Domhnall MacAuley is a CMAJ Associate Editor and a professor of primary care in Northern Ireland, UK. This week he is attending the CASEM-OMA Sports Medicine symposium in Ottawa.
Edu-tainment is how we need engage audiences, according to Andrew Pipe, chair of the opening session of the CASEM-OMA 2015 meeting in Ottawa. And what a superb opening session. Ian Shrier and Pierre Frémont introduced their five key sports medicine papers and debates of the last year. From a CMAJ perspective, it was great to hear Ian cite our systematic review on arthroscopic surgery for degenerative tears of the meniscus as a key paper. He made a very important point that the outcome was the minimally important difference to patients. The authors had used the average but, looking at the minimally important difference distribution, this may not be entirely reflective, and some people may have had a benefit in the short term although, in the long term, there was no effect.
Concussion is a major issue and Pierre reminded us of a paper emphasising that concussion management protocols should include cervicovestibular evaluation especially in patients who do not improve in 10 days. This fitted seamlessly with a later symposium on concussion related research. Screening for sudden cardiac death is always controversial and Ian drew our attention to the ongoing debate on screening. Jon Drezner, based on the data in his study, felt that screening of high school athlete was desirable but Barry Maron disagreed. This debate will continue, as will the controversy over the nomenclature surrounding the Female Athletic Triad – or Relative Energy Deficiency in Sport – where the discussion seems more focused to epistemology than epidemiology.
Pierre Frémont discussed a systematic review on the impact of exercise type on osteoarthritis. His message was that exercise is of benefit but ‘keep it simple’, with straightforward protocols based on either aerobic or resistance exercise. However, the value of this session was that it was interactive and a key question from the audience was whether exercise had any effect on the disease state or if it only affected symptoms. Ian’s response was that there was objective evidence of disease effect. Jack Taunton’s urban Nordic sticks were used to illustrate the benefits of reducing load when walking, and Jack added that their departmental research on eccentric exercise showed that it was the key to walking rehabilitation and return to activity in people with osteoarthritis.
A paper on low and high intensity cycling in diesel exhaust on plasma norepinephrine might seem arcane- unless you commute to work in a large city. The subjects of this research cycled in an atmosphere with a particle level of 300 µg/m3, which seems rather high, although levels in Bejing may occasionally reach 300 µg/m3. Yet you may be surprised that in the Arve valley in the French Alps, on roads leading to resorts such as Chamonix and to the Mont Blanc tunnel, levels reached 125 µg/m3 in January, pushing the local prefecture to ban road-use by lorries of greater than 7.5 tonnes – a ban that lasted four days.
Connie Lebrun told us about her work on competency based assessment of sport and exercise medicine skills in family medicine focused on specialty related clinical domains with daily feedback documented in a field note. Implementation was challenging but effective and there is continuing evaluation at the universities of Calgary and Alberta. It was also very encouraging to hear from Connie of the expansion of academic sport and exercise medicine in Canada at a time when austerity elsewhere has put academic sport and exercise medicine under pressure. She attributes the growth to the increasing recognition of the need to expand teaching of sport and exercise medicine skills in family medicine.
Dr Tom Pashby was a pioneer who brought evidence based change into the rules of a sport. An ophthalmologist, he was instrumental in introducing helmets and eye protection in ice hockey. It was entirely fitting that Carolyn Emery gave his eponymous lecture. As someone who has listened to innumerable keynote lectures, I found Emery’s remarkable, and not just because of her immense contribution to advances in research. Most keynote speakers take the opportunity to tell us all about their own work. Not Carolyn. She glossed over her own remarkable achievements and spoke almost entirely about both the work of others. A generosity of spirit rarely encountered- true leadership.
Alan Vernec, from the World Anti Doping Agency – WADA – shared an educational nugget. Everyone should learn at least one thing from a lecture. If not, the problem is with the speaker. But, if you find you are learning too much, the problem is with you!
Watch Domhnall’s video blog – a recap of the conference:
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