Wellness Check: Exercise | 2 Minute Remedy

Various simple and multi-structured knee injuries increase the chances of knee osteoarthritis

1. In this systematic review and meta-analysis, moderate certainty evidence suggested that damage to various knee structures may increase the odds of symptomatic osteoarthritis (OA).

2. Furthermore, modifiable risk factors for OA remain more established than modifiable risk factors for post-traumatic OA.

Evidence Rating Level: 1 (Excellent)

OA is the most common joint condition that affects millions of people around the world. Post-traumatic OA accounts for at least 12% of these cases. Contrary to the availability of high-level evidence to guide the prevention of post-traumatic knee OA, there is a gap that remains in how to delay or prevent the development of OA after a traumatic injury. As a result, the aim of the present systematic review and meta-analysis was to identify and quantify the magnitude of modifiable and non-modifiable risk factors for symptomatic and structural knee OA after trauma.

Of 5621 identified registries, 66 RCTs and cohort studies (n = 873,785) were included in the final analysis between 2000 and 2021. Studies were included if they evaluated a potential risk factor for OA for a minimum period of 2 years after a traumatic injury knee injury. Studies that did not report knee trauma were excluded. The risk of bias was assessed using the Quality in Prognosis Studies (QUIPS) tool. Data analysis was performed using random effects models as well as semi-quantitative synthesis. The assessment of prognostic factors was performed using the modified Grading of Recommendations Assessment, Development and Evaluation (GRADE).

The results demonstrated that moderate certainty evidence suggested that collateral ligament, cruciate ligament, chondral, meniscal, patellar/tibiofemoral dislocation, fracture and multistructural injuries may increase the odds of symptomatic osteoarthritis (OA). Furthermore, there is a lack of high-certainty evidence for modifiable risk factors for OA after traumatic injury, as opposed to non-traumatic OA. Despite these results, this study was limited, as the odds of OA may have been underestimated by including data from earlier time points, when structural changes and/or symptoms were less prevalent. However, the present study represents the most extensive synthesis, analysis and presentation of potential risk factors for OA after knee trauma to date.

Regular physical activity may improve vaccine efficacy against COVID-19 outcomes

1. In this South African case-control study, there was an inverse dose-response association with activity levels and risk of hospitalization for COVID-19.

2. In addition, high levels of activity in fully vaccinated subjects conferred high levels of vaccine efficacy.

Evidence Rating Level: 3 (Medium)

Exercise immunology is a growing field that has demonstrated how regular physical activity of moderate intensity improves immunosurveillance. Currently, the most studied vaccine in the context of chronic physical activity and vaccine efficacy is the influenza vaccine. In contrast, evidence for the COVID vaccine is lacking. As a result, the purpose of the present case-control study was to evaluate the effectiveness of low, moderate, and high levels of physical activity on the effectiveness of the single-dose Ad26.COV2.S vaccine (Janssen/Johnson & Johnson).

The present negative test case-control study design was a retrospective analysis that used anonymised customer Discovery Health and Vitality data from February 2021 to October 2021 in South Africa. Of the 269,101 patients with PCR tests for COVID-19, 196,444 were included in the analysis. Patients were excluded if they received vaccines other than Ad26.COV2.S, had indeterminate test results, a negative result within 21 days of a positive test result, and a negative test within 7 days of each other. Subjects were mapped to physical activity subgroups using their average monthly allocation of physical points over the 2 years prior to the study start date. Statistical analysis was performed using a modified Poisson regression model.

Results demonstrated that, compared with subjects with low activity levels, vaccinated subjects with moderate and high activity levels had a lower risk of COVID-19 admission in a dose-response mode. Additionally, fully vaccinated subjects with high levels of activity had an 86% vaccine efficacy against COVID-19 hospitalization. Despite these findings, the study was limited by the lack of assessment of confounding variables such as diet, alcohol consumption and sleep patterns. However, the study’s large sample of vaccinated subjects in which the majority had directly measured physical activity data strengthens the study’s findings. This suggests that physical activity may play a role in the effectiveness of the COVID-19 vaccine against hospitalization.

Mindfulness-based programs may improve mental health outcomes in elite athletes

1. In this systematic review and meta-analysis, mindfulness-based programs (MBP) helped improve mental health-related outcomes in elite athletes.

2. In addition, large but not significant effect sizes were found to reduce depression in elite athletes.

Evidence Rating Level: 2 (good)

Elite athletes may experience mental health symptoms that exceed those of non-athletes due to the unique stressors placed on them. MBPs have been linked to improvements in athletic performance, but have not been evaluated in the context of mental health. As a result, the aim of the present systematic review and meta-analysis was to determine the effect that MBPs have on the mental health of elite athletes.

From 2386 selected registries, 12 RCTs (n = 614 athletes; 75% men) were included in the final analysis. Dates ranged from 2011 to 2020. Studies were included if they were randomized controlled trials that assessed the effectiveness of MBP on mental health outcomes in elite athletes of any age. Studies were excluded if MBP lasted <4 weeks or if non-elite athletes were included in the population. Study quality was assessed using the Joanna Briggs Institute checklist for randomized controlled trials. The certainty of the evidence was measured using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework. Various statistical methods were used, including random effects models, exploratory subgroup analyzes, and meta-regression models.Results demonstrated that mindfulness-based programs (MBP) reduced anxiety and stress symptoms and increased psychological well-being in elite athletes. Additionally, two of the three studies reported large significant reductions in depression; however, one reported small and non-significant results. Despite these findings, the study was limited by the significant proportion of male athletes (75%) and the minimal inclusion of para-athletes (3%). However, the present study demonstrated the potential of MBPs to reduce general anxiety symptoms and specific competition anxiety, which may help support overall performance.Self-monitoring of physical activity can be improved through additional interventions

1. In this systematic review and meta-analysis, prescribed goal and human counseling increased physical activity (PA) more than self-monitoring.

2. Additionally, remote telephone/video counseling has been shown to be highly effective in scaling up physical activity interventions.

Evidence Rating Level: 2 (good)

Self-monitoring of physical exercise through pedometers, fitness trackers and smartphone apps has become a pillar to improve PA adherence. Currently, the effect of adding supplementary interventions to self-monitoring to further increase PA adherence has not been well studied. As a result, the aim of the present systematic review and meta-analysis was to determine whether PA interventions that combine self-monitoring using activity monitors with other intervention components provide an additional benefit compared with self-monitoring alone.

Of 2,251 records identified, 85 (n=12,057 participants) were included from 2007 to 2022. Studies were included if they compared an intervention using self-monitoring with an activity monitor to increase PA, with an intervention comprising the same treatment as the active control plus any additional components designed to increase BP. Studies were excluded if the active control arm received anything that was not also contained in the intervention arm. Effect measures were the mean difference in daily step count between the intervention and control arms. The risk of bias was assessed using the Cochrane Risk of Bias tool. Statistical analyzes were performed using random effects models.

Overall, the results demonstrated that combining intervention components with self-monitoring led to an additional benefit of approximately 1,000 steps per day, compared with self-monitoring alone, post-intervention. Furthermore, prescribed goal and human counseling increased physical activity (PA) more than self-monitoring. Specifically, remote telephone/video counseling was found to be highly effective in scaling up physical activity interventions. Despite these findings, the study was limited by the inclusion of several low-quality studies (39 of 75 overall studies identified as having low risk of bias). However, the results suggest that combining self-monitoring with other components may provide additional benefits for PA, with particular emphasis on counseling such as remote telephone/video counseling.

Image: DP

©2022 2 Minute Medicine, Inc. All rights reserved. No work may be reproduced without the express written consent of 2 Minute Medicine, Inc. Find out about licensing here. No article should be construed as medical advice and is not intended as such by the authors or 2 Minute Medicine, Inc.

Wellness Check: Exercise | 2 Minute Remedy

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