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Journal of Perinatal Medicine Jan 2022The aim of this article is to provide a comprehensive literature review, gathering the strongest evidence about the risks and benefits and the prescription of physical...
OBJECTIVES
The aim of this article is to provide a comprehensive literature review, gathering the strongest evidence about the risks and benefits and the prescription of physical exercise during pregnancy.
CONTENT
Regular physical exercise during pregnancy is associated with numerous benefits. In general women are not adequately advised on this matter. Along with their concerns regarding the potential associated risks, it contributes to the abandonment or refusal to start exercising during pregnancy. A systematic review was conducted in including articles considered to have the highest level of scientific evidence. Fifty-seven articles, including 32 meta-analysis, 9 systematic reviews and 16 randomized controlled trials were included in the final literature review.
SUMMARY
Exercise can help preventing relevant pregnancy related disorders, such as gestational diabetes, excessive gestational weight gain, hypertensive disorders, urinary incontinence, fetal macrosomia, lumbopelvic pain, anxiety and prenatal depression. Exercise is not related with an increased risk of maternal or perinatal adverse outcomes. Compliance with current guidelines is sufficient to achieve the main benefits, and exercise type and intensity should be based on woman's previous fitness level.
OUTLOOK
Exercise in pregnancy is safe for both mother and fetus, contributing to prevent pregnancy related disorders. Exercise type and intensity should be adapted to woman's previous fitness level, medical history and characteristics of the ongoing pregnancy.
Topics: Exercise; Exercise Therapy; Female; Health Behavior; Health Promotion; Humans; Pregnancy; Pregnancy Complications; Prenatal Care
PubMed: 34478617
DOI: 10.1515/jpm-2021-0315 -
Journal of Cachexia, Sarcopenia and... Jun 2023Sarcopenia is a serious public health concern among older adults worldwide. Exercise is the most common intervention for sarcopenia. This study aimed to compare the... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Sarcopenia is a serious public health concern among older adults worldwide. Exercise is the most common intervention for sarcopenia. This study aimed to compare the effectiveness of different exercise types for older adults with sarcopenia.
METHODS
Randomized controlled trials (RCTs) that examined the effectiveness of exercise interventions on patient-important outcomes for older adults with sarcopenia were eligible. We systematically searched MEDLINE, Embase and Cochrane Central Register of Controlled Trials via Ovid until 3 June 2022. We used frequentist random-effects network meta-analyses to summarize the evidence and applied the Grading of Recommendations, Assessment, Development, and Evaluations framework to rate the certainty of evidence.
RESULTS
Our search identified 5988 citations, of which 42 RCTs proved eligible with 3728 participants with sarcopenia (median age: 72.9 years, female: 73.3%) with a median follow-up of 12 weeks. We are interested in patient-important outcomes that include mortality, quality of life, muscle strength and physical function measures. High or moderate certainty evidence suggested that resistance exercise with or without nutrition and the combination of resistance exercise with aerobic and balance training were the most effective interventions for improving quality of life compared to usual care (standardized mean difference from 0.68 to 1.11). Moderate certainty evidence showed that resistance and balance exercise plus nutrition (mean difference [MD]: 4.19 kg) was the most effective for improving handgrip strength (minimally important difference [MID]: 5 kg). Resistance and balance exercise with or without nutrition (MD: 0.16 m/s, moderate) were the most effective for improving physical function measured by usual gait speed (MID: 0.1 m/s). Moderate certainty evidence showed that resistance and balance exercise (MD: 1.85 s) was intermediately effective for improving physical function measured by timed up and go test (MID: 2.1 s). High certainty evidence showed that resistance and aerobic, or resistance and balance, or resistance and aerobic exercise plus nutrition (MD from 1.72 to 2.28 s) were intermediately effective for improving physical function measured by the five-repetition chair stand test (MID: 2.3 s).
CONCLUSIONS
In older adults with sarcopenia, high or moderate certainty evidence showed that resistance exercise with or without nutrition and the combination of resistance exercise with aerobic and balance training were the most effective interventions for improving quality of life. Adding nutritional interventions to exercise had a larger effect on handgrip strength than exercise alone while showing a similar effect on other physical function measures.
Topics: Female; Humans; Aged; Network Meta-Analysis; Sarcopenia; Exercise; Exercise Therapy; Muscle Strength
PubMed: 37057640
DOI: 10.1002/jcsm.13225 -
British Journal of Sports Medicine Aug 2023To estimate the efficacy of exercise on depressive symptoms compared with non-active control groups and to determine the moderating effects of exercise on depression and... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To estimate the efficacy of exercise on depressive symptoms compared with non-active control groups and to determine the moderating effects of exercise on depression and the presence of publication bias.
DESIGN
Systematic review and meta-analysis with meta-regression.
DATA SOURCES
The Cochrane Central Register of Controlled Trials, PubMed, MEDLINE, Embase, SPORTDiscus, PsycINFO, Scopus and Web of Science were searched without language restrictions from inception to 13 September2022 (PROSPERO registration no CRD42020210651).
ELIGIBILITY CRITERIA FOR SELECTING STUDIES
Randomised controlled trials including participants aged 18 years or older with a diagnosis of major depressive disorder or those with depressive symptoms determined by validated screening measures scoring above the threshold value, investigating the effects of an exercise intervention (aerobic and/or resistance exercise) compared with a non-exercising control group.
RESULTS
Forty-one studies, comprising 2264 participants post intervention were included in the meta-analysis demonstrating large effects (standardised mean difference (SMD)=-0.946, 95% CI -1.18 to -0.71) favouring exercise interventions which corresponds to the number needed to treat (NNT)=2 (95% CI 1.68 to 2.59). Large effects were found in studies with individuals with major depressive disorder (SMD=-0.998, 95% CI -1.39 to -0.61, k=20), supervised exercise interventions (SMD=-1.026, 95% CI -1.28 to -0.77, k=40) and moderate effects when analyses were restricted to low risk of bias studies (SMD=-0.666, 95% CI -0.99 to -0.34, k=12, NNT=2.8 (95% CI 1.94 to 5.22)).
CONCLUSION
Exercise is efficacious in treating depression and depressive symptoms and should be offered as an evidence-based treatment option focusing on supervised and group exercise with moderate intensity and aerobic exercise regimes. The small sample sizes of many trials and high heterogeneity in methods should be considered when interpreting the results.
Topics: Humans; Depression; Depressive Disorder, Major; Exercise; Exercise Therapy
PubMed: 36731907
DOI: 10.1136/bjsports-2022-106282 -
American Journal of Physical Medicine &... Jul 2019The translation of knowledge from exercise training research into the clinical management of multiple sclerosis, stroke, and Parkinson disease requires evidence-based...
The translation of knowledge from exercise training research into the clinical management of multiple sclerosis, stroke, and Parkinson disease requires evidence-based guidelines that are uniformly recognizable by healthcare practitioners and patients/clients. This article synthesized resources that reported aerobic and resistance training guidelines for people with multiple sclerosis, stroke, and Parkinson disease. Systematic searches yielded 25 eligible resources from electronic databases and Web sites or textbooks of major organizations. Data were extracted (exercise frequency, intensity, time, and type) and synthesized into three sets of recommendations. Exercise guidelines for multiple sclerosis consistently recommended 2-3 d/wk of aerobic training (10-30 mins at moderate intensity) and 2-3 d/wk of resistance training (1-3 sets between 8 and 15 repetition maximum). Exercise guidelines for stroke recommended 3-5 d/wk of aerobic training (20-40 mins at moderate intensity) and 2-3 d/wk of resistance training (1-3 sets of 8-15 repetitions between 30% and 50% 1 repetition maximum). Exercise guidelines for Parkinson disease recommended 3-5 d/wk of aerobic training (20-60 mins at moderate intensity) and 2-3 d/wk of resistance training (1-3 sets of 8-12 repetitions between 40% and 50% of 1 repetition maximum). This harmonization of exercise guidelines provides a prescriptive basis for healthcare providers, exercise professionals, and people with multiple sclerosis, stroke, and Parkinson disease regarding exercise programming.
Topics: Exercise; Exercise Therapy; Health Promotion; Humans; Multiple Sclerosis; Parkinson Disease; Physical Fitness; Resistance Training; Stroke
PubMed: 30844920
DOI: 10.1097/PHM.0000000000001174 -
Medicine Jul 2019Due to demographic changes the world's population is progressively ageing. The physiological decay of the elderly adult may lead to a reduction in the ability to balance...
BACKGROUND
Due to demographic changes the world's population is progressively ageing. The physiological decay of the elderly adult may lead to a reduction in the ability to balance and an increased risk of falls becoming an important issue among the elderly. In order to counteract the decay in the ability to balance, physical activity has been proven to be effective. The aim of this study is to systematically review the scientific literature in order to identify physical activity programs able to increase balance in the elderly.
METHODS
This review is based on the data from Medline-NLM, Pubmed, ScienceDirect, and SPORTDiscuss and includes randomized control trials that have analyzed balance and physical activity in healthy elderly over 65 years of age during the last decade. A final number of 8 manuscripts were included in the qualitative synthesis, which comprised 200 elderly with a mean age of 75.1 ± 4.4 years. The sample size of the studies varied from 9 to 61 and the intervention periods from 8 to 32 weeks.
RESULTS
Eight articles were considered eligible and included in the quantitative synthesis. The articles investigated the effects of resistance and aerobic exercise, balance training, T-bow© and wobble board training, aerobic step and stability ball training, adapted physical activity and Wii Fit training on balance outcomes. Balance measures of the studies showed improvements between 16% and 42% compared to baseline assessments.
CONCLUSIONS
Balance is a multifactorial quality that can be effectively increased by different exercise training means. It is fundamental to promote physical activity in the aging adult, being that a negative effect on balance performance has been seen in the no-intervention control groups.
Topics: Accidental Falls; Aged; Exercise; Exercise Therapy; Humans; Muscle Strength; Postural Balance
PubMed: 31277132
DOI: 10.1097/MD.0000000000016218 -
Annals of Physical and Rehabilitation... Mar 2019Insulin resistance is a determining factor in the pathophysiology of type 2 diabetes mellitus (T2DM). Exercise is known to improve insulin resistance, but a systematic... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Insulin resistance is a determining factor in the pathophysiology of type 2 diabetes mellitus (T2DM). Exercise is known to improve insulin resistance, but a systematic review of the literature is lacking.
OBJECTIVE
This systematic review and meta-analysis focused on identifying evidence for the effectiveness of a structured exercise intervention program for insulin resistance in T2DM.
METHODS
We searched MEDLINE via PubMed, CINHAL, Scopus and Web of Science, and the Cochrane Central Register of Controlled Trials for reports of studies on fasting insulin, homeostatic model assessment for insulin resistance (Homa-IR), fasting blood sugar, glycated hemoglobin and body mass index in patients with T2DM and healthy controls that were published between 1990 and 2017. Data are reported as the standardized mean difference or mean difference with 95% confidence intervals (CIs).
RESULTS
Among 2242 records retrieved, only 11 full-text articles were available for meta-analysis. Data for 846 participants were analyzed, 440 in the intervention group, and 406 in the control group. The mean difference for fasting insulin level was-1.64 (95% CI; -3.38 to 0.10), Homa-Ir 0.14 (-1.48 to 1.76), fasting blood sugar-5.12 (-7.78 to-2.45), hemoglobin A1c 0.63 (-0.82 to 2.08) and body mass index-0.36 (-1.51 to 0.79).
CONCLUSION
The evidence highlights the effectiveness of a structured exercise intervention program for insulin resistance in T2DM with a moderate level 2 of evidence.
Topics: Adolescent; Adult; Blood Glucose; Diabetes Mellitus, Type 2; Exercise; Exercise Therapy; Fasting; Female; Humans; Insulin Resistance; Male; Treatment Outcome; Young Adult
PubMed: 30553010
DOI: 10.1016/j.rehab.2018.11.001 -
BMC Geriatrics Dec 2021We conducted a systematic review and meta-analysis to clarify the effects of different exercise modes (resistance training [RT], whole body vibration training [WBVT],... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
We conducted a systematic review and meta-analysis to clarify the effects of different exercise modes (resistance training [RT], whole body vibration training [WBVT], and mixed training [MT, resistance training combined with other exercises such as balance, endurance and aerobic training]) on muscle strength (knee extension strength [KES]) and physical performance (Timed Up and Go [TUG], gait speed [GS] and the Chair Stand [CS]) in older people with sarcopenia.
METHOD
All studies published from January 2010 to March 2021 on the effects of exercise training in older people with sarcopenia were retrieved from 6 electronic databases: Pubmed, Cochrane Library, Embase, Web of Science, the China National Knowledge Infrastructure (CNKI), and Wanfang Database. Two researchers independently extracted and evaluated studies that met inclusion and exclusion criteria. Pooled analyses for pre- and post- outcome measurements were performed using Review Manager 5.4 with standardized mean differences (SMDs) and fixed-effect models.
RESULT
Twenty-six studies (25 randomized controlled trails [RCTs] and one non-randomized controlled trail) were included in this study with 1191 older people with sarcopenia (mean age 60.6 ± 2.3 to 89.5 ± 4.4). Compared with a control group, RT and MT significantly improved KES (RT, SMD = 1.36, 95% confidence intervals [95% CI]: 0.71 to 2.02, p < 0.0001, I = 72%; MT, SMD = 0.62, 95% CI: 0.29 to 0.95, p = 0.0002, I = 56%) and GS (RT, SMD = 2.01, 95% CI: 1.04 to 2.97, p < 0.0001, I = 84%; MT, SMD = 0.69, 95% CI: 0.29 to 1.09, p = 0.008, I = 81%). WBVT showed no changes in KES (SMD = 0.65, 95% CI: - 0.02 to 1.31, p = 0.06, I = 80%) or GS (SMD = 0.12, 95% CI: - 0.15 to 0.39, p = 0.38, I = 0%). TUG times were significantly improved with all exercise training modes (SMD = -0.66, 95% CI: - 0.94 to - 0.38, p < 0.00001, I = 60%). There were no changes in CS times with any of the exercise training modes (SMD = 0.11, 95% CI: - 0.36 to 0.57, p = 0.65, I = 87%).
CONCLUSIONS
In older people with sarcopenia, KES and GS can be improved by RT and MT, but not by WBVT. All three training modes improved TUG times, but not improved CS times.
Topics: Aged; Humans; Exercise; Muscle Strength; Physical Functional Performance; Randomized Controlled Trials as Topic; Resistance Training; Sarcopenia
PubMed: 34911483
DOI: 10.1186/s12877-021-02642-8 -
Cancer Medicine Oct 2022Health professionals predict that the number of people who will suffer and die from oncological diseases will continue to increase. It is vitally important to provide... (Meta-Analysis)
Meta-Analysis Review
Health professionals predict that the number of people who will suffer and die from oncological diseases will continue to increase. It is vitally important to provide comprehensive care to these patients and prescribe physical exercise programs as adjuvant therapy. The objective of this systematic review was to determine the impact of physical exercise on advanced-stage cancer patients. A literature search was performed in eight different databases. This search focused on randomized controlled trials (RCTs) published during the last 10 years. To assess the methodological quality of the sample of 15 RCTs finally obtained, the PEDro scale was used. Aerobic and strength training methods were used. The combination of both aerobic and strength training methods was the most frequently reported. Likewise, different physical and psychological variables were recorded, from which improvements were seen in fatigue, independence, quality of life and sleep, among others. The participation in physical exercise programs by advanced-stage cancer patients has a positive impact on health. Providing these programs serves as adjuvant therapy, facilitating the comprehensive care of patients. Similarly, aerobic, strength or mixed training programs increase the muscle mass of patients and therefore reduce hypotonia, the main side effect during the advanced-stages of cancer.
Topics: Exercise; Exercise Therapy; Fatigue; Humans; Neoplasms; Quality of Life; Resistance Training
PubMed: 35411694
DOI: 10.1002/cam4.4746 -
Breast Cancer (Tokyo, Japan) May 2022This systematic review aims to identify the effects of exercise interventions in patients with breast cancer (BCP) and survivors (BCS) on selected variables of physical... (Review)
Review
BACKGROUND
This systematic review aims to identify the effects of exercise interventions in patients with breast cancer (BCP) and survivors (BCS) on selected variables of physical fitness.
METHODS
A comprehensive literature search was conducted using Medline and Scopus. Randomized controlled trials with isolated exercise interventions in BCP and BCS women (< 5 years from therapy completion) were included. The risk of bias (RoB) assessment was conducted using the Cochrane RoB-2-tool. Variables regarding cardiorespiratory fitness (CRF), strength (ST), fatigue (F) and health-related quality of life (HRQoL) were discussed.
RESULTS
Of the 336 studies initially identified, 22 met all the inclusion criteria and were deemed eligible. RoB assessment indicated that the studies had predominantly "some concerns" or had "low RoB", with only 3 studies presenting a "high RoB". The mean duration and frequency of exercise interventions were 19 weeks and 3 sessions/week, performed at moderate intensity (65% VOmax and 66% 1RM, for aerobic and resistance-training interventions, respectively).
CONCLUSIONS
Exercise interventions seem to be a valuable strategy in BCP to avoid the decline of CRF, ST, F and HRQoL. Conversely, improved physical function among BCS is observed for the same variables. Resistance training and combined interventions seem to provide the most encouraging variations of the selected outcomes.
PROSPERO REGISTRATION ID
CRD42021237917.
Topics: Breast Neoplasms; Exercise; Exercise Therapy; Female; Humans; Physical Fitness; Quality of Life; Resistance Training; Survivors
PubMed: 35278203
DOI: 10.1007/s12282-022-01347-z -
The International Journal of Behavioral... Jul 2018Current international guidelines recommend aerobic, resistance, and combined exercises for the management of type 2 diabetes mellitus (T2DM). In our study, we conducted... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Current international guidelines recommend aerobic, resistance, and combined exercises for the management of type 2 diabetes mellitus (T2DM). In our study, we conducted a network meta-analysis to assess the comparative impact of different exercise training modalities on glycemic control, cardiovascular risk factors, and weight loss in patients with T2DM.
METHODS
We searched five electronic databases to identify randomized controlled trials (RCTs) that compared the differences between different exercise training modalities for patients with T2DM. The risk of bias in the included RCTs was evaluated according to the Cochrane tool. Network meta-analysis was performed to calculate mean difference the ratio of the mean and absolute risk differences. Data were analyzed using R-3.4.0.
RESULTS
A total of 37 studies with 2208 patients with T2DM were included in our study. Both supervised aerobic and supervised resistance exercises showed a significant reduction in HbA1c compared to no exercise (0.30% lower, 0.30% lower, respectively), however, there was a less reduction when compared to combined exercise (0.17% higher, 0.23% higher). Supervised aerobic also presented more significant improvement than no exercise in fasting plasma glucose (9.38 mg/dl lower), total cholesterol (20.24 mg/dl lower), triacylglycerol (19.34 mg/dl lower), and low-density lipoprotein cholesterol (11.88 mg/dl lower). Supervised resistance showed more benefit than no exercise in improving systolic blood pressure (3.90 mmHg lower]) and total cholesterol (22.08 mg/dl lower]. In addition, supervised aerobic exercise was more powerful in improving HbA1c and weight loss than unsupervised aerobic (HbA1c: 0.60% lower; weight loss: 5.02 kg lower) and unsupervised resistance (HbA1c: 0.53% lower) exercises.
CONCLUSION
Compared with either supervised aerobic or supervised resistance exercise alone, combined exercise showed more pronounced improvement in HbA1c levels; however, there was a less marked improvement in some cardiovascular risk factors. In terms of weight loss, there were no significant differences among the combined, supervised aerobic, and supervised resistance exercises.
TRIAL REGISTRATION
Our study protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO); registration number: CRD42017067518 .
Topics: Aged; Blood Glucose; Blood Pressure; Cholesterol, LDL; Diabetes Mellitus, Type 2; Exercise; Exercise Therapy; Female; Glycated Hemoglobin; Humans; Lipids; Male; Middle Aged; Network Meta-Analysis; Resistance Training; Weight Loss
PubMed: 30045740
DOI: 10.1186/s12966-018-0703-3