Changes in technique, footwear and intervention prevent running-related knee injuries
1. In this study, technical modifications such as softer landings were shown to reduce the risk of knee injury by two-thirds.
2. Active (eg technical rehabilitation and exercise therapy) and passive (foot orthoses, osteopathic manipulations) activities can reduce patellofemoral pain.
Level of evidence assessment: 1 (Excellent)
Although running is one of the most popular forms of exercise and offers significant health benefits, injuries are common and can lead to long recovery periods. There is currently a need to provide an up-to-date summary of running injury prevention and management strategies. Therefore, the aim of this 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 records identified, 30 trials (18 prevention, 12 management) were included from the inception of the database until May 2022. Studies were included if they compared interventions aimed at preventing or managing injury related to running with another intervention or control. Participants had to be free of pre-existing injuries at baseline. Studies were excluded if they included military participants, primarily sprinters or sports other than running. The primary outcome of preventive interventions was the incidence of running-related knee injuries. The main outcome of the management interventions was self-reported knee pain. Risk of bias was assessed using the Cochrane Risk of Bias V.2 tool. Data were analyzed using random-effects meta-analysis.
The results showed that technical modifications such as softer landings can reduce the risk of knee injury by two-thirds. In addition, both active (eg technical rehabilitation and exercise therapy) and passive (foot orthoses, osteopathic manipulations) techniques can reduce patellofemoral pain. Despite these findings, the present study was limited not only by the low certainty of the evidence, but also by the varying definitions of ‘running-related injury’ which may have influenced the magnitude of the effect of the interventions. Nonetheless, this study provides early insight into strategies that can be adopted to reduce 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 higher dropout rate in studies that included exercise as a treatment modality, compared to antidepressant interventions.
Level of evidence assessment: 1 (Excellent)
Antidepressants are an integral part of treating depression; however, high costs, fear of addiction, and adverse effects may limit real-world use. Although many guidelines have encouraged the use of exercise as a treatment modality, its effectiveness has been understudied compared to antidepressants. Therefore, the aim of this 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 records identified, 21 studies were included in the analysis (n=2,551 participants) from January 1990 to January 2022. Studies were included if they investigated the effectiveness of exercise and/or antidepressants against treatment alone or control/placebo on symptom severity in patients with non-severe depression. The primary outcome measure was the severity of depressive symptoms based on a depression scale. Risk of bias was assessed using the Cochrane risk of bias assessment tool. Statistical analysis was performed using frequentist network meta-analysis according to the Hartung-Knapp-Sidik-Jonkman method.
The results demonstrated that all treatments had similar benefits on depressive symptoms in patients with non-severe depression, compared to controls. In comparing each of the treatment modalities with each other, it is interesting to note that the exercise interventions had higher dropout rates than those of the antidepressant interventions. However, collectively, no treatment was superior to the other. Despite these findings, this review was limited due to the overall low number of studies, thus precluding the ability to assess publication sources and heterogeneity bias. Nevertheless, this study was significant in suggesting that there was no difference in effectiveness between exercise and antidepressants, which may guide future treatment modalities in patients with non-severe depression.
Adding weightlifting exercises may further reduce mortality risk
1. After adjusting for moderate-to-vigorous aerobic physical activity (MVPA), weightlifting was associated with a 9% reduced risk of all-cause and cardiovascular mortality.
2. Among adults reporting no aerobic MVPA, any weightlifting exercise was associated with 9-22% lower all-cause mortality.
Level of evidence assessment: 2 (good)
Although the evidence is undisputed regarding the health benefits of aerobic MVPA, most of the health benefits of muscle-strengthening exercise (MSE) come from studies with specific populations and shorter-term outcomes. Weightlifting is a popular modality of MSE; however, its relationship to mortality has been understudied. Therefore, the aim of this prospective study was to examine the relationship between weightlifting and all-cause, cardiovascular, and cancer mortality.
The current study used data from the Prostate, Lung, Colorectal and Ovarian Cancer (PLCO) Screening Trial which included 154,897 patients. In 2006, follow-up questionnaires were sent to 104,002 participants. Of these, 99,713 (46.8% male) eligible patients completed the follow-up questionnaire in 2006 and were then followed 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 family or physician reports. Statistical analysis was performed using Cox proportional hazards regression.
The results demonstrated that after adjusting for aerobic MVPA, weightlifting was associated with a 9% reduced risk of all-cause and cardiovascular mortality. Additionally, among adults reporting no aerobic MVPA, any weightlifting exercise was associated with 9–22% lower all-cause mortality. Without adjusting for MVPA, weightlifting was also associated with a decrease in cancer mortality. Despite these findings, the present study was limited by its homogeneity (primarily non-Hispanic white males). Nonetheless, the study supported the inclusion of weightlifting as an important health behavior to improve longevity in older adults.
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