Analysis of behavioral change techniques used in exercise and nutritional interventions targeting adults around retirement age with sarcopenic obesity in a systematic review.

BACKGROUND: Sarcopenic obesity significantly burdens health and autonomy. Strategies to intervene in or prevent sarcopenic obesity generally focus on losing body fat and building or maintaining muscle mass and function. For a lifestyle intervention, it is important to consider psychological aspects such as behavioral change techniques (BCTs) to elicit a long-lasting behavioral change. PURPOSE: The study was carried out to analyze BCTs used in exercise and nutritional interventions targeting community-dwelling adults around retirement age with sarcopenic obesity. METHODS: We conducted an analysis of articles cited in an existing systematic review on the effectiveness of exercise and nutritional interventions on physiological outcomes in community-dwelling adults around retirement age with sarcopenic obesity. We identified BCTs used in these studies by applying a standardized taxonomy. RESULTS: Only nine BCTs were identified. Most BCTs were not used intentionally (82 %), and those used derived from the implementation of lifestyle components, such as exercise classes ("instructions on how to perform a behavior," "demonstration of the behavior," "behavioral practice/rehearsal," and "body changes"). Only two studies used BCTs intentionally to reinforce adherence in their interventions. CONCLUSIONS: Few studies integrated BCTs in lifestyle interventions for community-dwelling persons around retirement age with sarcopenic obesity. Future studies on interventions to counteract sarcopenic obesity should include well-established BCTs to foster adherence and, therefore, their effectiveness.

Exploring the effects of the COVID-19 pandemic on nurse managers.

BACKGROUND: Research shows that front-line nurses' workload and stress levels increased during the coronavirus disease 2019 (COVID-19) pandemic, however, there is little research of these factors in relation to nurse managers. Previous research undertaken in Austria found that some nurse managers working in nursing homes undertook clinical as well as managerial functions during the pandemic, a double burden that could have increased their stress levels and have had adverse psychological, physical and social consequences. AIM: To investigate the effects of the COVID-19 pandemic on nurse managers' workload, perceptions of teamwork and stress levels, and the physical, psychological and social consequences of working during the pandemic. METHOD: A cross-sectional design was used. Respondents (n=238) were sent an online questionnaire during the second wave of the pandemic (which in Austria was November 2020 to March 2021) containing questions on demographics and fear of infection, their current workload compared with pre-pandemic workload, their perceptions of the influence of the pandemic on teamwork, their levels of stress measured using the Perceived Stress Scale (PSS), and the physical, psychological and social consequences of working during the pandemic. RESULTS: Most respondents (95%) had to undertake more or much more work than usual during the pandemic, while just over half (52%) perceived that the influence of the pandemic on teamwork had been positive throughout or partially positive. Overall, the respondents' level of stress was moderate, as measured by the PSS. Around 28% of respondents were afraid of infecting someone other than themselves, notably their families, employees and patients. Fear for themselves, their families and their patients or residents were commonly reported psychological consequences of working during the pandemic, while confusion due to information overload was the second most commonly reported psychological consequence. CONCLUSION: Comparing results with previous research is difficult due to the lack of research of nurse managers' experiences of the pandemic. Fear appears to have been a major issue for nurse managers during the pandemic, particularly in relation to infection and information overload. This emphasises the need for healthcare organisations to focus on the mental health and well-being of nurse managers, as well as front-line staff, during and after crisis situations such as a pandemic. Organisations may consider reworking and adopting already-established COVID-19 regulations, schedules and local guidelines, particularly in terms of communication and infection control, which could help to reduce nurse managers' fear in future crisis situations.

Psychosocial interventions for healthcare workers during the COVID-19 pandemic: rapid review and meta-analysis.

This rapid review was conducted by following a predefined protocol developed by the Cochrane Rapid Reviews Methods Group. A total of 172 potential reviews and 167 primary studies of interest were found. AMSTAR II was used to assess the quality of the included reviews and the JBI Checklist for Randomized Controlled Trials for primary studies. Overall, four studies were included in this review. The study quality ranged from 5 to 12 out of 13 possible stars. No robust evidence was found that psychosocial interventions can reduce psychological distress. No significant effect could be found regarding post-traumatic stress. Two studies on anxiety were identified, one which showed an effect and another which did not. The psychosocial intervention had no beneficial effect on burnout and depression, whereas providing a mindfulness- or relaxation-based intervention resulted in a significant improvement in sleep quality. By considering the secondary results and results of previous reviews, a combination of training and mindfulness seems to be beneficial for decreasing anxiety and stress in home care workers. In summary, the evidence-based recommendations are still limited and, therefore, more evidence is needed to make a general statement of high certainty about the effects.

Effects of Nutrition and Exercise Interventions on Persons with Sarcopenic Obesity: An Umbrella Review of Meta-Analyses of Randomised Controlled Trials.

BACKGROUND: Sarcopenic obesity (SO) is an increasing phenomenon and has been linked to several negative health consequences. The aim of this umbrella review is the assessment of effectiveness and certainty of evidence of nutrition and exercise interventions in persons with SO. METHOD: We searched for meta-analyses of RCTs in PubMed, EMBASE and CENTRAL that had been conducted in the last five years, focusing on studies on the treatment and prevention of SO. The primary endpoints were parameters for SO, such as body fat in %, skeletal muscle mass index (SMMI), gait speed, leg strength and grip strength. The methodological quality was evaluated using AMSTAR and the certainty of evidence was assessed using GRADE. RESULTS: Four systematic reviews with between 30 to 225 participants were included in the umbrella review. These examined four exercise interventions, two nutrition interventions and four interventions that combined nutrition and exercise. Resistance training was the most frequently studied intervention and was found to improve gait speed by 0.14 m/s to 0.17 m/s and lower leg strength by 9.97 kg. Resistance, aerobic, mixed exercise and hypocaloric diet combined with protein supplementation is not significantly effective on selected outcomes for persons with SO compared to no intervention. The low number of primary studies included in the reviews resulted in moderate to very low certainty of evidence. CONCLUSION: Despite the lack in certainty of evidence, resistance training may be a suitable intervention for persons with SO, in particular for improving muscle function. Nevertheless, further research is necessary to strengthen the evidence.

Nutrition and Exercise Interventions to Improve Body Composition for Persons with Overweight or Obesity Near Retirement Age: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials.

The retirement phase is an opportunity to integrate healthy (nutrition/exercise) habits into daily life. We conducted this systematic review to assess which nutrition and exercise interventions most effectively improve body composition (fat/muscle mass), body mass index (BMI), and waist circumference (WC) in persons with obesity/overweight near retirement age (ages 55-70 y). We conducted a systematic review and network meta-analysis (NMA) of randomized controlled trials, searching 4 databases from their inception up to July 12, 2022. The NMA was based on a random effects model, pooled mean differences, standardized mean differences, their 95% confidence intervals, and correlations with multi-arm studies. Subgroup and sensitivity analyses were also conducted. Ninety-two studies were included, 66 of which with 4957 participants could be used for the NMA. Identified interventions were clustered into 12 groups: no intervention, energy restriction (i.e., 500-1000 kcal), energy restriction plus high-protein intake (1.1-1.7 g/kg/body weight), intermittent fasting, mixed exercise (aerobic and resistance), resistance training, aerobic training, high protein plus resistance training, energy restriction plus high protein plus exercise, energy restriction plus resistance training, energy restriction plus aerobic training, and energy restriction plus mixed exercise. Intervention durations ranged from 8 wk to 6 mo. Body fat was reduced with energy restriction plus any exercise or plus high-protein intake. Energy restriction alone was less effective and tended to decrease muscle mass. Muscle mass was only significantly increased with mixed exercise. All other interventions including exercise effectively preserved muscle mass. A BMI and/or WC decrease was achieved with all interventions except aerobic training/resistance training alone or resistance training plus high protein. Overall, the most effective strategy for nearly all outcomes was combining energy restriction with resistance training or mixed exercise and high protein. Health care professionals involved in the management of persons with obesity need to be aware that an energy-restricted diet alone may contribute to sarcopenic obesity in persons near retirement age. This network meta-analysis is registered at https://www.crd.york.ac.uk/prospero/ as CRD42021276465.

Nutritional and exercise interventions in individuals with sarcopenic obesity around retirement age: a systematic review and meta-analysis.

CONTEXT: Retirement is an opportune time for people to establish new healthy routines. Exercise and nutritional interventions are promising in the prevention and treatment of sarcopenic obesity. OBJECTIVE: This systematic review aimed.to assess the effectiveness of nutritional and exercise interventions for the treatment of sarcopenic obesity in persons of retirement age. DATA SOURCES: PubMed, Embase, CINAHL, and CENTRAL databases were searched in September 2021 for randomized controlled trials; a manual search was also conducted. The search yielded 261 studies, of which 11 were eligible for inclusion. DATA EXTRACTION: Studies of community-dwelling individuals with sarcopenic obesity receiving any nutritional or exercise intervention ≥ 8 weeks with the mean age ± standard deviation between 50 and 70 years were included. Primary endpoint was body composition, and secondary endpoints were body mass index, muscle strength, and physical function. The literature review, study selection, data extraction, and risk-of-bias assessment were performed by two reviewers independently. Data were pooled for meta-analysis when possible. RESULTS: Meta-analysis was only possible for the exposure "resistance training" and the exposure "training (resistance or aerobic)" in combination with the exposure "added protein" as compared with "no intervention" or "training alone." Resistance training led to a significant body fat reduction of -1.53% (95%CI, -2.91 to -0.15), an increase in muscle mass of 2.72% (95%CI, 1.23-4.22), an increase in muscle strength of 4.42 kg (95%CI, 2.44-6.04), and a slight improvement in gait speed of 0.17 m/s (95%CI, 0.01-0.34). Protein combined with an exercise intervention significantly reduces fat mass (-0.80 kg; 95%CI, -1.32 to -0.28). Some individual studies of dietary or food supplement interventions for which data could not be pooled showed positive effects on body composition. CONCLUSION: Resistance training is an effective treatment for persons of retirement age with sarcopenic obesity. Increased protein intake combined with exercise may increase reductions in fat mass. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration no. CRD42021276461.

Rapid review and meta-analysis of the effectiveness of personal protective equipment for healthcare workers during the COVID-19 pandemic.

Objectives: Healthcare workers (HCWs) worldwide have and are using personal protective equipment (PPE) as COVID-19 prevention measures, including gloves, gowns, goggles, masks and hand hygiene. Although several reviews have been published on the effectiveness of PPE, these often include studies on other inflectional diseases. This is problematic, because these diseases differ with regard to, e.g. the transmissibility and viral loads in the days after infection. Therefore, we assessed the effectiveness of PPE to protect HCWs from COVID-19 infections. Design: Rapid review of literature. Methods: We followed a practical guide to conduct the rapid review based on a protocol established by the Cochrane Rapid Reviews Methods Group. Meta-analyses have been conducted to synthesize the results. The confidence in the evidence was determined using the GRADE method. Results: We found 461 reviews and 208 primary studies, of which 16 systematic reviews included 11 observational studies of interest. Wearing PPE conferred significant protection against infection with COVID-19 as opposed to not wearing adequate PPE. Overall, the review results show that wearing face masks can significantly protect HCWs from infection. We found no effects for wearing gloves and gowns. Practicing thorough hand hygiene and having proper PPE, as compared to lacking proper PPE, showed a protective but not statistically significant effect. No studies reported the side effects of wearing PPE or acceptance rates. Conclusion: This evidence supports PPE use by HCW, and especially N95 masks, to reduce the risk of a COVID-19 infection.