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Clinical Rehabilitation Jan 2022This systematic review and meta-analysis investigates the effects of strength training program in children and adolescents with cerebral palsy to improve function,... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
This systematic review and meta-analysis investigates the effects of strength training program in children and adolescents with cerebral palsy to improve function, activity, and participation.
DATA SOURCES
Five electronic databases (MEDLINE-Pubmed, Cochrane Library, PEDro, CINAHL, and SPORTDiscus) were systematically searched for full-text articles published from inception to 30 June 2021.
REVIEW METHODS
Randomized controlled trials were included, who compared: (i) child population with spastic cerebral palsy population between 0 and 22 years; (ii) studies in which a muscle strength training program was performed and included dosing information; (iii) studies comparing strength training with other physical therapy technique(s) or untreated control group. Studies with similar outcomes were pooled by calculating standardized mean differences. Risk of bias was assessed with Cochrane Collaboration's tool for assessing the risk of bias and PROSPERO's registration number ID: CRD42020193535.
RESULTS
Twenty-seven studies, comprising 847 participants with spastic cerebral palsy. The meta-analyses demonstrated significant standardized mean differences in favor of strength training program compared to other physical therapy technique(s) or untreated control group(s) for muscle strength at the knee flexors, at the knee extensor, at the plantarflexors, maximum resistance, balance, gait speed, GMFM (global, D and E dimension) and spasticity.
CONCLUSION
A strength training program has positive functional and activity effects on muscle strength, balance, gait speed, or gross motor function without increasing spasticity for children and adolescents with cerebral palsy in Gross Motor Function Classification System levels I, II, and III when adequate dosage and specific principles are utilized.
Topics: Adolescent; Cerebral Palsy; Child; Humans; Muscle Strength; Muscles; Resistance Training; Walking Speed
PubMed: 34407619
DOI: 10.1177/02692155211040199 -
BMJ (Clinical Research Ed.) Apr 2020To determine the relative effectiveness of dietary macronutrient patterns and popular named diet programmes for weight loss and cardiovascular risk factor improvement... (Meta-Analysis)
Meta-Analysis
Comparison of dietary macronutrient patterns of 14 popular named dietary programmes for weight and cardiovascular risk factor reduction in adults: systematic review and network meta-analysis of randomised trials.
OBJECTIVE
To determine the relative effectiveness of dietary macronutrient patterns and popular named diet programmes for weight loss and cardiovascular risk factor improvement among adults who are overweight or obese.
DESIGN
Systematic review and network meta-analysis of randomised trials.
DATA SOURCES
Medline, Embase, CINAHL, AMED, and CENTRAL from database inception until September 2018, reference lists of eligible trials, and related reviews.
STUDY SELECTION
Randomised trials that enrolled adults (≥18 years) who were overweight (body mass index 25-29) or obese (≥30) to a popular named diet or an alternative diet.
OUTCOMES AND MEASURES
Change in body weight, low density lipoprotein (LDL) cholesterol, high density lipoprotein (HDL) cholesterol, systolic blood pressure, diastolic blood pressure, and C reactive protein at the six and 12 month follow-up.
REVIEW METHODS
Two reviewers independently extracted data on study participants, interventions, and outcomes and assessed risk of bias, and the certainty of evidence using the GRADE (grading of recommendations, assessment, development, and evaluation) approach. A bayesian framework informed a series of random effects network meta-analyses to estimate the relative effectiveness of the diets.
RESULTS
121 eligible trials with 21 942 patients were included and reported on 14 named diets and three control diets. Compared with usual diet, low carbohydrate and low fat diets had a similar effect at six months on weight loss (4.63 4.37 kg, both moderate certainty) and reduction in systolic blood pressure (5.14 mm Hg, moderate certainty 5.05 mm Hg, low certainty) and diastolic blood pressure (3.21 2.85 mm Hg, both low certainty). Moderate macronutrient diets resulted in slightly less weight loss and blood pressure reductions. Low carbohydrate diets had less effect than low fat diets and moderate macronutrient diets on reduction in LDL cholesterol (1.01 mg/dL, low certainty 7.08 mg/dL, moderate certainty 5.22 mg/dL, moderate certainty, respectively) but an increase in HDL cholesterol (2.31 mg/dL, low certainty), whereas low fat (-1.88 mg/dL, moderate certainty) and moderate macronutrient (-0.89 mg/dL, moderate certainty) did not. Among popular named diets, those with the largest effect on weight reduction and blood pressure in comparison with usual diet were Atkins (weight 5.5 kg, systolic blood pressure 5.1 mm Hg, diastolic blood pressure 3.3 mm Hg), DASH (3.6 kg, 4.7 mm Hg, 2.9 mm Hg, respectively), and Zone (4.1 kg, 3.5 mm Hg, 2.3 mm Hg, respectively) at six months (all moderate certainty). No diets significantly improved levels of HDL cholesterol or C reactive protein at six months. Overall, weight loss diminished at 12 months among all macronutrient patterns and popular named diets, while the benefits for cardiovascular risk factors of all interventions, except the Mediterranean diet, essentially disappeared.
CONCLUSIONS
Moderate certainty evidence shows that most macronutrient diets, over six months, result in modest weight loss and substantial improvements in cardiovascular risk factors, particularly blood pressure. At 12 months the effects on weight reduction and improvements in cardiovascular risk factors largely disappear.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO CRD42015027929.
Topics: Blood Pressure; Body Mass Index; Body Weight; Cardiovascular Diseases; Cholesterol, HDL; Cholesterol, LDL; Diet, Carbohydrate-Restricted; Diet, Fat-Restricted; Diet, Mediterranean; Humans; Network Meta-Analysis; Nutrients; Obesity; Randomized Controlled Trials as Topic; Risk Reduction Behavior; Weight Loss
PubMed: 32238384
DOI: 10.1136/bmj.m696 -
International Journal of Environmental... Aug 2022A ketogenic diet, characterized by low calories with high levels of fat, adequate levels of protein, and low levels of carbohydrates, has beneficial effects on body... (Meta-Analysis)
Meta-Analysis Review
Ketogenic Diet Benefits to Weight Loss, Glycemic Control, and Lipid Profiles in Overweight Patients with Type 2 Diabetes Mellitus: A Meta-Analysis of Randomized Controlled Trails.
A ketogenic diet, characterized by low calories with high levels of fat, adequate levels of protein, and low levels of carbohydrates, has beneficial effects on body weight control in overweight patients. In the present study, a meta-analysis was conducted to investigate the role of a ketogenic diet in body weight control and glycemic management in overweight patients with type 2 diabetes mellitus (T2DM). In summary, we systematically reviewed articles from the Embase, PubMed, Web of Science and Cochrane Library databases and obtained eight randomized controlled trials for meta-analysis. The results show that a ketogenic diet had significantly beneficial effects on the loss of body weight (SMD, -5.63, = 0.008), the reduction of waist circumference (SMD, -2.32, = 0.04), lowering glycated hemoglobin (SMD, -0.38, = 0.0008) and triglycerides (SMD, -0.36, = 0.0001), and increasing high-density lipoproteins (SMD, 0.28, = 0.003). Overall, these results suggest that a ketogenic diet may be an effective dietary intervention for body weight and glycemic control, as well as improved lipid profiles in overweight patients with T2DM. Hence, a ketogenic diet can be recommended for the therapeutic intervention of overweight patients with T2DM.
Topics: Blood Glucose; Body Weight; Diabetes Mellitus, Type 2; Diet, Ketogenic; Glycemic Control; Humans; Overweight; Triglycerides; Weight Loss
PubMed: 36012064
DOI: 10.3390/ijerph191610429 -
Nutrients Apr 2022We conducted a systematic review and meta-analysis of randomized clinical trials and pilot trial studies to compare the effectiveness of intermittent fasting (IF) and... (Meta-Analysis)
Meta-Analysis
We conducted a systematic review and meta-analysis of randomized clinical trials and pilot trial studies to compare the effectiveness of intermittent fasting (IF) and continuous calorie restriction (CCR) in overweight and obese people. The parameters included body mass index (BMI), body weight, and other metabolism-related indicators. A systematic search in PubMed, Embase, Cochrane Library, and Web of Science was conducted up to January 2022. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were used to measure the effectiveness. Publication bias was assessed using Egger's test. The stability of the results was evaluated using sensitivity analyses. The significance of body weight change (SMD = -0.21, 95% CI (-0.40, -0.02) = 0.028) was more significant after IF than CCR. There was no significant difference in BMI (SMD = 0.02, 95% CI (-0.16, 0.20) = 0.848) between IF and CCR. These findings suggest that IF may be superior to CCR for weight loss in some respects.
Topics: Body Weight; Caloric Restriction; Fasting; Humans; Overweight; Weight Loss
PubMed: 35565749
DOI: 10.3390/nu14091781 -
Ageing Research Reviews Dec 2022The potential role of Tai Chi in improving sarcopenia and frailty has been shown in randomized controlled trials (RCTs). This systematic review and meta-analysis aimed... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The potential role of Tai Chi in improving sarcopenia and frailty has been shown in randomized controlled trials (RCTs). This systematic review and meta-analysis aimed to examine the effect of Tai Chi on muscle mass, muscle strength, physical function, and other geriatric syndromes in elderly individuals with sarcopenia and frailty.
METHODS
Systematic searches of the PubMed, Cochrane Library, PEDro, EMBASE, Web of Science, CINAHL, and Medline databases for RCTs published between 1989 and 2022 were conducted; the database searchers were supplemented with manual reference searches. The inclusion criteria were as follows: (1) the study was designed as a RCT; (2) Tai Chi was one of the intervention arms; (3) the participants had a minimum age of ≥ 60 years and were diagnosed with frailty or sarcopenia, and the diagnostic guidelines or criteria were mentioned; (4) the number of participants in each arm was ≥ 10; and (5) the outcome reports included ≥ 1 item from the following primary or secondary outcomes. The exclusion criteria were as follows: (1) non-RCT studies; (2) nonhuman subjects; (3) participants aged < 60 years; (4) no description of the diagnostic guidelines or criteria for frailty or sarcopenia in the text; and (5) reported outcomes not among the following primary or secondary outcomes. The primary outcomes were muscle mass, grip strength and muscle performance (gait speed, 30-second chair stand test (30CST), sit-to-stand test (SST), Timed up and go test (TUGT), balance, and the Short Physical Performance Battery (SPPB)). The secondary outcomes included the number of falls and fear of falling (FOF), diastolic blood pressure (DBP), Mini-Mental State Examination (MMSE) score, and depression and quality of life (QOL) assessments.
RESULTS
Eleven RCTs were conducted from 1996 to 2022 in 5 countries that investigated 1676 sarcopenic or frail elderly individuals were included in the review. There were 804 participants in the Tai Chi exercise cohort and 872 participants in the control cohort (nonexercised (n = 5)/ exercise (n = 8)). The mean age of participants was 70-89.5 years and the numbers of participants from each arm in each study were 10-158. The majority of the participants practiced Yang-style Tai Chi (n = 9), and the numbers of movement ranged from 6 to 24. The prescriptions of training were 8-48 weeks, 2-7 sessions per weeks, and 30-90 min per session. Most studies used Tai Chi expert as instructor (n = 8). The lengths of follow-up period were 8-48 weeks. The results from our meta-analysis revealed significant improvements for Tai Chi compared to control group (nonexercise/ exercise) on measures of the 30CST (weighted mean difference (WMD): 2.36, 95% confidence interval (CI) 1.50-3.21, p < 0.00001, I = 87%), the TUGT (WMD: -0.72, 95% CI -1.10 to -0.34, p = 0.0002, I =0%), numbers of fall (WMD: -0.41, 95% CI -0.64 to -0.17, p = 0.0006, I =0%) and FOF (standardized MD (SMD): -0.50, 95% CI -0.79 to -0.22, p = 0.0006, I = 57%); and for Tai Chi compared to 'nonexercise' controls on measures of SST (WMD: -2.20, 95% CI -2.22 to -2.18, p < 0.00001), balance (SMD: 9.85, 95% CI 8.88-10.82, p < 0.00001), DBP (WMD: -7.00, 95% CI -7.35 to -6.65, p < 0.00001), MMSE (WMD: 1.91, 95% CI 1.73-2.09, p < 0.00001, I =0%), depression (SMD: -1.37, 95% CI -1.91 to -0.83, p < 0.00001) and QOL (SMD: 10.72, 95% CI 9.38-12.07, p < 0.00001). There were no significant differences between Tai Chi and control groups on any of the remaining 4 comparisons: body muscle mass (WMD: 0.53, 95% CI -0.18 to 1.24; P = 0.14; I =0%), grip strength (WMD: -0.06, 95% CI -1.98 to 1.86; P = 0.95; I =0%), gait speed (WMD: 0.05, 95% CI -0.11 to 0.20; P = 0.55; I =99%), and SPPB (WMD: 0.55, 95% CI -0.04 to 1.14; P = 0.07). The variables of bias summary, Tai Chi instructor, Tai Chi movements, and Tai Chi training duration without significant association with the 30CST or the TUGT through meta-regression analyses.
CONCLUSIONS
Our results demonstrated that patients with frailty or sarcopenia who practiced Tai Chi exhibited improved physical performance in the 30-second chair stand test, the Timed up and go test, number of falls and fear of falling. However, there was no difference in muscle mass, grip strength, gait speed, or Short Physical Performance Battery score between the Tai Chi and control groups. Improvements in the sit-to-stand test, balance, diastolic blood pressure, Mini-Mental State Examination score, and depression and quality of life assessments were found when comparing the Tai Chi cohort to the nonexercise control cohort rather than the exercise control cohort. To explore the effectiveness of Tai Chi in sarcopenic and frail elderly individuals more comprehensively, a standardized Tai Chi training prescription and a detailed description of the study design are suggested for future studies.
Topics: Aged; Humans; Aged, 80 and over; Tai Ji; Sarcopenia; Frailty; Randomized Controlled Trials as Topic; Muscle Strength
PubMed: 36223875
DOI: 10.1016/j.arr.2022.101747 -
Advances in Nutrition (Bethesda, Md.) May 2023The retirement phase is an opportunity to integrate healthy (nutrition/exercise) habits into daily life. We conducted this systematic review to assess which nutrition... (Meta-Analysis)
Meta-Analysis Review
Nutrition and Exercise Interventions to Improve Body Composition for Persons with Overweight or Obesity Near Retirement Age: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials.
The retirement phase is an opportunity to integrate healthy (nutrition/exercise) habits into daily life. We conducted this systematic review to assess which nutrition and exercise interventions most effectively improve body composition (fat/muscle mass), body mass index (BMI), and waist circumference (WC) in persons with obesity/overweight near retirement age (ages 55-70 y). We conducted a systematic review and network meta-analysis (NMA) of randomized controlled trials, searching 4 databases from their inception up to July 12, 2022. The NMA was based on a random effects model, pooled mean differences, standardized mean differences, their 95% confidence intervals, and correlations with multi-arm studies. Subgroup and sensitivity analyses were also conducted. Ninety-two studies were included, 66 of which with 4957 participants could be used for the NMA. Identified interventions were clustered into 12 groups: no intervention, energy restriction (i.e., 500-1000 kcal), energy restriction plus high-protein intake (1.1-1.7 g/kg/body weight), intermittent fasting, mixed exercise (aerobic and resistance), resistance training, aerobic training, high protein plus resistance training, energy restriction plus high protein plus exercise, energy restriction plus resistance training, energy restriction plus aerobic training, and energy restriction plus mixed exercise. Intervention durations ranged from 8 wk to 6 mo. Body fat was reduced with energy restriction plus any exercise or plus high-protein intake. Energy restriction alone was less effective and tended to decrease muscle mass. Muscle mass was only significantly increased with mixed exercise. All other interventions including exercise effectively preserved muscle mass. A BMI and/or WC decrease was achieved with all interventions except aerobic training/resistance training alone or resistance training plus high protein. Overall, the most effective strategy for nearly all outcomes was combining energy restriction with resistance training or mixed exercise and high protein. Health care professionals involved in the management of persons with obesity need to be aware that an energy-restricted diet alone may contribute to sarcopenic obesity in persons near retirement age. This network meta-analysis is registered at https://www.crd.york.ac.uk/prospero/ as CRD42021276465.
Topics: Humans; Overweight; Network Meta-Analysis; Retirement; Randomized Controlled Trials as Topic; Obesity; Body Mass Index; Body Composition; Resistance Training
PubMed: 37028708
DOI: 10.1016/j.advnut.2023.04.001 -
International Journal of Environmental... Nov 2022Resistance training is considered to be an efficient treatment for age-related sarcopenia and can improve muscle strength and quality in patients. However, there are... (Meta-Analysis)
Meta-Analysis Review
Resistance training is considered to be an efficient treatment for age-related sarcopenia and can improve muscle strength and quality in patients. However, there are currently no recommendations on resistance training parameters to improve muscle strength and quality in elderly patients with sarcopenia. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) and included 13 eligible RCTs. Resistance training significantly improved grip strength, gait speed, and skeletal muscle index in patients with age-related sarcopenia, and kettlebell was found to be the most effective modality. However, it is noteworthy that the elastic band is also a recommended form of resistance training considering that the kettlebell intervention was tested in only one study, while the elastic band was confirmed by multiple studies. Elastic band training (Hedges's g = 0.629, 95%CI = 0.090-1.168, < 0.05) (40-60 min per session, more than three times per week for at least 12 weeks) was the most efficient training method. Thus, resistance training can significantly improve muscle strength and muscle quality in elderly patients with sarcopenia. In addition, moderate-intensity resistance training using elastic bands may be the best training prescription for elderly patients with sarcopenia.
Topics: Humans; Aged; Resistance Training; Sarcopenia; Muscle Strength; Muscle, Skeletal; Hand Strength
PubMed: 36497565
DOI: 10.3390/ijerph192315491 -
Journal of Medical Internet Research Jan 2022Numerous wrist-wearable devices to measure physical activity are currently available, but there is a need to unify the evidence on how they compare in terms of... (Review)
Review
BACKGROUND
Numerous wrist-wearable devices to measure physical activity are currently available, but there is a need to unify the evidence on how they compare in terms of acceptability and accuracy.
OBJECTIVE
The aim of this study is to perform a systematic review of the literature to assess the accuracy and acceptability (willingness to use the device for the task it is designed to support) of wrist-wearable activity trackers.
METHODS
We searched MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, and SPORTDiscus for studies measuring physical activity in the general population using wrist-wearable activity trackers. We screened articles for inclusion and, for the included studies, reported data on the studies' setting and population, outcome measured, and risk of bias.
RESULTS
A total of 65 articles were included in our review. Accuracy was assessed for 14 different outcomes, which can be classified in the following categories: count of specific activities (including step counts), time spent being active, intensity of physical activity (including energy expenditure), heart rate, distance, and speed. Substantial clinical heterogeneity did not allow us to perform a meta-analysis of the results. The outcomes assessed most frequently were step counts, heart rate, and energy expenditure. For step counts, the Fitbit Charge (or the Fitbit Charge HR) had a mean absolute percentage error (MAPE) <25% across 20 studies. For heart rate, the Apple Watch had a MAPE <10% in 2 studies. For energy expenditure, the MAPE was >30% for all the brands, showing poor accuracy across devices. Acceptability was most frequently measured through data availability and wearing time. Data availability was ≥75% for the Fitbit Charge HR, Fitbit Flex 2, and Garmin Vivofit. The wearing time was 89% for both the GENEActiv and Nike FuelBand.
CONCLUSIONS
The Fitbit Charge and Fitbit Charge HR were consistently shown to have a good accuracy for step counts and the Apple Watch for measuring heart rate. None of the tested devices proved to be accurate in measuring energy expenditure. Efforts should be made to reduce the heterogeneity among studies.
Topics: Exercise; Fitness Trackers; Heart Rate; Humans; Wearable Electronic Devices; Wrist
PubMed: 35060915
DOI: 10.2196/30791 -
Ageing Research Reviews May 2021Engaging in physical activity (PA) and avoiding sedentary behavior (SB) are important for healthy ageing with benefits including the mitigation of disability and... (Meta-Analysis)
Meta-Analysis Review
The association of objectively measured physical activity and sedentary behavior with skeletal muscle strength and muscle power in older adults: A systematic review and meta-analysis.
BACKGROUND
Engaging in physical activity (PA) and avoiding sedentary behavior (SB) are important for healthy ageing with benefits including the mitigation of disability and mortality. Whether benefits extend to key determinants of disability and mortality, namely muscle strength and muscle power, is unclear.
AIMS
This systematic review aimed to describe the association of objective measures of PA and SB with measures of skeletal muscle strength and muscle power in community-dwelling older adults.
METHODS
Six databases were searched from their inception to June 21, 2020 for articles reporting associations between objectively measured PA and SB and upper body or lower body muscle strength or muscle power in community dwelling adults aged 60 years and older. An overview of associations was visualized by effect direction heat maps, standardized effect sizes were estimated with albatross plots and summarized in box plots. Articles reporting adjusted standardized regression coefficients (β) were included in meta-analyses.
RESULTS
A total of 112 articles were included representing 43,796 individuals (range: 21 to 3726 per article) with a mean or median age from 61.0 to 88.0 years (mean 56.4 % female). Higher PA measures and lower SB were associated with better upper body muscle strength (hand grip strength), upper body muscle power (arm curl), lower body muscle strength, and lower body muscle power (chair stand test). Median standardized effect sizes were consistently larger for measures of PA and SB with lower compared to upper body muscle strength and muscle power. The meta-analyses of adjusted β coefficients confirmed the associations between total PA (TPA), moderate-to-vigorous PA (MVPA) and light PA (LPA) with hand grip strength (β = 0.041, β = 0.057, and β = 0.070, respectively, all p ≤ 0.001), and TPA and MVPA with chair stand test (β = 0.199 and β = 0.211, respectively, all p ≤ 0.001).
CONCLUSIONS
Higher PA and lower SB are associated with greater skeletal muscle strength and muscle power, particularly with the chair stand test.
Topics: Aged; Aged, 80 and over; Exercise; Female; Hand Strength; Humans; Male; Middle Aged; Muscle Strength; Muscle, Skeletal; Sedentary Behavior
PubMed: 33607291
DOI: 10.1016/j.arr.2021.101266 -
Nutrients Jan 2023(1) Background: In this study, a meta-analysis was performed to investigate the effects of whey protein, leucine, and vitamin D in sarcopenia; (2) Methods: We searched... (Meta-Analysis)
Meta-Analysis Review
(1) Background: In this study, a meta-analysis was performed to investigate the effects of whey protein, leucine, and vitamin D in sarcopenia; (2) Methods: We searched PubMed, Cochrane Library, Embase, and Scopus databases and retrieved studies published until 5 December 2022. Randomized controlled trials were included to evaluate muscle mass, strength, and function, after using whey protein, leucine, and vitamin D supplementation in patients with sarcopenia; (3) Results: A total of three studies including 637 patients reported the effectiveness of using whey protein, leucine, and vitamin D supplementation in patients with sarcopenia. Without considering whether or not a physical exercise program was combined with nutritional supplementation, no significant differences in grip strength or short physical performance battery (SPPB) scores between the experimental and control groups were noted. However, appendicular muscle mass significantly improved in the experimental group compared to the control group. The results were analyzed according to the presence or absence of a concomitant physical exercise program. With the use of a concomitant physical exercise program, handgrip strength and SPPB scores in the experimental group significantly improved when compared to the control group. In contrast, when physical exercise was not combined, there was no significant improvement in the handgrip strength and SPPB scores of patients with sarcopenia. In addition, the appendicular muscle mass significantly increased regardless of the presence of a concomitant physical exercise program; (4) Conclusions: Whey protein, leucine, and vitamin D supplementation can increase appendicular muscle mass in patients with sarcopenia. In addition, combining a physical exercise program with whey protein, leucine, and vitamin D supplementation can improve muscle strength and function.
Topics: Humans; Sarcopenia; Leucine; Whey Proteins; Hand Strength; Muscle, Skeletal; Muscle Strength; Vitamin D; Dietary Supplements
PubMed: 36771225
DOI: 10.3390/nu15030521