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The Cochrane Database of Systematic... Oct 2020Congenital heart disease (ConHD) affects approximately 1% of all live births. People with ConHD are living longer due to improved medical intervention and are at risk... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Congenital heart disease (ConHD) affects approximately 1% of all live births. People with ConHD are living longer due to improved medical intervention and are at risk of developing non-communicable diseases. Cardiorespiratory fitness (CRF) is reduced in people with ConHD, who deteriorate faster compared to healthy people. CRF is known to be prognostic of future mortality and morbidity: it is therefore important to assess the evidence base on physical activity interventions in this population to inform decision making.
OBJECTIVES
To assess the effectiveness and safety of all types of physical activity interventions versus standard care in individuals with congenital heart disease.
SEARCH METHODS
We undertook a systematic search on 23 September 2019 of the following databases: CENTRAL, MEDLINE, Embase, CINAHL, AMED, BIOSIS Citation Index, Web of Science Core Collection, LILACS and DARE. We also searched ClinicalTrials.gov and we reviewed the reference lists of relevant systematic reviews.
SELECTION CRITERIA
We included randomised controlled trials (RCT) that compared any type of physical activity intervention against a 'no physical activity' (usual care) control. We included all individuals with a diagnosis of congenital heart disease, regardless of age or previous medical interventions. DATA COLLECTION AND ANALYSIS: Two review authors (CAW and CW) independently screened all the identified references for inclusion. We retrieved and read all full papers; and we contacted study authors if we needed any further information. The same two independent reviewers who extracted the data then processed the included papers, assessed their risk of bias using RoB 2 and assessed the certainty of the evidence using the GRADE approach. The primary outcomes were: maximal cardiorespiratory fitness (CRF) assessed by peak oxygen consumption; health-related quality of life (HRQoL) determined by a validated questionnaire; and device-worn 'objective' measures of physical activity.
MAIN RESULTS
We included 15 RCTs with 924 participants in the review. The median intervention length/follow-up length was 12 weeks (12 to 26 interquartile range (IQR)). There were five RCTs of children and adolescents (n = 500) and 10 adult RCTs (n = 424). We identified three types of intervention: physical activity promotion; exercise training; and inspiratory muscle training. We assessed the risk of bias of results for CRF as either being of some concern (n = 12) or at a high risk of bias (n = 2), due to a failure to blind intervention staff. One study did not report this outcome. Using the GRADE method, we assessed the certainty of evidence as moderate to very low across measured outcomes. When we pooled all types of interventions (physical activity promotion, exercise training and inspiratory muscle training), compared to a 'no exercise' control CRF may slightly increase, with a mean difference (MD) of 1.89 mL/kg/min (95% CI -0.22 to 3.99; n = 732; moderate-certainty evidence). The evidence is very uncertain about the effect of physical activity and exercise interventions on HRQoL. There was a standardised mean difference (SMD) of 0.76 (95% CI -0.13 to 1.65; n = 163; very low certainty evidence) in HRQoL. However, we could pool only three studies in a meta-analysis, due to different ways of reporting. Only one study out of eight showed a positive effect on HRQoL. There may be a small improvement in mean daily physical activity (PA) (SMD 0.38, 95% CI -0.15 to 0.92; n = 328; low-certainty evidence), which equates to approximately an additional 10 minutes of physical activity daily (95% CI -2.50 to 22.20). Physical activity and exercise interventions likely result in an increase in submaximal cardiorespiratory fitness (MD 2.05, 95% CI 0.05 to 4.05; n = 179; moderate-certainty evidence). Physical activity and exercise interventions likely increase muscular strength (MD 17.13, 95% CI 3.45 to 30.81; n = 18; moderate-certainty evidence). Eleven studies (n = 501) reported on the outcome of adverse events (73% of total studies). Of the 11 studies, six studies reported zero adverse events. Five studies reported a total of 11 adverse events; 36% of adverse events were cardiac related (n = 4); there were, however, no serious adverse events related to the interventions or reported fatalities (moderate-certainty evidence). No studies reported hospital admissions.
AUTHORS' CONCLUSIONS
This review summarises the latest evidence on CRF, HRQoL and PA. Although there were only small improvements in CRF and PA, and small to no improvements in HRQoL, there were no reported serious adverse events related to the interventions. Although these data are promising, there is currently insufficient evidence to definitively determine the impact of physical activity interventions in ConHD. Further high-quality randomised controlled trials are therefore needed, utilising a longer duration of follow-up.
Topics: Adolescent; Adult; Bias; Breathing Exercises; Cardiorespiratory Fitness; Child; Exercise; Female; Heart Defects, Congenital; Humans; Male; Muscle Strength; Oxygen Consumption; Quality of Life; Randomized Controlled Trials as Topic
PubMed: 33112424
DOI: 10.1002/14651858.CD013400.pub2 -
Medicine and Science in Sports and... Oct 2020Although over 100 studies and reviews have examined the ergogenic effects of dietary nitrate (NO3) supplementation in young, healthy men and women, it is unclear if... (Meta-Analysis)
Meta-Analysis
Although over 100 studies and reviews have examined the ergogenic effects of dietary nitrate (NO3) supplementation in young, healthy men and women, it is unclear if participant and environmental factors modulate the well-described ergogenic effects-particularly relevant factors include biological sex, aerobic fitness, and fraction of inspired oxygen (FiO2) during exercise. To address this limitation, the literature was systematically reviewed for randomized, crossover, placebo-controlled studies reporting exercise performance outcome metrics with NO3 supplementation in young, healthy adults. Of the 2033 articles identified, 80 were eligible for inclusion in the meta-analysis. Random-effects meta-analysis demonstrated that exercise performance improved with NO3 supplementation compared with placebo (d = 0.174; 95% confidence interval (CI), 0.120-0.229; P < 0.001). Subgroup analyses conducted on biological sex, aerobic fitness, and FiO2 demonstrated that the ergogenic effect of NO3 supplementation was as follows: 1) not observed in studies with only women (n = 6; d = 0.116; 95% CI, -0.126 to 0.358; P = 0.347), 2) not observed in well-trained endurance athletes (≥65 mL·kg·min; n = 26; d = 0.021; 95% CI, -0.103 to 0.144; P = 0.745), and 3) not modulated by FiO2 (hypoxia vs normoxia). Together, the meta-analyses demonstrated a clear ergogenic effect of NO3 supplementation in recreationally active, young, healthy men across different exercise paradigms and NO3 supplementation parameters; however, the effect size of NO3 supplementation was objectively small (d = 0.174). NO3 supplementation has more limited utility as an ergogenic aid in participants with excellent aerobic fitness that have optimized other training parameters. Mechanistic research and studies incorporating a wide variety of subjects (e.g., women) are needed to advance the study of NO3 supplementation; however, additional descriptive studies of young, healthy men may have limited utility.
Topics: Cardiorespiratory Fitness; Dietary Supplements; Drug Administration Schedule; Exercise; Humans; Inhalation; Nitrates; Oxygen Consumption; Performance-Enhancing Substances; Physical Endurance; Sex Characteristics
PubMed: 32936597
DOI: 10.1249/MSS.0000000000002363 -
JAMA Network Open Oct 2022Reduced exercise capacity is commonly reported among individuals with COVID-19 symptoms more than 3 months after SARS-CoV-2 infection (long COVID-19 [LC]).... (Meta-Analysis)
Meta-Analysis
IMPORTANCE
Reduced exercise capacity is commonly reported among individuals with COVID-19 symptoms more than 3 months after SARS-CoV-2 infection (long COVID-19 [LC]). Cardiopulmonary exercise testing (CPET) is the criterion standard to measure exercise capacity and identify patterns of exertional intolerance.
OBJECTIVES
To estimate the difference in exercise capacity among individuals with and without LC symptoms and characterize physiological patterns of limitations to elucidate possible mechanisms of LC.
DATA SOURCES
A search of PubMed, EMBASE, Web of Science, preprint servers, conference abstracts, and cited references was performed on December 20, 2021, and again on May 24, 2022. A preprint search of medrxiv.org, biorxiv.org, and researchsquare.com was performed on June 9, 2022.
STUDY SELECTION
Studies of adults with SARS-CoV-2 infection more than 3 months earlier that included CPET-measured peak oxygen consumption (V̇o2) were screened independently by 2 blinded reviewers; 72 (2%) were selected for full-text review, and 35 (1%) met the inclusion criteria. An additional 3 studies were identified from preprint servers.
DATA EXTRACTION AND SYNTHESIS
Data extraction was performed by 2 independent reviewers according to the PRISMA reporting guideline. Data were pooled using random-effects models.
MAIN OUTCOMES AND MEASURES
Difference in peak V̇o2 (in mL/kg/min) among individuals with and without persistent COVID-19 symptoms more than 3 months after SARS-CoV-2 infection.
RESULTS
A total of 38 studies were identified that performed CPET on 2160 individuals 3 to 18 months after SARS-CoV-2 infection, including 1228 with symptoms consistent with LC. Most studies were case series of individuals with LC or cross-sectional assessments within posthospitalization cohorts. Based on a meta-analysis of 9 studies including 464 individuals with LC symptoms and 359 without symptoms, the mean peak V̇o2 was -4.9 (95% CI, -6.4 to -3.4) mL/kg/min among those with symptoms with a low degree of certainty. Deconditioning and peripheral limitations (abnormal oxygen extraction) were common, but dysfunctional breathing and chronotropic incompetence were also described. The existing literature was limited by small sample sizes, selection bias, confounding, and varying symptom definitions and CPET interpretations, resulting in high risk of bias and heterogeneity.
CONCLUSIONS AND RELEVANCE
The findings of this systematic review and meta-analysis study suggest that exercise capacity was reduced more than 3 months after SARS-CoV-2 infection among individuals with symptoms consistent with LC compared with individuals without LC symptoms, with low confidence. Potential mechanisms for exertional intolerance other than deconditioning include altered autonomic function (eg, chronotropic incompetence, dysfunctional breathing), endothelial dysfunction, and muscular or mitochondrial pathology.
Topics: Adult; COVID-19; Cross-Sectional Studies; Exercise Test; Humans; Oxygen; SARS-CoV-2; Post-Acute COVID-19 Syndrome
PubMed: 36223120
DOI: 10.1001/jamanetworkopen.2022.36057 -
International Journal of Sports Medicine Apr 2022Training-intensity distribution (TID) is considered the key factor to optimize performance in endurance sports. This systematic review aimed to: I) characterize the TID...
Training-intensity distribution (TID) is considered the key factor to optimize performance in endurance sports. This systematic review aimed to: I) characterize the TID typically used by middle-and long-distance runners; II) compare the effect of different types of TID on endurance performance and its physiological determinants; III) determine the extent to which different TID quantification methods can calculate same TID outcomes from a given training program. The keywords and search strategy identified 20 articles in the research databases. These articles demonstrated differences in the quantification of the different training-intensity zones among quantification methods (i. e. session-rating of perceived exertion, heart rate, blood lactate, race pace, and running speed). The studies that used greater volumes of low-intensity training such as those characterized by pyramidal and polarized TID approaches, reported greater improvements in endurance performance than those which used a threshold TID. Thus, it seems that the combination of high-volume at low-intensity (≥ 70% of overall training volume) and low-volume at threshold and high-intensity interval training (≤ 30%) is necessary to optimize endurance training adaptations in middle-and long-distance runners. Moreover, monitoring training via multiple mechanisms that systematically encompasses objective and subjective TID quantification methods can help coaches/researches to make better decisions.
Topics: Endurance Training; High-Intensity Interval Training; Humans; Oxygen Consumption; Physical Endurance; Running
PubMed: 34749417
DOI: 10.1055/a-1559-3623 -
Physical Therapy Dec 2020The benefits of inspiratory muscle training (IMT) have already been demonstrated in patients with heart failure (HF), but the best mode of training and which patients... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
The benefits of inspiratory muscle training (IMT) have already been demonstrated in patients with heart failure (HF), but the best mode of training and which patients benefit from this intervention are not clear. The purpose of this study was to review the effects of IMT on respiratory muscle strength, functional capacity, pulmonary function, quality of life, and dyspnea in patients with HF; IMT isolated or combined with another intervention (combined IMT), the presence of inspiratory muscle weakness, training load, and intervention time were considered.
METHODS
The search included the databases MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Physiotherapy Evidence Database, and LILACS database through September 2019. The review included randomized studies that assessed IMT in isolation or combined with another intervention-in comparison with a control group, a placebo, or another intervention-in patients with HF. Fourteen studies were included, 13 for meta-analysis (10 for isolated IMT and 3 for combined IMT).
RESULTS
Isolated IMT demonstrated an increase in maximal inspiratory pressure (MIP) (25.12 cm H2O; 95% CI = 15.29 - 34.95), 6-Minute Walk Test (81.18 m; 95% CI = 9.73 - 152.63), maximum oxygen consumption (12 weeks: 3.75 mL/kg/min; 95% CI = 2.98 to 4.51), and quality of life (-20.68; 95% CI = -29.03 to -12.32). The presence of inspiratory muscle weakness, higher loads, and longer intervention times resulted in greater increases in MIP. IMT combined with another intervention demonstrated an increase only in MIP.
CONCLUSIONS
Isolated IMT resulted in an increase in inspiratory muscle strength, functional capacity, and quality of life. IMT combined with another intervention resulted only in a small increase in inspiratory strength. Isolated IMT with higher loads can be considered an adjuvant intervention, especially for those who do not adhere to conventional rehabilitation and who have respiratory muscle weakness.
IMPACT
A systematic review was necessary to review the effects of IMT on respiratory muscle strength, lung function, functional capacity, quality of life, and dyspnea in patients with HF. Various clinical issues important for a better training prescription were considered; these included whether the performance of the training IMT as a form of isolated training benefits patients with HF, whether the combination of IMT with another intervention has additional effects, whether any patient with HF can benefit from IMT (alone or combined with another intervention), and whether only patients who already have respiratory muscle weakness benefit. Also important was establishing which training load provides the best result and the best intervention time, so that health care can be provided more efficiently.
LAY SUMMARY
For people with heart failure, IMT by itself, without being combined with other exercise, can improve ease of breathing, increase the amount of distance that they can walk, and improve quality of life. Inspiratory training with higher loads might be helpful for those with respiratory muscle weakness who are unable to do conventional exercise.
Topics: Bias; Breathing Exercises; Dyspnea; Exercise Tolerance; Heart Failure; Humans; Lung; Maximal Respiratory Pressures; Muscle Strength; Muscle Weakness; Oxygen Consumption; Quality of Life; Respiratory Muscles; Walk Test
PubMed: 32936904
DOI: 10.1093/ptj/pzaa171 -
Journal of Strength and Conditioning... Mar 2020Vasconcelos, BB, Protzen, GV, Galliano, LM, Kirk, C, and Del Vecchio, FB. Effects of high-intensity interval training in combat sports: A systematic review with... (Meta-Analysis)
Meta-Analysis
Vasconcelos, BB, Protzen, GV, Galliano, LM, Kirk, C, and Del Vecchio, FB. Effects of high-intensity interval training in combat sports: A systematic review with meta-analysis. J Strength Cond Res 34(3): 888-900, 2020-Combat sports (CS) are intermittent by nature and high-intensity interval training (HIIT) has been used as a tool to maintain and improve physical fitness among CS athletes. The aim of this study was to perform a systematic review and meta-analysis about chronic effects of HIIT in CS athletes. An electronic search was performed in PubMed, Science Direct, and Google Scholar using the following Boolean criteria: ("CS" OR "martial arts" OR "judo" OR "taekwondo" OR "jiu jitsu" OR "boxing" OR "karate" OR "wrestling" OR "wushu" OR "kung fu") AND ("HIIT" OR "intermittent exercise" OR "sprint interval training" OR "repeated sprint training [RST]"). To be included, the studies needed to be original, involve CS athletes, present HIIT intervention protocol (HIIT, sprint interval training [SIT] or RST), and analyze chronic physiological outcomes. From 2,211 identified studies, after screening and eligibility evaluation, 12 studies were included in this review with meta-analysis. Aerobic (aerobic capacity, heart rate, and maximum oxygen uptake), anaerobic (peak and mean power in single and successive Wingate tests, and blood lactate concentration), and anthropometric outcomes (body mass and body fat percentage) were evaluated. Data of 255 subjects from 12 studies were assessed. Regarding methodological quality, 7 studies obtained 9-10/12 on the TESTEX scale. For the interventions, 5 studies used HIIT, 4 studies used RST protocols, one used SIT protocols, and one used an intermittent protocol that could not be classified. Relating to aerobic power, was found an increase in V[Combining Dot Above]O2max, with a mean difference (MD) of 2.83 ml·kg·min (CI 95% = 0.40-5.25; p < 0.001) for striking and 2.36 ml·kg·min (CI 95% = 1.05-3.66; p < 0.001) for grappling athletes. No differences on anaerobic peak power for striking (MD = 0.67 W; CI 95% = -0.43 to 1.77; p = 0.23) were found, and a statistical improvement for grappling athletes, (MD = 0.51 W; CI 95% = 0.03-0.98; p = 0.04) was found. Seven studies analyzed anthropometric variables, with differences for body mass in striking (MD = -0.93 kg; CI 95% = -1.68 to -0.19; p = 0.01) and no differences for grappling (MD = -0.09 kg; CI 95% = -2.80 to 2.62; p = 0.95). Differences in body fat percentage in striking (MD = 0.50%; CI 95% = 0.30-0.70; p < 0.001) and no differences in grappling (MD = -0.87%; CI 95% = -1.77 to 0.03; p = 0.06) were found. It was concluded that HIIT positively influences maximum oxygen uptake and anaerobic power in combat sport athletes, with a minor impact on body composition.
Topics: Athletes; Athletic Performance; Cardiorespiratory Fitness; Heart Rate; High-Intensity Interval Training; Humans; Male; Martial Arts; Oxygen; Oxygen Consumption; Physical Fitness; Young Adult
PubMed: 31904713
DOI: 10.1519/JSC.0000000000003255 -
Annals of Physical and Rehabilitation... Jan 2020Knowledge of the optimal protocol and safety of particularly high-intensity exercise applied to individuals with stroke is lacking. (Meta-Analysis)
Meta-Analysis
BACKGROUND
Knowledge of the optimal protocol and safety of particularly high-intensity exercise applied to individuals with stroke is lacking.
OBJECTIVE
This systematic review and meta-analysis aimed to investigate the effect of high-intensity exercise on cardiorespiratory fitness in stroke survivors.
METHODS
We performed a systematic electronic search for articles in MedLine via PubMed, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials, CINAHL, and SPORTSDiscus up to April 1, 2019. Peak oxygen consumption (VOpeak), 6-min walk test (6MWT), fastest 10-m walk test (10MWT), and adverse events were assessed. The standardized mean difference (SMD), weighted mean difference (WMD), and odds ratios (ORs) were used to compute the effect size, and subgroup analysis was conducted to test the consistency of results as well as sensitivity analysis to assess the robustness of the results. The quality of evidence was assessed with the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system.
RESULTS
We included 17 studies (PEDro score≥4) in the meta-analysis. Post-intervention, high-intensity exercise had a significant effect on peak oxygen uptake (VOpeak; SMD=0.56, P<0.01, I=8%; WMD=2.53mL/kg/min; high quality of evidence) and 6MWT (SMD=0.26, P<0.01, I=40%; WMD=17.08m; moderate quality of evidence) but not fastest 10MWT (SMD=0.33, P=0.27, I=77%; WMD=0.05m/s; low quality of evidence). Subgroup analysis showed better effects of higher-intensity treadmill training (≥70% heart rate reserve/VOpeak) for a longer duration (≥12 weeks) on VOpeak and 6MWT in sub-acute or chronic stroke survivors. The high-intensity exercise and control groups did not differ in adverse events including falls [odds ratio (OR) 1.40, P=0.35, I=11%; low quality of evidence], pain (OR 3.34, P=0.09, I=0%; moderate quality of evidence), or skin injuries (OR 1.08, P=0.90, I=0%; low quality of evidence).
CONCLUSIONS
Our meta-analysis suggests that high-intensity exercise is beneficial for cardiorespiratory fitness in stroke survivors and might be safe as a novel intervention in cardiopulmonary rehabilitation after stroke.
Topics: Cardiorespiratory Fitness; Exercise; Exercise Therapy; Humans; Oxygen Consumption; Stroke; Stroke Rehabilitation; Walk Test
PubMed: 31465865
DOI: 10.1016/j.rehab.2019.07.006 -
Respiratory Research Jan 2021Pulmonary rehabilitation (PR) has been proposed as an effective method for many respiratory diseases. However, the effects of exercise-based PR on asthma are currently... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Pulmonary rehabilitation (PR) has been proposed as an effective method for many respiratory diseases. However, the effects of exercise-based PR on asthma are currently inconclusive. This review aimed to investigate the effects of exercise-based PR on adults with asthma.
METHODS
The PubMed, Embase, Cochrane Library, Web of Science, International Clinical Trials Registry Platform and ClinicalTrials.gov databases were searched from inception to 31 July 2019 without language restriction. Randomized controlled trials (RCTs) investigating the effects of exercise-based PR on adults with asthma were included. Study selection, data extraction and risk of bias assessment were performed by two investigators independently. Meta-analysis was conducted by RevMan software (version 5.3). Evidence quality was rated by the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system.
RESULTS
Ten literatures from nine studies (n = 418 patients) were identified. Asthma quality of life questionnaire total scores (MD = 0.39, 95% CI: 0.02 to 0.76) improved significantly in the experimental group compared to control group, including activity domain scores (MD = 0.58, 95% CI: 0.21 to 0.94), symptom domain scores (MD = 0.52, 95% CI: 0.19 to 0.85), emotion domain scores (MD = 0.53, 95% CI: - 0.03 to 1.09) and environment domain scores (MD = 0.56, 95% CI: 0.00 to 1.11). Both the 6-min walk distance (MD = 34.09, 95% CI: 2.51 to 65.66) and maximum oxygen uptake (MD = 4.45, 95% CI: 3.32 to 5.58) significantly improved. However, improvements in asthma control questionnaire scores (MD = - 0.25, 95% CI: - 0.51 to 0.02) and asthma symptom-free days (MD = 3.35, 95% CI: - 0.21 to 6.90) were not significant. Moreover, there was no significant improvement (MD = 0.10, 95% CI: - 0.08 to 0.29) in forced expiratory volume in 1 s. Nonetheless, improvements in forced vital capacity (MD = 0.23, 95% CI: 0.08 to 0.38) and peak expiratory flow (MD = 0.39, 95% CI: 0.21 to 0.57) were significant.
CONCLUSIONS
Exercise-based PR may improve quality of life, exercise tolerance and some aspects of pulmonary function in adults with asthma and can be considered a supplementary therapy. RCTs of high quality and large sample sizes are required.
CLINICAL TRIAL REGISTRATION
The review was registered with PROSPERO (The website is https://www.crd.york.ac.uk/prospero/ , and the ID is CRD42019147107).
Topics: Adult; Asthma; Breathing Exercises; Exercise Therapy; Exercise Tolerance; Humans; Oxygen Consumption; Quality of Life; Treatment Outcome
PubMed: 33516207
DOI: 10.1186/s12931-021-01627-w -
Journal of Science and Medicine in Sport Aug 2019To examine the effects of different protocols of high-intensity interval training (HIIT) on VOmax improvements in healthy, overweight/obese and athletic adults, based on... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
To examine the effects of different protocols of high-intensity interval training (HIIT) on VOmax improvements in healthy, overweight/obese and athletic adults, based on the classifications of work intervals, session volumes and training periods.
DESIGN
Systematic review and meta-analysis.
METHODS
PubMed, Scopus, Medline, and Web of Science databases were searched up to April 2018. Inclusion criteria were randomised controlled trials; healthy, overweight/obese or athletic adults; examined pre- and post-training VOmax/peak; HIIT in comparison to control or moderate intensity continuous training (MICT) groups.
RESULTS
Fifty-three studies met the eligibility criteria. Overall, the degree of change in VOmax induced by HIIT varied by populations (SMD=0.41-1.81, p<0.05). When compared to control groups, even short-intervals (≤30s), low-volume (≤5min) and short-term HIIT (≤4weeks) elicited clear beneficial effects (SMD=0.79-1.65, p<0.05) on VOmax/peak. However, long-interval (≥2min), high-volume (≥15min) and moderate to long-term (≥4-12weeks) HIIT displayed significantly larger effects on VOmax (SMD=0.50-2.48, p<0.05). When compared to MICT, only long-interval (≥2min), high-volume (≥15min) and moderate to long-term (≥4-12weeks) HIIT showed beneficial effects (SMD=0.65-1.07, p<0.05).
CONCLUSIONS
Short-intervals (≤30s), low-volume (≤5min) and short-term (≤4weeks) HIIT represent effective and time-efficient strategies for developing VOmax, especially for the general population. To maximize the training effects on VOmax, long-interval (≥2min), high-volume (≥15min) and moderate to long-term (≥4-12weeks) HIIT are recommended.
Topics: Adult; High-Intensity Interval Training; Humans; Oxygen Consumption; Randomized Controlled Trials as Topic
PubMed: 30733142
DOI: 10.1016/j.jsams.2019.01.013 -
The Cochrane Database of Systematic... Jan 2020Infants in the neonatal intensive care unit (NICU) are subjected to stress, including sound of high intensity. The sound environment in the NICU is louder than most home... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Infants in the neonatal intensive care unit (NICU) are subjected to stress, including sound of high intensity. The sound environment in the NICU is louder than most home or office environments and contains disturbing noises of short duration and at irregular intervals. There are competing auditory signals that frequently challenge preterm infants, staff and parents. The sound levels in NICUs often exceed the maximum acceptable level of 45 decibels (dB), recommended by the American Academy of Pediatrics. Hearing impairment is diagnosed in 2% to 10% of preterm infants versus 0.1% of the general paediatric population. Noise may cause apnoea, hypoxaemia, alternation in oxygen saturation, and increased oxygen consumption secondary to elevated heart and respiratory rates and may, therefore, decrease the amount of calories available for growth. Elevated levels of speech are needed to overcome the noisy environment in the NICU, thereby increasing the negative impacts on staff, newborns, and their families. High noise levels are associated with an increased rate of errors and accidents, leading to decreased performance among staff. The aim of interventions included in this review is to reduce sound levels to 45 dB or less. This can be achieved by lowering the sound levels in an entire unit, treating the infant in a section of a NICU, in a 'private' room, or in incubators in which the sound levels are controlled, or reducing the sound levels that reaches the individual infant by using earmuffs or earplugs. By lowering the sound levels that reach the neonate, the resulting stress on the cardiovascular, respiratory, neurological, and endocrine systems can be diminished, thereby promoting growth and reducing adverse neonatal outcomes.
OBJECTIVES
Primary objective To determine the effects of sound reduction on growth and long-term neurodevelopmental outcomes of neonates. Secondary objectives 1. To evaluate the effects of sound reduction on short-term medical outcomes (bronchopulmonary dysplasia, intraventricular haemorrhage, periventricular leukomalacia, retinopathy of prematurity). 2. To evaluate the effects of sound reduction on sleep patterns at three months of age. 3. To evaluate the effects of sound reduction on staff performance. 4. To evaluate the effects of sound reduction in the neonatal intensive care unit (NICU) on parents' satisfaction with the care.
SEARCH METHODS
We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library), MEDLINE, EMBASE, CINAHL, abstracts from scientific meetings, clinical trials registries (clinicaltrials.gov; controlled-trials.com; and who.int/ictrp), Pediatric Academic Societies Annual meetings 2000 to 2014 (Abstracts2View), reference lists of identified trials, and reviews to November 2014.
SELECTION CRITERIA
Preterm infants (< 32 weeks' postmenstrual age (PMA) or < 1500 g birth weight) cared for in the resuscitation area, during transport, or once admitted to a NICU or a stepdown unit.
DATA COLLECTION AND ANALYSIS
We performed data collection and analyses according to the Cochrane Neonatal Review Group.
MAIN RESULTS
One small, high quality study assessing the effects of silicone earplugs versus no earplugs qualified for inclusion. The original inclusion criteria in our protocol stipulated an age of < 48 hours at the time of initiating sound reduction. We made a deviation from our protocol and included this study in which some infants would have been > 48 hours old. There was no significant difference in weight at 34 weeks postmenstrual age (PMA): mean difference (MD) 111 g (95% confidence interval (CI) -151 to 374 g) (n = 23). There was no significant difference in weight at 18 to 22 months corrected age between the groups: MD 0.31 kg, 95% CI -1.53 to 2.16 kg (n = 14). There was a significant difference in Mental Developmental Index (Bayley II) favouring the silicone earplugs group at 18 to 22 months corrected age: MD 14.00, 95% CI 3.13 to 24.87 (n = 12), but not for Psychomotor Development Index (Bayley II) at 18 to 22 months corrected age: MD -2.16, 95% CI -18.44 to 14.12 (n =12).
AUTHORS' CONCLUSIONS
To date, only 34 infants have been enrolled in a randomised controlled trial (RCT) testing the effectiveness of reducing sound levels that reach the infants' ears in the NICU. Based on the small sample size of this single trial, we cannot make any recommendations for clinical practice. Larger, well designed, conducted and reported trials are needed.
Topics: Ear Protective Devices; Employee Performance Appraisal; Health Personnel; Humans; Infant, Newborn; Infant, Premature; Infant, Very Low Birth Weight; Intensive Care Units, Neonatal; Noise; Randomized Controlled Trials as Topic; Sound; Stress, Physiological
PubMed: 31986231
DOI: 10.1002/14651858.CD010333.pub3