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  • Clinical Highlights from Current Sports Medicine Reports | Q2 2024

    by Caitlin Kinser | Jul 15, 2024
    Quarterly Editor's picks with a headshot of Dr. Shawn Kane and the cover of Current Sports Medicine Reports

    Welcome to the highlights and the review of the AWESOME articles and case reports published over the last quarter in Current Sports Medicine Reports (CSMR). This past quarter for CSMR was amazing. I was going through the articles and cases that were published and on my first review I selected almost all of them. While this is a great problem to have, it would make this quarterly highlight too long, so I went back and selected what I thought were the best of the best.

    Four highlighted section articles from the past quarter:

    Oxygen Straight to the Brain: An Overview of Hyperbaric Oxygen Therapy for a Variety of Brain Morbidities written by Leighton, VanHorne and Parsons. This is a very interesting topic to me as we are frequently asked about hyperbaric oxygen therapy (HBOT) by veterans and first responders who are participating in the The THRIVE Program here at the University of North Carolina, Chapel Hill. The authors do a great job explaining what HBOT is, how it works and what the current FDA indications are for HBOT. They then examine the use of HBOT for mTBI, PTSD and headaches. They present and critique the evidence that is out there and rightly state “hyperbaric therapeutic impacts for these in the acute and chronic or prolonged symptoms are elusive.” Cost and lack of sustained relief are two areas emphasized by the authors and they conclude that better studies are needed to provide high fidelity treatment metrics.

    Adaptive Athlete Considerations for Races and Other Mass Participation Sporting Events written by Sedgley, et al. There is always a lot of discussion on emergency action plans (EAPs) and one thing I liked about this topic when the authors approached me was the singular focus on adaptive athletes. Both the number of adaptive athletes participating in sports and the number of sports available to adaptive athletes continues to rise. This is a population that has unique medical complications and risks from athletic participation that must be considered. The authors did a great job of using current EAPs and highlighting the specific needs of adaptive athletes.

    Vigorous Exercise in Patients with Hypertrophic Cardiomyopathy written by Fox, et al. It always felt to me that we talked about hypertrophic cardiomyopathy (HCM) from the standpoint of you can’t miss this on the PPE -- sudden cardiac death = no sports. However, we never talked about what can we do for these patients, other than not let them play sports.  The authors do a great job reviewing the evolving data on the topic and emphasizing shared decision making with HCM patients to allow participation in health promoting activities. 

    A Scoping Review of the Epidemiology, Management, and Outcomes of Golf-Related Fractures written by Chen, et al. We just had the US Open down the road a bit in Pinehurst and I wanted to highlight golfers and note that Donald Ross can make some challenging greens. I love the game of golf but can’t really play due to some injuries. When I did golf, I just hoped my shots landed on earth. Watching the pros try to land their ball in a 3 x 5-inch area from 300 yards away is impressive. I wanted to highlight this article that thoroughly reviews golf-related fractures, not just the pisiform bone.

     

    Case Reports

    Case reports are a great way to learn, whether it is some rare, uncommon condition or just a different presentation of a common problem. I would like to highlight three not-to-be-missed cases from the past quarter:

    Ice Sheet Cooling in the Field Reduces Morbidity in Exertional Heat Stroke written by Willcox, Rhodehouse and DeGroot. I had the privilege to work with Dr. Dave DeGroot while in the military and the work that continues to come out of The Army Heat Center under his direction is saving lives. They are working to find and show evidence-based ways to decrease the morbidity and mortality related to heat stroke during military training. Ice sheets work!

    Gluteus Maximus Distal Myotendinous Junction Tear in a Pickleball Player: A Case Report written by King, Johnson and Jelsing. I have a couple older patients who are very active and competitive playing pickleball -- I never thought you could get hurt playing it. This is an interesting case report about a 72-year-old male who injured his gluteus maximus playing pickleball. This is an interesting case with an excellent review of anatomy.

    Ankle Pain Due to Pigmented Villonodular Synovitis written by Chambers, Carey and Silvis. This is a super interesting case that reminds us to create broad differential diagnosis. I will admit I have only seen pigmented villonodular synovitis a couple times in the knee and it wouldn’t have been on my initial differential, but it will be now.

    CSMR is ACSM’s official monthly clinical review e-journal. Written specifically for physician and clinician members, CSMR articles provide thorough overviews of the most current sports medicine literature. ACSM physician members receive an online subscription to this journal as a member benefit.

     

    Shawn F. Kane, MD, FACSM, is a family physician, professor in the Department of Family Medicine, and adjunct assistant professor in the Department of Exercise and Sports Science at the University of North Carolina (UNC) Chapel Hill. He received his medical degree from the Uniformed Services University of the Health Sciences and served in the U.S. Army for 27 years. While in the Army he spent more than 18 years serving as a physician-leader in numerous units within the US Army Special Operations Command. He is interested in sports medicine, concussion care, veterans’ health, and primary care of patients with post-traumatic stress disorder. Dr. Kane joined ACSM in 2003 and became a fellow in 2011. He currently serves as the editor-in-chief for Current Sports Medicine Reports, on ACSM’s Clinical Sports Medicine Leadership Committee, ACSM’s Health & Fitness Summit Program Committee, and ACSM’s Program Committee. Outside of the office, Dr. Kane enjoys hanging out with his Leonbergers (big furry, cute German Mountain dogs), as well as working out and traveling.

  • Get to Know 2024-2025 ACSM President Stella Volpe

    by Greg Margason | Jun 25, 2024

    ACSM President Stella Volpe, Ph.D., RDN, ACSM-CEP, FACSM, is professor and head of the Department of Human Nutrition, Foods, and Exercise at Virginia Polytechnic Institute and State University (Virginia Tech) in Blacksburg, Virginia. Dr. Volpe earned her Ph.D. in human nutrition and foods from Virginia Tech in 1991. She earned her Master of Science in exercise physiology from Virginia Tech in 1987 and her Bachelor of Science in exercise science from the University of Pittsburgh in 1985. She became an ACSM Certified Clinical Exercise Physiologist® (ACSM-CEP) in 1988 and an ACSM fellow in 1996. She is also a registered dietitian nutritionist (board certified since 1996). 

    Volpe assumed the role of the 2024-2025 ACSM president at the 2024 ACSM Annual Meeting in Boston. 

    Q: What will be your highest priority when you take office? 

    A: My highest priority will be to increase membership engagement and retention. I also want to involve more early career members in ACSM, and further engage our certified professionals. Being an ACSM-CEP myself, I value the importance of the ACSM certifications. 

    My motto is: “We are ACSM!” — that includes every member! 

    Q: What part of ACSM’s new strategic plan most excites you? 

    2024-2027 ACSM Strategic Plan infographicA: The parts of ACSM’s new strategic plan that most excite me are: 

    • Create a compelling customer experience by optimizing all ACSM meetings and educational activities to increase constituent and stakeholder engagement, awareness and overall value of the activity. 

    • Promote excellence in science and evidence-based practice and expand ACSM’s reputation as a global scientific leader. 

    • Enhance the collaboration and representation of disciplines across ACSM activities to reflect the continuum of science and practice. 

    • Create and enhance ACSM’s relationship with partners and stakeholders to provide reciprocal benefits.

    • Advance ACSM’s reputation as the leader and go-to source in exercise, sports science and sports medicine. 

    Q: What do you think will be your biggest challenge in office, and how do you expect to address it? 

    A: Ensuring that we retain trainee members for the duration of their careers. I became a member of ACSM in my senior year of college and never looked back at making this my primary scientific organization. I hope that our new members (whether trainees or not) will retain their membership with ACSM. 

    Q: How does your ACSM-CEP certification inform your perspective on the organization and its goals? 

    A: The ACSM certifications are all science based, and that is what makes them well respected and well recognized. 

    Being an ACSM-CEP provides me with the training needed in my role as a researcher and educator. 

    Q: What do you do like to do in your spare time? 

    A: I like to hike, and I also work out in CrossFit. I play field hockey and also row and play ice hockey. Mostly, what I like to do is activity/sports based in my spare time! 

  • Advancing Evidence-based Sport Science

    by Greg Margason | Jun 24, 2024

    We have all heard the following sports and exercise recommendations: “Load up on carbohydrates prior to an athletic event,” “Stretch prior to activity to avoid injury,” “Stand up straight and place your hands behind your head to recover from rigorous aerobic exercise,” “Buy running shoes based on foot arch and/or running form (and/or as assessed by an employee at the local shoe store)” and “Hydrate to prevent cramping, soreness and exertional heat illness.”

    While some of these recommendations can be helpful in certain settings, they may not apply or may have less-than-positive effects in others; regardless, they are dogmatically repeated by well-meaning coaches, staff, parents and enthusiasts in the name of sports medicine and human performance without much additional consideration for their validity.

    Such beliefs are ingrained in many sport and exercise circles and may only eventually be overcome with substantial evidence to the contrary. Even so, despite the 2019 study published in TJACSM by Michaelson et al. indicating that athletes recover better in the hands-on-knees position following high-intensity physical activity1, I continue to hear participants confidently directed to stand up tall and place their hands behind their heads by coaches at my kids’ youth sports and at military physical fitness events.

    The results of sports medicine and exercise science research are useful to a wide range of people, and our field is therefore readily accessible to the general public — that’s what makes it so great to be a part of. But because of this, there is also an abundance of forums where active people share ideas and dogma. We owe it to our field, and to those enthusiastic about active lifestyles, to critically test sport and exercise claims and practices and expand the sport science evidence base — particularly in service of safety. Such research represents valuable low-hanging fruit that may stand to help a lot of people.

    Training programs, such as those in the military, may go many years between updates due to preference for the status quo and the cost required to modernize. It’s often difficult to get buy-in to change processes and approaches, even when addressed by respected subject matter experts sharing science-backed reasoning. To facilitate buy-in by decision makers when there is not direct evidence to apply to a specific situation or recommendation, sport science professionals should work to objectively confirm or refute the current approach by doing the relevant research. This valuable step of translational sport science is what my team set out to take in our recent study published in TJACSM.

    Our study, “The Effect of Lightweight Shoes on Air Force Basic Training Injuries: A Randomized Controlled Trial” questioned whether the shoes the Department of Defense (DoD) issues its trainees —sturdy shoes with three customization options based on specific foot support needs — would be best at reducing injury. After all, they had been issued with that exact intent. Our sports medicine team, having noticed an association between the issued shoes and injuries treated in our clinics —and having heard trainees express dissatisfaction with said shoes — hypothesized that the practice of issuing such shoes in order to reduce injury ran contrary to what the ACSM describes as a good, safe running shoe, as well as to other evidence and recommendations. However, gaining traction toward changing the shoes issued to all enlisted DoD trainees without direct evidence of this suspected harm proved to be a tall task. So, we set out to put the standard-issue shoes to the test in this population by comparing them to a lightweight alternative.

    Our results, gleaned from studying trainees at Air Fore basic military training, indeed suggest that issuing lightweight running shoes with a wide toe box and low heel-to-toe drop reduced injury risk.

    Although we as sports medicine professionals might not need to be convinced of certain recommendations based on our experience and expertise, we often should pursue and share evidence like this with our patients, clients, and the lay public in order to overcome cognitive inertia and status quo bias. I encourage my colleagues to identify dogmatic practices and put the status quo to the test to promote evidence-based sport science for their specific populations.

    Major Korey Kasper is an active duty and board-certified sports medicine and family medicine physician in the US Air Force. Dr. Kasper received his B.S. in Kinesiology from the University of Wisconsin-Madison and his MD from the Uniformed Services University of the Health Sciences in Bethesda, MD.  He subsequently completed a residency in family medicine in at the University of Nebraska Medical Center and a sports medicine fellowship at the National Capital Consortium in Washington, DC. Following training, he served as the Medical Director of Trainee Health Clinic and the VIPER Sports Medicine and Human Performance Program, where he worked to optimize the care, safety, wellness, and performance of military service members in training on JBSA-Lackland, TX. Currently, he is the Medical Director of Sports Medicine for the 6th Medical Group at MacDill AFB, FL. 

  • Upholding Standards: Why Open-Book Exams Fall Short in Professional Certification

    by Greg Margason | Jun 11, 2024
    Upholding Standards

    In the ongoing effort to position exercise professionals as part of the health care continuum, maintaining professionalism is paramount. As an industry, we must be hold steadfastly to the ideal of professionalism if exercise professionals (e.g., personal trainers, exercise physiologists, strength and conditioning coaches, clinical exercise physiologists) are to earn the respect of established health occupations. Open-book exams undermine our efforts to position exercise professionals as uniquely qualified professionals in the health care. Further, it is also essential we clarify the distinct roles and significance of educational training programs vs. professional certifications. While both play vital roles in workforce development, conflating the two erodes our ability to defend and protect the health fitness space. 

    Educational Programs Assess Student Learning 

    Educational programs, particularly those offering certificates, are designed to provide foundational knowledge and skills for a specific job. These programs are essential for laying the groundwork in various in exercise science-related careers and also include opportunities to explore avenues of professional growth. Certificates provide structured learning experiences, covering essential theories, methodologies and practical skills that prepare individuals for entry-level positions. However, the primary objective of an educational certificate is to demonstrate that students have met the learning objectives of a program rather than identify individuals who are qualified and effective professionals. 

    Certifications Assess Professional Competency 

    NCCA and ISO/IEC 17024 accredited certifications, on the other hand, are independent assessments of professional competency. They serve as a legally defensible validation that an individual has acquired the necessary knowledge and skills, and that they have demonstrated an ability to apply them effectively in real-world scenarios. Certification exams require candidates to pass a standardized assessment that assures the public they are competent and capable of performing their duties safely and effectively. In short, professional certifications are essential for public protection. 

    The Danger in Conflating Open-Book Certificate Programs and Professional Certifications 

    Conflating open-book certificate programs with professional certification raises substantial concerns about the credibility of the health fitness profession. It is critical we maintain a clear distinction between training (educational programs) and competency assessment (certification). Organizations that consider themselves legitimate cannot call themselves “gold standard” if they use open-book exams. If we in the health fitness industry want to be recognized as essential members of the health care continuum, we must uphold the rigor, value and purpose of professional certification. It’s not just semantics. It’s about professional integrity. 

    Commitment to Scientific and Professional Integrity 

    2024-2027 ACSM Strategic Plan infographicThe ACSM Board of Trustees (BOT) and the ACSM Committee on Certification and Registry Boards (CCRB) maintain an unwavering commitment to scientific and professional integrity. Science is a fundamental part of all facets of ACSM and has been for 70 years. Science remains front and center in ACSM’s new 2024-2027 strategic plan. In conjunction with the new strategic plan, the ACSM BOT transformed its vision to “extend and enrich lives through the power of movement.” To support this vision, the CCRB revised its mission to “advance the credibility and integrity of ACSM-certified professionals through career-long development with evidence-based practices to benefit all.” ACSM aims to elevate the standards of practice within the health fitness and clinical exercise sectors through rigorous adherence to professional standards and the latest scientific research. ACSM assures its stakeholders that exercise professionals are equipped with the skills and knowledge necessary to navigate the evolving landscape of the health fitness industry. Through rigorous defense of professional standards, ACSM can assure key stakeholders that its certified professionals are not only qualified but invaluable members of multidisciplinary health care teams. 

    Parting Thoughts 

    While educational programs play an important role in providing foundational knowledge and skills in the health fitness profession, professional certifications protect the public. Health fitness organizations like ACSM must uphold the distinctions among and unique roles of education, accredited certification and professional registration. ACSM and its CCRB ensure that our registered exercise professionals possess the level of professionalism required to be integral members of the health care continuum. 

    Francis_Neric, MS,MBAFrancis Neric, M.S., MBA, currently serves as the associate vice president of certification and credentialing at the American College of Sports Medicine® (ACSM). With professional credentialing experience spanning 16 years, Francis has been instrumental in leading strategic initiatives to enhance the certification, advanced certificate and exam preparation programs to meet the needs of the domestic and international stakeholders of ACSM. Francis holds an MBA in business management from the University of Colorado at Colorado Springs; an M.S. in clinical exercise physiology from California State University, Fullerton; and a B.S. in exercise science from California State University, Long Beach. Francis combines academic and industry knowledge to drive innovation and excellence in the health fitness industry. Francis is a passionate advocate for raising the bar for professionalism in the health fitness industry and expanding opportunities for exercise professionals in health care.