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The Cochrane Database of Systematic... Mar 2021Cancer cachexia is a multifactorial syndrome characterised by an ongoing loss of skeletal muscle mass, with or without a loss of fat mass, leading to progressive... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Cancer cachexia is a multifactorial syndrome characterised by an ongoing loss of skeletal muscle mass, with or without a loss of fat mass, leading to progressive functional impairment. Physical exercise may attenuate cancer cachexia and its impact on patient function. This is the first update of an original Cochrane Review published in Issue 11, 2014, which found no studies to include.
OBJECTIVES
To determine the effectiveness, acceptability and safety of exercise, compared with usual care, no treatment or active control, for cancer cachexia in adults.
SEARCH METHODS
We searched CENTRAL, MEDLINE, Embase, and eight other databases to March 2020. We searched for ongoing studies in trial registries, checked reference lists and contacted experts to seek relevant studies.
SELECTION CRITERIA
We sought randomised controlled trials in adults with cancer cachexia, that compared a programme of exercise alone or in combination with another intervention, with usual care, no treatment or an active control group.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed titles and abstracts for relevance and extracted data on study design, participants, interventions and outcomes from potentially relevant articles. We used standard methodological procedures expected by Cochrane. Our primary outcome was lean body mass and secondary outcomes were adherence to exercise programme, adverse events, muscle strength and endurance, exercise capacity, fatigue and health-related quality of life. We assessed the certainty of evidence using GRADE and included two Summary of findings tables.
MAIN RESULTS
We included four new studies in this update which overall randomised 178 adults with a mean age of 58 (standard deviation (SD) 8.2) years. Study sample size ranged from 20 to 60 participants and in three studies the proportion of men ranged from 52% to 82% (the fourth study was only available in abstract form). Three studies were from Europe: one in the UK and Norway; one in Belgium and one in Germany. The remaining study was in Canada. The types of primary cancer were head and neck (two studies), lung and pancreas (one study), and mixed (one study). We found two comparisons: exercise alone (strength-based exercise) compared to usual care (one study; 20 participants); and exercise (strength-based exercise/endurance exercise) as a component of a multimodal intervention (pharmacological, nutritional or educational (or a combination) interventions) compared with usual care (three studies, 158 participants). Studies had unclear and high risk of bias for most domains. Exercise plus usual care compared with usual care We found one study (20 participants). There was no clear evidence of a difference for lean body mass (8 weeks: MD 6.40 kg, 95% CI -2.30 to 15.10; very low-certainty evidence). For our secondary outcomes, all participants adhered to the exercise programme and no participant reported any adverse event during the study. There were no data for muscle strength and endurance, or maximal and submaximal exercise capacity. There was no clear evidence of a difference for either fatigue (4 to 20 scale, lower score was better) (8 weeks: MD -0.10, 95% CI -4.00 to 3.80; very low-certainty evidence) or health-related quality of life (0 to 104 scale, higher score was better) (8 weeks: MD 4.90, 95% CI -15.10 to 24.90; very low-certainty evidence). Multimodal intervention (exercise plus other interventions) plus usual care compared with usual care We found three studies but outcome data were only available for two studies. There was no clear evidence of a difference for lean body mass (6 weeks: MD 7.89 kg, 95% CI -9.57 to 25.35; 1 study, 44 participants; very low-certainty evidence; 12 weeks: MD -2.00, 95% CI -8.00 to 4.00; one study, 60 participants; very low-certainty evidence). For our secondary outcomes, there were no data reported on adherence to the exercise programme, endurance, or maximal exercise capacity. In one study (44 participants) there was no clear evidence of a difference for adverse events (patient episode report) (6 weeks: risk ratio (RR) 1.18, 95% CI 0.67 to 2.07; very low-certainty evidence). Another study assessed adverse events but reported no data and the third study did not assess this outcome. There was no clear evidence of a difference in muscle strength (6 weeks: MD 3.80 kg, 95% CI -2.87 to 10.47; 1 study, 44 participants; very low-certainty evidence; 12 weeks MD -5.00 kg, 95% CI -14.00 to 4.00; 1 study, 60 participants; very low-certainty evidence), submaximal exercise capacity (6 weeks: MD -16.10 m walked, 95% CI -76.53 to 44.33; 1 study, 44 participants; very low-certainty evidence; 12 weeks: MD -62.60 m walked, 95% CI -145.87 to 20.67; 1 study, 60 participants; very low-certainty evidence), fatigue (0 to 10 scale, lower score better) (6 weeks: MD 0.12, 95% CI -1.00 to 1.24; 1 study, 44 participants; very low-certainty evidence) or health-related quality of life (0 to 104 scale, higher score better) (12 weeks: MD -2.20, 95% CI -13.99 to 9.59; 1 study, 60 participants; very low-certainty evidence).
AUTHORS' CONCLUSIONS
The previous review identified no studies. For this update, our conclusions have changed with the inclusion of four studies. However, we are uncertain of the effectiveness, acceptability and safety of exercise for adults with cancer cachexia. Further high-quality randomised controlled trials are still required to test exercise alone or as part of a multimodal intervention to improve people's well-being throughout all phases of cancer care. We assessed the certainty of the body of evidence as very low, downgraded due to serious study limitations, imprecision and indirectness. We have very little confidence in the results and the true effect is likely to be substantially different from these. The findings of at least three more studies (one awaiting classification and two ongoing) are expected in the next review update.
Topics: Bias; Cachexia; Combined Modality Therapy; Exercise; Exercise Tolerance; Fatigue; Female; Head and Neck Neoplasms; Humans; Lung Neoplasms; Male; Middle Aged; Muscle Strength; Neoplasms; Pancreatic Neoplasms; Patient Compliance; Physical Endurance; Quality of Life; Randomized Controlled Trials as Topic; Thinness
PubMed: 33735441
DOI: 10.1002/14651858.CD010804.pub3 -
Nutrients Apr 2022Evidence exists to suggest that ROS induce muscular injury with a subsequent decrease in physical performance. Supplementation with certain antioxidants is important for... (Review)
Review
Evidence exists to suggest that ROS induce muscular injury with a subsequent decrease in physical performance. Supplementation with certain antioxidants is important for physically active individuals to hasten recovery from fatigue and to prevent exercise damage. The use of nutritional supplements associated with exercise, with the aim of improving health, optimizing training or improving sports performance, is a scientific concern that not only drives many research projects but also generates great expectations in the field of their application in pathology. Since its discovery in the 1970s, coenzyme Q (CoQ) has been one of the most controversial molecules. The interest in determining its true value as a bioenergetic supplement in muscle contraction, antioxidant or in the inflammatory process as a muscle protector in relation to exercise has been studied at different population levels of age, level of physical fitness or sporting aptitude, using different methodologies of effort and with the contribution of data corresponding to very diverse variables. Overall, in the papers reviewed, although the data are inconclusive, they suggest that CoQ supplementation may be an interesting molecule in health or disease in individuals without a pathological deficiency and when used for optimising exercise performance. Considering the results observed in the literature, and as a conclusion of this systematic review, we could say that it is an interesting molecule in sports performance. However, clear approaches should be considered when conducting future research.
Topics: Antioxidants; Athletic Performance; Dietary Supplements; Exercise; Humans; Ubiquinone
PubMed: 35565783
DOI: 10.3390/nu14091811 -
JAMA Network Open Oct 2021Short-term and long-term persistent postacute sequelae of COVID-19 (PASC) have not been systematically evaluated. The incidence and evolution of PASC are dependent on...
IMPORTANCE
Short-term and long-term persistent postacute sequelae of COVID-19 (PASC) have not been systematically evaluated. The incidence and evolution of PASC are dependent on time from infection, organ systems and tissue affected, vaccination status, variant of the virus, and geographic region.
OBJECTIVE
To estimate organ system-specific frequency and evolution of PASC.
EVIDENCE REVIEW
PubMed (MEDLINE), Scopus, the World Health Organization Global Literature on Coronavirus Disease, and CoronaCentral databases were searched from December 2019 through March 2021. A total of 2100 studies were identified from databases and through cited references. Studies providing data on PASC in children and adults were included. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines for abstracting data were followed and performed independently by 2 reviewers. Quality was assessed using the Newcastle-Ottawa Scale for cohort studies. The main outcome was frequency of PASC diagnosed by (1) laboratory investigation, (2) radiologic pathology, and (3) clinical signs and symptoms. PASC were classified by organ system, ie, neurologic; cardiovascular; respiratory; digestive; dermatologic; and ear, nose, and throat as well as mental health, constitutional symptoms, and functional mobility.
FINDINGS
From a total of 2100 studies identified, 57 studies with 250 351 survivors of COVID-19 met inclusion criteria. The mean (SD) age of survivors was 54.4 (8.9) years, 140 196 (56%) were male, and 197 777 (79%) were hospitalized during acute COVID-19. High-income countries contributed 45 studies (79%). The median (IQR) proportion of COVID-19 survivors experiencing at least 1 PASC was 54.0% (45.0%-69.0%; 13 studies) at 1 month (short-term), 55.0% (34.8%-65.5%; 38 studies) at 2 to 5 months (intermediate-term), and 54.0% (31.0%-67.0%; 9 studies) at 6 or more months (long-term). Most prevalent pulmonary sequelae, neurologic disorders, mental health disorders, functional mobility impairments, and general and constitutional symptoms were chest imaging abnormality (median [IQR], 62.2% [45.8%-76.5%]), difficulty concentrating (median [IQR], 23.8% [20.4%-25.9%]), generalized anxiety disorder (median [IQR], 29.6% [14.0%-44.0%]), general functional impairments (median [IQR], 44.0% [23.4%-62.6%]), and fatigue or muscle weakness (median [IQR], 37.5% [25.4%-54.5%]), respectively. Other frequently reported symptoms included cardiac, dermatologic, digestive, and ear, nose, and throat disorders.
CONCLUSIONS AND RELEVANCE
In this systematic review, more than half of COVID-19 survivors experienced PASC 6 months after recovery. The most common PASC involved functional mobility impairments, pulmonary abnormalities, and mental health disorders. These long-term PASC effects occur on a scale that could overwhelm existing health care capacity, particularly in low- and middle-income countries.
Topics: COVID-19; Fatigue; Humans; Lung Diseases; Mental Disorders; Mobility Limitation; Muscle Weakness; Nervous System Diseases; Survivors
PubMed: 34643720
DOI: 10.1001/jamanetworkopen.2021.28568 -
The Physician and Sportsmedicine Feb 2023Hamstring strain injuries are one of the most common injuries in Rugby Union, representing up to 15% of all injuries sustained. We aimed to systematically review and... (Review)
Review
BACKGROUND
Hamstring strain injuries are one of the most common injuries in Rugby Union, representing up to 15% of all injuries sustained. We aimed to systematically review and summarize the scientific literature that addressed hamstring strain injury incidence, risk factors, injury prevention or strengthening strategies, and strength or asymmetry measures in Rugby Union.
METHODS
We conducted a systematic search to locate published peer-reviewed articles from PubMed, SPORTDiscus, Web of Science®, and Scopus® e-databases. Studies included were original research conducted in Rugby Union that evaluated hamstring strength, hamstring strengthening interventions, and/or hamstring injury outcomes. Included studies were quality assessed using the Newcastle-Ottawa Scale.
RESULTS
Twenty-four studies met inclusion and altogether involved 2866 participants. Isokinetic testing was the most common method used to quantify hamstring strength and imbalances in Rugby Union; with data indicating that professionals are stronger than amateurs, and forwards are stronger than backs. Regarding risk factors, we identified playing position, fatigue, previous injuries, between leg strength imbalances, lack of readiness to return to play post injury, and game actions (i.e. running). There is evidence to support the use of Nordic eccentric strength measures to inform practice, with strength and imbalances useful in predicting injuries. Strengthening programs with Nordic exercises significantly increased hamstring strength, increased muscle thickness, and decreased imbalance ratios in female and male players. A significant reduction in injury incidence and severity in professional players has been observed in players performing routines incorporating progressive Nordic exercises.
CONCLUSION
The etiology of hamstring strain injuries is multifactorial, with playing position, fatigue, previous injuries, leg imbalances, lack of readiness to return to play, and running actions identified as contributing factors across levels. Combining strategies to prevent hamstring injuries and recurrences, and to inform return to play, is likely worthwhile and should include Nordic strength assessment and Nordic exercises.
Topics: Humans; Male; Female; Incidence; Rugby; Athletic Injuries; Risk Factors; Leg Injuries; Soft Tissue Injuries; Muscle Strength
PubMed: 34637371
DOI: 10.1080/00913847.2021.1992601 -
Sports Medicine (Auckland, N.Z.) Dec 2023Protein supplements are important to maintain optimum health and physical performance, particularly in athletes and active individuals to repair and rebuild their...
Effect of Soy Protein Supplementation on Muscle Adaptations, Metabolic and Antioxidant Status, Hormonal Response, and Exercise Performance of Active Individuals and Athletes: A Systematic Review of Randomised Controlled Trials.
BACKGROUND
Protein supplements are important to maintain optimum health and physical performance, particularly in athletes and active individuals to repair and rebuild their skeletal muscles and connective tissues. Soy protein (SP) has gained popularity in recent years as an alternative to animal proteins.
OBJECTIVES
This systematic review evaluates the evidence from randomised controlled clinical trials of the effects of SP supplementation in active individuals and athletes in terms of muscle adaptations, metabolic and antioxidant status, hormonal response and exercise performance. It also explores the differences in SP supplementation effects in comparison to whey protein.
METHODS
A systematic search was conducted in PubMed, Embase and Web of Science, as well as a manual search in Google Scholar and EBSCO, on 27 June 2023. Randomised controlled trials that evaluated the applications of SPs supplementation on sports and athletic-related outcomes that are linked with exercise performance, adaptations and biomarkers in athletes and physically active adolescents and young adults (14 to 39 years old) were included, otherwise, studies were excluded. The risk of bias was assessed according to Cochrane's revised risk of bias tool.
RESULTS
A total of 19 eligible original research articles were included that investigated the effect of SP supplementation on muscle adaptations (n = 9), metabolic and antioxidant status (n = 6), hormonal response (n = 6) and exercise performance (n = 6). Some studies investigated more than one effect. SP was found to provide identical increases in lean mass compared to whey in some studies. SP consumption promoted the reduction of exercise-induced metabolic/blood circulating biomarkers such as triglycerides, uric acid and lactate. Better antioxidant capacity against oxidative stress has been seen with respect to whey protein in long-term studies. Some studies reported testosterone and cortisol fluctuations related to SP; however, more research is required. All studies on SP and endurance performance suggested the potential beneficial effects of SP supplementation (10-53.3 g) on exercise performance by improving high-intensity and high-speed running performance, enhancing maximal cardiac output, delaying fatigue and improving isometric muscle strength, improving endurance in recreational cyclists, increasing running velocity and decreasing accumulated lactate levels; however, studies determining the efficacy of soy protein on VOmax provided conflicted results.
CONCLUSION
It is possible to recommend SP to athletes and active individuals in place of conventional protein supplements by assessing their dosage and effectiveness in relation to different types of training. SP may enhance lean mass compared with other protein sources, enhance the antioxidant status, and reduce oxidative stress. SP supplementation had an inconsistent effect on testosterone and cortisol levels. SP supplementation may be beneficial, especially after muscle damage, high-intensity/high-speed or repeated bouts of strenuous exercise.
Topics: Adolescent; Adult; Humans; Young Adult; Antioxidants; Athletes; Biomarkers; Dietary Supplements; Hydrocortisone; Lactates; Muscle, Skeletal; Soybean Proteins; Testosterone; Whey Proteins; Randomized Controlled Trials as Topic
PubMed: 37603200
DOI: 10.1007/s40279-023-01899-w -
Sports (Basel, Switzerland) Jan 2022Weight resistance training (RT) has been shown to positively influence physical performance. Within the last two decades, a methodology based on monitoring RT through... (Review)
Review
Weight resistance training (RT) has been shown to positively influence physical performance. Within the last two decades, a methodology based on monitoring RT through movement velocity (also called velocity-based resistance training, VBRT) has emerged. The aim of this PRISMA-based systematic review was to evaluate the effect of VBRT programs on variables related to muscle strength (one-repetition maximum, 1-RM), and high-speed actions (vertical jump, and sprint performance) in trained subjects. The search for published articles was performed in PubMed/MEDLINE, SPORT Discus/EBSCO, OVID, Web of Science, Scopus, and EMBASE databases using Boolean algorithms independently. A total of 22 studies met the inclusion criteria of this systematic review (a low-to-moderate overall risk of bias of the analyzed studies was detected). VBRT is an effective method to improve 1-RM, vertical jump and sprint. According to the results of the analyzed studies, it is not necessary to reach high muscle failure in order to achieve the best training results. These findings reinforce the fact that it is possible to optimize exercise adaptations with less fatigue. Future studies should corroborate these findings in female population.
PubMed: 35050973
DOI: 10.3390/sports10010008 -
International Journal of Environmental... Apr 2020Studies in tennis injuries have successfully identified the incident rate, the location, and the type of the injury. The majority of the studies have multiple...
Studies in tennis injuries have successfully identified the incident rate, the location, and the type of the injury. The majority of the studies have multiple perspectives (epidemiology, biomechanics, performance), however only a few studies were able to identify risk factors or mechanisms that contribute to tennis injuries. Until now, there has not been a systematic literature review that identifies risk factors for tennis injuries. The objective of this review was to identify and critically appraise the evidence related to risk factors for upper limb injury in tennis players. A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework, using a research question developed by the Patient Problem, (or Population) Intervention, Comparison or Control, and Outcome (PICO) methodology. The quality of the studies included was moderate to low, indicating prolonged tennis (exposure to tennis), scapular dyskinesis, muscle fatigue, scapulothoracic properties, shoulder kinetics or kinematics, skill level, and technique as risk factors for upper limb injury in tennis players. In this review, it is evidenced that the majority of tennis injuries are associated with overuse and a chronic time course, however, tennis injuries do not arise from a linear combination of isolated and predictive factors. Therefore, the multifactorial and complex nature of tennis injuries has to be further examined. The necessity of more randomized control trial studies is highly recommended.
Topics: Athletic Injuries; Biomechanical Phenomena; Humans; Risk Factors; Scapula; Shoulder; Shoulder Joint; Tennis
PubMed: 32316156
DOI: 10.3390/ijerph17082744 -
Nutrients Sep 2019Most studies that have shown the positive effects of caffeine supplementation on sports performance have been carried out on men. However, the differences between sexes...
Most studies that have shown the positive effects of caffeine supplementation on sports performance have been carried out on men. However, the differences between sexes are evident in terms of body size, body composition, and hormonal functioning, which might cause different outcomes on performance for the same dosage of caffeine intake in men vs. women. The main aim of this systematic review was to analyze and compare the effects of caffeine intake between men and women on sports performance to provide a source of knowledge to sports practitioners and coaches, especially for those working with women athletes, on the use of caffeine as an ergogenic aid. A structured search was carried out following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines in the Web of Science, Cochrane Library, and Scopus databases until 28 July 2019. The search included studies in which the effects of caffeine supplementation on athletic performance were compared between sexes and to an identical placebo situation (dose, duration and timing). No filters were applied for participants' physical fitness level or age. A total of 254 articles were obtained in the initial search. When applying the inclusion and exclusion criteria, the final sample was 10 articles. The systematic review concluded that four investigations (100% of the number of investigations on this topic) had not found differences between sexes in terms of caffeine supplementation on aerobic performance and 3/3 (100%) on the fatigue index. However, four out of seven articles (57.1%) showed that the ergogenicity of caffeine for anaerobic performance was higher in men than women. In particular, it seems that men are able to produce more power, greater total weight lifted and more speed with the same dose of caffeine than women. In summary, caffeine supplementation produced a similar ergogenic benefit for aerobic performance and the fatigue index in men and women athletes. Nevertheless, the effects of caffeine to produce more power, total weight lifted and to improve sprint performance with respect to a placebo was higher in men than women athletes despite the same dose of caffeine being administered. Thus, the ergogenic effect of acute caffeine intake on anaerobic performance might be higher in men than in women.
Topics: Adult; Caffeine; Dietary Supplements; Female; Humans; Male; Middle Aged; Muscle Contraction; Muscle Strength; Muscle, Skeletal; Performance-Enhancing Substances; Physical Endurance; Sex Factors; Time Factors; Treatment Outcome; Young Adult
PubMed: 31574901
DOI: 10.3390/nu11102313 -
Respirology (Carlton, Vic.) Nov 2023Long COVID, or post-acute COVID-19 sequelae, is experienced by an estimated one in eight adults following acute COVID-19. Long COVID is a new and complex chronic health... (Review)
Review
Long COVID, or post-acute COVID-19 sequelae, is experienced by an estimated one in eight adults following acute COVID-19. Long COVID is a new and complex chronic health condition that typically includes multiple symptoms that cross organ systems and fluctuate over time; a one-size-fits-all approach is, therefore, not likely to be appropriate nor relevant for long COVID treatment. 'Treatable Traits' is a personalized medicine approach, purpose-built to address the complexity and heterogeneity of complex chronic conditions. This comprehensive review aimed to understand how a treatable traits approach could be applied to long COVID, by first identifying the most prevalent long COVID treatable traits and then the available evidence for strategies to target these traits. An umbrella review of 22 systematic reviews identified 34 symptoms and complications common with long COVID, grouped into eight long COVID treatable trait clusters: neurological, chest, psychological, pain, fatigue, sleep impairment, functional impairment and other. A systematic review of randomized control trials identified 18 studies that explored different intervention approaches for long COVID prevention (k = 4) or management (k = 14). While a single study reported metformin as effective for long COVID prevention, the findings need to be replicated and consensus is required around how to define long COVID as a clinical trial endpoint. For long COVID management, current evidence supports exercise training or respiratory muscle training for long COVID treatable traits in the chest and functional limitation clusters. While there are studies exploring interventions targeting other long COVID treatable traits, further high-quality RCTs are needed, particularly targeting treatable traits in the clusters of fatigue, psychological, pain and sleep impairment.
Topics: Adult; Humans; Post-Acute COVID-19 Syndrome; COVID-19; Chronic Disease; Fatigue; Pain
PubMed: 37715729
DOI: 10.1111/resp.14596 -
The Oncologist Dec 2021The development of immune checkpoint inhibitors (ICIs) represents a paradigm shift in the treatment of cancers. Despite showing remarkable efficacy, these agents can be...
BACKGROUND
The development of immune checkpoint inhibitors (ICIs) represents a paradigm shift in the treatment of cancers. Despite showing remarkable efficacy, these agents can be associated with life-threatening immune-related adverse events. In recent years, several cases of myocarditis with myositis and/or myasthenia gravis overlap syndrome (IM3OS) have been reported. However, given the rarity, the clinical features and outcomes of these cases remain poorly understood. We, therefore, attempted to systematically review and summarize all cases of IM3OS reported in the literature.
MATERIALS AND METHODS
Studies reporting IM3OS were identified in Embase and MEDLINE. Only case reports and case series published in journals or presented at conferences were included. We conducted a systematic review according to the PRISMA Harms guidelines.
RESULTS
A total of 60 cases were eligible. The patients' median age was 71 years, and the majority (67%) were males; melanoma was the most common indication for ICIs (38%). The most-reported symptoms were fatigue (80%) and muscle weakness (78%). The median number of doses to the development of IM3OS was one. The average creatine kinase level was 9,645 IU/L. Cardiac arrhythmias occurred in 67% of patients, and 18% had depressed ejection fraction. Initial treatment consisted of immunosuppression with high-dose steroids and supportive therapies. Sixty percent of the patients died in hospital because of acute complications.
CONCLUSION
IM3OS can be associated with significant mortality and morbidity. Prospective studies are needed to understand the optimal approach to diagnose and manage these patients and to develop biomarkers to predict the occurrence and severity of this rare but serious condition.
IMPLICATIONS FOR PRACTICE
Clinicians should suspect coexisting myositis and/or myasthenia gravis in all patients with immune checkpoint inhibitor-induced myocarditis, given their propensity to occur together. Early recognition and prompt treatment with the help of a multidisciplinary team might help improve the outcomes of this life-threatening condition.
Topics: Aged; Humans; Immune Checkpoint Inhibitors; Myasthenia Gravis; Myocarditis; Myositis
PubMed: 34378270
DOI: 10.1002/onco.13931