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Ageing Research Reviews Sep 2022To determine the effects of low- vs. high-intensity aerobic and resistance training on motor and cognitive function, brain activation, brain structure, and neurochemical... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To determine the effects of low- vs. high-intensity aerobic and resistance training on motor and cognitive function, brain activation, brain structure, and neurochemical markers of neuroplasticity and the association thereof in healthy young and older adults and in patients with multiple sclerosis, Parkinson's disease, and stroke.
DESIGN
Systematic review and robust variance estimation meta-analysis with meta-regression.
DATA SOURCES
Systematic search of MEDLINE, Web of Science, and CINAHL databases.
RESULTS
Fifty studies with 60 intervention arms and 2283 in-analyses participants were included. Due to the low number of studies, the three patient groups were combined and analyzed as a single group. Overall, low- (g=0.19, p = 0.024) and high-intensity exercise (g=0.40, p = 0.001) improved neuroplasticity. Exercise intensity scaled with neuroplasticity only in healthy young adults but not in healthy older adults or patient groups. Exercise-induced improvements in neuroplasticity were associated with changes in motor but not cognitive outcomes.
CONCLUSION
Exercise intensity is an important variable to dose and individualize the exercise stimulus for healthy young individuals but not necessarily for healthy older adults and neurological patients. This conclusion warrants caution because studies are needed that directly compare the effects of low- vs. high-intensity exercise on neuroplasticity to determine if such changes are mechanistically and incrementally linked to improved cognition and motor function.
Topics: Aged; Biomarkers; Cognition; Exercise; Humans; Multiple Sclerosis; Neuronal Plasticity; Resistance Training
PubMed: 35853549
DOI: 10.1016/j.arr.2022.101698 -
International Journal of Environmental... Apr 2018Childhood is an important and sensitive period for cognitive development. There is limited published research regarding the relationship between sports and cognitive...
Childhood is an important and sensitive period for cognitive development. There is limited published research regarding the relationship between sports and cognitive functions in children. We present studies that demonstrate the influence of physical activity on health, especially a positive correlation between sports and cognitive functions. The keywords “children, cognition, cognitive function, physical activity, and brain” were searched for using PsycInfo, Medline, and Google Scholar, with publication dates ranging from January 2000 to November 2017. Of the 617 results, 58 articles strictly connected to the main topics of physical activity and cognitive functioning were then reviewed. The areas of attention, thinking, language, learning, and memory were analyzed relative to sports and childhood. Results suggest that engaging in sports in late childhood positively influences cognitive and emotional functions. There is a paucity of publications that investigate the impact of sports on pre-adolescents’ cognitive functions, or explore which cognitive functions are developed by which sporting disciplines. Such knowledge would be useful in developing training programs for pre-adolescents, aimed at improving cognitive functions that may guide both researchers and practitioners relative to the wide range of benefits that result from physical activity.
Topics: Attention; Child; Cognition; Exercise; Humans; Language; Memory; Sports
PubMed: 29671803
DOI: 10.3390/ijerph15040800 -
The Cochrane Database of Systematic... Mar 2020Levels of physical activity and physical fitness are low after stroke. Interventions to increase physical fitness could reduce mortality and reduce disability through... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Levels of physical activity and physical fitness are low after stroke. Interventions to increase physical fitness could reduce mortality and reduce disability through increased function.
OBJECTIVES
The primary objectives of this updated review were to determine whether fitness training after stroke reduces death, death or dependence, and disability. The secondary objectives were to determine the effects of training on adverse events, risk factors, physical fitness, mobility, physical function, health status and quality of life, mood, and cognitive function.
SEARCH METHODS
In July 2018 we searched the Cochrane Stroke Trials Register, CENTRAL, MEDLINE, Embase, CINAHL, SPORTDiscus, PsycINFO, and four additional databases. We also searched ongoing trials registers and conference proceedings, screened reference lists, and contacted experts in the field.
SELECTION CRITERIA
Randomised trials comparing either cardiorespiratory training or resistance training, or both (mixed training), with usual care, no intervention, or a non-exercise intervention in stroke survivors.
DATA COLLECTION AND ANALYSIS
Two review authors independently selected studies, assessed quality and risk of bias, and extracted data. We analysed data using random-effects meta-analyses and assessed the quality of the evidence using the GRADE approach. Diverse outcome measures limited the intended analyses.
MAIN RESULTS
We included 75 studies, involving 3017 mostly ambulatory participants, which comprised cardiorespiratory (32 studies, 1631 participants), resistance (20 studies, 779 participants), and mixed training interventions (23 studies, 1207 participants). Death was not influenced by any intervention; risk differences were all 0.00 (low-certainty evidence). There were few deaths overall (19/3017 at end of intervention and 19/1469 at end of follow-up). None of the studies assessed death or dependence as a composite outcome. Disability scores were improved at end of intervention by cardiorespiratory training (standardised mean difference (SMD) 0.52, 95% CI 0.19 to 0.84; 8 studies, 462 participants; P = 0.002; moderate-certainty evidence) and mixed training (SMD 0.23, 95% CI 0.03 to 0.42; 9 studies, 604 participants; P = 0.02; low-certainty evidence). There were too few data to assess the effects of resistance training on disability. Secondary outcomes showed multiple benefits for physical fitness (VO peak and strength), mobility (walking speed) and physical function (balance). These physical effects tended to be intervention-specific with the evidence mostly low or moderate certainty. Risk factor data were limited or showed no effects apart from cardiorespiratory fitness (VO peak), which increased after cardiorespiratory training (mean difference (MD) 3.40 mL/kg/min, 95% CI 2.98 to 3.83; 9 studies, 438 participants; moderate-certainty evidence). There was no evidence of any serious adverse events. Lack of data prevents conclusions about effects of training on mood, quality of life, and cognition. Lack of data also meant benefits at follow-up (i.e. after training had stopped) were unclear but some mobility benefits did persist. Risk of bias varied across studies but imbalanced amounts of exposure in control and intervention groups was a common issue affecting many comparisons.
AUTHORS' CONCLUSIONS
Few deaths overall suggest exercise is a safe intervention but means we cannot determine whether exercise reduces mortality or the chance of death or dependency. Cardiorespiratory training and, to a lesser extent mixed training, reduce disability during or after usual stroke care; this could be mediated by improved mobility and balance. There is sufficient evidence to incorporate cardiorespiratory and mixed training, involving walking, within post-stroke rehabilitation programmes to improve fitness, balance and the speed and capacity of walking. The magnitude of VO peak increase after cardiorespiratory training has been suggested to reduce risk of stroke hospitalisation by ˜7%. Cognitive function is under-investigated despite being a key outcome of interest for patients. Further well-designed randomised trials are needed to determine the optimal exercise prescription, the range of benefits and any long-term benefits.
Topics: Activities of Daily Living; Exercise Therapy; Humans; Middle Aged; Muscle Strength; Oxygen Consumption; Physical Fitness; Physical Functional Performance; Postural Balance; Randomized Controlled Trials as Topic; Resistance Training; Stroke; Stroke Rehabilitation; Survivors; Walking; Walking Speed
PubMed: 32196635
DOI: 10.1002/14651858.CD003316.pub7 -
PloS One 2017Attention deficit hyperactivity disorder (ADHD) is one of the most commonly diagnosed psychiatric disorders in childhood. A wide variety of treatments have been used for... (Meta-Analysis)
Meta-Analysis
The pharmacological and non-pharmacological treatment of attention deficit hyperactivity disorder in children and adolescents: A systematic review with network meta-analyses of randomised trials.
BACKGROUND
Attention deficit hyperactivity disorder (ADHD) is one of the most commonly diagnosed psychiatric disorders in childhood. A wide variety of treatments have been used for the management of ADHD. We aimed to compare the efficacy and safety of pharmacological, psychological and complementary and alternative medicine interventions for the treatment of ADHD in children and adolescents.
METHODS AND FINDINGS
We performed a systematic review with network meta-analyses. Randomised controlled trials (≥ 3 weeks follow-up) were identified from published and unpublished sources through searches in PubMed and the Cochrane Library (up to April 7, 2016). Interventions of interest were pharmacological (stimulants, non-stimulants, antidepressants, antipsychotics, and other unlicensed drugs), psychological (behavioural, cognitive training and neurofeedback) and complementary and alternative medicine (dietary therapy, fatty acids, amino acids, minerals, herbal therapy, homeopathy, and physical activity). The primary outcomes were efficacy (treatment response) and acceptability (all-cause discontinuation). Secondary outcomes included discontinuation due to adverse events (tolerability), as well as serious adverse events and specific adverse events. Random-effects Bayesian network meta-analyses were conducted to obtain estimates as odds ratios (ORs) with 95% credibility intervals. We analysed interventions by class and individually. 190 randomised trials (52 different interventions grouped in 32 therapeutic classes) that enrolled 26114 participants with ADHD were included in complex networks. At the class level, behavioural therapy (alone or in combination with stimulants), stimulants, and non-stimulant seemed significantly more efficacious than placebo. Behavioural therapy in combination with stimulants seemed superior to stimulants or non-stimulants. Stimulants seemed superior to behavioural therapy, cognitive training and non-stimulants. Behavioural therapy, stimulants and their combination showed the best profile of acceptability. Stimulants and non-stimulants seemed well tolerated. Among medications, methylphenidate, amphetamine, atomoxetine, guanfacine and clonidine seemed significantly more efficacious than placebo. Methylphenidate and amphetamine seemed more efficacious than atomoxetine and guanfacine. Methylphenidate and clonidine seemed better accepted than placebo and atomoxetine. Most of the efficacious pharmacological treatments were associated with harms (anorexia, weight loss and insomnia), but an increased risk of serious adverse events was not observed. There is lack of evidence for cognitive training, neurofeedback, antidepressants, antipsychotics, dietary therapy, fatty acids, and other complementary and alternative medicine. Overall findings were limited by the clinical and methodological heterogeneity, small sample sizes of trials, short-term follow-up, and the absence of high-quality evidence; consequently, results should be interpreted with caution.
CONCLUSIONS
Clinical differences may exist between the pharmacological and non-pharmacological treatment used for the management of ADHD. Uncertainties about therapies and the balance between benefits, costs and potential harms should be considered before starting treatment. There is an urgent need for high-quality randomised trials of the multiple treatments for ADHD in children and adolescents. PROSPERO, number CRD42014015008.
Topics: Adolescent; Attention Deficit Disorder with Hyperactivity; Behavior Therapy; Central Nervous System Depressants; Central Nervous System Stimulants; Child; Complementary Therapies; Female; Humans; Male; Randomized Controlled Trials as Topic
PubMed: 28700715
DOI: 10.1371/journal.pone.0180355 -
Journal of Neurology Jun 2023Motor-cognitive training in Parkinson's disease (PD) can positively affect gait and balance, but whether motor-cognitive (dual-task) performance improves is unknown.... (Meta-Analysis)
Meta-Analysis Review
Motor-cognitive training in Parkinson's disease (PD) can positively affect gait and balance, but whether motor-cognitive (dual-task) performance improves is unknown. This meta-analysis, therefore, aimed to establish the current evidence on the effects of motor-cognitive training on dual-task performance in PD. Systematic searches were conducted in five databases and 11 studies with a total of 597 people (mean age: 68.9 years; mean PD duration: 6.8 years) were included. We found a mean difference in dual-task gait speed (0.12 m/s (95% CI 0.08, 0.17)), dual-task cadence (2.91 steps/min (95% CI 0.08, 5.73)), dual-task stride length (10.12 cm (95% CI 4.86, 15.38)) and dual-task cost on gait speed (- 8.75% (95% CI - 14.57, - 2.92)) in favor of motor-cognitive training compared to controls. The GRADE analysis revealed that the findings were based on high certainty evidence. Thus, we can for the first time systematically show that people with PD can improve their dual-task ability through motor-cognitive training.
Topics: Humans; Aged; Task Performance and Analysis; Parkinson Disease; Cognitive Training; Gait; Walking Speed
PubMed: 36820916
DOI: 10.1007/s00415-023-11610-8 -
British Journal of Sports Medicine May 2018To assess the relative effects of different types of exercise and other non-pharmaceutical interventions on cancer-related fatigue (CRF) in patients during and after... (Meta-Analysis)
Meta-Analysis Review
Exercise and other non-pharmaceutical interventions for cancer-related fatigue in patients during or after cancer treatment: a systematic review incorporating an indirect-comparisons meta-analysis.
AIM
To assess the relative effects of different types of exercise and other non-pharmaceutical interventions on cancer-related fatigue (CRF) in patients during and after cancer treatment.
DESIGN
Systematic review and indirect-comparisons meta-analysis.
DATA SOURCES
Articles were searched in PubMed, Cochrane CENTRAL and published meta-analyses.
ELIGIBILITY CRITERIA FOR SELECTING STUDIES
Randomised studies published up to January 2017 evaluating different types of exercise or other non-pharmaceutical interventions to reduce CRF in any cancer type during or after treatment.
STUDY APPRAISAL AND SYNTHESIS
Risk of bias assessment with PEDro criteria and random effects Bayesian network meta-analysis.
RESULTS
We included 245 studies. Comparing the treatments with usual care during cancer treatment, relaxation exercise was the highest ranked intervention with a standardisedmean difference (SMD) of -0.77 (95% Credible Interval (CrI) -1.22 to -0.31), while massage (-0.78; -1.55 to -0.01), cognitive-behavioural therapy combined with physical activity (combined CBT, -0.72; -1.34 to -0.09), combined aerobic and resistance training (-0.67; -1.01 to -0.34), resistance training (-0.53; -1.02 to -0.03), aerobic (-0.53; -0.80 to -0.26) and yoga (-0.51; -1.01 to 0.00) all had moderate-to-large SMDs. After cancer treatment, yoga showed the highest effect (-0.68; -0.93 to -0.43). Combined aerobic and resistance training (-0.50; -0.66 to -0.34), combined CBT (-0.45; -0.70 to -0.21), Tai-Chi (-0.45; -0.84 to -0.06), CBT (-0.42; -0.58 to -0.25), resistance training (-0.35; -0.62 to -0.08) and aerobic (-0.33; -0.51 to -0.16) showed all small-to-moderate SMDs.
CONCLUSIONS
Patients can choose among different effective types of exercise and non-pharmaceutical interventions to reduce CRF.
Topics: Cognitive Behavioral Therapy; Exercise Therapy; Fatigue; Massage; Neoplasms; Randomized Controlled Trials as Topic; Relaxation Therapy; Resistance Training; Tai Ji; Yoga
PubMed: 28501804
DOI: 10.1136/bjsports-2016-096422 -
Neurology Jan 2018To update the 2001 American Academy of Neurology (AAN) guideline on mild cognitive impairment (MCI).
Practice guideline update summary: Mild cognitive impairment: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology.
OBJECTIVE
To update the 2001 American Academy of Neurology (AAN) guideline on mild cognitive impairment (MCI).
METHODS
The guideline panel systematically reviewed MCI prevalence, prognosis, and treatment articles according to AAN evidence classification criteria, and based recommendations on evidence and modified Delphi consensus.
RESULTS
MCI prevalence was 6.7% for ages 60-64, 8.4% for 65-69, 10.1% for 70-74, 14.8% for 75-79, and 25.2% for 80-84. Cumulative dementia incidence was 14.9% in individuals with MCI older than age 65 years followed for 2 years. No high-quality evidence exists to support pharmacologic treatments for MCI. In patients with MCI, exercise training (6 months) is likely to improve cognitive measures and cognitive training may improve cognitive measures.
MAJOR RECOMMENDATIONS
Clinicians should assess for MCI with validated tools in appropriate scenarios (Level B). Clinicians should evaluate patients with MCI for modifiable risk factors, assess for functional impairment, and assess for and treat behavioral/neuropsychiatric symptoms (Level B). Clinicians should monitor cognitive status of patients with MCI over time (Level B). Cognitively impairing medications should be discontinued where possible and behavioral symptoms treated (Level B). Clinicians may choose not to offer cholinesterase inhibitors (Level B); if offering, they must first discuss lack of evidence (Level A). Clinicians should recommend regular exercise (Level B). Clinicians may recommend cognitive training (Level C). Clinicians should discuss diagnosis, prognosis, long-term planning, and the lack of effective medicine options (Level B), and may discuss biomarker research with patients with MCI and families (Level C).
Topics: Cognitive Dysfunction; Delphi Technique; Humans
PubMed: 29282327
DOI: 10.1212/WNL.0000000000004826 -
Journal of Affective Disorders Aug 2022Social anxiety is highly prevalent and has increased in young adults during the COVID-19 pandemic. Since social anxiety negatively impacts interpersonal functioning,... (Review)
Review
BACKGROUND
Social anxiety is highly prevalent and has increased in young adults during the COVID-19 pandemic. Since social anxiety negatively impacts interpersonal functioning, identifying aspects of social cognition that may be impaired can increase our understanding of the development and maintenance of social anxiety disorder. However, to date, studies examining associations between social anxiety and social cognition have resulted in mixed findings.
METHODS
The aim of this systematic review was to summarize the literature on the association between social anxiety and social cognition, while also considering several potential moderators and covariates that may influence findings.
RESULTS
A systematic search identified 52 studies. Results showed mixed evidence for the association between social anxiety and lower-level social cognitive processes (emotion recognition and affect sharing) and a trend for a negative association with higher-level social cognitive processes (theory of mind and empathic accuracy). Most studies examining valence-specific effects found a significant negative association for positive and neutral stimuli.
LIMITATIONS
Not all aspects of social cognition were included (e.g., attributional bias) and we focused on adults and not children, limiting the scope of the review.
CONCLUSIONS
Future studies would benefit from the inclusion of relevant moderators and covariates, multiple well-validated measures within the same domain of social cognition, and assessments of interpersonal functioning outside of the laboratory. Additional research examining the moderating role of attention or interpretation biases on social cognitive performance, and the potential benefit of social cognitive skills training for social anxiety, could inform and improve existing cognitive behavioral interventions.
Topics: Anxiety; COVID-19; Cognition; Humans; Pandemics; Social Cognition; Social Perception; Young Adult
PubMed: 35490878
DOI: 10.1016/j.jad.2022.04.130 -
The Cochrane Database of Systematic... Jun 2013Cognitive impairments, particularly memory problems, are a defining feature of the early stages of Alzheimer's disease (AD) and vascular dementia. Cognitive training and... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Cognitive impairments, particularly memory problems, are a defining feature of the early stages of Alzheimer's disease (AD) and vascular dementia. Cognitive training and cognitive rehabilitation are specific interventional approaches designed to address difficulties with memory and other aspects of cognitive functioning. The present review is an update of previous versions of this review.
OBJECTIVES
The main aim of the current review was to evaluate the effectiveness and impact of cognitive training and cognitive rehabilitation for people with mild Alzheimer's disease or vascular dementia in relation to important cognitive and non-cognitive outcomes for the person with dementia and the primary caregiver in the short, medium and long term.
SEARCH METHODS
The CDCIG Specialized Register, ALOIS, which contains records from MEDLINE, EMBASE, CINAHL, PsycINFO, LILACS and many other clinical trial databases and grey literature sources, was most recently searched on 2 November 2012.
SELECTION CRITERIA
Randomised controlled trials (RCTs), published in English, comparing cognitive rehabilitation or cognitive training interventions with control conditions, and reporting relevant outcomes for the person with dementia and/or the family caregiver, were considered for inclusion.
DATA COLLECTION AND ANALYSIS
Eleven RCTs reporting cognitive training interventions were included in the review. A large number of measures were used in the different studies, and meta-analysis could be conducted for 11 of the primary and secondary outcomes of interest. Several outcomes were not measured in any of the studies. The unit of analysis in the meta-analysis was the change from baseline score. Overall estimates of treatment effect were calculated using a fixed-effect model, and statistical heterogeneity was measured using a standard Chi(2) statistic. One RCT of cognitive rehabilitation was identified, allowing examination of effect sizes, but no meta-analysis could be conducted.
MAIN RESULTS
Cognitive training was not associated with positive or negative effects in relation to any reported outcomes. The overall quality of the trials was low to moderate. The single RCT of cognitive rehabilitation found promising results in relation to a number of participant and caregiver outcomes, and was generally of high quality.
AUTHORS' CONCLUSIONS
Available evidence regarding cognitive training remains limited, and the quality of the evidence needs to improve. However, there is still no indication of any significant benefit derived from cognitive training. Trial reports indicate that some gains resulting from intervention may not be captured adequately by available standardised outcome measures. The results of the single RCT of cognitive rehabilitation show promise but are preliminary in nature. Further, well-designed studies of cognitive training and cognitive rehabilitation are required to obtain more definitive evidence. Researchers should describe and classify their interventions appropriately using available terminology.
Topics: Alzheimer Disease; Cognitive Behavioral Therapy; Dementia, Vascular; Humans; Randomized Controlled Trials as Topic
PubMed: 23740535
DOI: 10.1002/14651858.CD003260.pub2 -
Clinical Interventions in Aging 2017The use of dual-task training paradigm to enhance postural stability in patients with balance impairments is an emerging area of interest. The differential effects of... (Meta-Analysis)
Meta-Analysis Review
The use of dual-task training paradigm to enhance postural stability in patients with balance impairments is an emerging area of interest. The differential effects of dual tasks and dual-task training on postural stability still remain unclear. A systematic review and meta-analysis were conducted to analyze the effects of dual task and training application on static and dynamic postural stability among various population groups. Systematic identification of published literature was performed adhering to Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines, from inception until June 2016, on the online databases Scopus, PEDro, MEDLINE, EMBASE, and SportDiscus. Experimental studies analyzing the effects of dual task and dual-task training on postural stability were extracted, critically appraised using PEDro scale, and then summarized according to modified PEDro level of evidence. Of 1,284 records, 42 studies involving 1,480 participants met the review's inclusion criteria. Of the studies evaluating the effects of dual-task training on postural stability, 87.5% of the studies reported significant enhancements, whereas 30% of the studies evaluating acute effects of dual tasks on posture reported significant enhancements, 50% reported significant decrements, and 20% reported no effects. Meta-analysis of the pooled studies revealed moderate but significant enhancements of dual-task training in elderly participants (95% CI: 1.16-2.10) and in patients suffering from chronic stroke (-0.22 to 0.86). The adverse effects of complexity of dual tasks on postural stability were also revealed among patients with multiple sclerosis (-0.74 to 0.05). The review also discusses the significance of verbalization in a dual-task setting for increasing cognitive-motor interference. Clinical implications are discussed with respect to practical applications in rehabilitation settings.
Topics: Exercise; Humans; Postural Balance
PubMed: 28356727
DOI: 10.2147/CIA.S125201