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Prize Winning Abstracts BASEM Conference 2017

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01: Trajectories of adherence to home-based exercise programs among people with knee osteoarthritis

PJA Nicolson

RS Hinman

J Kasza

KL Bennell

1Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Victoria, Australia

2Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia

10.1136/bjsports-2018-099100.1

Aim Investigate the presence of groups showing different trajectories of self-reported adherence to home exercise programs among people with knee osteoarthritis, and to compare baseline characteristics across identified groups.

Methods We performed a pooled analysis of data from three randomised controlled trials involving exercise interventions for people aged ≥50 years with clinical knee osteoarthritis (n=331) in Australia. Exercise adherence was self-reported on an 11-point numerical rating scale (NRS, 0=not at all, 10=completely as instructed). Latent class growth analysis was used to identify groups of participants with distinct trajectories of adherence, at intervals from 12 weeks up to 78 weeks from baseline. Baseline characteristics of these groups were compared using chi-squared tests, t-tests and Wilcoxon rank-sum tests where appropriate.

Results Two groups with different adherence trajectories were identified: a ‘Rapidly declining adherence’ group (n=167, 50.4%) whose adherence was 7.2±2.3 (out of 10) at 12 weeks, declining to 3.8±2.4 by 22 weeks and remaining low thereafter; and a ‘Gradually declining adherence’ group (n=164, 49.6%) whose adherence declined from 8.3±1.7 to 7.6±1.6 over the same period, and continued to decline slowly to 78 weeks. The ‘Rapidly declining adherence’ group was younger (p=0.03), reported lower baseline WOMAC pain (p=0.01), better WOMAC function (p<0.00), higher quality-of-life (p<0.00) and higher self-efficacy (p=0.04) than the ‘Gradually declining adherence’ group.

Conclusions Two distinct trajectories of self-reported adherence to prescribed home exercise among people with knee osteoarthritis were found. Identification of patients within these groups on the basis of characteristic differences may enable adherence interventions to be better targeted to those who may benefit most.

02: Reliability of hip rotation and passive knee extension measurements using smartphone based goniometry among expert and novice clinicians- a preliminary report

TÓ Doinn

E Whyte

M Downey

N McCaffrey

School of Health and Human Performance, Dublin City University, Dublin, Ireland

10.1136/bjsports-2018-099100.2

Aim To determine if a smartphone ‘Clinometer’ application can provide reliable measurements of hip rotation range of motion (ROM) and the passive knee extension (PKE) test among expert and novice clinicians.

Methods Measurements were obtained bilaterally in 17 young healthy males (mean ±SD age: 19.92±1.7 years, height: 184.7±5.2 cm, mass 74.1±4.7 kg) using a smartphone ‘Clinometer’ application. Testing was carried out in a randomised, blinded fashion by an experienced (>30 years) and novice (<1 year) clinician, then repeated approximately three hours later. Each measurement was read and recorded by a university student assistant. Hip rotation ROM was recorded in a seated position with the feet elevated off the floor. The hip was passively rotated (internally and externally) until the clinician felt a firm end feel and prior to any compensatory pelvic movement. A smartphone was placed 5 cm proximal to the lateral malleolus and ‘Clinometer’ application readings were recorded at this point. The PKE test was performed with subjects in a supine position with fixation belts placed anterior to each anterior superior iliac spine and the thigh of the non-test limb. The test limb was then positioned in 90° hip flexion and a plastic dowel was secured against the anterior thigh. The knee was then passively extended until a strong but comfortable stretch was reported. ‘Clinometer’ application readings were recorded at this point, with the smartphone placed longitudinally along the anterior tibial border, 5 cm distal to the tibial tuberosity. Intraclass correlation coefficients (ICCs) with 95% confidence intervals were used to assess intertester and intratester reliability. Paired t-tests assessed for any systematic intertester bias. P-values were considered significant at <0.05.

Results Excellent relative intertester (ICC 0.92–0.95) and intratester (ICC 0.80–0.95) reliability for expert and novice clinicians were demonstrated for internal and external hip rotation ROM. Similarly, excellent relative intertester (ICC 0.96) and intratester (ICC 0.93–0.95) reliability for expert and novice clinicians were demonstrated for the PKE test. There were no significant intertester differences (p>0.05).

Conclusions Smartphone based goniometry of hip rotation ROM and the PKE test display high intertester and intratester reliability among novice and expert clinicians, suggesting it is a viable goniometric tool.

03: Attitudes towards and knowledge of concussion. a cross sport international survey conducted through social media

D Fitzpatrick

V Semogas

1University Hospital Lewisham, Lewisham, London, UK

2Charring Cross Hospital, Hammersmith, London, UK

10.1136/bjsports-2018-099100.3

Aim Concussion is prevalent in sport. There are efforts to increase education around concussion to improve awareness and behaviours amongst participants. This study aimed to characterise these attitudes, knowledge and behaviours. It also aimed to identify factors that contribute towards this.

Methods This study uses a questionnaire and recruited participants through social media over 10 months. Participants from all sports and all levels were included. The questionnaire established demographics, concussion history, concussion education, knowledge of concussion, attitudes towards concussion and predicted behaviours in response to concussion.

Results There were 613 participants. Mean age was 28.8 years. 81.9% were male. Rugby Union was the highest represented sport (n=344). 28.71% had a diagnosed concussion, 51.55% believed they had been concussed, without diagnosis. The rate was higher in contact sports (Rugby Union RR=1.43, Ice Hockey RR=1.89) and at higher levels of competition (RR=1.61). 57.10% of participants had received concussion education. Those playing at higher levels were more likely to have received education (RR=1.36). There was no correlation between higher-risk sports and prevalence of education (R2=0.6448, p=0.5440). The factor shown to improve knowledge and attitudes towards concussion the most was having received education on concussion. Educated participants identified more correct symptoms of concussion. Those who had received education were more likely to remove themselves from play if they thought they were concussed (RR=1.41), to report it to someone afterwards (RR=3.14) and to return to play safely (RR=1.96).

Conclusions Education is effective in improving understanding of concussion, and concussion behaviours. Education is more prevalent at higher levels of competition, however the majority of participants play at lower levels and may be at greater risk. Increased provision of education at lower levels may lead to reduced risk from concussion.

04: Metro walk: exercise levels of metro users, an opportunity for increasing activity?

AM Love

G Rae

1Newcastle Medical School, Faculty of Medical Sciences, Newcastle University

2Sunderland Integrated Musculoskeletal Services, Sunderland Royal Hospital, City Hospitals Sunderland Karyl Road

10.1136/bjsports-2018-099100.4

Aim Recent studies have shown the health benefits of active commuting and have garnered public attention1 leading to active commuting being endorsed as a practical way to increase activity levels.2 Our objectives were to assess activity levels and usage habits of Tyne and Wear Metro users and to evaluate whether a targeted campaign to encourage Metro users to walk the final leg of their journey could support them to meet Public Health England (PHE) activity targets.

Methods Over a 4 week period, Metro users at various stations were asked to complete a questionnaire concerning: metro use (how often, usual stops etc.); awareness of guidelines; and physical activity levels (assessed using the validated general practitioner physical activity questionnaire).

Results Of 142 respondents, 49% were moderately inactive (MI) or inactive (I) and 42% were unaware of the existence of recommendations on physical activity levels. A significant 70% thought they should be more active (58% of whom were MI or I). Of this 70%, when asked how much more exercise they thought they should do, the median suggested time was 36mins/day. Meanwhile, the mean walking time between the earlier station on their trip and their usual station was 17 min (35 mins/day). 58% of free text answers on what prevented them doing more were related to time, work or being busy.

Conclusions With time-related issues being such a common barrier to exercise, there is potential to encourage Metro-travellers to utilise their commute as a time-efficient way to increase their activity. Although the time respondents believed they should do is more than the 120 min recommendation, there is a close correlation between the 36 mins/day aim, and the average walking time between Metro stations, which could be capitalised on. The production of a ‘Walking Metro’ map would raise awareness of this as well as the public health recommendations on exercise.

References

1. Celis-Morales CA, Lyall DM, Welsh P, et al. Association between active commuting and incident cardiovascular disease, cancer, and mortality: Prospective cohort study. BMJ2017;357:j1456.

2. National Institute for Health and Care Excellence. Public health guidance; physical activity: Walking and cycling2012

05: Intensity and volume of high-intensity interval training necessary to reduce cardiometabolic risk: a systematic review

E Morrison

Brighton and Sussex Medical School, Institute of Cellular Medicine, Newcastle University, UK

10.1136/bjsports-2018-099100.5

Aim High-intensity interval training (HIIT) is a time efficient method of reducing cardiometabolic risk, however, the optimum protocol is unknown. A systematic review was carried out to assess current evidence regarding HIIT and cardiometabolic outcomes, to produce a recommended protocol.

Methods Four electronic databases were searched (October 2016) for original research articles. Randomised trials evaluating the use of HIIT on at least one cardiometabolic risk factor (anthropometric measurements, glucose regulation, lipids, blood pressure and VO2max) were included. Studies were excluded if participants were <18 years of age, had pre-existing health conditions, or if a wider intervention was implemented than exercise training alone (e.g. diet). Quality of studies was assessed using the Physiotherapy Evidence Database (PEDro) scale.

Results 27 randomised trials were included in the review, within which HIIT protocols varied significantly. Studies demonstrated different protocol characteristics are important in the reduction of risk in specific cardiometabolic outcome measures. The optimum protocol to produce improvements in a wide range of cardiometabolic markers is ≥12 weeks duration, with three 30–47 min session per week, comprising 30 s-2 minute high-intensity intervals. The effect of active recovery vs. complete rest and of changing work-to-rest ratio was unclear.

Conclusions The optimal amount of HIIT training is difficult to determine and varies due to individual responses. However, protocol characteristics best suited to reducing risk in a wide range of cardiometabolic outcomes can be predicted. The review was limited by variation in reporting by authors, making interval intensity effects unclear. Future studies are necessary to evaluate the effects of varying HIIT protocol characteristics on cardiometabolic risk.

Acknowledgements Stephanie Hemmings, Dylan Morrissey and Christian Barton.

Centre for Sport and Exercise Medicine, Queen Mary University of London.

06: The effect of high intensity interval training on cardiac autonomic regulation in patients with type 2 diabetes

V Vaidya

S Cassidy

M Trenell

R Taylor

G MacGowan

D Jakovljevic

Institute of Cellular Medicine, Newcastle University, UK

10.1136/bjsports-2018-099100.6

Aims Type 2 Diabetes Mellitus (T2DM) is associated with reduced cardiac autonomic regulation and increased risk for cardiovascular morbidity and mortality. We aimed to

  1. assess the relationship between glycaemic control and autonomic regulation,

  2. define the effect of high–intensity interval training on glycaemic control and autonomic regulation in patients with T2DM.

Methods Twenty-two individuals with T2DM (age 60±2 years, 17 males/5 females) underwent cardiac autonomic function assessment in a resting supine position. Time-domain and power-spectral analysis of heart rate variability (HRV), blood pressure variability (BPV), and baroreflex receptor sensitivity (BRS) were recorded. Blood samples were taken to assess glycaemic control (HbA1c). Following baseline assessments, participants were randomised into a high-intensity interval training (HIIT, i.e. cycling on the stationary bike 3 times per week) or a standard care control group, and variables were repeated after 12 weeks.

Results HbA1c significantly related to BRS (r=−0.592, p<0.01), but not with other measures of HRV or BPV (p>0.05). After 12 weeks HbA1c was reduced in the HIIT group (54.4±3.3 mmol/mol, to 51.6±3.2 mmol/mol, p=0.151) and increased in the controls (55.0±1.81 mmol/mol to 57.0±2.27 mmol/mol p=0.074); the difference in HbA1c change between groups was significant (p=0.03). Following HIIT there were no significant changes in HRV (p>0.05), BPV (p>0.05) and BRS (p=0.09). No significant changes were found in the controls for HRV (p>0.05), BPV (p>0.05) and BRS (p>0.05).

Conclusions Patients with T2DM with better glycaemic control demonstrated improved baroreflex receptor sensitivity. High-intensity interval training improves glycaemic control but has limited effect on autonomic regulation of the heart.