6/4/18 Jeff Hebert, DC, PhD Professor CCRF/NBHRF MSK Health Research Chair Faculty of Kinesiology • Could sport be an effective health intervention? • How does spinal pain relate to physical activity behvaviour / co-morbidity? 10 • Can we understand the individual outcomes 9 Leg pain intensity (0 - 10) 8 7 experienced by patients? 6 5 4 3 2 1 0 3 6 9 12 15 18 21 24 Months Non-communicable disease 1
6/4/18 (Ischemic Heart Disease) (Ischemic Heart Disease) 2
6/4/18 Sport Health performance Sport Injury participation Sport Health performance Sport Injury participation 3
6/4/18 The Childhood Health, Activity, and Motor Performance School Study Denmark (CHAMPS-study DK) Design : Prospective Cohort Sample : 1197 primary school students Exposure : Organized leisure-time sport participation reported by parents via SMS weekly for 1 year (response rate = 96%) Outcome : Clustered cardiovascular risk (serum triglycerides, HOMA-IR, total:HDL ratio, and systolic BP). Serum insulin and glucose, BMI categories. Analysis : Generalized estimating equations. Averaging 1 sport session/week associated with ~3% reduction in clustered carvardiovascular risk. 4
6/4/18 Clinical messages o In children sport participation is associated with o Greater health-related physical activity (Hebert JJ, et al. PLoS One. 2015 Aug 11;10(8)) o Lower risk of cardiovascular disease o Sport may is more than a leisure pursuit o Sport could be an effective physical activity/ cardiovascular health intervention • Could sport be an effective health intervention? • How does spinal pain relate to physical activity behvaviour / co-morbidity? 10 • Can we understand the individual outcomes 9 Leg pain intensity (0 - 10) 8 7 experienced by patients? 6 5 4 3 2 1 0 3 6 9 12 15 18 21 24 Months Cardiovascular Spinal pain Disease Physical Quality of Life Activity 5
6/4/18 Cardiovascular Spinal pain Disease Physical Quality of Life Activity OPEN Physical activity is prospectively associated with spinal pain in children (CHAMPS Study-DK) Claudia Franz, Niels Christian Møller, Lars Korsholm, Eva Jespersen , Jeffrey J. Hebert & Niels Wedderkopp 2017 Sep 14;7(1):11598 Design : Prospective Cohort Sample : 1205 primary school students Exposure : Objectively measured physical activity (accelerometry) Outcome : Occurrences of spinal pain tracked over 1.5 years via SMS messaging Analysis : Logistic regression with robust SE. Moderate PA tends to protect against spinal pain Vigorous PA may predispose children to spinal pain (Children should not avoid vigorous activities!) 6
6/4/18 Cardiovascular Spinal pain Disease Physical Quality of Life Activity Spinal pain is prospectively associated with cardiovascular risk in girls but not boys (The CHAMPS Study-DK) Jeffrey J. Hebert, DC, PhD, Claudia Franz, DC, PhD, Heidi Klakk, PhD, Martin Sénéchal, PhD, Neil Manson, MD, Niels Wedderkopp, MD, PhD ( In review ) Design : Prospective Cohort Sample : 1197 primary school students Exposures : Spinal pain reported by parents via SMS weekly for 1.5 years (response rate = 96%), objectively measured physical activity. Outcome : Clustered cardiovascular risk (serum triglycerides, HOMA-IR, total:HDL ratio, and systolic BP). Serum insulin and glucose, BMI categories. Analysis : Generalized estimating equations. Clinical messages o Physical activity is associated with spinal pain in children o Moderate activity protective? o Vigorous activity a risk factor? o Spinal pain is associated with an increase in cardiovascular risk factors in girls. o Not only driven by physical activity o Relation does not hold in boys o Why? o Shared (pain and CV disease) genetic/environmental exposures? o Others? o Girls with spinal pain may require additional clinical consideration. 7
6/4/18 • Could sport be an effective health intervention? • How does spinal pain relate to physical activity behvaviour / co-morbidity? 10 • Can we understand the individual outcomes 9 Leg pain intensity (0 - 10) 8 7 experienced by patients? 6 5 4 3 2 1 0 3 6 9 12 15 18 21 24 Months One-size-fit-all Stratified Precision From To Medicine Medicine Medicine Individual patient level: Patients are grouped by: • Disease Subtypes • Genomics and Omics • Risk Profiles • Lifestyle • Demographics • Preferences • Socio-economic • Health History • Clinical features • Medical Records • Biomarker • Compliance • Molecular sub-populations • Exogenous Factors Therapy Precision medicine ensures delivery of the right intervention to the right patient at the right time The example of spinal stenosis Adverse No Benefit Event Benefit Each Patient Benefits From Individualized Treatment The example of spinal stenosis Fritsch CG, Ferreira ML, Maher CG, et al. The clinical course of pain and disability following surgery for spinal stenosis: a systematic review and meta-analysis of cohort studies. Eur Spine J. 2017 Feb;26(2):324-335. 8
6/4/18 The example of spinal stenosis Fritsch CG, Ferreira ML, Maher CG, et al. The clinical course of pain and disability following surgery for spinal stenosis: a systematic review and meta-analysis of cohort studies. Eur Spine J. 2017 Feb;26(2):324-335. 10 The example of 9 spinal stenosis leg pain intensity (0 - 10) 8 • 606 patients (44.9% female) scheduled for surgery for degenerative 7 lumbar spinal stenosis followed for 24 months 6 • Age = 64.6 (11.5) years 5 • Leg pain intensity = 7.4/10 4 3 • Back pain intensity = 7.0/10 2 Oswestry score = 46.5/100 • 1 0 3 6 9 12 15 18 21 24 Months 10 9 Leg pain intensity (0 - 10) 8 7 6 5 4 3 2 1 0 3 6 9 12 15 18 21 24 Months 9
6/4/18 • Sport may be effective at improving health related physical activity behavior and reducing cardiovascular risk in children. • Spinal pain is associated with physical activity behavior and increased cardiovascular risk in children. 10 9 • There are important individual differences in Leg pain intensity (0 - 10) 8 7 clinical outcome following spine surgery for 6 5 4 lumbar stenosis. 3 2 1 0 3 6 9 12 15 18 21 24 Months Jeff Hebert, DC, PhD Professor CCRF/NBHRF Musculoskeletal Health Research Chair Faculty of Kinesiology J.Hebert@UNB.CA @JHebertPhD 10
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