will be speaking at the upcoming 2019 ACSEP conference (https://bit.ly/2HkQsi5) in Queenstown, NZ, and at the 2019 AMSSM Annual Meeting (https://bit.ly/2U573rD) in Houston, USA. Don't miss out!
Further reading:
Harmon KG, Drezner JA, Gammons M Endorsed by the National Trainers’ Athletic Association and the American College of Sports Medicine, et al. American Medical Society for Sports Medicine position statement: concussion in sport Br J Sports Med 2013;47:15-26. https://bjsm.bmj.com/content/47/1/15.short
Turner M Happy Birthday Concussion! Br J Sports Med Published Online First: 01 December 2018. doi: 10.1136/bjsports-2018-100316
McCrory P, Meeuwisse W, Dvorak J, et al
Consensus statement on concussion in sport—the 5th international conference on concussion in sport held in Berlin, October 2016.
Br J Sports Med 2017;51:838-847

Can the EAT-Lancet ‘Planetary Health Diet’ save patients and the planet? Episode #365

Traditionally, sports medicine may have focussed on joints and tendons and muscles, but, as with medicine more widely, nutrition is now being properly recognised as an essential aspect of health. Food is a very strong lever to improve human health and environmental sustainability on earth. However, food is currently threatening both people and planet. The food we eat, the ways we produce it, and the amounts wasted or lost affect us all – athletes, patients and clinicians.
On this BJSM podcast Prof Jess Fanzo (T: @jessfanzo) from Johns Hopkins (full bio below) joins BJSM’s Daniel Friedman (T: @ddfriedman) to discuss the recently published report Food in the Anthropocene: the EAT–Lancet Commission on healthy diets from sustainable food systems that is making headlines around the world.
The report is also creating much controversy. Not everyone will agree with the commission, just as not everyone agrees with all nutrition advice. At BJSM, our job is to share major views from the scientific world with our community and here you can listen to a major player in this report.
In this 15-minute conversation, Prof Fanzo shares the report’s key takeaways (!) and how sport and exercise medicine clinicians can contribute to “the great food transformation".
Prof Jess Fanzo PhD is the Bloomberg Distinguished Associate Professor of Ethics and Global Food & Agriculture at the Johns Hopkins Berman Institute of Bioethics, the School of Advanced International Studies, and the Bloomberg School of Public Health, Department of International Health. She also serves as the Director of the Global Food Ethics and Policy Program. Prof Fanzo received her PhD in Nutrition at the University of Arizona, and was the Stephen I. Morse Postdoctoral Fellow in Immunology in the Department of Molecular Medicine at Columbia University. https://eatforum.org/contributor/dr-jessica-fanzo/
Have something to say about the commission or the podcast? Let us know your thoughts by leaving us a comment via social media or wherever you get your podcasts!
Further reading:
https://eatforum.org/eat-lancet-commission/
https://eatforum.org/lancet-commission/healthcare-professionals/
Full report: Food in the Anthropocene: the EAT–Lancet Commission on healthy diets from sustainable food systems https://hubs.ly/H0gcll-0

How to encourage translational research among our peers? The Collaborative Research Network. #364

Is it possible to support small, individual clinicians with an interest for research, while also encouraging collaborative research from major medical centers and teaching hospitals? These topics and others are explored on this episode of the AMSSM Sports Medcast.
Host Dr. Devin McFadden, MD is joined by a panel which includes Dr. Anthony Beutler, MD, Dr. Andrew Peterson, MD, and Dr. Stephanie Kliethermes, PhD who help form a portion of the AMSSM’s Collaborative Research Network leadership. They cover the history of this organization from inception to present day, and discuss the challenges and strategic issues which the organization has faced in its brief existence to date.
Collaborative Research Network website: https://www.amssm.org/CRN.php
Editorial on the CRN- https://bjsm.bmj.com/content/early/2018/11/26/bjsports-2018-100330
Kliethermes SA, Beutler AI. Clinical research and the AMSSM collaborative research network.
Br J Sports Med. Published Online First: 27 November 2018. doi: 10.1136/bjsports-2018-100330

Making exercise trials more useful with Professor John Ioannidis. Episode #363

We have known for a long time that exercise is effective in lowering blood pressure. But how does it stack up against antihypertensive medication?
On this episode, Dr. John Ioannidis joins BJSM’s Daniel Friedman (T: @ddfriedman) to discuss his recently published BJSM meta-analysis that made headlines around the world https://bit.ly/2EYW66J
Dr Ioannidis is recognised as one the most influential scientists alive today. A Professor of Medicine and of Health Research and Policy at Stanford University School of Medicine and a Professor of Statistics at Stanford University School of Humanities and Sciences, Dr Ioannidis has authored close to 1,000 academic papers and served on the editorial boards of 30 of the world's top journals. He is best known for his legendary 2005 PLOS medicine paper “Why Most Published Research Findings Are False”, which has been viewed over 2.5 million times. https://profiles.stanford.edu/john-ioannidis
In this 15 minute conversation, Dr Ioannidis discusses:
· The findings of his latest BJSM meta-analysis
· How trials that examine exercise’s effects on blood pressure can be made more useful
· How exercise can become part of routine hypertension management
· What needs fixing in the world of evidence-based medicine
Further reading:
Naci H, Salcher-Konrad M, Dias S, et al How does exercise treatment compare with antihypertensive medications? A network meta-analysis of 391 randomised controlled trials assessing exercise and medication effects on systolic blood pressure Br J Sports Med Published Online First: 18 December 2018. doi: 10.1136/bjsports-2018-099921
Naci H, Ioannidis JP. Comparative effectiveness of exercise and drug interventions on mortality outcomes: metaepidemiological study. Bmj. 2013 Oct 1;347:f5577.
Ioannidis JP. Why most clinical research is not useful. PLoS medicine. 2016 Jun 21;13(6):e1002049.
Ioannidis JP. Why most published research findings are false. PLoS medicine. 2005 Aug 30;2(8):e124.

Bumping up physical activity in pregnancy. Global guidelines. Dr Margie Davenport Episode #362

Did you know that fewer than 15% of women will actually achieve the minimum recommendation of 150 min per week of moderate-intensity physical activity throughout their pregnancy? Meeting the recommendation can reduce the risk of pregnancy-related illness such as depression by at least 25%, and the risk of developing gestational diabetes, hypertension and preeclampsia by 40%! So why are some clinicians still scared to prescribe physical activity to soon-to-be-mums?
On this week’s episode, Dr. Margie Davenport PhD joins BJSM’s Daniel Friedman (T: @ddfriedman) to address common misconceptions regarding physical activity during pregnancy and explain the new 2019 Canadian guideline for physical activity throughout pregnancy (https://bjsm.bmj.com/content/52/21/1339) that was recently published in the BJSM.
Dr. Davenport is an Assistant Professor in the Faculty of Kinesiology, Sport, and Recreation at the University of Alberta. She received her PhD in Integrative Exercise Physiology from the University of Western Ontario and conducted a two year Postdoctoral Fellowship at the University of Calgary. She is an emerging expert in metabolic and cardiovascular adaptations associated with normal and complicated pregnancies. Her primary interest is in the benefits of exercise prior to, during and following pregnancy for both mother and child.
In this 20 minute conversation, Dr. Davenport discusses:
· Who should be physically active throughout pregnancy + contraindications
· How much physical activity is recommended throughout pregnancy
· Examples of physical activity
· Common misconceptions and safety precautions
Resources:
www.exerciseandpregnancy.ca
Program for Pregnancy and Postpartum Health videos: https://www.youtube.com/channel/UCtvzYizIALcs5-RzfHrf5UA
2019 Canadian Guideline: http://csepguidelines.ca/wp-content/uploads/2018/10/4208_CSEP_Pregnancy_Guidelines_En_P2A.pdf.
https://bjsm.bmj.com/content/52/21/1339

Comparing exercise and drugs for hypertension with Dr Huseyin Naci. Episode #361

Did you know that one in four people have hypertension? And with recent changes to diagnostic criteria in major clinical practice guidelines, the prevalence is only going to increase. With concerns about the cost, effectiveness, and potential for side effects of antihypertensive drugs, isn’t it time we looked beyond the pharmacy shelves to lower blood pressure?
On this episode, Dr. Huseyin Naci PhD (T: @huseyinnaci2) joins BJSM’s Daniel Friedman (T:@ddfriedman) to discuss his recently published BJSM meta-analysis that compares the effectiveness of exercise and antihypertensive medications on lowering blood pressure.
Dr Naci is an Assistant Professor of Health Policy at the London School of Economics and Political Science. During the 2018-2019 academic year, he is a UK Harkness Fellow in Health Care Policy and Practice at the Harvard Kennedy School of Government and Harvard Medical School. His research to date has evaluated the quality and quantity of the evidence base underpinning the approval, adoption, and reimbursement of new pharmaceutical and health technologies in Europe and the US. He has a PhD in Health Policy from the Department of Social Policy at the LSE and an MHS in International Health from the Johns Hopkins Bloomberg School of Public Health.
In this 20 minute conversation, Dr Naci discusses:
· The history of antihypertensive medications
· Exercise’s effects on blood pressure
· The findings of his latest meta-analysis
· His 2013 study that compared the effectiveness of pharmacological and non-pharmacological interventions on mortality
· The clinical practice and guideline implications of the meta-analysis
Further reading:
Naci H, Ioannidis JP. Comparative effectiveness of exercise and drug interventions on mortality outcomes: metaepidemiological study. Bmj. 2013 Oct 1;347:f5577. https://bjsm.bmj.com/content/early/2018/12/05/bjsports-2018-099921.citation-tools
Naci H, Ioannidis JP. Comparative effectiveness of exercise and drug interventions on mortality outcomes: metaepidemiological study. Bmj. 2013 Oct 1;347:f5577. https://www.bmj.com/content/347/bmj.f5577

Regenerative medicine: Game changing innovation or the next big flop? Episode #360

Host Dr. Devin McFadden, MD is joined by Dr. Lisa Fortier, DVM, PhD on the AMSSM Sports Medcast to discuss regenerative medicine technologies and the current evidence for their use.
Dr. Fortier is a Professor of Surgery at Cornell University, College of Veterinary Medicine in Ithaca, New York, with a particular interest in translational research including the prevention of post- traumatic osteoarthritis. In addition, her internationally renowned research investigates the clinical application of stem cells and biologics such as platelet-rich plasma and bone marrow concentrate for
cartilage repair and tendinosis.
In this 15 minute conversation Dr. Fortier addresses the following topics:
What are orthobiologics and regenerative medicine?
What is the evidence behind their use?
What current research is being conducted in this field?
Where she see the field in 5-10 years.
IOC Consensus on Use of PRP in Sports Medicine- https://bjsm.bmj.com/content/44/15/1072
Engebretsen L, Steffen K, Alsousou J, et al. IOC consensus paper on the use of platelet-rich plasma in sports medicine. Br J Sports Med. 2010;44:1072-1081.
Systematic Review of Stem Cell Use in Tendon Injuries- https://bjsm.bmj.com/content/51/13/996
Pas HIMFL, Moen MH, Haisma HJ, et al. No evidence for the use of stem cell therapy for tendon disorders: a systematic review. Br J Sports Med. 2017;51:996-1002.
Role of platelet-rich plasma in articular cartilage injury and disease- https://www.thieme-connect.com/DOI/DOI?10.1055/s-0034-1384672
Mascarenhas R, Saltzman BM, Fortier LA, et al. Role of platelet rich plasma in articular cartilage injury and disease. J Knee Surg. 2015 Feb;28(1):3-10

Busting nutrition myths with Dr. Zoë Harcombe PhD. Episode 358

What should we eat in order to stay healthy and avoid disease? Nutrition is one of the biggest drivers of chronic disease, including obesity and diabetes, yet the answer to this seemingly simple question remains a subject of heated debate.
On this week’s episode, Dr. Zoë Harcombe (@zoeharcombe) joins BJSM’s Daniel Friedman (@ddfriedman) to address some common nutrition myths.
Zoë has a PhD in public health nutrition. The full title of her thesis is: “An examination of the randomised controlled trial and epidemiological evidence for the introduction of dietary fat recommendations in 1977 and 1983: A Systematic Review and Meta-analysis“. She researches in the fields of nutrition, diet, dietary advice, diet-related health and obesity and writes and talks about these topics daily - http://www.zoeharcombe.com/
In this 30 minute conversation, Zoë reviews the evidence supporting commonly held nutrition beliefs and discusses:
· Does red and process meat cause cancer?
· Should everyone follow a Mediterranean diet?
· Are wholegrains healthy?
· How many fruit + veg should we be eating daily?
· What makes up a nutritious diet?
Further reading:
Harcombe, Zoe. "Designed by the food industry for wealth, not health: the ‘Eatwell Guide’." (2017): 1730-1731.https://bjsm.bmj.com/content/early/2016/05/25/bjsports-2016-096297
Harcombe, Zoe. World Health Organisation, meat & cancer http://www.zoeharcombe.com/2015/10/world-health-organisation-meat-cancer/
Estruch, Ramón, et al. "Primary prevention of cardiovascular disease with a Mediterranean diet." New England Journal of Medicine 368.14 (2013): 1279-1290.

An A-Z of Sports Cardiology, with Prof Jon Drezner. Episode #357

Professor Jon Drezner, a world authority on Sports Cardiology and vastly experienced Sport & Exercise Medicine physician, kindly gives us his time on this BJSM podcast to fill us in on updates in the Sports Cardiology world.
Covering everything from high-risk groups, to the subsequent management of ‘positive’ screening results, this podcast will ensure that the listener is very much up-to-date with the latest research & developments in Sports Cardiology.
For more information & a deeper-dive into the publications mentioned:
Sports cardiology: preventing sudden cardiac death https://bjsm.bmj.com/content/48/15/1133
BMJ Learning ECG Interpretation Course: https://learning.bmj.com/learning/course-intro/.html?courseId=10042239
International criteria for electrocardiographic interpretation in athletes: Consensus statement https://bjsm.bmj.com/content/51/9/704
Outcomes of Cardiac Screening in Adolescent Soccer Players (NEJM) https://www.nejm.org/doi/full/10.1056/NEJMoa1714719
Cardiac arrest survival greatly increases when bystanders use an automated external defibrillator - Circulation Journal Report https://newsroom.heart.org/news/cardiac-arrest-survival-greatly-increases-when-bystanders-use-an-automated-external-defibrillator

It’s all about the shoes…well, maybe not. Episode #356

Minimalist? Maximalist? Zero drop? Is there really one running shoe paradigm to rule them all?
On this week’s episode, Dr. Chris Napier PhD (T: @runnerphysio) and Paul Blazey (T: @Blazey85) joins BJSM’s Daniel Friedman (T:@ddfriedman) to debate running shoe prescription.
Chris is a Clinical Assistant Professor in the Department of Physical Therapy at the University of British Columbia, where he recently obtained his his PhD (“Running biomechanics and injury
prevention”) in 2018. Since becoming a physio, Chris has specialised his training with postgraduate studies in manual therapy and sport physiotherapy. He is currently a physiotherapist of Athletics
Canada. Chris competed at the national level as a successful middle-distance runner and today is an avid skier, kayaker, and marathoner.
A self-proclaimed encyclopaedia of running shoes, Paul is a physio who has spent time working with Crystal Palace and Arsenal FC, with a keen interest in managing running and triathlon injuries. He left
his physiotherapy clinic in England behind in 2017 to take up research at the University of British Columbia and currently works as a senior associate editor for BJSM. Like Chris, Paul is an accomplished runner with envious marathon times.  
In this 20 minute conversation, Chris and Paul discuss:
       Eliud Kipchoge’s recent marathon world record
       Different running shoes’ effects on running economy
       Running shoe prescription and tips for choosing shoes in-store
       Gait retraining
       The future of running shoes
 
Further reading:
Brick NE, McElhinney MJ, Metcalfe RS. The effects of facial expression and relaxation cues on movement economy, physiological, and perceptual responses during running. Psychology of Sport
and Exercise. 2018 Jan 1;34:20-8.
https://www.sciencedirect.com/science/article/pii/S1469029217303461
Napier C, Willy RW. Logical fallacies in the running shoe debate: let the evidence guide prescription.
https://bjsm.bmj.com/content/early/2018/10/22/bjsports-2018-100117
Hoogkamer W, Kram R, Arellano CJ. How biomechanical improvements in running economy could
break the 2-hour marathon barrier. Sports Medicine. 2017 Sep 1;47(9):1739-50.https://link.springer.com/article/10.1007/s40279-017-0708-0
Barnes KR, Kilding AE. A Randomized Crossover Study Investigating the Running Economy of Highly-Trained Male and Female Distance Runners in Marathon Racing Shoes versus Track Spikes.
Sports Medicine. 2018:1-2. https://link.springer.com/article/10.1007/s40279-018-1012-3
Nigg BM, Baltich J, Hoerzer S, Enders H. Running shoes and running injuries: mythbusting and a proposal for two new paradigms:‘preferred movement path’and ‘comfort filter’. Br J Sports Med. 2015
Jul 28:bjsports-2015. https://bjsm.bmj.com/content/49/20/1290.short