BJSM Podcast

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

AMSSM Sports Medcast - FAI and hip dysplasia: two ends of an overlapping spectrum. Episode #355

Is this a dysplasia problem? Or is this an impingement problem? Did you know that a young adult with a non-arthritic hip problem sees an average of 4.2 health care providers before a diagnosis of
impingement is made?!
On this week’s podcast, Dr J.W. Thomas Byrd MD (T:@nashvillehipmds) joins AMSSM’s Sports Medcast (T: @TheAMSSM) to discuss femoroacetabular impingement and hip dysplasia.
Dr. Byrd founded the Nashville Hip Institute to help treat patients with complex hip disorders using advanced surgical techniques. A recent Past President of both the International Society for Hip
Arthroscopy (ISHA) and the Arthroscopy Association of North America (AANA), Dr Byrd has pioneered many of the surgical techniques for hip arthroscopy commonly employed throughout the
orthopaedic world and invented numerous instruments that have revolutionised aspects of orthopaedic surgery. He has been one of the leaders for defining and developing the role of less invasive arthroscopic techniques in and around the hip. Dr. Byrd is currently the team physician for the Tennessee Titans and consults for many professional sports teams. https://nashvillehip.org/jw-
thomas-byrd-md-orthopedic-hip-specialist-nashville-tn/ 
In this 20 minute conversation, Dr. Byrd addresses the following topics:
       What is FAI?
       The work-up of FAI – examination and imaging
       Management of FAI - when to intervene
       Hip dysplasia in athletes
       Common errors in managing hip pathology

Knowledge translation with Dr Sandro Demaio. Episode #354

Knowledge translation with Dr Sandro Demaio. Episode #354
There are over 1.5 million papers published each year…but as many as 50% of them are never read by anyone other than their authors, referees and journal editors. How can we move research from
the laboratory, the academic journal, and the medical conference into the hands of people and organisations who can put it to practical use?
On this week’s podcast, Dr Sandro Demaio (@SandroDemaio) joins BJSM’s Daniel Friedman (@ddfriedman) to discuss how we can bridge the gap between evidence and practice in the real
world.
After leaving his role as the WHO’s medical officer for NCDs and Nutrition, Sandro was appointed the CEO of EAT (https://eatforum.org/contributor/dr-alessandro-demaio), a non-profit startup focused on food and sustainability. Formerly an Assistant Professor and Course Director at the University of
Copenhagen’s School of Global Health, and a postdoctoral fellow at Harvard, Sandro regularly shares his knowledge and ideas at international conferences, universities and public events. He founded the PLOS Global Health Blog, NCDFREE (https://ncdfree.org)  and festival21 (https://www.festival21.com.au), and is currently a bestselling author and TV host. http://sandrodemaio.com/about
 
In this 20 minute conversation, Sandro addresses the following topics:
       The importance of knowledge translation
       Ways in which knowledge translation can be achieved
       Overcoming the “leaky research pipeline”
       Social media tips for clinicians

Sham surgery for shoulder impingement

Management of shoulder pain has been estimated to account for 4.5 million visits to the doctor and $3bn (£2.3bn; €2.6bn) each year in the US alone. 44-70% of patients with shoulder pain are diagnosed with shoulder impingement syndrome. Although various non-operative treatment modalities are recommended as initial treatment for patients with shoulder impingement, subacromial decompression has become one of the most frequently performed orthopaedic procedures in the world...BUT DOES IT ACTUALLY HELP?
On this week’s episode, Prof. Teppo Järvinen (@shamteppo) joins BJSM’s Daniel Friedman (@ddfriedman) to discuss the results from his latest clinical trial – the FIMPACT trial - that was recently published in the BMJ.
Teppo is a Professor of Orthopaedics and Traumatology at the University of Helsinki and Helsinki University Hospital, and is head of the Finnish Centre for Evidence-Based Orthopaedics. He recently organised the 2018 Too Much Medicine symposium that took place in Helsinki, Finland. http://too-much-medicine.com/
In this 15 minute conversation, Prof. Järvinen addresses:
∙ shoulder impingement and subacromial decompression
∙ a brief overview of the FIMPACT trial
∙ the results of the trial and how to integrate the findings into clinical practice
∙ what does too much medicine mean for orthopaedic surgery
∙ the future of sham surgery

Further reading:
Paavola Mika, Malmivaara Antti, Taimela Simo, Kanto Kari, Inkinen Jari, Kalske Juha et al. Subacromial decompression versus diagnostic arthroscopy for shoulder impingement: randomised, placebo surgery controlled clinical trial BMJ 2018; 362 :k2860 https://www.bmj.com/content/362/bmj.k2860
FIDELITY infographic: https://www.bmj.com/content/bmj/362/bmj.k2860/F1.large.jpg
Beard, David J., et al. "Arthroscopic subacromial decompression for subacromial shoulder pain (CSAW): a multicentre, pragmatic, parallel group, placebo-controlled, three-group, randomised surgical trial." The Lancet 391.10118 (2018): 329-338. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32457-1/fulltext
Sihvonen R, Paavola M, Malmivaara A, et al. Arthroscopic partial meniscectomy versus sham surgery for a degenerative meniscal tear. N Engl J Med 2013;369:2515–24. https://www.nejm.org/doi/10.1056/NEJMoa1305189?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dwww.ncbi.nlm.nih.gov
FIDELITY study video: https://www.youtube.com/watch?v=RaDWkJHmEB0
Savulescu, Julian, Karolina Wartolowska, and Andy Carr. "Randomised placebo-controlled trials of surgery: ethical analysis and guidelines." Journal of medical ethics (2016): medethics-2015.https://jme.bmj.com/content/42/12/776

An Update on Injury Prevention Programmes, and #SportSuisse2018, with Mario Bizzini. #352

We catch up with BJSM Deputy Editor, Physiotherapist and hugely influential researcher Mario Bizzini. We discuss everything from the evidence behind injury prevention programmes, maximising their implementation, and the upcoming #SportSuisse2018
Links below:
JOSPT Clinical Guideline https://www.jospt.org/doi/10.2519/jospt.2018.0303
Knakentroll (Swedish Group) - https://blogs.bmj.com/bjsm/2016/11/02/football-injuries-prevention-swedish-football-injury-warriors-martin-markus/
FIFA11+ https://bjsm.bmj.com/content/49/9/577
The Santa Monic Sports Medicine Research Foundation – The PEP Program: Prevent injury and Enhance Performance http://www.aclstudygroup.com/pdf/pep-program.pdf
Implementing Injury Prevention – Aspetar Journal - http://www.aspetar.com/journal/viewarticle.aspx?id=406#.W6TYAf4zbEY
Reference to Implementation Studies by Dr Alex Donaldson & colleagues in AFL https://www.ncbi.nlm.nih.gov/pubmed/30217833
#Sportsuisse2018 https://sportsuisse2018.ch/