Exercise Professional Education

01/01/2026

The Exercise Pro Ed & Physicians Fitness Family are wishing you all a happy and healthy New Year!

Cheers to all the problem solving in 2026 ✨

01/01/2026

12/30/2025

Physical Activity Over the Adult Life Course and Risk of Dementia in the Framingham Heart Study

IMPORTANCE
Being physically active is protective against dementia. Yet, it is unknown when during the adult life course physical activity is most associated with dementia risk.

OBJECTIVE
To determine whether higher physical activity levels in early adult life, mid-life, or late life are associated with lower risk of all-cause or Alzheimer disease (AD) dementia.

DESIGN, SETTING, AND PARTICIPANTS
This prospective cohort study used data from the Framingham Heart Study Offspring cohort. The offspring of participants in the original Framingham Heart Study cohort who were dementia free and had physical activity measured at baseline (early adult life [1979-1983], midlife [1987-1991], or late life [1998-2001]) were followed up for a mean (SD) of 37.2 (7.1), 25.9 (8.5), or 14.5 (6.6) years for the development of incident all-cause or AD dementia until December 31, 2023.

EXPOSURE
Physical activity was self-reported using the physical activity index, a composite score weighted by hours spent sleeping and in sedentary, slight, moderate, or heavy activities. Physical activity was divided into quintiles (Q).

MAIN OUTCOME AND MEASURE
All-cause and AD dementia were classified by expert consensus based on established diagnostic criteria.

RESULTS
This study included 1526 early adult–life (mean [SD]age,36.7[4.7] years;821[53.8%] female), 1943 midlife (mean [SD] age, 54.0 [5.8] years; 1010 [52.0%] female), and 885 late-life (mean [SD] age, 71.0 [4.5] years; 473 [53.4%] female) participants. There were 567 cases of incident all-cause dementia during follow-up. Higher levels of midlife and late-life physical activity were associated with lower risk of all-cause dementia. Midlife and late-life physical activity levels in Q4 or Q5 were associated with lower risk of all-cause dementia compared with Q1 (midlife Q4: HR, 0.60; 95% CI, 0.41-0.89; midlife Q5: HR, 0.59; 95% CI, 0.40-0.88; late-life Q4: HR, 0.64; 95% CI, 0.42-1.00; late-life Q5: HR, 0.55; 95% CI, 0.35-0.87). There were no associations between early adult–life physical activity and dementia risk. Findings were similar for incident AD (369 cases).

CONCLUSIONS AND RELEVANCE
In this cohort study of adults in the Framingham Heart Study Offspring cohort, higher levels of midlife and late-life physical activity were associated with similar reductions in risk of all-cause and AD dementia. These findings may inform future efforts to delay or prevent dementia through timing interventions during the most relevant stages of the adult life course.

Marino FR, Lyu C, Li Y, Liu T, Au R, Hwang PH. Physical Activity Over the Adult Life Course and Risk of Dementia in the Framingham Heart Study. JAMA Netw Open. 2025 Nov 3;8(11):e2544439. doi: 10.1001/jamanetworkopen.2025.44439. PMID: 41259024; PMCID: PMC12631490.

12/23/2025

Association Between Systemic Immune-Inflammation Index and Low Back Pain in American Adults: Evidence From a Large Population-Based Study

"Abstract
Background:
Low back pain imposes a substantial global health burden, impairing productivity and quality of life. Emerging evidence implicates systemic inflammation in its pathogenesis. The Systemic Immune-Inflammation Index (SII), a validated inflammatory biomarker, may elucidate this relationship. This study investigated the SII-low back pain association.

Methods:
The study employed data from the National Health and Nutrition Examination Survey (NHANES) for the cycles 2001-2004 and 2009-2010. The connection of SII with low back pain was investigated using a weighted multivariable regression analysis model. Subgroup analyses were conducted, stratifying participants by gender and age. Restricted cubic spline (RCS) examined potential nonlinear dose-response relationships.

Results:
This research analysed 17,286 subjects. Following log-transformation of SII, a fully adjusted model demonstrated that SII was significantly associated with low back pain (OR = 1.41; 95% CI: [1.31, 1.52]; p < 0.001). Participants in the highest quartile of SII had a 66% higher probability of having low back pain compared with those in the lowest quartile (OR = 1.66; 95% CI: [1.44, 1.92]; p < 0.001). This positive association remained significant in both sexes (OR = 1.37; 95% CI: [1.19, 1.57]; p < 0.001; OR = 1.45; 95% CI: [1.33, 1.59]; p < 0.001). In the 20-40 and 40-60 years age groups, the study found a similar association (OR = 2.05; 95% CI: [1.65, 2.55]; p < 0.001; OR = 1.46; 95% CI: [1.14, 1.86]; p = 0.004).

Conclusions:
Higher SII values show a significant correlation with a greater likelihood of developing low back pain.

Significance statement:
This large-scale study reveals, for the first time, a significant association between the systemic immune-inflammation index (SII) and low back pain in U.S. adults. Through stratified analysis, our study provides potential stratification indicators for the early prediction of low back pain."

Yuyang C. Association Between Systemic Immune-Inflammation Index and Low Back Pain in American Adults: Evidence From a Large Population-Based Study. Eur J Pain. 2026 Jan;30(1):e70179. doi: 10.1002/ejp.70179. PMID: 41320786.

12/22/2025

Hear from our Founder and Creator, Greg Mack, as he shares what sets the Muscle System Specialist Course apart from other continuing education courses and how it will help you stand out and thrive as an Exercise Professional!

Step outside the box in 2026!

12/16/2025

Intra-articular Corticosteroid Injections in the Hip and Knee: Perhaps Not as Safe as We Thought?

"Abstract
Osteoarthritis (OA) of the hip and knee is among the most common joint disorders. Intra-articular corticosteroid (IACS) injections are frequently performed to treat OA and other joint-related pain syndromes; however, there is conflicting evidence on their potential benefit. There is a lack of prospective and large retrospective studies evaluating potential joint findings, including increased risk for accelerated OA progression or adverse joint events, after treatment with IACS injection. Four main adverse joint findings have been structurally observed in patients after IACS injections: accelerated OA progression, subchondral insufficiency fracture, complications of osteonecrosis, and rapid joint destruction, including bone loss. Physicians, including radiologists, should be familiar with imaging findings and patient characteristics that may help them identify potential joints at risk for such events. The purpose of this report is to review the existing literature, describe observed adverse joint events after IACS injections, and provide an outlook on how this may affect clinical practice. Additional research endeavors are urgently needed to better understand and identify risk factors prior to intervention and to detect adverse joint events after injection as early as possible to prevent or minimize complications."

Kompel AJ, Roemer FW, Murakami AM, Diaz LE, Crema MD, Guermazi A. Intra-articular Corticosteroid Injections in the Hip and Knee: Perhaps Not as Safe as We Thought? Radiology. 2019 Dec;293(3):656-663. doi: 10.1148/radiol.2019190341. Epub 2019 Oct 15. PMID: 31617798.

12/09/2025

Exercise Leads to Faster Postural Reflexes, Improved Balance and Mobility, and Reduced Falls in Older Persons with Chronic Stroke

"Abstract

OBJECTIVES—To determine the effect of two different community-based group exercise programs on functional balance, mobility, postural reflexes, and falls in older adults with stroke.

DESIGN—A randomized, clinical trial. SETTING—Community centre.

PARTICIPANTS—Total of 61 community-dwelling older adults with chronic stroke.

INTERVENTION—Participants were randomly assigned to an Agility (n = 30) or Stretching/ weight-shifting (n = 31) exercise group. Both groups exercised three times a week for 10 weeks.

MEASUREMENTS—Participants were assessed prior to, immediately after, and one-month following the intervention for Berg Balance, Timed Up and Go, step reaction time, Activities specific Balance Confidence, and Nottingham Health Profile. Testing of standing postural reflexes and induced falls evoked by a translating platform was also performed. In addition, falls in the community were tracked for one year from the start of the interventions. RESULTS—Although exercise led to improvements in all clinical outcome measures for both groups, the Agility group demonstrated greater improvement in step reaction time and paretic re**us femoris postural reflex onset latency compared to the Stretching/weight-shifting group. Further, induced falls on the platform were reduced in the Agility group.

CONCLUSION—Group exercise programs that include Agility or Stretching/weight shifting exercises improve postural reflexes, functional balance and mobility and may lead to a reduction of falls in older adults with chronic stroke."

Marigold DS, Eng JJ, Dawson AS, Inglis JT, Harris JE, Gylfadóttir S. Exercise leads to faster postural reflexes, improved balance and mobility, and fewer falls in older persons with chronic stroke. J Am Geriatr Soc. 2005 Mar;53(3):416-23. doi: 10.1111/j.1532-5415.2005.53158.x. PMID: 15743283; PMCID: PMC3226796.

12/02/2025

Physiotherapy Compared With Shockwave Therapy for the Treatment of Proximal Hamstring Tendinopathy

"Background: Proximal hamstring tendinopathy (PHT) presents as localized lower buttock pain with tasks such as running and sitting.

Purpose: To investigate the effectiveness of individualized physiotherapy compared with shockwave therapy on pain and function in PHT.

Methods: This prospective parallel-group, assessor-blinded randomized controlled trial (RCT) was set in 10 primary care physiotherapy practices in Victoria, Australia. A total of 100 participants with PHT were randomly assigned to receive 6 sessions of either individualized physiotherapy or shockwave therapy, with both groups receiving standardized advice and education. Primary outcomes were global rating of change on a 7-point Likert scale and the Victorian Institute of Sport Assessment Scale for Proximal Hamstring Tendinopathy at 4, 12, 26, and 52 weeks post-randomization. Analyses were by intention-to-treat using linear mixed models.

Results: All except 1 patient received the allocated intervention, and the participant follow-up rate was 88% at 12 months. There were no significant differences between groups in primary outcomes at any time point. For secondary outcome measures, participants in the shockwave group had statistically significantly greater satisfaction with treatment at 26 weeks, satisfaction with results of treatment at 4 and 26 weeks, and general health at 52 weeks. Responder analyses of participants achieving clinically significant improvements showed no significant differences between groups at any time point.

Conclusion: This RCT found no difference in effectiveness of individualized physiotherapy compared with shockwave therapy on global effect or function in PHT. Future trials on PHT appear feasible but could explore a different sample population or other intervention and/or comparison groups."

Rich A, Ford J, Cook J, Hahne A. Physiotherapy Compared With Shockwave Therapy for the Treatment of Proximal Hamstring Tendinopathy: A Randomized Controlled Trial. Am J Sports Med. 2025 Dec;53(14):3396-3407. doi: 10.1177/03635465251391134. Epub 2025 Nov 16. PMID: 41243328; PMCID: PMC12657663.

11/27/2025

Enjoy the Holiday!

11/25/2025

More knee pain, less hip and ankle joint power: The relationship between knee osteoarthritis pain and joint power

“A B S T R A C T

It is unknown how knee osteoarthritis pain affects joint power distribution while cycling. The study purposes were to (1) investigate if seat height, workload and any difference in hip or knee extensor strength affected asymmetry of hip, knee and ankle joint power during cycling; and (2) determine the relationship between knee osteoarthritis pain asymmetry and joint power asymmetry at the hips, knees, ankles and total leg. Asymmetry was the difference between dominant and non-dominant legs. Twenty-six participants (13 female, 13 male) with (n = 21) and without (n = 5) symptomatic knee osteoarthritis participated [age 64.3 (7.3) y, body mass index 27.0 (4.1) kg/m2]. Participants completed six cycling bouts at three seat heights (20◦, 30◦, 40◦ minimum knee flexion angle) and two workloads (40 W, 75 W) on a stationary bike. Self-reported pain was recorded for each knee before the first bout and after each bout. Three-dimensional kinematics and kinetics were collected synchronously with motion capture and instrumented pedals. A greater workload was associated with greater hip power asymmetry (p < 0.01); otherwise, seat height and workload did not affect power asymmetry (p > 0.05). Relationships were found between knee pain asymmetry and hip, ankle and total leg power asymmetry (p < 0.01), but not knee (p > 0.05). The hip, ankle and total leg with the more painful knee produced less power than the opposite side. The more painful knee cannot be assumed to produce less power than the contralateral side. These findings show that, at low workloads, clinicians can adjust seat height to patient preference without affecting joint power production during cycling.”

Currie DJ, Grad D, Webster K, Liu H, Acker S, Knowles N, Maly MR. More knee pain, less hip and ankle joint power: The relationship between knee osteoarthritis pain and joint power. J Biomech. 2025 Nov;192:112937. doi: 10.1016/j.jbiomech.2025.112937. Epub 2025 Sep 1. PMID: 40913928.

11/18/2025

Keep that neck strong!

"a b s t r a c t

Objectives:
Primary prevention of concussions is a priority in contact sports, with growing interest in the role of neck strength in mitigating the risks of concussion. The aim of this study was to determine if neck function was associated with in-season concussions in adolescent rugby union and league athletes, and to establish clinical values to identify players with increased risk of sustaining a concussion.

Design:
Prospective cohort study.

Methods:
Assessment of neck function included isometric strength, endurance and proprioception. In-season concussion injuries were recorded. Preliminary multivariate analysis-of-covariance models were conducted to investigate differences in neck function between players who did and did not sustain an in-season concussion. If significant, receiver operated characteristic curves were used to determine optimal cut-points for each variable to distinguish between concussion groups. Unadjusted odds ratios were estimated from the cross tabulation chi-squared test. Significance was set at p < 0.1.

Results:
A total of 43 players (aged 15–18 years) were assessed during preseason. Eleven players sustained a concussion during the season. Players who sustained a concussion during the season had weaker neck extension strength in kilogrammes (p = 0.043, effect size = 0.74) and when normalised to body weight (p = 0.041, effect size = 0.74). The optimal cut-point for extension strength was 32.1 kg (sensitivity 0.64, specificity 0.75) and 3.71 N/kg (sensitivity 0.64, specificity 0.66). Players with a flexor to extensor strength ratio above 0.74 were 3-times more likely to sustain a concussion (p = 0.09). There were no differences for other neck function variables."

Leung FT, Brown DA, Warner E, Shamim S, Harris S, Hides JA. Neck strength deficit is a risk factor for concussion in high school rugby union and rugby league players. J Sci Med Sport. 2025 May;28(5):370-376. doi: 10.1016/j.jsams.2024.11.016. Epub 2024 Dec 4. PMID: 39672717.