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The American Journal of the Medical... Sep 2023Church-based interventions have been shown to reduce cardiovascular disease (CVD) risk factors and could reduce health disparities in groups with a high burden of CVD.... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Church-based interventions have been shown to reduce cardiovascular disease (CVD) risk factors and could reduce health disparities in groups with a high burden of CVD. We aim to conduct a systematic review and meta-analysis to determine the effectiveness of church-based interventions for CVD risk factor improvement and to examine the types of interventions that are effective.
METHODS
Systematic searches of MEDLINE, Embase, and manual reference searches were conducted through November 2021. Study inclusion criteria were church-based interventions delivered in the United States to address CVD risk factors. Interventions targeted barriers to improving blood pressure, weight, diabetes, physical activity, cholesterol, diet, or smoking. Two investigators independently extracted study data. Random effects meta-analyses were conducted.
RESULTS
A total of 81 studies with 17,275 participants were included. The most common interventions included increasing physical activity (n = 69), improving diet (n = 67), stress management (n = 20), medication adherence (n = 9), and smoking cessation (n = 7). Commonly used approaches for implementation included cultural tailoring of the intervention, health coaching, group education sessions, inclusion of spiritual components in the intervention, and home health monitoring. Church-based interventions were associated with significant reductions in body weight (-3.1 lb, [95% CI, -5.8, -1.2], N = 15), waist circumference (-0.8 in, [CI, -1.4, -0.1], N = 6), and systolic blood pressure (-2.3 mm Hg, [CI, -4.3, -0.3], N = 13).
CONCLUSIONS
Church-based interventions targeting CVD risk factors are effective for reducing CVD risk factors, particularly in populations with health disparities. These findings can be used to design future church-based studies and programs to improve cardiovascular health.
Topics: Humans; Cardiovascular Diseases; Diet; Health Promotion; Exercise; Heart Disease Risk Factors
PubMed: 37244637
DOI: 10.1016/j.amjms.2023.05.010 -
Obesity Reviews : An Official Journal... Sep 2023This systematic review critically appraised and synthesized evidence from economic evaluations of interventions targeting childhood excess weight. We conducted... (Review)
Review
This systematic review critically appraised and synthesized evidence from economic evaluations of interventions targeting childhood excess weight. We conducted systematic searches in 11 databases from inception to April 19, 2023. Studies were eligible if they evaluated interventions targeting children up to 18 years and the study intervention(s) targeted childhood excess weight or sought to improve diet or physical activity, regardless of the type of economic evaluation or the underpinning study design. We synthesized evidence using narrative synthesis methods. One-hundred fifty-one studies met the eligibility criteria and were classified into three groups based on the intervention approach: prevention-only (13 studies), prevention and treatment (100 studies), and treatment-only (38 studies). The predominant setting and study design differed considerably between the three groups of studies. However, compared with usual care, most interventions were deemed cost-effective. The study participants' ages, sex, and socioeconomic status were crucial to intervention cost-effectiveness. Interventions whose effects were projected beyond childhood, such as bariatric surgery, lower protein infant formula, and home-based general practitioner consultations, tended to be cost-effective. However, cost-effectiveness was sensitive to the assumptions underlying the persistence and intensity of such effects. Our findings can inform future recommendations on the conduct of economic evaluations of interventions targeting childhood overweight and obesity, as well as practice and policy recommendations.
Topics: Child; Humans; Pediatric Obesity; Cost-Benefit Analysis; Diet; Exercise; Bariatric Surgery
PubMed: 37463862
DOI: 10.1111/obr.13597 -
Sports Medicine (Auckland, N.Z.) May 2016Whilst previous meta-analyses have demonstrated that control group responses (CGRs) can negatively influence antidepressant efficacy, no such meta-analysis exists in... (Meta-Analysis)
Meta-Analysis Review
Challenges Establishing the Efficacy of Exercise as an Antidepressant Treatment: A Systematic Review and Meta-Analysis of Control Group Responses in Exercise Randomised Controlled Trials.
BACKGROUND
Whilst previous meta-analyses have demonstrated that control group responses (CGRs) can negatively influence antidepressant efficacy, no such meta-analysis exists in exercise randomised controlled trials (RCTs).
OBJECTIVE
The aim of this study was to conduct a systematic review and meta-analysis investigating CGRs and predictors in control groups of exercise RCTs among adults with depression.
METHODS
Three authors acquired RCTs from a previous Cochrane review (2013) and conducted updated searches of major databases from January 2013 to August 2015. We included exercise RCTs that (1) involved adults with major depressive disorder (MDD) or depressive symptoms; (2) measured depressive symptoms pre- and post-intervention using a validated measure [e.g. Hamilton Depression Scale (HAM-D)]; and (3) included a non-active control group. A random effects meta-analysis calculating the standardised mean difference (SMD) together with 95 % confidence intervals (CIs) was employed to determine CGR.
RESULTS
Across 41 studies, 1122 adults with depression were included [mean (SD) age 50 (18) years, 63 % female]. A large CGR of improved depressive symptoms was evident across all studies (SMD -0.920, 95 % CI -1.11 to -0.729). CGRs were elevated across all subgroup analyses, including high quality studies (n = 11, SMD -1.430, 95 % CI -1.771 to -1.090) and MDD participants (n = 18, SMD -1.248, 95 % CI = -1.585 to -0.911). The CGR equated to an improvement of -7.5 points on the HAM-D (95 % CI -10.30 to -4.89). In MDD participants, increasing age moderated a smaller CGR, while the percentage of drop-outs, baseline depressive symptoms and a longer control group duration moderated a larger CGR (i.e. improvement) (p < 0.05).
CONCLUSION
In order to demonstrate effectiveness, exercise has to overcome a powerful CGR of approximately double that reported for antidepressant RCTS.
Topics: Control Groups; Depressive Disorder; Exercise Therapy; Female; Humans; Male; Middle Aged; Randomized Controlled Trials as Topic
PubMed: 26707338
DOI: 10.1007/s40279-015-0441-5 -
Journal of the National Cancer Institute Oct 2012Although there is convincing epidemiological evidence that physical activity is associated with a reduced risk of colon cancer, it is unclear whether physical activity... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Although there is convincing epidemiological evidence that physical activity is associated with a reduced risk of colon cancer, it is unclear whether physical activity is differentially associated with the risks of proximal colon and distal colon cancers. We conducted a systematic review and meta-analysis to investigate this issue.
METHODS
MEDLINE and EMBASE were searched for English-language cohort and case-control studies that examined associations between physical activity and the risks of proximal colon and distal colon cancers. A random-effects meta-analysis was conducted to estimate the summary relative risks (RRs) for the associations between physical activity and the risks of the two cancers. All statistical tests were two-sided.
RESULTS
A total of 21 studies met the inclusion criteria. The summary relative risk of the main results from these studies indicated that the risk of proximal colon cancer was 27% lower among the most physically active people compared with the least active people (RR = 0.73, 95% confidence interval [CI] = 0.66 to 0.81). An almost identical result was found for distal colon cancer (RR = 0.74, 95% CI = 0.68 to 0.80).
CONCLUSION
The results of this systematic review and meta-analysis suggest that physical activity is associated with a reduced risk of both proximal colon and distal colon cancers, and that the magnitude of the association does not differ by subsite. Given this finding, future research on physical activity and colon cancer should focus on other aspects of the association that remain unclear, such as whether sedentary behavior and nonaerobic physical activity are associated with the risk of colon cancer.
Topics: Bias; Colonic Neoplasms; Female; Humans; Incidence; Male; Motor Activity; Physical Exertion; Risk Assessment; Risk Factors
PubMed: 22914790
DOI: 10.1093/jnci/djs354 -
Sleep Medicine Reviews Apr 2024Pharmacological treatments (i.e., melatonin) and non-pharmacological therapies (e.g., parent-based sleep education programs and behavioural interventions) have been... (Meta-Analysis)
Meta-Analysis Review
Pharmacological treatments (i.e., melatonin) and non-pharmacological therapies (e.g., parent-based sleep education programs and behavioural interventions) have been found to result in improved sleep in children and adolescents with autism spectrum disorder (ASD). However, there are several limitations to these treatment approaches, including concerns about the possible side-effects and safety, high-cost and uncertainties of long-term effects. Physical activity (PA) intervention is a promising behavioural intervention that has received increasing attention. However, the effects of PA intervention on sleep are still unclear in this clinical group. This study aimed to synthesize available empirical studies concerning the effects of PA interventions on sleep in children and adolescents with ASD. Following PRISMA guidelines, seven electronic databases: APA PsychInfo, CINAHL Ultimate, ERIC, MEDLINE, PubMed, SPORTDiscus, and Web of Science, were searched from inception to March 2023. Randomized controlled trials/quasi-experimental designs with comparison groups were included. Initially, 444 articles were identified, 13 articles underwent systematic review, and 8 studies with control groups and sufficient statistical data were selected for meta-analysis. Compared to no-treatment control groups, PA interventions had a large positive effect on parent-reported general sleep problems, night awakenings, sleep resistance, sleep duration and actigraphy-assessed sleep efficiency in children and adolescents with ASD.
Topics: Child; Humans; Adolescent; Autism Spectrum Disorder; Sleep; Sleep Initiation and Maintenance Disorders; Behavior Therapy; Exercise
PubMed: 38442500
DOI: 10.1016/j.smrv.2024.101913 -
Pain Medicine (Malden, Mass.) Sep 2013To compare the overall levels of physical activity of older adults with chronic musculoskeletal pain and asymptomatic controls. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To compare the overall levels of physical activity of older adults with chronic musculoskeletal pain and asymptomatic controls.
REVIEW METHODS
A systematic review of the literature was conducted using a Cochrane methodology and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Major electronic databases were searched from inception until December 2012, including the Cochrane Library, CINAHL, EBSCO, EMBASE, Medline, PubMed, PsycINFO, and the international prospective register of systematic reviews. In addition, citation chasing was undertaken, and key authors were contacted. Eligibility criteria were established around participants used and outcome measures focusing on daily physical activity. A meta-analysis was conducted on appropriate studies.
RESULTS
Eight studies met the eligibility criteria, four of these reported a statistically lower level of physical activity in the older adult sampl e with chronic pain compared with the asymptomatic group. It was possible to perform a non-heterogeneous meta-analysis on five studies. This established that 1,159 older adults with chronic pain had a significantly lower level of physical activity (-0.20, confidence interval 95% = -0.34 to -0.06, p = 0.004) compared with 576 without chronic pain.
CONCLUSION
Older adults with chronic pain appear to be less active than asymptomatic controls. Although this difference was small, it is likely to be clinically meaningful. It is imperative that clinicians encourage older people with chronic pain to remain active as physical activity is a central non-pharmacological strategy in the management of chronic pain and is integral for healthy aging. Future research should prioritize the use of objective measurement of physical activity.
Topics: Aged; Chronic Pain; Female; Humans; Male; Middle Aged; Motor Activity; Musculoskeletal Pain
PubMed: 23742160
DOI: 10.1111/pme.12154 -
Clinical Journal of Sport Medicine :... Nov 2016Physical activity represents a well-established way to prolong the life span; yet, it remains an unfulfilled goal for a great part of the population. In parallel, the... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Physical activity represents a well-established way to prolong the life span; yet, it remains an unfulfilled goal for a great part of the population. In parallel, the burden of gastric cancer is considerable throughout the globe. In that context, the present meta-analysis aims to shed light on the association between physical activity and gastric cancer risk.
DATA SOURCES
Eligible observational studies were sought in PubMed up to June 01, 2015. In addition, a snowball procedure was conducted and contact with authors was implemented. Separate analyses were performed by type of physical activity (total; occupational; recreational), study design, published/provided data, anatomical site, and study location, along with stratification by gender.
MAIN RESULTS
Ten cohort studies (7551 incident cases in a total cohort size of 1 541 208 subjects) and 12 case-control studies (5803 cases and 73 629 controls) were eligible. "Any" type of physical activity was associated with lower risk of gastric cancer [pooled relative risk (RR) = 0.81; 95% CI: 0.73 to 0.89], which was reproducible in men (pooled RR = 0.87; 95% CI: 0.77-0.99). The protective effect was significant in the subgroup analyses of published data, noncardia cancer (pooled RR = 0.62; 95% CI: 0.52-0.75), and studies stemming from Asia (pooled RR = 0.82; 95% CI: 0.74-0.90).
CONCLUSIONS
This meta-analysis suggests a protective effect of physical activity regarding gastric cancer risk, especially in Asian populations.
Topics: Asian People; Exercise; Humans; Stomach Neoplasms
PubMed: 27347864
DOI: 10.1097/JSM.0000000000000316 -
The Cochrane Database of Systematic... Nov 2020Stroke is one of the leading causes of disability worldwide. Functional impairment, resulting in poor performance in activities of daily living (ADL) among stroke... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Stroke is one of the leading causes of disability worldwide. Functional impairment, resulting in poor performance in activities of daily living (ADL) among stroke survivors is common. Current rehabilitation approaches have limited effectiveness in improving ADL performance, function, muscle strength, and cognitive abilities (including spatial neglect) after stroke, with improving cognition being the number one research priority in this field. A possible adjunct to stroke rehabilitation might be non-invasive brain stimulation by transcranial direct current stimulation (tDCS) to modulate cortical excitability, and hence to improve these outcomes in people after stroke.
OBJECTIVES
To assess the effects of tDCS on ADL, arm and leg function, muscle strength and cognitive abilities (including spatial neglect), dropouts and adverse events in people after stroke.
SEARCH METHODS
We searched the Cochrane Stroke Group Trials Register, CENTRAL, MEDLINE, Embase and seven other databases in January 2019. In an effort to identify further published, unpublished, and ongoing trials, we also searched trials registers and reference lists, handsearched conference proceedings, and contacted authors and equipment manufacturers.
SELECTION CRITERIA
This is the update of an existing review. In the previous version of this review, we focused on the effects of tDCS on ADL and function. In this update, we broadened our inclusion criteria to compare any kind of active tDCS for improving ADL, function, muscle strength and cognitive abilities (including spatial neglect) versus any kind of placebo or control intervention.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed trial quality and risk of bias, extracted data, and applied GRADE criteria. If necessary, we contacted study authors to ask for additional information. We collected information on dropouts and adverse events from the trial reports.
MAIN RESULTS
We included 67 studies involving a total of 1729 patients after stroke. We also identified 116 ongoing studies. The risk of bias did not differ substantially for different comparisons and outcomes. The majority of participants had ischaemic stroke, with mean age between 43 and 75 years, in the acute, postacute, and chronic phase after stroke, and level of impairment ranged from severe to less severe. Included studies differed in terms of type, location and duration of stimulation, amount of current delivered, electrode size and positioning, as well as type and location of stroke. We found 23 studies with 781 participants examining the effects of tDCS versus sham tDCS (or any other passive intervention) on our primary outcome measure, ADL after stroke. Nineteen studies with 686 participants reported absolute values and showed evidence of effect regarding ADL performance at the end of the intervention period (standardised mean difference (SMD) 0.28, 95% confidence interval (CI) 0.13 to 0.44; random-effects model; moderate-quality evidence). Four studies with 95 participants reported change scores, and showed an effect (SMD 0.48, 95% CI 0.02 to 0.95; moderate-quality evidence). Six studies with 269 participants assessed the effects of tDCS on ADL at the end of follow-up and provided absolute values, and found improved ADL (SMD 0.31, 95% CI 0.01 to 0.62; moderate-quality evidence). One study with 16 participants provided change scores and found no effect (SMD -0.64, 95% CI -1.66 to 0.37; low-quality evidence). However, the results did not persist in a sensitivity analysis that included only trials with proper allocation concealment. Thirty-four trials with a total of 985 participants measured upper extremity function at the end of the intervention period. Twenty-four studies with 792 participants that presented absolute values found no effect in favour of tDCS (SMD 0.17, 95% CI -0.05 to 0.38; moderate-quality evidence). Ten studies with 193 participants that presented change values also found no effect (SMD 0.33, 95% CI -0.12 to 0.79; low-quality evidence). Regarding the effects of tDCS on upper extremity function at the end of follow-up, we identified five studies with a total of 211 participants (absolute values) without an effect (SMD -0.00, 95% CI -0.39 to 0.39; moderate-quality evidence). Three studies with 72 participants presenting change scores found an effect (SMD 1.07; 95% CI 0.04 to 2.11; low-quality evidence). Twelve studies with 258 participants reported outcome data for lower extremity function and 18 studies with 553 participants reported outcome data on muscle strength at the end of the intervention period, but there was no effect (high-quality evidence). Three studies with 156 participants reported outcome data on muscle strength at follow-up, but there was no evidence of an effect (moderate-quality evidence). Two studies with 56 participants found no evidence of effect of tDCS on cognitive abilities (low-quality evidence), but one study with 30 participants found evidence of effect of tDCS for improving spatial neglect (very low-quality evidence). In 47 studies with 1330 participants, the proportions of dropouts and adverse events were comparable between groups (risk ratio (RR) 1.25, 95% CI 0.74 to 2.13; random-effects model; moderate-quality evidence). AUTHORS' CONCLUSIONS: There is evidence of very low to moderate quality on the effectiveness of tDCS versus control (sham intervention or any other intervention) for improving ADL outcomes after stroke. However, the results did not persist in a sensitivity analyses including only trials with proper allocation concealment. Evidence of low to high quality suggests that there is no effect of tDCS on arm function and leg function, muscle strength, and cognitive abilities in people after stroke. Evidence of very low quality suggests that there is an effect on hemispatial neglect. There was moderate-quality evidence that adverse events and numbers of people discontinuing the treatment are not increased. Future studies should particularly engage with patients who may benefit the most from tDCS after stroke, but also should investigate the effects in routine application. Therefore, further large-scale randomised controlled trials with a parallel-group design and sample size estimation for tDCS are needed.
Topics: Activities of Daily Living; Adult; Aged; Bias; Cognition Disorders; Confidence Intervals; Female; Humans; Lower Extremity; Male; Middle Aged; Motor Activity; Muscle Strength; Patient Dropouts; Perceptual Disorders; Randomized Controlled Trials as Topic; Recovery of Function; Stroke Rehabilitation; Transcranial Direct Current Stimulation; Upper Extremity
PubMed: 33175411
DOI: 10.1002/14651858.CD009645.pub4 -
The International Journal of Behavioral... Nov 2023Physical activity referral schemes (PARS) are complex multicomponent interventions that represent a promising healthcare-based concept for physical activity (PA)... (Review)
Review
BACKGROUND
Physical activity referral schemes (PARS) are complex multicomponent interventions that represent a promising healthcare-based concept for physical activity (PA) promotion. This systematic review and narrative synthesis aimed to identify the constitutive components of PARS and provide an overview of their effectiveness.
METHODS
Following a published protocol, we conducted a systematic search of PubMed, Scopus, Web of Science, CINAHL, ScienceDirect, SpringerLink, HTA, Wiley Online Library, SAGE Journals, Taylor & Francis, Google Scholar, OpenGrey, and CORE from 1990 to January 2023. We included experimental, quasi-experimental, and observational studies that targeted adults participating in PARS and reported PA outcomes, scheme uptake, or adherence rates. We performed an intervention components analysis using the PARS taxonomy to identify scheme components and extracted data related to uptake, adherence, and PA behavior change. We combined these to provide a narrative summary of PARS effectiveness.
RESULTS
We included 57 studies reporting on 36 PARS models from twelve countries. We identified 19 PARS components: a patient-centered approach, individualized content, behavior change theory and techniques, screening, brief advice, written materials, a written prescription, referral, baseline and exit consultation, counselling support session(s), PA sessions, education session(s), action for non-attendance, structured follow-up, a PA network, feedback for the referrer, and exit strategies/routes. The PARS models contained a mean of 7 ± 2.9 components (range = 2-13). Forty-five studies reported PA outcome data, 28 reported uptake, and 34 reported adherence rates. Of these, approximately two-thirds of studies reported a positive effect on participant PA levels, with a wide range of uptake (5.7-100.0%) and adherence rates (8.5-95.0%).
CONCLUSIONS
Physical activity referral scheme components are an important source of complexity. Despite the heterogeneous nature of scheme designs, our synthesis was able to identify 19 components. Further research is required to determine the influence of these components on PARS uptake, adherence, and PA behavior change. To facilitate this, researchers and scheme providers must report PARS designs in more detail. Process evaluations are also needed to examine implementation and increase our understanding of what components lead to which outcomes. This will facilitate future comparisons between PARS and enable the development of models to maximize impact.
Topics: Adult; Humans; Exercise; Motor Activity; Prescriptions; Referral and Consultation
PubMed: 38012688
DOI: 10.1186/s12966-023-01518-x -
Physical Therapy Mar 2023Preoperative exercise (prehabilitation) is commonly used as a method to reduce pain and improve function postoperatively. The purpose of this systematic review was to... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Preoperative exercise (prehabilitation) is commonly used as a method to reduce pain and improve function postoperatively. The purpose of this systematic review was to determine therapeutic benefits of preoperative exercise on postoperative pain, function, quality of life (QOL), and risk of complications across various types of surgeries.
METHODS
Three electronic databases were used to perform a literature search. Full articles with randomized designs comparing a preoperative exercise program vs no formal program were included. The primary outcome was postoperative pain. QOL, function, and postoperative complications were analyzed as secondary outcomes. The primary meta-analysis was performed in those with joint replacement surgery because there were only 5 with other surgical types.
RESULTS
A total of 28 articles were included, of which 23 were from individuals with total joint replacement surgery. Preoperative exercise resulted in lower pain ≤2 months and 3 to 5 months after joint replacement surgery with a moderate standardized mean difference (95% CI at <2 months = -0.34 [-0.59 to -0.09]; at 3 to 5 months = -0.41 [-0.70 to -0.11]) compared with nonexercised controls. However, ≥6 months after joint replacement surgery, preoperative exercise groups showed no significant differences in postoperative pain (standardized mean difference = -0.17 [-0.35 to 0.01]) compared with nonexercised controls. QOL and subjective and objective function were improved ≤2 months after joint replacement surgery but were not different ≥6 months post-surgery. Reduction in risk of postoperative complications was favored with preoperative exercise.
CONCLUSION
Preoperative exercise has a modest effect on postoperative pain, function, and quality of life within the first 6 months after surgery and reduces the risk of developing postoperative complications in individuals undergoing joint replacement surgery. The effect of preoperative exercise on other surgery types is inconclusive.
IMPACT
This systematic review supports using preoperative exercise to improve pain and function outcomes for those with joint replacement surgery.
Topics: Humans; Quality of Life; Preoperative Exercise; Preoperative Care; Arthroplasty, Replacement, Knee; Pain, Postoperative; Postoperative Complications
PubMed: 37172124
DOI: 10.1093/ptj/pzac169