Depressive Symptoms as Potential Mediator between Physical Activity and Bone Health—A Scoping Review

Depression constitutes a risk factor for osteoporosis (OP). Increasing physical activity might mitigate this risk, although intensive exercising may lead to opposing effects in depressed patients. The purpose of this scoping review was to summarize the evidence regarding the influence of exercise on bone health in depressed patients, divided into two sections: (1) Which bone markers are affected by depression? (2) How does exercise affect bone health in patients with depressive symptoms? A search of the literature was conducted in PubMed and Web of Science between August 2020–2022. Studies were included based on predetermined criteria for each sub-question. Regarding sub-question 1, eight studies revealed the following bone markers to be influenced by depression: P1NP, BAP, CTX, OC, RANKL, OPG, DPD, and PYD. Regarding sub-question 2, one study found a correlation between depression and bone health in an exercising population, and other studies detected improvements in bone health (n = 4) and depressive symptoms (n = 4) after exercise interventions. The current review shows the potential of exercise as a treatment form to improve bone health in depressed patients. Future trials are needed to assess the influence of exercise intervention on bone health in depressed patients

Sports Orthopedics

Psychosocial risk factors significantly influence the genesis of chronic non-specific low back pain (CLBP) as one potential factor in its multifactorial etiology. Therefore, the European Guideline for Diagnostics and Therapy of Back Pain recommend screenings for these factors at an early stage of preventive and therapeutic interventions. Relevant risk factors for the development of CLBP in athletes are pain experience and tolerance, stress, social and medical environment. However, as existing screening tools are not suitable for athletes, there is a need for indices that predict the risk of future back complaints and infer a stratified treatment allocation respecting the response to physical activity.The National Research Networkfor Medicine in Spine Exercise (MiSpEx) is aiming to fill that gap: a biopsychosocial diagnostic tool was developed which supports health care professionals to 1) predict the risk for pain chronicity, disability or extended absenteeism (risk-index, RSI), and 2) recommend a personalized treatment allocation to uni- or multimodal training (prevention-index, RPI-S). Both tools complement the functional indices developed in the MiSpEx network and add to adequate therapeutic strategies that fit individual needs. The present contribution summarizes the current state of research on psychosocial screenings and reports onthe development of RSI/RPI-S.Take Home: RSI and RPI-S can be used to identify biopsychosocial risk factors, which moderate the intervention success. An early screening is essential for athletes personalized care management and is strongly recommended.KEY WORDS: Pain-Diagnostic, Screening, Risk and Prevention Stratification, Personalized Therapy Allocatio

Medicine in spine exercise [mispex] – A national research network to evaluate back pain (Medicine in spine exercise [mispex] – Ein nationales forschungsnetzwerk zur evaluation von rückenschmerzen)

Idiopathic as well as nonspecific low back pain is relevant in health care systems as well as inleisure and high-performance sports. Neuromuscular and/or structural deficits, mostly accompanied by biopsychological factors,are known risk factors for both the onset and chronification of symptoms. Meta-analytic evidence describes positive effects of physical activity. However, type, dose-response relation, minimum of training required and setting-specific implementation has not been fully clarified. Since 2011, the national research network „Medicine in Spine Exercise“ [MiSpEx] has been following a project layout called „Ran Rücken“ focussing on the development and validation of intervention programs including neuromuscular and pain adaptation moderated by individual training status, pain behaviour, allostatic load and social settings. Overall about 8000 patients and athletes have been and are being followed experimentally and clinically in 34 studies. It could be shown that a training program focussing on compensation of external loads elicited by perturbations is effective in prevention and rehabilitation in both athletes and general population. Besides validation of further consecutively developed programs emphasis is put on the evaluation of transfer strategies to medical systems, sports as well as general population. Finally, the evaluation of an efficient dose-response relation is addressed

Psychosoziale Risikofaktoren für chronischen Rückenschmerz in der Allgemeingesellschaft und im Leistungssport: Von der Modellbildung zum klinischen Screening – ein Review aus dem MiSpEx-Netzwerk

Background: Lumbar back pain and the high risk of chronic complaints is not only an important health concern in the general population but also in high performance athletes. In contrast to non-athletes, there is a\ua0lack of research into psychosocial risk factors in athletes. Moreover, the development of psychosocial screening questionnaires that would be qualified to detect athletes with a\ua0high risk of chronicity is in the early stages. The purpose of this review is to give an overview of research into psychosocial risk factors in both populations and to evaluate the performance of screening instruments in non-athletes. Methods: The databases MEDLINE, PubMed, and PsycINFO were searched from March to June 2016 using the keywords “psychosocial screening”, “low back pain”, “sciatica” and “prognosis”, “athletes”. We included prospective studies conducted in patients with low back pain with and without radiation to the legs, aged ≥18 years and a\ua0follow-up of at least 3\ua0months. Results: We identified 16\ua0eligible studies, all of them conducted in samples of non-athletes. Among the most frequently published screening questionnaires, the Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ) demonstrated a\ua0sufficient early prediction of return to work and the STarT Back Screening Tool (SBT) revealed acceptable performance predicting pain-related impairment. The prediction of future pain was sufficient with the Risk Analysis of Back Pain Chronification (RISC-BP) and the Heidelberg Short Questionnaire (HKF). Conclusion: Psychosocial risk factors of chronic back pain, such as chronic stress, depressive mood, and maladaptive pain processing are becoming increasingly more recognized in competitive sports. Screening instruments that have been shown to be predictive in the general population are currently being tested for suitability in the German MiSpEx research consortium