We have read the respective article and we agreed with all great
findings. Nevertheless, we wish to emphasize the need to address the role
of some molecular and physiological markers that may elaborate and
possibly support the findings of the study. Intermittent hypoxia exposure
can enhance the generation of red blood cells, which may consequentially
increase hemoglobin concentration and hematocrit depending on the model...
We have read the respective article and we agreed with all great
findings. Nevertheless, we wish to emphasize the need to address the role
of some molecular and physiological markers that may elaborate and
possibly support the findings of the study. Intermittent hypoxia exposure
can enhance the generation of red blood cells, which may consequentially
increase hemoglobin concentration and hematocrit depending on the model of
IHE exposure and its effect on serum hypoxia inducible factors (HIF-1
alpha, HIF-2alpha and HIF-3 alpha), erythropointin (EPO) levels and some
signaling pathways (such as those mediated by the nuclear factor-kappa
light chain B: NF-kB for stress and inflammation examinations) [1].
Hypoxia-inducible factors (HIF-1 alpha, HIF-2alpha and HIF-3alpha) are
transcriptional regulatory factors that orchestrate cellular responses to
hypoxia and regulates oxygen homeostasis[2]. However hypoxic induction of
HIF-1alpha and HIF-2alpha leads to the transcriptional activation of HIF-
3alpha expression as a target gene, which in turn is involved in the
reverse negative regulation of other HIFs activities [3]. Less
intramuscular hypoxic shifts of metabolic parameters (lactate and pyruvate
concentration, lactate/pyruvate and NAD/NADH ratios) after IHT [4] are
accompanied by marked decrease of HIF-3alpha expression and increase in
the resistance to physical exercise (with up to 70% increase endurance and
25% oxygen pressure in muscle). This indicates the importance of
establishing the changes in HIFs system included in this study.
Successive normobaric hypoxia-reoxygenation cycles in intermittent hypoxia
exposure is associated with generation of cytosolic reactive oxygen
species (ROS) which aid in transduction of cellular signals by stabilizing
the HIF alpha subunits and promoting its translocation to nucleus and
subsequent dimeruization with its alpha subunit to form complexes that
binds to hypoxia response element (HRE) to express certain genes (e.g EPO,
VEGF, NOS/HO-1 etc) that mediate cellular oxygen adaptation mechanism
that will in the long run reflect on exercise performance and
endurance[5]. Erythropoiesis is a classic physiologic response to hypoxia
that is mediated by the HIFs through inducing cell-type specific gene
expression changes that result in increased erythropoietin (EPO)
production in kidney, liver and facilitates erythroid progenitor
maturation and proliferation. HIF-2 is the main transcription factor that
regulates EPO synthesis in the kidney and liver and plays a critical role
in the regulation of intestinal iron uptake [6].
Although the heart rate during graded swim test was found to be the same
before and after IHE, cardiac responses to hypoxia are quite dependent on
carotid body function, which is deeply affected by its oxygen sensing
capability. Tissue specificity of HIF-1 homolog (HIF-2alpha) may play an
important role in the stable heart rate observed because irrespective of
the wide expression of HIF-1 in many cells, including the carotid body
glomus cells, hypoxia elicits different responses in different cell types
[7]. Additionally, endurance training and intermittent hypoxia are
effective preventive strategies against stress induced cardiac and
mitochondrial dysfunction. There is need to support the findings of normal
heart rate with further studies on signaling pathways, consequent
metabolic and redox remodeling associated with a cardioprotective
phenotype. This could be achieved by analyzing the myocardial heat shock
proteins, cyclooxygenase-2 activity, endoplasmic reticulum stress
proteins, nitric oxide production, myocardial antioxidant capacity,
sarcolemmal and mitochondrial adenosine triphosphate (ATP)-sensitive
potassium channels [8]. In order to obtain a viable result, the inclusion
and exclusion criteria must address previous exposure ti intermittent
hypobaric hypoxia as it has been reported to decreases myocardial
infarction size, reduces the number of ventricular arrhythmias, and
improves the recovery of cardiac contractile function against acute
ischemia-reperfusion (I/R) injury [9]. The crucial role of mitochondria in
cellular energetics, metabolism and intracellular signaling processes
regulating cell death and survival [10] has made it important to assess
the role of mitochondria in the 4.8% and 1.6% performance declines
observed in middle-distance (MD) and long-distance (LD) subjects as
reported by the study.
References:
[1]. Zhang, C. Y., Zhang, J. X., L?, X. T., & Li, B. Y. (2009).
Effects of intermittent hypoxic exposure on the parameter of erythrocyte
and serum hypoxia inducible factor-1 alpha and erythropoietin levels. Xi
bao yu fen zi mian yi xue za zhi= Chinese journal of cellular and
molecular immunology, 25(10), 932.
[2]. Semenza, G. (2009). Regulation of oxygen homeostasis by hypoxia-
inducible factor 1. Physiology, 24:97-106.
[3]. Hara, S., Hamada, J., Kobayashi, C., Kondo, Y., Imura, N. (2001).
Expression and characterization of hypoxia-inducible factor (HIF)-3? in
human kidney: suppression of HIF-mediated gene expression by HIF-3?.
Biochemical and Biophysical Research Communications, 287:808-813.
[4]. Semenza, G.L. (2001). HIF-1 O2 and the 3 PHDs: how animal cells
signal hypoxia to the nucleus. Cell 107, 1-3.
[5]. Mankovskaya, I., Drevitskaya, T., Dosenko, V., Gavenauskas, B.,
Moiseenko E. (2006). Expression of transcriptional factor HIF subunits in
rat tissues under acute and intermittent hypoxia. Hypoxia Medical Journal,
35:1-2.
[6]. Haase, V. H. (2013). Regulation of erythropoiesis by hypoxia-
inducible factors. Blood reviews, 27(1), 41-53.
[7]. Lahiri, S., Di Giulio, C., & Roy, A. (2002). Lessons from chronic
intermittent and sustained hypoxia at high altitudes. Respiratory
physiology & neurobiology, 130(3), 223-233.
[8]. Kavazis, A.N. (2009). Exercise preconditioning of themyocardium.
Sports Med, 11:923-35
[9]. Ostadal, B. and Kolar, F. (2007). Cardiac adaptation to chronic high-
altitude hypoxia: beneficial and adverse effects. Respir Physiol
Neurobiol. 2(3):224-36.
[10]. Ascensao A, Magalhaes J, Soares JM, et al. Moderate endurance
training prevents doxorubicin-induced in vivo mitochondriopathy and
reduces the development of cardiac apoptosis. Am J Physiol Heart Circ
Physiol 2005;2:H722-31.
We have read the respective article and we agreed with all great
findings. But just need to emphasized on some thing very important and
crucial. We are working with adipocytes and adipose tissue is capable of
expanding many-fold during adulthood, therefore requiring the formation of
new vasculature to supply growing and proliferating adipocytes. The
expansion of the vasculature in adipose tissue occurs through
angiogenes...
We have read the respective article and we agreed with all great
findings. But just need to emphasized on some thing very important and
crucial. We are working with adipocytes and adipose tissue is capable of
expanding many-fold during adulthood, therefore requiring the formation of
new vasculature to supply growing and proliferating adipocytes. The
expansion of the vasculature in adipose tissue occurs through
angiogenesis, where new blood vessels develop from those pre-existing
within the tissue (Corvera et al., 2013). Previous studies indicated that
adipogenesis may be regulated by factors that drive angiogenesis.
Fundamental aspects of angiogenesis, including basement membrane
breakdown, vasculogenesis, angiogenic remodeling, vessel stabilization,
and vascular permeability. Critical angiogenic factors include vascular
endothelial growth factor (VEGF), VEGF receptors, angiopoietins (Ang),
ephrins, matrix metalloproteinases, and the plasminogen enzymatic system.
Vascular endothelial growth factor is the most critical factor because it
initiates the formation of immature vessels and disruption of a single
VEGF allele leads to embryonic lethality in mice. Expression of VEGF is
influenced by hypoxia, insulin, growth factors, and several cytokines
(Hausman et al., 2004). The VEGF has been reported to be modulated by
leptin and hCG (Islami et al., 2003) and more recently the expression of
angiogenic regulators, VGEF and leptin has been reported to be regulated
by the EGF/PI3K/STAT3 pathway (Cascio et al., 2009). These vital findings
reflects a regulation of secondary diseases related to obesity to be the
result of complex molecular events and adipose tissue vasculature as a
source of new targets for metabolic disease therapies. This gene is
located on chromosome 11q13 (7 exons). VEGFB has been reported to have a
role in endothelial targeting of lipids to peripheral tissues. Dietary
lipids present in circulation must be transported through the vascular
endothelium to be metabolized by tissue cells. Bioinformatic analysis
showed that VEGFB was tightly coexpressed with nuclear-encoded
mitochondrial genes across a large variety of physiologic conditions in
mice, pointing to a role for VEGFB in metabolism. VEGF specifically
controlled endothelial uptake of fatty acids via transcriptional
regulation of vascular fatty acid transport proteins. As a consequence,
Vegfb-/- mice showed less uptake and accumulation of lipids in muscle,
heart, and brown adipose tissue, and instead shunted lipids to white
adipose tissue. The co-expression of VEGFB and mitochondrial proteins
introduces a novel regulatory mechanism, whereby endothelial lipid uptake
and mitochondrial lipid use are tightly coordinated (Hagberg et al.,
2012). In our study, we are also looking in to identify the mutation(s) in
the VEGF-B gene in Malayisan Obese attributes towards CHD risk. We
hypothesized, if there is a mutation in VGEF-B, then the obese subject
will be predicted to have hypertension and if there will be no mutation
then signs of metabolic syndrome and diabetes type II will be predicted in
obese attribute in future. Most important the role of VEGF as major
autocrine mediator of FGF-2-induced angiogenesis and proliferation (Naim
et al 2005) should be considered by respective researchers in future.
References:
Cascio S, Ferla R, D'Andrea A, Gerbino A, Bazan V, Surmacz E, Russo
A. Expression of angiogenic regulators, VEGF and leptin, is regulated by
the EGF/PI3K/STAT3 pathway in colorectal cancer cells. J Cell Physiol.
2009
Oct;221(1):189-94. doi: 10.1002/jcp.21843.
Corvera S, Gealekman O. Adipose tissue angiogenesis: Impact on
obesity and type-2 diabetes. Biochim Biophys Acta. 2013 Jun 12. doi:pii:
S0925-4439(13)00211-1. 10.1016/j.bbadis.2013.06.003.
Hagberg CE, Mehlem A, Falkevall A, Muhl L, Fam BC, Orts?ter H,
Scotney P, Nyqvist D, Sam?n E, Lu L, Stone-Elander S, Proietto J,
Andrikopoulos S, Sj?holm A, Nash A, Eriksson U. Targeting VEGF-B as a
novel treatment for insulin resistance and type 2 diabetes. Nature. 2012
Oct 18;490(7420)
Islami D, Bischof P, Chardonnens D. Modulation of placental vascular
endothelial growth factor by leptin and hCG. Mol Hum Reprod. 2003
Jul;9(7):395-8.
Naim R, Chang RC, Sadick H, Bayerl C, Bran G, Hormann K. Effect of
vascular endothelial growth factor on fibroblasts from external auditory
canal cholesteatoma. Arch Med Res. 2005 Sep-Oct;36(5):518-23. PubMed PMID:
16099332.
Having taught medical students about the benefits of PA for the past
20 years and lived through WHO's 2002 World health day on PA, I had the
belief that PA was now integrated and implemented in everyday practice.
This nice little piece of research reminds us how difficult it is to
change "routine" and how uncomfortable some of us feel when encouraging
people to change their behaviour.
Back to the drawing board...
Having taught medical students about the benefits of PA for the past
20 years and lived through WHO's 2002 World health day on PA, I had the
belief that PA was now integrated and implemented in everyday practice.
This nice little piece of research reminds us how difficult it is to
change "routine" and how uncomfortable some of us feel when encouraging
people to change their behaviour.
Back to the drawing board...
The article suggests that using fat as an energy source is how to
fuel endurance events.
Why is it that top marathons runners and the SKY/GB team don't do
this but have a good balance of mainly carbohydrate and protein?
Because using fat requires 3% more oxygen for the same amount of
energy. Thus energy release is slower and it is why top athletes train
specifically to perform glycogen depleted. If you...
The article suggests that using fat as an energy source is how to
fuel endurance events.
Why is it that top marathons runners and the SKY/GB team don't do
this but have a good balance of mainly carbohydrate and protein?
Because using fat requires 3% more oxygen for the same amount of
energy. Thus energy release is slower and it is why top athletes train
specifically to perform glycogen depleted. If you understand the
physiology it is so wrong. Why do cyclists consume carbohydrate during
long stages
I read the excellent study by Halland et al with great interest (1).
This study adds further support to the link between higher jumping
performance and the development of patellar tendinopathy, as the authors
note in the discussion (2). The reasons for this link are unclear but it
is worth considering evolutionary theory in any explanation. The
'pleiotropy' theory for the evolution of ageing prop...
I read the excellent study by Halland et al with great interest (1).
This study adds further support to the link between higher jumping
performance and the development of patellar tendinopathy, as the authors
note in the discussion (2). The reasons for this link are unclear but it
is worth considering evolutionary theory in any explanation. The
'pleiotropy' theory for the evolution of ageing proposes that there are
genetically determined 'trade-offs' between benefits to younger organisms
and their viability at older ages (3, 4). In this way the advantage
conferred by better jumping performance at a young age may be part of the
same genetic package that results in the disadvantage of an increased
susceptibility to tendinopathy at an older age.
1. Helland C, Bojsen-Moller J, Raastad T, Seynnes OR, Moltubakk MM,
Jakobsen V, et al. Mechanical properties of the patellar tendon in elite
volleyball players with and without patellar tendinopathy. British journal
of sports medicine. 2013. Epub 2013/07/09.
2. Visnes H, Aandahl HA, Bahr R. Jumper's knee paradox--jumping ability is
a risk factor for developing jumper's knee: a 5-year prospective study.
British journal of sports medicine. 2013;47(8):503-7. Epub 2012/10/13.
3. Kirkwood TB. Evolution of ageing. Mechanisms of ageing and development.
2002;123(7):737-45. Epub 2002/03/01.
4. Partridge L, Gems D. Mechanisms of ageing: public or private? Nature
reviews Genetics. 2002;3(3):165-75. Epub 2002/04/25.
Dear Sir,
We have read the nice article "Oral health and impact on performance of
athletes participating in the London 2012 Olympic Games: a cross-sectional
study" by Dr. Needleman and colleagues in your journal (Br J Sports
Med2013;47: 1054-1058)(1). In developing countries, the prevalence of
dental and periodontal diseases is very high as people...
Dear Sir,
We have read the nice article "Oral health and impact on performance of
athletes participating in the London 2012 Olympic Games: a cross-sectional
study" by Dr. Needleman and colleagues in your journal (Br J Sports
Med2013;47: 1054-1058)(1). In developing countries, the prevalence of
dental and periodontal diseases is very high as people have lack of
knowledge and are ignorant about oral health(2). Even though the athletes
are having physical fitness they might not have given importance for oral
health. Food and liquids should be kept in the mouth for a very brief
period (3). Food particles continue to remain in the mouth after food and
liquid intake because sensory adaptation of the mouth for these particles
is very rapid. Lack of antioxidants and micronutrients increases the
incidence of dental and periodontal diseases. During high stress periods,
intake of micronutrients and antioxidants results in decreased
inflammatory processes. High stress exposure is one of the possible
factors for exerting an unfavorable influence on periodontal health such
as plaque accumulation, local gingivitis and a change in salivary
composition (4). In developing countries, the prevalence of vitamin D
deficiency ranges between 30-90% (5). Vitamin D acts as an anti-
inflammatory agent and stimulates the production of anti-microbial
peptides in the saliva (6). Use of 1-2 ml of virgin olive oil (rich in
Oleic acid and Phenolic antioxidants)after brushing in the morning and at
night before going to sleep will be of help in removing residual food
particles and decreasing bacterial growth and adhesion in oral cavity (7,
8).
REFERANCES
1. Needleman I, Ashley P, Petrie A, Fortune F et al. Oral health and
impact on performance of athletes participating in the London 2012 Olympic
Games: a cross-sectional study Br J Sports Med 2013;47:1054-1058
2. Petersen PE, Bourgeois D, Ogawa H, Estupinan-Day S, Ndiaye C. The
global burden of oral diseases and risks to oral health. Bull World Health
Organ. 2005; 83(9):661-9.
3. Dawes C Salivary flow patterns and the health of hard and soft
oral tissues.
JADA 2008; 139(5 supp); 18S-24S.
4. Willershausen B, Ross A, F?rsch M, Willershausen I, Mohaupt P, Callaway
A. The influence of micronutrients on oral and general health Eur J Med
Res. 2011; 16(11): 514-518
5. Arabi A, El Rassi R, El-Hajj Fuleihan G. Hypovitaminosis D in
developing countries-prevalence, risk factors and outcomes. Nat Rev
Endocrinol. 2010;6(10):550-61
6. Stein SH, Tipton DA; Vitamin D and its impact on oral health--an
update. [Journal Article, Review]; J Tenn Dent Assoc 2011; 91(2):30-33.
7. Pretty IA, Gallagher MJ, Martin MV, Edgar WM, Higham SMA study to
assess the effects of a new detergent-free, olive oil formulation
dentifrice in vitro and in vivo. Dent. 2003 Jul;31(5):327-32
8. Math M.V. Olive Oil and Water - Role in Oral Care. International
Journal of Medical and Clinical Research 2013; 4 (1); 258-260.
From .
Dr Mahantayya V Math
Dr Yashoda R kattimani
Dr Rita M khadkikar
MGM Medical College
Kamothe, Navi Mumbai
Maharashtra state, India
As a topic worthy of updating, it is disappointing to note
fundamental issues with both the methodology of this review as well as
errors in reporting of studies, leading to a limited perspective of the
role of exercise therapy and mobilisation techniques in treatment of
epicondylalgia. There are two major issues that readers ought to be made
aware of regarding this review.
As a topic worthy of updating, it is disappointing to note
fundamental issues with both the methodology of this review as well as
errors in reporting of studies, leading to a limited perspective of the
role of exercise therapy and mobilisation techniques in treatment of
epicondylalgia. There are two major issues that readers ought to be made
aware of regarding this review.
Issue 1: A major issue is the lack of a comprehensive search
strategy, with a simple pubmed search identifying several studies (Smidt
et al., 2002; Bisset et al., 2006; Croisier et al., 2007 ; Luginbuhl et
al., 2008; Nagrale et al., 2009) and at least two other systematic reviews
(Bisset et al., 2005; Herd et al., 2008) published within the author
specified census period. Stark omissions are two randomised trials, which
followed 185 (Smidt et al., 2002) and 198 (Bisset et al., 2006)
participants over one year. At least nine additional studies (Park et al.,
2010; Slater et al., 2010; Tyler et al., 2010; Peterson et al., 2011; Wen
et al., 2011; Fernandez-Carnero et al., 2012; Soderberg et al., 2012;
Viswas et al., 2012; Coombes et al., 2013) and a systematic review (Raman
et al., 2012) could be found beyond the census period, indicating that an
update is already timely.
The most noticeable gap in the literature presented by Hoogvliet, is
that in which exercise and manipulative treatments are included as a part
of a multimodal therapy program. Amongst missing evidence in this review,
is that which favours, in terms of speeding up resolution, the use of a
multimodal program including elbow mobilisation and concentric and
eccentric exercise compared to wait and see (Bisset et al., 2006) or
placebo intervention (Coombes et al., 2013). Given that combining exercise
and manual therapy reflects much of what occurs in clinical practice, its
absence is concerning.
Issue 2: There are errors in presentation of data from individual
studies. Readers might be better advised to refer to individual papers,
however, this in itself may be problematic given some studies were not
correctly referenced to the intended trials (e.g., #30(Cleland et al.,
2005), #11(Fernandez-Carnero et al., 2008)). That is, the study by Cleland
should refer to the pilot study of 10 participants (Cleland et al., 2005),
not the retrospective analysis of 112. There is misrepresentation of
studies, for example patient numbers, study design and results are ether
incorrect, incomplete or missing for #24 (Vicenzino et al., 1996) variably
so in Appendix 1 and text.
References:
Bisset, L., Beller, E., Jull, G., Brooks, P., Darnell, R. &
Vicenzino, B. (2006) Mobilisation with movement and exercise,
corticosteroid injection, or wait and see for tennis elbow: randomised
trial. BMJ 333, 939.
Bisset, L., Paungmali, A., Vicenzino, B. & Beller, E. (2005) A
systematic review and meta-analysis of clinical trials on physical
interventions for lateral epicondylalgia. Br J Sports Med 39, 411-422;
discussion 411-422.
Cleland, J., Flynn, T.W. & Palmer, J.A. (2005) Incorporation of
manual therapy directed at the cerviothoracic spine in patients with
lateral epicondylalgia. A pilot clinical trial. J Man Manip Ther 13, 143-
151.
Coombes, B.K., Bisset, L., Brooks, P., Khan, A. & Vicenzino, B.
(2013) Effect of corticosteroid injection, physiotherapy or both on
clinical outcomes in patients with unilateral lateral epicondylalgia. A
randomized controlled trial. JAMA 309, 461-469.
Croisier, J.L., Foidart-Dessalle, M., Tinant, F., Crielaard, J.M.
& Forthomme, B. (2007) An isokinetic eccentric programme for the
management of chronic lateral epicondylar tendinopathy. Br J Sports Med
41, 269-275.
Fernandez-Carnero, J., Cleland, J.A. & Arbizu, R.L. (2012)
Examination of motor and hypoalgesic effects of cervical vs thoracic spine
manipulation in patients with lateral epicondylalgia: a clinical trial. J
Manipulative Physiol Ther 34, 432-440.
Fernandez-Carnero, J., Fernandez-de-las-Penas, C. & Cleland, J.A.
(2008) Immediate hypoalgesic and motor effects after a single cervical
spine manipulation in subjects with lateral epicondylalgia. J Manipulative
Physiol Ther 31, 675-681.
Herd, C.R. & Meserve, B.B. (2008) A systematic review of the
effectiveness of manipulative therapy in treating lateral epicondylalgia.
J Man Manip Ther 16, 225-237.
Luginbuhl, R., Brunner, F. & Schneeberger, A.G. (2008) No effect
of forearm band and extensor strengthening exercises for the treatment of
tennis elbow: a prospective randomised study. La Chirurgia degli organi di
movimento 91, 35-40.
Nagrale, A.V., Herd, C.R., Ganvir, S. & Ramteke, G. (2009) Cyriax
physiotherapy versus phonophoresis with supervised exercise in subjects
with lateral epicondylalgia: a randomized clinical trial. J Man Manip Ther
17, 171-178.
Park, J.Y., Park, H.K., Choi, J.H., Moon, E.S., Kim, B.S., Kim, W.S.
& Oh, K.S. (2010) Prospective evaluation of the effectiveness of a
home-based program of isometric strengthening exercises: 12-month follow-
up. Clinics in orthopedic surgery 2, 173-178.
Peterson, M., Butler, S., Eriksson, M. & Svardsudd, K. (2011) A
randomized controlled trial of exercise versus wait-list in chronic tennis
elbow (lateral epicondylosis). Upsala journal of medical sciences 116, 269
-279.
Raman, J., Macdermid, J.C. & Grewal, R. (2012) Effectiveness of
different methods of resistane exercses in lateral epicondylosis - a
systematic review. J Hand Ther 25, 5-25.
Slater, H., Theriault, E., Ronningen, B.O., Clark, R. & Nosaka,
K. (2010) Exercise-induced mechanical hypoalgesia in musculotendinous
tissues of the lateral elbow. Man Ther 15, 66-73.
Smidt, N., van der Windt, D.A., Assendelft, W.J., Deville, W.L.,
Korthals-de Bos, I.B. & Bouter, L.M. (2002) Corticosteroid injections,
physiotherapy, or a wait-and-see policy for lateral epicondylitis: a
randomised controlled trial. Lancet 359, 657-662.
Soderberg, J., Grooten, W.J. & Ang, B.O. (2012) Effects of
eccentric training on hand strength in subjects with lateral
epicondylalgia: a randomized-controlled trial. Scand J Med Sci Sports 22,
797-803.
Tyler, T.F., Thomas, G.C., Nicholas, S.J. & McHugh, M.P. (2010)
Addition of isolated wrist extensor eccentric exercise to standard
treatment for chronic lateral epicondylosis: a prospective randomized
trial. J Shoulder Elbow Surg 19, 917-922.
Vicenzino, B., Collins, D. & Wright, A. (1996) The initial
effects of a cervical spine manipulative physiotherapy treatment on the
pain and dysfunction of lateral epicondylalgia. Pain 68, 69-74.
Viswas, R., Ramachandran, R. & Korde Anantkumar, P. (2012)
Comparison of effectiveness of supervised exercise program and Cyriax
physiotherapy in patients with tennis elbow (lateral epicondylitis): a
randomized clinical trial. TheScientificWorldJournal 2012, 939645.
Wen, D.Y., Schultz, B.J., Schaal, B., Graham, S.T. & Kim, B.S.
(2011) Eccentric strengthening for chronic lateral epicondylosis: a
prospective randomized study. Sports health 3, 500-503.
I would like to congratulate Dr. Nikos Malliaropoulos for the
initiative to organize a Judo and Martial Arts issue in this prestigious
journal1, a topic with increased number of publications in the last
decades.2 However, despite the broad range of topics suggested in the
initial call for papers1, only four papers (including the editorial) about
judo/martial arts were published, which can be an indicative that the high
-l...
I would like to congratulate Dr. Nikos Malliaropoulos for the
initiative to organize a Judo and Martial Arts issue in this prestigious
journal1, a topic with increased number of publications in the last
decades.2 However, despite the broad range of topics suggested in the
initial call for papers1, only four papers (including the editorial) about
judo/martial arts were published, which can be an indicative that the high
-level quality required by the British Journal of Sporst Medicine is still
to be achieved by researchers working on this topic, although no
information was provided in the editorial concerning the number of papers
submitted and the proportion of articles approved.
Other aspects in this editorial also deserve attention: (a) despite the
fact that the Kodokan Judo Institute 3 and the International Judo
Federation4 present the date of judo creation as 1882, the authors
presented 1888 as the year judo was invented, but no reference was given
for this fact; (b) the affirmation that "very little has changed since
judo was invented.."(p.1137)5 is greatly different from what researchers
in judo history6 and sport sociology7 have presented, especially about
what has been called judo Westernization or reflexive judo institutional
modernization7,8 and women participation, mainly in Japan9; (c) it is well
known that Dr. Jigoro Kano (the founder of judo) proposed this modality to
achieve different groups and to contribute to physical, moral and
intelectual development6 and that there is a tendency to believe that
martial arts can contribute to children development especifically 10, but
the use of the International Judo Federation4 as reference to describe the
benefits of judo lacks scientific background. Prudent skepticism was
recommended11 and a lack of evidence was presented12 concerning the real
effects of martial arts programs on children development. Furthermore,
many recent cases of catastrophic head and neck injuries13, and of female
Japanese athletes being physically punished by their coaches, among other
problems, have been reported recently in judo.14 Thus, a more balanced and
critical view would be preferred in this editorial; (d) although a
traditional judo especialization course has been promoted by the
International Budo University (Japan) for many years15, and a
specialization for judo coaches has been offered by Leipzig University
since 199116, the authors of the editorial opted to describe only a course
in which one of them is the coordinator and another is a former student,
while no competing interests were reported; (e) finally, there is no such
institution called "International Judo Federation Union" as presented in
the end of the editorial.
I hope this letter helps to improve the information provided by the
authors and contribute to discussions concerning judo and martial arts
research for mutual welfare and benefits as proposed by the founder of
judo, Dr. Jigoro Kano.
Emerson Franchini
Martial Arts and Combat Sports Research Group, School of Physical
Education and Sport, University of S?o Paulo, Brazil
The author of this letter declare no competing interests.
References
1. Khan, K. Call for papers - the ECOSEP BJSM judo and martial arts issue
2013. http://blogs.bmj.com/bjsm/2013/04/02/call-for-papers-the-ecosep-bjsm
-judo-and-martial-arts-issue-2013/ (accessed 19 Nov 2013)
2. Peset F, Ferrer-Sapena A, Villam?n M et al. Scientific literature
analysis of judo in Web of Science ?. Arch Budo 2013;9:81-91.
3. History of Kodokan Judo. Kodokan Judo Institute.
http://www.kodokan.org/e_basic/history.html (accessed 19 Nov 2013)
4. What is judo? International Judo Federation.
http://www.worldjudoday.com/en/WhatisJudo-57.html (accessed 20 Nov 2013)
5. Malliaropoulos, N, Callan M, Puim B. Judo, the gentle way. Br J Sports
Med 2013;47:1137.
6. Carr KG. Making way: war, philosophy and sport in Japanese judo. J
Sport Hist 1993;20:167-88.
7. Villam?n M, Brown D, Espartero J, Guti?rrez C. Reflexive modernization
and the disembedding of judo from 1946 to the 2000 Sydney Olympics. Int
Review Sociol Sport 2004;39:139-56.
8. Saeki T. Organizational reformation of the All Japan Judo Federation
organization: a sociological study of issues surrounding the conflict
between tradition and modernization in a sport. Int Review Sociol Sport
1994;29:301-15.
9. Miarka B, Marques JB, Franchini E. Reinterpreting the history of
women's judo in Japan. Int J Hist Sport 2011;28:1016-29.
10. Diamond A, Lee K. Interventions shown to aid executive function
development in children 4 to 12 years old. Science 2011;333:959-64.
11. Strayhorn JM, Strayhorn JC. Martial arts research: prudente
skepticism. Science 2011;334:310.
12. Mercer J. Martial arts research: weak evidence. 2011;334:310-1.
13. Kamitani T, Nimura Y, Nagahiro S, et al. Catastrophic head and neck
injuries in
judo players in Japan from 2003 to 2010. Am J Sports Med 2013;41:1915-21.
14. Judo coach's physical assault off emale athletes is a warning to
entire Japanese sporting world. http://www.japan-
press.co.jp/modules/news/index.php?id=5054 (accessed 20 Nov 2013).
15. International Budo University Special Course - Budo Specialization
Program. http://www.budo-u.ac.jp/english/pdf/Information.pdf (accessed 20
Nov 2013).
16. International Coaching Course. http://www.uni-
leipzig.de/~itk/itk/html/general_information.html. (accessed 20 Nov 2013).
My first question would be: what drug company funded this study?
How many studies have there been over this last century showing exercise
decreases and cures diabetes? Many.
I find this type of "so-called" science incredibly dangerous and
irresponsible as many women will make it an excuse to not exercise during
pregnancy. Exercise during pregnancy most definitely not only reduces risk
of diabetes but i have...
My first question would be: what drug company funded this study?
How many studies have there been over this last century showing exercise
decreases and cures diabetes? Many.
I find this type of "so-called" science incredibly dangerous and
irresponsible as many women will make it an excuse to not exercise during
pregnancy. Exercise during pregnancy most definitely not only reduces risk
of diabetes but i have over the last 20 years with many clients, not only
controlled, but some even reversed Gestational diabetes, within 2 weeks.
But it takes 5-6 days a week of minimum 45 minutes of decent intensity
exercise. And elimination of all white carbohydrates. And with Asian women
propensity for Gestational diabetes, which i would attribute to thousands
of years of eating white rice, eliminating white carbohydrates should be
mandatory for all pregnant women.
Exercise does reduce risk of obesity, depression, preeclampsia and
premature delivery and most gestational issues, all of which we have an
epidemic of in the States. Actually i would call them "In-activity issues"
not gestational. What are you thinking?
The research into the physical activity response to the Sydney
Olympics (and Paralympics) recognises that without a planned and
sustainable investment in physical activity programmes over time there is
no evidence of improvement.
This should not surprise us for three reasons:
1. People may be inspired by elite performance and feel the desire to
increase their participation but this will not be sufficie...
The research into the physical activity response to the Sydney
Olympics (and Paralympics) recognises that without a planned and
sustainable investment in physical activity programmes over time there is
no evidence of improvement.
This should not surprise us for three reasons:
1. People may be inspired by elite performance and feel the desire to
increase their participation but this will not be sufficient to convert
that intent into behaviour change
2. Individuals will respond to structured marketing which taps into
their personal goal motivations (for example in our research a focus on:
making friends, improving health, having fun, improving self image,
progressing in life will trigger a positive response from disabled people)
3. There needs to be strategic long term investment in the type of
inclusive participation opportunities which are designed to respond to the
demands of new participants and not just the needs of existing, committed
sports participants. For example Sporting bodies and gyms should consider
what their current club offer feels like for someone turning up for the
first time
I believe that the early indications are that this approach is being
applied effectively in England and the long term prognosis is
significantly more optimistic than the Australian experience.
Conflict of Interest:
EFDS is a Charity which is partly funded by Sport England to increase the participation of disabled people in sport.
We have read the respective article and we agreed with all great findings. Nevertheless, we wish to emphasize the need to address the role of some molecular and physiological markers that may elaborate and possibly support the findings of the study. Intermittent hypoxia exposure can enhance the generation of red blood cells, which may consequentially increase hemoglobin concentration and hematocrit depending on the model...
We have read the respective article and we agreed with all great findings. But just need to emphasized on some thing very important and crucial. We are working with adipocytes and adipose tissue is capable of expanding many-fold during adulthood, therefore requiring the formation of new vasculature to supply growing and proliferating adipocytes. The expansion of the vasculature in adipose tissue occurs through angiogenes...
Having taught medical students about the benefits of PA for the past 20 years and lived through WHO's 2002 World health day on PA, I had the belief that PA was now integrated and implemented in everyday practice. This nice little piece of research reminds us how difficult it is to change "routine" and how uncomfortable some of us feel when encouraging people to change their behaviour. Back to the drawing board...
...The article suggests that using fat as an energy source is how to fuel endurance events.
Why is it that top marathons runners and the SKY/GB team don't do this but have a good balance of mainly carbohydrate and protein?
Because using fat requires 3% more oxygen for the same amount of energy. Thus energy release is slower and it is why top athletes train specifically to perform glycogen depleted. If you...
Dear Editor
I read the excellent study by Halland et al with great interest (1). This study adds further support to the link between higher jumping performance and the development of patellar tendinopathy, as the authors note in the discussion (2). The reasons for this link are unclear but it is worth considering evolutionary theory in any explanation. The 'pleiotropy' theory for the evolution of ageing prop...
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Dear Sir, We have read the nice article "Oral health and impact on performance of athletes participating in the London 2012 Olympic Games: a cross-sectional study" by Dr. Needleman and colleagues in your journal (Br J Sports Med2013;47: 1054-1058)(1). In developing countries, the prevalence of dental and periodontal diseases is very high as people...
As a topic worthy of updating, it is disappointing to note fundamental issues with both the methodology of this review as well as errors in reporting of studies, leading to a limited perspective of the role of exercise therapy and mobilisation techniques in treatment of epicondylalgia. There are two major issues that readers ought to be made aware of regarding this review.
Issue 1: A major issue is the lack of...
I would like to congratulate Dr. Nikos Malliaropoulos for the initiative to organize a Judo and Martial Arts issue in this prestigious journal1, a topic with increased number of publications in the last decades.2 However, despite the broad range of topics suggested in the initial call for papers1, only four papers (including the editorial) about judo/martial arts were published, which can be an indicative that the high -l...
My first question would be: what drug company funded this study? How many studies have there been over this last century showing exercise decreases and cures diabetes? Many.
I find this type of "so-called" science incredibly dangerous and irresponsible as many women will make it an excuse to not exercise during pregnancy. Exercise during pregnancy most definitely not only reduces risk of diabetes but i have...
The research into the physical activity response to the Sydney Olympics (and Paralympics) recognises that without a planned and sustainable investment in physical activity programmes over time there is no evidence of improvement.
This should not surprise us for three reasons:
1. People may be inspired by elite performance and feel the desire to increase their participation but this will not be sufficie...
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