Efficacy of postexposure prophylaxis with doxycycline (Doxy-PEP) in reducing sexually transmitted infections: a systematic review and meta-analysis.

OBJECTIVES: This systematic review aimed to identify the efficacy, adherence, safety and impact on antimicrobial resistance of postexposure prophylaxis with doxycycline (Doxy-PEP) in different populations. METHODS: We searched MEDLINE (via PubMed), Embase and Cochrane CENTRAL databases from inception to 29 May 2024. Two reviewers independently screened the studies and extracted data. We included randomised clinical trials that evaluated the efficacy of Doxy-PEP within 72 hours after condomless sex. A random-effects meta-analysis was conducted to compare the risk of bacterial sexually transmitted infections (STIs) between Doxy-PEP and no prophylaxis. The risk of bias was assessed with the risk-of-bias tool for randomized trials (RoB 2) and the certainty of evidence (CoE) with Grading of Recommendations Assessment, Development and Evaluation (GRADE). RESULTS: Four studies were included in the systematic review, totalling 1727 participants. Studies were conducted between 2015 and 2022. Most participants (73%) were men who have sex with men, and the median age of participants varied from 24 to 43 years. Doxy-PEP reduced the risk of having any bacterial STI in different populations by 46% (hazard ratio (HR) 0.54; 95% CI 0.39 to 0.75; CoE moderate), the risk of chlamydia by 65% (relative risk (RR) 0.35; 95% CI 0.15 to 0.82; CoE low) and syphilis by 77% (RR 0.23; 95% CI 0.13 to 0.41; CoE high), without significant effect for risk of gonorrhoea infection (RR 0.90; 95% CI 0.64 to 1.26; CoE very low). The self-reported adherence rate of Doxy-PEP was approximately 80% and one drug-related serious adverse event was reported. CONCLUSION: Doxy-PEP reduced the incidence of chlamydia and syphilis infections. No significant reduction in gonorrhoea infection was observed. This strategy seems promising for some high-risk groups; however, there is still a lack of information on the induction of bacterial resistance and long-term adverse events. PROSPERO REGISTRATION NUMBER.

Higher risk of upper respiratory tract infection post marathon running: when physical exercise becomes a threat to the immune system.

Background: Several studies have reported that marathon runners have a higher risk of upper respiratory tract infections (URTI) post marathon than non-exercising controls. However, other studies did not find a higher risk of URTI in the same participants before and after a marathon, precluding a conclusive consensus. Besides the between-subjects effects, another important confounding factor in these results is the different pre and post follow-up time to track URTI. Objectives: Identify by meta-analysis whether a marathon Running increases the risk of URTI, adjusting the follow-up time to track URTI. Data sources: We searched for articles using MEDLINE (PubMed), Embase, Scopus, Web of Science, the Cochrane Library, and EBSCOhost, combining the marathon and respiratory infection descriptor synonyms, on 1st December 2022. Eligibility criteria: The PICOS framework included human population, comparison between pre and post marathon running, of URTI symptoms (assessed from one to 4 weeks), in noncontrolled intervention studies. Data Synthesis: Because follow-up was longer before the marathon in many studies, we adjusted the number of subjects with infections before marathon to the equivalent post-marathon follow-up duration. There was 18% higher incidence of URTI post-marathon (OR 1.18 95%CI [1.05-1.33], p= 0.005) in a very consistent meta-analysis (I2 = 0%, p = 0.69), with no risk of publication bias (Egger test p-value = 0.82) for the 7 studies included. The main issues with quality of the studies were bias in measuring the outcome, bias in classification of intervention (participation in the marathon) and time-varying confounding (corrected for analysis), and therefore the quality of evidence was moderate (GRADE approach = 3). Limitations: The need for follow-up time adjustment is a limitation, since the number of URTI recorded could be different if the original studies had used the same follow-up time pre and post marathon. The subjectivity of the URTI assessments is another limitation in this field. Conclusions: There is an increased risk of URTI post marathon running and research on this topic to understand mechanisms might support runners to find efficient interventions to reduce this risk. Protocol: Protocol registration on in the International Prospective Register of Systematic Reviews (PROSPERO): CRD42022380991.

Prevalence of sarcopenia in Parkinson's disease: A systematic review and meta-analysis.

We meta-analysed the sarcopenia prevalence among patients with Parkinson´s disease (PD) in comparison to a control group and tested the effects of age, sex, sarcopenia assessments, and PD progression in the sarcopenia prevalence. The literature search was performed using five databases in March 2022. The prevalence of sarcopenia in patients with PD was 3 times higher than in the control group (OR 3.98). Subgroup analyses showed that among individuals aged ≥ 70 years the higher prevalence of sarcopenia in PD compared to controls (OR 5.32, P=0.08) tended to be higher (P=0.08) than the group < 70 years. Regarding PD progression, the prevalence of sarcopenia was not different between individuals scoring < 2.5 and ≥ 2.5 in the Hoehn and Yahr scale. Patients with PD have a higher probability of developing sarcopenia when compared with the control group and older PD patients trended to have even higher chance of sarcopenia than their older controls.

Exercise effect on symptom severity, morbidity and mortality in viral infections: a systematic review and meta-analysis.

There is a knowledge gap regarding the consequences of exercise during acute infections in humans and contradictory findings in animal studies, compromising public health advice on the potential benefits of physical activity for immunity. Here, we carried out a meta-analysis of studies of the effects of moderate exercise (ME) and exercise until fatigue (EF) on symptom severity, morbidity and mortality during viral infection in animal models. The systematic review on PubMed, Scopus, Embase, Web of Science, Cochrane and EBSCOhost (CINAHL and SPORT Discus) identified 8 controlled studies, with 15 subgroups within them. The studies exposed the animals (mice [7 studies] and monkeys [1 study]) to exercise immediately before or after viral inoculation (HSV-1, H1N1 influenza and B.K. virus) with follow-up for 21 days. ME significantly reduced morbidity (OR 0.43 [0.19; 0.98], P = 0.04) with no change for symptom severity (SMD -3.37 [-9.01; 2.28], P = 0.24) or mortality (OR 0.48 [0.08;3.03], P = 0.43). In contrast, EF gave a trend towards increased symptom severity (SMD 0.96 [-0.06; 1.98], P = 0.07) and mortality (OR 1.47 [0.96;2.28], P =0.08) with no change in morbidity (OR 1.22 [0.60;2.5], P = 0.58). We conclude that in animals moderate exercise during infection is advantageous, whilst exercise until fatigue should be avoided. Further research is required to determine if moderate exercise may also be beneficial in humans during infection.

Effect of Exercise on Acute Senescent Lymphocyte Counts: A Systematic Review and Meta-Analysis.

BACKGROUND: Highly differentiated, senescent lymphocytes are pro-inflammatory and contribute to age-related systemic inflammation, called inflammageing. There are several reports of acute changes in senescent lymphocyte counts post exercise, which potentially have consequences for systemic inflammation. However, there is little consensus since the studies differ with respect to participants, exercise protocols, cellular markers assessed, and the time point of assessment post exercise. OBJECTIVE: We performed a systematic review and meta-analysis to assess the impact of exercise on senescent lymphocyte counts in blood immediately, 1 h and 2 h post exercise. METHODS: The search was performed in PubMed (MEDLINE), Web of Science, Embase, Scopus, and Cochrane, on January 11, 2021. The 13 studies selected tested aerobic exercise effects, mainly in young men. They assessed the counts of lymphocytes (CD4 T cells, CD8 T cells, and NK cells), with the following immune cell marker combinations: KLRG1+, CD57+ (only NK cells), EMRA T cells (CD45RA+CCR7-CD28-CD27-), CD28-CD27-, KLRG1+CD28-, and CD28-. Independent extraction of articles was done by 2 researchers. RESULTS: Standardized mean difference (SMD) and 95% confidence interval between baseline and post exercise showed significant increase (SMD >0.9, p < 0.003) in all types of senescent lymphocytes counts immediately post exercise. At 1 h post exercise, senescent CD4 T cells returned to baseline values (p = 0.74), CD8 T cells were reduced (-0.26 [-0.41; -0.11], p = 0.001), and senescent NK cells were raised (0.62 [0.14; 1.10], p = 0.01) above baseline. By 2 h post exercise, senescent CD4 T cells were reduced (-0.94 [-1.40; -0.48], p < 0.001), CD8 T cells remained below baseline (-0.53 [-1.04; -0.009], p = 0.04), and NK cells had returned to baseline values (-0.29 [-0.64; 0.07], p = 0.11). The main determinants of heterogeneity between studies were cytomegalovirus (CMV) serostatus and the characteristics of exercise protocols. CMV+ individuals had a higher immediate lymphocytosis and 1 h post lymphopenia than CMV- individuals. Exercise performed at higher intensities and shorter durations led to higher magnitude of change in senescent lymphocyte counts at all time-points. CONCLUSION: The differing effects of exercise on senescent NK cells and CD4 and CD8 T cells suggest differing susceptibility to factors modulating lymphocyte extravasation such as adrenaline and exercise intensity.

PRP does not improve the objective outcomes of anterior cruciate ligament reconstruction: a systematic review and meta-analysis.

PURPOSE: Platelet rich plasma (PRP) has been used in association with anterior cruciate ligament resconstruction (ACLR) to improve rehabilitation. The purpose was to systematically review the literature to compare the effects of PRP on ACLR in its objective and subjective outcomes. METHODS: A systematic review of the MEDLINE, Web of Science, Embase, Scopus, and Cochrane databases was performed. Two independent reviewers included all the English language literature of patients undergoing primary ACLR with autograft combined with PRP. The outcomes analyzed were graft ligamentization (MRI), tibial and femoral tunnel widening (MRI), knee laxity, IKDC, Lysholm, Tegner activity scale and visual analog scale. RESULTS: Nine studies were included with a total of 525 patients. PRP did not improve ligamentization of graft (standardized mean difference (SMD): 0.01 [95% CI: - 0.37; 0.39]), did not lead to lesser tunnel widening (SMD: 0.71 [95% CI: - 0.12; 1.54]), or lead to lesser knee laxity (raw mean difference: 0.33 [95% CI: - 0.84; 0.19]). Although there was statistical significance for PRP effects on Lysholm score and VAS (p < 0.01), their magnitude was limited. CONCLUSION: PRP showed no improvement in objective outcomes like ligamentization and less tunnel widening, while it showed just small improvements in terms of Lysholm, VAS and knee laxity. Therefore, there is not enough evidence to support a recommendation in favor of PRP and more research is needed. LEVEL OF EVIDENCE: I.

Cardiovascular Responses to Different Resistance Exercise Protocols in Elderly.

Increase in muscle mass and strength through resistance exercise (RE) has been highly recommended for healthy aging. On the other hand, RE could lead to acute cardiovascular risks prompted mainly by intense blood pressure elevations and cardiac autonomic imbalance. We compared the cardiovascular responses to three different RE protocols performed by 21 healthy elderly on a leg press machine. The protocols tested were high load (80% 1RM) until muscular failure (HL); low load (30% 1RM) until muscular failure (LL); low load, 30 repetitions followed by 3 sets of 15 repetitions, with 50% blood flow restriction (LL-BFR); and a control session (CON). Based on heart rate variability analysis, only LL kept parasympathetic indexes lower than CON at 30 min recovery. By finger photoplethysmography, LL-BFR prompted higher systolic and mainly diastolic blood pressure increments in many sets. The heart rate and cardiac output increase, and total peripheral resistance reduction following exercise were not different among RE protocols. There was no significant post-exercise hypotension and carotid arterial compliance changes. HL seems to be the safer protocol to be recommended for the healthy elderly, because it induces lower blood pressure increments and faster parasympathetic recovery compared to LL and LL-BFR.

Cardiac autonomic and haemodynamic recovery after a single session of aerobic exercise with and without blood flow restriction in older adults.

This study investigated the autonomic and haemodynamic responses to different aerobic exercise loads, with and without blood flow restriction (BFR). In a crossover study, 21 older adults (8 males and 13 females) completed different aerobic exercise sessions: low load without BFR (LL) (40% VO2max), low load with BFR (LL-BFR) (40% VO2max + 50% BFR) and high load without BFR (HL) (70% VO2max). Heart rate variability and haemodynamic responses were recorded during rest and throughout 30 min of recovery. HL reduced R-R interval, the root mean square of successive difference of R-R intervals and high frequency during 30 min of recovery at a greater magnitude compared with LL and LL-BFR. Sympathetic-vagal balance increased the values for HL during 30 min of recovery at a greater magnitude when compared with LL and LL-BFR. Post-exercise haemodynamic showed reduced values of double product at 30 min of recovery compared to rest in LL-BFR, while HL showed higher values compared to rest, LL-BFR and LL. Reduced systolic blood pressure was observed for LL-BFR (30 min) compared to rest. Autonomic and haemodynamic responses indicate lower cardiovascular stress after LL-BFR compared to HL, being this method, besides the functional adaptations, a potential choice to attenuate the cardiovascular stress after exercise in older adults.

Effects of Different Exercise Types on Chrna7 and Chrfam7a Expression in Healthy Normal Weight and Overweight Type 2 Diabetic Adults.

Purpose: Considering that the CHRNA7 and CHRFAM7A genes can be modulated by acute or chronic inflammation, and exercise modulates inflammatory responses, the question that arises is whether physical exercise could exert any effect on the expression of these genes. Thus, the aim of this work is to identify the effects of different types of exercises on the expression of the CHRNA7, CHRFAM7A and tumor necrosis factor-α (TNF-α) in leukocytes of healthy normal weight (HNW), and overweight with type 2 diabetes (OT2D) individuals. Methods: 15 OT2D and 13 HNW participants (men and women, from 40 to 60 years old) performed in a randomized crossover design three exercise sessions: aerobic exercise (AE), resistance exercise (RE) and combined exercise (CE). Blood samples were collected at rest and post-60-min of the exercise sessions. The leukocytes were the analysis of the CHRNA7, CHRFAM7A and (TNF-α) gene expression. Results: At baseline, OT2D had higher CHRFAM7A and TNF-α expression compared to HNW. No statistical differences were observed between groups for CHRNA7; however, the HNW group presented almost twice as many subjects with the expression of this gene (24% vs. 49%). Post exercise, the CHRFAM7A increased in AE, RE and CE for HNW, and in AE and CE for OT2D. There was no significant difference for TNF-α and CHRNA7 expression between any type of exercise and group. Conclusions: Our study shows that OT2D individuals presented higher baseline expression of TNF-α and CHRFAM7A, besides evidence of decreased CHRNA7A expression in leukocytes when compared with HNW. On the other hand, acutely physical exercise induces increased CHRFAM7A expression, especially when the aerobic component is present.

Pre-competitive overload period impairs parasympathetic modulation in athletes: A systematic review and meta-analysis.

OBJECTIVE: The aim was to meta-analyze the effect of different type of overloads on parasympathetic modulation to the heart, assessed by root-mean-square difference of successive normal RR intervals (RMSSD) of athletes. METHODS: The analysis of the 14 studies selected (20 subgroups within studies), compared RMSSD of the same athletes before and after an overload period. RESULTS: RMSSD of athletes were lower at pre-competition compared to baseline (SMD = -0.50 [-0.83; -0.18], p = 0.002), while volume, volume plus intensity and post-competition overloads showed similar RMSSD than their respective normal load periods. CONCLUSION: The lower RMSSD during pre-competition overload, characterize an loss of homeostasis, and could be explained by the presence of pre-competition anxiety, stress, and higher psychological challenges in addition to the same physical stress present in the other types of overloads (i.e.: higher volume or training intensity).

The effects of ageing, BMI and physical activity on blood IL-15 levels: A systematic review and meta-analyses.

AIM: The purpose of the study was to test the effect of ageing, BMI, physical activity and chronic exercise on IL-15 blood concentration by meta-analyses of the literature. METHODS: The search was performed on PubMed/MEDLINE, Web of Science, ProQuest, Embase and Cochrane databases. First meta-analysis compared blood IL-15 of healthy adults across three age groups (<35 years, 35-65 years, and >65 years), considering BMI as confounding factor; the second compared IL-15 levels between physically active and non-physically active individuals (cross-sectional studies); and the third tested the effect of chronic exercise interventions on blood IL-15 levels on participants of any age, sex, and health condition. RESULTS: From 2582 studies retrieved, 67 were selected for the three meta-analyses (age effect: 59; physical activity cross-sectional effect: 5; chronic exercise effect: 14). Older adults had lower blood IL-15 than young and middle-aged adults (5.30 pg/ml [4.76; 5.83]; 7.11 pg/ml [6.33; 7.88]; 7.10 pg/ml [5.55; 8.65], respectively). However, the subgroup of overweight older adults had higher IL-15 than young and middle aged overweight adults; Habitual physical activity did not affect blood IL-15 (standardized mean difference [SMD] 0.61 [-0.65; 1.88], p = 0.34); Chronic exercise reduced blood IL-15 in short-term interventions (<16 weeks) (SMD -0.14 [-0.27; -0.01], p = 0.04), but not studies of >16 weeks of intervention (SMD 0.44 [-0.26; 1.15], p = 0.22). CONCLUSION: The present meta-analyses highlight the complex interaction of age, BMI and physical activity on blood IL-15 and emphasize the need to take these factors into account when considering the role of this myokine in health throughout life.

Benefits of Patch Augmentation on Rotator Cuff Repair: A Systematic Review and Meta-analysis.

Background: Despite technological advances, the overall retear rate on rotator cuff repair is still high. Patches have shown significant reduction in retear rate and pain scores; however, this is not a universal finding and conflicting results have been shown among functional shoulder scales. Purpose: To analyze previous controlled trials of the literature to bring a consensus about the effectiveness of patch use on rotator cuff repair. Study Design: Systematic review; Level of evidence, 1. Methods: The search was conducted in PubMed, Web of Science, EMBASE, Scopus, and Cochrane in April 2020. The results of rotator cuff repair with patch augmentation versus without augmentation (control) were compared through odds ratio (OR), raw mean difference (RMD), and standardized mean difference (SMD) of retear rate; functional shoulder scales; strength; and range of motion (ROM). Results: Of 733 initial studies, 7 of them met the criteria to be included in the analysis. Compared with the control group, the patch augmentation group had a significantly lower retear rate (OR, 0.32 [95% CI, 0.18 to 0.55]; P < .001), lower pain (SMD, -0.42 [-0.71 to -0.12]; P < .01), a higher University of California Los Angeles Shoulder Rating Scale (RMD, 0.87 [0.15 to 1.60], P = .017), and a trend toward higher strength (SMD, 0.95 [-0.03 to 1.94], P = .05) and lower forward elevation ROM (RMD, -10.50 [-21.86 to 0.67]; P = .06), while no changes were noted for other functional scales or for internal and external rotation ROM. Conclusion: The results point to benefits of patch augmentation in rotator cuff repair, particularly a reduction in retear rate. More interventional studies with better methodological quality should be conducted to confirm the results of this initial review.

Effects of Resistance Training to Muscle Failure on Acute Fatigue: A Systematic Review and Meta-Analysis.

BACKGROUND: Proper design of resistance training (RT) variables is a key factor to reach the maximum potential of neuromuscular adaptations. Among those variables, the use of RT performed to failure (RTF) may lead to a different magnitude of acute fatigue compared with RT not performed to failure (RTNF). The fatigue response could interfere with acute adaptive changes, in turn regulating long-term adaptations. Considering that the level of fatigue affects long-term adaptations, it is important to determine how fatigue is affected by RTF versus RTNF. OBJECTIVE: The aim of this systematic review and meta-analysis was to compare the effects of RTF versus RTNF on acute fatigue. METHODS: The search was conducted in January 2021 in seven databases. Only studies with a crossover design that investigated the acute biomechanical properties (vertical jump height, velocity of movement, power output, or isometric strength), metabolic response (lactate or ammonia concentration), muscle damage (creatine kinase activity), and rating of perceived exertion (RPE) were selected. The data (mean ± standard deviation and sample size) were extracted from the included studies and were either converted into the standardized mean difference (SMD) or maintained in the raw mean difference (RMD) when the studies reported the results in the same scale. Random-effects meta-analyses were performed. RESULTS: Twenty studies were included in the systematic review and 12 were included in the meta-analysis. The main meta-analyses indicated greater decrease of biomechanical properties for RTF compared with RTNF (SMD - 0.96, 95% confidence interval [CI] - 1.43 to - 0.49, p < 0.001). Furthermore, there was a larger increase in metabolic response (RMD 4.48 mmol·L-1, 95% CI 3.19-5.78, p < 0.001), muscle damage (SMD 0.76, 95% CI 0.31-1.21, p = 0.001), and RPE (SMD 1.93, 95% CI 0.87-3.00, p < 0.001) for RTF compared with RTNF. Further exploratory subgroup analyses showed that training status (p = 0.92), timepoint (p = 0.89), load (p = 0.10), and volume (p = 0.12) did not affect biomechanical properties; however, greater loss in the movement velocity test occurred on upper limbs compared with lower limbs (p < 0.001). Blood ammonia concentration was greater after RTF than RTNF (RMD 44.66 µmol·L-1, 95% CI 32.27-57.05, p < 0.001), as was 48 h post-exercise blood creatine kinase activity (SMD 0.86, 95% CI 0.33-1.42, p = 0.002). Furthermore, although there was considerable heterogeneity in the overall analysis (I2 = 83.72%; p < 0.01), a significant difference in RPE after RTF compared with RTNF was only found for studies that did not equalize training volumes. CONCLUSIONS: In summary, RTF compared with RTNF led to a greater decrease in biomechanical properties and a simultaneous increase in metabolic response, higher muscle damage, and RPE. The exploratory analyses suggested a greater impairment in the velocity of movement test for the upper limbs, more pronounced muscle damage 48 h post-exercise, and a greater RPE in studies with non-equalized volume after the RTF session compared with RTNF. Therefore, it can be concluded that RTF leads to greater acute fatigue compared with RTNF. The higher acute fatigue after RTF can also have an important impact on chronic adaptive processes following RT; however, the greater acute fatigue following RTF can extend the time needed for recovery, which should be considered when RTF is used. PROTOCOL REGISTRATION: The original protocol was prospectively registered (CRD42020192336) in the International Prospective Register of Systematic Reviews (PROSPERO).

The Effect of Aging on Body Temperature: A Systematic Review and Meta- Analysis.

BACKGROUND: Since age is the major risk factor for chronic diseases and mortality, it seems mistaken that older adults have lower basal temperature than young individuals. Many confounding factors could hinder the achievement of a consensus, such as the different sites of measurement, control of basal conditions, health conditions, age difference compared, sex, and others. OBJECTIVE: The aim was to meta-analyze previous studies in order to find a consensus regarding the effects of aging on body temperature in humans, considering different types of temperature assessments, age difference and sex. METHODS: A systematic search was performed in PubMed and 16 studies comparing basal temperature between older and young adults were meta-analyzed. RESULTS: Older adults have significantly lower body temperature than young adults (-0.17 °C (-0.30; -0.03), p=0.04). Considering the different sites of measure, while core temperature tended to be lower in older adults (-0.13 °C (-0.27; 0.01), p=0.07), and skin temperature was not different (-0.21 °C (-0.5; 0.08), p=0.15). The aging effects were more prominent in men when assessed by oral temperature and when compared between higher age difference. CONCLUSION: Indeed, there is a small reduction in overall temperature with aging, drove by the reduction in core temperature rather than skin temperature. The confirmation of these findings by this meta-analysis, now provide the base for the development of strategies to face the impairment in thermoregulation and metabolic efficiency with aging.

The effects of exercise training on hypertensive older adults: an umbrella meta-analysis.

Exercise training has been shown to blunt many of the physiological declines and common diseases of the aging process. One such beneficial effect is the reduction of blood pressure (BP) in hypertensive older adults. However, there is no consensus about which benefits of aerobic (AT) or resistance training (RT) may be lost by the use of combined training (CT) or even what benefits could be acquired only by performing CT, considering the extensive health needs of older adults with hypertension. Thus, we performed an umbrella meta-analysis. The benefits conferred by CT are extensive and encompass cardiorespiratory fitness, muscular fitness, and blood lipid profile improvements. CT may be recommended to improve the extensive health needs of hypertensive older adults that go beyond blood pressure reduction.

HIIT vs. SIT: What Is the Better to Improve V˙O2max? A Systematic Review and Meta-Analysis.

Lack of time is seen as a barrier to maintaining a physically active lifestyle. In this sense, interval training has been suggested as a time-efficient strategy for improving health, mainly due to its potential to increase cardiorespiratory fitness. Currently, the most discussed interval training protocols in the literature are the high-intensity interval training (HIIT) and the sprint interval training (SIT). Objective: We investigated, through a systematic review and meta-analysis, which interval training protocol, HIIT or SIT, promotes greater gain in cardiorespiratory fitness (V˙O2max/peak). The studies were selected from the PubMed (MEDLINE), Scopus and Web of Science databases. From these searches, a screening was carried out, selecting studies that compared the effects of HIIT and SIT protocols on V˙O2max/peak. A total of 19 studies were included in the final analysis. Due to the homogeneity between studies (I2 = 0%), fixed-effects analyses were performed. There was no significant difference in the V˙O2max/peak gains between HIIT and SIT for the standardized mean difference (SMD = 0.150; 95% CI = -0.038 to 0.338; p = 0.119), including studies that presented both measurements in mL·kg-1·min-1 and l·min-1; and raw mean differences (RMD = 0.921 mL·kg-1·min-1; 95% CI = -0.185 to 2.028; p = 0.103) were calculated only with data presented in mL·kg-1·min-1. We conclude that the literature generates very consistent data to confirm that HIIT and SIT protocols promote similar gains in cardiorespiratory fitness. Thus, for this purpose, the choice of the protocol can be made for convenience.

Time-Dependent Effect of Platelet-Rich Plasma in Reducing Donor-Site Pain After Anterior Cruciate Ligament Reconstruction.

BACKGROUND: Anterior cruciate ligament reconstruction (ACLR) has a high incidence among sports players, and one important side effect of the surgery is graft donor site morbidity. Although some evidence suggests that application of platelet-rich plasma (PRP) during ACLR reduces pain and improves knee function, it is not a universal finding. PURPOSE: To perform a meta-analysis of previous studies testing the effects of PRP on donor site morbidity after ACLR. STUDY DESIGN: Systematic review and meta-analysis. METHODS: We reviewed PubMed (Medline), Web of Science, Embase, Scopus, and Cochrane databases to find studies testing the effects of PRP on the donor site of ACLR autograft. After identifying 4 studies, we conducted 2 meta-analyses, 1 for the effects of PRP on pain, assessed by visual analog scale (VAS), and the other for the functional knee scores. We also tested the ability of time after ACLR to predict the PRP-related reduction of pain. RESULTS: In the 4 studies identified, 157 patients were analyzed. Although the VAS score was lower with PRP at 6 months (raw mean difference [RMD], -0.97 [95% CI, -1.59 to -0.36]; P = .001) and 12 months (RMD, -0.61 [95% CI,-1.02 to -0.21]; P = .003), the effects of PRP disappeared at 24 months (RMD, -0.08 [95% CI,-0.38 to 0.22]; P = .586). A univariate regression analysis reinforced the ability of time after ACLR to predict the PRP-related reduction of VAS pain score (r2 = 0.98). However, knee function after ACLR was not improved by the use of PRP (standardized mean difference, 0.71 [95% CI,-0.17 to 1.60]; P = .114). CONCLUSION: PRP applied to a bone-patellar tendon-bone donor site could reduce knee pain within a year, and this reduction had a correlation with time, meaning that the effect of PRP decreased with time after surgery. However, pain reduction did not reach clinical relevance and did not lead to better functional knee scores.

DETERMINANTS OF RETURN TO PLAY AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION.

OBJECTIVE: To systematically review and meta-analyze the performance of return to play (RTP) and non-RTP patients in different assessment tools after anterior cruciate ligament reconstructions (ACLR). METHODS: Out of 182 studies searched on PubMed, 11 presented RTP and non-RTP groups assessing the performance of young individuals, practitioners of different sports, with different tools. RESULTS: There was higher limb symmetry (7.13% [95%CI 4.55; 9.70], p < 0.001), Tegner activity scale (2.41 [95%CI 0.18; 4.64], p = 0.03), functional scores such as International Knee Documentation Committee (x7.44 [95%CI 4.69; 10.19], p < 0.001), Knee Osteoarthritis Outcome score for quality of life (14.75 [95%CI 10.96; 18.54], p < 0.001) and for sports/recreation (11.86 [95%CI 8.87; 14.86], p < 0.001); and lower knee laxity (-0.25 mm [95%CI -0.36; -0.14], p < 0.001) in RTP compared to non-RTP patients following ACLR. CONCLUSION: We confirmed that these different tools can differentiate RTP for non-RTP patients, which may contribute to the physician's decision about the ideal time for RTP. Level of Evidence III, Systematic review of Level III studies.

OBJETIVO: Revisar sistematicamente e meta-analisar o desempenho de atletas que retornaram (RTP) e não retornaram (não RTP) ao esporte em diferentes ferramentas de avaliação após cirurgia de ligamento cruzado anterior (RLCA). MÉTODOS: De 182 estudos pesquisados no PubMed, 11 tiveram grupos RTP e não RTP avaliando a performance de jovens, praticantes de distintas modalidades esportivas, em diferentes ferramentas. RESULTADOS: Houve melhor simetria dos membros (7,13% [95%IC 4,55; 9,70], p < 0,0001), escala de atividade de Tegner (2,41 [95%IC 0,18; 4,64], p = 0,03), escores funcionais como o International Knee Documentation Comittee (7,44 [95%IC 4,69; 10,19], p < 0.001), Knee Osteoarthritis Outcome Score para qualidade de vida (14,75 [95%IC 10,96; 18,54], p < 0,001) e esportes/recreação (11,86 [95%IC 8,87; 14,86], p < 0,001); e frouxidão ligamentar do joelho (-0,25 mm [95%IC -0,36; -0,14], p < 0,001) em RTP comparados com pacientes não RTP após RLCA. CONCLUSÃO: Concluímos que essas ferramentas conseguem diferenciar pacientes RTP de não RTP, o que deverá contribuir com a decisão de médicos sobre o momento ideal de retorno ao esporte. Nível de Evidência III, Revisão sistemática de Estudos de Nível III .

Do baseline blood pressure and type of exercise influence level of reduction induced by training in hypertensive older adults? A meta-analysis of controlled trials.

BACKGROUND: Exercise recommendations for hypertensive individuals encourage the use of aerobic training (AT) for lowering blood pressure (BP). However, it is not clear whether equivalent BP-lowering effects are obtained with different exercise training types in older adults, among whom hypertension is more prevalent. DESIGN: We meta-analyzed previous literature testing different types of training [AT, resistance (RT) and combined (CT)] effects on casual systolic BP (SBP) and diastolic BP (DBP), taking into account age and baseline BP influences. METHODS: Randomized controlled trials (RCTs), published up to August 2019 (PubMed), assessing exercise training effects on BP in hypertensive older adults (aged ≥50 years) were included (11, 8 and 3 RCTs tested the effects of AT, RT and CT, respectively). RESULTS AND CONCLUSIONS: First, both AT and RT reduced SBP (-12.31 [-16.39; -8.24] and - 6.76 [-8.36; -5.17] mm Hg, respectively) and DBP (-4.31 [-5.96; -2.65] and - 3.53 [-4.22; -2.85] mm Hg, respectively) in older adults, while there was not enough evidence for the effects of CT on SBP, due to high variance among the small number of CT studies. Second, training-induced BP reductions were more prominent in patients <65 years compared to those >65 years. However, this difference was mostly driven by differences between AT and CT versus RT intervention on age subgroups. Third, baseline BP values, rather than type of exercise and age, were the main determinant of BP response to exercise (predicted 74% and 53% of SBP and DBP reduction, respectively), indicating this is a major confounding factor to be considered in studies evaluating the impact of exercise training on BP.

Effect of resistance training on inflammatory markers of older adults: A meta-analysis.

INTRODUCTION: Low-grade inflammation is associated with several deleterious health outcomes and may aggravate sarcopenia and dynapenia during aging. A strategy to alleviate these conditions is resistance training (RT). Thus, the aim was to critically examine the effects of regular RT on inflammatory markers of older adults from previous studies. METHODS: The search was conducted on MEDLINE, July 2017. Only randomized controlled trials (RCTs) testing RT effects on C-reactive protein (CRP), tumor necrosis factor-α (TNF-α) and/or interleukin-6 (IL-6) of adults over 50 years-of-age were selected by two independent reviewers. RESULTS: The main meta-analyses showed RT reduced CRP in older adults (standard mean difference [SMD] = -0.61, 95%CI = -0.83; -0.31, p < 0.001), tended to reduce IL-6 (SMD = -0.19, 95%CI = -0.42; 0.02, p = 0.07) and did not change TNF-α. Further exploratory sub-group analyses showed a potential association of muscle mass for both CRP and TNF-α changes. Reductions in CRP and TNF-α only occurred in RCTs performing a higher number of exercises (>8), higher weekly frequency (3 times/week) and longer durations than 12 weeks. CONCLUSIONS: Anti-inflammatory effects of RT were significant only for CRP with a tendency for a decrease in IL-6 as well. The exploratory analyses suggested the reduction in inflammatory markers could be dependent on increases in muscle mass and higher volume of RT protocols. These potential mediators of RT anti-inflammatory effects should be addressed in future meta-analyses to clarify the effects of RT on inflammatory markers of older adults with very specific conditions and larger numbers of studies.