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Why Is Exercise Underutilized in Clinical Practice Despite Evidence It Is Effective? Lessons in Pragmatism From the Inclusion of Exercise in Guidelines for the Treatment of Depression in the British National Health Service

Panteleimon Ekkekakis

Exercise remains greatly underutilized in clinical practice for reasons that are only partly understood. This critical review situates the problem within the broader political and economic context. It focuses on depression, the leading cause of disability worldwide, and the processes that followed the inclusion of exercise as a treatment option in clinical practice guidelines in the British National Health Service. The review highlights previously unaddressed phenomena, including antiexercise lobbying by primary care physicians and efforts to present the evidence for the antidepressant effects of exercise as weak, nonexistent, or methodologically flawed. Notably, the field of kinesiology remained silent while these processes unfolded. This information suggests that the path from research evidence to implementation in clinical settings remains dependent on factors beyond the amount and quality of research evidence. The review underscores the need to vigilantly monitor, critically appraise, and actively participate in the clinical research literature and the development of guidelines.

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Extraordinary Claims in the Literature on High-Intensity Interval Training: II. Are the Extraordinary Claims Supported by Extraordinary Evidence?

Panteleimon Ekkekakis and Nicholas B. Tiller

Dishman challenged kinesiologists to seek a compromise between “the ideal physiological prescription and a manageable behavioral prescription.” High-intensity interval training (HIIT) is the first exercise modality that has been claimed to meet this challenge, combining substantial benefits for fitness and health with pleasure and enjoyment. If true, these claims may revolutionize the science and practice of exercise. In this paper, four claims are critically appraised: (a) HIIT lowers the risk of mortality more than moderate-intensity continuous exercise, (b) HIIT doubles endurance performance after only 15 min of training over 2 weeks, (c) 1 min of HIIT is equivalent to 45 min of moderate-intensity continuous exercise, and (d) HIIT is more pleasant and enjoyable than moderate-intensity continuous exercise. The evidence for these claims appears questionable. Kinesiology should heed the principle endorsed by Hume, Laplace, and Sagan, namely that extraordinary claims should be supported by commensurate evidence.

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Overcoming the “Ostrich Effect”: A Narrative Review on the Incentives and Consequences of Questionable Research Practices in Kinesiology

Nicholas B. Tiller and Panteleimon Ekkekakis

Increasing transparency and openness in science is an ongoing endeavor, one that has stimulated self-reflection and reform in many fields. However, kinesiology and its related disciplines are among those exhibiting an “ostrich effect” and a reluctance to acknowledge their methodological shortcomings. Notwithstanding several high-profile cases of scientific misconduct, scholars in the field are frequently engaged in questionable research practices (QRPs) such as biased experimental designs, inappropriate statistics, and dishonest/inexplicit reporting. To advance their careers, researchers are also “gaming the system” by manipulating citation metrics and publishing in predatory and/or pay-to-publish journals that lack robust peer review. The consequences of QRPs in the discipline may be profound: from increasing the false positivity rate to eroding public trust in the very institutions tasked with informing public health policy. But what are the incentives underpinning misconduct and QRPs? And what are the solutions? This narrative review is a consciousness raiser that explores (a) the manifestations of QRPs in kinesiology; (b) the excessive publication pressures, funding pressures, and performance incentives that are likely responsible; and (c) possible solutions for reform.