Wellness Check: Exercise

Changes in technique, footwear and intervention prevent running-related knee injuries

1. In this study, technique modifications such as softer landings was shown to reduce knee injury risk by two-thirds.

2. Active (e.g. technique retraining and exercise therapy) and passive (foot orthoses, osteopathic manipulation) may reduce patellofemoral pain.

Evidence Rating Level: 1 (Excellent)

Although running is one of the most popular forms of exercise and provides significant health benefits, injury is common with the potential for prolonged periods of recovery. There is currently a need to provide an updated synthesis on prevention and management strategies of running injuries. As a result, the objective of the present systemic review of randomized controlled trials was to synthesize and critically appraise the evidence on the prevention and management of running-related knee injuries.

Of 4057 identified records, 30 trials (18 preventions, 12 management) were included from database inception to May 2022. Studies were included if they compared interventions aimed at prevention or management of running-related injuries with another intervention or control. Participants had to be free from pre-existing injury at baseline. Studies were excluded if they included military participants, primarily sprinters, or sports other than running. The primary outcome of prevention interventions was the incidence of running-related knee injury. The primary outcome for management interventions was self-reported knee pain. Risk of bias was assessed using the Cochrane Risk of Bias tool V.2. Data was analyzed using a random-effects meta-analysis.

Results demonstrated that technique modifications such as softer landings may reduce knee injury risk by two-thirds. Furthermore, active (e.g. technique retraining and exercise therapy) and passive (foot orthoses, osteopathic manipulation) may reduce patellofemoral pain. Despite these findings, the present study was limited not only by the low certainty of the evidence, but by the various definitions of “running-related injury” which may have influenced the effect size of the interventions. Nonetheless, this study provides early insight into strategies that may be adopted to decrease running related injuries.

Exercise is an effective alternative in the management of non-severe depression

1. In this systematic review and meta-analysis, there was no difference between exercise and antidepressant treatment in patients with non-severe depression.

2. Interestingly, there was a stronger dropout rate in studies including exercise as a treatment modality, compared to antidepressant interventions.

Evidence Rating Level: 1 (Excellent)

Antidepressants are integral in the treatment of depression; however, the high costs, fear of addiction, and adverse effects may limit real world usage. Though many guidelines have promoted the use of exercise as a treatment modality, it’s effectiveness has been minimally studied in comparison to antidepressants. As a result, the objective of the present systematic review and network meta-analysis was to compare the effectiveness of exercise and antidepressants versus either treatment alone, as well as their synergistic effects.

Of 23,209 identified records, 21 studies were included in the analysis (n=2551 participants) from January 1990 to January 2022. Studies were included if they investigated the efficacy of exercise and/or antidepressants against treatment alone or a control/placebo on symptom severity in patients with non-severe depression. The primary outcome was depressive symptoms severity based on a depression scale. Risk of bias was assessed using the Cochrane risk of bias assessment tool. Statistical analysis was performed using a frequentist network meta-analysis using the Hartung-Knapp-Sidik-Jonkman method.

Results demonstrated that all treatments had similar benefit on depressive symptoms amongst patients with non-severe depression, when compared to controls. Comparing each of the treatment modalities amongst one another, exercise interventions interestingly had greater drop-out rates compared to those on antidepressant interventions. However, collectively, no treatment was superior to the other. Despite these results, this study was limited due to the overall low number of studies, thereby precluding the ability to evaluate sources of publication and heterogeneity bias. Nonetheless, this study was significant in suggesting that there was no difference in effectiveness between exercise and anti-depressants which may guide future treatment modalities in patients with non-severe depression.

Adding weightlifting exercises may further reduce risk of mortality

1. After adjusting for aerobic moderate to vigorous physical activity (MVPA), weightlifting was associated with a 9% lower risk of all-cause and cardiovascular mortality.

2. Among adults reporting no aerobic MVPA, any weightlifting was associated with 9-22% lower all-cause mortality.

Evidence Rating Level: 2 (Good)

Though the evidence is undisputed for the health benefits of aerobic MVPA, most of the health benefits for muscle-strengthening exercise (MSE) come from studies with specific populations and shorter time outcomes. Weightlifting is a popular modality of MSE; however, its relationship with mortality has been understudied. As a result, the objective of the present prospective study was to examine the relationship between weightlifting and all-cause, cardiovascular, and cancer mortality.

The present study used data from The Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial which included 154,897 patients. In 2006, follow-up questionnaires were sent to 104,002 participants. Of these, 99,713 (46.8% men) eligible patients completed the follow-up questionnaire in 2006 who were then followed up through 2016 to determine mortality. The follow-up questionnaire prompted patients to list details about their exercise habits. Mortality data were obtained from study update questionnaires as well as reports from family or physicians. Statistical analysis was performed using Cox proportional hazards regression.

Results demonstrated that after adjusting for aerobic MVPA, weightlifting was associated with a 9% lower risk of all-cause and cardiovascular mortality. Furthermore, among adults reporting no aerobic MVPA, any weightlifting was associated with 9-22% lower all-cause mortality. Without adjusting for MVPA, weightlifting was also associated with decreased cancer mortality. Despite these findings, the present study was limited by its homogeneity (mainly non-Hispanic white men). Nonetheless, the study provided support for the inclusion of weightlifting as an important health behavior in improving the longevity of older adults.

Image: PD

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