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BMC Geriatrics Nov 2021Health-promoting interventions are important for preventing frailty and sarcopenia in older adults. However, there is limited evidence that nutritional interventions... (Meta-Analysis)
Meta-Analysis
Does the combination of resistance training and a nutritional intervention have a synergic effect on muscle mass, strength, and physical function in older adults? A systematic review and meta-analysis.
BACKGROUND
Health-promoting interventions are important for preventing frailty and sarcopenia in older adults. However, there is limited evidence that nutritional interventions yield additional effects when combined with resistance training. This systematic review and meta-analysis aimed to compare the effectiveness of nutritional interventions with resistance training and that of resistance training alone.
METHODS
Randomized controlled trials published in peer-reviewed journals prior to July 2020 were retrieved from databases and other sources. The articles were screened according to the inclusion and exclusion criteria. The methodological quality of the included studies was assessed using Cochrane's risk of bias tool 2. A meta-analysis was performed using the RevMan 5.4 program and STATA 16 program.
RESULTS
A total of 22 studies were included in the meta-analysis. The results of the meta-analysis showed no significant differences between groups in muscle mass, muscle strength, or physical functional performance. In the subgroup analysis regarding the types of nutritional interventions, creatine showed significant effects on lean body mass (n = 4, MD 2.61, 95% CI 0.51 to 4.72). Regarding the other subgroup analyses, there were no significant differences in appendicular skeletal muscle mass (p = .43), hand grip strength (p = .73), knee extension strength (p = .09), chair stand test results (p = .31), or timed up-and-go test results (p = .31). In the meta-regression, moderators such as the mean age of subjects and duration of interventions were not associated with outcome variables.
CONCLUSIONS
This meta-analysis showed that nutritional interventions with resistance training have no additional effect on body composition, muscle strength, or physical function. Only creatine showed synergistic effects with resistance training on muscle mass.
TRIAL REGISTRATION
CRD42021224843 .
Topics: Aged; Hand Strength; Humans; Muscle Strength; Muscle, Skeletal; Muscles; Resistance Training; Sarcopenia
PubMed: 34772342
DOI: 10.1186/s12877-021-02491-5 -
The Clinical Teacher Dec 2022Medical students are at risk of burnout and reduced quality of life (QoL). The risk of burnout doubles from third to sixth year of medical school, and medical students...
BACKGROUND
Medical students are at risk of burnout and reduced quality of life (QoL). The risk of burnout doubles from third to sixth year of medical school, and medical students have an 8%-11% lower QoL than nonmedical students. It is imperative to prevent this, as burnout and reduced QoL is independently associated with errors in practice. This systematic review aims to examine whether physical activity/exercise is associated with burnout and/or QoL in medical students.
METHODS
Articles were identified through database searches of Embase, Medline, PsycINFO, Scopus and Web of Science. Studies were included if both physical activity/exercise and burnout or QoL were measured and limited to those focussing on medical students. Risk of bias was assessed using accredited cohort and cross-sectional checklists. A narrative synthesis was conducted due to heterogeneity in the dataset.
FINDINGS
Eighteen studies were included, comprising 11,500 medical students across 13 countries. Physical activity was negatively associated with burnout and positively associated with QoL. Furthermore, the findings were suggestive of a dose-response effect of physical activity on both burnout and QoL; higher intensities and frequencies precipitated greater improvements in outcomes.
CONCLUSIONS
This multinational review demonstrates that physical activity is associated with reduced burnout and improved QoL in medical students. It also identifies a paucity of research into the optimal intensity, frequency, volume and mode of physical activity. Further research, building on this review, is likely to inform the long overdue development of evidence-based, well-being curricula. This could involve incorporating physical activity into medical education which may improve well-being and better prepare students for the demands of medical practice.
Topics: Humans; Quality of Life; Students, Medical; Cross-Sectional Studies; Burnout, Professional; Burnout, Psychological; Exercise
PubMed: 36052814
DOI: 10.1111/tct.13525 -
International Journal of Nursing Studies Jun 2020Falls often cause unexpected injuries that older adults find difficult to recover from (e.g., hip and other major fractures, intracranial bleeding); therefore, fall... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Falls often cause unexpected injuries that older adults find difficult to recover from (e.g., hip and other major fractures, intracranial bleeding); therefore, fall prevention and interventions are of particular significance.
OBJECTIVES
This study aimed to examine the effectiveness of multifactorial fall prevention interventions among community-dwelling older adults and compare subgroups that differed in terms of their degree of fall risk and the intensity and components of interventions.
METHODS
An exhaustive systematic literature search was undertaken using the following databases: Ovid-Medline, Ovid-Embase, and the Cochrane Central Register of Controlled Trials (Central). Two investigators independently extracted data and assessed the quality of the studies by examining the risk of bias. We conducted a meta-analysis of randomized controlled trials that had been published up to March 31st, 2019, using Review Manager.
RESULTS
Of 1,328 studies, 45 articles were relevant to this study. In total, 29 studies included participants in the high-risk group, 3 in the frail group, and 13 in the healthy older adult group. Additionally, 28 and 17 studies used active and referral multifactorial interventions, respectively. Multifactorial interventions included the following components: exercise, education, environmental modification, medication, mobility aids, and vision and psychological management. Multifactorial interventions significantly reduced fall rates in the high-risk (risk ratio 0.66; 95% confidence interval 0.52-0.84) and healthy groups (risk ratio 0.72; 95% confidence interval 0.58-0.89), when compared to the control group. Active multifactorial interventions (risk ratio 0.64; 95% confidence interval 0.51-0.80) and those featuring exercise (risk ratio 0.66; 95% confidence interval 0.54-0.80) and environmental modification also showed significantly reduced fall rates (risk ratio 0.65; 95% confidence interval 0.54-0.79) compared to usual care. Multifactorial interventions had a significantly lower number of people who experienced falls during the study period compared to usual care in the healthy group (risk ratio 0.77; 95% confidence interval 0.62-0.95). Active multifactorial interventions (risk ratio 0.73; 95% confidence interval 0.60-0.89) and those featuring exercise (risk ratio 0.79; 95% confidence interval 0.66-0.95) and environmental modification (risk ratio 0.80; 95% confidence interval 0.68-0.95) had a significantly lower number of people who experienced falls compared to those receiving usual care.
CONCLUSIONS
Active multifactorial interventions had positive effects on fall rates and the number of people experiencing falls. Thus, healthcare workers, including nurses, should be involved in planning fall prevention programs so that older adults can be provided with optimal care; multifactorial interventions that include exercise and environmental modification are particularly effective in reducing falls.
Topics: Accidental Falls; Aged; Aged, 80 and over; Exercise; Humans; Independent Living; Program Development; Vitamin D Deficiency
PubMed: 32272282
DOI: 10.1016/j.ijnurstu.2020.103564 -
BMJ Open Sep 2021To determine the benefits and harms of pre-admission interventions (prehabilitation) on postoperative outcomes in patients undergoing major elective surgery. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To determine the benefits and harms of pre-admission interventions (prehabilitation) on postoperative outcomes in patients undergoing major elective surgery.
DESIGN
Systematic review and meta-analysis of randomised controlled trials (RCTs) (published or unpublished). We searched Medline, Embase, CENTRAL, DARE, HTA and NHS EED, The Cochrane Library, CINAHL, PsychINFO and ISI Web of Science (June 2020).
SETTING
Secondary care.
PARTICIPANTS
Patients (≥18 years) undergoing major elective surgery (curative or palliative).
INTERVENTIONS
Any intervention administered in the preoperative period with the aim of improving postoperative outcomes.
OUTCOMES AND MEASURES
Primary outcomes were 30-day mortality, hospital length of stay (LoS) and postoperative complications. Secondary outcomes included LoS in intensive care unit or high dependency unit, perioperative morbidity, hospital readmission, postoperative pain, heath-related quality of life, outcomes specific to the intervention, intervention-specific adverse events and resource use.
REVIEW METHODS
Two authors independently extracted data from eligible RCTs and assessed risk of bias and the certainty of evidence using Grading of Recommendations, Assessment, Development and Evaluation. Random-effects meta-analyses were used to pool data across trials.
RESULTS
178 RCTs including eight types of intervention were included. Inspiratory muscle training (IMT), immunonutrition and multimodal interventions reduced hospital LoS (mean difference vs usual care: -1.81 days, 95% CI -2.31 to -1.31; -2.11 days, 95% CI -3.07 to -1.15; -1.67 days, 95% CI -2.31 to -1.03, respectively). Immunonutrition reduced infective complications (risk ratio (RR) 0.64 95% CI 0.40 to 1.01) and IMT, and exercise reduced postoperative pulmonary complications (RR 0.55, 95% CI 0.38 to 0.80, and RR 0.54, 95% CI 0.39 to 0.75, respectively). Smoking cessation interventions reduced wound infections (RR 0.28, 95% CI 0.12 to 0.64).
CONCLUSIONS
Some prehabilitation interventions may reduce postoperative LoS and complications but the quality of the evidence was low.
PROSPERO REGISTRATION NUMBER
CRD42015019191.
Topics: Elective Surgical Procedures; Exercise; Humans; Length of Stay; Postoperative Complications; Preoperative Exercise
PubMed: 34593498
DOI: 10.1136/bmjopen-2021-050806 -
Advances in Nutrition (Bethesda, Md.) Feb 2021Subcutaneous abdominal adipose tissue (SAT), is the largest fat depot and major provider of free fatty acids to the liver. Abdominal fat is indirectly (via increased... (Meta-Analysis)
Meta-Analysis
The Effect of Aerobic and Resistance Training and Combined Exercise Modalities on Subcutaneous Abdominal Fat: A Systematic Review and Meta-analysis of Randomized Clinical Trials.
Subcutaneous abdominal adipose tissue (SAT), is the largest fat depot and major provider of free fatty acids to the liver. Abdominal fat is indirectly (via increased levels of low-grade inflammation) correlated with many of the adverse health effects of obesity. Although exercise is one of the most prominent components of obesity management, its effects on SAT are still unclear. The aim of this study was to investigate the independent effects of aerobic training (AT) and resistance training (RT) modalities and combined exercise modalities on SAT in adults. PubMed, SCOPUS, and Google Scholar were searched to find relevant publications up to November 2018. The effect sizes were represented as weighted mean difference (WMD) and 95% CIs. Between-study heterogeneity was examined using the I2 test. Overall, 43 identified trials that enrolled 3552 subjects (2684 women) were included. After removal of outliers, combining effect sizes indicated a significant effect of AT (WMD: -13.05 cm2; 95% CI: -18.52, -7.57; P < 0.001), RT (WMD: -5.39 cm2; 95% CI: -9.66, -1.12; P = 0.01), and combined exercise training (CExT; WMD: -28.82 cm2; 95% CI: -30.83, -26.81; P < 0.001) on SAT relative to control groups. Pooled effect sizes demonstrated a significant effect of AT on SAT compared with a CExT group (WMD: 11.07 cm2; 95% CI: 1.81, 20.33; P = 0.01). However, when comparing the AT and RT groups, no significant difference was seen in SAT (WMD: -0.73 cm2; 95% CI: -4.50, 3.04; P = 0.70). Meta-analysis of relevant trials indicated that AT, RT, and CExT lead to SAT reduction. Aerobic exercise was shown to produce greater efficacy in decreasing SAT.
Topics: Abdominal Fat; Diabetes Mellitus, Type 2; Exercise; Humans; Randomized Controlled Trials as Topic; Resistance Training
PubMed: 32804997
DOI: 10.1093/advances/nmaa090 -
Journal of Physical Activity & Health Dec 2019The physical and psychosocial benefits of physical activity for typically developing youth are well established; however, its impact on youth with intellectual... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The physical and psychosocial benefits of physical activity for typically developing youth are well established; however, its impact on youth with intellectual disabilities is not as well understood. The aims of this review and meta-analysis were to synthesize the literature and quantify the effects of physical activity on the physical and psychosocial health of youth with intellectual disabilities.
METHOD
Studies meeting the inclusion criteria were grouped by their focus on physical health and/or psychosocial health outcomes. Meta-analyses were performed using 3-level, random effects and mixed effects models.
RESULTS
One hundred nine studies met the inclusion criteria. Physical activity had a large effect on physical health (g = 0.773, P < .001) and a moderately large effect (g = 0.682, P < .001) on psychosocial health. Participant age, intellectual disability level, other developmental disabilities, outcome type, and intervention type moderated the effects of physical activity on physical health, whereas study design, risk of bias, other developmental disabilities, outcome type, and intervention type were moderators on psychosocial health.
CONCLUSIONS
Physical activity has positive effects on the physical and psychosocial health of youth with intellectual disabilities. Although resistance training shows the most physical benefits, teaching movement and sports skills appear to benefit their physical and psychosocial health.
Topics: Adolescent; Cardiorespiratory Fitness; Chronic Disease; Exercise; Female; Humans; Intellectual Disability; Male; Quality of Life; Resistance Training; Sports
PubMed: 31586434
DOI: 10.1123/jpah.2018-0675 -
The Cochrane Database of Systematic... May 2023Surgery is the cornerstone in curative treatment of colorectal cancer. Unfortunately, surgery itself can adversely affect patient health. 'Enhanced Recovery After... (Review)
Review
BACKGROUND
Surgery is the cornerstone in curative treatment of colorectal cancer. Unfortunately, surgery itself can adversely affect patient health. 'Enhanced Recovery After Surgery' programmes, which include multimodal interventions, have improved patient outcomes substantially. However, these are mainly applied peri- and postoperatively. Multimodal prehabilitation includes multiple preoperative interventions to prepare patients for surgery with the aim of increasing resilience, thereby improving postoperative outcomes.
OBJECTIVES
To determine the effects of multimodal prehabilitation programmes on functional capacity, postoperative complications, and quality of life in adult patients undergoing surgery for colorectal cancer.
SEARCH METHODS
We searched CENTRAL, MEDLINE, Embase and PsycINFO in January 2021. We also searched trial registries up to March 2021.
SELECTION CRITERIA
We included randomised controlled trials (RCTs) in adult patients with non-metastatic colorectal cancer, scheduled for surgery, comparing multimodal prehabilitation programmes (defined as comprising at least two preoperative interventions) with no prehabilitation. We focused on the following outcomes: functional capacity (i.e. 6-minute walk test, VOpeak, handgrip strength), postoperative outcomes (i.e. complications, mortality, length of hospital stay, emergency department visits, re-admissions), health-related quality of life, compliance, safety of prehabilitation, and return to normal activities.
DATA COLLECTION AND ANALYSIS
Two authors independently selected studies, extracted data, assessed risk of bias and used GRADE to assess the certainty of the evidence. Any disagreements were solved with discussion and consensus. We pooled data to perform meta-analyses, where possible.
MAIN RESULTS
We included three RCTs that enrolled 250 participants with non-metastatic colorectal cancer, scheduled for elective (mainly laparoscopic) surgery. Included trials were conducted in tertiary care centres and recruited patients during periods ranging from 17 months to 45 months. A total of 130 participants enrolled in a preoperative four-week trimodal prehabilitation programme consisting of exercise, nutritional intervention, and anxiety reduction techniques. Outcomes of these participants were compared to those of 120 participants who started an identical but postoperative programme. Postoperatively, prehabilitation may improve functional capacity, determined with the 6-minute walk test at four and eight weeks (mean difference (MD) 26.02, 95% confidence interval (CI) -13.81 to 65.85; 2 studies; n = 131; and MD 26.58, 95% CI -8.88 to 62.04; 2 studies; n = 140); however, the certainty of evidence is low and very low, respectively, due to serious risk of bias, imprecision, and inconsistency. After prehabilitation, the functional capacity before surgery improved, with a clinically relevant mean difference of 24.91 metres (95% CI 11.24 to 38.57; 3 studies; n = 225). The certainty of evidence was moderate due to downgrading for serious risk of bias. The effects of prehabilitation on the number of complications (RR 0.95, 95% CI 0.70 to 1.29; 3 studies; n = 250), emergency department visits (RR 0.72, 95% CI 0.39 to 1.32; 3 studies; n = 250) and re-admissions (RR 1.20, 95% CI 0.54 to 2.65; 3 studies; n = 250) were small or even trivial. The certainty of evidence was low due to downgrading for serious risk of bias and imprecision. The effects on VOpeak, handgrip strength, length of hospital stay, mortality rate, health-related quality of life, return to normal activities, safety of the programme, and compliance rate could not be analysed quantitatively due to missing or insufficient data. The included studies did not report a difference between groups for health-related quality of life and length of hospital stay. Data on remaining outcomes were not reported or were reported inadequately in the included studies.
AUTHORS' CONCLUSIONS
Prehabilitation may result in an improved functional capacity, determined with the 6-minute walk test both preoperatively and postoperatively. A solid effect on the number of omplications, postoperative emergency department visits and re-admissions could not be established. The certainty of evidence ranges from moderate to very low, due to downgrading for serious risk of bias, imprecision and inconsistency. In addition, only three heterogeneous studies were included in this review. Therefore, the findings of this review should be interpreted with caution. Numerous relevant RCTs are ongoing and will be included in a future update of this review.
Topics: Adult; Humans; Colorectal Neoplasms; Digestive System Surgical Procedures; Postoperative Complications; Preoperative Exercise; Quality of Life
PubMed: 37162250
DOI: 10.1002/14651858.CD013259.pub3 -
BMC Geriatrics Sep 2020Exercise intervention can significantly improve physical function and bone strength; however, the effect of exercise on fall-related fractures in older adults remains... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Exercise intervention can significantly improve physical function and bone strength; however, the effect of exercise on fall-related fractures in older adults remains controversial. This study aimed to assess the effectiveness of exercise intervention on fall-related fractures in older adults by conducting a meta-analysis of randomized controlled trials (RCTs).
METHODS
PubMed, EMBASE, and Cochrane databases were systematically searched for RCTs through November 24, 2019 to investigate the effectiveness of exercise intervention on fall-related fractures in older adults. Pooled relative risk (RR) with 95% confidence interval (CI) was calculated using the random-effects model. Sensitivity, subgroup, and publication bias analyses were also conducted.
RESULTS
A total of 7704 older adults and 428 fall-related fracture events from 20 RCTs were selected for the final meta-analysis. The follow-up duration across included trials ranged from 6.0 months to 7.0 years. The pooled RR suggested that exercise intervention was associated with a reduced fall-related fracture risk in older adults (RR: 0.74; 95% CI: 0.59-0.92; P = 0.007; I = 12.6%). The pooled conclusion was robust and not affected by any individual trial. Subgroup analysis revealed that the significant effect of exercise intervention on fall-related fractures was mainly detected when the study reported results from both male and female subjects, when it did not report the baseline body mass index, when individuals received both home- and center-based interventions, when the follow-up duration was > 1.0 year, and when it was a high-quality study.
CONCLUSIONS
Regular exercise intervention could prevent fall-related fractures in older adults. Further large-scale RCTs should be conducted to assess the effectiveness of different exercise programs on fall-related fractures at various sites.
Topics: Aged; Female; Humans; Male; Accidental Falls; Exercise; Exercise Therapy; Fractures, Bone; Randomized Controlled Trials as Topic
PubMed: 32887571
DOI: 10.1186/s12877-020-01721-6 -
British Journal of Sports Medicine Aug 2020To assess the effects of exercise interventions for preventing falls in older people living in the community.
OBJECTIVES
To assess the effects of exercise interventions for preventing falls in older people living in the community.
SELECTION CRITERIA
We included randomised controlled trials evaluating the effects of any form of exercise as a single intervention on falls in people aged 60+years living in the community.
RESULTS
Exercise reduces the rate of falls by 23% (rate ratio (RaR) 0.77, 95% CI 0.71 to 0.83; 12 981 participants, 59 studies; high-certainty evidence). Subgroup analyses showed no evidence of a difference in effect on falls on the basis of risk of falling as a trial inclusion criterion, participant age 75 years+ or group versus individual exercise but revealed a larger effect of exercise in trials where interventions were delivered by a health professional (usually a physiotherapist). Different forms of exercise had different impacts on falls. Compared with control, balance and functional exercises reduce the rate of falls by 24% (RaR 0.76, 95% CI 0.70 to 0.81; 7920 participants, 39 studies; high-certainty evidence). Multiple types of exercise (commonly balance and functional exercises plus resistance exercises) probably reduce the rate of falls by 34% (RaR 0.66, 95% CI 0.50 to 0.88; 1374 participants, 11 studies; moderate-certainty evidence). Tai Chi may reduce the rate of falls by 19% (RaR 0.81, 95% CI 0.67 to 0.99; 2655 participants, 7 studies; low-certainty evidence). We are uncertain of the effects of programmes that primarily involve resistance training, dance or walking.
CONCLUSIONS AND IMPLICATIONS
Given the certainty of evidence, effective programmes should now be implemented.
Topics: Accidental Falls; Aged; Exercise; Humans; Independent Living; Middle Aged; Postural Balance; Randomized Controlled Trials as Topic; Resistance Training; Risk Factors; Tai Ji
PubMed: 31792067
DOI: 10.1136/bjsports-2019-101512 -
Sports Medicine (Auckland, N.Z.) Apr 2024Running economy is defined as the energy demand at submaximal running speed, a key determinant of overall running performance. Strength training can improve running... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Running economy is defined as the energy demand at submaximal running speed, a key determinant of overall running performance. Strength training can improve running economy, although the magnitude of its effect may depend on factors such as the strength training method and the speed at which running economy is assessed.
AIM
To compare the effect of different strength training methods (e.g., high loads, plyometric, combined methods) on the running economy in middle- and long-distance runners, over different running speeds, through a systematic review with meta-analysis.
METHODS
A systematic search was conducted across several electronic databases including Web of Science, PubMed, SPORTDiscus, and SCOPUS. Using different keywords and Boolean operators for the search, all articles indexed up to November 2022 were considered for inclusion. In addition, the PICOS criteria were applied: Population: middle- and long-distance runners, without restriction on sex or training/competitive level; Intervention: application of a strength training method for ≥ 3 weeks (i.e., high loads (≥ 80% of one repetition maximum); submaximal loads [40-79% of one repetition maximum); plyometric; isometric; combined methods (i.e., two or more methods); Comparator: control group that performed endurance running training but did not receive strength training or received it with low loads (< 40% of one repetition maximum); Outcome: running economy, measured before and after a strength training intervention programme; Study design: randomized and non-randomized controlled studies. Certainty of evidence was assessed with the GRADE approach. A three-level random-effects meta-analysis and moderator analysis were performed using R software (version 4.2.1).
RESULTS
The certainty of the evidence was found to be moderate for high load training, submaximal load training, plyometric training and isometric training methods and low for combined methods. The studies included 195 moderately trained, 272 well trained, and 185 highly trained athletes. The strength training programmes were between 6 and 24 weeks' duration, with one to four sessions executed per week. The high load and combined methods induced small (ES = - 0.266, p = 0.039) and moderate (ES = - 0.426, p = 0.018) improvements in running economy at speeds from 8.64 to 17.85 km/h and 10.00 to 14.45 km/h, respectively. Plyometric training improved running economy at speeds ≤ 12.00 km/h (small effect, ES = - 0.307, p = 0.028, β = 0.470, p = 0.017). Compared to control groups, no improvement in running economy (assessed speed: 10.00 to 15.28 and 9.75 to 16.00 km/h, respectively) was noted after either submaximal or isometric strength training (all, p > 0.131). The moderator analyses showed that running speed (β = - 0.117, p = 0.027) and VOmax (β = - 0.040, p = 0.020) modulated the effect of high load strength training on running economy (i.e., greater improvements at higher speeds and higher VOmax).
CONCLUSIONS
Compared to a control condition, strength training with high loads, plyometric training, and a combination of strength training methods may improve running economy in middle- and long-distance runners. Other methods such as submaximal load training and isometric strength training seem less effective to improve running economy in this population. Of note, the data derived from this systematic review suggest that although both high load training and plyometric training may improve running economy, plyometric training might be effective at lower speeds (i.e., ≤ 12.00 km/h) and high load strength training might be particularly effective in improving running economy (i) in athletes with a high VOmax, and (ii) at high running speeds.
PROTOCOL REGISTRATION
The original protocol was registered ( https://osf.io/gyeku ) at the Open Science Framework.
Topics: Humans; Resistance Training; Running; Athletic Performance; Plyometric Exercise; Physical Endurance; Muscle Strength
PubMed: 38165636
DOI: 10.1007/s40279-023-01978-y