Kids Cardio Health Falls Short

The American Heart Association lists seven criteria for ideal cardiovascular health in U.S. children, and the vast majority don’t meet them. (go to article)


Breast Cancer Early Detection vs. Overdiagnosis

Mammography for women who have no signs of breast cancer leads to more overdiagnosis than it does early breast cancer detection.
(go to article)


Harnessing Your Kid’s Defiance “For Their Own Good”

Researchers are testing the effectiveness of framing good habits as acts of defiance. The results are promising. (go to article)


Inflammation: It’s Complicated

Just as a fire can provide warmth and light, the inflammation that helps heal us, when left unchecked, becomes analogous to a devastating wildfire. (go to article)


Tech Report: Combined Training and VR Can Lower Fall Risk

Forcing elderly subjects to adjust their steps on a treadmill by imposing obstacles in virtual reality improves later incident rate of falls.
(go to article)


Are Fitness Trackers Worth it?

Researchers attempted to isolate the technology variable specifically, not the monitoring of diet and activity that is thought to be important to weight loss plans. (go to article)


The Clinic

Eight Months of Patellar Pain
(go to article)

What Are My Options For Osteochondritis?
(go to article)

Where the Tendon Meets the Hamstring, Chronic Pain
(go to article)

Even Cycling Can Trouble The ITB
(go to article)


The Back Page

The RUN A MILE DAYS Youth Campaign

AMAA’s MCM Sports Medicine Conference 2016:
Big move across the Potomac

(go to page)


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New IOC Paper Weighs in on Training During Pregnancy

The International Olympic Committee has issued a detailed statement on the effects of training—both intensely and moderately—on specific aspects of fetal development and natal outcomes. The evidence statement was based on systematic research of the existing literature on pregnancy and exercise.. The group was able to draw conclusions on the effects of exercise on fetal heart rate, the risk of miscarriage, fetal growth and risk of preterm birth, among other outcomes.

For each section of the statement, available databases were searched for terms in various combinations, including pregnancy, exercise, leisure, recreational activity, postpartum, miscarriage, cesarean section, etc. The researchers looked for studies on PubMed, Embase, Cochrane, PEDro, Web of Science and SPORTDiscus.

Fetal heart rate (FHR)
Maternal exercise, regardless of intensity, triggers an increase in FHR; they report that on average this increase is by about 10 to 15 bpm. Prolonged high-intensity exercise, they note, could “compromise fetal well-being,” though this seems to be largely theoretical for now because in all of the studies they looked at, FHR returned to normal once the exercise ceased. They also found that HR decelerations were sometimes reported during exercise, these were “transitory” and only “rare and sporadic.” No newborn abnormalities related to these FHR changes were reported.

Miscarriage
Incidents of miscarriage (with “early miscarriage” usually defined as occurring before week 22 of pregnancy), is greater than 10% in the general population, so not uncommon. Early miscarriages account for about 80% of miscarriages. Prevalence is tied to maternal age, with just 5 to 7% of women under age 35 and 22% of women over 40 experiencing miscarriage at any time during pregnancy.

While fertility treatment raises risk, the major cause of miscarriage is thought to be chromosomal abnormalities of the fetus. Female athletes may sustain a miscarriage, then, just as any woman. But does strenuous exercise increase the risk?

In a cohort of over 92,000 women, of whom 3,187 had experienced a miscarriage, 2,551 were interviewed about their exercise habits. The data were obtained either during pregnancy or after an early miscarriage. The risk of early miscarriage increased as the amount of exercise increased, in particular for women in their first trimester who exercised more than 7 hours per week compared to non-exercisers. High-impact exercise such as jogging and racquet sports was also associated with an increased risk of early miscarriage. However, there was no association between exercise and the risk of miscarriage after week 18.

High-impact or highly strenuous physical activity may then be associated with a higher risk of miscarriage during the “fetal implantation phase,” during which the blastocyst can still be flushed out of the uterus. This phase usually ends by day 24. Repetitive heavy lifting during the first trimester also might increase the risk for miscarriage. Accordingly, the IOC says elite athletes "may consider" limiting such activity.

A systematic review concluded that light to moderate intensity physical activity does not increase the risk of miscarriage and may perhaps decrease it. (continued)

Can We Fight the Rise of the Superbug?

As cold and flu season again rears its ugly head, it bears repeating that antibiotics do not fight infections caused by viruses like colds, flu, bronchitis and many sinus and ear infections. Instead, symptom relief is generally the best or only course of action for viral infections.

In fact, it is extremely important that we curb our overuse of antibiotics to decelerate the evolution of antibiotic-resistant bacterial strains. But it is not sufficient. Antibiotic resistance, even in the most prudent use scenarios, is still fast becoming a critical public health issue. We do not appear to have the mechanisms in place to keep pace with the rapid evolution of bacteria, in large measure due to a lack of public policy legislation combined with little free market incentive to develop the next generation of antibiotics.

A political morass
Funding for antibiotic research, as lifesaving as it obviously is, is not politically sexy, given that scientific progress is at best incremental and always uncertain, and so definitive legislative action eludes us.

The government is not only always fighting the perception that it has already over-committed public money (“read my lips”), but it is also too short-sighted to swiftly usher in policy changes that do not result in rapid and visible—and so politically attractive—change. The word "research" sounds just as nebulous and expensive as it actually is. (continued)


editorial board

Kenneth Cooper, MD
Kevin Beck
Jack Daniels, PhD
Randy Eichner, MD
Mary Jo Feeney, MS, RD
Mitchell Goldflies, MD
Paul Kiell, MD
Sarah Harding Laidlaw, MS, RD
Paul Langer, DPM
Douglas Lentz, CSCS
Todd Miller, MD
Gabe Mirkin, MD
Col Francis O’Connor, MD
Stephen Perle, DC, CCSP
Pete Pfitzinger, MS
Charles L. Schulman, MD
Bruce Wilk, PT, OCS
Michael Yessis, PhD
Jeff Venables, Editor

board of directors

Jeff Harbison, President
Bill Young, Secretary-Treasurer
Immediate Past-President
(Vacant) Vice President
Robert Corliss
Charles L. Schulman, MD, AMAA Pres.
AMAA President
Terry Adirim, MD, MPH
Gayle Barron
Sue Golden
Senator Bill Frist, MD
Jeff Galloway
Jeff Harbison
Ronald M. Lawrence, MD, PhD
Jeff Moore
Noel D. Nequin, MD
David Pattillo

Association Staff

Executive Director: Dave Watt
Project Consultant: Barbara Baldwin, MPH

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