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September 2024 - Volume 34 - Issue 5
- Editor-in-Chief: Christopher Hughes, MBBS, MSc
- ISSN: 1050-642X
- Online ISSN: 1536-3724
- Frequency: 6 issues / year
- Ranking: Orthopedics 45/136 Sport Sciences 51/127 Physiology 53/85
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Just as the 2024 Paralympic Games are underway in Paris, we are pleased to bring you our September 2024 issue of the Clinical Journal of Sport Medicine.
Our Lead Editorial this month by Rickerby and Colleagues focuses on the common issue of the athlete's perception of pain.
Given that pain is that most common of presenting complaints, it is interesting to observe the variation in individual approaches used by clinicians when assessing their patients who present with pain as their main problem. Concepts surrounding pain presentations are varied and have evolved over time to become more broad in their nature, with many clinicians adopting a ' bio-psychosocial' multimodal model as part of their assessment strategy and management framework.
The individual athlete's response to their unique experience of pain is equally of interest. Many athletes push on through pain in order to attempt to achieve their goals, whilst others exhibit pain-avoidance behaviours in what might appear to be similar circumstances. There may be conscious, or subconscious reasons for pain-avoidance behaviours which may be in evolutionary context or maladaptive in nature.
Rickerby and Colleagues discuss the Behavioural Inhibition System (BIS)-Behavioural Activation System (BAS) model of behavioural regulation, motivation and emotion which takes into account a broad range of external modifiers of pain presentations (including, for example, the influences of coaching staff and agents as behavioural modifiers).
They discuss the relationship between this model and injury avoidance behaviours, together with proposing the future development of a data-driven approach in modifying individual BIS-BAS responses.
We are interested to hear your thoughts and reflections on this Editorial, together with your experiences of adopting objective, data-driven approaches to symptoms, in clinical practice. Letters to the Editor concerning this Editorial are welcome.
Jo and Colleagues focus on the question as to whether a pre-injury history of migraines is associated with worse acute symptoms following sports-related concussion events. In a retrospective cohort study of 1190 NCAA Division III Collegiate athletes (<=25 years of age) with sports-related concussion (SRC), 93 athletes (7.8%) reported a pre-injury history of migraine. No significant differences in total post-concussion symptom scale scores collected at 3 days post-injury were found between the athletes with a prior history of migraines and those without a pre-injury migraine history.
Uyeno and Colleagues examined the relationship between eye tracking proficiency markers and vestibular symptoms in a retrospective cohort study of 119 varsity college athletes aged 18-24 years following acute mild traumatic brain injury.
Amongst 119 athletes, 177 diagnoses of mTBI were made between 2013 and 2019. The authors found that 44% of athletes displayed abnormal eye tracking within 72 hours post-event compared with baseline assessments. They highlight the importance of eye-tracking in the diagnosis and management of mTBI and call for further research into the use of eye-tracking proficiency testing in other acute settings.
Powers and Colleagues set out to identify geographical issues related to accessing optimal concussion care for pediatric athletes with concussion , using virtual internet searches to identify local care options within various rural and metropolitan geographic regions within each State of the United States. Using their unique search strategy, significant differences in access based on rural versus metropolitan areas were found, with regional and geographic variation in optimal care provision.
The Authors concluded that an overall lack of access to multidisciplinary concussion care exists for pediatric patients, particularly in rural communities, and call for the establishment of resources to optimize concussion care based on these existing gaps in access and optimal care.
We bring you three studies relating to the topic of hamstring injuries this issue, including work by Gendron and Colleagues on flexibility and point-of-care musculoskeletal ultrasound (POCUS) measures for prognosticating return to play following a first hamstring strain injury, Talu and Colleagues who sought to determine the reliability, validity and applicability of the isolated hamstring flexibility test (IHFT) , and Boltz and Colleagues who conducted a descriptive epidemiological study of athletes involved in various NCAA sports using NCAA Injury surveillance data.
Following on from previous work examining the prevalence of female and male athlete triad risk factors amongst ultramarathon runners which was published by Høeg and Colleagues in CJSM in 2022, Roche and Colleagues present a Brief Report on Triad Prevalence and Exploratory Hormonal Biomarker Analyses in Ultramarathon Runners, with additional data collated from a 2021 cohort of runners from the Western States Endurance run 100-mile race.
In our General Review this issue, Harvey and Colleagues present a Systematic Review and Meta Analysis on the Effects of Cycle Ergometer versus Treadmill Exercise Stress Testing on QTc Interval Prolongation in Patients with Long QT syndrome.
We also bring you two interesting case reports, the first on Paget-Schroetter syndrome in a patient with posterior shoulder subluxation , and the second on a case of acute compartment Syndrome and rhabdomyolysis caused by a single electrical muscle stimulation in a 46-year-old female professional athlete with fibromyalgia, chronic fatigue syndrome, and myofascial disorder .
Don't forget to check out our CJSM social media channels for the latest CJSM content and updates from the world of primary care sports medicine including Instagram , Twitter and Facebook , and feel free to explore our CME offerings on the Lippincott CME Connection website with some free modules available for all to try, offering ACCME credits.
Finally, enjoy tuning into our podcasts with Dr Erin Hammer and guests, which are available on our website and on iTunes.
Here's hoping you enjoy our latest issue, and wishing the best of luck to all of those working hard in the summer months at the 2024 Paralympics and at all other sporting events at this time,
Best wishes,
Christopher Hughes MBBS MSc
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Editor's Picks
Avoiding the Edge Before It Is Too Late: When Is Pain a Sign of Injury in Athletes?
Clinical Journal of Sport Medicine. 34(5):401-403, September 2024.
- Permissions
Is Access to Optimal Concussion Care for Pediatric Athletes Limited by Geography?
Clinical Journal of Sport Medicine. 34(5):425-429, September 2024.
- Abstract Abstract
Go to Full Text of this Article
An Update on Triad Prevalence and Exploratory Hormonal Biomarker Analyses in Ultramarathon Runners
Clinical Journal of Sport Medicine. 34(5):469-473, September 2024.
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- Current Opinion
- Open access
- Published: 26 August 2020
Muscle-strengthening Exercise Epidemiology: a New Frontier in Chronic Disease Prevention
- Jason A. Bennie 1 ,
- Jane Shakespear-Druery 1 &
- Katrien De Cocker 1
Sports Medicine - Open volume 6 , Article number: 40 ( 2020 ) Cite this article
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This current opinion provides an overview of the emerging discipline of muscle-strengthening exercise epidemiology. First, we define muscle-strengthening exercise, and discuss its recent addition into the global physical activity guidelines, which were historically mainly focused on aerobic physical activity (walking, running, cycling etc.). Second, we provide an overview of the current clinical and epidemiological evidence on the associations between muscle-strengthening exercise and health, showing a reduced mortality risk, and beneficial cardiometabolic, musculoskeletal, functional and mental health-related outcomes. Third, we describe the latest epidemiological research on the assessment, prevalence, trends and correlates of muscle-strengthening exercise. An overview of recent population estimates suggests that the proportion of adults meeting the current muscle-strengthening exercise guideline (10-30%; ≥ 2 sessions/week) is far lower than adults reporting meeting the aerobic exercise guideline (~ 50%; ≥ 150 min/week). Fourth, we discuss the complexity of muscle-strengthening exercise promotion, highlighting the need for concurrent, coordinated, and multiple-level strategies to increase population-level uptake/adherence of this exercise modality. Last, we explore key research gaps and strategies that will advance the field of muscle-strengthening exercise epidemiology. Our objective is to provide a case for increased emphasis on the role of muscle-strengthening exercise for chronic disease prevention, and most importantly, stimulate more research in this currently understudied area of physical activity epidemiology.
Whilst clinical and epidemiological evidence links muscle-strengthening exercise to optimal health and well-being, over 80% of adults do not report meeting the muscle-strengthening exercise guidelines (≥ 2 times/week).
Compared to aerobic physical activity/exercise, muscle-strengthening exercise has been generally overlooked in public health approaches for chronic disease prevention.
Future research in muscle-strengthening exercise epidemiology should focus on standardising assessment instruments and assessing constructs beyond frequency (type, duration, intensity etc.); developing device-based assessments to improve measurement precision; and the inclusion of muscle-strengthening exercise into existing health surveillance systems.
Introduction
Strong clinical and emerging epidemiological evidence shows that muscle-strengthening exercise (i.e. use of weight machines/body weight exercises) is independently associated with multiple health outcomes, including a reduced risk of all-cause mortality [ 1 , 2 , 3 ], incidence of diabetes [ 4 , 5 ] and enhanced cardiometabolic [ 6 , 7 ], musculoskeletal [ 8 , 9 , 10 ] and mental health [ 11 , 12 ]. However, recent health surveillance data from multiple countries suggest only 10-30% adults meet the muscle-strengthening exercise guideline (≥ 2 sessions/week) [ 13 , 14 , 15 , 16 , 17 , 18 ]. Moreover, despite its numerous independent health benefits, in comparison to aerobic physical activity (e.g. walking, running or cycling), muscle-strengthening exercise has been largely overlooked in public health approaches for chronic disease prevention [ 14 , 17 , 19 ]. This current opinion paper:
i.Provides a narrative review of the emerging discipline of muscle-strengthening exercise epidemiology
ii.Argues the case for an increased emphasis on the role of muscle-strengthening exercise for chronic disease prevention
iii.Discusses key research gaps and strategies to advance this field
Defining Muscle-strengthening Exercise
Muscle-strengthening exercise, sometimes referred to as strength/weight/resistance training or exercise, is a voluntary activity that includes the use of weight machines, exercise bands, hand-held weights, or own body weight (e.g. push-ups or sit-ups) [ 20 ]. When performed regularly, clinical exercise studies show that muscle-strengthening exercise increases skeletal muscle strength, power, endurance and mass [ 21 ]. This exercise-related behaviour is usually performed during a person’s leisure time, commonly within community (fitness centres/gyms) or home settings [ 22 ]. An individual may engage in muscle-strengthening exercise for numerous purposes, including for strength-related sports (e.g. weight/power lifting), aesthetic purposes (e.g. body-building/sculpting); physical therapy (e.g. rehabilitation from injury); conditioning for sports performance and for general fitness and health [ 23 ].
Muscle-strengthening Exercise and Physical Activity Guidelines—a Recent Addition
Since the 1970s, physical activity recommendations for public health focused on promoting moderate-to-vigorous intensity aerobic physical activity (MVPA: e.g. walking, running or cycling) [ 24 ]. However, over the past decade, muscle-strengthening exercise has since been adopted. Muscle-strengthening exercise was initially included in the ‘2008 Physical Activity Guidelines for Americans’ [ 25 ], subsequently adopted in the World Health Organisation’s ‘2010 Global Recommendations on Physical Activity for Health’ [ 26 ] and is now included in many national public health recommendations [ 27 , 28 , 29 , 30 ]. The current global recommendations state that adults (18-64 years) should engage in:
i.At least 150 min of moderate-intensity aerobic physical activity, or at least 75 min of vigorous-intensity aerobic physical activity, or an equivalent combination of both a week
ii.Muscle-strengthening activities involving major muscle groups on 2 or more days a week [ 26 ]
Despite this inclusion, aerobic MVPA still remains the core focus of physical activity for chronic disease prevention [ 31 , 32 , 33 ]. The combination of muscle-strengthening exercise only being a recent addition into physical activity guidelines, and that it is still rarely assessed in health surveillance is likely to explain the current lack of research focus [ 16 ]. However, from a health promotion perspective, it might be possible that some may simply not ‘enjoy’ or find it difficult to engage in regular aerobic MVPA. For example, among those living in restrictive built environments lacking street connectivity, access to greenspace, and safe places to engage in common aerobic MVPA-related activities (e.g. walking, cycling and running) [ 34 , 35 ]. Moreover, this exercise modality may be effective for those that are not able to perform aerobic MVPA due to co-morbidities, such as functional limitations or chronic obstructive pulmonary disease [ 36 , 37 ]. Hence, there is a need to promote alternative forms of physical activity/exercise beyond aerobic MVPA [ 36 , 37 ].
Muscle-strengthening Exercise and Health
The addition of muscle-strengthening exercise into physical activity recommendations is due to the strong scientific evidence showing that this physical activity mode has multiple and unique health benefits. Since comprehensive reviews on muscle-strengthening exercise and health outcomes are available elsewhere [ 20 , 21 , 23 , 38 ], we will only briefly discuss this evidence base.
First, the Clinical
The health benefits of muscle-strengthening exercise from a clinical perspective are well established from over 30 years of research [ 38 ]. In brief, meta-analyses of short-duration clinical exercise studies show that muscle-strengthening exercise increases skeletal muscle mass/strength [ 23 , 39 , 40 ], bone mineral density [ 9 , 41 ], the ability to perform activities of daily living [ 42 ], improves cardiometabolic health [ 6 , 43 ] and reduces symptoms of depression/anxiety [ 11 , 12 ]. In many of these meta-analyses, the benefits of muscle-strengthening exercise are independent of, or in some cases more effective than, aerobic MVPA [ 6 , 11 , 21 , 39 ]. In addition, compared to aerobic MVPA, muscle-strengthening exercise has greater effects on emerging health conditions, such as preventing/treating sarcopenia [ 10 ] and maintaining physical function [ 44 , 45 ]. This is particularly important when considering the current demographic trend of an ageing population [ 46 ], with declines in muscle mass/function projected to be amongst the key twenty-first-century public health challenges [ 10 , 44 , 45 ].
Now, the Epidemiological
A limitation of findings from clinical exercise studies, even at the meta-analytical level, is the inclusion of small and homogeneous samples [ 6 , 11 ]. From a public health perspective, it is necessary to establish how health benefits observed in controlled exercise studies translate to free-living community-dwelling adults. However, in comparison to the decades of epidemiological research on aerobic MVPA [ 38 , 47 , 48 ], similar research on muscle-strengthening exercise is limited. Nonetheless, recently epidemiological studies on the association between muscle-strengthening exercise and health have begun to emerge. A brief overview of the latest evidence now follows.
Saeidifard et al. conducted the first meta-analysis on the associations of muscle-strengthening exercise with mortality [ 1 ]. That analysis of 11 longitudinal studies (370,256 participants; mean follow-up = 8.85 years) showed that compared to no exercise, muscle-strengthening exercise was independently associated with 21% lower risk of all-cause mortality (after adjusting for aerobic MVPA, age, sex) [ 1 ]. Interestingly, a sub-analysis showed that compared to no muscle-strengthening exercise, 1-2 sessions/week was associated with reduced risk of mortality, whereas ≥ 3 sessions/week was not [ 49 ] suggesting that high doses (above the current guideline) of muscle-strengthening exercise may not necessarily be protective against morality. Since that meta-analysis, other longitudinal studies have shown that muscle-strengthening exercise is independently associated with reduced mortality risk [ 2 , 3 ]. Prospective data from the US cohort studies have also identified that compared to those doing none, muscle-strengthening exercise is independently associated with a reduced incidence of diabetes [ 4 , 5 ], cardiovascular disease [ 50 ], colon/kidney cancer [ 51 ], and gains in waist circumference [ 52 ].
Run, Lift or Both?—Emerging Epidemiological Evidence for Combining Aerobic MVPA and Muscle-strengthening Exercise
In addition to these independent health benefits, our recent epidemiological studies suggest that, compared to engaging in either the muscle-strengthening exercise guideline (≥ 2 sessions/week) or the aerobic MVPA guideline alone (≥ 150 min/week), the combination of both (as is prescribed in the current guideline) may be most beneficial for the prevention and/or management of multiple prevalent chronic health conditions [ 14 , 49 , 53 , 54 , 55 , 56 , 57 , 58 ]. Our cross-sectional studies, amongst large samples (range: ~ 10,000 to ~ 1.7 million adults) across several countries (e.g. the USA, Germany and South Korea) have shown that compared to meeting the aerobic MVPA or muscle-strengthening exercise guideline alone, meeting both guidelines was associated with several important indicators of health. These include a reduced prevalence of cardiometabolic (hypertension, diabetes, cardiovascular disease) and general health conditions (arthritis, chronic obstructive pulmonary disease, asthma) [ 54 , 58 ]; depression/depressive symptom severity [ 53 , 56 , 57 ]; obesity [ 49 ]; and prevalence of hyperglycaemia and dyslipidaemia [ 55 ]. Given the cross-sectional nature of these data, we urge caution in drawing strong causal inferences. Nonetheless, our findings are consistent with evidence from clinical studies demonstrating that, compared to engaging in either activity alone, combining aerobic MVPA and muscle-strengthening exercise has more favourable effects on cardiometabolic biomarkers [ 59 , 60 , 61 ], gains in lean muscle mass [ 62 ] and indicators of mental health [ 63 ].
Assessment, Prevalence and Correlates of Muscle-strengthening Exercise in Health Surveillance
Whilst research on the assessment, prevalence and correlates of physical activity has historically focused on aerobic MVPA [ 31 , 32 , 33 , 64 , 65 , 66 ], over the past decade, there has been some focus on the descriptive epidemiology of muscle-strengthening exercise [ 13 , 14 , 16 ]. We provide a brief overview of the common ways muscle-strengthening exercise is assessed in health surveillance, and the latest research on its prevalence and correlates.
In health surveillance, muscle-strengthening exercise is exclusively assessed by self-report, typically assessing its frequency only (sessions/week). In contrast to aerobic MVPA, there is currently no available validated device-based assessment method, such as accelerometry, to assess muscle-strengthening exercise in large population studies. Consequently, since self-reporting assessments of physical activity are prone to issues with social desirability and/or over reporting [ 67 ], muscle-strengthening exercise prevalence estimates obtained by self-report are likely to be overestimations [ 14 ]. Nonetheless, compared to aerobic MVPA, it is likely that individuals are able to more reliably recall engagement in muscle-strengthening exercise [ 68 ]. Yore et al. (2007) compared the reliability of survey items assessing both aerobic MVPA and muscle-strengthening exercise used in the US behavioural risk factor surveillance system survey, the largest and most consistently implemented survey assessing both exercise modalities [ 68 ]. That study showed that reliability estimates for muscle-strengthening exercise (Cohen’s kappa [ k ] = 0.85), exceed those for aerobic MVPA ( k = 0.67) [ 68 ].
The available studies on public health surveillance data (sample size range: ~ 9,000 to ~ 1.7 million adults) from several countries (e.g. the USA, Australia, Finland, the UK and Germany) suggest that between 10 and 30% of adults meet the muscle-strengthening exercise guideline (≥ 2 sessions/week) [ 13 , 14 , 15 , 16 , 17 , 18 ]. Moreover, our recent paper on trends of muscle-strengthening exercise amongst US adults suggests that at the population level muscle-strengthening exercise levels were stable between 2011 and 2017 (29.1 to 30.3%) [ 69 ].
Compared to the proportions meeting the muscle-strengthening exercise guideline, the prevalence of those reporting sufficient aerobic MVPA guideline is considerably higher (~ 50%) [ 13 , 15 , 54 ]. Importantly, as shown in Fig. 1 , our data amongst ~ 1.7 million US adults indicates that almost twofold greater proportions of US adults report no muscle-strengthening exercise (57.2%), compared to no aerobic exercise (32.2%) [ 49 ]. A potential explanation for these vastly differing prevalence levels is the fact that compared to certain types of aerobic physical activity/exercise that are common in daily living (e.g. walking for transport purposes/shopping), individuals have limited opportunity to engage in unintentional/incidental muscle-strengthening exercise. Based on this comparison, we argue that when paralleled to aerobic MVPA, equal (or possibly, greater) public health emphasis should be placed on the development of strategies and large-scale interventions to support the uptake/adherence of muscle-strengthening exercise at the population level [ 16 , 54 , 56 , 57 ]. However, muscle-strengthening exercise has rarely been the focus of physical activity promotion for public health [ 19 ], and has even been referred to as the ‘forgotten’ [ 17 ] or ‘neglected’ guideline [ 70 ].
Percentages of adults (≥ 18 years; n = 1,677,108) reporting ‘No’ or ‘Sufficient’ moderate-to-vigorous intensity aerobic physical activity (MVPA: e.g. walking, running or cycling) and muscle-strengthening exercise (MSE; weight machines/body weight exercises)*. The asterisk indicates that data for this figure are drawn from pooling the 2011, 2013, 2015, and 2017 behavioural risk factor surveillance system surveys. Data available from Centers for Disease Control and Prevention Data and Documentation Repository: https://www.cdc.gov/brfss/data_documentation/index.htm
At present, most research on the correlates of muscle-strengthening exercise has focused on sociodemographic and lifestyle-related factors. Studies have consistently shown that older age, being female, having low education/income and being overweight/obese are inversely independently associated with not meeting the muscle-strengthening exercise guideline [ 13 , 14 , 15 , 16 , 17 , 18 ]. Moreover, our Australian data suggest that compared to those living in metropolitan settings, those living in rural and remote regions are less likely to meet the muscle-strengthening exercise guideline [ 14 ]. A systematic review by Rhodes et al. found based on the current limited literature, intrapersonal factors such as self-efficacy, affective judgements and self-regulation, and interpersonal factors including programme leadership and subjective norms may have a key role in muscle-strengthening exercise adherence [ 71 ].
Muscle-strengthening Exercise Promotion—a Challenging Prospect
Despite being recommended by global/national public health agencies [ 26 , 27 , 29 , 38 ], muscle-strengthening exercise has been a limited focus for public health approaches in chronic disease prevention [ 17 , 19 , 54 ]. This lack of focus is likely due to the fact that muscle-strengthening exercise is a complex behaviour with multiple and unique health promotion challenges [ 16 ]. For example, optimal muscle-strengthening exercise progression requires a basic understanding of specific terminology (e.g. sets, repetitions, large-muscle groups) [ 21 ], access to basic equipment (resistance bands/barbells) [ 20 ], self-efficacy to perform muscle-strengthening exercise-related activities (squats, lunges, push-ups) [ 71 ] and the likelihood of multiple entrenched negative social norms (e.g. fear of injury/excessive muscle gain/hyper-masculine settings) [ 37 , 72 , 73 , 74 ].
To address these complicated factors, it is likely that concurrent, coordinated and multiple-level strategies are needed [ 16 ]. Some of these may include the following:
-Providing educational programmes and materials that offer basic information on muscle-strengthening exercise and its importance for health. Such educational strategies should focus on the fact that muscle-strengthening exercise does not necessarily require expensive equipment or access to specialised professionals. This approach would be particularly useful for older adults and those who are home-bound.
Increasing the availability of equipment (barbells, resistance bands etc.) to encourage muscle-strengthening exercise in multiple settings (home, workplace etc.).
Providing affordable/attractive spaces for muscle-strengthening exercise (community health clubs/centres, machines in open spaces).
Enabling affordable public access to professionals who have skills in prescribing muscle-strengthening exercise (exercise physiologists/fitness instructors/strength coaches).
Using behaviour-change science techniques to understand how different activities suit different sub-groups (e.g. older adults, culturally/linguistically diverse populations).
Providing mass media campaigns endorsing muscle-strengthening exercise as important for health, and challenging its negative stereotypes.
Moving Forward—Next Phases in Muscle-strengthening Exercise Epidemiology
Since research on the muscle-strengthening exercise epidemiology is still in its initial stages, there are multiple areas for future research. Some potential priority areas include the following:
Standardising Assessment
Amongst studies of nationally representative samples, prevalence estimates for meeting the muscle-strengthening exercise guideline ranged from ~ 10% in Australia [ 14 ] to ~ 30% in the USA [ 16 , 18 ]. Whilst this may be reflective of diverse muscle-strengthening exercise levels across countries, it is more likely that these differences are a consequence of the different surveillance instruments used across studies. Researchers should consider developing standardised muscle-strengthening exercise assessment items, as this would enhance the validity of cross-country comparisons and assist in accurately tracking/monitoring muscle-strengthening exercise levels.
Beyond Frequency
At present muscle-strengthening exercise assessment items used in public health research predominantly only assess its frequency. Since clinical exercise studies demonstrate duration, intensity and type (single vs. multi-joint; body weight vs. use of weight machines etc.) of muscle-strengthening exercise may affect outcomes such as skeletal muscle strength/size/endurance [ 23 ], items that assess these muscle-strengthening exercise participation constructs will provide a more nuanced insight into this exercise modality and its associations with health.
Device-based Assessments
As noted, a key limitation of assessment of muscle-strengthening exercise surveillance is that it is exclusively assessed by self-report. Whilst being of low cost/participant burden, self-report assessment of health behaviours is prone to issues with recall bias (e.g. social desirability and over/under reporting) [ 67 ]. Whilst currently unavailable, future studies should explore the use of wearable technologies/smart phone applications and their potential to assess muscle-strengthening exercise with greater precision.
Beyond Sociodemographic Correlates
Congruent with the expansive research on the correlates of aerobic MVPA [ 31 , 64 ], research should assess the potential for a wider range of possible influences, such as social (e.g. social norms/behavioural modelling) and physical environmental (e.g. access to facilities/equipment) factors. Moreover, future studies should examine the key barriers and facilitators amongst population sub-groups most at risk of low muscle-strengthening exercise engagement (e.g. older adults, females, those experiencing sociodemographic disadvantage).
More Surveillance
Despite being globally recommended for a decade, muscle-strengthening exercise is still rarely assessed in physical activity surveillance [ 19 ]. As with common practice for aerobic MVPA [ 32 , 33 , 66 ], there is a need for surveillance systems to provide large-scale cross-country assessments of muscle-strengthening exercise. Such information is essential for the tracking and monitoring of this important health behaviour and establishing at risk population sub-groups for low-level engagement.
This current opinion paper presents an overview of the emerging discipline of muscle-strengthening exercise epidemiology. The current scientific evidence indicates that the multiple and independent health benefits of muscle-strengthening exercise from a clinical perspective are strong, and rapidly emerging from an epidemiological standpoint. Importantly, epidemiological evidence suggests that amongst those doing none, small-to-moderate increases in muscle-strengthening exercise at the population level are likely to have considerable public health benefits. Yet, current conservative population estimates suggest that between 10-30% of adults report meeting the muscle-strengthening exercise guideline, a far lower proportion than those meeting the MVPA guideline (~ 50%). Success in large-scale interventions adherence/adherence of the muscle-strengthening exercise guideline at the population level will likely be contingent upon several multi-level and concurrent approaches. Future muscle-strengthening exercise epidemiology research should consider developing standardised muscle-strengthening exercise assessments in health surveillance (assessing constructs beyond frequency), examining a wider range of the potential correlates of muscle-strengthening exercise, and integrating assessments of muscle-strengthening exercise into existing health surveillance systems.
Availability of Data and Materials
Not applicable
Abbreviations
Moderate-to-vigorous intensity aerobic physical activity
Cohen’s kappa
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Bennie, J.A., Shakespear-Druery, J. & De Cocker, K. Muscle-strengthening Exercise Epidemiology: a New Frontier in Chronic Disease Prevention. Sports Med - Open 6 , 40 (2020). https://doi.org/10.1186/s40798-020-00271-w
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Sports Medicine and Movement Sciences
Giuseppe musumeci.
a Department of Biomedical and Biotechnological Sciences, Human Anatomy and Histology Section, School of Medicine, University of Catania, Via S. Sofia 87, 95123, Catania, Italy
b Research Center on Motor Activities (CRAM), University of Catania, 95123, Catania, Italy
c Department of Biology, College of Science and Technology, Temple University, Philadelphia, PA, 19122, USA
Sports Medicine is a relatively new topic in medicine and includes a variety of medical and paramedical fields. Although sports medicine is mistakenly thought to be mainly for sports professionals/athletes, it actually encompasses the entire population, including the active and non-active healthy populations, as well as the sick [ 1 ]. Sports medicine also engages amateur sportsmen and strives to promote physical activity and quality of life in the general population. Hence, the field involves all ages from childhood to old age, aiming to preserve and support every person at every age. Sports medicine, which started developing in the 19 th century, is today a medical speciality.
Currently, there exist different technologies applied in the world of sports medicine dedicated to the detection of health problems. Evidence has demonstrated that virtual environments can be useful therapeutic tools with demonstrated positive outcomes. Modern technological advances have led to the implementation of digital devices, such as wearables and smartphones, which have been shown to provide opportunities for healthcare professionals and researchers to monitor physical activity and therefore engage patients in daily exercising. Additionally, the use of digital devices has emerged as a promising tool for improving frequent health data collection, disease monitoring, and supporting public health surveillance. The leveraging of digital data has laid the foundation for the development of a new concept of epidemiological study, known as “Digital Epidemiology”, which could contribute in the future to personalized and precision sports medicine.
The understanding of the importance of physical activity and fitness as part of a healthy lifestyle is increasing all over the world, as well as the number of amateur athletes and the profession of sports medicine takes a big part in this process.
Physical inactivity is the fourth leading cause of morbidity and mortality worldwide [ 2 ]. Regular physical activity is highly beneficial for the primary, secondary and tertiary management of many common chronic conditions. There is considerable evidence for the benefits of physical activity for cardiovascular disease, diabetes, obesity, musculoskeletal conditions, some cancers, mental health and dementia [ 3 ]. Yet there remains a large evidence-practice gap between physicians’ knowledge of the contribution of physical inactivity to chronic disease and routine effective assessment and prescription of physical activity.
The benefits of physical activity for the prevention and treatment of many chronic diseases are well established, including the infection of Sars-CoV-2. Considering the countless positive effects of exercise, planning an adapted physical activity in all phases of recovery (bed rest, rehabilitation, and post-hospitalization) of the patient represents an important strategy to mitigate the decline of cognitive functions and improve the physical and psychological wellbeing of subjects affected by COVID-19. Physical activity, if adapted to the needs of the individual, practiced consistently and regularly, shows a positive influence on the immune system due to its natural protective and anti-inflammatory action. Correct and constant physical exercise, even at home, at all ages and especially in the elderly, is an extra shield against Sars-CoV-2 [ 4 ]. Thanks to the Adapted Physical Activity patients improve the skills: psychological, mental, cardiorespiratory and muscular.
For some chronic conditions, structured exercise interventions are at least as effective as drug therapy. The adapted physical activity should be prescribed in the same way as pharmacological treatment, deciding on the “dosage” and “formulation” for each patient. The “dosage” is calculated to reach a specific level of efficacy that prevents or improves symptoms but does not result in toxic effects [ 3 ]. The exercise regime should always be "adapted" personalized and "tailored" since the level of exercise will depend on the tolerability of the individual, since the body of each of us always responds differently. No do-it-yourself or generalized training/protocols should be allowed, because physical activity if done poorly, can cause more damage than a sedentary lifestyle. As stated by the American College of Sports Medicine, physical activity should be prescribed/administered, alternatively or in association with drug treatment by the Sports and/or Family Physician and/or the Kinesiologist [ 5 ].
With sincere satisfaction and pride, I present to you the Special Issue titled “Sports Medicine and Movement Sciences” . This Special Issue bridging the gap between science and practice in the promotion of exercise and health and in the scientific assessment, study, and understanding of sports performance, sports injury prevention and treatment, exercise for health as non-surgical and non-pharmacological treatments, rehabilitation techniques, adapted physical activity, drugs in sport, and recommendations for training and nutrition.
This Special issue comprises 3 review articles and 16 original research publications from a number of Sports Medicine and Movement Sciences researchers [ 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 ]. Taken together, these articles are geared toward the advancement of our understanding Sports Medicine and Movement Sciences arena, including: Cognitive function; Brain health; Gait analysis; Biomechanics; Health sciences; Physiology; Physical activity; Occupational health; Musculoskeletal system; Evidence-based medicine; Aerobic threshold; Anaerobic threshold; Maximal oxygen uptake; Neuroscience; Exercise; Physical Activity; Balance; Metastability; Neuromuscular control; Prevention; Rehabilitation; Health Promotion; Anatomy; Health Technology; Three-dimensional motion analysis; Reliability; knee injury; Athletic pubalgia; Cardiology; Women's Health; Female athletes; Applied psychology; Clinical psychology; Paralympic sport; Goalball; Soccer; Cognitive psychology; Quality of life; Disability; Regenerative medicine; Osteoarthritis; Virtual reality; Sensorimotor control; Sports injury prevention; Epidemiology; Public health; Psychology; COVID-19; Pandemic; Quarantine; Home based exercise; IPAQ-SF; Psychological well-being; PGWBI; Nerve injury; Nerve regeneration; Therapeutic exercise; Wearable technologies; Sprint initiation; Step technique; Multi-directional movement; Novel training environments and digital devices; Adherence; Breast cancer; Lifestyle; Public Health and Digital Epidemiology.
I hope that readers of Heliyon enjoy reading these significant contributions that remind us of the crucial importance of interdisciplinary collaboration between those working in Sports Medicine and their counterparts in Movement Sciences.
Conflict of interest declaration
The author of this editorial does not have any conflict of interests.
Acknowledgements
The author of this editorial wishes to thank all authors who have contributed to this Special Issue and express his gratitude to Heliyon Clinical Research editorial Team for their assistance and co-operation, in particular Dr. Christian Schulz the Lead Editor of Heliyon and Dr. Lo, On Ching the Editorial Team Leader of Heliyon Clinical Research. Special thanks to the publishing group (Cell Press) who encouraged and made possible the realization of this special issue.
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The American Journal of Sports Medicine, founded in 1972, is the official publication of the American Orthopaedic Society for Sports Medicine.It contains original articles addressed to orthopaedic surgeons specializing in sports medicine, and to team physicians, athletic trainers, and physical therapists focusing on the causes and effects of injury or disease resulting from or affected by ...
British Journal of Sports Medicine (BJSM) is a Plan S compliant Transformative Journal. British Journal of Sports Medicine (BJSM) is a multimedia portal for authoritative original research, systematic reviews, consensus statements and debate in sport and exercise medicine (SEM). We define sport and exercise medicine broadly. BJSM's web, print, video and audio material serves the ...
Comment on "Exercise Snacks and Other Forms of Intermittent Physical Activity for Improving Health in Adults and Older Adults: A Scoping Review of Epidemiological, Experimental and Qualitative Studies". Mingyue Yin. Hansen Li. Yongming Li. Letter to the Editor 22 July 2024 Pages: 2199 - 2203.
Aritra Majumdar, Rashid Bakirov and Tim Rees. Sports Medicine - Open 2024 10 :85. Letter Published on: 29 July 2024. The original article was published in Sports Medicine - Open 2024 10 :84. The Leading Article to this article has been published in Sports Medicine - Open 2022 8 :73. Full Text.
Medicine & Science in Sports & Exercise. 56 (9):1830-1839, September 2024. * MSSE 2021 Paper of the Year *. Medicine & Science in Sports & Exercise (MSSE), ACSM's flagship monthly peer-reviewed journal, is the leading multidisciplinary original research journal for members. Each issue features original investigations, clinical studies and ...
Research in Sports Medicine is a broad journal that aims to bridge the gap between all professionals in the fields of sports medicine. The journal serves an international audience and is of interest to professionals worldwide. The journal covers major aspects of sports medicine and sports science - prevention, management, and rehabilitation of sports, exercise and physical activity related ...
Featured Jobs. Clinical Journal of Sport Medicine is an international refereed journal published for clinicians with a primary interest in sports medicine practice. The journal publishes original research and reviews covering diagnostics, therapeutics, and rehabilitation in healthy and physically challenged individuals of all ages and levels of ...
The American Journal of Sports Medicine (AJSM) is the official peer-reviewed scientific journal of the American Orthopaedic Society for Sports Medicine (AOSSM). Founded in 1972, AJSM is an essential forum for independent orthopaedic sports medicine research and education, allowing clinical practitioners the ability to make decisions based on sound scientific information.
Aims and scope. Sports Medicine - Open focuses on original research and definitive reviews in the field of sport and exercise medicine. The Journal includes medical and scientific research relating to: Sporting performance enhancement including nutrition, equipment and training. Medical syndromes associated with sport and exercise.
Sports Medicine also welcomes the submission of high-quality original research in the above fields. As a hybrid journal, Sports Medicine does not charge authors to publish using the traditional subscription-based publishing route, but does offer the option to publish accepted articles open access if authors so wish or if their funders require ...
Incidence and burden of 671 injuries in professional women footballers: time to focus on context-specific injury risk reduction strategies. Olivier Materne et al. Published online: 19 Jun 2024. Explore the current issue of Research in Sports Medicine, Volume 32, Issue 5, 2024.
As injury is an inevitable part of sports participation, more and more attention has been paid to the research of sports medicine. Due to the rapid growth of sports medicine of athletes research, it is a challenge to entirely understand its research status and hotspots. ... Marx W. HistCite analysis of papers constituting the h index research ...
Sports Health: A Multidisciplinary Approach (SPH) is a bi-monthly, peer-reviewed journal for primary care physicians, orthopaedic surgeons, physical therapists, athletic trainers and other medical and health care professionals involved in the training and care of the competitive or recreational athlete.SPH publishes review articles, original research articles, case studies, images, short ...
This current opinion paper: i.Provides a narrative review of the emerging discipline of muscle-strengthening exercise epidemiology. ii.Argues the case for an increased emphasis on the role of muscle-strengthening exercise for chronic disease prevention. iii.Discusses key research gaps and strategies to advance this field
With our six leading scholarly journals, ACSM offers access to cutting-edge research, translational science, relevant clinical reports and evidence-informed practical content for researchers, students, clinicians, those working to improve health outcomes, and health and fitness professionals. Click on a journal cover to learn more.
As such, optimising performance, improving the best players' availability, and decreasing the risk of injury have become the main thrusts of sports science and sports medicine when tied to high-performance teams. 5. Sports science research can help lead to evidence-based approaches that will allow athletes and active individuals to exercise ...
Sports Medicine is a relatively new topic in medicine and includes a variety of medical and paramedical fields. Although sports medicine is mistakenly thought to be mainly for sports professionals/athletes, it actually encompasses the entire population, including the active and non-active healthy populations, as well as the sick [].Sports medicine also engages amateur sportsmen and strives to ...
Sports Medicine focuses on definitive and comprehensive review articles that interpret and evaluate the current literature to provide the rationale for and application of research findings in the sports medicine and exercise field. Major topics covered by reviews published in the journal include: Sports medicine and sports science, including performance research.
Journal of Sports Science and Medicine. Journal of Sports Science and Medicine (JSSM) is a nonprofit scientific electronic journal, publishing research and case studies, and review article in the fields of sports medicine and exercise sciences. JSSM is an open access journal which means that all content is freely available without charge to the ...
Respond to the needs of your patients. Current Sports Medicine Reports ( CSMR), a monthly e-journal for clinician members, responds to your unique information needs by addressing one sports medicine topic in-depth in each issue. This is one of the most thorough reviews of current sports medicine literature you'll find out there.
Research in Sports Medicine is a broad journal that aims to bridge the gap between all professionals in the fields of sports medicine. The journal serves an international audience and is of interest to professionals worldwide. The journal covers major aspects of sports medicine and sports science - prevention, management, and rehabilitation of sports, exercise and physical activity related ...
Sports science. The importance of science in elite sport — from helping athletes to train safely to protecting sporting integrity. The competition to be crowned the fastest, strongest or most ...
The use of lubricating materials in sports medicine is a compelling area of research that offers innovative solutions for the prevention and treatment of sports-related orthopaedic problems. Lubricating materials can mimic the lubrication mechanisms of natural organisms thereby reducing wear and tear and promoting tissue regeneration in joints ...
The American Sports Medicine Institute (ASMI) is a national and international leader in sports medicine research related to clinical and surgical outcomes, biomechanics, and rehabilitation. The foci of ongoing studies at ASMI includes both clinical and biomechanical research, and our team includes researchers with expertise in motion capture ...
Adding to the terminological confusion in sport is the definition of 'player'. For example, the categorization of 'player' is commonly used in both applied and research settings from team sports to individual sports to sedentary games [18,19,20,21].Specifically, practitioners and researchers have been shown to refer to some individual sport participants as players [], despite this not ...
Two of the included articles use cohorts developed for aging research. In an article by Mudalige et al. ( Citation 2024 ), the Canadian Platform for Research Online to Investigate Health, Quality of Life, Cognition, Behaviour, Function and Caregiving in Aging (CAN-PROTECT) study is used to examine the relationship between physical activity and ...