Sport and exercise medicine and the Olympic health legacy

London 2012 is the first Olympic and Paralympic Games to explicitly try and develop socioeconomic legacies for which success indicators are specified - the highest profile of which was to deliver a health legacy by getting two million more people more active by 2012. This editorial highlights how specialists in Sport and Exercise Medicine can contribute towards increasing physical activity participation in the UK, as well as how the National Centre for Sport and Exercise Medicine might be a useful vehicle for delivering an Olympic health legacy. Key challenges are also discussed such as acquisition of funding to support new physical activity initiatives, appropriate allocation of resources, and how to assess the impact of legacy initiatives

Enclosing a pen in a postal questionnaire follow-up to increase response rate: a study within a trial

Background: Poor response rates to follow-up questionnaires can adversely affect the progress of a randomised controlled trial and the validity of its results. This embedded ‘study within a trial’ aimed to investigate the impact of including a pen with the postal 3-month questionnaire completed by the trial participants on the response rates to this questionnaire. Methods: This study was a two-armed randomised controlled trial nested in the Gentle Years Yoga (GYY) trial. Participants in the intervention group of the GYY trial were allocated 1:1 using simple randomisation to either receive a pen (intervention) or no pen with their 3-month questionnaire (control). The primary outcome was the proportion of participants sent a 3-month questionnaire who returned it. Secondary outcomes were time taken to return the questionnaire, proportion of participants sent a reminder to return the questionnaire, and completeness of the questionnaire. Binary outcomes were analysed using logistic regression, time to return by Cox Proportional hazards regression and number of items completed by linear regression. Results: There were 111 participants randomised to the pen group and 118 to the no pen group who were sent a 3-month questionnaire. There was no evidence of a difference in return rates between the two groups (pen 107 (96.4%), no pen 117 (99.2%); OR 0.23, 95% CI 0.02 to 2.19, p=0.20). Furthermore, there was no evidence of a difference between the two groups in terms of time to return the questionnaire (HR 0.90, 95% CI 0.69 to 1.18, p=0.47), the proportion of participants sent a reminder (OR 0.85, 95% CI 0.48 to 1.53, p=0.60) nor the number of items completed (mean difference 0.51, 95% CI -0.04 to 1.06, p=0.07). Conclusion: The inclusion of a pen with the postal 3-month follow-up questionnaire did not have a statistically significant effect on response rate. Keywords study within a trial, pen, postal questionnaire, retention, randomised controlled trial, older people, multimorbidit

Effect of hand cooling on body temperature, cardiovascular and perceptual responses during recumbent cycling in a hot environment

The purpose of this study was to quantify physiological and perceptual responses to hand immersion in water during recumbent cycling in a hot environment. Seven physically active males (body mass 79.8 ± 6.3 kg; stature 182 ± 5 cm; age 23 ± 3 years) immersed their hands in 8, 14 and 34°C water whilst cycling at an intensity (W) equivalent to 50% (Formula presented.)O2peak for 60 min in an environmental chamber (35°C, 50% relative humidity). 8 and 14°C water attenuated an increase in body temperature, and lowered cardiorespiratory and skin blood flow demands. These effects were considered to be practically beneficial (standardised effect size > 0.20). There was a tendency for 8 and 14°C to extend exercise duration versus 34°C (>7%). Heart rate, intestinal, mean skin and mean body temperature were less in 8°C compared to 14°C; these differences were considered practically beneficial. Augmented heat loss at the palm-water surface might enable cooler blood to return to the body and limit physiological strain. These findings provide a mechanistic basis for continuous hand cooling and indicate that endurance exercise in hot environments could be improved using this method. Future research should investigate its effectiveness during cycling and running performanc

Reliability of intestinal temperature using an ingestible telemetry pill system during exercise in a hot environment

Ingestible telemetry pill systems are being increasingly used to assess the intestinal temperature during exercise in hot environments. The purpose of this investigation was to assess the interday reliability of intestinal temperature during an exercise-heat challenge. Intestinal temperature was recorded as 12 physically active men (25 ± 4 years, stature 181.7 ± 7.0 cm, body mass 81.1 ± 10.6 kg) performed two 60-minute bouts of recumbent cycling (50% of peak aerobic power [watts]) in an environmental chamber set at 35° C 50% relative humidity 3-10 days apart. A range of statistics were used to calculate the reliability, including a paired t-test, 95% limits of agreement (LOA), coefficient of variation (CV), standard error of measurement (SEM), Pearson's correlation coefficient (r), intraclass correlation coefficient (ICC), and Cohen's d. Statistical significance was set at p ≤ 0.05. The method indicated a good overall reliability (LOA = ± 0.61° C, CV = 0.58%, SEM = 0.12° C, Cohen's d = 0.12, r = 0.84, ICC = 0.84). Analysis revealed a statistically significant (p = 0.02) mean systematic bias of -0.07 ± 0.31° C, and the investigation of the Bland-Altman plot suggested the presence of heteroscedasticity. Further analysis revealed the minimum "likely" change in intestinal temperature to be 0.34° C. Although the method demonstrates a good reliability, researchers should be aware of heteroscedasticity. Changes in intestinal temperature >0.34° C as a result of exercise or an intervention in a hot environment are likely changes and less influenced by error associated with the method

Physical activity habits, limitations and predictors in people with inflammatory bowel disease: a large cross-sectional online survey

Background: Limited evidence suggests that physical activity has beneficial effects in people with inflammatory bowel disease (IBD). This study aimed to determine the physical activity habits of adults with IBD, the limitations to physical activity they experience because of their disease, and the extent to which their physical activity is affected by various demographic, clinical, and psychological factors. Methods: Data were collected on 859 adult participants (52% with Crohn's disease, 75% women) through an online survey conducted between May and June 2016. Measures included physical activity (International Physical Activity Questionnaire), psychological symptoms (Hospital Anxiety and Depression Scale), fatigue (subitems of IBD fatigue scale), exercise perceptions (Exercise Benefits/Barriers Scale), and disease activity. Regression analyses were used to identify predictors of physical activity. Results: Only 17% of respondents were categorized as "high active." Self-reported physical activity levels decreased, and fatigue and psychological scores increased, with increasing disease activity. Walking was the most common activity performed (57% of respondents) and running/jogging the most commonly avoided (34%). Many participants (n = 677) reported that IBD limited their physical activity, for reasons including abdominal/joint pain (70%), fatigue/tiredness (69%), disease flare-up (63%), and increased toilet urgency (61%). Physical activity was independently associated with depression, disease activity, and perceived barriers to exercise in people with Crohn's disease, and depression and age in people with ulcerative or indeterminate colitis (all P <= 0.038). Conclusions: This survey highlights several important factors that should be considered by designers of future physical activity interventions for people with IBD

Comparison of laser speckle contrast imaging with laser Doppler for assessing microvascular function

Objective: To compare the inter-day reproducibility of post-occlusive reactive hyperaemia (PORH) and sympathetic vasomotor reflexes assessed by single-point laser Doppler flowmetry (SP-LDF), integrating-probe LDF (IP-LDF) and laser speckle contrast imaging (LSCI), and the spatial variability of PORH assessed by IP-LDF and LSCI. We also evaluated the relationship between IP-LDF and LSCI perfusion values across a broad range of skin blood flows. Methods: Eighteen healthy adults (50% male, age 27 ± 4 years) participated in this study. Using SP-LDF, IP-LDF and LSCI, an index of skin blood flow was measured on the forearm during PORH (1-, 5- and 10-min occlusions) and on the finger pad during inspiratory gasp and cold pressor tests. These tests were repeated 3-7 days later. Data were converted to cutaneous vascular conductance (CVC; laser Doppler flow/mean arterial pressure) and expressed as absolute and relative changes from pre-stimulus CVC (ΔCVCABS and ΔCVCREL, respectively), as well as normalised to peak CVC for the PORH tests. Reproducibility was expressed as within-subjects coefficients of variation (CV, in %) and intraclass correlation coefficients. Results: The reproducibility of PORH on the forearm was poorer when assessed with SP-LDF and IP-LDF compared to LSCI (e.g., CV for 5-min PORH ΔCVCABS = 35, 27 and 19%, respectively), with no superior method of data expression. In contrast, the reproducibility of the inspiratory gasp and cold pressor test responses on the finger pad were better with SP-LDF and IP-LDF compared to LSCI (e.g., CV for inspiratory gasp ΔCVCREL = 13, 7 and 19%, respectively). The spatial variability of PORH responses was poorer with IP-LDF compared to LSCI (e.g., CV ranging 11-35% versus 3-16%, respectively). The association between simultaneous LSCI and IP-LDF perfusion values was non-linear. Conclusion: The reproducibility of cutaneous PORH was better when assessed with LSCI compared to SP-LDF and IP-LDF; probably due to measuring larger skin areas (lower inter-site variability). However, when measuring sympathetic vasomotor reflexes on the finger pad, reproducibility was better with SP-LDF and IP-LDF, perhaps due to the high sensitivity of LSCI to changes in skin blood flow at low levels

Barriers and enablers to walking in individuals with intermittent claudication: a systematic review to conceptualize a relevant and patient-centered program

Background: Walking limitation in patients with peripheral arterial disease (PAD) and intermittent claudication (IC) contributes to poorer disease outcomes. Identifying and examining barriers to walking may be an important step in developing a comprehensive patient-centered self-management intervention to promote walking in this population. Aim: To systematically review the literature regarding barriers and enablers to walking exercise in individuals with IC. Methods: A systematic review was conducted utilizing integrative review methodology. Five electronic databases and the reference lists of relevant studies were searched. Findings were categorized into personal, walking activity related, and environmental barriers and enablers using a social cognitive framework. Results: Eighteen studies including quantitative (n = 12), qualitative (n = 5), and mixed method (n = 1) designs, and reporting data from a total of 4376 patients with IC, were included in the review. The most frequently reported barriers to engaging in walking were comorbid health concerns, walking induced pain, lack of knowledge (e.g. about the disease pathology and walking recommendations), and poor walking capacity. The most frequently reported enablers were cognitive coping strategies, good support systems, and receiving specific instructions to walk. Findings suggest additionally that wider behavioral and environmental obstacles should be addressed in a patient-centered self-management intervention. Conclusions: This review has identified multidimensional factors influencing walking in patients with IC. Within the social cognitive framework, these factors fall within patient level factors (e.g. comorbid health concerns), walking related factors (e.g. claudication pain), and environmental factors (e.g. support systems). These factors are worth considering when developing self-management interventions to increase walking in patients with IC. Systematic review registration CRD42018070418

Does Yoga Reduce the Risk of Falls in Older People?

Nearly a third of people aged over 65 years and over half of people older than 80 have a fall at least once a year. Falls and fall related injuries can be life changing and may result in chronic disability, admission to assisted living, or death. A fall can also precipitate a fear of falling, which may lead to restriction of activity and hence physical deconditioning. This in turn increases the risk of future falls. Clinical guidelines from several countries recommend multifactorial interventions for preventing falls in older people, with exercise as a key component. A recent Cochrane review (108 randomised controlled trials, 23 407 participants) concluded there is strong evidence that well designed exercise programmes reduce the number of falls by about a quarter among older people living in the community. Such programmes also reduce the number of people experiencing one or more falls. Exercise that mainly involved balance and functional training reduced falls. Yoga is a mind-body practice that typically involves a combination of physical postures, breathing exercises, and concentration/meditation. Yoga has become a popular means of promoting physical and mental wellbeing and is shown to improve health related quality of life in older people. Evidence from observational studies suggests it is an acceptable and attractive form of exercise among older people. There are many different types of yoga, each of which places varying emphasis on physical, mental, and spiritual practices. In the West, the term “yoga” often denotes a modern form of hatha yoga, consisting largely of postural exercises performed with the goal of developing strength, balance, and flexibility (see fig 1). Yoga is not recommended specifically in fall prevention guidelines. The effect of yoga on falls in community-dwelling older people is uncertain

Exploring the feasibility of implementing a supervised exercise training and compression hosiery intervention in patients with venous ulceration: a case study

Study background and context (please read poster for more information) Over 180,000 people in the UK suffer from venous leg ulcers; it is a major health problem (Whiteley, 2013). A leg ulcer is defined as a break in the skin of the leg which has not healed after 4-6 weeks (Morris & Sander, 2007). Treatment of venous ulcers costs the NHS between £400,000 - £600,000 annually (Whiteley, 2013). Exercise training offers a financially viable adjunct to compression hosiery in the prevention and treatment of venous ulcers, via favourable effects on lower-limb blood flow and vascular function (Davies et al, 2008). Despite the potential benefits, the combined effect of exercise and compression has not yet been examined and the Royal College of Nursing is requesting for more studies to be undertaken in this area