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South African Journal of Surgery

On-line version ISSN 2078-5151
Print version ISSN 0038-2361

S. Afr. j. surg. vol.52 n.2 Cape Town Feb. 2014 




Major steps in 2021



Mike Lambert




The South African Journal of Sports Medicine (SAJSM) took major steps in 2021. Seventy-nine submissions were received during the year with 37 submissions getting accepted for publication after review. This is a record. The 53% rejection rate may seem harsh, but not when compared to the top journal in the field (British Journal of Sports Medicine) which has a rejection rate of 78%. The SAJSM's abstracts were viewed 8746 times, and 5064 PDFs were downloaded during the year. The highlight of the year was receiving the news that the journal passed the National Library of Medicine's scientific quality review. The journal's papers from 2019 onwards will be included in the NCBI's PubMed Central database. A full listing of the other databases which cover the SAJSM is described in the index/listing section of journal.

The growth of the journal can be attributed to several factors. Firstly, the small but dedicated support staff working tirelessly to maintain the workflow from the time a paper enters the review process. Secondly, the_stable platform from which to host the journal. This was provided by the Academy of Science of South Africa (ASSAf). Their management team was superb in maintaining the publication's platform and responding to queries. This had a major impact on the growth of the journal and is aligned with their goal of 'growing the peer-reviewed open access scholarly journals in South Africa'. A third factor contributing to this journal's growth is the expanding pool of reviewers. Many reviewers were drawn from the membership of the South African Sports Medicine Association, which reflects the maturity of the organisation. Reviewers from overseas institutions were also recruited. In the majority of cases the quality of reviews was high. Reviewing is a time-consuming job for which there is no public recognition. Without these high-quality reviews it is not possible to raise the standard of the published work. It is for this reason that much gratitude is extended to all the reviewers of 2021.

Another pleasing aspect of 2021 was that the publications represented eleven institutions from around the country (Cape Peninsula University of Technology, IIE's Varsity College, Nelson Mandela University, Stellenbosch University, Tshwane University of Technology, University of Cape Town, University of Johannesburg, University of KwaZulu-Natal, University of Pretoria, University of the Free State, University of the Witwatersrand). This shows the discipline of Sports Medicine has spread throughout the country and is not the domain of a few universities as it was a decade ago. Papers were also received from institutions in Zimbabwe, Mauritius, Kenya, England and Ireland.

There are still challenges ahead. During the COVID pandemic the "scientific process" has been stress-tested. Political influence has crept into a few high level medical journals. This has been divisive and destructive to the scientific process. Politics and science have to remain separate. Mixing the two creates a murky environment to the detriment of both. Journals have a role to play in maintaining the integrity of the scientific process. They can do this by ensuring that the review process is fair and rigorous. A rigorous review considers the research question and design of the study. Are the results believable? Do the conclusions match the results? Are any biases acknowledged?

There should be no influence from outside sources with a preferred outcome of the study. These include advertisers, policy makers, and scientists invested in a particular finding. Failure of journals to uphold these basic principles of the review will contribute to the further contamination of the scientific process.

As mentioned earlier, the discipline of sport and exercise medicine has matured. But fundamental questions remain important. For example; what is the best training approach to reduce the risk of injury? What impact does injury during competition have on the athlete's quality of life after they have retired? What are the positive effects of regular exercise on quality of life? Researchers have tried to answer these questions using measurements available at the time of the research. As new measurement techniques become available further insight into these questions are possible. The health and fitness industry has been flooded with new wearable technology with a variety of sensors (e.g. electrochemical, optical, acoustic, and pressure-sensitive). M Accelerometers, gyroscopes and real-time position detectors are also included in some devices. These sensors can measure heart rate, ECG, EMG, tissue oxygenation, lactate, temperature, distribution of plantar pressure, acceleration of body segments, and speed while exercising. As the sensors have become more sophisticated, the potential for greater data collection has increased. This opens opportunities for studies using machine learning and artificial intelligence. This has provided an opportunity to use big data mining analytics to answer specific questions that could not be answered in the same way previously. For example, the Fitbit company has patented an algorithm which identifies depression and predicts bipolar conditions using data (sleep, resting heart rate and voice of the user) measured with the Fitbit. Pi The accuracy of the prediction is unknown, but it indicates the potential to use a variety of measurements from wearable devices for clinical purposes.

Data scientists with expertise in artificial intelligence will be attracted to innovative applications of wearable technology using big data. There are many opportunities to revisit some of the fundamental questions and answer them using more sophisticated measurements. There is still much work to be done!




1. Düking P, Fuss FK, Holmberg H-C, et al. Recommendations for Assessment of the Reliability, Sensitivity, and Validity of Data Provided by Wearable Sensors Designed for Monitoring Physical Activity. JMIR Mhealth Uhealth 2018;6(4):e102. [doi: 10.2196/mhealth.9341] [PMID: 29712629]        [ Links ]

2. Stables J. New Fitbit patent targets depression and bipolar detection. December 28, 2021. (accessed 07 January 2022)        [ Links ]^rND^sDüking^nP^rND^sFuss^nFK^rND^sHolmberg^nH-C^rND^1A01^nRM^sWilkinson^rND^1A01^nL^sSmith^rND^1A01^nS^sFerreira^rND^1A01^nRM^sWilkinson^rND^1A01^nL^sSmith^rND^1A01^nS^sFerreira^rND^1A01^nRM^sWilkinson^rND^1A01^nL^sSmith^rND^1A01^nS^sFerreira



Pain and physical activity levels among Rheumatoid Arthritis patients between the ages of 18 to 50 years in South Africa



RM WilkinsonI; L SmithII; S FerreiraII

IBBio; Department of Sport and Movement Studies in the Faculty of Health Sciences, University of Johannesburg, Doornfontein Campus, P.O. Box 524, Auckland Park, 2006, Johannesburg, South Africa
IIMPhil; Department of Sport and Movement Studies in the Faculty of Health Sciences, University of Johannesburg, Doornfontein Campus, P.O. Box 524, Auckland Park, 2006, Johannesburg, South Africa





BACKGROUND: Little epidemiological research on rheumatoid arthritis (RA) has been done in Africa, suggesting that it is an uncommon illness. In rural South Africa, RA has an overall prevalence of 0.07% and a prevalence of 2.5% in urban areas; therefore, it is not as uncommon as perceived by the lack of research. Patient-centred programmes to improve physical function have been lacking and, as a result, the prior assumption was that physical activity should be avoided.
OBJECTIVES: To determine pain and physical activity levels among RA patients between the ages of 18 to 50 years in South Africa.
METHODS: A combination of two questionnaires were used, namely, the Global Physical Activity Questionnaire (2002) and the Pain Outcomes Questionnaire (2003). The collated questionnaires were distributed by rheumatologists and on social media platforms to RA patients between the ages of 18 to 50 years old living in South Africa. This study had a sample size of 105 participants, with participation occurring through the online Google forms platform.
RESULTS: One hundred and five participants with RA were recruited with an average age of 38±9 years. Most of the participants were females (93.3%). Seventy-two percent of the sample was classified as physically active, where work, leisure and travel activities were considered. No significant correlation between pain and physical activity was evident (r=0.10; p=0.311). Results showed significant correlations between pain and personal grooming (r=0.30; p=0.002), pain and ambulation (r=0.60; p=0.000), and pain and stair climbing (r=0.60; p=0.000.
CONCLUSION: Physical activity has proven to have multiple benefits for those suffering with RA. In this South African sample of RA patients, the majority were classified as physically active, and pain did not affect the activity levels of the involved participants. This study opens further research questions regarding RA prevalence in South Africa, and the type and intensity of physical activity that would be beneficial for RA.

Keywords: inflammatory disease, exercise, physical limitations



Arthritis is a musculoskeletal disorder which holds the potential of being disabling. [1] Arthritis affects people worldwide, with disability and functional limitations being characteristics of the disorder. [1] Rheumatoid arthritis is characterised by systemic inflammation, which can result in joint damage, disability and functional limitations. [1] Disease-modifying anti-rheumatic drugs, anti-inflammatories and analgesics are the types of medications commonly prescribed for the management of RA. [1] However, when the systemic inflammation in RA is poorly controlled and patients follow an unhealthy lifestyle, they are at risk for developing various comorbidities. [1,2,3] The incidence of cardiovascular events in those diagnosed with RA is estimated to be double that compared to the general population, with cardiovascular disease (CVD) typically developing at an earlier age in this population. [2] Obesity further increases the comorbidity risk in those with RA, with obesity and poor body composition related to RA, pharmacology and to physical inactivity. [1,3]

It has been suggested that RA patients are less active due to joint manifestations relating to the disease as well as other 'general' barriers, yet regular physical activity is an effective treatment and management tool for RA. [2,3] Currently, exercise and the broad range of treatment options for RA are trumped by medication as the favoured modality; however, when considering longevity, interventions such as exercise become essential. [2,4] Physical activity as therapeutic management has been proven to possess a range of benefits, including the improvement of general health and functional ability, as well as the reduction of associated disability. [2] Furthermore, physical activity is suitable for most individuals and can be used in conjunction with prescribed medications, which may allow for a reduced dosage while simultaneously benefitting general health status. [1,2] However, various international research studies demonstrate that only a small percentage of RA patients are physically active. [1,5,6] Several countries have conducted research on physical activity participation among RA patients, but with the unpredictable and changing landscape in South Africa, as well as its economic development, there is a need to assess the current physical activity levels in a local context, and to identify barriers to physical activity participation. [1,5,6] Therefore, the purpose of this study was to determine pain and activity levels at work, while travelling or during leisure activities of RA patients in a South African context. The objectives of the study were: (1) determine whether most physical activity is completed during work, travel or recreation; (2) quantify the amount of time spent sedentary on a normal day; (3) determine the correlation between the pain, physical activity level, ambulation and personal grooming; (4) determine self-reported physical activity levels, overall energy levels, strength and endurance; and (5) determine patients' perceptions on injury, risk and safety of exercise.



Study design

This study was cross-sectional in design and quantitative data were collected and analysed. To achieve the aim of the study, a combination of two questionnaires were utilised: the Global Physical Activity Questionnaire (GPAQ) and the Pain Outcomes Questionnaire (POQ). The collated questionnaires were made available on the Google Forms platform, allowing participants to access and complete them online.

Selection and description of participants

Various rheumatologists were contacted to distribute the Google Forms link to the patients in their practices who met the inclusion criteria of this study. Additionally, the link was published to RA support groups and social media platforms by the researcher.

A sample of 105 participants complying with the inclusion criteria were recruited by means of purposive sampling Participants were diverse in terms of backgrounds, provinces and treating rheumatologists.

Inclusion criteria

Clinically diagnosed with RA.

Between the ages of 18 and 50 years at the time of data collection. The minimum age of 18 years was established to allow the participant to consent independently to participation in the research study. The exclusion of individuals older than 50 years of age was determined due to the relationship between increased age and comorbidities, which could impact physical activity levels and the performance of daily activities.

Residents in South Africa at the time of data collection.

Male or female.

Internet access to complete the questionnaire.

Ethical considerations

All participants were informed about the purpose of the research by means of an information letter and were required to provide consent before data collection commenced. The study participants were aware that participation was voluntary and that withdrawal from the study could only take place before submission of the questionnaire. Every precaution was taken to protect the privacy of the participants and confidentiality of their personal information was ensured. This study was approved by the institutional Research Ethics Committee (REC-171-2019).


As mentioned, two combined questionnaires were used to gather subjective data relating to the pain and physical activity levels of the participants. Although the questionnaires included demographic questions, no identifying data was gathered and therefore, participation was anonymous. The questions in the GPAQ were centred on the participants' activity levels during work, travel and leisure. The POQ was adapted by removing questions that were not relevant to the aims and objectives of this study. Therefore, the POQ was centred on the participants' overall pain levels, as well as how pain affects their daily activities.

Statistical analysis

The data collected were quantitative in nature. Statistical analysis was completed using the Statistical Package for Social Science (SPSS) version 26.0 and included percentages, means, standard deviations and correlations. The Kolmogorov-Smirnov test was used to assess the normality of the distribution of the data. To determine the correlations between the variables of interest, the Pearson product-moment correlation coefficient was computed because normality of the data was established. A calculation of statistical significance was done yielding 5% as the level of significance.




A total of 105 RA patients took part in the present study, with the demographic results demonstrated in Table 1. The mean age of the participants was 38±9, and only 7 participants were of the male gender. The mean age of RA diagnosis was 32 years. Eighteen of the 105 participants were not currently seeking treatment for their condition. Majority of the participants resided in the Gauteng province, with only 36 participants residing elsewhere.



Global Physical Activity Questionnaire

Many participants had declared that they were physically active across more than one of the categories presented in Table 2. Based on the general physical activity guidelines, 29 participants (27.6%) were classified as physically inactive, while 76 participants (72.4%) were classified as physically active. [3]

Both vigorous and moderate intensity activity was performed at work by 10 (9.5%) and 43 (41%) of the participants respectively. The mean time spent being physically active at work at a vigorous intensity was 229 minutes with a mean of four and a half days, while the mean amount of time spent doing moderate intensity activity at work was 175 minutes with a mean of four days.

The number of participants in the different categories of physical activity is shown in Fig. 1. Sixteen participants (15%) performed no physical activity. Leisure activity had the highest number of participants and travel the least, with 27 (26%) and six (6%) respectively. Nine participants (9%) performed physical activity in all three categories.

The participants were required to select the amount of time they spend seated or reclining on a typical day. The categories of choice were 1-2 hours, 3-4 hours, 56 hours and >7 hours, with 12 (11.43%), 24 (22.86%), 42 (40%) and 27 (25.71%) selected respectively.

Pain Outcomes Questionnaire

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