Prospective associations between systolic blood pressure, serum cholesterol, and physical activity behaviour and the development of cardiovascular disease.

AIMS: To systematically appraise and summarise meta-analyses of longitudinal studies to determine the effect size, and quality and certainty of the evidence summaries for systolic blood pressure (SBP), serum cholesterol, and physical activity behaviour in developing cardiovascular disease (CVD). METHODS AND RESULTS: An umbrella review was conducted by searching MEDLINE, Embase, and Scopus databases. Eligible meta-analyses were longitudinal studies investigating the association between SBP, serum cholesterol, or physical activity behaviour on CVD development. Summary risk estimates were extracted. Quality and certainty of the evidence summaries of included records were performed using AMSTAR 2 and GRADE, respectively. Forty-one eligible records were found of which thirteen related to SBP, five to cholesterol, and twenty-three to physical activity behaviour. The quality and certainty of the evidence summaries were variable, with most studies rating 'low'. Reported risk estimates for the risk of developing CVD ranged from: no change to a 68% decreased risk for lower SBP; a 21% increased risk to a 44% decreased risk for lower cholesterol; and a 1% decreased risk to a 56% decreased risk for higher physical activity levels. CONCLUSIONS: There were strong associations with CVD risk at the meta-analysis level for all three exposures, with a proportionally greater number of meta-analyses and primary studies for physical activity than SBP or serum cholesterol. Given the number of meta-analyses and similar CVD risk reductions and certainty of evidence associated with physical activity behaviour, there is a strong case for its routine assessment alongside SBP and serum cholesterol in primary CVD prevention.

Water-Based Interventions for People With Neurological Disability, Autism, and Intellectual Disability: A Scoping Review.

The purpose of this study was to produce a descriptive overview of the types of water-based interventions for people with neurological disability, autism, and intellectual disability and to determine how outcomes have been evaluated. Literature was searched through MEDLINE, EMBASE, Ovid Emcare, SPORTDiscus, Google Scholar, and Google. One hundred fifty-three papers met the inclusion criteria, 115 hydrotherapy, 62 swimming, 18 SCUBA (self-contained underwater breathing apparatus), and 18 other water-based interventions. Common conditions included cerebral palsy, spinal cord injury, Parkinson's disease, and intellectual disability. Fifty-four papers explored physical outcomes, 36 psychosocial outcomes, and 24 both physical and psychosocial outcomes, with 180 different outcome measures reported. Overall, there is a lack of high-quality evidence for all intervention types. This review provides a broad picture of water-based interventions and associated research. Future research, guided by this scoping review, will allow a greater understanding of the potential benefits for people with neurological disability, autism, and intellectual disability.

Comparison of objectively measured and estimated cardiorespiratory fitness to predict all-cause and cardiovascular disease mortality in adults: A systematic review and meta-analysis of 42 studies representing 35 cohorts and 3.8 million observations.

BACKGROUND: Cardiorespiratory fitness (CRF) is a powerful health marker recommended by the American Heart Association as a clinical vital sign. Comparing the predictive validity of objectively measured CRF (the "gold standard") and estimated CRF is clinically relevant because estimated CRF is more feasible. Our objective was to meta-analyze cohort studies to compare the associations of objectively measured, exercise-estimated, and non-exercise-estimated CRF with all-cause and cardiovascular disease (CVD) mortality in adults. METHODS: Systematic searches were conducted in 9 databases (MEDLINE, SPORTDiscus, Embase, Scopus, PsycINFO, Web of Science, PubMed, CINAHL, and the Cochrane Library) up to April 11, 2024. We included full-text refereed cohort studies published in English that quantified the association (using risk estimates with 95% confidence intervals (95%CIs)) of objectively measured, exercise-estimated, and non-exercise-estimated CRF with all-cause and CVD mortality in adults. CRF was expressed as metabolic equivalents (METs) of task. Pooled relative risks (RR) for all-cause and CVD mortality per 1-MET (3.5 mL/kg/min) higher level of CRF were quantified using random-effects models. RESULTS: Forty-two studies representing 35 cohorts and 3,813,484 observations (81% male) (362,771 all-cause and 56,471 CVD deaths) were included. The pooled RRs for all-cause and CVD mortality per higher MET were 0.86 (95%CI: 0.83-0.88) and 0.84 (95%CI: 0.80-0.87), respectively. For both all-cause and CVD mortality, there were no statistically significant differences in RR per higher MET between objectively measured (RR range: 0.86-0.90) and maximal exercise-estimated (RR range: 0.85-0.86), submaximal exercise-estimated (RR range: 0.91-0.94), and non-exercise-estimated CRF (RR range: 0.81-0.85). CONCLUSION: Objectively measured and estimated CRF showed similar dose-response associations for all-cause and CVD mortality in adults. Estimated CRF could provide a practical and robust alternative to objectively measured CRF for assessing mortality risk across diverse populations. Our findings underscore the health-related benefits of higher CRF and advocate for its integration into clinical practice to enhance risk stratification.

Recommendations for objective cardiovascular assessment to inform clinical exercise prescription: An Exercise Physiologist and Physiotherapist expert consensus.

OBJECTIVES: Exercise is beneficial in managing cardiovascular health. Objective assessments of cardiovascular function assist in identifying the presence or absence of exertional symptoms, and functional and physiological thresholds necessary to inform safe and effective exercise programmes. This study aimed to generate expert consensus on assessments of cardiovascular function to support clinical decision-making for professionals providing clinical exercise services. DESIGN: Three-round e-Delphi. METHODS: Expert Exercise Physiologists and Physiotherapists were recruited to participate in an e-Delphi. Experts were asked to list all objective cardiovascular assessments deemed necessary to inform safe and effective exercise prescription. In subsequent e-Delphi rounds, experts rated the importance of each item, provided a rationale to support their assertions, and reconsidered others' ratings and rationale to shift or reaffirm their position. These results were then translated into a clinical guidance document by the authors in consultation with a Cardiologist and an experienced Exercise Physiologist with expertise in cardiovascular assessment. RESULTS: Thirty-one experts participated in the e-Delphi and fourteen participants completed all three rounds. Forty objective assessments were initially suggested. Six items reached consensus by the end of Round 2 (resting and exercise heart rate, resting, exercise, and recovery blood pressure, and peak exercise-induced rating of perceived exertion). One additional item reached consensus in Round 3 (exercise oxygen saturation). CONCLUSIONS: In the absence of research evidence, the collective experience and insights of an expert panel can inform an evidence gap. Further research is required to determine the feasibility of implementing these seven assessments in practice where CV assessment is indicated.

Interventions Using Wearable Activity Trackers to Improve Patient Physical Activity and Other Outcomes in Adults Who Are Hospitalized: A Systematic Review and Meta-analysis.

Importance: Low levels of physical activity during hospitalization are thought to contribute to a range of poor outcomes for patients. Using wearable activity trackers during hospitalization may help improve patient activity, sedentary behavior, and other outcomes. Objective: To evaluate the association of interventions that use wearable activity trackers during hospitalization with patient physical activity, sedentary behavior, clinical outcomes, and hospital efficiency outcomes. Data Sources: OVID MEDLINE, CINAHL, Embase, EmCare, PEDro, SportDiscuss, and Scopus databases were searched from inception to March 2022. The Cochrane Central Register for Controlled trials, ClinicalTrials.gov, and World Health Organization Clinical Trials Registry were also searched for registered protocols. No language restrictions were imposed. Study Selection: Randomized clinical trials and nonrandomized clinical trials of interventions that used wearable activity trackers to increase physical activity or reduce sedentary behavior in adults (aged 18 years or older) who were hospitalized were included. Data Extraction and Synthesis: Study selection, data extraction, and critical appraisal were conducted in duplicate. Data were pooled for meta-analysis using random-effects models. The Preferred Reporting Items for Systematic Reviews and Meta-analyses guideline was followed. Main Outcomes and Measures: The primary outcomes were objectively measured physical activity or sedentary behavior. Secondary outcomes included clinical outcomes (eg, physical function, pain, mental health), and hospital efficiency outcomes (eg, length of stay, readmission). Results: Fifteen studies with a total of 1911 participants were included, representing various surgical cohorts (4 studies), stroke rehabilitation (3 studies), orthopedic rehabilitation (3 studies), mixed rehabilitation (3 studies), and mixed medical (2 studies). All studies were included in meta-analyses. There was a significant association between wearable activity tracker interventions with higher overall physical activity (standardized mean difference, 0.35; 95% CI, 0.15 to 0.54; I2 = 72%; P < .002) and less sedentary behavior (mean difference, -35.46 min/d; 95% CI, -57.43 to -13.48 min/d; I2 = 0; P = .002), and a significant association between wearable activity tracker interventions with improvements in physical function (standardized mean difference, 0.27; 95% CI, 0.08 to 0.46; I2 = 0; P = .006) compared with usual care. There was no significant association between wearable activity tracker interventions with pain, mental health, length of stay, or readmission risk. Conclusions and Relevance: In this systematic review and meta-analysis, interventions that used wearable activity trackers with patients who are hospitalized were associated with higher physical activity levels, less sedentary behavior, and better physical functioning compared with usual care.

Lack of Cited Evidence Underpinning Recommendations for Objective Assessment of Cardiovascular Function to Inform Exercise Prescription: A Systematic Review.

BACKGROUND: The effectiveness of exercise in managing cardiovascular (CV) health and function is well established. Less clear is the process for optimising the safety and efficacy of an intervention, particularly how objective assessments might inform this process. OBJECTIVE: The aim of this review was to investigate the cited evidence underpinning recommendations for assessing CV function to inform the safe and effective prescription of exercise in populations with established CV disease, as published in documents to guide practice authored by prominent organisations in cardiology and sports medicine. METHODS: A systematic review of position statements and guiding documents on exercise prescription for CV health was conducted. Included documents were published between 1997 and 2016. RESULTS: Following removal of duplicates, 3158 documents were considered, with full-text screening required for 334. Twenty-seven documents were included which provided 106 individual recommendations for specific objective assessments. Of the total number of recommendations, 60% had no accompanying citation and 28% of recommendations provided citations that did not directly support the statement made. Additionally, 52% of included documents did not state the methods of document development. That is, it was not clear if there was a literature review and/or expert consensus that was used to form recommendations included within. CONCLUSION: Almost no cited evidence underpinning the extracted recommendations from the included guiding documents, nor any acknowledgement of this deficiency was established. There were limited explanations found for the methods involved in developing such guiding documents.