Navigating the 'new normal': what guidelines exist for postpartum return to physical activity and sport? A scoping review.

OBJECTIVE: Women are often advised to return to activity (RTA) as early as 6 weeks postpartum, despite undergoing significant physical, physiological and psychological changes. Our objective was to examine existing evidence and clinical practice guidelines to navigate a safe and successful RTA or return to sport (RTS) postpartum. METHODS: We searched CINAHL, Embase, Medline, PsycINFO and SPORTDiscus and included any secondary studies with recommendations or guidelines for RTA or RTS postpartum. Grey literature and primary sources were excluded. Four reviewers independently screened titles and abstracts, followed by full-text review for eligibility, with conflicts resolved by a third-party reviewer. One reviewer extracted data, which was cross-referenced by another reviewer. RESULTS: 5851 studies were screened, and 33 were included in this scoping review. Most studies stated that RTS postpartum can begin once 'medically safe', around 6 weeks postpartum, but this term was generally left undefined. In addition, most studies recommended engaging in 150 min of moderate-vigorous physical activity per week after 6 weeks postpartum, but the type of exercise recommended was often non-specific. CONCLUSION: A lack of consistent, evidence-based guidelines exist for RTA or RTS postpartum. Multiple evidence gaps require additional research to inform patient and activity specific guidelines for a safe and successful RTA or RTS postpartum.

Effectiveness of Pilates exercise on low back pain: a systematic review with meta-analysis.

PURPOSE: Low back pain is the most frequently reported musculoskeletal disorder and represents one of the highest patient burdens in healthcare. This systematic review and meta-analysis aimed to investigate the effectiveness of Pilates exercise on pain intensity and functional disability caused by low back pain (LBP). MATERIALS AND METHODS: A Systematic review with meta-analysis was conducted. Data sources: MEDLINE-NLM and MEDLINE-EBSCO. We also searched on Scopus Elsevier, Cochrane, DOAJ, SciELO, PEDro, and PLOS ONE databases. Eligibility criteria: randomized controlled trials (RCTs) evaluating LBP in which the primary treatment was based on Pilates exercise compared with no exercise, or non-specific exercise. RESULTS: The search returned 1566 records of which 36 articles were included in the systematic review and 19 in the meta-analysis. Twenty-two studies compared the effects of Pilates exercise vs no exercise and 13 studies examined the effects of Pilates exercise vs non-specific exercise. Analysis showed that Pilates had a positive effect on the perception of LBP vs no exercise. A similar trend occurred with non-specific exercise. CONCLUSIONS: Pilates exercise can decrease LBP compared to no exercise and non-specific exercise. General practitioners should consider Pilates exercise as an effective strategy to manage LBP and counteract the growing health. TRIAL REGISTRATION: PROSPERO registration number: CRD42022308387.IMPLICATIONS FOR REHABILITATIONPilates is a good strategy for improving low back pain and is more effective than other exercise programs or no exercise.Pilates is a safe tool to apply to most of the population with low back pain.Pilates is a non-pharmacological strategy useful for counteracting low back pain.

High tibial osteotomy to neutral alignment improves medial knee articular cartilage composition.

PURPOSE: The purpose of this study was to: (1) test the hypothesis that HTO improves articular cartilage composition in the medial compartment without adversely affecting the lateral compartment and patella, and; (2) explore associations between knee alignment and cartilage composition after surgery. METHODS: 3T MRI and standing radiographs were obtained from 34 patients before and 1-year after HTO. Articular cartilage was segmented from T2 maps. Mechanical axis angle (MAA), posterior tibial slope, and patellar height were measured from radiographs. Changes in T2 and radiographic measures were assessed using paired t tests, and associations were assessed using Pearson correlation coefficients. RESULTS: The mean (SD) MAA before and after HTO was - 6.5° (2.4) and 0.6° (3.0), respectively. There was statistically significant shortening [mean (95%CI)] of T2 in the medial femur [- 2.8 ms (- 4.2; - 1.3), p < 0.001] and medial tibia [- 2.2 ms (- 3.3; - 1.0), p < 0.001], without changes in the lateral femur [- 0.5 ms (- 1.6; 0.6), p = 0.3], lateral tibia [0.2 ms (- 0.8; 1.1), p = NS], or patella [0.5 ms (- 1.0; 2.1), p = NS). Associations between radiographic measures and T2 were low. 23% of the increase in lateral femur T2 was explained by postoperative posterior tibial slope (r = 0.48). CONCLUSION: Performing medial opening wedge HTO without overcorrection improves articular cartilage composition in the medial compartment of the knee without compromising the lateral compartment or the patella. Although further research is required, these results suggest HTO is a disease structure-modifying treatment for knee OA.

Are we missing the target? Are we aiming too low? What are the aerobic exercise prescriptions and their effects on markers of cardiovascular health and systemic inflammation in patients with knee osteoarthritis? A systematic review and meta-analysis.

OBJECTIVES: We systemically reviewed published studies that evaluated aerobic exercise interventions in patients with knee osteoarthritis (OA) to: (1) report the frequency, intensity, type and time (FITT) of exercise prescriptions and (2) quantify the changes in markers of cardiovascular health and systemic inflammation. DATA SOURCES: PubMed, CINAHL, Scopus; inception to January 2019. ELIGIBILITY CRITERIA: Randomised clinical trials (RCT), cohort studies, case series. DESIGN: We summarised exercise prescriptions for all studies and calculated effect sizes with 95% CIs for between-group (RCTs that compared exercise and control groups) and within-group (pre-post exercise) differences in aerobic capacity (VO2), heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and inflammatory markers (interleukin-6 (IL-6), tumour necrosis factor-alpha). We pooled results where possible using random effects models. RESULTS: Interventions from 49 studies were summarised; 8% (4/49) met all FITT guidelines; 16% (8/49) met all or most FITT guidelines. Fourteen studies (10 RCTs) reported at least one marker of cardiovascular health or systemic inflammation. Mean differences (95% CI) indicated a small to moderate increase in VO2 (0.84 mL/min/kg; 95% CI 0.37 to 1.31), decrease in HR (-3.56 beats per minute; 95% CI -5.60 to -1.52) and DBP (-4.10 mm Hg; 95% CI -4.82 to -3.38) and no change in SBP (-0.36 mm Hg; 95% CI -3.88 to 3.16) and IL-6 (0.37 pg/mL; 95% CI -0.11 to 0.85). Within-group differences were also small to moderate. CONCLUSIONS: In studies of aerobic exercise in patients with knee OA, very few interventions met guideline-recommended dose; there were small to moderate changes in markers of cardiovascular health and no decrease in markers of systemic inflammation. These findings question whether aerobic exercise is being used to its full potential in patients with knee OA. PROSPERO REGISTRATION NUMBER: CRD42018087859.

Sodium nitroglycerin induces middle cerebral artery vasodilatation in young, healthy adults.

NEW FINDINGS: What is the central question of this study? Nitric oxide causes dilatation in peripheral vessels; however, whether nitric oxide affects basal cerebral artery dilatation has not been explored. What is the main finding and its importance? This study demonstrated that vasodilatation occurs in the right middle cerebral artery in response to exogenous nitric oxide. However, blood velocity decreased and, therefore, overall cerebral blood flow remained unchanged. This study provides new insight into the role of nitric oxide in cerebral blood flow control. ABSTRACT: Recent evidence indicates that basal cerebral conduit vessels dilate with hypercapnia, with a nitric oxide (NO) mechanism explaining one way in which parenchymal cerebral arterioles dilate. However, whether NO affects basal cerebral artery dilatation remains unknown. This study quantified the effect of an exogenous NO donor [sodium nitroglycerin (NTG); 0.4 mg sublingual spray] on the right middle cerebral artery (rMCA) cross-sectional area (CSA), blood velocity and overall blood flow. Measures of vessel CSA (7 T magnetic resonance imaging) and MCA blood velocity (transcranial Doppler ultrasound) were made at baseline (BL) and after exogenous NTG or placebo (PLO) administration in young, healthy individuals (n = 10, two males, age range 20-23 years). The CSA increased in the rMCA [BL, 5.2 ± 1.2 mm2 ; PLO, 5.4 ± 1.5 mm2 ; NTG, 6.6 ± 1.5 mm2 , P < 0.05; mean ± SD]. Concurrently, rMCA blood velocity decreased from BL during NTG compared with PLO (BL, 67 ± 10 cm s-1 ; PLO, 62 ± 10 cm s-1 ; NTG, 59 ± 9.3 cm s-1 , P < 0.05; mean ± SD]. However, total MCA blood flow did not change with NTG or PLO [BL, 221 ± 37.4 ml min-1 ; PLO, 218 ± 35.0 ml min-1 ; NTG, 213 ± 46.4 ml min-1 ). Therefore, exogenous NO mediates a dilatory response in the rMCA, but not in its downstream vascular bed.