BJSM Podcast

Professor Jon Drezner, a world authority on Sports Cardiology and vastly experienced Sport & Exercise Medicine physician, kindly gives us his time on this BJSM podcast to fill us in on updates in the Sports Cardiology world. Covering everything from high-risk groups, to the subsequent management of ‘positive’ screening results, this podcast will ensure that the listener is very much up-to-date with the latest research & developments in Sports Cardiology. For more information & a deeper-dive into the publications mentioned: Sports cardiology: preventing sudden cardiac death https://bjsm.bmj.com/content/48/15/1133 BMJ Learning ECG Interpretation Course: https://learning.bmj.com/learning/course-intro/.html?courseId=10042239 International criteria for electrocardiographic interpretation in athletes: Consensus statement https://bjsm.bmj.com/content/51/9/704 Outcomes of Cardiac Screening in Adolescent Soccer Players (NEJM) https://www.nejm.org/doi/full/10.1056/NEJMoa1714719 Cardiac arrest survival greatly increases when bystanders use an automated external defibrillator - Circulation Journal Report https://newsroom.heart.org/news/cardiac-arrest-survival-greatly-increases-when-bystanders-use-an-automated-external-defibrillator

Minimalist? Maximalist? Zero drop? Is there really one running shoe paradigm to rule them all? On this week’s episode, Dr. Chris Napier PhD (T: @runnerphysio) and Paul Blazey (T: @Blazey85) joins BJSM’s Daniel Friedman (T:@ddfriedman) to debate running shoe prescription. Chris is a Clinical Assistant Professor in the Department of Physical Therapy at the University of British Columbia, where he recently obtained his his PhD (“Running biomechanics and injury prevention”) in 2018. Since becoming a physio, Chris has specialised his training with postgraduate studies in manual therapy and sport physiotherapy. He is currently a physiotherapist of Athletics Canada. Chris competed at the national level as a successful middle-distance runner and today is an avid skier, kayaker, and marathoner. A self-proclaimed encyclopaedia of running shoes, Paul is a physio who has spent time working with Crystal Palace and Arsenal FC, with a keen interest in managing running and triathlon injuries. He left his physiotherapy clinic in England behind in 2017 to take up research at the University of British Columbia and currently works as a senior associate editor for BJSM. Like Chris, Paul is an accomplished runner with envious marathon times.   In this 20 minute conversation, Chris and Paul discuss:        Eliud Kipchoge’s recent marathon world record        Different running shoes’ effects on running economy        Running shoe prescription and tips for choosing shoes in-store        Gait retraining        The future of running shoes   Further reading: Brick NE, McElhinney MJ, Metcalfe RS. The effects of facial expression and relaxation cues on movement economy, physiological, and perceptual responses during running. Psychology of Sport and Exercise. 2018 Jan 1;34:20-8. https://www.sciencedirect.com/science/article/pii/S1469029217303461 Napier C, Willy RW. Logical fallacies in the running shoe debate: let the evidence guide prescription. https://bjsm.bmj.com/content/early/2018/10/22/bjsports-2018-100117 Hoogkamer W, Kram R, Arellano CJ. How biomechanical improvements in running economy could break the 2-hour marathon barrier. Sports Medicine. 2017 Sep 1;47(9):1739-50.https://link.springer.com/article/10.1007/s40279-017-0708-0 Barnes KR, Kilding AE. A Randomized Crossover Study Investigating the Running Economy of Highly-Trained Male and Female Distance Runners in Marathon Racing Shoes versus Track Spikes. Sports Medicine. 2018:1-2. https://link.springer.com/article/10.1007/s40279-018-1012-3 Nigg BM, Baltich J, Hoerzer S, Enders H. Running shoes and running injuries: mythbusting and a proposal for two new paradigms:‘preferred movement path’and ‘comfort filter’. Br J Sports Med. 2015 Jul 28:bjsports-2015. https://bjsm.bmj.com/content/49/20/1290.short

Is this a dysplasia problem? Or is this an impingement problem? Did you know that a young adult with a non-arthritic hip problem sees an average of 4.2 health care providers before a diagnosis of impingement is made?! On this week’s podcast, Dr J.W. Thomas Byrd MD (T:@nashvillehipmds) joins AMSSM’s Sports Medcast (T: @TheAMSSM) to discuss femoroacetabular impingement and hip dysplasia. Dr. Byrd founded the Nashville Hip Institute to help treat patients with complex hip disorders using advanced surgical techniques. A recent Past President of both the International Society for Hip Arthroscopy (ISHA) and the Arthroscopy Association of North America (AANA), Dr Byrd has pioneered many of the surgical techniques for hip arthroscopy commonly employed throughout the orthopaedic world and invented numerous instruments that have revolutionised aspects of orthopaedic surgery. He has been one of the leaders for defining and developing the role of less invasive arthroscopic techniques in and around the hip. Dr. Byrd is currently the team physician for the Tennessee Titans and consults for many professional sports teams. https://nashvillehip.org/jw- thomas-byrd-md-orthopedic-hip-specialist-nashville-tn/  In this 20 minute conversation, Dr. Byrd addresses the following topics:        What is FAI?        The work-up of FAI – examination and imaging        Management of FAI - when to intervene        Hip dysplasia in athletes        Common errors in managing hip pathology

Knowledge translation with Dr Sandro Demaio. Episode #354 There are over 1.5 million papers published each year…but as many as 50% of them are never read by anyone other than their authors, referees and journal editors. How can we move research from the laboratory, the academic journal, and the medical conference into the hands of people and organisations who can put it to practical use? On this week’s podcast, Dr Sandro Demaio (@SandroDemaio) joins BJSM’s Daniel Friedman (@ddfriedman) to discuss how we can bridge the gap between evidence and practice in the real world. After leaving his role as the WHO’s medical officer for NCDs and Nutrition, Sandro was appointed the CEO of EAT (https://eatforum.org/contributor/dr-alessandro-demaio), a non-profit startup focused on food and sustainability. Formerly an Assistant Professor and Course Director at the University of Copenhagen’s School of Global Health, and a postdoctoral fellow at Harvard, Sandro regularly shares his knowledge and ideas at international conferences, universities and public events. He founded the PLOS Global Health Blog, NCDFREE (https://ncdfree.org)  and festival21 (https://www.festival21.com.au), and is currently a bestselling author and TV host. http://sandrodemaio.com/about   In this 20 minute conversation, Sandro addresses the following topics:        The importance of knowledge translation        Ways in which knowledge translation can be achieved        Overcoming the “leaky research pipeline”        Social media tips for clinicians

Management of shoulder pain has been estimated to account for 4.5 million visits to the doctor and $3bn (£2.3bn; €2.6bn) each year in the US alone. 44-70% of patients with shoulder pain are diagnosed with shoulder impingement syndrome. Although various non-operative treatment modalities are recommended as initial treatment for patients with shoulder impingement, subacromial decompression has become one of the most frequently performed orthopaedic procedures in the world...BUT DOES IT ACTUALLY HELP? On this week’s episode, Prof. Teppo Järvinen (@shamteppo) joins BJSM’s Daniel Friedman (@ddfriedman) to discuss the results from his latest clinical trial – the FIMPACT trial - that was recently published in the BMJ. Teppo is a Professor of Orthopaedics and Traumatology at the University of Helsinki and Helsinki University Hospital, and is head of the Finnish Centre for Evidence-Based Orthopaedics. He recently organised the 2018 Too Much Medicine symposium that took place in Helsinki, Finland. http://too-much-medicine.com/ In this 15 minute conversation, Prof. Järvinen addresses: ∙ shoulder impingement and subacromial decompression ∙ a brief overview of the FIMPACT trial ∙ the results of the trial and how to integrate the findings into clinical practice ∙ what does too much medicine mean for orthopaedic surgery ∙ the future of sham surgery Further reading: Paavola Mika, Malmivaara Antti, Taimela Simo, Kanto Kari, Inkinen Jari, Kalske Juha et al. Subacromial decompression versus diagnostic arthroscopy for shoulder impingement: randomised, placebo surgery controlled clinical trial BMJ 2018; 362 :k2860 https://www.bmj.com/content/362/bmj.k2860 FIDELITY infographic: https://www.bmj.com/content/bmj/362/bmj.k2860/F1.large.jpg Beard, David J., et al. "Arthroscopic subacromial decompression for subacromial shoulder pain (CSAW): a multicentre, pragmatic, parallel group, placebo-controlled, three-group, randomised surgical trial." The Lancet 391.10118 (2018): 329-338. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32457-1/fulltext Sihvonen R, Paavola M, Malmivaara A, et al. Arthroscopic partial meniscectomy versus sham surgery for a degenerative meniscal tear. N Engl J Med 2013;369:2515–24. https://www.nejm.org/doi/10.1056/NEJMoa1305189?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dwww.ncbi.nlm.nih.gov FIDELITY study video: https://www.youtube.com/watch?v=RaDWkJHmEB0 Savulescu, Julian, Karolina Wartolowska, and Andy Carr. "Randomised placebo-controlled trials of surgery: ethical analysis and guidelines." Journal of medical ethics (2016): medethics-2015.https://jme.bmj.com/content/42/12/776

We catch up with BJSM Deputy Editor, Physiotherapist and hugely influential researcher Mario Bizzini. We discuss everything from the evidence behind injury prevention programmes, maximising their implementation, and the upcoming #SportSuisse2018 Links below: JOSPT Clinical Guideline https://www.jospt.org/doi/10.2519/jospt.2018.0303 Knakentroll (Swedish Group) - https://blogs.bmj.com/bjsm/2016/11/02/football-injuries-prevention-swedish-football-injury-warriors-martin-markus/ FIFA11+ https://bjsm.bmj.com/content/49/9/577 The Santa Monic Sports Medicine Research Foundation – The PEP Program: Prevent injury and Enhance Performance http://www.aclstudygroup.com/pdf/pep-program.pdf Implementing Injury Prevention – Aspetar Journal - http://www.aspetar.com/journal/viewarticle.aspx?id=406#.W6TYAf4zbEY Reference to Implementation Studies by Dr Alex Donaldson & colleagues in AFL https://www.ncbi.nlm.nih.gov/pubmed/30217833 #Sportsuisse2018 https://sportsuisse2018.ch/

Type 2 diabetes is a complex systems disease, caused by interactions between lifestyle and genes. It is an illusion to believe that it can be cured by medication. Lifestyle change should always be at the heart of treatment. Hanno Pijl is an internist-endocrinologist and professor of Diabetology at the Leiden University Medical Center (LUMC) In Leiden, The Netherlands. He co-authored over 250 papers in peer reviewed scientific journals, primarily related to obesity and type 2 diabetes. He has been a member of the Dutch Health Council (standing committee on nutrition) from 2008-2016. He currently co-chairs the Dutch Innovation center for Lifestyle Medicine (www.nilg.eu), a joint effort of LUMC and the Dutch Organisation of Applied Science (TNO) focusing on lifestyle interventions in health care.   Esther van Zuuren is a dermatologist at the Leiden University Medical Centre, but apart from that and more relevant for now is that her expertise lies in Evidence Based Medicine. She has been with Cochrane for almost 20 years, has held the position of Key Editor and Methods editor for Cochrane Skin group for several years and conducted over 30 systematic reviews on a wide variety of topics. Furthermore, she is member of the GRADE working group, is a Recommendations Editor for DynaMed Plus (clinical evidence-based reference tool for clinicians) and Associate Editor for Systematic Reviews for the British Journal of Dermatology. In our 20 min conversation we discuss Dietary advice for people with type 2 diabetes The importance of other lifestyle measures Effects of lifestyle intervention in clinical practice Patient preferences

Do I really need this test, treatment or procedure? What are the downsides? What happens if I do nothing? And are there simpler, safer alternatives?   Dr. Ray Moynihan (@raymoynihan) joins BJSM’s Daniel Friedman (@ddfriedman) to discuss the growing problem of overdiagnosis and overtreatment, and what is being done to wind back the harms of too much medicine.       Ray is an Australian academic, author and award-winning health journalist who completed his PhD on overdiagnosis in 2015 at the Centre for Research in Evidence-Based Practice at Bond University in Australia, where he is also a senior research fellow. Having reported across print, radio, television and social media, Dr Moynihan has worked at the ABC TV’s investigative program, Four Corners and the 7:30 Report, and The Australian Financial Review. He has also developed an impressive body of academic work published in the Lancet, the New England Journal of Medicine, PLOS ONE and the BMJ.   Dr. Moynihan has won several awards for his investigative journalism, and his book ‘Selling Sickness’ (2005) was described in the New York Times as a “compelling case” and has been translated into a dozen languages. His fourth book, ‘Sex, Lies & Pharmaceuticals’ was released globally in 2010 and generated widespread interest internationally.   Dr Moynihan hosts the very popular podcast, ‘The Recommended Dose’, that is produced by Cochrane Australia and co-published by the BMJ. https://soundcloud.com/therecodo   In this 25 minute conversation, Dr Moynihan explains the drivers of too much medicine and addresses:        embracing healthy scepticism in healthcare        the threat of too much medicine to our health        the problem with diagnostic labels        his ground-breaking discovery of a dangerous new disease        what clinicians should do to practice ‘just the right amount’ of medicine (Goldilocks Principle)

We were thrilled to catch up again with Dr Andrew Murray, the recently appointed Chief Medical Officer to the PGA European Tour, European Tour Performance Institute, and Ryder Cup Europe. He is universally known for his work promoting physical activity for health, his ultra-endurance challenges, and for leading the ‘Golf and Health project’. In this podcast he covers everything from the health benefits of golf, how to produce a consensus statement, the WHO’s GAPPA, to how to overcome various factors affecting knowledge translation #Gold Various papers/resources are referred to throughout the podcast, links to which can be found below: http://bjsm.bmj.com/lookup/doi/10.1136/bjsports-2018-099509 http://bjsm.bmj.com/lookup/doi/10.1136/bjsports-2018-099771 The relationships between golf and health: a scoping review https://bjsm.bmj.com/content/51/1/12 Previous BJSM podcast on Golf & Health: https://soundcloud.com/bmjpodcasts/andrew-murray-1 The World Health Organization’s Global Action Plan for Physical Activity: Prof Fiona Bull https://soundcloud.com/bmjpodcasts/the-world-health-organizations-global- action-plan-for-physical-activity-prof-fiona-bull?in=bmjpodcasts/sets/bjsm-1 It is time to replace publish or perish with get visible or vanish: opportunities where digital and social media can reshape knowledge translation https://bjsm.bmj.com/content/early/2017/11/17/bjsports-2017-098367 We hope you enjoyed the podcast – get in touch with us via social media if you have any questions for @docandrewmurray

Contrary to the long held contention that low fat diets are best for people with type 2 diabetes (DM2), the totality of current evidence suggests that low carb diets are at least as effective in ameliorating metabolic health in DM2. In fact, low carb seems to be somewhat better, particularly in the short to medium term, although the evidence is of moderate certainty.   On this week’s episode Prof Hanno Pijl (@HannoPijl) and dr Esther van Zuuren (@Ezzoef) join Dr Aseem Malhotra (@DrAseemMalhotra) to discuss the most appropriate diet for people with DM2   Hanno Pijl is an internist-endocrinologist and professor of Diabetology at the Leiden University Medical Center (LUMC) In Leiden, The Netherlands. He co-authored over 250 papers in peer reviewed scientific journals, primarily related to obesity and type 2 diabetes. He has been a member of the Dutch Health Council (standing committee on nutrition) from 2008-2016. He currently co-chairs the Dutch Innovation center for Lifestyle Medicine (www.nilg.eu), a joint effort of LUMC and the Dutch Organisation of Applied Science (TNO) focusing on lifestyle interventions in health care.   Esther van Zuuren is a dermatologist at the Leiden University Medical Centre, but apart from that and more relevant for now is that her expertise lies in Evidence Based Medicine. She has been with Cochrane for almost 20 years, has held the position of Key Editor and Methods editor for Cochrane Skin group for several years and conducted over 30 systematic reviews on a wide variety of topics. Furthermore, she is member of the GRADE working group, is a Recommendations Editor for DynaMed Plus (clinical evidence-based reference tool for clinicians) and Associate Editor for Systematic Reviews for the British Journal of Dermatology   In our 20 min conversation we discuss   Efficacy of low fat versus low carb diets in the treatment of type 2 diabetes The method of weighing the certainty of evidence we used in our systematic review of the literature Dietary recommendations for people with type 2 diabetes https://academic.oup.com/ajcn/article-abstract/108/2/300/5051863