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Archives of Osteoporosis Jul 2022Osteoporosis or decreased bone mineral density (BMD) is the most important risk factor for fractures, especially in older postmenopausal women (PMW). However, the... (Meta-Analysis)
Meta-Analysis Review
UNLABELLED
Osteoporosis or decreased bone mineral density (BMD) is the most important risk factor for fractures, especially in older postmenopausal women (PMW). However, the interactions between exercise training and bone mineral density are not completely understood. We evaluated the effects of physical exercise on BMD in women aged ≥ 60 years postmenopausal.
PURPOSE
This systematic review and meta-analysis sets out to determine the effects of physical exercise on BMD in older postmenopausal women.
METHODS
A systematic search was conducted in Medline, Science Direct, Cochrane, PubMed, CINAHL, Google Scholar, Scopus, and ProQuest up to December 25, 2021. Fifty-three studies, which assessed a total of 2896 participants (mean age: between 60 and 82 years), were included and analyzed using a random-effects model to estimate weighted mean differences (WMD) with 95% confidence intervals (CI).
RESULTS
The meta-analysis found that exercise training significantly (p < 0.05) increased femoral neck (WMD: 0.01 g/cm; 95% CI, 0.00 to 0.01], p = 0.0005; I = 57%; p < 0.0001), lumbar spine (WMD: 0.01 g/cm, 95% CI, 0.01 to 0.02], I = 81%; p = 0.0001), and trochanter (WMD: 0.01 g/cm, 95% CI 0.00, 0.02]; p = 0.009; I = 17%; p = 0.23). There were no significant differences between the intervention and control groups for total body and total hip BMD.
CONCLUSION
Our findings suggest that exercise training may improve bone mineral density in older PMW. This improvement is mediated by increases in the femoral neck, lumbar spine, and trochanter BMD. Further long-term studies are required to confirm these findings.
Topics: Aged; Aged, 80 and over; Bone Density; Exercise; Female; Humans; Lumbar Vertebrae; Middle Aged; Osteoporosis, Postmenopausal; Postmenopause; Randomized Controlled Trials as Topic
PubMed: 35896850
DOI: 10.1007/s11657-022-01140-7 -
The Journal of Orthopaedic and Sports... Feb 2022To investigate the effectiveness of walking/running, cycling, or swimming for treating or preventing nonspecific low back pain (LBP). (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To investigate the effectiveness of walking/running, cycling, or swimming for treating or preventing nonspecific low back pain (LBP).
DESIGN
Intervention systematic review.
LITERATURE SEARCH
Five databases were searched to April 2021.
STUDY SELECTION CRITERIA
Randomized controlled trials evaluating walking/running, cycling, or swimming to treat or prevent LBP were included.
DATA SYNTHESIS
We calculated standardized mean differences (SMDs) and 95% confidence intervals (CIs). Certainty of evidence was evaluated with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.
RESULTS
No trials assessed LBP prevention or addressed acute LBP. Nineteen trials (2362 participants) assessed treatment of chronic/recurrent LBP. Low-certainty evidence suggests that walking/running was less effective than alternate interventions in reducing pain in the short term (8 trials; SMD, 0.81; 95% CI: 0.28, 1.34) and medium term (5 trials; SMD, 0.80; 95% CI: 0.10, 1.49). High-certainty evidence suggests that walking/running was less effective than alternate interventions at reducing disability in the short term (8 trials; SMD, 0.22; 95% CI: 0.06, 0.38) and medium term (4 trials; SMD, 0.28; 95% CI: 0.05, 0.51). There was high-certainty evidence of a small effect in favor of walking/running compared to minimal/no intervention for reducing pain in the short term (10 trials; SMD, -0.23; 95% CI: -0.35, -0.10) and medium term (6 trials; SMD, -0.26; 95% CI: -0.40, -0.13) and disability in the short term (7 trials; SMD, -0.19; 95% CI: -0.33, -0.06). Scarcity of trials meant few conclusions could be drawn regarding cycling and swimming.
CONCLUSION
Although less effective than alternate interventions, walking/running was slightly more effective than minimal/no intervention for treating chronic/recurrent LBP. .
Topics: Back Pain; Chronic Pain; Humans; Low Back Pain; Swimming; Walking
PubMed: 34783263
DOI: 10.2519/jospt.2022.10612 -
Archives of Women's Mental Health Feb 2019Postpartum depression can have detrimental effects on both a mother's physical and mental health and on her child's growth and emotional development. The aim of this... (Meta-Analysis)
Meta-Analysis
Postpartum depression can have detrimental effects on both a mother's physical and mental health and on her child's growth and emotional development. The aim of this study is to assess the effectiveness of exercise/physical activity-based interventions in preventing and treating postpartum depressive symptoms in primiparous and multiparous women to the end of the postnatal period at 52 weeks postpartum. Electronic databases were searched for published and unpublished randomised controlled trials of exercise/physical activity-based interventions in preventing and treating depressive symptoms and increasing health-related quality of life in women from 4 to 52 weeks postpartum. The results of the studies were meta-analysed and effect sizes with confidence intervals were calculated. The Grading of Recommendations Assessment and Development and Evaluation (GRADE) system was used to determine the confidence in the effect estimates. Eighteen trials conducted across a range of countries met the inclusion criteria. Most of the exercise interventions were aerobic and coaching compared to usual care, non-intervention and active controls. Small effect sizes of exercise-based interventions in reducing depressive symptoms were observed collectively and the quality of evidence was low across the individual studies. Although exercise-based interventions could create an alternative therapeutic approach for preventing major depression in postpartum women who experience subthreshold elevated depressive symptoms, the clinical effectiveness and the cost-effectiveness of exercise-based and physical activity interventions need to be better established. There is a need for further more rigorous testing of such interventions in high-quality randomised controlled trials against active control conditions before large-scale roll-out of these interventions in clinical practice is proposed.
Topics: Depression; Depression, Postpartum; Exercise; Exercise Therapy; Female; Humans; Postpartum Period; Quality of Life; Treatment Outcome
PubMed: 29882074
DOI: 10.1007/s00737-018-0869-3 -
New South Wales Public Health Bulletin Jun 2011This systematic review update includes 54 randomised controlled trials and confirms that exercise as a single intervention can prevent falls (pooled rate ratio 0.84, 95%... (Meta-Analysis)
Meta-Analysis Review
This systematic review update includes 54 randomised controlled trials and confirms that exercise as a single intervention can prevent falls (pooled rate ratio 0.84, 95% CI 0.77-0.91). Meta-regression revealed programs that included balance training, contained a higher dose of exercise and did not include walking training to have the greatest effect on reducing falls. We therefore recommend that exercise for falls prevention should provide a moderate or high challenge to balance and be undertaken for at least 2 hours per week on an ongoing basis. Additionally, we recommend that: falls prevention exercise should target both the general community and those at high risk for falls; exercise may be undertaken in a group or home-based setting; strength and walking training may be included in addition to balance training but high risk individuals should not be prescribed brisk walking programs; and other health-related risk factors should also be addressed.
Topics: Accidental Falls; Aged; Exercise; Humans; Randomized Controlled Trials as Topic; Resistance Training; Risk Factors; Walking
PubMed: 21632004
DOI: 10.1071/NB10056 -
The Cochrane Database of Systematic... Nov 2014Fear of falling is common in older people and associated with serious physical and psychosocial consequences. Exercise (planned, structured, repetitive and purposive... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Fear of falling is common in older people and associated with serious physical and psychosocial consequences. Exercise (planned, structured, repetitive and purposive physical activity aimed at improving physical fitness) may reduce fear of falling by improving strength, gait, balance and mood, and reducing the occurrence of falls.
OBJECTIVES
To assess the effects (benefits, harms and costs) of exercise interventions for reducing fear of falling in older people living in the community.
SEARCH METHODS
We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (July 2013), the Central Register of Controlled Trials (CENTRAL 2013, Issue 7), MEDLINE (1946 to July Week 3 2013), EMBASE (1980 to 2013 Week 30), CINAHL (1982 to July 2013), PsycINFO (1967 to August 2013), AMED (1985 to August 2013), the World Health Organization International Clinical Trials Registry Platform (accessed 7 August 2013) and Current Controlled Trials (accessed 7 August 2013). We applied no language restrictions. We handsearched reference lists and consulted experts.
SELECTION CRITERIA
We included randomised and quasi-randomised trials that recruited community-dwelling people (where the majority were aged 65 and over) and were not restricted to specific medical conditions (e.g. stroke, hip fracture). We included trials that evaluated exercise interventions compared with no intervention or a non-exercise intervention (e.g. social visits), and that measured fear of falling. Exercise interventions were varied; for example, they could be 'prescriptions' or recommendations, group-based or individual, supervised or unsupervised.
DATA COLLECTION AND ANALYSIS
Pairs of review authors independently assessed studies for inclusion, assessed the risk of bias in the studies and extracted data. We combined effect sizes across studies using the fixed-effect model, with the random-effect model used where significant statistical heterogeneity was present. We estimated risk ratios (RR) for dichotomous outcomes and incidence rate ratios (IRR) for rate outcomes. We estimated mean differences (MD) where studies used the same continuous measures and standardised mean differences (SMD) where different measures or different formats of the same measure were used. Where possible, we performed various, usually prespecified, sensitivity and subgroup analyses.
MAIN RESULTS
We included 30 studies, which evaluated 3D exercise (Tai Chi and yoga), balance training or strength and resistance training. Two of these were cluster-randomised trials, two were cross-over trials and one was quasi-randomised. The studies included a total of 2878 participants with a mean age ranging from 68 to 85 years. Most studies included more women than men, with four studies recruiting women only. Twelve studies recruited participants at increased risk of falls; three of these recruited participants who also had fear of falling.Poor reporting of the allocation methods in the trials made it difficult to assess the risk of selection bias in most studies. All of the studies were at high risk of performance and detection biases as there was no blinding of participants and outcome assessors and the outcomes were self reported. Twelve studies were at high risk of attrition bias. Using GRADE criteria, we judged the quality of evidence to be 'low' for fear of falling immediately post intervention and 'very low' for fear of falling at short or long-term follow-up and all other outcomes.Exercise interventions were associated with a small to moderate reduction in fear of falling immediately post intervention (SMD 0.37 favouring exercise, 95% confidence interval (CI) 0.18 to 0.56; 24 studies; 1692 participants, low quality evidence). Pooled effect sizes did not differ significantly between the different scales used to measure fear of falling. Although none of the sensitivity analyses changed the direction of effect, the greatest reduction in the size of the effect was on removal of an extreme outlier study with 73 participants (SMD 0.24 favouring exercise, 95% CI 0.12 to 0.36). None of our subgroup analyses provided robust evidence of differences in effect in terms of either the study primary aim (reduction of fear of falling or other aim), the study population (recruitment on the basis of increased falls risk or not), the characteristics of the study exercise intervention or the study control intervention (no treatment or alternative intervention). However, there was some weak evidence of a smaller effect, which included no reduction, of exercise when compared with an alternative control.There was very low quality evidence that exercise interventions may be associated with a small reduction in fear of falling up to six months post intervention (SMD 0.17, 95% CI -0.05 to 0.38; four studies, 356 participants) and more than six months post intervention (SMD 0.20, 95% CI -0.01 to 0.41; three studies, 386 participants).Very low quality evidence suggests exercise interventions in these studies that also reported on fear of falling reduced the risk of falling measured either as participants incurring at least one fall during follow-up or the number of falls during follow-up. Very low quality evidence from four studies indicated that exercise interventions did not appear to reduce symptoms of depression or increase physical activity. The only study reporting the effects of exercise interventions on anxiety found no difference between groups. No studies reported the effects of exercise interventions on activity avoidance or costs. It is important to remember that our included studies do not represent the totality of the evidence of the effect of exercise interventions on falls, depression, anxiety or physical activity as our review only includes studies that reported fear of falling.
AUTHORS' CONCLUSIONS
Exercise interventions in community-dwelling older people probably reduce fear of falling to a limited extent immediately after the intervention, without increasing the risk or frequency of falls. There is insufficient evidence to determine whether exercise interventions reduce fear of falling beyond the end of the intervention or their effect on other outcomes. Although further evidence from well-designed randomised trials is required, priority should be given to establishing a core set of outcomes that includes fear of falling for all trials examining the effects of exercise interventions in older people living in the community.
Topics: Accidental Falls; Aged; Aged, 80 and over; Exercise; Fear; Female; Humans; Independent Living; Male; Postural Balance; Randomized Controlled Trials as Topic; Resistance Training; Tai Ji; Yoga
PubMed: 25432016
DOI: 10.1002/14651858.CD009848.pub2 -
BMC Musculoskeletal Disorders Apr 2022Non-specific low back pain in children and adolescents has increased in recent years. The purpose of this study was to upgrade the evidence of the most effective... (Meta-Analysis)
Meta-Analysis
Effectiveness of physiotherapy interventions for back care and the prevention of non-specific low back pain in children and adolescents: a systematic review and meta-analysis.
BACKGROUND
Non-specific low back pain in children and adolescents has increased in recent years. The purpose of this study was to upgrade the evidence of the most effective preventive physiotherapy interventions to improve back care in children and adolescents.
METHODS
The study settings were children or adolescents aged 18 years or younger. Data were obtained from the Cochrane Library, MEDLINE, PEDro, Web of Science, LILACS, IBECS, and PsycINFO databases and the specialized journals BMJ and Spine. The included studies were published between May 2012 and May 2020. Controlled trials on children and adolescents who received preventive physiotherapy for back care were considered. Data on all the variables gathered in each individual study were extracted by two authors separately. Two authors assessed risk of bias of included studies using the RoB2 and quality of the body of evidence using the GRADE methodology. Data were described according to PRISMA guidelines. To calculate the effect size, a standardized mean difference "d" was used and a random-effects model was applied for the following outcome variables: behaviour, knowledge, trunk flexion muscle endurance, trunk extension muscle endurance, hamstring flexibility and posture.
RESULTS
Twenty studies were finally included. The most common physiotherapy interventions were exercise, postural hygiene and physical activity. The mean age of the total sample was 11.79 years. When comparing the change from baseline to end of intervention in treatment and control groups, the following overall effect estimates were obtained: behaviour d = 1.19 (95% CI: 0.62 and 1.76), knowledge d = 1.84 (0.58 and 3.09), trunk flexion endurance d = 0.65 (-0.02 and 1.33), trunk extension endurance d = 0.71 (0.38 and 1.03), posture d = 0.65 (0.24 and 1.07) and hamstrings flexibility d = 0.46 (0.36 and 0.56). At follow-up, the measurement of the behaviour variable was between 1 and 12 months, with an effect size of d = 1.00 (0.37 and 1.63), whereas the knowledge variable obtained an effect size of d = 2.08 (-0.85 and 5.02) at 3 months of follow-up.
CONCLUSIONS
Recent studies provide strong support for the use of physiotherapy in the improvement of back care and prevention of non-specific low back pain in children and adolescents. Based on GRADE methodology, we found that the evidence was from very low to moderate quality and interventions involving physical exercise, postural hygiene and physical activity should be preferred.
Topics: Adolescent; Child; Exercise; Humans; Low Back Pain; Physical Therapy Modalities; Posture; Range of Motion, Articular
PubMed: 35366847
DOI: 10.1186/s12891-022-05270-4 -
The Journal of Sports Medicine and... May 2019Cutting-edge technologies and the rapid urbanization have led to several advantages for mankind and society. However such benefits have been accompanied with the...
INTRODUCTION
Cutting-edge technologies and the rapid urbanization have led to several advantages for mankind and society. However such benefits have been accompanied with the alarming diffusion of sedentary lifestyle disorders, metabolic diseases, major depression and socialization problems, affecting global economy dramatically. The pandemic expansion of chronic diseases is associated with physical inactivity. During the last decade, numerous cities and organizations worldwide have started to adopt strategies aimed at improving outdoor physical activity levels in city residents.
EVIDENCE ACQUISITION
A systematic review focusing on the effects of regular outdoor sports and physical activities across all ages was conducted through multiple databases, according to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) standards.
EVIDENCE SYNTHESIS
Performing outdoor sports and physical activities may bear social, psychological and physiological benefits. Preventive effects are similarly documented in youth and seniors towards several morbid conditions: vitamin D deficiency, multiple sclerosis, osteoporosis and myopia.
CONCLUSIONS
Giving the beneficial effects of outdoor sports and physical activities, promotion strategies should be strongly advocated and developed nationally and globally. Likewise, dedicated research areas should inspire guidelines for the promotion of various outdoor activities - a good practice for the social scenario and the healthcare system.
Topics: Chronic Disease; Exercise; Health Promotion; Humans; Sedentary Behavior; Sports
PubMed: 30650943
DOI: 10.23736/S0022-4707.18.08771-6 -
The Cochrane Database of Systematic... Jul 2011Many people stretch before or after engaging in athletic activity. Usually the purpose is to reduce risk of injury, reduce soreness after exercise, or enhance athletic... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Many people stretch before or after engaging in athletic activity. Usually the purpose is to reduce risk of injury, reduce soreness after exercise, or enhance athletic performance. This is an update of a Cochrane review first published in 2007.
OBJECTIVES
The aim of this review was to determine effects of stretching before or after exercise on the development of delayed-onset muscle soreness.
SEARCH STRATEGY
We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (to 10 August 2009), the Cochrane Central Register of Controlled Trials (2010, Issue 1), MEDLINE (1966 to 8th February 2010), EMBASE (1988 to 8th February 2010), CINAHL (1982 to 23rd February 2010), SPORTDiscus (1949 to 8th February 2010), PEDro (to 15th February 2010) and reference lists of articles.
SELECTION CRITERIA
Eligible studies were randomised or quasi-randomised studies of any pre-exercise or post-exercise stretching technique designed to prevent or treat delayed-onset muscle soreness (DOMS). For the studies to be included, the stretching had to be conducted soon before or soon after exercise and muscle soreness had to be assessed.
DATA COLLECTION AND ANALYSIS
Risk of bias was assessed using The Cochrane Collaboration's 'Risk of bias' tool and quality of evidence was assessed using GRADE. Estimates of effects of stretching were converted to a common 100-point scale. Outcomes were pooled in fixed-effect meta-analyses.
MAIN RESULTS
Twelve studies were included in the review. This update incorporated two new studies. One of the new trials was a large field-based trial that included 2377 participants, 1220 of whom were allocated stretching. All other 11 studies were small, with between 10 and 30 participants receiving the stretch condition. Ten studies were laboratory-based and other two were field-based. All studies were exposed to either a moderate or high risk of bias. The quality of evidence was low to moderate.There was a high degree of consistency of results across studies. The pooled estimate showed that pre-exercise stretching reduced soreness at one day after exercise by, on average, half a point on a 100-point scale (mean difference -0.52, 95% CI -11.30 to 10.26; 3 studies). Post-exercise stretching reduced soreness at one day after exercise by, on average, one point on a 100-point scale (mean difference -1.04, 95% CI -6.88 to 4.79; 4 studies). Similar effects were evident between half a day and three days after exercise. One large study showed that stretching before and after exercise reduced peak soreness over a one week period by, on average, four points on a 100-point scale (mean difference -3.80, 95% CI -5.17 to -2.43). This effect, though statistically significant, is very small.
AUTHORS' CONCLUSIONS
The evidence from randomised studies suggests that muscle stretching, whether conducted before, after, or before and after exercise, does not produce clinically important reductions in delayed-onset muscle soreness in healthy adults.
Topics: Exercise; Humans; Muscle Stretching Exercises; Muscular Diseases; Pain; Randomized Controlled Trials as Topic
PubMed: 21735398
DOI: 10.1002/14651858.CD004577.pub3 -
Journal of Physical Activity & Health Feb 2017Many young children are not meeting the Canadian physical activity guidelines. In an effort to change this, the term active play has been used to promote increased... (Review)
Review
BACKGROUND
Many young children are not meeting the Canadian physical activity guidelines. In an effort to change this, the term active play has been used to promote increased physical activity levels. Among young children, physical activity is typically achieved in the form of active play behavior. The current study aimed to review and synthesize the literature to identify key concepts used to define and describe active play among young children. A secondary objective was to explore the various methods adopted for measuring active play.
METHODS
A systematic review was conducted by searching seven online databases for English-language, original research or reports, and were eligible for inclusion if they defined or measured active play among young children (ie, 2 to 6 years).
RESULTS
Nine studies provided a definition or description of active play, six measured active play, and 13 included both outcomes. While variability in active play definitions did exist, common themes included: increased energy exerted, rough and tumble, gross motor movement, unstructured, freely chosen, and fun. Alternatively, many researchers described active play as physical activity (n = 13) and the majority of studies used a questionnaire (n = 16) to assess active play among young children.
CONCLUSION
Much variability in the types of active play, methods of assessing active play, and locations where active play can transpire were noted in this review. As such, an accepted and consistent definition is necessary, which we provide herein.
Topics: Child; Exercise; Humans; Pediatric Obesity; Play and Playthings; Surveys and Questionnaires
PubMed: 27775475
DOI: 10.1123/jpah.2016-0195 -
Annals of Internal Medicine Jan 2018The prevalence of cognitive impairment and dementia is expected to increase dramatically as the population ages, creating burdens on families and health care systems.
BACKGROUND
The prevalence of cognitive impairment and dementia is expected to increase dramatically as the population ages, creating burdens on families and health care systems.
PURPOSE
To assess the effectiveness of physical activity interventions in slowing cognitive decline and delaying the onset of cognitive impairment and dementia in adults without diagnosed cognitive impairments.
DATA SOURCES
Several electronic databases from January 2009 to July 2017 and bibliographies of systematic reviews.
STUDY SELECTION
Trials published in English that lasted 6 months or longer, enrolled adults without clinically diagnosed cognitive impairments, and compared cognitive and dementia outcomes between physical activity interventions and inactive controls.
DATA EXTRACTION
Extraction by 1 reviewer and confirmed by a second; dual-reviewer assessment of risk of bias; consensus determination of strength of evidence.
DATA SYNTHESIS
Of 32 eligible trials, 16 with low to moderate risk of bias compared a physical activity intervention with an inactive control. Most trials had 6-month follow-up; a few had 1- or 2-year follow-up. Evidence was insufficient to draw conclusions about the effectiveness of aerobic training, resistance training, or tai chi for improving cognition. Low-strength evidence showed that multicomponent physical activity interventions had no effect on cognitive function. Low-strength evidence showed that a multidomain intervention comprising physical activity, diet, and cognitive training improved several cognitive outcomes. Evidence regarding effects on dementia prevention was insufficient for all physical activity interventions.
LIMITATION
Heterogeneous interventions and cognitive test measures, small and underpowered studies, and inability to assess the clinical significance of cognitive test outcomes.
CONCLUSION
Evidence that short-term, single-component physical activity interventions promote cognitive function and prevent cognitive decline or dementia in older adults is largely insufficient. A multidomain intervention showed a delay in cognitive decline (low-strength evidence).
PRIMARY FUNDING SOURCE
Agency for Healthcare Research and Quality.
Topics: Aged; Alzheimer Disease; Cognitive Dysfunction; Exercise; Humans; Middle Aged
PubMed: 29255839
DOI: 10.7326/M17-1528