-
American Journal of Physical Medicine &... Apr 2024This study aimed to evaluate the effect of different exercises for improving fatigue in maintenance hemodialysis patients. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
This study aimed to evaluate the effect of different exercises for improving fatigue in maintenance hemodialysis patients.
DESIGN
PubMed, Embase, Web of Science, Cochrane, PEDro, CNKI, VIP, Wanfang data, CBM, and CINAHL were conducted from the establishment of the database to July 2023. We independently screened the literature, evaluated the quality, analyzed the data using Stata 15.0, and performed subgroup analysis on intervention time and exercise intervention adherence.
RESULTS
Twenty-three studies were analyzed, with 1867 patients and nine interventions. Based on the surface under cumulative ranking curves and pairwise comparisons effects, overall long-term, short-term, and exercise intervention adherence >90% effects have all presented that during dialysis aerobic-resistance combined exercise was ranked as the most effective compared with routine care (surface under cumulative ranking curves = 83.9%, standardized mean difference = -1.45, 95% CI = -2.23 to -0.67; surface under cumulative ranking curves = 85.9%, standardized mean difference = -1.38, 95% CI = -2.24 to -0.52; surface under cumulative ranking curves = 86.6%, standardized mean difference = -1.54, 95% CI = -2.58 to -0.49; surface under cumulative ranking curves = 83.6%, standardized mean difference = -1.45, 95% CI = -2.25 to -0.66, respectively), followed by interdialytic period muscle relaxation exercise, interdialytic period aerobic-resistance combined exercise, interdialytic period aerobic exercise, and interdialytic period Baduanjin.
CONCLUSIONS
Dialysis aerobic-resistance combined exercise may be considered in practice when resources allow. However, high-quality, multicenter, and large-sample randomized control trials must further verify this conclusion.
Topics: Humans; Exercise; Exercise Therapy; Fatigue; Network Meta-Analysis; Quality of Life
PubMed: 37816191
DOI: 10.1097/PHM.0000000000002348 -
Cognitive Neurodynamics Oct 2023Driving a vehicle is a complex, multidimensional, and potentially risky activity demanding full mobilization and utilization of physiological and cognitive abilities.... (Review)
Review
Driving a vehicle is a complex, multidimensional, and potentially risky activity demanding full mobilization and utilization of physiological and cognitive abilities. Drowsiness, often caused by stress, fatigue, and illness declines cognitive capabilities that affect drivers' capability and cause many accidents. Drowsiness-related road accidents are associated with trauma, physical injuries, and fatalities, and often accompany economic loss. Drowsy-related crashes are most common in young people and night shift workers. Real-time and accurate driver drowsiness detection is necessary to bring down the drowsy driving accident rate. Many researchers endeavored for systems to detect drowsiness using different features related to vehicles, and drivers' behavior, as well as, physiological measures. Keeping in view the rising trend in the use of physiological measures, this study presents a comprehensive and systematic review of the recent techniques to detect driver drowsiness using physiological signals. Different sensors augmented with machine learning are utilized which subsequently yield better results. These techniques are analyzed with respect to several aspects such as data collection sensor, environment consideration like controlled or dynamic, experimental set up like real traffic or driving simulators, etc. Similarly, by investigating the type of sensors involved in experiments, this study discusses the advantages and disadvantages of existing studies and points out the research gaps. Perceptions and conceptions are made to provide future research directions for drowsiness detection techniques based on physiological signals.
PubMed: 37786662
DOI: 10.1007/s11571-022-09898-9 -
Frontiers in Endocrinology 2023This study aims to assess the association between sodium-glucose cotransporter type-2 inhibitor (SGLT-2i) treatment and muscle atrophy in patients with type 2 diabetes... (Meta-Analysis)
Meta-Analysis
AIM
This study aims to assess the association between sodium-glucose cotransporter type-2 inhibitor (SGLT-2i) treatment and muscle atrophy in patients with type 2 diabetes mellitus (T2DM).
METHODS
We searched six databases from 1 January 2012 to 1 May 2023, without language restrictions. The primary outcome was muscle. Secondary outcomes were weight loss, weakness, malaise, or fatigue. Subgroup analyses were performed according to different definitions of muscle, treatment duration, and measurement methods. The quality of the studies was assessed using the Cochrane tool. The quality of the evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) tool.
RESULTS
Nineteen randomized controlled trials (RCTs) involving 1,482 participants were included. Compared with the control group, a meta-analysis showed that T2DM participants in the group treated with SGLT-2i demonstrated statistically significant reductions in lean body mass of 0.66 (95% confidence interval (CI), -1.05 to -0.27; = 0.0009) and skeletal muscle mass of 0.35 (95% CI, -0.66 to -0.04; = 0.03). No deaths or serious adverse events were reported. The quality of evidence in the included trials was low.
CONCLUSIONS
SGLT-2i may lead to a reduction in muscle strength in the treatment of T2DM compared to the control group. However, there is still a lack of high-quality evidence to evaluate muscle atrophy caused by SGLT-2i.
SYSTEMATIC REVIEW REGISTRATION
https://inplasy.com/inplasy-2022-12-0061/, identifier 2022120061.
Topics: Humans; Diabetes Mellitus, Type 2; Hypoglycemic Agents; Muscular Atrophy; Randomized Controlled Trials as Topic; Sodium-Glucose Transporter 2 Inhibitors
PubMed: 37780608
DOI: 10.3389/fendo.2023.1220516 -
Journal of Cachexia, Sarcopenia and... Dec 2023Cancer cachexia (CC) is a multifactorial syndrome driven by inflammation, defined by ongoing loss of skeletal muscle mass (with or without loss of fat mass) that cannot... (Review)
Review
Cancer cachexia (CC) is a multifactorial syndrome driven by inflammation, defined by ongoing loss of skeletal muscle mass (with or without loss of fat mass) that cannot be fully reversed by conventional nutritional support. CC leads to progressive functional impairment, with its clinical management complicated and limited therapeutic options available. The objective of this review was to assess the efficacy and safety of non-steroidal anti-inflammatory drugs (NSAIDs) on patient-centred outcomes in patients with CC. In 2013, two systematic reviews concluded that there was insufficient evidence to recommend NSAIDs for clinical management of CC outside of clinical trials. However, clinical trials of multi-component CC interventions have included NSAIDs as an intervention component, so an up-to-date assessment of the evidence for NSAIDs in the treatment of CC is warranted. Four databases (MEDLINE, EMBASE, CENTRAL and CINAHL) and three trial registers (clinicaltrials.gov, WHO ICTRP and ISRCTN) were searched on 16 December 2022. Randomized controlled trials (RCTs) comparing any NSAID (any dose or duration) with a control arm, in adult patients with CC, reporting measures of body weight, body composition, nutrition impact symptoms, inflammation, physical function or fatigue, were eligible for inclusion. Primary outcomes (determined with patient involvement) were survival, changes in muscle strength, body composition, body weight and quality of life. Included studies were assessed for risk of bias using the Revised Cochrane risk-of-bias tool for randomized trials. Five studies were included, which investigated Indomethacin (n = 1), Ibuprofen (n = 1) and Celecoxib (n = 3). Four studies were judged to be at high risk of bias for all outcomes, with one study raising concerns for most outcomes. Considerable clinical and methodological heterogeneity amongst the studies meant that meta-analysis was not appropriate. There was insufficient evidence to determine whether Indomethacin or Ibuprofen is effective or safe for use in patients with CC; RCTs with lower risk of bias are needed. Celecoxib studies indicated it was safe for use in this population at the doses tested (200-400 mg/day) but found contrasting results regarding efficacy, potentially reflecting heterogeneity amongst the studies. There is inadequate evidence to recommend any NSAID for CC. While current clinical trials for CC treatments are shifting towards multi-component interventions, further research to determine the efficacy and safety of NSAIDs alone is necessary if they are to be included in such multi-component interventions. Furthermore, the lack of data on patient-determined primary outcomes in this review highlights the need for patient involvement in clinical trials for CC.
Topics: Adult; Humans; Ibuprofen; Celecoxib; Cachexia; Anti-Inflammatory Agents, Non-Steroidal; Indomethacin; Inflammation; Neoplasms
PubMed: 37750475
DOI: 10.1002/jcsm.13327 -
JAMA Network Open Sep 2023Current rehabilitation guidelines for patients with post-COVID-19 condition (PCC) are primarily based on expert opinions and observational data, and there is an urgent... (Meta-Analysis)
Meta-Analysis
IMPORTANCE
Current rehabilitation guidelines for patients with post-COVID-19 condition (PCC) are primarily based on expert opinions and observational data, and there is an urgent need for evidence-based rehabilitation interventions to support patients with PCC.
OBJECTIVE
To synthesize the findings of existing studies that report on physical capacity (including functional exercise capacity, muscle function, dyspnea, and respiratory function) and quality of life outcomes following rehabilitation interventions in patients with PCC.
DATA SOURCES
A systematic electronic search was performed from January 2020 until February 2023, in MEDLINE, Scopus, CINAHL, and the Clinical Trials Registry. Key terms that were used to identify potentially relevant studies included long-covid, post-covid, sequelae, exercise therapy, rehabilitation, physical activity, physical therapy, and randomized controlled trial.
STUDY SELECTION
This study included randomized clinical trials that compared respiratory training and exercise-based rehabilitation interventions with either placebo, usual care, waiting list, or control in patients with PCC.
DATA EXTRACTION AND SYNTHESIS
This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. A pairwise bayesian random-effects meta-analysis was performed using vague prior distributions. Risk of bias was assessed using the Cochrane risk of bias tool version 2, and the certainty of evidence was evaluated using the GRADE system by 2 independent researchers.
MAIN OUTCOMES AND MEASURES
The primary outcome was functional exercise capacity, measured at the closest postintervention time point by the 6-minute walking test. Secondary outcomes were fatigue, lower limb muscle function, dyspnea, respiratory function, and quality of life. All outcomes were defined a priori. Continuous outcomes were reported as standardized mean differences (SMDs) with 95% credible intervals (CrIs) and binary outcomes were summarized as odds ratios with 95% CrIs. The between-trial heterogeneity was quantified using the between-study variance, τ2, and 95% CrIs.
RESULTS
Of 1834 identified records, 1193 were screened, and 14 trials (1244 patients; 45% female participants; median [IQR] age, 50 [47 to 56] years) were included in the analyses. Rehabilitation interventions were associated with improvements in functional exercise capacity (SMD, -0.56; 95% CrI, -0.87 to -0.22) with moderate certainty in 7 trials (389 participants). These improvements had a 99% posterior probability of superiority when compared with current standard care. The value of τ2 (0.04; 95% CrI, 0.00 to 0.60) indicated low statistical heterogeneity. However, there was significant uncertainty and imprecision regarding the probability of experiencing exercise-induced adverse events (odds ratio, 1.68; 95% CrI, 0.32 to 9.94).
CONCLUSIONS AND RELEVANCE
The findings of this systematic review and meta-analysis suggest that rehabilitation interventions are associated with improvements in functional exercise capacity, dyspnea, and quality of life, with a high probability of improvement compared with the current standard care; the certainty of evidence was moderate for functional exercise capacity and quality of life and low for other outcomes. Given the uncertainty surrounding the safety outcomes, additional trials with enhanced monitoring of adverse events are necessary.
Topics: Humans; Adult; Female; Middle Aged; Male; Quality of Life; Post-Acute COVID-19 Syndrome; Bayes Theorem; COVID-19; Dyspnea; Randomized Controlled Trials as Topic
PubMed: 37725376
DOI: 10.1001/jamanetworkopen.2023.33838 -
Respirology (Carlton, Vic.) Nov 2023Long COVID, or post-acute COVID-19 sequelae, is experienced by an estimated one in eight adults following acute COVID-19. Long COVID is a new and complex chronic health... (Review)
Review
Long COVID, or post-acute COVID-19 sequelae, is experienced by an estimated one in eight adults following acute COVID-19. Long COVID is a new and complex chronic health condition that typically includes multiple symptoms that cross organ systems and fluctuate over time; a one-size-fits-all approach is, therefore, not likely to be appropriate nor relevant for long COVID treatment. 'Treatable Traits' is a personalized medicine approach, purpose-built to address the complexity and heterogeneity of complex chronic conditions. This comprehensive review aimed to understand how a treatable traits approach could be applied to long COVID, by first identifying the most prevalent long COVID treatable traits and then the available evidence for strategies to target these traits. An umbrella review of 22 systematic reviews identified 34 symptoms and complications common with long COVID, grouped into eight long COVID treatable trait clusters: neurological, chest, psychological, pain, fatigue, sleep impairment, functional impairment and other. A systematic review of randomized control trials identified 18 studies that explored different intervention approaches for long COVID prevention (k = 4) or management (k = 14). While a single study reported metformin as effective for long COVID prevention, the findings need to be replicated and consensus is required around how to define long COVID as a clinical trial endpoint. For long COVID management, current evidence supports exercise training or respiratory muscle training for long COVID treatable traits in the chest and functional limitation clusters. While there are studies exploring interventions targeting other long COVID treatable traits, further high-quality RCTs are needed, particularly targeting treatable traits in the clusters of fatigue, psychological, pain and sleep impairment.
Topics: Adult; Humans; Post-Acute COVID-19 Syndrome; COVID-19; Chronic Disease; Fatigue; Pain
PubMed: 37715729
DOI: 10.1111/resp.14596 -
Sports Medicine (Auckland, N.Z.) Feb 2024Daytime napping is used by athletes as a strategy to supplement night time sleep and aid physical performance. However, no meta-analytical overview regarding the impact... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Daytime napping is used by athletes as a strategy to supplement night time sleep and aid physical performance. However, no meta-analytical overview regarding the impact of napping following a night of normal sleep (7-9 h) on physical performance is available.
OBJECTIVE
The aim of this study was to evaluate the effect of daytime napping following normal night-time sleep on physical performance in physically active individuals and athletes.
METHODS
This systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Seven electronic databases (i.e., PubMed, Web of Science, Scopus, SPORTDiscus, CINAHL, SCIELO, and EBSCOhost) were used to search for relevant studies that investigated the impact of daytime napping, following normal night-time sleep, on physical performance in physically active individuals and athletes, published in any language, and available before September 01, 2022. Studies that included assessments of any physical performance measures were included. QualSyst was used to assess the methodological quality of the studies.
RESULTS
Of 18 selected articles, 15 were of strong quality and 3 were of moderate quality. Compared with no-nap conditions, physically active individuals and athletes who napped experienced an increase in highest distance (effect size [ES] 1.026; p < 0.001) and total distance (ES 0.737; p < 0.001), and a decrease in fatigue index (ES 0.839, p = 0.008) during the 5-m shuttle run test (5MSRT). However, napping yielded no effect on muscle force (ES 0.175; p = 0.267). No effect of napping was found in one study that measured sprint performance and in two studies that measured performance during the 30-s Wingate test. Two of three studies reported an increase in jump performance after napping. Two of three studies reported an increase in repeated sprints after napping. One study reported an increase in upper-body power performance after napping, and napping was beneficial for endurance performance in one of two studies.
CONCLUSION
Following normal sleep, napping is beneficial for the performance of the 5MSRT, with no significant effect on muscle force. No firm conclusions can be drawn regarding other physical performance measures due to the limited number of studies.
Topics: Humans; Sleep; Physical Examination; Electrocardiography; Fatigue; Athletes
PubMed: 37700141
DOI: 10.1007/s40279-023-01920-2 -
Journal of Science and Medicine in Sport Nov 2023This systematic review aimed to analyze the effects of different exercise protocols on physical fitness (cardiorespiratory fitness, muscle strength, and body... (Review)
Review
OBJECTIVES
This systematic review aimed to analyze the effects of different exercise protocols on physical fitness (cardiorespiratory fitness, muscle strength, and body composition), quality of life, cancer-related fatigue, and sleep quality in patients with different types of cancer undergoing neoadjuvant treatment.
DESIGN
Systematic review.
METHOD
A comprehensive search of existing literature was carried out using four electronic databases: PubMed, Scopus, Web of Science, and Cochrane Library (published until October 19, 2022). All databases were searched for randomized controlled trials, quasi-experimental investigations, and pre-post investigations assessing the effects of exercise in cancer patients during neoadjuvant treatment. Excluded articles included multicomponent interventions, such as exercise plus diet or behavioral therapy, and investigations performed during adjuvant treatment or survivorship. The methodological quality of each study was assessed using the Physiotherapy Evidence Database (PEDro) scale.
RESULTS
Twenty-seven trials involving 999 cancer patients were included in this review. The interventions were conducted in cancer patients undergoing neoadjuvant treatment for rectal (n = 11), breast (n = 5), pancreatic (n = 4), esophageal (n = 3), gastro-esophageal (n = 2), and prostate (n = 1) cancers, and leukemia (n = 1). Among the investigations included, 14 utilized combined exercise protocols, 11 utilized aerobic exercise, and two utilized both aerobic and resistance training separately. Exercise interventions appeared to improve cardiorespiratory fitness, muscle strength, body composition, and quality of life, although many investigations lacked a between-group analysis.
CONCLUSION
Despite limited evidence, exercise interventions applied during neoadjuvant treatment demonstrate promising potential in enhancing cardiorespiratory fitness, muscle strength, body composition, and overall quality of life. However, a scarcity of evidence remains on the effects of exercise on cancer-related fatigue and sleep quality. Further research with high-quality randomized controlled trials is warranted.
Topics: Humans; Male; Exercise; Exercise Therapy; Fatigue; Neoadjuvant Therapy; Neoplasms; Quality of Life; Female
PubMed: 37696693
DOI: 10.1016/j.jsams.2023.08.178 -
Sports Medicine (Auckland, N.Z.) Dec 2023Protein supplements are important to maintain optimum health and physical performance, particularly in athletes and active individuals to repair and rebuild their...
Effect of Soy Protein Supplementation on Muscle Adaptations, Metabolic and Antioxidant Status, Hormonal Response, and Exercise Performance of Active Individuals and Athletes: A Systematic Review of Randomised Controlled Trials.
BACKGROUND
Protein supplements are important to maintain optimum health and physical performance, particularly in athletes and active individuals to repair and rebuild their skeletal muscles and connective tissues. Soy protein (SP) has gained popularity in recent years as an alternative to animal proteins.
OBJECTIVES
This systematic review evaluates the evidence from randomised controlled clinical trials of the effects of SP supplementation in active individuals and athletes in terms of muscle adaptations, metabolic and antioxidant status, hormonal response and exercise performance. It also explores the differences in SP supplementation effects in comparison to whey protein.
METHODS
A systematic search was conducted in PubMed, Embase and Web of Science, as well as a manual search in Google Scholar and EBSCO, on 27 June 2023. Randomised controlled trials that evaluated the applications of SPs supplementation on sports and athletic-related outcomes that are linked with exercise performance, adaptations and biomarkers in athletes and physically active adolescents and young adults (14 to 39 years old) were included, otherwise, studies were excluded. The risk of bias was assessed according to Cochrane's revised risk of bias tool.
RESULTS
A total of 19 eligible original research articles were included that investigated the effect of SP supplementation on muscle adaptations (n = 9), metabolic and antioxidant status (n = 6), hormonal response (n = 6) and exercise performance (n = 6). Some studies investigated more than one effect. SP was found to provide identical increases in lean mass compared to whey in some studies. SP consumption promoted the reduction of exercise-induced metabolic/blood circulating biomarkers such as triglycerides, uric acid and lactate. Better antioxidant capacity against oxidative stress has been seen with respect to whey protein in long-term studies. Some studies reported testosterone and cortisol fluctuations related to SP; however, more research is required. All studies on SP and endurance performance suggested the potential beneficial effects of SP supplementation (10-53.3 g) on exercise performance by improving high-intensity and high-speed running performance, enhancing maximal cardiac output, delaying fatigue and improving isometric muscle strength, improving endurance in recreational cyclists, increasing running velocity and decreasing accumulated lactate levels; however, studies determining the efficacy of soy protein on VOmax provided conflicted results.
CONCLUSION
It is possible to recommend SP to athletes and active individuals in place of conventional protein supplements by assessing their dosage and effectiveness in relation to different types of training. SP may enhance lean mass compared with other protein sources, enhance the antioxidant status, and reduce oxidative stress. SP supplementation had an inconsistent effect on testosterone and cortisol levels. SP supplementation may be beneficial, especially after muscle damage, high-intensity/high-speed or repeated bouts of strenuous exercise.
Topics: Adolescent; Adult; Humans; Young Adult; Antioxidants; Athletes; Biomarkers; Dietary Supplements; Hydrocortisone; Lactates; Muscle, Skeletal; Soybean Proteins; Testosterone; Whey Proteins; Randomized Controlled Trials as Topic
PubMed: 37603200
DOI: 10.1007/s40279-023-01899-w -
Cancer Medicine Sep 2023Women with breast cancer and improved survival often experience treatment-related impairments. High-intensity interval training (HIIT) has emerged as a promising...
BACKGROUND
Women with breast cancer and improved survival often experience treatment-related impairments. High-intensity interval training (HIIT) has emerged as a promising exercise therapy modality for adult cancer patients. However, the overall effects of HIIT in breast cancer patients remain scarce and controversial. Therefore, we conducted a systematic review and meta-analysis to comprehensively evaluate the impact of HIIT on health-related outcomes in breast cancer patients.
METHODS
We searched the PubMed, Embase, and Web of Science from inception to November 7, 2022. Eligible studies included randomized controlled trials that compared HIIT interventions with usual care (UC) or MICT in breast cancer patients. The primary outcome assessed was physical fitness, and exploratory outcomes included body composition, blood-borne biomarkers, and patient-reported outcomes. Summary data were extracted, and standardized mean differences (SMD) were calculated for meta-analysis. For outcomes that could not be pooled, a systematic review was conducted.
RESULTS
Our analysis included 19 articles from 10 studies, encompassing 532 participants who met the inclusion criteria. Pooled results demonstrated that HIIT was superior to UC in improving peak oxygen uptake (VO ). The SMD for VO (L/min) and VO (mL/kg/min) was 0.79 (95% CI 0.13, 1.45) and 0.59 (95% CI 0.01, 1.16), respectively. No significant differences in VO were found between the HIIT and MICT groups. Meta-analyses on body composition and blood-borne biomarkers showed no significant differences between HIIT and UC. Systematic review indicated favorable effects of HIIT on muscle strength, fatigue, and emotional well-being.
CONCLUSIONS
HIIT is a time-efficient alternative to MICT for improving VO and may also enhance muscle strength and alleviate fatigue and emotional symptoms in breast cancer patients. HIIT should be considered as an important component of exercise prescription in breast cancer care. Further studies with larger cohorts are needed to determine the clinical significance of HIIT-induced changes in terms of other outcomes in women with breast cancer.
PubMed: 37587859
DOI: 10.1002/cam4.6387