How to promote physical activity during pregnancy : A systematic review

INTRODUCTION

Sedentary lifestyles and physical inactivity have been shown to increase during pregnancy and are a cause of obstetric comorbidity. The objective of this study was to conduct a systematic review of interventions aiming to promote physical activity during pregnancy.

MATERIAL AND METHODS

Databases were searched from January 2008 to September 2019. Selection criteria included randomized controlled trials evaluating the efficacy of interventions promoting physical activity during pregnancy.

RESULTS

In total, 256 articles were extracted from databases. 202 articles were excluded. Finally, 15 articles were included in the study. 5633 patients were included from various populations. Six studies rated physical activity (PA) as the primary outcome. Five studies suggested promoting physical activity through individual interviews which in two studies showed an increase in PA. Three studies evaluated an intervention based on group interviews and one of these reported a significant increase in PA. Two studies evaluated the use of a Smartphone application to promote physical activity but they did not conclude that they were effective because they were designed with low statistical power.

CONCLUSION

The practice of regular PA during pregnancy reduces obstetrical comorbidity. However, interventions seem to have a low impact on the promotion of PA during pregnancy. New intervention strategies need to assessed, such as the use of mobile health interventions.

[Chronic instability in the ankle area]

For ankle sprains, the initial radiological work-up must include weight-bearing AP and lateral stress views of the sprained and healthy ankle. Films are taken in auto-varus. Other explorations included arthroMRI, arthroscanner or MRI which can be indicated preoperatively to confirm suspected cartilage injury or an associated ligament tear. These techniques should be employed when pertinent information can be expected according to the clinical situation and the operator's experience. In the emergency setting, ultrasonography can provide a simple low-cost confirmation of joint hematoma which is more precise than x-rays with a positive predictive value of nearly 100%. The objective and subjective clinical outcome after surgical anatomic repair or ligamentoplasty are quite similar. The two principal differences relate to persistent subjective instability and post-operative surgical complications. Thus there are advantages and disadvantages for each option advantage for anatomical repair because of the low rate of surgical complications and advantage for ligament repairs which stabilize the subtalar joint with a low rate of residual instability.

Contralateral spondylolysis and fracture of the lumbar pedicle in an elite female gymnast: a case report

STUDY DESIGN

The case of an elite female gymnast whose pathology started in her 12th year and whose evolution has been exceptional is reported.

OBJECTIVE

To present a fracture of the right lumbar pedicle showing complete spontaneous consolidation despite gymnastic practice 15 hours a week.

SUMMARY OF BACKGROUND DATA

Lumbar pain, which has an incidence of approximately 75% among young athletes, often results from diseases of the posterior arch of vertebrae in gymnasts, including spondylolysis. The association between unilateral spondylolysis and fracture of the contralateral lumbar pedicle in young athletes is poorly described.

METHODS

An elite young female gymnast underwent clinical examination and lumbar radiographs (as systematically required by the French Federation for high-level gymnasts) from 1994 to 1997 to join a sports program in gymnastics.

RESULTS

Clinical examination and lumbar radiographs systematically required of an asymptomatic female gymnast allowed the condensation of the right pedicle to be observed before lysis of the left isthmus of L5 in 1994, unilateral lysis of the left isthmus of L5 in 1995, a right pedicular fracture of L5 in 1996, and healing of the pedicular fracture in 1997.

CONCLUSION

Inconsistency between radiographs and clinical observations can be noted, and spontaneous consolidation of pedicular fractures can occur despite the practice of the gymnastics 15 hours a week.

Are tennis players at increased risk for low back pain and sciatica?

OBJECTIVE

Tennis practiced intensively is generally held to be a risk factor for low back pain. The objective of our study was to evaluate the prevalence of low back pain with or without sciatica during the last week in tennis players versus controls.

PATIENTS AND METHODS

During an international tennis competition held in Brest, France, ten physicians or medical students interviewed 633 spectators older than 18 years and divided them into tennis players and controls. The sample size was selected to allow detection of a twofold increase in the risk of low back pain in tennis players (with alpha = 5% and 1-beta = 80%).

RESULTS

Of the 633 subjects, 388 were and 245 were not tennis players. There were 421 men with a mean age of 37 +/- 13.7 years and 212 women with a mean age of 34.3 +/- 12.7. Among the men, 49 of the 281 tennis players (17.4%) reported low back pain during the last week versus 26 of the 140 controls (18.6%). Corresponding figures in women were 20 of 107 tennis players (18.7%) and 29 of 105 controls (27.6%). Sciatica was not more common in tennis players (men, 20 of 281 tennis players [7.1%] versus 6 of 140 controls [4.3%]; women, 8 of 107 tennis players [7.5%] versus 10 of 105 controls [9.5%]). None of the differences between tennis players and controls were significant. The number of hours spent playing tennis per week was similar in tennis players with and without low back pain.

CONCLUSION

Our interview-based cross-sectional study found no evidence that playing tennis involves a higher risk of low back pain with or without sciatica.