I must fully concur with Dr McCrory's assessment of youth
sport. Here in the US, we have a great many fathers find enjoyment in
coaching their children-however there are far more whom become engulfed in
the desire to win at all cost, pushing their children, dramatizing local
saturday morning football as if it were the Super Bowl or World Cup. I
find it highly objectionable to their behavior and the role...
I must fully concur with Dr McCrory's assessment of youth
sport. Here in the US, we have a great many fathers find enjoyment in
coaching their children-however there are far more whom become engulfed in
the desire to win at all cost, pushing their children, dramatizing local
saturday morning football as if it were the Super Bowl or World Cup. I
find it highly objectionable to their behavior and the role models they
provide. It is a shame that we have so many good sports, but not so many
good sports to play them.
Dear Editor,
First, we commend the efforts of the International Scientific Tendinopathy Symposium Consensus (ICON) group in defining health-related core domains for tendinopathy treatment outcomes. However, in this rapid response, we want to share our concern with the conclusion from the ICON 2020 statement concerning the development of a core outcome set for gluteal tendinopathy, written by Fearon et al. and published in the British Journal of Sports Medicine.(1)
Our primary concern relates to the suggestion that the Victorian Institute of Sport Assessment-Greater trochanteric pain syndrome (VISA-G) questionnaire, as the only condition/region-specific patient-reported outcome measure (PROM), should be considered in clinical trials - and that this measure currently is the best measure of relevant tendinopathy domains. Presently, we do not find any evidence from the literature(2,3,4) or the ICON consensus process(1) that supports such a strong statement, and we would like to support our claim in three main points:
1. The development of the VISA questionnaires has not sufficiently included patients, and the content validity of the VISA questionnaires is therefore questionable.(2,3,4) The Delphi process from the ICON paper by Fearon et al. also seems to question the content validity of the VISA-G questionnaire, as only 14% of patients (1 in 7 patients) considered the VISA-G an appropriate measure concerning gluteal tendinopathy core-domains.(1) As content...
Dear Editor,
First, we commend the efforts of the International Scientific Tendinopathy Symposium Consensus (ICON) group in defining health-related core domains for tendinopathy treatment outcomes. However, in this rapid response, we want to share our concern with the conclusion from the ICON 2020 statement concerning the development of a core outcome set for gluteal tendinopathy, written by Fearon et al. and published in the British Journal of Sports Medicine.(1)
Our primary concern relates to the suggestion that the Victorian Institute of Sport Assessment-Greater trochanteric pain syndrome (VISA-G) questionnaire, as the only condition/region-specific patient-reported outcome measure (PROM), should be considered in clinical trials - and that this measure currently is the best measure of relevant tendinopathy domains. Presently, we do not find any evidence from the literature(2,3,4) or the ICON consensus process(1) that supports such a strong statement, and we would like to support our claim in three main points:
1. The development of the VISA questionnaires has not sufficiently included patients, and the content validity of the VISA questionnaires is therefore questionable.(2,3,4) The Delphi process from the ICON paper by Fearon et al. also seems to question the content validity of the VISA-G questionnaire, as only 14% of patients (1 in 7 patients) considered the VISA-G an appropriate measure concerning gluteal tendinopathy core-domains.(1) As content validity is the prerequisite for developing a patient-reported outcome questionnaire,(5,6) it seems contradictory to refer to VISA-G as the best measure.(1)
2. The structural validity of the VISA questionnaires has previously been questioned.(2,3,7) The internal structure of the original VISA questionnaires (VISA-A and VISA-P) was never evaluated in the initial development studies.(2,3) Still, a 2-factor structure (pain/function and sporting activity) exists across the initial VISA questionnaires,(2,3) and in the VISA-G (pain/function and weight-bearing activities).(2,3) Modern Test Theory, a collection of statistical models including confirmatory factor analysis and item response theory,(8) will be able to shed more light on PROMs used in patients with gluteal tendinopathy in the future. This approach is considered the gold standard for validating patient-reported outcomes and their structural validity(8)—and has recently shown that an inconsistent underlying structure for the VISA questionnaires seems to exist.(7) This questions the assumption that the VISA questionnaires are unidimensional measures, meaning that computing VISA scores as a total sum score of all VISA items should be avoided.(2,3,7,8)
3. It is difficult for us in the ICON paper(1) to decipher how the VISA-G was recommended as a relevant interim outcome measure when patients did not find it relevant.(1) According to ICON authors, a reflexive practice was adopted where all authors identified and discussed their potential bias and addressed this continuously, which was shared in a supplementary file.(1) This reflexive practice report did not include any specific reference to the disagreement between patients and health practitioners on the relevance of the VISA-G.(1) Such a reflection could have given valuable and transparent insights as to why the patients’ initial judgment of the VISA-G was disregarded in the final part of the consensus process.(1)
Thus, in summary, we hope that the ICON authors can provide more clarity and transparency to their interim recommendation that the VISA-G, as the only condition/region-specific PROM, should be considered in future clinical trials – when empirical evidence of its superiority is lacking. Our concern is that this statement may end up guiding future trialists, peer-reviewers, and journals, in a way that may be counterproductive to the common goal - namely, to understand and use relevant and best available PROMs (existing, interim, or future ones) in patients with gluteal tendinopathy.
References
1: Fearon AM, Grimaldi A, Mellor R, Nasser AM, Fitzpatrick J, Ladurner A; COS-GT
consensus group; Vicenzino B. ICON 2020-International Scientific Tendinopathy
Symposium Consensus: the development of a core outcome set for gluteal
tendinopathy. Br J Sports Med. 2024 Mar 8;58(5):245-254. doi:
10.1136/bjsports-2023-107150. PMID: 38216320.
2: Korakakis V, Kotsifaki A, Stefanakis M, Sotiralis Y, Whiteley R, Thorborg K.
Evaluating lower limb tendinopathy with Victorian Institute of Sport Assessment
(VISA) questionnaires: a systematic review shows very-low-quality evidence for
their content and structural validity-part I. Knee Surg Sports Traumatol
Arthrosc. 2021 Sep;29(9):2749-2764. doi: 10.1007/s00167-021-06598-5. Epub 2021
May 21. PMID: 34019117; PMCID: PMC8384789.
3: Korakakis V, Whiteley R, Kotsifaki A, Thorborg K. Tendinopathy VISAs have
expired-is it time for outcome renewals? Knee Surg Sports Traumatol Arthrosc.
2021 Sep;29(9):2745-2748. doi: 10.1007/s00167-021-06596-7. Epub 2021 May 10.
Erratum in: Knee Surg Sports Traumatol Arthrosc. 2022 Aug;30(8):2880. PMID:
33970294; PMCID: PMC8384781.
4: Nasser AM, Fearon AM, Grimaldi A, Vicenzino B, Mellor R, Spencer T, Semciw
AI. Outcome measures in the management of gluteal tendinopathy: a systematic
review of their measurement properties. Br J Sports Med. 2022
Aug;56(15):877-887. doi: 10.1136/bjsports-2021-104548. Epub 2022 Apr 8. PMID:
35396205.
5: Terwee CB, Mokkink LB, Knol DL, Ostelo RW, Bouter LM, de Vet HC. Rating the
methodological quality in systematic reviews of studies on measurement
properties: a scoring system for the COSMIN checklist. Qual Life Res. 2012
May;21(4):651-7. doi: 10.1007/s11136-011-9960-1. Epub 2011 Jul 6. PMID:
21732199; PMCID: PMC3323819.
6: Mokkink LB, Terwee CB, Patrick DL, Alonso J, Stratford PW, Knol DL, Bouter
LM, de Vet HC. The COSMIN checklist for assessing the methodological quality of
studies on measurement properties of health status measurement instruments: an
international Delphi study. Qual Life Res. 2010 May;19(4):539-49. doi:
10.1007/s11136-010-9606-8. Epub 2010 Feb 19. PMID: 20169472; PMCID: PMC2852520.
7: Comins J, Siersma V, Couppe C, Svensson RB, Johansen F, Malmgaard-Clausen NM,
Magnusson SP. Assessment of content validity and psychometric properties of
VISA-A for Achilles tendinopathy. PLoS One. 2021 Mar 11;16(3):e0247152. doi:
10.1371/journal.pone.0247152. PMID: 33705412; PMCID: PMC7951845.
8: Christensen KB, Comins JD, Krogsgaard MR, Brodersen J, Jensen J, Hansen CF,
Kreiner S. Psychometric validation of PROM instruments. Scand J Med Sci Sports.
2021 Jun;31(6):1225-1238. doi: 10.1111/sms.13908. Epub 2021 Jan 22. PMID:
33341986.
What am I missing? The authors measured the number of steps taken by participants for only three days then they followed them for years to see who had better outcomes? Did the participants promise to keep the same level of activity until they died? Is it accurate to assume one’s level of activity will always be the same?
Have data from transgender women after GAS been included in the studies?
Surgeries undergone as part of GAS:
-Gives testosterone levels much lower than the reference values for cisgender women and much more stable than all other groups
- permanent and irreversible trauma to the muscular area (psoas, etc.) which generates losses of strength, mobility and flexibility
Singh and colleagues’ comprehensive systematic review of meta-analyses (97 reviews of 1039 trials including 128,119 participants) confirms that ‘physical activity (PA) is highly beneficial for improving symptoms of depression, anxiety and psychological distress’ with ‘effect size reductions in symptoms of depression (−0.43) and anxiety (−0.42) comparable to or slightly greater than those observed for psychotherapy and pharmacotherapy’.
This finding has important clinical implications and the authors conclude that PA should be included in public health guidelines as a mainstay approach (i.e. not just as an adjunct to psychological therapy and medication). They also recognise that ‘while the benefit of exercise for depression and anxiety is generally recognised, it is often overlooked in the management of these conditions’ .
Despite these really impressive results and their important clinical implications, it is unfortunate that the Singh et al review is unlikely to make a significant difference to clinical practice. There are many reasons why physical activity is not used as a first-line intervention for depression and other mental health problems, but one of the problems is that the field has not really addressed an issue I highlighted in a review of the field a quarter of a century ago. The evidence that PA can be an effective stand-alone or adjunctive intervention for a range of mental health problems is diluted amongst the public health/ mental wellbeing st...
Singh and colleagues’ comprehensive systematic review of meta-analyses (97 reviews of 1039 trials including 128,119 participants) confirms that ‘physical activity (PA) is highly beneficial for improving symptoms of depression, anxiety and psychological distress’ with ‘effect size reductions in symptoms of depression (−0.43) and anxiety (−0.42) comparable to or slightly greater than those observed for psychotherapy and pharmacotherapy’.
This finding has important clinical implications and the authors conclude that PA should be included in public health guidelines as a mainstay approach (i.e. not just as an adjunct to psychological therapy and medication). They also recognise that ‘while the benefit of exercise for depression and anxiety is generally recognised, it is often overlooked in the management of these conditions’ .
Despite these really impressive results and their important clinical implications, it is unfortunate that the Singh et al review is unlikely to make a significant difference to clinical practice. There are many reasons why physical activity is not used as a first-line intervention for depression and other mental health problems, but one of the problems is that the field has not really addressed an issue I highlighted in a review of the field a quarter of a century ago. The evidence that PA can be an effective stand-alone or adjunctive intervention for a range of mental health problems is diluted amongst the public health/ mental wellbeing studies focusing on lifestyle/ general health/ quality of life outcomes. What we need are effectively powered randomised controlled trials of carefully designed PA interventions compared to medication and psychological therapy in primary and secondary care clinical populations. It is important to note that, similar to the Singh et al. review, the Cochrane review ‘Exercise for depression’ (Cooney et al., 2013) included a preponderance of trials with non-clinical populations (23 out of the 39 trials included in the review).
Nonetheless, it is encouraging to see that the 2022 update of the NICE Guideline for Depression in adults (NG222) now includes the following:
‘Advise people that doing any form of physical activity on a regular basis (for example, walking, jogging, swimming, dance, gardening) could help enhance their sense of wellbeing. The benefits can be greater if this activity is outdoors.’
The Singh et al. review has implications for future research (e.g. neuromolecular mechanisms by which PA appears to improve depression) and clinical practice (e.g. resistance exercise was most effective for depression, while Yoga and other mind–body exercises were most effective for anxiety).
Research should not focus on neuroscience alone, however, as the mechanism responsible for the relationship between physical activity and mental health is complex and lies in a combination of biological, psychological and social factors (Biddle & Mutrie, 2001). The field therefore would also benefit from in-depth qualitative studies. A good example is a study by Crone et al. (2005) of people referred to ‘exercise prescription’ schemes, which demonstrated the importance of contextual factors such as social network, environment, culture and social support. However, this study also concluded that PA referral schemes appeared to be better suited to the needs of physical- than mental- health patients. This points to the need to research which factors encourage people referred for different mental health problems to engage with, and benefit from, different types of physical activity. Motivational factors may be unique to an individual, but we may find that a physical activity intervention that optimises the ‘therapeutic ingredients’ will have the best outcomes; for example, a specialist PA activity which is provided within a setting which maximises both social support and interaction with nature.
REFERENCES
Burbach, F. R. (1997). The efficacy of physical activity interventions within mental health services: Anxiety and depressive disorders. Journal of Mental Health, 6(6), 543-566.
Cooney, G. M., Dwan, K., Greig, C. A., Lawlor, D. A., Rimer, J., Waugh, F. R., ... & Mead, G. E. (2013). Exercise for depression. Cochrane database of systematic reviews, (9).
Crone, D., Smith, A., & Gough, B. (2005). “I feel totally alive, totally happy and totally at one”: A psycho-social explanation of the physical activity and mental health relationship from the experiences of participants on exercise referral schemes. Health Education Research, 20(5), 600–611.
Biddle, S. J. H., & Mutrie, N. (2001). Psychology of physical activity determinants, well-being and interventions.Routledge: London.
Singh, B., Olds, T., Curtis, R., Dumuid, D., Virgara, R., Watson, A., ... & Maher, C. (2023). Effectiveness of physical activity interventions for improving depression, anxiety and distress: an overview of systematic reviews. British Journal of Sports Medicine.
This meta-analysis undertaken by Currier et al. is welcomed to help further understanding of resistance-based training regimen for strength and hypertrophy. Currier et al. identified that future work to identify the optimal protocol and dose for specific exercise prescriptions is needed. While this recommendation is uncontentious, they could have perhaps gone further. The literature is flooded with different types of studies which incorporate strength-related protocols and is reflected in the number of records excluded in this study. For future studies and - where applicable - existing studies should use a harmonized data collection approach which is common in areas of medicine, for example when attempting to characterize infectious diseases (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7266570/). Ensuring that categorical variables such as age, sex, ethnicity, somatotype, exercise experience, and other appropriate biological parameters are all collected in a standardized way, with datasets made available for reuse could lead to better stratification of data, thus resulting in better insights for future analyses and meta-analyses like the one undertaken by Currier et al.
On behalf of all authors, I would like to express our gratitude for the attention given to our work and for providing a thorough response.
We agree that the ICIQ-FLUTs tool has been identified as a reliable instrument for evaluating lower urinary tract symptoms (LUTS); however, our objective extended beyond solely assessing LUTS. We aimed to incorporate a comprehensive range of symptoms, encompassing pelvic organ prolapse, anal incontinence, and pelvic pain.
Additional and complete information regarding the rationale behind this decision can be found in the Supplementary file 3.
Then, we sought the expertise of panellists in rating each symptom for potential inclusion in the tool.
I am open to further discuss. Thank you again.
Regards,
Silvia
I read with interest the Saavedra et al.’s study1 aiming to evaluate the associations of cardiorespiratory fitness and body-mass-index with incident restrictive-ventilatory-impairment (RVI). The study’ rational is interesting since the RVI is frequent (eg; prevalence: 3 to 50%).2 One strong point of the aforementioned study1 was the use of the 2012 global-lung-function-initiative (GLI) task force of multi-ethnic norms for spirometry (GLI-2012).3 Saavedra et al.1 retained the diagnosis of a RVI in front of the combination of a low forced-vital-capacity (FVC) (ie; FVC < lower-limit-of-normal (LLN)) and a normal ratio between forced-expiratory-volume-in-one-second (FEV1) and FVC (ie; FEV1/FVC ≥ LLN). Saavedra et al.1 followed some “old” approaches. In 2022, the European-respiratory-society and the American-thoracic-society (ERS/ATS) published a “new” technical standard on interpretive strategies for lung function tests.4 This guidelines should be considered by researchers in the field of sports medicine.4 The definition applied by Saavedra et al.1 to retain the diagnosis of a RVI is questionable, and the following two points need to be clarified: i) what is a low spirometric data?, ii) what is a RVI?
What is a low spirometric data?
Interpretation of spirometric data necessitates 2 steps: i) comparison of the spirometric data with these of reference.4 5 , and ii) comparison of the data’ value with the distinctive thresholds of the main ventilatory-impairment not...
I read with interest the Saavedra et al.’s study1 aiming to evaluate the associations of cardiorespiratory fitness and body-mass-index with incident restrictive-ventilatory-impairment (RVI). The study’ rational is interesting since the RVI is frequent (eg; prevalence: 3 to 50%).2 One strong point of the aforementioned study1 was the use of the 2012 global-lung-function-initiative (GLI) task force of multi-ethnic norms for spirometry (GLI-2012).3 Saavedra et al.1 retained the diagnosis of a RVI in front of the combination of a low forced-vital-capacity (FVC) (ie; FVC < lower-limit-of-normal (LLN)) and a normal ratio between forced-expiratory-volume-in-one-second (FEV1) and FVC (ie; FEV1/FVC ≥ LLN). Saavedra et al.1 followed some “old” approaches. In 2022, the European-respiratory-society and the American-thoracic-society (ERS/ATS) published a “new” technical standard on interpretive strategies for lung function tests.4 This guidelines should be considered by researchers in the field of sports medicine.4 The definition applied by Saavedra et al.1 to retain the diagnosis of a RVI is questionable, and the following two points need to be clarified: i) what is a low spirometric data?, ii) what is a RVI?
What is a low spirometric data?
Interpretation of spirometric data necessitates 2 steps: i) comparison of the spirometric data with these of reference.4 5 , and ii) comparison of the data’ value with the distinctive thresholds of the main ventilatory-impairment noted during chronic diseases [eg; obstructive-ventilatory-impairment (OVI), RVI, mixed-ventilatory-impairment (MVI)].4 5 In this context, norms are useful for classifying a spirometric data as decreased, normal, or increased based on the 95% confidence interval (eg; LLN and upper-limit-of-normal).4 5 After the development of the GLI-2012 spirometric norms,3 the application of a more suitable and new statistical techniques for determining the LLN is commended.3 6 The LMS [lambda, mu, sigma] technique was used.3 6 Based on the LMS method, a further approach based on the determined data’ z-scores, was suggested to interpret spirometric data.3 6 The z-score specifies by how many standard-deviations a subject’ spirometric data is deviated from its predicted normal value, with merely 5% of healthy subjects having a z-score ≤ -1.645.3 6 Disparate percentage predicted, z-score is free from bias due to sex, age, height, and ethnicity, and is consequently principally convenient in defining the LLN.3 6 Z-score simplifies uniform analysis of spirometric results.3 6 In brief, a lung function data value is considered low when its z-score is < -1.645, and normal when its z-score is ≥ -1.645.4 7 In Saavedra et al’s study.1, it is unclear if the authors have applied the z-score approach.
What is a RVI?
A reduction in lung volumes defines a RVI, which is classically characterized by a low total-lung-capacity (TLC).4 The presence of a RVI may be suspected (but not confirmed) from spirometry alone when FVC is low, FEV1/FVC is normal, and the flow-volume curve displays a convex pattern (ie; revealing a high elastic recoil).4 Nevertheless, a low FVC by itself does not confirm a RVI.2 4 Certainly, a low FVC is connected with a low TLC less than half the time.8 Contrariwise, normal “FVC and FEV1/FVC” are greatly trustworthy at ruling out a RVI as measured by low TLC.8 Finally, a MVI (ie, presence of both OVI and RVI) is retained in front of the association of “low TLC and low FEV1/FVC ratio”.4
To conclude, in practice, two distinct, yet complementary aspects of spirometry interpretation, should be considered.4 First, cataloging the observed values as within/outside the normal range with respect to the GLI-2012 norms (eg, z-score < 1.645 or ≥ 1.645). Second, incorporating information of physiologic factors of test results into a functional classification of the recognized impairments (eg, OVI, RVI, MVI).
REFERENCES
1. Saavedra JM, Brellenthin AG, Song BK, et al. Associations of cardiorespiratory fitness and body mass index with incident restrictive spirometry pattern. Br J Sports Med 2023 doi: 10.1136/bjsports-2022-106136 [published Online First: 20230106]
2. Backman H, Eriksson B, Hedman L, et al. Restrictive spirometric pattern in the general adult population: Methods of defining the condition and consequences on prevalence. Respir Med 2016;120:116-23. doi: 10.1016/j.rmed.2016.10.005 [published Online First: 20161012]
3. Quanjer PH, Stanojevic S, Cole TJ, et al. Multi-ethnic reference values for spirometry for the 3-95-yr age range: the global lung function 2012 equations. Eur Respir J 2012;40(6):1324-43. doi: 10.1183/09031936.00080312 [published Online First: 20120627]
4. Stanojevic S, Kaminsky DA, Miller MR, et al. ERS/ATS technical standard on interpretive strategies for routine lung function tests. Eur Respir J 2022;60(1) doi: 10.1183/13993003.01499-2021 [published Online First: 20220713]
5. Ben Saad H. Interpretation of respiratory functional explorations of deficiency and incapacity in adult. Tunis Med 2020;98(11):797-815. [published Online First: 2021/01/23]
6. Hall GL, Filipow N, Ruppel G, et al. Official ERS technical standard: Global Lung Function Initiative reference values for static lung volumes in individuals of European ancestry. Eur Respir J 2021;57(3) doi: 10.1183/13993003.00289-2020 [published Online First: 20210311]
7. Ben Saad H. Review of the current use of global lung function initiative norms for spirometry (GLI-2012) and static lung volumes (GLI-2021) in Great Arab Maghreb (GAM) countries and steps required to improve their utilization. Libyan J Med 2022;17(1):2031596. doi: 10.1080/19932820.2022.2031596
8. Aaron SD, Dales RE, Cardinal P. How accurate is spirometry at predicting restrictive pulmonary impairment? Chest 1999;115(3):869-73. doi: 10.1378/chest.115.3.869.
Dear Editor
I must fully concur with Dr McCrory's assessment of youth sport. Here in the US, we have a great many fathers find enjoyment in coaching their children-however there are far more whom become engulfed in the desire to win at all cost, pushing their children, dramatizing local saturday morning football as if it were the Super Bowl or World Cup. I find it highly objectionable to their behavior and the role...
Dear Editor,
First, we commend the efforts of the International Scientific Tendinopathy Symposium Consensus (ICON) group in defining health-related core domains for tendinopathy treatment outcomes. However, in this rapid response, we want to share our concern with the conclusion from the ICON 2020 statement concerning the development of a core outcome set for gluteal tendinopathy, written by Fearon et al. and published in the British Journal of Sports Medicine.(1)
Our primary concern relates to the suggestion that the Victorian Institute of Sport Assessment-Greater trochanteric pain syndrome (VISA-G) questionnaire, as the only condition/region-specific patient-reported outcome measure (PROM), should be considered in clinical trials - and that this measure currently is the best measure of relevant tendinopathy domains. Presently, we do not find any evidence from the literature(2,3,4) or the ICON consensus process(1) that supports such a strong statement, and we would like to support our claim in three main points:
1. The development of the VISA questionnaires has not sufficiently included patients, and the content validity of the VISA questionnaires is therefore questionable.(2,3,4) The Delphi process from the ICON paper by Fearon et al. also seems to question the content validity of the VISA-G questionnaire, as only 14% of patients (1 in 7 patients) considered the VISA-G an appropriate measure concerning gluteal tendinopathy core-domains.(1) As content...
Show MoreWhat am I missing? The authors measured the number of steps taken by participants for only three days then they followed them for years to see who had better outcomes? Did the participants promise to keep the same level of activity until they died? Is it accurate to assume one’s level of activity will always be the same?
Have data from transgender women after GAS been included in the studies?
Surgeries undergone as part of GAS:
-Gives testosterone levels much lower than the reference values for cisgender women and much more stable than all other groups
- permanent and irreversible trauma to the muscular area (psoas, etc.) which generates losses of strength, mobility and flexibility
Singh and colleagues’ comprehensive systematic review of meta-analyses (97 reviews of 1039 trials including 128,119 participants) confirms that ‘physical activity (PA) is highly beneficial for improving symptoms of depression, anxiety and psychological distress’ with ‘effect size reductions in symptoms of depression (−0.43) and anxiety (−0.42) comparable to or slightly greater than those observed for psychotherapy and pharmacotherapy’.
This finding has important clinical implications and the authors conclude that PA should be included in public health guidelines as a mainstay approach (i.e. not just as an adjunct to psychological therapy and medication). They also recognise that ‘while the benefit of exercise for depression and anxiety is generally recognised, it is often overlooked in the management of these conditions’ .
Despite these really impressive results and their important clinical implications, it is unfortunate that the Singh et al review is unlikely to make a significant difference to clinical practice. There are many reasons why physical activity is not used as a first-line intervention for depression and other mental health problems, but one of the problems is that the field has not really addressed an issue I highlighted in a review of the field a quarter of a century ago. The evidence that PA can be an effective stand-alone or adjunctive intervention for a range of mental health problems is diluted amongst the public health/ mental wellbeing st...
Show MoreThis meta-analysis undertaken by Currier et al. is welcomed to help further understanding of resistance-based training regimen for strength and hypertrophy. Currier et al. identified that future work to identify the optimal protocol and dose for specific exercise prescriptions is needed. While this recommendation is uncontentious, they could have perhaps gone further. The literature is flooded with different types of studies which incorporate strength-related protocols and is reflected in the number of records excluded in this study. For future studies and - where applicable - existing studies should use a harmonized data collection approach which is common in areas of medicine, for example when attempting to characterize infectious diseases (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7266570/). Ensuring that categorical variables such as age, sex, ethnicity, somatotype, exercise experience, and other appropriate biological parameters are all collected in a standardized way, with datasets made available for reuse could lead to better stratification of data, thus resulting in better insights for future analyses and meta-analyses like the one undertaken by Currier et al.
On behalf of all authors, I would like to express our gratitude for the attention given to our work and for providing a thorough response.
We agree that the ICIQ-FLUTs tool has been identified as a reliable instrument for evaluating lower urinary tract symptoms (LUTS); however, our objective extended beyond solely assessing LUTS. We aimed to incorporate a comprehensive range of symptoms, encompassing pelvic organ prolapse, anal incontinence, and pelvic pain.
Additional and complete information regarding the rationale behind this decision can be found in the Supplementary file 3.
Then, we sought the expertise of panellists in rating each symptom for potential inclusion in the tool.
I am open to further discuss. Thank you again.
Regards,
Silvia
International CONsensus (https://bjsm.bmj.com/content/54/8/442)
What does ICON stand for? I could not find the meaning of the abbreviation in the text?
I read with interest the Saavedra et al.’s study1 aiming to evaluate the associations of cardiorespiratory fitness and body-mass-index with incident restrictive-ventilatory-impairment (RVI). The study’ rational is interesting since the RVI is frequent (eg; prevalence: 3 to 50%).2 One strong point of the aforementioned study1 was the use of the 2012 global-lung-function-initiative (GLI) task force of multi-ethnic norms for spirometry (GLI-2012).3 Saavedra et al.1 retained the diagnosis of a RVI in front of the combination of a low forced-vital-capacity (FVC) (ie; FVC < lower-limit-of-normal (LLN)) and a normal ratio between forced-expiratory-volume-in-one-second (FEV1) and FVC (ie; FEV1/FVC ≥ LLN). Saavedra et al.1 followed some “old” approaches. In 2022, the European-respiratory-society and the American-thoracic-society (ERS/ATS) published a “new” technical standard on interpretive strategies for lung function tests.4 This guidelines should be considered by researchers in the field of sports medicine.4 The definition applied by Saavedra et al.1 to retain the diagnosis of a RVI is questionable, and the following two points need to be clarified: i) what is a low spirometric data?, ii) what is a RVI?
Show MoreWhat is a low spirometric data?
Interpretation of spirometric data necessitates 2 steps: i) comparison of the spirometric data with these of reference.4 5 , and ii) comparison of the data’ value with the distinctive thresholds of the main ventilatory-impairment not...
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