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Background: Despite the fact that more athletes participate in competitions after the age of 35 years, very few studies have documented the potential health benefits and risk for master athletes in later life.

Research question/s: What are the potential health benefits and risks in master athletes compared with controls?

Methodology:Subjects:102 male Finnish master track and field athletes (MAST; mean age 58.3 years) and 777 controls (CON; mean age 55 years).

Experimental procedure: All the subjects were evaluated in 1985 (baseline) and again 10 and 16 years later. Validated questionnaires were used to assess musculoskeletal health (shoulder and Achilles tendon injury, physician-diagnosed hip and knee osteoarthritis (OA) and disability), self-reported general health, presence of chronic medical disease, and mortality was documented (all cause and natural cause).

Measures of outcome: Self-rated health, adjusted odds ratio (OR) (musculoskeletal conditions, and chronic diseases).

Main finding/s::

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  • Self-rated health: at follow-up, MAST subjects self-rated their health as better (p<0.001) and coped better with leisure-time daily activities (p<0.05) than CON subjects.

  • Chronic medical disease: at follow-up, (1) 9% of the CON group had diabetes mellitus and none of the MAST group, (2) the adjusted OR of having at least one metabolic syndrome disease was 0.43 (p = 0.01) in the MAST group vs CON group, and (3) the age-adjusted hazard ratio of death from natural cause was 0.41 (p<0.01) in the MAST group vs the CON group.

Conclusion/s: In later life, master athletes have a higher risk of developing tendon injuries (shoulder and Achilles) compared with control subjects, but the risk of developing chronic metabolic diseases (including diabetes) as well as mortality risk from all causes is reduced in master athletes.

Evidence based rating: 7/10

Clinical interest rating: 7/10

Type of study: Prospective cohort study

Methodological considerations: Small sample size, selection bias (self-selection)

Keywords: master athletes, exercise, musculoskeletal health, tendon injury, chronic disease, mortality


Background: Shin pain (“shin splints”) is a common overuse injury in military recruits undergoing training as well as in runners. The treatment of this condition is still controversial and the use of an orthosis has been advocated.

Research question/s: Does the “shin saver” reduce pain and improve time of recovery (pain-free running) in military recruits presenting with shin pain (“shin splints”)?

Methodology:Subjects: 25 military recruits with shin splints (chronic shin pain with negative bone scan).

Experimental procedure: Subjects were randomly assigned to two treatment groups: control group (CON) receiving rest, ice massage and gradual return to activity; and an orthosis group (ORTHOSIS) (receiving the same treatment in addition to a “shin saver” orthosis to wear at all times (except sleeping and bathing). Follow-up was conducted bi-weekly and pain (visual analogue scale; VAS), ability to run 800 m pain free, as well as a Global Rating of Change (GRC) score were documented.

Measures of outcome: GRC score, days to completion of an 800m run pain free, treatment sessions to completion of the 800m run.

Main finding/s::

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VAS for pain: there was no significant difference between the two groups for pain at intake vs after 1 week of relative rest.

Conclusion/s: In a pilot study among military recruits, the use of a “shin saver” orthosis did not significantly accelerate return to pain-free running more than rest, ice massage and a graded return to activity programme.

Evidence based rating: 7/10

Clinical interest rating: 7.5/10

Type of study: Randomised clinical trial

Methodological considerations: Pilot study with very small sample size, subjective measures of outcome

Keywords: lower leg, injury, shin treatment, orthosis


Background: It is well known that participation in regular physical activity reduces the risk of developing diabetes mellitus; however, the relationship between physical activity and life expectancy in diabetics requires investigation.

Research question/s: What is the difference in life expectancy with and without type 2 diabetes in patients with different levels of physical activity?

Methodology:Subjects: 9122 subjects studied during three time periods (part of the Framingham Heart Study) (46% males).

Experimental procedure: Multistate life tables were constructed starting at age 50 years for men and women. Transition rates by level of physical activity were derived for three transitions: non-diabetic to death, non-diabetic to diabetes, and diabetes to death. Physical activity was classified into three groups (low, moderate and high), according to data from questions about time spent daily on physical activity.

Measures of outcome: Hazard ratios associated with different physical activity levels after adjustment for age, sex and potential confounders.

Main finding/s::

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Conclusion/s: In a prospective cohort study, moderate and highly active people have a longer total life expectancy and live more years free of diabetes than their sedentary counterparts; however, once they have diabetes, their life expectancy does not change.

Evidence based rating: 8/10

Clinical interest rating: 8/10

Type of study: Prospective cohort study

Methodological considerations: Well conducted study, self-reported physical activity, possible reverse causation (disease at baseline may cause decreased physical activity)

Keywords: physical activity, diabetes, life expectancy, mortality


Background: There are a number of surgical techniques for repairing the acutely ruptured anterior cruciate ligament (ACL) but the long-term outcomes of these is not well described.

Research question/s: What is the long-term outcome following ACL repair using three different surgical techniques (acute primary repair, a repair augmented with a synthetic ligament-augmentation device, and acute repair augmented with autologous bone-patellar tendon-bone graft)?

Methodology:Subjects: 150 subjects with acute ruptures of the ACL (mean age 29 years) between 1986 and 1988.

Experimental procedure: All subjects were evaluated and then randomised into three groups for surgical treatment: acute primary repair (AR), acute repair augmented with a synthetic ligament-augmentation device (AR-S), and acute repair augmented with autologous bone-patellar tendon-bone graft (AR-BTB). Subjects were followed up at 1, 2, 5 and 16 years. 88% of the 147 patients who were available for the follow-up completed the study.

Measures of outcome: Rate of revision (%), stability (Lachman test, KT-1000), knee osteoarthritis (%), function (Lysholm score), activity (Tegner score).

Main finding/s::

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  • Knee osteoarthritis: knee osteoarthritis was present in 11% of the subjects—not different between groups.

  • Function: Lysholm score at 16 years was not different between groups.

  • Activity: Tegner activity score at 16 years was not different between groups.

Conclusion/s: In a 16 year follow-up after anterior cruciate ligament reconstruction using three different surgical techniques, the rate of revision surgery was much higher following primary repair than after primary repair augmented by a bone-patellar tendon-bone graft. About 10% of patients developed osteoarthritis in the reconstructed knee.

Evidence based rating: 8/10

Clinical interest rating: 7/10

Type of study: Randomised clinical trial

Methodological considerations: Well conducted study

Keywords: anterior cruciate ligament, rupture, repair, surgery, knee

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