359 e-Letters

published between 2021 and 2024

  • Lots of good sports not a lot of good sports to play them
    Richard Clarke Cobey

    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...

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  • Letter to Editor: Patient-reported outcome measures for gluteal tendinopathy – more empirical evidence is needed?

    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...

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  • Three days measured?

    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

  • Physical activity will remain ‘overlooked’ in the treatment of depression and anxiety until we focus our research on people referred to mental health services.

    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...

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  • Standardized data collection can lead to more insightful outcomes

    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.

  • Response to: Did the authors consider the ICIQ-FLUTs (Neil Heron)

    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.

  • ICON abbreviation

    International CONsensus (https://bjsm.bmj.com/content/54/8/442)

  • Please clarify

    What does ICON stand for? I could not find the meaning of the abbreviation in the text?

  • How to interpret spirometry data in 2023? The new criteria to retain the diagnosis of ventilatory impairments

    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...

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