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Jones, Paris A T; Moolyk, Amy; Ruchat, Stephanie-May; Ali, Muhammad Usman; Fleming, Karen; Meyer, Sarah; Sjwed, Talia Noel; Wowdzia, Jenna B; Maier, Lauren; Mottola, Michelle; Sivak, Allison; Davenport, Margie H
doi: 10.1136/bjsports-2024-108483pmid: 39375006
ObjectiveTo examine the relationship between postpartum physical activity and maternal postnatal cardiometabolic health, breastfeeding, injury, and infant growth and development.DesignSystematic review with random-effects meta-analysis and meta-regression.Data sourcesEight online databases were searched up until 12 January 2024.Eligibility criteriaStudies of all designs in all languages were eligible (except case studies and reviews) if they contained information on the population (postpartum people), intervention (frequency, intensity, duration, volume, or type of exercise, alone (‘exercise-only’) or in combination with other intervention components (eg, dietary; ‘exercise+co-intervention’), comparator (no or low volumes of physical activity), and outcomes: hypertension, diabetes, cardiometabolic risk factors (systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol, high density lipoproteins, low density lipoproteins, and triglycerides, glycated hemoglobin (HbA1C), glucose and insulin concentration), breastfeeding (breast milk quality and volume), infant growth (length and weight) and development, or postpartum injury.Results46 unique studies (n=8766 participants) from 20 countries were included. Moderate certainty of evidence showed exercise+co-interventions reduced the odds of developing diabetes by 28% (7 randomised controlled trials (RCTs), n=2496; OR 0.72 95% CI 0.54, 0.98, I2 12%), reduced SBP (10 RCTs, n=2753; mean difference (MD) −2.15 95% CI −3.89 to –0.40, I2 73%) and DBP (9 RCTs, n=2575; MD −1.38 95% CI −2.60 to –0.15, I2 66%) compared with controls. Infant growth and development, breast milk quality and quantity, and risk of injury were not different between exercise and control groups.ConclusionsPhysical activity improves cardiometabolic health without adversely impacting breast milk supply or quality, infant growth or maternal injury.
Neal, Bradley Stephen; Lack, Simon David; Bartholomew, Clare; Morrissey, Dylan
doi: 10.1136/bjsports-2024-108110pmid: 39401870
ObjectiveDefine a best practice guide for managing people with patellofemoral pain (PFP).MethodsA mixed-methods convergent segregated synthesis of meta-analysed data with a thematic analysis of semistructured interviews and focus groups. Agreement between subproject results informed the strength of clinical recommendation for interventions eligible for best practice recommendation.Data sourcesMedline, Web of Science, Scopus, reference lists and citation tracking; semistructured interviews of people with PFP; and semistructured interviews and focus groups with clinical experts.Eligibility criteriaHigh-quality (PEDro scale >7) randomised controlled trials (RCTs) were retained for efficacy estimation using meta-analysis. People with PFP were required to have experienced an episode of care in the past 6 months and clinical experts were required to have>5 years of clinical experience alongside direct involvement in research.ResultsData from 65 high-quality RCTs involving 3796 participants informed 11 meta-analyses of interventions. Interviews with 12 people with PFP led to 3 themes and interviews with 19 clinical experts led to 4 themes. These were further explored in three clinical expert focus groups. Best practice for PFP should first involve understanding a patient’s background risk factors, their reasons for seeking care, greatest symptoms, and physical impairments, to inform treatment selection. Synthesis led to six distinct interventions being recommended. Knee-targeted±hip-targeted exercise therapy underpinned by education should be delivered, with additional supporting interventions such as prefabricated foot orthoses, manual therapy, movement/running retraining, or taping decided on and tailored to a patient’s needs and preferences.ConclusionA best practice guide based on a synthesis of three data streams recommends that exercise therapy and education be delivered as the primary intervention for people with PFP. Prescription of other supporting interventions should be aligned with the individual patient’s particular presentation following a thorough assessment.
Bailey, Sasha; Trevitt, Benjamin; Zwickl, Sav; Newell, Beau; Staples, Emma; Storr, Ryan; Cheung, Ada S
doi: 10.1136/bjsports-2023-107852pmid: 39467621
ObjectivesThis study aimed to assess participation rates of transgender and gender diverse (trans) people in sport/fitness activities, compare mental health outcomes for trans people participating in sport/fitness with those who do not and explore internal/external barriers and bullying experiences faced by trans people in sport/fitness contexts.MethodsA cross-sectional online survey open to trans people aged ≥16 years living in Australia was conducted between February and April 2023 and it assessed rates of sport/fitness participation, barriers to participation and bullying experiences through multiple-choice questions. Mental health measures comprised the Kessler Psychological Distress Scale (K10) and self-reported history of self-harm and suicidality. Covariate-adjusted binary logistic regression models tested associations between interpersonal factors, sport/fitness variables and mental health outcomes.ResultsOf 664 respondents (median age 32 years), around one-third (32.8%) regularly participated in sport/fitness. Common internal barriers to participation included anxiety about others’ reactions (63.9%), body dissatisfaction/dysphoria (56.5%) and fears about feeling accepted/affirmed by others (54.7%). Respondents commonly reported experiencing inadequate bathroom/changing facilities (44.4%), exclusionary rules and regulations surrounding gender (36.7%), and invasive or uncomfortable policies or procedures (23.3%). Over one-third (34.4%) of trans people had experienced gender-based bullying or exclusion. Regular sport/fitness participation was associated with significantly lower K10 scores (mean difference=−4.4, 95% CI−5.8, –2.9, p<0.001) and a 40% reduction in odds of recent thoughts of self-harm and suicide (aOR 0.6, 95% CI 0.5, 0.9, p=0.01; aOR 0.6, 95%CI 0.4, 0.9, p=0.02).ConclusionTrans people face significant barriers to sport/fitness despite experiencing significant mental health and personal benefits from participation. Affirming and including trans people in sport and fitness should be a key priority for sport and fitness federations, organisations and policy-makers.
Montgomery, Laura R C; Swain, Michael; Dario, Amabile B; O'Keeffe, Mary; Yamato, Tie P; Hartvigsen, Jan; French, Simon; Williams, Christopher; Kamper, Steve
doi: 10.1136/bjsports-2024-108648pmid: 39438037
ObjectiveTo evaluate whether sedentary behaviour is a risk or prognostic factor for spinal pain in children and adolescents. Specifically, to estimate the (1) direction and strength of the association; (2) risk of spinal pain onset and (3) effect on spinal pain prognosis.DesignSystematic review with meta-analysis.Data sourcesElectronic searches of MEDLINE, Embase, CINAHL and Web of Science up to 23 March 2023.Eligibility criteria for selecting studiesReports estimating the effect of sedentary behaviour on spinal pain in young people (≤19 years).ResultsWe included 129 reports, 14 were longitudinal (n = 8 433) and 115 were cross-sectional (n > 697 590). We incorporated 86 studies into meta-analyses. (1) From cross-sectional data, we found low certainty evidence of a small positive association between sedentary behaviour and spinal pain (adjusted odds ratio 1.25 (95% CI 1.17 to 1.33), k = 44, n > 92 617). (2) From longitudinal data, we found low certainty evidence of no increased risk for the onset of spinal pain due to sedentary behaviour (adjusted risk ratio 1.07 (95% CI 0.84 to 1.35), k = 4, n = 1 292). (3) No studies assessed prognosis.ConclusionCross-sectional data suggest minimally higher odds of spinal pain for children and adolescents who engage in greater sedentary behaviours. However, longitudinal data do not support a causal relationship, indicating that sedentary behaviour does not increase the risk for onset of spinal pain. Due to the low certainty of evidence, these findings must be interpreted with caution. We found no evidence of the effect sedentary behaviour has on spinal pain prognosis in children and adolescents, highlighting a considerable gap in the literature.
Mountjoy, Margo; Verhelle, Helena; Finnoff, Jonathan T; Murray, Andrew; Paynter, Amanda; Pigozzi, Fabio; Tooth, Camille; Verhagen, Evert; Vertommen, Tine
doi: 10.1136/bjsports-2024-108210pmid: 39393838
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ObjectivesTo assess the clinical competence of sports medicine physicians to recognise and report harassment and abuse in sports, and to identify barriers to reporting and the need for safeguarding education.MethodsWe implemented a cross-sectional cohort study design recruiting through social media and international sports medicine networks in 2023. The survey captured participant perceptions related to the harmfulness of harassment and abuse. The survey incorporated the reasoned action approach as a theoretical framework to design survey questions to identify attitudes and self-efficacy to detect and report suspicions of harassment and abuse and to identify barriers to reporting.ResultsSports medicine physicians (n=406) from 115 countries completed the survey. The situations of harassment and abuse presented in the survey were described by sports medicine physicians as having occurred in the 12 months before participating in the survey. Despite recognising the situations as harmful, sports medicine physicians were somewhat uncomfortable being vigilant for the signs and symptoms and reporting suspicions and disclosures of harassment and abuse (M=2.13, SD=0.67). In addition, just over one-quarter (n=101, 26.9%) was unaware of where to report harassment and abuse, and over half did not know (n=114, 28.1%), or were uncertain (n=95, 23.4%) of who the safeguarding officer was in their sports organisation. Participants identified many barriers to reporting harassment and abuse, including concerns regarding confidentiality, misdiagnosis, fear of reprisals, time constraints and lack of knowledge. Over half felt insufficiently trained (n=223, 57.6%), and most respondents (n=324, 84.6%) desired more education in the field.ConclusionsEducational programmes to better recognise and report harassment and abuse in sports are needed for sports medicine trainees and practising clinicians. An international safeguarding code for sports medicine physicians should be developed.