Exercise for depression and depressive symptoms in older adults: an umbrella review of systematic reviews and Meta-analyses.

OBJECTIVES: We aimed to gather and update the evidence on the impact of exercise on late-life depression. METHOD: We conducted an umbrella review of meta-analyses of randomized controlled trials (RCTs) that assessed the effects of an exercise intervention for depression in older adults (e.g. 60+). Searches were conducted in Scopus, Web of Science, Embase, PubMed, BIREME, LILACS, SciELO, Cochrane Library for Systematic Reviews, and Opengray.eu. Methodological quality was assessed using A MeaSurement Tool to Assess Systematic Reviews (AMSTAR 2). Data analysis was performed with RStudio (version 4.0.2) and the generic inverse-variance method was used to pool the effect sizes from the included studies. RESULTS: Twelve meta-analyses of 97 RCTs were included. The AMSTAR 2 rating was considered critically low in five studies, low in six studies, and high in one study. The effect size expressed by the standardized mean difference (SMD) varied between studies from -0.90 (95% CI = -1.51; -0.28) to -0.14 (95% CI = -0.36; 0.07) in favor of the exercise intervention. Pooling of the effect sizes produced a statistically significant moderate effect in which exercise was associated with lower levels of depression and depressive symptoms (OR = 2.24, 95% CI 1.77; 2.84). CONCLUSION: Our findings suggest that exercise produces a moderate improvement in depression and depressive symptoms in older patients. We recommend providing physical activity for older adults. KEY-POINTS: We investigated the effects of exercise interventions for depression in older adults.Supplemental data for this article can be accessed online at https://doi.org/10.1080/13607863.2021.1951660.

The Impact of Obesity on Plastic Surgery Outcomes: A Systematic Review and Meta-analysis.

BACKGROUND: Obesity is a potential risk factor for complications in plastic surgeries. However, the data presented by primary studies are contradictory. OBJECTIVES: The aim of this study was to summarize and clarify the divergences in the literature to provide a better understanding of the impact of obesity in different plastic surgery procedures. METHODS: We conducted a systematic review and meta-analysis of the impact of obesity on plastic surgery outcomes. Searches were conducted in MEDLINE, LILACS, SciELO, Scopus, Embase, Web of Science, Opengrey.eu, and the Cochrane Database of Systematic Reviews. The primary outcomes assessed were surgical complications, medical complications, and reoperation rates. The secondary outcome assessed was patient satisfaction. Subgroup analysis was performed to investigate the impact of each BMI category on the outcomes. RESULTS: Ninety-three articles were included in the qualitative synthesis, and 91 were used in the meta-analysis. Obese participants were 1.62 times more likely to present any of the primary outcomes (95% CI, 1.48-1.77; P < 0.00001). The highest increase in risk among plastic surgery types was observed in cosmetic procedures (risk ratio [RR], 1.80; 95% CI, 1.43-2.32; P < 0.00001). Compared with normal-weight participants, overweight participants presented a significantly increased RR for complications (RR, 1.16; 95% CI, 1.07-1.27; P = 0.0004). Most authors found no relation between BMI and overall patient satisfaction. CONCLUSIONS: Obesity leads to more complications and greater incidence of reoperation compared with nonobese patients undergoing plastic surgeries. However, this effect is not evident in reconstructive surgeries in areas of the body other than the breast.