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Sports Medicine (Auckland, N.Z.) Apr 2024Repeated-sprint training (RST) is a common training method for enhancing physical fitness in athletes. To advance RST prescription, it is important to understand the... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Repeated-sprint training (RST) is a common training method for enhancing physical fitness in athletes. To advance RST prescription, it is important to understand the effects of programming variables on physical fitness and physiological adaptation.
OBJECTIVES
This study (1) quantifies the pooled effects of running RST on changes in 10 and 20 m sprint time, maximal oxygen consumption (VO), Yo-Yo Intermittent Recovery Test Level 1 (YYIR1) distance, repeated-sprint ability (RSA), countermovement jump (CMJ) height and change of direction (COD) ability in athletes, and (2) examines the moderating effects of program duration, training frequency, weekly volume, sprint modality, repetition distance, number of repetitions per set and number of sets per session on changes in these outcome measures.
METHODS
Pubmed, SPORTDiscus and Scopus databases were searched for original research articles up to 04 July 2023, investigating RST in healthy, able-bodied athletes, between 14 and 35 years of age, and a performance calibre of trained or above. RST interventions were limited to repeated, maximal running (land-based) sprints of ≤ 10 s duration, with ≤ 60 s recovery, performed for 2-12 weeks. A Downs and Black checklist was used to assess the methodological quality of the included studies. Eligible data were analysed using multi-level mixed-effects meta-analysis, with standardised mean changes determined for all outcomes. Standardised effects [Hedges G (G)] were evaluated based on coverage of their confidence (compatibility) intervals (CI) using a strength and conditioning specific reference value of G = 0.25 to declare an improvement (i.e. G > 0.25) or impairment (i.e. G < - 0.25) in outcome measures. Applying the same analysis, the effects of programming variables were then evaluated against a reference RST program, consisting of three sets of 6 × 30 m straight-line sprints performed twice per week for 6 weeks (1200 m weekly volume).
RESULTS
40 publications were included in our investigation, with data from 48 RST groups (541 athletes) and 19 active control groups (213 athletes). Across all studies, the effects of RST were compatible with improvements in VO (G 0.56, 90% CI 0.32-0.80), YYIR1 distance (G 0.61, 90% CI 0.43-0.79), RSA decrement (G - 0.61, 90% CI - 0.85 to - 0.37), linear sprint times (10 m: G - 0.35, 90% CI - 0.48 to - 0.22; 20 m: G - 0.48, 90% CI - 0.69 to - 0.27), RSA average time (G - 0.34, 90% CI - 0.49 to - 0.18), CMJ height (G 0.26, 90% CI 0.13-0.39) and COD ability (G - 0.32, 90% CI - 0.52 to - 0.12). Compared with the reference RST program, the effects of manipulating training frequency (+ 1 session per week), program duration (+ 1 extra training week), RST volume (+ 200 m per week), number of reps (+ 2 per set), number of sets per session (+ 1 set) or rep distance (+ 10 m per rep) were either non-substantial or comparable with an impairment in at least one outcome measure per programming variable.
CONCLUSIONS
Running-based RST improves speed, intermittent running performance, VO, RSA, COD ability and CMJ height in trained athletes. Performing three sets of 6 × 30 m sprints, twice per week for 6 weeks is effective for enhancing physical fitness and physiological adaptation. Additionally, since our findings do not provide conclusive support for the manipulation of RST variables, further work is needed to better understand how programming factors can be manipulated to augment training-induced adaptations.
STUDY REGISTRATION
Open Science Framework registration https://doi.org/10.17605/OSF.IO/RVNDW .
Topics: Humans; Running; Adaptation, Physiological; Physical Fitness; Athletic Performance; Oxygen Consumption; Physical Conditioning, Human; Athletes; Exercise Test
PubMed: 38041768
DOI: 10.1007/s40279-023-01959-1 -
Sports Medicine (Auckland, N.Z.) Apr 2024Cardiorespiratory fitness (CRF) is an important indicator of current and future health. While the impact of habitual physical activity on CRF is well established, the... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Cardiorespiratory fitness (CRF) is an important indicator of current and future health. While the impact of habitual physical activity on CRF is well established, the role of sedentary behaviour (SB) remains less understood.
OBJECTIVE
We aimed to determine the effect of SB on CRF.
METHODS
Searches were conducted in MEDLINE, Embase, PsycINFO, CINAHL and SPORTDiscus from inception to August 2022. Randomised controlled trials, quasi-experimental studies and cohort studies that assessed the relationship between SB and CRF were eligible. Narrative syntheses and meta-analyses summarised the evidence, and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) certainty was based on evidence from randomised controlled trials.
RESULTS
This review included 18 studies that focused on youth (four randomised controlled trials, three quasi-experimental studies, 11 cohort studies) and 24 on adult populations (15 randomised controlled trials, five quasi-experimental studies, four cohort studies). In youth and adults, evidence from randomised controlled trials suggests mixed effects of SB on CRF, but with the potential for interventions to improve CRF. Quasi-experimental and cohort studies also support similar conclusions. Certainty of evidence was very low for both age groups. A meta-analysis of adult randomised controlled trials found that interventions targeting reducing SB, or increasing physical activity and reducing SB, had a significant effect on post-peak oxygen consumption (mean difference = 3.16 mLkgmin, 95% confidence interval: 1.76, 4.57).
CONCLUSIONS
Evidence from randomised controlled trials indicates mixed associations between SB and CRF, with the potential for SB to influence CRF, as supported by meta-analytical findings. Further well-designed trials are warranted to confirm the relationship between SB and CRF, explore the effects of SB independent from higher intensity activity, and investigate the existence of such relationships in paediatric populations.
CLINICAL TRIAL REGISTRATION
PROSPERO CRD42022356218.
Topics: Humans; Cardiorespiratory Fitness; Sedentary Behavior; Exercise; Adult; Randomized Controlled Trials as Topic
PubMed: 38225444
DOI: 10.1007/s40279-023-01986-y -
Legal Medicine (Tokyo, Japan) Mar 2024Volatile substance abuse is widespread among adolescents due to its easy availability and methods of consumption. Inhalant abuse represents a current problematic issue,... (Review)
Review
Volatile substance abuse is widespread among adolescents due to its easy availability and methods of consumption. Inhalant abuse represents a current problematic issue, causing significant morbidity and mortality due to direct toxicity on several target organs and displacement of gas which results in a lack of oxygen. This review aims to evaluate post-mortem and toxicological investigations in cases of suspected butane intoxication. We performed comprehensive research using the Preferred Reporting Items for Systematic Review (PRISMA) standards. Forty scientific papers fulfilled the inclusion criteria. A total of 58 cases of butane-related deaths were found. Among these, we found 11 cases of suicide (18%), 1 case of homicide (2%), 44 cases of accidental poisoning (76%), and 2 cases of work-related deaths (4%). Autopsy and post-mortem examinations were performed in 54 cases, whereas toxicological analyses were presented in 56 cases. In autopsy, pulmonary edema (51%) and poli-visceral congestion (59%) were the most common findings. When death by butane inhalation is hypothesized, autopsy and histological findings may be nonspecific, therefore toxicological investigations assume a crucial role along with attention to the methods used to collect biological samples.
PubMed: 38579662
DOI: 10.1016/j.legalmed.2024.102442 -
SAGE Open Medicine 2024Functional electrical stimulation is important for the rehabilitation of patients with chronic heart failure. This meta-analysis of randomized controlled trials compared... (Review)
Review
The effect of functional electrical stimulation of the legs on cardiopulmonary function and quality of life in patients with chronic heart failure: A systematic review and meta-analysis.
INTRODUCTION
Functional electrical stimulation is important for the rehabilitation of patients with chronic heart failure. This meta-analysis of randomized controlled trials compared the efficacy of functional electrical stimulation versus conventional exercise training or placebo in patients with chronic heart failure.
METHODS
Studies were searched through PubMed, Embase, and the Cochrane Library databases up to 1 November 2023. The outcomes were cardiopulmonary function index (6-minute walking distance), peak oxygen consumption, and Minnesota Heart Failure Life Questionnaire quality of life scores. A subgroup analysis was conducted according to the ejection fraction. The 95% confidence interval and mean difference represented the outcome of the effect size.
RESULTS
Seventeen studies involving 732 participants were included. Compared with the control, functional electrical stimulation significantly improved peak oxygen consumption (MD = 2.84 ml/kg/min, 95% Cl: 1.99-3.68 ml/kg/min), increased 6-minute walking distance (MD = 49.52 m, 95% Cl: 22.61-76.43 m), and improved the life quality scores (MD = -12.86, 95% Cl: -17.48 to -7.88). Compared with functional electrical stimulation, exercise training also improved peak oxygen consumption (MD = -0.94 ml/kg/min, 95% Cl: -1.36 to -0.52 ml/kg/min), and the quality of life (QoL, MD = 0.66, 95% Cl: 0.34-0.98, < 0.05, = 38%), but the result of 6-minute walking distance (MD = -6.97 m, 95% Cl: -18.32 to -4.38 m) did not show a difference. Further subgroup analysis showed that outcomes including the above, significantly improved under the functional electrical stimulationfor both HF patients with reduced ejection fraction and HF patients with preserved ejection fraction patients, but difference is insignificant of the results between groups of aerobic exercise and functional electrical stimulationacted on patients with HF patients with reduced ejection fraction.
CONCLUSIONS
Our study demonstrates that compared with placebo, functional electrical stimulation benefits the patients with chronic heart failure on cardiopulmonary function and quality of life. Furthermore, HF patients with reduced ejection fraction patients benefit more from functional electrical stimulation than HF patients with reduced ejection fraction patients. Therefore, functional electrical stimulation is a promising complementary therapy for patients with chronic heart failure.
PubMed: 38855004
DOI: 10.1177/20503121241245003 -
Journal of Applied Physiology... Jun 2024This systematic review and meta-analysis examined the physiological mechanisms responsible for lower peak exercise leg oxygen uptake (V̇o) in patients with chronic... (Meta-Analysis)
Meta-Analysis Review
This systematic review and meta-analysis examined the physiological mechanisms responsible for lower peak exercise leg oxygen uptake (V̇o) in patients with chronic disease. Studies measuring peak leg V̇o (primary outcome) and its physiological determinants during large (cycle) or small muscle mass exercise (single-leg knee extension, SLKE) in patients with chronic disease were included in this meta-analysis. Pooled estimates for each outcome were reported as a weighted mean difference (WMD) between chronic disease and controls. We included 10 studies that measured peak leg V̇o in patients with chronic disease ( = 109, mean age: 45 yr; encompassing chronic obstructive pulmonary disease, COPD, heart failure with reduced ejection fraction, HFrEF, or chronic renal failure, RF) and age-matched controls ( = 88). In pooled analysis, peak leg V̇o (WMD; -0.23 L/min, 95% CI: -0.32 to -0.13), leg oxygen (O) delivery (WMD: -0.27 L/min, 95% CI: -0.37 to -0.17), and muscle O diffusive conductance (WMD: -5.2 mL/min/mmHg, 95% CI: -7.1 to -3.2) were all significantly lower during cycle and SLKE exercise in chronic disease versus controls. These results highlight that during large and small muscle mass exercise in patients with COPD, HFrEF, or RF, there is no single factor causing peak V̇o limitations. Specifically, the lower peak V̇o in these pathologies is due to not only the expected impairments in convective O delivery but also impairments in muscle oxygen diffusive transport from capillary to mitochondria. Whether impaired muscle O transport is caused solely by inactivity or additional muscle pathology remains in question. Peripheral (skeletal muscle and vasculature) factors contribute significantly to reduced exercise capacity during both large and small muscle mass exercise in chronic diseases such as COPD, HFrEF, or RF and should be important targets of therapy in addition to the primary organs (lungs, heart, and kidneys) affected by disease.
Topics: Humans; Oxygen Consumption; Leg; Muscle, Skeletal; Chronic Disease; Exercise; Pulmonary Disease, Chronic Obstructive; Oxygen; Heart Failure
PubMed: 38482572
DOI: 10.1152/japplphysiol.00918.2023 -
Journal of Cardiovascular Medicine... Jul 2024We aimed to comprehensively assess the safety and efficacy of mavacamten in hypertrophic cardiomyopathy (HCM) patients. (Meta-Analysis)
Meta-Analysis
AIMS
We aimed to comprehensively assess the safety and efficacy of mavacamten in hypertrophic cardiomyopathy (HCM) patients.
METHODS
A systematic review and meta-analysis was conducted, and efficacy [changes in postexercise left ventricular outflow tract (LVOT) gradient, left ventricular ejection fraction (LVEF), peak oxygen consumption (pVO 2 ), Kansas City Cardiomyopathy Questionnaire Clinical Summary Score (KCCQ CSS), and the proportion of patients exhibiting an improvement of at least one New York Heart Association (NYHA) functional class from baseline)], safety (total count of treatment-emergent adverse events and SAEs, as well as the proportion of patients experiencing at least one adverse event or SAE), and cardiac biomarkers (NT-proBNP and cTnI) outcomes were evaluated.
RESULTS
We incorporated data from four randomized controlled trials, namely EXPLORER-HCM, VALOR-HCM, MAVERICK-HCM, and EXPLORER-CN. Mavacamten demonstrated significant efficacy in reducing the postexercise LVOT gradient by 49.44 mmHg ( P = 0.0001) and LVEF by 3.84 ( P < 0.0001) and improving pVO 2 by 0.69 ml/kg/min ( P = 0.4547), KCCQ CSS by 8.11 points ( P < 0.0001), and patients with at least one NYHA functional class improvement from baseline by 2.20 times ( P < 0.0001). Importantly, mavacamten increased 1.11-fold adverse events ( P = 0.0184) 4.24-fold reduced LVEF to less than 50% ( P = 0.0233) and 1.06-fold SAEs ( P = 0.8631). Additionally, mavacamten decreased NT-proBNP by 528.62 ng/l ( P < 0.0001) and cTnI by 8.28 ng/l ( P < 0.0001).
CONCLUSION
Mavacamten demonstrates both safety and efficacy in patients with HCM, suggesting its potential as a promising therapeutic strategy for this condition. Further research is warranted to confirm these results and explore its long-term effects.
Topics: Humans; Cardiomyopathy, Hypertrophic; Treatment Outcome; Randomized Controlled Trials as Topic; Ventricular Function, Left; Stroke Volume; Middle Aged; Male; Female; Natriuretic Peptide, Brain; Pyrimidines; Exercise Tolerance; Biomarkers; Adult; Recovery of Function; Oxygen Consumption; Aged; Benzylamines; Uracil
PubMed: 38814051
DOI: 10.2459/JCM.0000000000001638 -
Archives of Physical Medicine and... May 2024To determine the effectiveness of non-pharmacologic interventions and the additional benefits of their combination in patients with heart failure with reduced ejection... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To determine the effectiveness of non-pharmacologic interventions and the additional benefits of their combination in patients with heart failure with reduced ejection fraction (HFrEF).
DATA SOURCES
We searched PubMed, Embase, and the Cochrane Clinical Trials Register from the date of database inception to April 22, 2023.
STUDY SELECTION
Randomized controlled trials involving non-pharmacologic interventions conducted in patients with HFrEF were included.
DATA EXTRACTION
Data were extracted by 2 independent reviewers based on a pre-tested data extraction form. The quality of evidence was assessed using the Cochrane Risk of Bias tool and the Grading of Recommendations Assessment, Development, and Evaluation method.
DATA SYNTHESIS
A total of 82 eligible studies (4574 participants) were included. We performed a random-effects model within a Bayesian framework to calculate weighted mean differences (WMDs) and 95% credibility intervals. High or moderate certainty evidence indicated that high-intensity aerobic interval training (HIAIT) was best on improving 6-minute walk distance (6MWD; 68.55 m [36.41, 100.47]) and left ventricular ejection fraction (6.28% [3.88, 8.77]), while high-intensity aerobic continuous training (HIACT) is best on improving peak oxygen consumption (Peak VO; 3.48 mL/kg•min [2.84, 4.12]), quality of life (QOL; -17.26 [-29.99, -7.80]), resting heart rate (-8.20 bpm [-13.32, -3.05]), and N-terminal pro-B-type natriuretic peptide (-600.96 pg/mL [-902.93, -404.52]). Moderate certainty evidence supported the effectiveness of inspiratory muscle training to improve peak oxygen consumption and functional electrical stimulation to improve QOL. Moderate-intensity aerobic continuous training (MIACT) plus moderate-intensity resistance training (MIRT) had additional benefits in Peak VO, 6MWD, and QOL. This review did not provide a comprehensive evaluation of adverse events.
CONCLUSIONS
Both HIAIT and HIACT are the most effective single non-pharmacologic interventions for HFrEF. MIACT plus MIRT had additional benefits in improving peak oxygen consumption, 6MWD, and QOL.
Topics: Humans; Heart Failure; Stroke Volume; Network Meta-Analysis; Exercise Therapy; Randomized Controlled Trials as Topic; Quality of Life; High-Intensity Interval Training; Walk Test
PubMed: 37499852
DOI: 10.1016/j.apmr.2023.07.004 -
IScience Dec 2023We carried out a meta-analysis on the effect of cardiac rehabilitation (CR) on cardiopulmonary function after coronary artery bypass grafting (CABG). Four databases were...
We carried out a meta-analysis on the effect of cardiac rehabilitation (CR) on cardiopulmonary function after coronary artery bypass grafting (CABG). Four databases were searched for studies comparing CR with control. A random-effects model was used to pool mean difference (MD). The meta-analysis showed an increase in peak oxygen consumption (peak VO) (MD = 1.93 mL/kg/min, p = 0.0006), and 6-min walk distance (6MWD) (MD = 59.21 m, p < 0.00001), and a decrease in resting heart rate (resting HR) (MD = 5.68 bpm, p < 0.0001) in the CR group. The subgroup analysis revealed aerobic exercise could further improve resting HR and peak HR, and physical/combination with aerobic exercise could further increase 6MWD. The improvement of peak VO, workload, resting HR, peak HR, and 6MWD regarding CR performed within one week after CABG is greater than that one week after CABG. CR after CABG can improve the cardiopulmonary function, which is reflected by the improvement of peak VO, 6MWD, and resting HR.
PubMed: 38058302
DOI: 10.1016/j.isci.2023.107861 -
Clinical Breast Cancer Aug 2023Current anticancer treatments for breast cancer (BC) may cause cardiotoxicity. This study aimed to investigate the effectiveness of aerobic exercise in mitigating... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Current anticancer treatments for breast cancer (BC) may cause cardiotoxicity. This study aimed to investigate the effectiveness of aerobic exercise in mitigating cardiotoxicity caused by BC therapy.
MATERIALS AND METHODS
PubMed, Embase, Cochrane Library, Web of Science, and the Physiotherapy Evidence Database were searched until February 7, 2023. Clinical trials investigating the effectiveness of exercise training, including aerobic exercise, in BC patients receiving treatments that could cause cardiotoxicity were eligible. Outcome measures included cardiorespiratory fitness (CRF) (peak oxygen consumption, VOpeak), left ventricular ejection fraction, and peak oxygen pulse. Intergroup differences were determined by standard mean differences (SMD) and 95% confidence intervals (CIs). Trial sequential analysis (TSA) was utilized to ensure whether the current evidence was conclusive.
RESULTS
Sixteen trials involving 876 participants were included. Aerobic exercise significantly improved CRF measured by VOpeak in mL/kg/min (SMD 1.79, 95% CI 0.99-2.59) when compared to usual care. This result was confirmed through TSA. Subgroup analyses revealed that aerobic exercise given during BC therapy significantly improved VOpeak (SMD 1.84, 95% CI 0.74-2.94). Exercise prescriptions at a frequency of up to 3 times per week, an intensity of moderate to vigorous, and a >30-minute session length also improved VOpeak.
CONCLUSION
Aerobic exercise is effective in improving CRF when compared to usual care. Exercise performed up to 3 times per week, at a moderate-to-vigorous intensity, and having a session length >30 minutes is considered effective. Future high-quality research is needed to determine the effectiveness of exercise intervention in preventing cardiotoxicity caused by BC therapy.
Topics: Humans; Female; Breast Neoplasms; Cardiotoxicity; Feasibility Studies; Stroke Volume; Ventricular Function, Left; Exercise
PubMed: 37286435
DOI: 10.1016/j.clbc.2023.04.010 -
BMJ Open Respiratory Research Oct 2023Pectus excavatum (PEx) is the most common congenital chest wall abnormality affecting 1 in 400 births in the UK. PEx is associated with significant physiological and...
BACKGROUND
Pectus excavatum (PEx) is the most common congenital chest wall abnormality affecting 1 in 400 births in the UK. PEx is associated with significant physiological and psychological impairment. While readily surgically correctable, the benefits that surgery can bring have been debated and proven difficult to objectively measure. In the UK, this has led to the decommissioning of PEx surgery. The aim of this review is to conduct a systematic search of the literature on PEx surgery to assess physiological and psychological outcomes.
METHODS
A systematic review of the MEDLINE (PubMed), Embase and Cochrane databases was performed. Articles were sought which included patients undergoing surgery for PEx and reported on changes in cardiopulmonary measures, symptoms, quality of life and psychological assessments before and after surgical repair. Last search was performed in July 2022 and relevant findings were synthesised by narrative review.
RESULTS
Fifty-one articles were included in qualitative synthesis, with 34 studies relating to physiological outcomes and 17 studies relating to psychological and quality of life measures. Twenty-one studies investigated pulmonary function at rest. There was no change in forced vital capacity or forced expiratory volume in 1 second following open repair and transient reductions followed closed repair. In the 11 studies investigating echocardiography, transthoracic rarely demonstrated cardiac compression; however, transoesophageal demonstrated intraoperative relief in cardiac compression in severe cases. Sixteen studies investigated exercise testing (cardiopulmonary exercise testing, CPET), 12 of which demonstrated significant improvement following surgery, both in maximal oxygen consumption and oxygen pulse. Seventeen studies investigated quality of life, all but one of which showed improvement following repair of PEx. All papers that reported on patient satisfaction following surgery found high rates, between 80% and 97%.
DISCUSSION
While the majority of studies to date have been small and data heterogeneous, the literature shows that for many patients with PEx, there exists a cardiopulmonary limitation that while difficult to objectify, is likely to improve with surgical repair. Resting parameters offer little yield in aiding this except in the most severe cases. CPET therefore offers a better option for dynamic assessment of this limitation and improvements following repair. Surgery significantly improves psychological well-being and quality of life for patients with PEx.
Topics: Humans; Funnel Chest; Quality of Life; Lung; Vital Capacity; United Kingdom
PubMed: 37827806
DOI: 10.1136/bmjresp-2023-001665