Wellness Check: Exercise

Various single and multistructure knee injuries increase the odds of knee osteoarthritis

1. In this systematic review and meta-analysis, moderate certainty evidence suggested that damage to various structures of the knee may increase the odds of symptomatic osteoarthritis (OA).

2. Furthermore, modifiable risk factors for OA remain more established than modifiable risk factors for post-traumatic OA.

Evidence Rating Level: 1 (Excellent)

OA is the most common joint condition affects millions of people worldwide. Post-traumatic OA represents at least 12% of these cases. Unlike the availability of high-level evidence to guide prevention of post-traumatic knee OA, there is a gap that remains in how to delay or prevent the development of OA after a traumatic injury. As a result, the objective of the present systematic review and meta-analysis was to identify and quantify the magnitude of modifiable and non-modifiable risk factors for symptomatic and structural knee OA following trauma.

Of 5621 identified records, 66 randomized controlled trials and cohort studies (n=873,785) were included in the final analysis between 2000 and 2021. Studies were included if they assessed a potential risk factor for OA for a minimum of 2-years after a traumatic knee injury. Studies that did not report knee trauma were excluded. Risk of bias was assessed using the Quality in Prognosis Studies (QUIPS) tool. Data analysis was performed using random effects models as well as semiquantitative synthesis. Assessment for prognostic factors was performed using the modified Grading of Recommendations Assessment, Development and Evaluation (GRADE).

Results demonstrated that moderate certainty evidence suggested that collateral ligament, cruciate ligament, chondral, meniscal, patellar/tibiofemoral dislocation, fracture and multistructure injuries may increase the odds of symptomatic osteoarthritis (OA). Furthermore, there is a lack of high-certainty evidence for modifiable risk factors for OA after traumatic injury, unlike for non-traumatic OA. Despite these results, this study was limited as the odds of OA may have been underestimated by including data from early timepoints when structural changes and/or symptoms were less prevalent. Nonetheless, the present study represents the most extensive synthesis, analysis, and presentation of potential risk factors for OA after knee trauma to date.

Regular physical activity may improve vaccine effectiveness against COVID-19 outcomes

1. In this South African case-control study, there was an inverse dose-response association with activity levels and the risk of COVID-19 admission.

2. Furthermore, high levels of activity in fully vaccinated individuals conferred elevated levels of vaccine effectiveness.

Evidence Rating Level: 3 (Average)

Exercise immunology is a growing field that has demonstrated how regular moderate intensity physical activity improves immunosurveillance. Currently, the most studied vaccine in the context of chronic physical activity and vaccine effectiveness is the influenza vaccine. In contrast, evidence for the COVID vaccine is lacking. As a result, the objective of the present case-control study was to assess the effectiveness of low, moderate, and high physical activity levels on vaccine effectiveness of a single dose of Ad26.COV2.S (Janssen/Johnson & Johnson).

The present test negative case-control study design was a retrospective analysis that used anonymized Discovery Health and Vitality client data from February 2021 to October 2021 in South Africa. Of 269,101 patients with COVID-19 PCR tests, 196,444 were included in the analysis. Patients were excluded if they received vaccines other than Ad26.COV2.S, had indeterminate test results, a negative result within 21 days of a positive test result, and a negative test within 7 days of each other. Individuals were mapped to physical activity subgroups using their average monthly physical point allocation in the 2 years prior to the study start date. Statistical analysis was performed using a modified Poisson regression model.

Results demonstrated that compared to individuals with low activity levels, vaccinated individuals with moderate and high activity levels had a lower risk of COVID-19 admission in a dose-response fashion. Furthermore, fully vaccinated individuals with high levels of activity had a vaccine effectiveness of 86% against COVID-19 hospitalization. Despite these findings, the study was limited by the lack of assessment of confounding variables such as diet, alcohol consumption, and sleeping patterns. Nonetheless, the study’s large sample of vaccinated individuals in whom the majority had directly measured physical activity data strengthens the study’s findings. This suggests physical activity may play a role in COVID-19 vaccine effectiveness against hospitalization.

Mindfulness-based programs may improve mental health outcomes in elite athletes

1. In this systematic review and meta-analysis, mindfulness-based programs (MBP) helped to improve mental health-related outcomes in elite athletes.

2. Furthermore, large, but non-significant effect sizes were found for reduced depression in elite athletes.

Evidence Rating Level: 2 (Good)

Elite athletes may experience mental health symptoms that exceed those of non-athletes due to the unique stressors placed upon them. MBPs have previously been associated with improvements in athletic performance, but have not been evaluated in the context of mental health. As a result, the objective of the present systematic review and meta-analysis was to determine the effect MBPs have on mental health of elite athletes.

Of 2386 screened records, 12 randomized controlled trials (n=614 athletes; 75% men) were included in the final analysis. Dates ranged from 2011-2020. Studies were included if they were randomized controlled trials which assessed the effectiveness of MBP on mental health outcomes in elite athletes of any age. Studies were excluded if the MBP lasted <4 weeks or if non-elite athletes were included in the population. Study quality was evaluated using the Joanna Briggs Institute’s checklist for randomized controlled trials. Certainty of the evidence was measured using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework. Several statistical methods were used including random effects models, exploratory subgroup analyses and meta-regression models.

Results demonstrated that mindfulness-based programs (MBP) reduced symptoms of anxiety, stress, and increased psychological well-being in elite athletes. Furthermore, two of three studies reported large significant reductions in depression; however, one reported small, non-significant results. Despite these findings, the study was limited by the significant proportion of male athletes (75%) and the minimal inclusion of para-athletes (3%). However, the present study demonstrated the potential of MBPs to reduce both general symptoms of anxiety and competition-specific anxiety which may aid in supporting overall performance.

Self-monitoring of physical activity may be enhanced through additional interventions

1. In this systematic review and meta-analysis, prescribed goal and human counseling increased physical activity (PA) more than self-monitoring.

2. Furthermore, remote phone/video counselling was found to be highly effective at increasing physical activity interventions.

Evidence Rating Level: 2 (Good)

Self-monitoring of physical exercise through pedometers, fitness trackers and smartphone apps have become a cornerstone in improving PA adherence. Currently, the effect of adding supplemental interventions to self-monitoring, to further enhance PA adherence, has not been well studied. As a result, the objective of the present systematic review and meta-analysis was to determine whether PA interventions that combine self-monitoring using activity monitors with other intervention components provides an additional benefit compared to self-monitoring alone.

Of 2251 identified records, 85 (n=12 057 participants) were included from 2007 to 2022. Studies were included if they compared an intervention using self-monitoring with an activity monitor to increase PA, to an intervention that comprised of the same treatment as the active control plus any additional component intended to increase PA. Studies were excluded if the active control arm received anything that was not also contained in the intervention arm. Effect measures were mean difference in daily step count between intervention and control arms. Risk of bias was assessed using the Cochrane Risk of Bias tool. Statistical analyses were performed using random-effects models.

Overall, results demonstrated that combining interventional components with self-monitoring led to an additional benefit of approximately 1000 steps a day, compared to self-monitoring alone, post-intervention. Furthermore, prescribed goal and human counseling increased physical activity (PA) more than self-monitoring. Specifically, remote phone/video counselling was found to be highly effective at increasing physical activity interventions. Despite these findings, the study was limited by the inclusion of several low-quality studies (39 of 75 overall studies identified to be low risk of bias). Nonetheless, the results suggest that combining self-monitoring with other components may provide additional benefits to PA with particular emphasis towards counselling such as remote phone/video counselling.

Image: PD

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