Does isometric exercise result in exercise induced hypoalgesia in people with local musculoskeletal pain? A systematic review

ObjectiveThe aim of this review was to investigate if exercise induced hypoalgesia (EIH) occurs following isometric muscle contraction in people with local musculoskeletal symptoms.DesignSystematic review.Data sourcesMEDLINE, EMBASE, CINAHL & SportDiscus electronic databases were searched (inception to April 2020).Eligibility criteriaTwo authors independently evaluated eligibility. Randomised controlled and crossover (repeated measures) trials that measured the effects of isometric exercise in participants with localised musculoskeletal pain during, and up to 2 hours after isometric exercise were included. Other inclusion criteria included comparison to another intervention, or comparison to healthy controls. Primary outcomes were experimentally induced pain thresholds and secondary outcomes included measures of pain sensitivity from clinical testing.Results13 studies with data from 346 participants were included for narrative synthesis. EIH was reported in some upper and lower limb studies but there were no consistent data to show isometric exercises were superior to comparison interventions.ConclusionThere was no consistent evidence for EIH following isometric exercise in people with musculoskeletal pain. These findings are different to those reported in asymptomatic populations (where EIH is consistently demonstrated) as well as conditions associated with widespread symptoms such as fibromyalgia (where isometric exercise may induce hyperalgesia). Although well tolerated when prescribed, isometric exercise did not induce EIH consistently for people seeking care for local musculoskeletal symptoms. The variance in the dose, location of contraction and intensity of protocols included in this review may explain the inconsistent findings. Further work is required to better understand endogenous analgesia in musculoskeletal pain conditions.     

Can exercise improve self esteem in children and young people? A systematic review of randomised controlled trials

A systematic review to determine if exercise alone or as part of a comprehensive intervention can improve self esteem in children and young people is described. Twenty three randomised controlled trials were analysed. A synthesis of several small, low quality trials indicates that exercise may have short term beneficial effects on self esteem in children and adolescents. However, high quality research on defined populations with adequate follow up is needed.     

A systematic review of incubator-based neonatal radiography – What does the evidence say?

ObjectivesThis systematic review aimed to explore the impact of incubator design (canopy, mattress, and mattress support) on neonatal imaging in terms of imaging technique, radiation dose and image quality.Key FindingsA systematic literature review was performed by searching multiple healthcare databases. Following study selection and extraction, 7 articles were deemed eligible and included within the study. Of these 7 studies, six were experimental phantom based with the remaining one being a retrospective analysis. Four studies reported a percentage reduction in beam attenuation for incubator components ranging from 12% to 72% with one other study reporting a reduction but with no numerical data. This wide variation in radiation beam attenuation from the incubator components was correlated with image quality within five studies, two suggesting reduced image quality when using the incubator tray under the mattress support whilst the other three found no significant difference. Although the seven studies reported that incubator components reduced X-ray beam intensity, there was limited evidence on whether this required an increase in exposure factors. Only one study suggested increasing exposure parameters to accommodate for the increase in beam attenuation when using an incubator tray.ConclusionThe literature clearly demonstrates that with existing incubator designs, there is considerable beam attenuation between placing the image receptor directly behind the neonate as oppose to the incubator tray. However, this radiation beam attenuation is not well correlated to neonatal radiation dose or image quality effects and therefore is very confusing when considering clinical implementation.Implications for practiceThis review highlights the need for standardisation and further optimisation work to ensure best practice for this vulnerable patient group.     

Is inertial flywheel resistance training superior to gravity-dependent resistance training in improving muscle strength? A systematic review with meta-analyses

Objective

The primary aim of this systematic review was to determine if inertial flywheel resistance training is superior to gravity-dependent resistance training in improving muscle strength. The secondary aim was to determine whether inertial flywheel resistance training is superior to gravity-dependent resistance training in improving other muscular adaptations.

The effect of exercise for improving bone health in cancer survivors — A systematic review and meta-analysis

ObjectiveTo evaluate the effectiveness of exercise for improving bone-related outcomes among cancer survivors.DesignSystematic review and meta-analysis.MethodsAn electronic search using the following databases: SPORTDiscus, Science Direct, CINAHL, MEDLINE, Cochrane, Pubmed, Ebscohost, ProQuest Nursing and Allied Health Source.Randomised, controlled, exercise trials involving cancer survivors were eligible. Effect data on bone mineral content (BMC) and density (BMD) outcomes were extracted. Risk of bias was assessed using the Physiotherapy Evidence Database tool. Standardised mean differences (SMD) were calculated to compare differences between exercise and usual care. Subgroup analyses were conducted to assess whether effect differed by exercise mode, intervention length, supervision, treatment, cancer type and risk of bias.ResultsTwenty-six trials were included, with intervention durations ranging between 12 weeks and 2 years. Most trials involved breast cancer (n = 13, 50%), and most interventions were supervised (n = 18, 69%) and evaluated mixed-mode (i.e., combined aerobic and resistance) exercise (n = 13, 50%). Significant effects in favour of exercise (aerobic, resistance, mixed-mode and other exercise) were observed for whole body BMD, hip BMD, trochanter BMD and femoral neck BMD (SMD range: 0.19–0.39, all p < 0.05) compared to usual care.ConclusionParticipation in various modes (aerobic, resistance, mixed-mode and other) of supervised and unsupervised exercise is associated with improvements in BMD. The present results provide evidence for clinicians and other health care professionals (e.g., exercise physiologists and physiotherapists) to recommend exercise for cancer survivors to prevent bone loss during and following treatment.     

What is the relationship between exercise and metabolic abnormalities? A review of the metabolic syndrome

Prevention of the metabolic syndrome and treatment of its main characteristics are now considered of utmost importance in order to combat the epidemic of type 2 diabetes mellitus and to reduce the increased risk of cardiovascular disease and all-cause mortality. Insulin resistance/hyperinsulinaemia are consistently linked with a clustering of multiple clinical and subclinical metabolic risk factors. It is now widely recognised that obesity (especially abdominal fat accumulation), hyperglycaemia, dyslipidaemia and hypertension are common metabolic traits that, concurrently, constitute the distinctive insulin resistance or metabolic syndrome. Cross-sectional and prospective data provide an emerging picture of associations of both physical activity habits and cardiorespiratory fitness with the metabolic syndrome. The metabolic syndrome, is a disorder that requires aggressive multi-factorial intervention. Recent treatment guidelines have emphasised the clinical utility of diagnosis and an important treatment role for 'therapeutic lifestyle change', incorporating moderate physical activity. Several previous narrative reviews have considered exercise training as an effective treatment for insulin resistance and other components of the syndrome. However, the evidence cited has been less consistent for exercise training effects on several metabolic syndrome variables, unless combined with appropriate dietary modifications to achieve weight loss. Recently published randomised controlled trial data concerning the effects of exercise training on separate metabolic syndrome traits are evaluated within this review. Novel systematic review and meta-analysis evidence is presented indicating that supervised, long-term, moderate to moderately vigorous intensity exercise training, in the absence of therapeutic weight loss, improves the dyslipidaemic profile by raising high density lipoprotein-cholesterol and lowering triglycerides in overweight and obese adults with characteristics of the metabolic syndrome. Lifestyle interventions, including exercise and dietary-induced weight loss may improve insulin resistance and glucose tolerance in obesity states and are highly effective in preventing or delaying the onset of type 2 diabetes in individuals with impaired glucose regulation. Randomised controlled trial evidence also indicates that exercise training decreases blood pressure in overweight/obese individuals with high normal blood pressure and hypertension. These evidence-based findings continue to support recommendations that supervised or partially supervised exercise training is an important initial adjunctive step in the treatment of individuals with the metabolic syndrome. Exercise training should be considered an essential part of 'therapeutic lifestyle change' and may concurrently improve insulin resistance and the entire cluster of metabolic risk factors.     

Does exercise during growth have a long-term effect on bone health?

There is increasing evidence that growth is a critical time for altering body tissue composition and fostering either the development or the prevention of disease. The focus of this review is to examine the effect of regular exercise during growth on long-term bone health.     

Anode heel effect: Does it impact image quality in digital radiography? A systematic literature review

IntroductionThe anode heel effect can be used to optimize image quality and/or patient dose in digital radiography (DR). In film-screen radiography, the effect can equalize optical density in regions of varying attenuation. Clinical experience suggests that the implementation of DR has led to less awareness of anode orientation. Post-processing is assumed to compensate, but may also alter image impression and potentially obscure image details. Published evidence was examined for the influence of the anode heel effect on image quality in DR.MethodA systematic literature search was carried out using PubMed, Embase, and Web of Science databases. Title and abstracts were screened blinded by three authors, according to in-/exclusion criteria, followed by full-text analysis for final inclusion. Studies where technical and/or visual image quality were reported, was included. All studies were analyzed and assigned quality scores, according to relevant questions. The authors devised a scoring system based on reported information pertaining to reproducibility, interpretation, and generalizability of the methods and conclusions.ResultsFive studies were included of heterogeneous design, each with methodological shortcomings. Only a few anatomical areas were covered. Very few patients were examined, and in no studies were images evaluated by radiologists or reporting radiographers. Relevant information such as post-processing, image quality criteria and analysis was insufficient in most studies, making reproduction difficult. Results were contradictory, especially concerning technical vs visual image quality.ConclusionLimited published evidence was found quantifying the influence of the anode heel effect on image quality using DR technology. More methodologically, robust studies are needed. The published evidence neither proves nor disproves the impact of the heel effect on image quality in DR.Implications for practiceBased on a systematic review, no firm recommendations for anode orientation relating to image quality in DR can be provided.     

Culture: what is its effect on stress in the military?

Culture provides the unwritten rules that inform and shape expected behaviors. To date, little research has been conducted into the attitudes or opinions that service personnel hold toward mental health issues. This article examines current literature and research into the recognition of mental health problems in the military and potential organizational barriers to care including stigma and the specific characteristics of a military culture such as the significant reliance on buddy support. We conclude that the barriers to care which operate in both military and civilian populations are not insignificant. Western militaries in fact currently face an uphill struggle to combat the substantial barriers to care that exist.     

Does lower-limb asymmetry increase injury risk in sport? A systematic review

ObjectiveThe aim of this review was to synthesize the current understanding relating to the risks of lower body functional asymmetry with injury in athletic populations.MethodsAn iterative data mining and sampling approach was used to construct a search phrase from key words, which were used to identify studies within SPORTdiscus, Medline and Academic Search Complete databases. Additional references were sourced from the reference lists of these articles.ResultsAfter screening, 31 papers were reviewed, from an initial search identifying 302 possible studies. A total of 6228 participants were involved in the studies, of which soccer players were the most observed sporting demographic (n = 2171). Of the 31 studies reviewed eight found no statistical association between lower limb asymmetry and injury risk, 10 studies provided partial statistically significant evidence and a further 10 provided statistically significant statistical links.ConclusionOverall moderate to lower quality evidence for functional asymmetry as a risk factor for injury in sport was observed. While the possibility of a relationship between lower limb functional asymmetry and injury risk cannot be ruled out, further higher quality investigations, adopting standardised methodologies, is required.     

What are the risk factors for groin strain injury in sport? A systematic review of the literature

Groin injury is among the most common cited injuries in the sports of ice hockey, soccer, Australian Rules football, calisthenics and cricket. There are very few prospective studies examining risk factors for groin strain injury in sport. There is support for an association of previous injury and greater abductor to adductor strength ratios as well as sport specificity of training and pre-season sport-specific training, as individual risk factors in groin strain injury in athletes. Core muscle weakness or delayed onset of transversus abdominal muscle recruitment may increase the risk of groin strain injury. Debate exists in the literature regarding the role of adductor strength and length as well as age and/or sport experience as risk factors for groin injury. There is no strong evidence to support a causal association for any of these risk factors and groin injury.     

Symptom response following acute bouts of exercise in concussed and non-concussed individuals – A systematic narrative review

BackgroundAthletes suspected of being concussed are frequently evaluated on the side-line for self-reported symptoms which guide subsequent management and return-to-play decisions. Concussion-like symptoms have been shown to be influenced by prior participation in physical activity; however, the potential contribution of acute exercise on symptoms is not well understood.ObjectiveThe purpose of this study was to systematically review the literature in order to further understand the acute effects of exercise on documented self-reported symptoms in both concussed and non-concussed individuals.DesignSystematic narrative review.MethodsNine electronic databases were systematically searched using keywords and MeSH terms that included; self-reported symptoms, sports-related concussion, brain concussion, exercise and athletic injuries. In addition, an extensive search of the grey literature was conducted.ResultsOf the 785 articles retrieved, only five met the inclusion criteria comprising a total of 295 concussed and non-concussed participants. In general, the mean symptom scores increased from pre-exercise to post-exercise levels immediately following acute bouts of exercise in both concussed and non-concussed individuals.ConclusionAlthough the symptom scores increased following exercise in both concussed and non-concussed participants, this increase was only maintained for a relatively short duration. Thus, the application to real world situation is still to be established.     

Split-belt treadmill walking in patients with Parkinson’s disease: A systematic review

BackgroundWalking on a split-belt treadmill (SBT) can help to modulate an asymmetric gait, particularly for people with neurological conditions, such as Parkinson’s disease (PD), where asymmetry plays a role due to the laterality of the disease.Research questionThis systematic review critically evaluates the literature on SBT in PD. First, different SBT paradigms and methodological approaches were evaluated. Second, the review explored how people with PD adapt their gait to different SBT conditions compared to healthy controls (HC).MethodsWe conducted a systematic search of the PubMED, PsychINFO, and Web of Knowledge databases. Original research articles, published in English and investigating SBT walking in people with PD, were included.ResultsFrom the 925 studies originally identified, seven met the inclusion criteria and were selected for evaluation (n = 118 individuals with PD of whom 44 had freezing of gait (FOG)). The SBT paradigms varied across studies regarding the SBT settings, definitions of gait variables, and criteria for determining dominance of body side. Gait variability and bilateral coordination were found to adapt to the SBT condition similarly in people with PD and healthy controls (HC). Inconsistent results were found with respect to the adaptation of gait asymmetry, for the differences between PD and HC participants. The subgroup of people with PD and FOG showed reduced accuracy in detecting belt speed differences and slower adaptation to SBT conditions.ConclusionIndividuals with mild to moderately severe PD adapted similarly to HCs to SBT walking for gait variability and bilateral gait coordination. However, those with FOG had impaired perception of belt speed differences and did not adapt their gait so readily. Although SBT can be useful for modulating gait asymmetry in some people with PD, it was not beneficial for all. We recommend standardization of SBT protocols for clinical practice in future studies.     

Coordination in adults with neurological impairment – A systematic review of uncontrolled manifold studies

BackgroundAnalysis of sensorimotor synergies has been greatly advanced by the Uncontrolled Manifold (UCM) approach. The UCM method is based on partitioning inter-trial variance displayed by elemental variables into ‘good’ (V_UCM) and ‘bad’ (V_ORT) variability that, respectively, indicate maintenance or loss of task stability. In clinical populations, these indices can be used to investigate the strength, flexibility, stereotypy and agility of synergistic control.Research questionHow are synergies affected by neurological impairment in adults? Specifically, this study aimed to determine i) the impact of pathology on V_UCM, V_ORT, and their ratio (synergy index); ii) the relationship between synergy indices and functional performance; iii) changes in anticipatory synergy adjustments (ASAs); and iv) the effects of interventions on synergies.MethodsSystematic review of UCM studies on adults with neurological impairment.ResultsMost of the 17 studies had moderate to high quality scores in the adapted Critical Review Form and the UCM reporting quality checklist developed for this review. i) Most of the studies found reduced synergy indices for patients with Parkinson's disease (PD), olivo-ponto-cerebellar atrophy, multiple sclerosis and spinocerebellar degeneration, with variable levels of change in V_UCM and V_ORT. Reduction in synergy indices was not as consistent for stroke, in three out of six studies it was unchanged. ii) Five of seven studies found no significant correlations between scores on motor function scales and UCM indices. iii) Seven studies consistently reported ASAs that are smaller in magnitude, delayed, or both, for patients compared to healthy controls. iv) Two studies reported increased synergy indices, either via increase in V_UCM or decrease in V_ORT, after dopaminergic drugs for patients with PD. There were similar synergy indices but improved ASAs after deep brain stimulation for patients with PD.SignificanceUCM can provide reliable and sensitive indicators of altered synergistic control in adults with neurological impairment.