Ew Derman

International Olympic Committee Consensus Statement: Molecular Basis of Connective Tissue and Muscle Injuries in Sport

Tendon and ligament injures cause significant loss of performance in sport and decreased functional capacity in the workplace. Many of these injures remain difficult to treat, and many individuals have long-term pain and discomfort. Animal studies of growth factor and cell-based therapies have shown promising results, but these treatments also can be misused to enhance athletic performance. The International Olympic Committee (IOC) now has high-level scientific advisors who can advise the IOC as to the use and abuse of these technologies.

Common injuries in cycling: prevention, diagnosis and management

Extracted from text ... SA Fam Pract 2005;47(7) 14 CPD Introduction The health benefits of participating in regular physical activity are well established, and prescribing exercise to prevent and treat chronic disease is becoming more frequent. In addition, medical insurers and medical schemes use various incentive schemes to encourage their members to engage in regular physical activity. Recreational cycling, as one of the options for regular exercise, is therefore also increasing in popularity. In South Africa, mass participation in recreational and competitive cycling events is growing. It is therefore not surprising that patients presenting with injuries related to cycling have also increased. As ..

Healthy lifestyle interventions in general practice

Abstract Chronic respiratory diseases, in particular chronic obstructive pulmonary disease (COPD), can be classified as a part of the chronic diseases of lifestyle. A lifestyle intervention programme is therefore an essential component of the non-pharmacological management of COPD and other chronic respiratory diseases. The main indication for referral to a lifestyle intervention programme is any symptomatic patient with either COPD or any other chronic respiratory disease, and who also has limited functional capacity. Following a comprehensive initial assessment, patients are recommended to attend either a group-based programme (medically supervised or medically directed, depending on the severity of the disease and the presence of any co-morbidities) or a home-based intervention programme. The main elements of the intervention programme are smoking cessation, exercise training (minimum of three times per week), education, psychosocial support and nutritional support. Regular monitoring should be conducted during training sessions, and a follow-up assessment is indicated after 2–3 months to assess progress and to re-set goals. Longer-term (56 months) intervention programmes are associated with better long-term outcomes.

Healthy lifestyle interventions in general practice: Part 1: An introduction to lifestyle and diseases of lifestyle

Abstract Poor lifestyle choices including physical inactivity, adverse nutrition and tobacco use are strongly associated with heart disease, diabetes, respiratory disease and cancer. These four diseases are responsible for over 50% of mortality worldwide. Yet lifestyle intervention is underemphasised in the undergraduate training of doctors and other health professionals. This article reviews the lifestyle factors related to chronic non-communicable disease and suggests small but meaningful interventions for general practitioners to incorporate into daily practice. The upcoming series to be published in Family Practice regarding “lifestyle modification in chronic disease states” is introduced.

Healthy Lifestyle Interventions in General Practice: Part 10: Lifestyle and Arthritic Conditions - Osteoarthritis

Abstract Chronic musculoskeletal disease is one of the most common causes of disability worldwide with considerable economic impact in health care. Osteoarthritis (OA) is the most common chronic musculoskeletal disease affecting a large proportion of the population with an increasing predicted prevalence in the next two decades. Regular physical exercise, nutritional intervention, psychological support and other lifestyle interventions are very important components of the non- pharmacological management of patients with OA. The main rationale to include regular exercise as part of a lifestyle intervention programme for OA is to improve muscle strength and proprioception, and to promote the other general health benefits of participating in regular physical activity. Nutritional intervention should focus on weight reduction while basic nutrients that are required for healthy joints should be provided. Glucosamine and chondroitin supplemention is commonly used and may reduce pain, improve function and reduce or arrest disease progression. Psychological intervention has a particular role in assisting with pain management.

Healthy lifestyle interventions in general practice Part 4: Lifestyle and diabetes mellitus

Abstract Diabetes mellitus, in particular Type 2 diabetes, can be classified as a chronic disease of lifestyle. A lifestyle intervention programme is therefore an essential component of the primary and secondary prevention (management) of diabetes mellitus. The main indication for referral to a lifestyle intervention programme is any patient with either pre-diabetes or established diabetes mellitus. Following a comprehensive initial assessment, patients are recommended to attend either a group-based programme (medically supervised or medically directed, depending on the severity of the disease and the presence of any co-morbidities) or a home-based intervention programme. The main elements of the intervention programme are nutritional intervention, exercise training (minimum of 150 minutes at moderate intensity per week), psychosocial support and education. Regular monitoring should be conducted during training sessions, and a follow-up assessment is indicated after 2–3 months to assess progress and to re-set goals. Longer-term (5–6 months) intervention programmes are associated with better long-term outcomes.

Healthy lifestyle interventions in general practice: Part 9: Lifestyle and HIV/AIDS

This article forms the ninth part of the series on the role of lifestyle modification in general practice with specific reference to patients living with HIV/AIDS. AIDS continues to be a major global health priority. The global prevalence of HIV-1, the aetiologic agent responsible for AIDS, has stabilised at 0.8%, yet the number of people living with HIV worldwide continues to grow. In 2008, there were 33.4 million people living with HIV/AIDS, 2.7 million new infections, and 2.0 million AIDS related deaths. Heterosexual spread is the main mode of transmission in sub-Saharan Africa, which remains the most affected geographical area, with 67% of the global burden.1 Whilst rates of infection are declining in some geographical areas, including some of the most heavily affected countries in Africa, they are increasing elsewhere including Eastern Europe and central Asia. Recent HIV epidemiologic research findings include new insights into the role of HIV viral load, co-infection with sexually transmitted infections, male circumcision, antiretroviral treatment, and superinfection in HIV transmission and prevention.1;2

Healthy lifestyle interventions in general practice Part 6: Lifestyle and metabolic syndrome

Abstract Although there is no clarity on the precise definition of the metabolic syndrome, there is consensus that it is a cluster of inter-related risk factors (elevated blood pressure, elevated plasma glucose, atherogenic dyslipidaemia) that are due to mainly abdominal obesity and insulin resistance, and which appear to directly promote the development of atherosclerotic cardiovascular disease (ASCVD), and increase the risk for developing type 2 diabetes mellitus. The prevalence of the metabolic syndrome is increasing globally, including in the adolescent population. In developed countries the prevalence of the metabolic syndrome is about 30% of the adult population. The cornerstone of management of this syndrome is lifestyle intervention. Following a comprehensive initial assessment to risk-stratify patients, they are recommended to attend either a group-based programme (medically supervised or medically directed, depending on the severity of the disease and the presence of any co-morbidities) or a home-based intervention programme. The main elements of a lifestyle intervention programme for metabolic syndrome are nutritional intervention (mainly for weight loss and to improve the atherogenic dyslipidaemia), exercise training (minimum of 30–60 minutes at moderate intensity on most days of the week), and psychosocial interventions. Regular monitoring should be conducted and a follow-up assessment is indicated after three months to assess progress and to re-set goals. Longer-term (5–6 months) and supervised intervention programmes are associated with better long-term outcomes.

Healthy lifestyle interventions in general practice : part 16 : lifestyle and fibromyalgia

Abstract Fibromyalgia is a chronic disorder, characterised by chronic widespread musculoskeletal pain, and the presence of multiple tender points as well as a host of associated symptomatology. Optimal management of patients with fibromyalgia requires a multidisciplinary approach, with a combination of pharmacological and non-pharmacological interventions that are tailored to the patients pain, dysfunction and associated features, including depression, sleep disorder and fatigue. Non-pharmacological lifestyle-based interventions to treat this disorder include exercise therapy, dietary modification, and psychosocial interventions. This review outlines these three forms of lifestyle intervention in patients with fibromyalgia.

Jet lag and environmental conditions that may influence exercise performance during the 2010 FIFA World Cup in South Africa

Abstract The 2010 FIFA World Cup will be held in South Africa in June/July 2010. This is the largest international sports event ever to be held in this country. At this time 32 international football teams, with their management and supporters, will travel to South Africa. These players and visitors will be exposed to changes in time zones (those travelling from continents in the East and West) as well as different environmental conditions. In particular, for the players, the achievement of peak sporting performance during this event is most important. It is well established that, in order to achieve peak exercise performance, many variables need to be optimised. These variables include physical and mental training, rest, nutrition, team dynamics and tactics. However, adjustments to differences in time zones as well as environmental factors on and around the playing field can also have a significant impact on exercise performance. In this review, the potential effects of “jet lag”, as well as several important environmental conditions, on exercise performance will be discussed. The climatic, atmospheric and weather conditions that are likely to be prevalent in each of the South African host cities at the time of the 2010 FIFA World Cup will be reviewed. Finally, practical recommendations to deal with the effects of jet lag, as well as guidelines to optimise performance under different environmental conditions that are expected during the 2010 FIFA World Cup, will be provided.