Wellness Check: Exercise

2 Minute Medicine is pleased to announce that we are launching Wellness Check, a new series dedicated to exploring new research evidence focused on wellness. Each week, we will report on articles examining different aspects of wellness, including (but not limited to) nutrition, sleep, reproductive health, substance use and mental health. This week, we explore the latest evidence-based updates in exercise.

High intensity interval training may improve overall mental health

1. In this systematic review and meta-analysis, high intensity interval training (HIIT) led to small improvements in overall mental wellbeing compared to other forms of exercise in healthy populations and those with physical illnesses.

2. Compared to no exercise, those who participated in HIIT had moderate improvements in mental wellbeing, depression severity, and perceived stress compared to inactive individuals.

Evidence Rating Level: 1 (Excellent)

Compared to the general population, those who suffer from physical illness are known to suffer from higher rates of depression, anxiety and stress. High intensity interval training (HIIT) has been recently popularized due to its ability to achieve similar benefits compared to lower intensity sessions. However, due to the paucity of data on this topic, the aim of this systematic review and meta-analysis was to investigate the mental health benefits of HIIT in both healthy populations and those with physical illnesses, and to compare its effects to non-exercising individuals (non-active controls) and those performing other forms of exercise (active controls).

From 3659 screened records, 58 studies (3038 participants) were included from the database’s inception to July 2020. Included studies evaluated all forms of HIIT on mental health outcomes in healthy populations and those with physical illnesses. Studies reporting patients with a structural mental health diagnosis were excluded. The quality of the evidence was assessed through the Grading of Recommendations, Development and Evaluation criteria. Mental health outcomes were measured using the Mental Component Summary (MCS) score.

The results of this study demonstrated that HIIT leads to improvements in mental well-being, depression severity, and perceived stress compared with those who didn’t exercise. In addition, HIIT showed small improvements in mental health compared to active controls. It was also suggested that HIIT may improve psychological distress and sleep compared to non-exercising individuals; however, few RCT’s reported this finding. This study was limited by the mixed quality of the included studies which may limit interpretability. However, the study’s inclusion of a wide variety of physical conditions that hold a high mental health burden holds promise that HIIT may have a larger therapeutic role in the near future.

Running may increase injury risk in overweight children

1. In this cross-sectional study, overweight/obese children displayed higher ground reaction forces while running compared to children of healthy weight.

2. Overweight/obese children displayed higher hip, knee, and ankle joint moments while running compared to children of healthy weight.

Evidence Rating Level: 2 (Good)

The medical literature has demonstrated that excess body weight can distort movement patterns and lead to excessive joint stress. This may be especially problematic in children with excess body weight, as it puts them at a higher risk for injury and joint malalignments. As running is a popular form of weight loss, the present study sought to examine differences in various running mechanics such as joint moments and ground reaction forces in overweight/obese (OW/OB) children compared to healthy weight (HW) children.

This cross-sectional study recruited 42 self-selected children from the local community (17 OW/OB, 25 HW) between 8-12 yrs. Children were included if they were healthy and free of injury within the previous 3 months. Participants were placed in the OW/OB group if their BMI was ≥85^th percentile. Children underwent a single 2hr testing session of their running mechanics at a biomechanics laboratory. Multiple limb measurements were taken in the laboratory and 27 anatomical markers were identified using a modified Helen Hayes market set.

Following the 2hr testing session, results showed that the OW/OB group displayed greater peak vertical force, vertical impact peaks and vertical loading rates compared to HW. The OW/OB group also displayed greater hip, knee, and ankle joint moments compared to HW. The results of this study should be taken into consideration given its limitations. Of note, a universal running speed was used across all participants which may artificially distort the mechanics of OW/OB children compared to HW. However, the study’s use of multiple anatomical landmarks and standardized footwear aided in providing a strong collection of variables used to study gait mechanics. Altogether, this study was significant in suggesting running may increase the risk of injury amongst overweight children, warranting further studies.

Multimodal physical interventions may lower concussion symptom scores

1. Individuals with concussions with persistent symptoms were three times more likely to return to sport by 8 weeks if they received presentation-specific multimodal interventions.

2. In comparison to controls, multimodal interventions had a moderate effect in improving concussion symptom scores.

Evidence Rating Level: 1 (Excellent)

Concussions are a common injury that are known to be under-reported and undermanaged. Current recommendations suggest 24-48 hours of cognitive and physical rest followed by a stepwise return to physical activity. However, with emerging evidence for the incorporation of physical interventions such as subthreshold aerobic exercise, cervical therapy, vestibular and/or oculomotor rehabilitation, management may ultimately change. Therefore, the objective of the present systematic review and meta-analysis was to synthesize the available evidence and determine the influence of these physical interventions on acute and ongoing symptoms of concussion.

From 2977 identified articles,12 trials (647 participants) were included from database inception to September 2020. Studies were eligible if they examined the effect of subthreshold aerobic exercise, cervical therapy, vestibular therapy or oculomotor therapy on recovery following concussion (either acute or ongoing, from any cause). Studies that were not in English or were published in abstract form were excluded. The quality of the studies was found to be fair to excellent according to the PEDro scale.

The results of this study found that concussed individuals with persistent (>2 week) symptoms who received tailored multimodal interventions sustained a reduction in symptoms and were three times more likely to return to sports by 8 weeks. Furthermore, multimodal interventions were shown to have a moderate effect on improving concussion symptom scores compared to control. This study was limited by the small number of studies for certain interventions, which could have led to a bias in the results. However, this study identified 6 new randomized controlled trials of fair to excellent quality since the prior systematic review which has added additional evidence to support the use of physical interventions in the management of concussion symptoms.

Image: PD

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