Low-impact Activities Research Articles

Nature-based winter sports and their ephemeral tracks: interspecies (non-)encounters in snow

Nature-based winter sports are often framed as a solution to the tension between people’s desire for pristine snowy landscapes and their effects on that environment. Low-impact activities such as ski touring and cross-country skiing allow outdoor enthusiasts to visit remote and mountainous locations without the need for hard infrastructure of ski resorts, leaving no permanent marks in the landscape. Yet their growing popularity raises a dilemma about negative effects, especially on wildlife conservation areas. We use the tracks and traces left behind by people as well as animals in Northern Europe and the Alps as a nexus through which to explore how humans and non-humans interact, ignore or avoid each other. Often imagined as ephemeral activities, we argue that the cumulative impacts of nature-based winter sports have significant consequences for wildlife and the way we aim to protect it long after its traces in the snow have disappeared.

Efficacy of the combination of water aerobics and metacognitive training on psychological and physical health variables and their relationship with SP1 and SP4 biomarkers in people with psychosis: a study protocol.

Metacognitive Training (MCT) is widely used and effective in reducing positive symptoms in psychosis. Physical exercise, such as Water Aerobics (WA), improves general health, quality of life and symptoms as a low impact activity that allows social interactions. Preliminary results suggest a relationship between dopamine and psychotic symptoms, through SP transcription factors, SP1 and SP4 biomarkers. The aims of the project are to evaluate the efficacy of a combined intervention (WA and MCT) for psychosis to improve psychotic symptoms, physical health, and transcription levels of SP biomarkers. This is a unicentric randomized controlled trial of three parallel intervention groups: MCT, WA and combined intervention. The estimated sample will be 48 patients with a psychotic spectrum disorder diagnosis. The assessment will be performed at baseline and at 2-months' follow-up. Instruments used in the assessment will include clinical, cognitive, metacognitive, social cognitive and psychosocial variables. This will be the first study investigating the impact of the combination of MCT and WA in psychosis. Moreover, it will be the first study analyzing changes in the transcriptional biomarkers SP1 and SP4 after interventions. The results of this study may have clinical implications contributing to the improvement of treatment selection. https://clinicaltrials.gov/, identifier: NCT05455593.

Walking for mental health and well-being

Walking is one of the easiest ways to keep healthy and well. It does not requiretechnical skill or complex equipment. It can be fitted in flexibly into personalroutines. It is a low impact activity, both on the pocket and the knees but deepin its positive impact on both mind and body. It fosters a touch with nature andbuilds spaces for reflection and self-discovery. It can be done solo, in families,with friends or colleagues. It is possible to start out with short trails andextend horizons gradually.This article shares stories from personal and professional experiences. As apsychiatrist, I could not recommend walking enough, for the extensivebenefits it can have on people’s lives both physically and mentally.

Return to Sport After Unicompartmental Knee Arthroplasty and Patello-Femoral Arthroplasty

BackgroundData on sports/physical activity participation following unicompartmental knee arthroplasty (UKA) and patello-femoral arthroplasty (PFA) is variable and limited. The purpose of this study was to assess participations, outcomes, and limitations in sports following UKA and PFA. MethodsPatients who underwent UKA and PFA at a single institution from 2015 to 2020 were surveyed on sports participation before and after surgery. Data was correlated with perioperative patient characteristics and outcome scores. Among 776 patients surveyed, 356 (50%) patients responded. Of respondents, 296 (83.1%) underwent UKA, 44 (12.6%) underwent PFA, and 16 (4.5%) underwent both UKA/PFA. ResultsActivity participation rates were 86.5, 77.3, and 87.5% five years prior, and 70.9, 61.4, and 75% at one year prior to UKA, PFA, and UKA/PFA, respectively. Return to sports rates were 81.6, 64.7, and 62.3% at mean 4.6 years postoperatively, respectively. The most common activities were recreational walking, swimming, cycling, and golf. Patients returned to a similar participation level for low-impact activities, whereas participation decreased for intermediate- and high-impact activities. Patients participating in activities had higher postoperative Knee Injury and Osteoarthritis Outcome Score Joint Replacement (P < .001), 12-Item Short Form Physical Component Score (P = .045) and Mental Component Score (P = .012). Activity restrictions were reported among 25, 36.4, and 25% of UKA, PFA, and UKA/PFA patients, respectively, and were more commonly self-imposed than surgeon-directed. ConclusionsThough UKA patients’ postoperative sports participation may improve compared to one year preoperatively, participation for patients surgically treated for isolated osteoarthritis is decreased compared to 5 years preoperatively and varies among patient subsets.

Loading of the Hip and Knee During Swimming: An in Vivo Load Study.

Swimming is commonly recommended as postoperative rehabilitation following total hip arthroplasty (THA) and total knee arthroplasty (TKA). So far, in vivo hip and knee joint loads during swimming remain undescribed. In vivo hip and knee joint loads were measured in 6 patients who underwent THA and 5 patients who underwent TKA with instrumented joint implants. Joint loads, including the resultant joint contact force (F Res ), torsional moment around the femoral shaft axis or the tibial axis (M Tors ), bending moment at the middle of the femoral neck (M Bend ), torsional moment around the femoral neck axis (M Tne ), and medial force ratio (MFR) in the knee, were measured during breaststroke swimming at 0.5, 0.6, and 0.7 m/s and the breaststroke and crawl kicks at 0.5 and 1.0 m/s. The ranges of the median maximal F Res were 157% to 193% of body weight for the hip and 93% to 145% of body weight for the knee during breaststroke swimming. Greater maxima of F Res (hip and knee), M Tors (hip and knee), M Bend (hip), and M Tne (hip) were observed with higher breaststroke swimming velocities, but significance was only identified between 0.5 and 0.6 m/s in F Res (p = 0.028), M Tors (p = 0.028), and M Bend (p = 0.028) and between 0.5 and 0.7 m/s in F Res (p = 0.045) in hips. No difference was found in maximal MFR between different breaststroke swimming velocities. The maximal F Res was significantly positively correlated with the breaststroke swimming velocity (hip: r = 0.541; p < 0.05; and knee: r = 0.414; p < 0.001). The maximal F Res (hip and knee) and moments (hip) were higher in the crawl kick than in the breaststroke kick, and a significant difference was recognized in F Res Max for the hip: median, 179% versus 118% of body weight (p = 0.028) for 0.5 m/s and 166% versus 133% of body weight (p = 0.028) for 1.0 m/s. Swimming is a safe and low-impact activity, particularly recommended for patients who undergo THA or TKA. Hip and knee joint loads are greater with higher swimming velocities and can be influenced by swimming styles. Nevertheless, concrete suggestions to patients who undergo arthroplasty on swimming should involve individual considerations. Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence.

Community perceptions and attitudes towards the management of protected areas in Seychelles with Morne Seychellois National Park as case study

Designated as a protected area (PA) in 1979, the Morne Seychellois National Park (MSNP) hosts one of the three Ramsar sites in Seychelles – the Mare Aux Cochon (MAC). The park occurs partly in an area with private land ownership suffering from development pressure. Understanding community perceptions and attitudes towards the MSNP can improve the park's role in addressing climate change and biodiversity loss. This study used a stratified random sampling of 130 households to (i) determine socio-demographic factors that influence local communities' attitudes toward biodiversity conservation in the MSNP, (ii) pereceived importance of the MSNP, (iii) to assess what activities are (un)acceptable in the MAC and the rest of the park, and (iv) who has rights to access, land ownership and land-use decision making in the park. The findings indicated that the positive behavior of local communities towards biodiversity conservation is influenced by the frequency of visits and benefits derived in terms of ecosystem services at the 5% significance level. Chief among the importance of the MSNP as viewed by community members included ecotourism (93.5%), biodiversity conservation (84.6%), and environmental protection (66.7%). Respondents generally perceived that low-impact activities should occur at the MAC and the rest of the park. However, the impact from activities such as camping and picnic, hiking, and nature walks, and the harvesting of non-timber forest products, a non-tourism activity, was of greater concern in the MAC. On the other hand, high-impact activities, such as logging and infrastructural development, received over 70% disagreement in the MAC and the rest of the park. Our findings have implications for Seychelles’ land acquisition in the public interest Act 1996, which is silent about land within PAs.

Forest Clearing Dynamics and Its Relation to Remotely Sensed Carbon Density and Plant Species Diversity in the Puuc Biocultural State Reserve, Mexico

The Puuc Biocultural State Reserve (PBSR) is a unique model for tropical dry forest conservation in Mexico. Preserving forest biodiversity and carbon within the PBSR depends on maintaining low-impact productive activities coordinated by multiple communal and private landowners. In this study, we used state-of-the-art remote sensing data to investigate past spatial patterns in forest clearing dynamics and their relation to forest carbon density and forest plant species richness and diversity in the context of the forest conservation goals of the PBSR. We used a Landsat-based continuous change detection product for the 2000–2021 period and compared it to carbon density and tree species richness models generated from ALOS-2 PALSAR 2 imagery and national scale forest inventory data. The estimated error-adjusted area of detected annual forest clearings from the year 2000 until the year 2021 was 230,511 ha in total (±19,979 ha). The analysis of annual forest clearing frequency and area suggests that although forest clearing was significantly more intensive outside of the PBSR than within the PBSR during the entire 2000–2021 period, there is no evidence suggesting that the frequency and magnitude of forest clearing changed over the years after the creation of the PBSR in 2011. However, an emergent hotspot analysis shows that high spatiotemporal clustering of forest clearing events (hotspots) during the 2012–2021 period was less common than prior to 2011, and these more recent hotspots have been confined to areas outside the PBSR. After comparing forest clearing events to carbon density and tree species richness models, the results show that landowners outside the PBSR often clear forests with lower carbon density and species diversity than those inside the PBSR. This suggests that, compared to landowners outside the PBSR, landowners within the PBSR might be practicing longer fallow periods allowing forests to attain higher carbon density and tree species richness and hence better soil nutrient recovery after land abandonment. In conclusion, our results show that the PBSR effectively acted as a stabilizing forest management scheme during the 2012–2021 period, minimizing the impact of productive activities by lowering the frequency of forest clearing events and preserving late secondary forests within the PBSR. We recommend continuing efforts to provide alternative optimal field data collection strategies and modeling techniques to spatially predict key tropical forest attributes. Combining these models with continuous change detection datasets will allow for underlying ecological processes to be revealed and the generation of information better adapted to forest governance scales.

KE ARAH PENGURUSAN KAWASAN PERLINDUNGAN MARIN YANG LESTARI: PERSPEKTIF TEMUBUAL MENDALAM BERSAMA SAINTIS

Efforts to expand Marine Protected Areas (MPA) are very important to ensure continued generation of ocean resources and sources of income. The health and quality of marine ecosystems need to be preserved and restored to ensure that these marine ecosystems can continue to supply resources and services such as fisheries, tourism and recreation opportunities, as well as protection from disasters such as climate change, erosion and tsunamis. It should be emphasized that the protection of this marine area does not mean that access to coastal areas and oceans is closed and the implementation of any activity is completely prevented. On the other hand, control mechanisms will be applied to ensure low-impact socio-economic activities can be carried out sustainably and any uncontrolled development and use of resources can be monitored. This study examines the issues that influence the current planning of sustainability management in marine parks in an effort to expand the network of MPA while maintaining the sustainability of existing MPA. Qualitative methods are used in this study through in-depth interviews with scientists who are involved in marine park research with the Fisheries Department. The results of the study found that effective governance and strict enforcement of regulations can lead to the success of sustainable MPA management and subsequently able to increase the number of MPA. Therefore, there is an advocacy of improvement especially from a management perspective where the informants of this study suggest the concept of seascape management which is a management approach based on ecosystem services of marine areas. The responsibility for the sustainability of this MPA does not depend entirely on government institutions alone but requires the efforts and cooperation of various parties.

Exploring Tourists’ Responsible Behavior: Evidence from Thailand

The study aims to measure tourists’ responsible behavior, and to develop a structural equation model of responsible tourist behavior among Thai tourists. A questionnaire survey was conducted using an online questionnaire. A total of 503 Thai domestic tourists who practiced responsible behavior participated in the study. The data were analyzed through structural equation modeling with a two-stage approach. The results of the analysis revealed a good fit with the empirical data (CMIN/DF = 2.62, RMSEA = 0.06, CFI = 0.94, TLI = 0.92). Moreover, the findings highlight two underlying factors which emerged for responsible behavior, namely impact consideration and local connections. The establishment of an extended Theory of Planned Behavior (TPB) model with two additional predictors including environmental and social concern, and pro-environmental behavior in everyday life, explains the formation of tourists’ responsible behavior. Destination managers and marketers can encourage tourists’ responsible behavior by implementing meaningful experiences with various low-impact tourism activities. Relevant government agencies and policy makers can promote responsible campaigns and events to enhance responsible behavior.

Walking 200 min per day keeps the bariatric surgeon away

Exercise and increased physical activity are vital components of the standard treatment guidelines for many chronic diseases such as diabetes, obesity and cardiovascular disease. Although strenuous exercise cannot be recommended to people with numerous chronic conditions, walking is something most people can perform. In comparison to high-intensity training, the metabolic consequences of low-intensity walking have been less well studied. We present here a feasibility study of a subject who performed an exercise intervention of low-intensity, non-fatiguing walking on a deskmill/treadmill for 200 min daily, approximately the average time a German spends watching television per day. This low-impact physical activity has the advantages that it can be done while performing other tasks such as reading or watching TV, and it can be recommended to obese patients or patients with heart disease. We find that this intervention led to substantial weight loss, comparable to that of bariatric surgery. To study the metabolic changes caused by this intervention, we performed an in-depth metabolomic profiling of the blood both directly after walking to assess the acute changes, as well as 1.5 days after physical activity to identify the long-term effects that persist. We find changes in acylcarnitine levels suggesting that walking activates fatty acid beta oxidation, and that this mitochondrial reprogramming is still visible 1.5 days post-walking. We also find that walking mildly increases gut permeability, leading to increased exposure of the blood to metabolites from the gut microbiome. Overall, these data provide a starting point for designing future intervention studies with larger cohorts.

Scuba diving tourism and the challenge of sustainability: evidence from an explorative study in North African-Mediterranean countries

PurposeScuba diving tourism is reputed to be a potential low-impact recreational activity that allow environmental conservation and socioeconomic benefits for local communities. Few studies have addressed the issue of sustainability of scuba diving tourism through the simultaneously investigation on the economic and socio-cultural aspects and its implications for tourism development. This study aims to examine the scuba diving tourism in three under-explored North African tourism destinations with high ecotourist potential. The authors present an exploratory picture of scuba diving tourist demand, divers' preferences, motivations for recreational diving experiences and their propensity towards conservation.Design/methodology/approachThe authors developed a case study research strategy collecting profile data on 123 divers. Furthermore, regression analysis was performed to investigate the divers' preferences, motivations and propensity towards conservation.FindingsThe divers' limited number, the presence of mainly local seasonal tourists and a moderate propensity towards conservation influence the potential of the diving tourism segment to generate significant socioeconomic benefits for local sustainable development in these destinations. However, establishing a marine protected area (MPA) could foster the development of a long-term strategy for scuba diving tourism, improve conservation awareness and increase divers' satisfaction.Practical implicationsDiverse profiles, preferences and motivations can provide tools to sustainably manage and preserve coastal and marine biodiversity, while also maximising the quality of the recreational experience. One of the most effective site-based strategies to orient the diving sector towards sustainability involves the design and strengthening of MPAs.Originality/valueThe research provides an original contribution to the debate on sustainable tourism strategies by demonstrating how the study of economic and socio-cultural aspects of scuba diving could provide guidelines to orient the tourism development of marine and coastal areas towards the principles of sustainability (also through the establishment of MPAs). The findings present an overview of the sustainability of the scuba diving tourism segment by investigating the preferences, motivations and inclination towards conservation among tourists for whom the diving experience is not a core holiday activity.

Few Runners Return to Running after Total Joint Arthroplasty, While Others Initiate Running

Introduction: This study examines self-reported running practices in total joint arthroplasty (TJA) patients. Methods: This prospective, cross-sectional study of a multi-institutional database identified 4,462 primary total hip arthroplasty (THA) and total or partial knee arthroplasty (TKA/UKA) patients from June 2015 to June 2020. TJA patients completed an online survey capturing pre-TJA running experience and expectations, surgeon recommendations about return to running, postoperative characteristics, revision surgeries, and the Commitment to Exercise Scale and Brief Resilience Scale. Patient-reported follow-up reached 5 years. Logistic regression, the chi square test, and analysis of variance tests were used. Results: Five hundred forty-nine patients (12.2%) self-reported running preoperatively, and 65 patients (11.8%) returned to running after surgery. 67.2% were satisfied with their return to running. 40 patients (1.0%) who were not preoperative runners started running after TJA. Preoperative runners who returned to running had higher mean Brief Resilience Scale (3.9 ± 0.7) scores and the highest Commitment to Exercise Scale scores (46.5 ± 17.6, F[2,510] = 3.88, P = 0.02). Runners who returned to running had a 6.2% revision rate while those who did not run postoperatively had a 4.8% revision rate (P = 0.55). Surgeon recommendations included no return to running (29.5%), maintain low-impact activities (35.2%), return to preoperative levels (5.1%), and no recommendations (30.1%). Discussion: 12% of TJA preoperative runners returned to running, mostly within 1 year, and 67.2% were satisfied with their running ability.

Metabolic and ventilatory changes during postural change from the supine position to the reclining position in bedridden older patients.

The prevention of pneumonia in bedridden older patients is important, and its recurrence in these patients is a relevant issue. Patients who are bedridden and inactive, and have dysphagia are considered to be at risk for pneumonia. Efforts to reduce the bedridden state and low activity may be necessary to reduce the risk of developing pneumonia in bedridden older patients. This study aimed to clarify the effects of postural change from the supine position to the reclining position on metabolic and ventilatory parameters and on safety in bedridden older patients. Using a breath gas analyzer and other tools, we assessed the following 3 positions: lying on the back (supine), resting in the Fowler position (Fowler), and resting in an 80° recline wheelchair (80°). Measurements were oxygen uptake, carbon dioxide output, gas exchange ratio, tidal volume (VT), minute volume, respiratory rate, inspiratory time, expiratory time, total respiratory time, mean inspiratory flow, metabolic equivalents, end-expiratory oxygen, and end-expiratory carbon dioxide as well as various vital signs. The study analysis included 19 bedridden participants. The change in oxygen uptake driven by changing the posture from the supine position to the Fowler position was as small as 10.8 mL/minute. VT significantly increased from the supine position (398.4 ± 111.2 mL) to the Fowler position (426.9 ± 106.8 mL) (P = .037) and then showed a decreasing trend in the 80° position (416.8 ± 92.5 mL). For bedridden older patients, sitting in a wheelchair is a very low-impact physical activity, similar to that in normal people. The VT of bedridden older patients was maximal in the Fowler position, and the ventilatory volume did not increase with an increasing reclining angle, unlike that in normal people. These findings suggest that appropriate reclining postures in clinical situations can promote an increase in the ventilatory rate in bedridden older patients.

Postoperative recommendations for single-level lumbar disc herniation: a cross-section survey.

Lumbar degenerative disc disease is one of the leading causes of low back and leg pain. Conservative treatment is the mainstay treatment, but for some patients surgical approach is required. The literature concerning postoperative recommendations on patients' return to work is sparse. The aim of this study is to assess spine surgeons' consensus regarding postoperative recommendations, including return to work, restart of daily-living activities, analgesic medication usage and rehabilitation referral. An online GoogleForms survey was sent, via electronic mail, during January 2022, to 243 surgeons described as having expertise in spine surgery, using the dissemination means of Sociedade Portuguesa de Patologia da Coluna Vertebral and Sociedade Portuguesa de Neurocirurgia. Participants (n = 59) had predominantly hybrid clinical practice in Neurosurgery field. Only in a minority of cases (1.7%) no recommendation was given to patients. Nearly 68% of participants advised patients to return to sedentary professional work up until the 4th postoperative week. Light and heavy workload workers were advised to wait longer until initiating work activity. Low mechanical impact activities are started up to 4weeks, and higher stress activities should be further postponed. Half of the surveyed surgeons estimates to refer to rehabilitation 10% or more patients. No differences were found when comparing recommendations given by more and less experienced surgeons-as defined by number of years in practice and number of annual surgeries-for most activities. Despite not having clear guidelines in postoperative management of surgically treated patients, Portuguese practice is in line with international experience and literature.

Participation in Sports and Physical Activities After Total Joint Arthroplasty

BackgroundQuality data on physical activity participation following total joint arthroplasty (TJA) are limited. The purpose of this study was to explore patient participation, outcomes, and limitations in sports/physical activities following TJA. MethodsPatients who underwent total hip arthroplasty (THA) and total knee arthroplasty (TKA) at a single institution from 2015 to 2020 were surveyed on sports/physical activity participation before and after TJA. Data were correlated with perioperative demographic and outcome scores. In total, 2,366 patients were surveyed: 788 (33.3%) underwent THA, 1,175 (49.7%) underwent TKA, and 403 (17.0%) underwent both THA/TKA. ResultsParticipation rates were 69.2, 61.5, and 61.3% at one year prior and 86.8, 81.5, and 81.6% at five years prior to THA, TKA, and THA/TKA, respectively. Participation rates were 73.1, 72.0, and 60.8% at mean 4.0 years postoperatively. Weekly time spent (P < .05) and exertion levels (P < .001) increased postoperatively for all three cohorts. For all three cohorts, the most common sports/activities were recreational walking, cycling, swimming, and golf, while intermediate- and high-impact activity participation decreased postoperatively. Independent predictors of postoperative sports/physical activity participation were younger age [THA (P < .001); TKA (P = .010)], lower body mass index [THA (P < .001); TKA (P < .001)], fewer comorbidities [THA (P < .001)], and higher postoperative Hip Injury and Osteoarthritis Outcome Score Junior[THA (P = .012)], Knee Injury and Osteoarthritis Outcome Score Junior[TKA (P = .004)], 12-Item Short Form Physical Component Score[THA (P < .001); TKA (P < .001); THA/TKA (P = .004)], and 12-Item Short Form Mental Component Score[TKA (P = .004)] scores. Activity restrictions were reported among 17.5, 20.9, and 25.1% of THA, TKA, and THA/TKA patients, respectively, and were more commonly self-imposed than surgeon-directed for all cohorts. ConclusionThough sports/physical activity participation may improve following TJA compared to one year preoperatively, participation is decreased compared to five years preoperatively, transitions to low-impact activities, and varies among subsets of patients.

Potential of Neuromuscular Electrical Stimulation as a Bone Loss Countermeasure in Microgravity

INTRODUCTION: For future long-duration spaceflight missions, additional methods of loading the skeleton may be required to supplement exercise to minimize bone loss. Neuromuscular electrical stimulation (NMES) can elicit muscular contractions that create strain on bone. However, the potential effectiveness of NMES on the proximal femur during disuse is not known.METHODS: We measured the maximum isometric force of NMES-induced contractions of the rectus femoris and the hamstrings of 10 subjects (5 male, 5 female), sitting with the hips and knees at 90 degrees of flexion. We employed 2-D biomechanical models of the knee and hip to estimate the hip joint reaction forces, applied these forces to a generic femur finite element analysis model, and qualitatively compared the peak principal strains of the proximal femoral neck to the peak strains modeled in previous studies for other forms of exercise.RESULTS: The average peak tensile/compressive strains were 1380 ± 719 µε/-2179 ± 1130 µε and 573 ± 345 µε/-900 ± 543 µε for the male and female subjects, respectively. While results varied between studies, the strains achieved during NMES generally were comparable to those achieved during walking or stairs, with some individuals matching higher intensity activities.DISCUSSION: This study demonstrated that isometric NMES contractions of the thigh muscles can create strain in the proximal femoral neck similar to that achieved during low impact activities. While NMES alone will unlikely create a sufficient daily strain stimulus to prevent bone loss, it will likely improve the current spaceflight countermeasures by adding more frequent loading throughout the day.Abitante TJ, Bouxsein ML, Duda KR, Newman DJ. Potential of neuromuscular electrical stimulation as a bone loss countermeasure in microgravity. Aerosp Med Hum Perform. 2022; 93(11):774-782.

Effectiveness of an 8-week hatha yoga intervention to improve lower back pain in university office workers: A mixed-methods pilot exploratory study.

Hatha yoga programs have been shown to be effective at improving low back pain among a variety of populations; however, methods to decrease low back pain of university office employees have not been studied. To examine the impact of an 8-week hatha yoga intervention on measures of health among university office employees. Seven participants completed the 8-week yoga intervention. All measures, including anthropometric measures and online questionnaires, were completed at baseline and post-intervention. Baseline pain intensity (6.6±3.1) and pain interference (15.6±4.7) reflected a moderate level of back pain and moderate to severe interference. Pain intensity showed a non-significant improvement with medium-to-large effect size [p = 0.07, (d = 0.7)]. There was a significant improvement with a large effect size [p = 0.002, (d = 2.4)] in pain interference. Baseline anxiety (7.4±3.6) reflected a borderline abnormal symptom level, but anxiety significantly reduced to normal levels at post-intervention with a medium effect size [p = 0.002 (d = 0.5)]. Focus group themes were improvements in health and development of a sense of community. Hatha yoga may be an effective mode of low-impact physical activity to decrease pain and improve mental health while facilitating a sense of community for office workers employed by a university. This study demonstrates promising results with large effect sizes; however, more research with larger sample size and randomized treatment and control groups are needed for future study efforts.

Shift to low-impact sports and recreational activities following total knee replacement.

Background:A growing number of physically active patients undergoing total knee replacement (TKR) desires to resume their preoperative activity levels and to be able to engage in sports after surgery. The purpose of this study was to assess the sporting and physical activities of patients who had undergone TKR. It was hypothesized that the majority of patients treated by TKR would have been able to return to amateur sports and recreational activity .Methods:Ninety-seven patients who underwent TKR between 2014 and 2016, were retrospectively reviewed. Mean age was 70.1 years (range 64–83). Average follow-up time was 4.2 years (SD: 1.7). Assessment included Knee Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC), and Tegner activity level. Sporting and physical activities of all patients were reported. Wilcoxon’s signed ranks test was used for comparison between pre-operative and follow-up data. Significance was set at p < 0.05.Results:Both KOOS score and IKDC significantly improved after surgery (p < 0.001). No statistically significant differences were reported concerning Tegner activity level before and after surgery (p = n.s.). After surgery, a total number of 52 patients (53.6%) successfully returned to sporting and recreational activities, such as cycling, hiking, dancing and swimming. A return to activity rate of 81% of patients practicing sport before surgery was reported.Conclusions:TKR provides a high rate of return to sport postoperatively and confirms improved subjective results and reduced pain compared to preoperative status. However, most patients returned to low-impact activities, while a significant decrease was reported for mid- and high-impact sports.

Patients older than 55years regain sporting and recreational activities after arthroscopic anterior cruciate ligament reconstruction.

(1) To compare sporting and recreational activity levels before and at a minimum 6year follow-up, and (2) to assess the clinical and functional outcomes after anterior cruciate ligament (ACL) reconstruction in patients older than 55years. A retrospective evaluation of prospectively collected data of 150 patients with a mean age of 64 ± 4.5 (57-74) years was evaluated 8.6 ± 1.4 (6-11) years after primary ACL reconstruction using hamstring autograft. All patients were assessed using the International Knee Documentation Committee scoring system (IKDC), Knee injury and Osteoarthritis Outcome Score (KOOS), Tegner activity level, and visual analog scale (VAS) for pain. The level of recreational activities was assessed using a sport-specific questionnaire. All patients were categorized according to Isolated and Combined ACL injury groups. The data of 125 patients were analyzed at the last follow-up. While 25 patients were lost to follow-up, 117 of 125 patients were active before their injury in at least one sports discipline compared to 121 of 125 patients after ACL reconstruction. One hundred and two (82%) patients had returned to their recreational activities at the final follow-up. The mean IKDC subjective score increased from 49.5 ± 23.2 (11.5-100) to 76.2 ± 14.8 (33.3-100) (p < 0.0001). The mean KOOS sport increased significantly from 36 ± 36.2 (0-100) to 74.1 ± 25.5 (0-100) (p < 0.0001). The mean VAS score improved from 6.0 ± 2.6 (0-10) to 1.0 ± 1.4 (0-6) (p < 0.0001). There was no significant difference in the median Tegner activity level (preoperative 5 (2-8) vs. follow-up 5 (2-8) (n.s). There was no significant difference in the number of sports disciplines and duration when comparing pre-injury and mid-term follow-up activity after ACL reconstruction. High-impact activities experienced a significant decline, while a significant increase in participation in low-impact activities was recorded. The majority of patients with symptomatic instability regained their pre-injury recreational activity level with excellent clinical and functional outcomes after arthroscopic ACL reconstruction. Nevertheless, a change from high-to low-impact activities has been observed. Level IV.

Meniscal transplantation in the football player

IntroductionSport activity after meniscal allograft transplantation (MAT) still represents a controversial topic even among knee experts. The major discordance between the authors is whether patients are able to return to pre-injury levels of sports activity, and wether a return to a high impact sport will result in a higher rate of graft failure compared to a low-impact activity. ObjectivesThe aim of this narrative review is to evaluate the results of MAT in football players. MethodsIn this narrative review we report the data of the literature regarding the return to sport after MAT, with a special focus on football players. ResultsAt the moment, there is still a lack of high-level clinical data to evaluate the long-term results of MAT. Moreover, only few papers specifically evaluate results of meniscal allograft transplantation in football players. ConclusionsThe main finding of this narrative review is that the results of MAT in young active patients are good indeed, with a high number of patients going back to their previous level of sport activity. But this requires a long period of rehabilitation and consequently a long period of stop from the official training. Age is considered a bad prognostic factor, with worse results as age increases. Treatment choice must be discussed by the surgeon and patients together, thus the surgeons must also take in consideration that professional athletes have a high motivation to go back to sports. Shared rehabilitation protocols could help to standardize the return to sport of these active patients.