Re: eLetter from Adriana Suely de Oliveira Melo et al.
Authors responses are in bold:
Barakat et al. [1] have presented us with a paper of
excellent
methodological quality, following all the steps recommended in the
Consolidated Standards of Reporting Trials (CONSORT) and dealing with a
question that never fails to generate controversy with respect to the
practice of physical activity dur...
Re: eLetter from Adriana Suely de Oliveira Melo et al.
Authors responses are in bold:
Barakat et al. [1] have presented us with a paper of
excellent
methodological quality, following all the steps recommended in the
Consolidated Standards of Reporting Trials (CONSORT) and dealing with a
question that never fails to generate controversy with respect to the
practice of physical activity during pregnancy: prematurity. Another
strongpoint of the paper is the fact that the physical exercise was
systematized and monitored, guaranteeing that the pregnant woman indeed
followed the prescribed program.
Various controversies continue to surround the topic of
physical
exercise and pregnancy and the real effects of exercise on the conceptus
remain to be clarified. The spectrum of these effects ranges from fetal
growth to the duration of the pregnancy, with some studies associating
prematurity and growth restriction with the practice of physical
exercise [2-4].
Despite these speculations, until recently no randomized clinical
trials (RCT) with adequate sample sizes had been identified in which
pregnant women were systematically followed up for a period encompassing
the second and third trimesters.
Authors Response We acknowledge the authors of the letter for their nice comments.
Please see our responses and comments below.
The excellent quality of this paper prompted us to examine
it in
detail in an attempt to understand some points that we would now like to
put to the authors. Since the objective of the RCT was to evaluate the
risk of premature labor, would it not have been better to have excluded
all the pregnant women with a history of premature labor in view of the
fact that the results show that one of the cases of prematurity in the
intervention group was precisely due to a prior history of prematurity?
Authors Response
History of premature labour is not an absolute contraindication
for exercising during pregnancy. It is actually a relative
contraindication. In fact, we only studied women with no history of
recurrent spontaneous preterm birth, i.e., number of previous preterm
deliveries ≤1.
Anyway, the potential confounding factor arising from including women with
one prior preterm delivery was controlled for as the % of women with such
history was very similar (and actually very low) in both groups (please
see Table 1).
As indicated in the paper, of the two women of the training group showing
preterm delivery, only one (gestational age: 36wk 2d) had previous history
of preterm delivery (n=1).
We judged interesting to analyse individually what happened with
gestational outcome in those cases of one previous preterm labour. This
could only be achieved by studying women with prior history of
prematurity.
Another point that drew our attention concerns the
exclusions in both
groups, which were the result of various situations that may have
affected the outcome "gestational age", such as bleeding, pregnancy-
induced
hypertension and threatened preterm labor. In our opinion, these women
should have continued in the study and an intent-to-treat analysis
should have been carried out. We were also intrigued by the fact that one
patient was excluded because her pregnancy was a twin pregnancy. Was a
single pregnancy not one of the inclusion criteria?
Authors Response
Indeed, it would have been interesting to study individually some 'case
reports' with such conditions (same as we did with women with one prior
preterm delivery). Bleeding, pregnancy-induced hypertension and threatened
preterm labor are however absolute contraindications for exercise during
pregnancy. As such, there were considered to be exclusion criteria. The
ACOG guidelines establish that exercise during pregnancy must be safe.
As for twin pregnancy, the first inclusion criteria for study participants
(as indicated in the paper) was being "i) gravida with singleton and
uncomplicated gestation" (i.e., women with twin pregnancy were excluded
from our study).
We believe that future RCTs are needed including solely women with twin
pregnancy.
It may perhaps have been interesting NOT to have included
women
With a history of premature delivery. Although the inclusion criteria
Accepted the possibility of the participants having had at the most one
previous
premature delivery, this may have had an effect on the mean gestational
age reported in the present study.
Authors Response
Please see our response above, which shows that this was not a confounding
factor at all.
We were unable to identify in the paper any description of the
parameters used to calculate sample size to determine whether the final
number of participants included was sufficient to demonstrate any
differences between the groups. Could a type II statistical error have
occurred?
Authors Response
We employed a conservative approach for sample size estimation. Power
calculations were made for the primary outcome measures of gestational
age, Apgar score, birth weight and length. It was determined that adequate
power (>0.80) would be achieved with 72 pregnant women in the training
group and with 70 pregnant women in the non-exercising control group. All
power computations assumed that comparisons of baseline to 26-week* scores
would be tested at the 5% significance level. All power computations
allowed for 10% dropouts over 26 weeks.
*(The duration of the training program was of 26 weeks).
Another minor question we would like to pose is whether
the
intensity of the prescribed exercise was light-to-moderate or moderate,
since it
is described in different ways in the various sections of the manuscript
and it is known that some outcomes are dependent on the intensity of
exercise.
Authors Response Training intensity was ≤ light-to-moderate (< moderate).
Indeed, heart rate was consistently ≤80% age-predicted maximum HR value
(220 minus age) and we included toning and very light resistance
exercises.
Finally, we would like to know whether the authors have
data on
Other gestational or perinatal outcomes, since such a well-conducted RCT
as
This one should have generated interesting results that deserve to be
published.
Authors Response
Yes, we do have a complete set of data (included post-natal follow-up),
some of which will be analysed in further studies. As for the present
paper, we did not judge it adequate to include such a big amount of data
as many of them are not really related to mean gestational outcome per se
and it would deviate readers¡¯ attention from the main study findings.
References
1. Barakat R, Stirling JR, Lucia A. Does exercise
training during
pregnancy affect gestational age? A randomised controlled trial. Br J
Sports Med 2008; 42(8):674-8.
2. De Ver Dye T, Fernandez ID, Rains A, Fershteyn Z.
Recent studies in the epidemiologic assessment of physical activity, fetal growth,
and
preterm delivery: a narrative review. Clin Obstet Gynecol 2003;
46(2):415-
22.
3. Grisso JA, Main DM, Chiu G, Synder ES, Holmes JH.
Effects of
physical activity and life-style factors on uterine contraction
frequency.
Am J Perinatol 1992; 9(5-6):489-92.
4. Misra DP, Strobino DM, Stashinko EE, Nagey DA,
Nanda J. Effects
of
physical activity on preterm birth. Am J Epidemiol 1998; 147(7):628-35.
Barakat et al. [1] have presented us with a paper of excellent
methodological quality, following all the steps recommended in the
Consolidated Standards of Reporting Trials (CONSORT) and dealing with a
question that never fails to generate controversy with respect to the
practice of physical activity during pregnancy: prematurity. Another
strongpoint of the paper is the fact that the physical exerc...
Barakat et al. [1] have presented us with a paper of excellent
methodological quality, following all the steps recommended in the
Consolidated Standards of Reporting Trials (CONSORT) and dealing with a
question that never fails to generate controversy with respect to the
practice of physical activity during pregnancy: prematurity. Another
strongpoint of the paper is the fact that the physical exercise was
systematized and monitored, guaranteeing that the pregnant woman indeed
followed the prescribed program.
Various controversies continue to surround the topic of physical
exercise and pregnancy and the real effects of exercise on the conceptus
remain to be clarified. The spectrum of these effects ranges from fetal
growth to the duration of the pregnancy, with some studies associating
prematurity and growth restriction with the practice of physical exercise
[2-4]. Despite these speculations, until recently no randomized clinical
trials (RCT) with adequate sample sizes had been identified in which
pregnant women were systematically followed up for a period encompassing
the second and third trimesters.
The excellent quality of this paper prompted us to examine it in
detail in an attempt to understand some points that we would now like to
put to the authors. Since the objective of the RCT was to evaluate the
risk of premature labor, would it not have been better to have excluded
all the pregnant women with a history of premature labor in view of the
fact that the results show that one of the cases of prematurity in the
intervention group was precisely due to a prior history of prematurity?
Another point that drew our attention concerns the exclusions in both
groups, which were the result of various situations that may have affected
the outcome “gestational age”, such as bleeding, pregnancy-induced
hypertension and threatened preterm labor. In our opinion, these women
should have continued in the study and an intent-to-treat analysis should
have been carried out. We were also intrigued by the fact that one
patient was excluded because her pregnancy was a twin pregnancy. Was a
single pregnancy not one of the inclusion criteria?
It may perhaps have been interesting NOT to have included women with
a history of premature delivery. Although the inclusion criteria accepted
the possibility of the participants having had at the most one previous
premature delivery, this may have had an effect on the mean gestational
age reported in the present study.
We were unable to identify in the paper any description of the
parameters used to calculate sample size to determine whether the final
number of participants included was sufficient to demonstrate any
differences between the groups. Could a type II statistical error have
occurred?
Another minor question we would like to pose is whether the intensity
of the prescribed exercise was light-to-moderate or moderate, since it is
described in different ways in the various sections of the manuscript and
it is known that some outcomes are dependent on the intensity of exercise.
Finally, we would like to know whether the authors have data on other
gestational or perinatal outcomes, since such a well-conducted RCT as this
one should have generated interesting results that deserve to be
published.
References
1. Barakat R, Stirling JR, Lucia A. Does exercise training during
pregnancy affect gestational age? A randomised controlled trial. Br J
Sports Med 2008; 42(8):674-8.
2. De Ver Dye T, Fernandez ID, Rains A, Fershteyn Z. Recent studies
in the epidemiologic assessment of physical activity, fetal growth, and
preterm delivery: a narrative review. Clin Obstet Gynecol 2003; 46(2):415-
22.
3. Grisso JA, Main DM, Chiu G, Synder ES, Holmes JH. Effects of
physical activity and life-style factors on uterine contraction frequency.
Am J Perinatol 1992; 9(5-6):489-92.
4. Misra DP, Strobino DM, Stashinko EE, Nagey DA, Nanda J. Effects of
physical activity on preterm birth. Am J Epidemiol 1998; 147(7):628-35.
The Editorial by Shephard addresses the potential problems involved
in a mass ECG screening for athletes. He explains that on the one
hand Italian (sport)cardiologists are in favor of a (mandatory) mass
screening program, while on the other hand US physicians seem to have
good reasons for opposing this Italian model.
Although Shepard’s review is agreeable to the current situation, he
neglects some important issues....
The Editorial by Shephard addresses the potential problems involved
in a mass ECG screening for athletes. He explains that on the one
hand Italian (sport)cardiologists are in favor of a (mandatory) mass
screening program, while on the other hand US physicians seem to have
good reasons for opposing this Italian model.
Although Shepard’s review is agreeable to the current situation, he
neglects some important issues. I will just sketch two of them:
• What about genetic testing? Could genetic testing be a helpful tool
for diagnosis/differential diagnosis? Could a cascade screening, i.e.
testing of family members of a person at risk help to reduce the numbers
of sudden death in athletes and at the same time reduce the costs?
• What about further legal and ethical aspects? Is it only a factual
disagreement? Or is there maybe a moral divergence behind the opposing
view in the US? Or is the opposition to a mass screening the result of US
physicians fears of lawsuits? Do the athletes have a voice in this
process? What about the athletes right to know – their right not to know
about their medical condition?
Besides these two important aspects of pre participation screening in
general and the question if the ECG should be part of it, I finally wanted
to mention that the often simplified picture on Europe suggests that there
is this dichotomy of views that Shephard offers us (USA vs. Europe). But
the range of opinions on this issue in Europe is far more heterogeneous
than this. For example many Scandinavian countries are not convinced by
the Italian model so far and therefore do not support the implementation
of a mandatory mass ECG screening for athletes.
I agree with Professor Tim Noakes that the presence of
an end-spurt cannot be explained by either the traditional peripheral
fatigue model, or the more recent negative feedback model proposed by
Amann and Dempsey [1, 4]. However, I think that the presence of an end-spurt is also at odds with Noakes’ central governor model.
In fact, a subconscious intelligent system capable of regulating in
anti...
I agree with Professor Tim Noakes that the presence of
an end-spurt cannot be explained by either the traditional peripheral
fatigue model, or the more recent negative feedback model proposed by
Amann and Dempsey [1, 4]. However, I think that the presence of an end-spurt is also at odds with Noakes’ central governor model.
In fact, a subconscious intelligent system capable of regulating in
anticipation the central neural drive to the locomotor muscles on the
basis of a known end-point and afferent feedback from a variety of intero-and extero-receptors should not allow for an end-spurt. On the contrary,
it should choose from the very start the maximum speed that can be
sustained over 4 miles without dangerous homeostatic failure and, in
stable environmental conditions, provide very small but frequent
adjustments in central motor command/speed during the race in relation to
unpredictable small changes in the physiological conditions of the body.
This is the typical functioning of subconscious physiological control
systems of homeostasis, and this principle should apply to the central
governor as well.
On the other hand, the end-spurt is perfectly compatible with an
effort-based decision-making model of exercise performance. When the
exercise task is simple (constant-workload or incremental exercise tests
to exhaustion), the goal is to last for as long as possible and the
conscious decision to take is simple: do I keep going or do I stop? In
these testing conditions anticipation is not necessary, and time to
exhaustion is determined by two psychological factors: i) potential
motivation (the maximum effort a person is willing to exert in order to
satisfy a motive) and ii) perceived exertion [2-3, 5].
When the exercise task is more complex (time trials in the lab or
actual endurance competitions such as the 4-mile races analysed by
Noakes), the conscious decision to take is also more complex: at which
speed do I run at the beginning, middle, and end* of the race? Again
potential motivation and perception of effort play a major role. However,
we need additional conscious information to allow for such complex
decision-making process. These conscious information are iii) memory of
perception of effort during previous exercise bouts of different
intensities and duration, and in different environmental conditions, iv)
knowledge of total distance to cover, v) knowledge of distance
covered/remaining. Precise knowledge of running speed (or, in the field,
running time over a certain distance) certainly helps conscious regulation
of pacing, but it is not crucial because our kinaesthetic sense gives us
good enough information. Conveniently, we also exclude tactical
considerations and we assume that the goal (as in time trials) is to
finish the race in the shortest time possible.
Because precise conscious anticipation of perceived exertion and
running speed at the end of the race is not possible (and because
finishing the race is paramount), athletes usually choose a slightly
conservative pace for most of the race. Near the end of the race, when the
information provided by the conscious sensation of effort at a certain
running speed is more reliable, most “conservative” athletes realise that
they can significantly increase running speed without reaching exhaustion
before the finishing line, and decide to go for an end-spurt. No
additional subconscious intelligent system needed, just our conscious
brain.
* such simplistic tripartite subdivision is for illustration purposes
only. Decisions about running speed may vary in frequency depending on
tactical considerations and other factors
References
1. Marcora S. Is peripheral locomotor muscle fatigue during endurance
exercise a variable carefully regulated by a negative feedback system? J
Physiol. 2008; 586(7): 2027-8.
2. Marcora SM. Do we really need a central governor to explain brain
regulation of exercise performance? Eur J Appl Physiol. 2008; DOI:
10.1007/s00421-008-0818-3.
3. Marcora SM, Bosio A, de Morree HM. Locomotor muscle fatigue
increases cardiorespiratory responses and reduces performance during
intense cycling exercise independently from metabolic stress. Am J Physiol
Regul Integr Comp Physiol. 2008; 294(3): R874-83.
4. Noakes TD, Marino FE. Arterial oxygenation, central motor output
and exercise performance in humans. J Physiol. 2007; 585(Pt 3): 919-21.
5. Wright RA. Refining the Prediction of Effort: Brehm's Distinction
between Potential Motivation and Motivation Intensity. Soc Pers Psychol
Compass. 2008; 2(2): 682-701.
I am extremely concerned by the article by Cools et al. The paper
offers an algorithm to the differentiation of external from internal
impingement.
The basis of their differentiation is purely on the relocation test alone.
The only article they reference for this fact is Blevins (1997), which
only refers to rotator cuff pathology in athletes. The authors also
clearly state the inaccuracy of the re...
I am extremely concerned by the article by Cools et al. The paper
offers an algorithm to the differentiation of external from internal
impingement.
The basis of their differentiation is purely on the relocation test alone.
The only article they reference for this fact is Blevins (1997), which
only refers to rotator cuff pathology in athletes. The authors also
clearly state the inaccuracy of the relocation test and then discuss the
posterior impingement sign, which improves the accuracy.
It would be more accurate to use this test to differentiate between
internal and external impingement and to run a proper controlled study to
ascertain this.
The impression given by the authors is that the relocation test is an
accurate test for internal impingement, which it is clearly not.
I had lateral epicondylitis surgery in January 3, 2008, wore a cast
for two weeks then about three weeks of physical therapy and sent back to
work on light duty and first of March 2008 I was put back to full work
duty and physical therapy was stopped also. I am still in pain and my
doctor has closed my case even though he informed me that injury would
only get worse as long as I continue to perform my job as a city lette...
I had lateral epicondylitis surgery in January 3, 2008, wore a cast
for two weeks then about three weeks of physical therapy and sent back to
work on light duty and first of March 2008 I was put back to full work
duty and physical therapy was stopped also. I am still in pain and my
doctor has closed my case even though he informed me that injury would
only get worse as long as I continue to perform my job as a city letter
carrier and that I needed to quit my job if I wanted my arm to get better.
He did do another MRI or x-ray to see what is going on with my arm. Please
help!
Doping can severely affect individual’s health.[1] The
international community took action and nowadays an advanced mechanism to
tackle doping in sport and recreational activity exists (www.wada.com).
In a recent Warm up section of the Journal, Pluim presented her view
of sins and cheating, based on the International Tennis Federation
statistics. Focusing on “social drugs” and failure to comply
with therapeuti...
Doping can severely affect individual’s health.[1] The
international community took action and nowadays an advanced mechanism to
tackle doping in sport and recreational activity exists (www.wada.com).
In a recent Warm up section of the Journal, Pluim presented her view
of sins and cheating, based on the International Tennis Federation
statistics. Focusing on “social drugs” and failure to comply
with therapeutic use exemption (TUE) procedure represents a bias and
implies that in certain circumstances doping should not be sanctioned.
Athletes are professionals and have to comply with rules and regulations,
as others have to respect their working conditions. Additionally, athletes
are role models for youngsters and influence their behavioural patterns
substantially. Regarding the alarming data on doping ignorance [2] it
would be extremely dangerous to allow for any indulgence of the sins. This
could eventually lead to repetitive and/or risky behaviour, potentially
escalating as more serious offences. Next to dependence with long term
health risk, one should not neglect acute life threatening complications
with “social drugs” [3] or harmful steroid side effects.[4]
Prevention is the key strategy in modern medicine. Education,
screening, and comprehensive management are mainstay of good
interventional programme and should be implemented in fight against
doping. Among ongoing programmes, UEFA established a very sophisticated
approach (www.uefa.ch). Education through every modern and classical media
is sine qua non. Information channels/networks allow exchange of
information and mutual recognition of TUE. Out-of-competition testing is
steadily increasing whilst sufficient emphasis is put on lower ranked
competitions and particularly to younger athletes. Although time and
resource consuming, it is rewarding as at the end of a day the results are
worth the effort invested. Such comprehensive strategy to prevent negative
social and health implications of doping should certainly be preferred
over the notions to outwit the applicable principles for short-lived
gains.
References
1. Franke WW, Berendonk B. Hormonal doping and androgenization of
athletes: a secret program of the German Democratic Republic government.
Clin Chem. 1997;43:1262-73.
2. Wanjek B, Rosendahl J, Strauss B, et al. Doping, drugs and drug abuse
among adolescents in the State of Thuringia (Germany): prevalence,
knowledge and attitudes. Int J Sports Med. 2007;28:346-53.
4. Lainscak M, Doehner W, Anker SD. Metabolic disturbances in chronic
heart failure: a case for the "macho" approach with testosterone?! Eur J
Heart Fail. 2007;9:2-3.
In an overview of the 40 most recent cases of doping in tennis,
Babette Pluim highlighted that in only 13 of the cases (32%) was a
prohibited substance taken to enhance performance, whereas most frequently
banned substances were taken with no intent to enhance performance or
without (significant) fault or negligence.[1] I definitely agree that
products that are on the list of prohibited substances should be
critically r...
In an overview of the 40 most recent cases of doping in tennis,
Babette Pluim highlighted that in only 13 of the cases (32%) was a
prohibited substance taken to enhance performance, whereas most frequently
banned substances were taken with no intent to enhance performance or
without (significant) fault or negligence.[1] I definitely agree that
products that are on the list of prohibited substances should be
critically reviewed, but I also emphasize that the current anti-doping
policy is essentially a costly, repressive, zero tolerance approach, which
seems only partly successful.[2] It is also to mention, however, that there
may be additional explanations to justify adverse findings on antidoping
testing, which have little to do with cheating. The use of dietary
supplements is commonplace in sports, most elite athletes using some form
of licit supplementation to burst athletic performance and improve
recovery after training or competition. Nevertheless, there is widespread
evidence that some of these legitimate products, especially those sold on
the “black market”, contain banned substances that are not claimed as a
result of poor manufacturing practice or adulteration. Contaminants mostly
include anabolic androgenic steroids, hormones, ephedrine and caffeine.[3,4]
Indeed, in some cases the adverse findings might be the consequence of
deliberate cheating. However, we should still consider the possibility
that some positive tests might arise from unintentional consumption of
prohibited substances, contaminating dietary supplements. In this respect,
not only antidoping agencies should focus on products that are truly
harmful and performance-enhancing, but they should also issue a clear
regulation on the use of nutritional supplements and establish appropriate
bans for inadvertent use of banned molecules. Doping is always to blame,
especially when the athletes use illicit methods or substances that might
produce a serious risk for their health. However, as different sanctions
are imposed when crimes are intentional or preterintentional, bans should
also be clearly differentiated from deliberate and unintentional
positivity to banned substances.
References
1. Pluim B. A doping sinner is not always a cheat. Br J Sports Med
2008;42:549-50.
2. Kayser B, Smith AC. Globalisation of anti-doping: the reverse side
of the medal. BMJ 2008 Jul 4;337:a584. doi: 10.1136/bmj.a584.
3. Maughan RJ. Contamination of dietary supplements and positive drug
tests in sport. J Sports Sci 2005;23:883-9.
4. Linksvan der Merwe PJ, Grobbelaar E. Unintentional doping through
the use of contaminated nutritional supplements. S Afr Med J 2005;95:510-
1.
I have just had a book published called "A football Goalpost Killed
My Son," it is published by www.chipmunkapublishers.co.uk I have been
campaigning for goalpost safety in the UK for 17 years and hope for
legislation eventually.
I decided to write my book after my first book was published early this
year. My first book is mainly about bringing up a child with complex
special needs, but contained a chapter about my sons...
I have just had a book published called "A football Goalpost Killed
My Son," it is published by www.chipmunkapublishers.co.uk I have been
campaigning for goalpost safety in the UK for 17 years and hope for
legislation eventually.
I decided to write my book after my first book was published early this
year. My first book is mainly about bringing up a child with complex
special needs, but contained a chapter about my sons death.
This is a world wide problem and awareness needs to reach wherever
possible.
The study presented by Hamish Kerr et al on "Collegiate rugby union
injuries..." deserves comment.In a general sense the injury pattern may be
atrributed to the confrontational type of game that the players had been
taught.The tackle features as the event with more injuries occurring as
illustrated in the study.In this type of game the fact that T-boning
occurs, that is, where the ball carrier runs directly towards an onc...
The study presented by Hamish Kerr et al on "Collegiate rugby union
injuries..." deserves comment.In a general sense the injury pattern may be
atrributed to the confrontational type of game that the players had been
taught.The tackle features as the event with more injuries occurring as
illustrated in the study.In this type of game the fact that T-boning
occurs, that is, where the ball carrier runs directly towards an oncoming
defender(s) the tackler(s) creates an opportunity for a front-on tackle
where head/neck and shoulder injuries are a commonality for the tackler
and lower limb injuries for the ball carrier.
Reference is made to 'ball in play' time of 42 percent in 2003 Rugby
World Cup but at the Under 21 Rugby World Cup in 2006 this was 40 perecent
with an average of 134 rucks/game.These figures may suggest that most of
the time more infringements were occurring and that there were more
interaction instances between the ball carrier and the defenders. The
authors however, suggest that U.S collegiate games may have lower 'ball in
play' time and fewer rucks(Law 16) and tackles (Law 15) per game.Does less
'ball in play' time mean that there were more stoppages? More
infringements occurring?
Nevertheless, the authors' observations where there were fewer rucks
in a game suggests that there may have been fewer tackles and a more open
type of game was being played.
Less tackle injuries could be expected if that were the case.
The results from the data could have benefitted from categorising the
injury data as relating to the defence injury pattern and the offensive
injury pattern.Such an account would enhance the interpretations to be
made of the data.
This study provides an opportunity for relating injuries to how the game
is played.A comparison with an open type of game may be worth an anlysis.
Reference: The International Rugby Board. (2007). Laws of the game.
Dublin: The International Rugby Board.
Dear Editor
Re: eLetter from Adriana Suely de Oliveira Melo et al.
Authors responses are in bold:
Barakat et al. [1] have presented us with a paper of excellent methodological quality, following all the steps recommended in the Consolidated Standards of Reporting Trials (CONSORT) and dealing with a question that never fails to generate controversy with respect to the practice of physical activity dur...
Dear Editor
Barakat et al. [1] have presented us with a paper of excellent methodological quality, following all the steps recommended in the Consolidated Standards of Reporting Trials (CONSORT) and dealing with a question that never fails to generate controversy with respect to the practice of physical activity during pregnancy: prematurity. Another strongpoint of the paper is the fact that the physical exerc...
The Editorial by Shephard addresses the potential problems involved in a mass ECG screening for athletes. He explains that on the one hand Italian (sport)cardiologists are in favor of a (mandatory) mass screening program, while on the other hand US physicians seem to have good reasons for opposing this Italian model.
Although Shepard’s review is agreeable to the current situation, he neglects some important issues....
Dear Editor
I agree with Professor Tim Noakes that the presence of an end-spurt cannot be explained by either the traditional peripheral fatigue model, or the more recent negative feedback model proposed by Amann and Dempsey [1, 4]. However, I think that the presence of an end-spurt is also at odds with Noakes’ central governor model.
In fact, a subconscious intelligent system capable of regulating in anti...
Dear Sir/Madam
I am extremely concerned by the article by Cools et al. The paper offers an algorithm to the differentiation of external from internal impingement. The basis of their differentiation is purely on the relocation test alone. The only article they reference for this fact is Blevins (1997), which only refers to rotator cuff pathology in athletes. The authors also clearly state the inaccuracy of the re...
I had lateral epicondylitis surgery in January 3, 2008, wore a cast for two weeks then about three weeks of physical therapy and sent back to work on light duty and first of March 2008 I was put back to full work duty and physical therapy was stopped also. I am still in pain and my doctor has closed my case even though he informed me that injury would only get worse as long as I continue to perform my job as a city lette...
Doping can severely affect individual’s health.[1] The international community took action and nowadays an advanced mechanism to tackle doping in sport and recreational activity exists (www.wada.com).
In a recent Warm up section of the Journal, Pluim presented her view of sins and cheating, based on the International Tennis Federation statistics. Focusing on “social drugs” and failure to comply with therapeuti...
In an overview of the 40 most recent cases of doping in tennis, Babette Pluim highlighted that in only 13 of the cases (32%) was a prohibited substance taken to enhance performance, whereas most frequently banned substances were taken with no intent to enhance performance or without (significant) fault or negligence.[1] I definitely agree that products that are on the list of prohibited substances should be critically r...
I have just had a book published called "A football Goalpost Killed My Son," it is published by www.chipmunkapublishers.co.uk I have been campaigning for goalpost safety in the UK for 17 years and hope for legislation eventually. I decided to write my book after my first book was published early this year. My first book is mainly about bringing up a child with complex special needs, but contained a chapter about my sons...
The study presented by Hamish Kerr et al on "Collegiate rugby union injuries..." deserves comment.In a general sense the injury pattern may be atrributed to the confrontational type of game that the players had been taught.The tackle features as the event with more injuries occurring as illustrated in the study.In this type of game the fact that T-boning occurs, that is, where the ball carrier runs directly towards an onc...
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