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Signal transduction and exercise
Published in Adam P. Sharples, James P. Morton, Henning Wackerhage, Molecular Exercise Physiology, 2022
Brendan Egan, Adam P. Sharples
On a similar note, the recently established Molecular Transducers of Physical Activity Consortium (MoTrPAC), funded to the tune of $170 million by multiple agencies at the National Institutes of Health (USA), aims to elucidate how exercise improves health and ameliorates diseases by building a map of the molecular responses to acute and chronic exercise in preclinical rodent and clinical human studies using multi-omic and bioinformatic analyses (113). The overarching themes echo the personalised exercise medicine concept in that a better understanding of these biological processes and pathways would allow for the development of targeted exercise interventions and prescriptions. In their recent overview of the programme (113), the MoTrPAC investigators also stated an aim of providing a foundation for developing pharmacologic interventions, which are broadly termed ‘exercise mimetics’, and this concept forms the final part of this chapter.
Ethical practice and sports physician protection
Published in Mike McNamee, Sport, Medicine, Ethics, 2014
Sports medicine has developed at a dramatic pace over recent decades (Howe 2004). Though its roots are in ancient Greek and Roman athletics (Berryman 1992) it is nevertheless in its early phases of professionalization. In the proposals above, we have avoided reference to the broader configuration of sports and exercise medicine. Our justification for this focus is that the ethics of exercise medicine draws upon, and is more closely related to, the ethics of public health. It should, therefore, come as no surprise that sports physicians are still, and will continue for some time to be, working in contexts where it is far from clear how they are best to proceed in ethical terms for the good of their patients. It is to be expected that medical practice is always likely to yield ethical problems because of the nature of medicine and the role that health, illness and injury play in the lives of patients. Sports medicine finds itself in particularly challenging, though not unique, contexts because of the role of the body in athletic performance, especially at elite and professional levels. The positions set out here, we hope, should serve to challenge and stimulate national and international sports medicine organizations to reflect publicly on what is admirable, permissible and impermissible in sports medicine, and to help to support individuals striving for the highest levels of professional conduct in sports medicine.
Sports and exercise medicine clinic in public hospital settings: a real-life concept and experiences of the treatment of the first 1151 patients
Published in Postgraduate Medicine, 2023
Lauri Alanko, Jari A. Laukkanen, Mirva Rottensteiner, Salla Rasmus, Tero Kuha, Maarit Valtonen, Urho M. Kujala
Despite the overwhelming evidence, the systematic implementation of physical exercise therapy in medical care system has been limited. Healthcare professionals may have been reluctant to recognize physical exercise as a part of medical treatment. Systematic use of physical exercise training has been thought to belong more to the world of sports, and its wider implementation from younger to adult populations is thought to be the mission/duty of organizations other than the healthcare system. There are different types of sports and exercise medicine clinics, but usually they are not linked to public health care, which would give all patients with NCDs the opportunity to access physical exercise therapy, and clinics for specific diseases have only randomly included physical exercise in their treatment protocols. This paper describes the protocol and preliminary results of the recently developed Sports and Exercise Medicine Clinic (SEMC) in the Central Finland Central Hospital (CFCH), discusses experiences and offers suggestions for further development.
Challenges and opportunities for promoting physical activity in health care: a qualitative enquiry of stakeholder perspectives
Published in European Journal of Physiotherapy, 2021
Helen Speake, Robert Copeland, Jeff Breckon, Simon Till
One suggestion to mitigate current challenges in relation to the promotion of PA in healthcare settings is to improve end-user involvement in the design and development of PA interventions [7]. Hale and colleagues [8] reconsidered their evidence-based PA programme for people with multiple sclerosis (MS) after reflecting that taking an ‘ivory tower’ approach risks developing interventions that may not be ‘feasible, let alone acceptable’ for recipients. The International Olympic Committee (IOC) and Faculty of Sport and Exercise Medicine (FSEM) have both called for a patient-centred and less disease-specific approach that could enable better use of local resources and meet the needs of more patients [9,10]. Increasing the depth and quality of public-patient involvement also reflects ongoing calls for patients to be acknowledged as the experts in their own health [11]. Internationally and in the UK, healthcare policy and strategy is increasingly patient-centred with campaigns such as ‘no decision about me, without me’ [12] and the proliferation of standards for patient involvement in research and development [13]. There are aspirations amongst policy makers and healthcare professionals to support patients, control long-term conditions more effectively and reduce reliance on healthcare services, for example by developing their own self-management skills and ‘activating’ patients [14]. Applying user-centred design principles could lead to the creation of empowering (and ultimately, effective) interventions to promote PA.
Epidemiological analysis of coronary heart disease and its main risk factors: are their associations multiplicative, additive, or interactive?
Published in Annals of Medicine, 2022
Ari Voutilainen, Christina Brester, Mikko Kolehmainen, Tomi-Pekka Tuomainen
To enable the identification of study participants who were not free of CHD at baseline, KIHD examinations included a maximal symptom-limited exercise tolerance test carried out at the Kuopio Research Institute of Exercise Medicine [21]. Bicycle ergometers with a linear (Medical Fitness Equipment 400 L, Mearn, the Netherlands) or a step-by-step (Tunturi EL 400, Turku, Finland) increase in the workload by 20 W per minute served as devices for the assessment of physical work. Measurements of oxygen uptake were based on a breath-by-breath method (MGC 2001, Medical Graphics, St. Paul, MN) or a mixing-chamber method (Mijnhardt Oxycon 4, Odijk, the Netherlands). The test procedure consisted standard 12-lead ECG recordings (Kone, Turku, Finland) before, during, and after the ergometer test. The before recordings corresponded a resting ECG. Moreover, KIHD questionnaires included the following CHD-related questions: (a) has your physician told you that you have had a myocardial infarction, (b) has your physician told you that you suffer from angina pectoris, (c) have you used medicines for angina pectoris during the past 7 days, (d) do you use sublingual nitroglycerine once a week or more frequently, and (e) have you undergone a coronary bypass operation? Based on results of the exercise test and ECG recordings and answers to questionnaire items we defined study participants having CHD at baseline as follows: unable to complete the ergometer test due to angina pectoris-type chest pain, or Q waves on the ECG indicating a myocardial infarction, or horizontal or downsloping ST depression ≥1 mm in aVF or V5 leads, or answering “yes” to at least one of the questions a − e. As certain inaccuracies relate to exercise stress testing in general [22], in this study, we carried out statistical analyses and reported their results also concerning the dataset without exclusions.