Effect of exercise for depression: systematic review and network meta-analysis of randomised controlled trials.

OBJECTIVE: To identify the optimal dose and modality of exercise for treating major depressive disorder, compared with psychotherapy, antidepressants, and control conditions. DESIGN: Systematic review and network meta-analysis. METHODS: Screening, data extraction, coding, and risk of bias assessment were performed independently and in duplicate. Bayesian arm based, multilevel network meta-analyses were performed for the primary analyses. Quality of the evidence for each arm was graded using the confidence in network meta-analysis (CINeMA) online tool. DATA SOURCES: Cochrane Library, Medline, Embase, SPORTDiscus, and PsycINFO databases. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Any randomised trial with exercise arms for participants meeting clinical cut-offs for major depression. RESULTS: 218 unique studies with a total of 495 arms and 14 170 participants were included. Compared with active controls (eg, usual care, placebo tablet), moderate reductions in depression were found for walking or jogging (n=1210, κ=51, Hedges' g -0.62, 95% credible interval -0.80 to -0.45), yoga (n=1047, κ=33, g -0.55, -0.73 to -0.36), strength training (n=643, κ=22, g -0.49, -0.69 to -0.29), mixed aerobic exercises (n=1286, κ=51, g -0.43, -0.61 to -0.24), and tai chi or qigong (n=343, κ=12, g -0.42, -0.65 to -0.21). The effects of exercise were proportional to the intensity prescribed. Strength training and yoga appeared to be the most acceptable modalities. Results appeared robust to publication bias, but only one study met the Cochrane criteria for low risk of bias. As a result, confidence in accordance with CINeMA was low for walking or jogging and very low for other treatments. CONCLUSIONS: Exercise is an effective treatment for depression, with walking or jogging, yoga, and strength training more effective than other exercises, particularly when intense. Yoga and strength training were well tolerated compared with other treatments. Exercise appeared equally effective for people with and without comorbidities and with different baseline levels of depression. To mitigate expectancy effects, future studies could aim to blind participants and staff. These forms of exercise could be considered alongside psychotherapy and antidepressants as core treatments for depression. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42018118040.

Association of physical behaviours with sarcopenia in older adults: a systematic review and meta-analysis of observational studies.

BACKGROUND: Physical behaviours (ie, physical activity and sedentary behaviour) might have a role in the development of sarcopenia, although the evidence is unclear. We aimed to explore the association of total and intensity-specific levels of physical activity and sedentary behaviour with sarcopenia and its components (ie, muscle mass, muscle strength, and physical performance) in older adults. METHODS: We conducted a systematic review and meta-analysis and searched MEDLINE (via PubMed), Scopus, and Web of Science from inception to July 26, 2022, for peer-reviewed, observational studies or baseline data from randomised clinical trials conducted in older adults (ie, individual age ≥60 years or mean age ≥65 years) and published in English that reported on the association of physical activity or sedentary behaviour or both with sarcopenia (or its determinants: muscle mass or strength, and physical performance). Physical activity and sedentary behaviour were measured by any method. The main outcome was sarcopenia, which could be diagnosed by any means. Estimates were extracted and pooled using Bayesian meta-analytic models and publication bias was assessed using the Egger's test. This study is registered with PROSPERO, CRD42022315865. FINDINGS: We identified 15 766 records, of which 124 studies (230 174 older adults; 121 301 [52·7%] were female and 108 873 [47·3%] were male) were included in the systematic review. 86 studies were subsequently included in the meta-analysis. Higher levels of total physical activity were inversely associated with sarcopenia both cross-sectionally (21 studies, n=59 572; odds ratio 0·49, 95% credible interval 0·37-0·62) and longitudinally (four studies, n=7545; 0·51, 0·27-0·94). A protective association was also identified for moderate-to-vigorous physical activity in cross-sectional research (five studies, n=6787; 0·85, 0·71-0·99), whereas no association was identified for the remaining physical behaviours (ie, steps, light physical activity, or sedentary behaviour). INTERPRETATION: Total and moderate-to-vigorous physical activity are inversely associated with sarcopenia. These findings might support the importance of moderate-to-vigorous, rather than light, intensity physical activity-based interventions to prevent sarcopenia. FUNDING: None. TRANSLATION: For the Spanish translation of the abstract see Supplementary Materials section.

What exercise programme is the most appropriate to mitigate anterior cruciate ligament injury risk in football (soccer) players? A systematic review and network meta-analysis.

OBJECTIVES: To examine the effectiveness of different exercise-based interventions to mitigate the risk of anterior cruciate ligament injury in football players, and to determine which is the most appropriate for them, specifically for female football players. DESIGN: Four databases were accessed in July 2023 using the keywords football, soccer, athletic injuries, anterior cruciate ligament, knee injuries, injury prevention, exercise-based programme, and risk factor. METHODS: Randomised controlled trials that evaluated any exercise-based injury prevention intervention compared with a control group on the prevention of anterior cruciate ligament injury in football players were included. RESULTS: Eleven studies were included. Data were presented as logarithm hazard ratio, credible intervals and standard deviation. FIFA 11+ was the most effective in reducing anterior cruciate ligament injury risk in football players (logarithm hazard ratio = -1.23 [95% credible intervals: -2.20, -0.35]; SD = 0.47), followed by the Knäkontroll programme (logarithm hazard ratio = -0.76 [95% credible intervals: -1.60, -0.03]; standard deviation = 0.42). For females, only Knäkontroll had a significant impact on reducing the risk of anterior cruciate ligament injury (logarithm hazard ratio = -0.62 [95% credible intervals: -1.71, 0.62]; standard deviation = 0.58). CONCLUSIONS: Our results support the use of FIFA 11+ and Knäkontroll to mitigate injury incidence at overall level. However, the effectiveness of these interventions changed when adjusting for females. Knäkontroll is postulated as the programme with the greatest preventive nature, although these results should be interpreted with caution due to the lack of the sample.

Optimal Dose and Type of Physical Activity to Improve Glycemic Control in People Diagnosed With Type 2 Diabetes: A Systematic Review and Meta-analysis.

BACKGROUND: The optimal dose or type of physical activity to control glycosylated hemoglobin (HbA1c) in people with diabetes remains unknown. Current guidelines do not include consideration of baseline HbA1c for activity prescription. PURPOSE: To examine the dose-response relationship between physical activity and HbA1c (%) in individuals with type 2 diabetes. DATA SOURCES: A systematic search was performed in Embase, MEDLINE, Scopus, CINAHL, SPORTDiscus, and Web of Science. STUDY SELECTION: We included trials that involved participants diagnosed with type 2 diabetes that included any type of physical activity as intervention. DATA EXTRACTION: Pre- and postintervention HbA1c data, population and interventions characteristics, and descriptive statistics were collected to calculate change scores for each study arm. DATA SYNTHESIS: We used Bayesian random-effects meta-analyses to summarize high-quality evidence from 126 studies (6,718 participants). The optimal physical activity dose was 1,100 MET min/week, resulting in HbA1c reductions, ranging from -1.02% to -0.66% in severe uncontrolled diabetes, from -0.64% to -0.49% in uncontrolled diabetes, from -0.47% to -0.40% in controlled diabetes, and from -0.38% to -0.24% in prediabetes. LIMITATIONS: The time required to achieve these HbA1c reductions could not be estimated due to the heterogeneity between interventions' duration and protocols and the interpersonal variability of this outcome. CONCLUSIONS: The result of this meta-analysis provide key information about the optimal weekly dose of physical activity for people with diabetes with consideration of baseline HbA1c level, and the effectiveness of different types of active interventions. These results enable clinicians to prescribe tailored physical activity programs for this population.

Variability in meta-analysis estimates of continuous outcomes using different standardization and scale-specific re-expression methods.

OBJECTIVES: To explore the impact of using different data standardization and scale-specific re-expression methods (i.e., processes to convert standardized data into scale-specific units) in meta-analyses using standardized mean differences (SMDs). STUDY DESIGN AND SETTING: We used data assessed by the Short Physical Performance Battery and the Barthel Index from a meta-analysis of randomized controlled trials which synthesized evidence of physical activity effectiveness on the functional capacity of hospitalized older adults. We standardized the data using study-specific pooled standard deviations (SDs), an internal, and an external SD references. Bayesian meta-analyses were performed for each method to compare the posterior distributions of the meta-analysis parameters. Posterior estimates were re-expressed into scale-specific units applying different methods established in the Cochrane guidelines. RESULTS: Meta-analysis estimates depend on the used standardization method. Analyses including data standardized using the largest SD reference presented lower estimates with less uncertainty in both scales. The method applied for re-expressing SMDs into scale-specific units impacted in their posterior clinical interpretation. The most similar results across models were obtained when using the same SD reference to standardize and re-express data. CONCLUSION: Different data standardization methods yielded different meta-analysis estimates on the SMD scale. To avoid the introduction of bias, the use of a single scale-specific SD reference to standardize data is recommended and instead of study-specific pooled sample SDs. Meta-analysis software packages may therefore change their default methods to allow this method by a single scale-specific SD. To re-express the SMDs into scale-specific units, we suggest the application of the same SD reference that was used for data standardization.

Optimal dose and type of physical activity to improve functional capacity and minimise adverse events in acutely hospitalised older adults: a systematic review with dose-response network meta-analysis of randomised controlled trials.

OBJECTIVE: To identify the optimal dose and type of physical activity to improve functional capacity and reduce adverse events in acutely hospitalised older adults. DESIGN: Systematic review and Bayesian model-based network meta-analysis. DATA SOURCES: Four databases were searched from inception to 20 June 2022. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Randomised controlled trials that assessed the effectiveness of a physical activity-based intervention on at least one functional outcome in people aged ≥50 years hospitalised due to an acute medical condition were included. Pooled effect estimates (ie, standardised mean differences for functional capacity and the ratio of means for adverse events) were calculated using random treatment effects network meta-analysis models. RESULTS: Nineteen studies (3842 participants) met the inclusion criteria. Approximately 100 Metabolic Equivalents of Task per day (METs-min/day) (~40 min/day of light effort or ~25 min/day of moderate effort activities) was the minimal dose to improve the functional capacity of acute hospitalised older adults (standardised mean difference (SMD)=0.28, 95% credible interval (CrI) 0.01 to 0.55). The optimal dose was estimated at 159 METs-min/day (~70 min/day of light effort or ~40 min/day of moderate effort activities; SMD=0.41, 95% CrI 0.08 to 0.72). Ambulation was deemed the most efficient intervention, and the optimal dose was reached at 143 METs-min/day (~50 min/day of slow-paced walking; SMD=0.76, 95% CrI 0.35 to 1.16), showing a high evidential power (87.68%). The minimal effective ambulation dose was estimated at 74 METs-min/day (~25 min/day of slow-paced walking; SMD=0.25, 95% CrI 0.01 to 0.41). Physical activity interventions resulted in a decrease in the rate of adverse events compared with usual care at discharge (ratio of means=0.96, 95% CrI 0.95 to 0.97; median time 7 days). CONCLUSIONS: This meta-analysis yielded low to moderate evidence supporting the use of in-hospital supervised physical activity programmes in acutely hospitalised older adults. As little as ~25 min/day of slow-paced walking is sufficient to improve functional capacity and minimise adverse events in this population. TRIAL REGISTRATION NUMBER: PROSPERO CRD42021271999.

Effects of physical exercise on physical function in older adults in residential care: a systematic review and network meta-analysis of randomised controlled trials.

BACKGROUND: Physical exercise is effective at attenuating ageing-related physical decline in general, but evidence of its benefits for older adults in residential care, who often have functional dependency, multimorbidity, and polypharmacy, is inconclusive. We aimed to establish the effects of exercise interventions on the physical function of this population. METHODS: For this systematic review and network meta-analysis, we searched PubMed, Web of Science, Cochrane Library, Rehabilitation & Sports Medicine Source, and SPORTDiscus to identify randomised controlled trials assessing the effects of exercise interventions (vs usual care) on physical function (ie, functional independence, physical performance, and other related measures, such as muscle strength, balance, or flexibility) in adults aged 60 years or older living in residential care. Relevant studies published in English or Spanish up to Jan 12, 2023, were included in the systematic review. The quality of studies was assessed using the Tool for the Assessment of Study Quality and Reporting in Exercise (TESTEX) score. A network meta-analysis was performed for physical function-related outcomes reported in at least ten studies, with subanalyses for specific intervention (ie, exercise type, training volume, and study duration) and participant (eg, having cognitive impairment or dementia, pre-frail or frail status, and being functionally dependent) characteristics. The study protocol was registered on PROSPERO (CRD42021247809). FINDINGS: 147 studies (11 609 participants, with mean ages ranging from 67 years [SD 9] to 92 years [2]) were included in the systematic review, and were rated as having overall good quality (median TESTEX score 9 [range 3-14]). In the meta-analysis (including 105 studies, n=7759 participants), exercise interventions were associated with significantly improved overall physical function, with a standardised mean difference [SMD] of 0·13 (95% credible interval [CrI] 0·04-0·21), which was confirmed in all analysed subpopulations. The strongest association was observed with 110-225 min per week of exercise, and the greatest improvements were observed with 170 min per week (SMD 0·36 [95% CrI 0·20-0·52]). No significant differences were found between exercise types. Subanalyses showed significant improvements for almost all analysed physical function-related outcomes (Barthel index, five-times sit-to-stand test, 30-s sit-to-stand test, knee extension, hand grip strength, bicep curl strength, Short Physical Performance Battery, 6-min walking test, walking speed, Berg balance scale, and sit-and-reach test). Large heterogeneity was found between and within studies in terms of population and intervention characteristics. INTERPRETATION: Exercise interventions are associated with improved physical function in older adults in residential care, and should, therefore, be routinely promoted in long-term care facilities. FUNDING: None. TRANSLATION: For the Spanish translation of the abstract see Supplementary Materials section.

Exercise to treat psychopathology and other clinical outcomes in schizophrenia: A systematic review and meta-analysis.

BACKGROUND: Psychopathology and side effects of antipsychotic drugs contribute to worsening physical health and long-term disability, and increasing the risk of mortality in these patients. The efficacy of exercise on these factors is not fully understood, and this lack of knowledge may hamper the routine application of physical activity as part of the clinical care of schizophrenia. AIMS: To determine the effect of exercise on psychopathology and other clinical markers in patients with schizophrenia. We also looked at several moderators. METHOD: MEDLINE, Web of Science, Scopus, CINAHL, SPORTDiscus, PsycINFO, and Cochrane Library databases were systematically searched from inception to October 2022. Randomized controlled trials of exercise interventions in patients 18-65 years old diagnosed with schizophrenia disorder were included. A multilevel random-effects meta-analysis was conducted to pool the data. Heterogeneity at each level of the meta-analysis was estimated via Cochran's Q, I2, and R2. RESULTS: Pooled effect estimates from 28 included studies (1,460 patients) showed that exercise is effective to improve schizophrenia psychopathology (Hedges' g = 0.28, [95% CI 0.14, 0.42]). Exercise presented stronger effects in outpatients than inpatients. We also found exercise is effective to improve muscle strength and self-reported disability. CONCLUSIONS: Our meta-analysis demonstrated that exercise could be an important part in the management and treatment of schizophrenia. Considering the current evidence, aerobic and high-intensity interval training exercises may provide superior benefits over other modalities. However, more studies are warranted to determine the optimal type and dose of exercise to improve clinical outcomes in people with schizophrenia.

Effects of physical exercise on aerobic capacity and quality oflife in patients diagnosed with asthma: A systematic review andmeta-analysis / Efectos del ejercicio físico en la capacidad aeróbica y la calidad de vida enpacientes diagnosticados con asma: revisión sistemática y meta-análisis

Introduction: Nowadays, asthma is a disabling disease with no cure, and the development of effective non-pharmacological treatments which can alleviate side effects of drugs and pathological symptoms is urgent. Some studies have shown that physical exercise may have beneficial effects in patients with asthma, but results were controversial and inconsistent. More evidence is needed to ensure exercise as possible effective treatment in people with asthma.Objectives: To examine the effects of physical exercise on aerobic capacity and quality of life in patients with asthma. Also, we analyze the possible moderation effects of the selected covariates. As a final aim, we verified if a correlation exists between benefits on aerobic capacity and those obtained on quality of life.Material and method: We followed the PRISMA statement to search for randomized controlled trials that used physical exercise as intervention to improve aerobic capacity or quality of life in patients diagnosed with asthma. After data extraction, we conducted a random-effects meta-analysis model with moderation analysis. Then, we inspected the correlation between both outcomes through a multivariate approach. Finally, we performed some additional analyses: methodological quality analysis through the PEDro scale, publication bias analysis through funnel asymmetry tests and funnel plot visualization, and sensitivity analyses by outliers and influential cases detection.(AU)

Introducción: Actualmente, el asma es una enfermedad incapacitante sin cura, y urge el desarrollo de tratamientos no farmacológicos eficaces que puedan aliviar los efectos secundarios de los fármacos y los síntomas patológicos. Algunos estudios han demostrado que el ejercicio físico puede tener efectos beneficiosos en pacientes con asma, pero los resultados fueron controvertidos e inconsistentes. Se necesita más evidencia para garantizar que el ejercicio sea un posible tratamiento eficaz en personas con asma. Objetivos: Examinar los efectos del ejercicio físico sobre la capacidad aeróbica y la calidad de vida en pacientes con asma. Además, analizamos los posibles efectos de moderación de las covariables seleccionadas. Como objetivo final, verificamos si existe una correlación entre los beneficios en la capacidad aeróbica y los obtenidos sobre la calidad de vida.Material y método: Seguimos la declaración PRISMA para buscar ensayos controlados aleatorios que utilizaran el ejercicio físico como intervención para mejorar la capacidad aeróbica o la calidad de vida en pacientes con diagnóstico de asma. Después de la extracción de datos, realizamos un modelo de meta-análisis de efectos aleatorios con análisis de moderación. Luego, inspeccionamos la correlación entre ambos resultados a través de un enfoque multivariado. Finalmente, realizamos algunos análisis adicionales: análisis de calidad metodológica a través de la escala PEDro, análisis de sesgos de publicación a través de pruebas de asimetría de embudo y visualización de gráficos de embudo, y análisis de sensibilidad mediante la detección de ‘outliers’ y de casos influyentes. Resultados: El ejercicio físico tuvo efectos beneficiosos en la capacidad aeróbica y en la calidad de vida. Ninguna de las covariables presentó un efecto moderador significativo. Encontramos una correlación positiva entre los efectos del ejercicio sobre la capacidad aeróbica y los provocados en la calidad de vida.(AU)

Handgrip strength measurement protocols for all-cause and cause-specific mortality outcomes in more than 3 million participants: A systematic review and meta-regression analysis.

BACKGROUND & AIMS: Handgrip strength is a strong predictor of the risk of mortality. The objective of this systematic review was to analyse handgrip strength measurement protocols used in all-cause and cause-specific mortality studies. METHOD: A systematic search of PubMed/MEDLINE, Web of Science and Scopus was conducted from inception to February 2022. Prospective cohort studies with objective measures of handgrip strength were included. Studies had to report at least one all-cause, cancer, or cardiovascular mortality outcome. The quality of the included studies was assessed using the Newcastle Ottawa Scale. Meta-regression was used to quantify the bias associated with handgrip strength values in relation to the use of different measurement protocols. RESULTS: Forty-eight studies with a total of 3,135,473 participants (49.6% women) were included. Half of the studies controlled body position, 39.6% arm position, 33.3% elbow position, 12.5% wrist position, 13% handgrip duration, 23% hand-adjustment to dynamometer and 12.5% verbal encouragement. The number of measurements, the laterality of the hand tested, and the estimation method of the handgrip strength value varied considerably between the study protocols. The spline regression model showed a non-linear inverse association between the values of handgrip strength and the number of protocol items controlled. Handgrip strength was higher when the number of measurements per hand or arm position was not controlled. Conversely, handgrip strength was lower when elbow position was not controlled or verbal encouragement were not provided. CONCLUSION: In general, the protocols used to assess handgrip strength in mortality studies are incomplete and highly heterogeneous. Handgrip strength values were higher when studies controlled fewer handgrip strength measurement protocol variables. There is a need to improve the controlling of handgrip strength measurement protocols and to standardise the method to enhance the accuracy of mortality risk estimates associated with handgrip strength. PROSPERO REGISTRATION NUMBER: CRD42022334929.

Cancer survivor inspiratory muscle training: systematic review and Bayesian meta-analysis.

BACKGROUND: The long-term impact of cancer treatment is associated with respiratory dysfunction and physical fitness impairment. Although inspiratory muscle training (IMT) has been shown as an effective exercise therapy in cancer survivors, there is no evidence on the optimal dose, application moment nor specific population effects of this intervention. The main objective of this meta-analysis is to analyse the effects of IMT on pulmonary function, physical fitness and quality of life (QoL) in cancer survivors. METHODS: This systematic review and meta-analysis was preregistered in the International Prospective Register of Systematic Reviews (PROSPERO) register and conducted according to the Preferred Reporting for Systematic Reviews and Meta-analysis statement. We used a Bayesian multilevel random-effects meta-analysis model to pool the data. Multilevel metaregression models were used to examine the conditional effects of our covariates. Convergence and model fit were evaluated through specific model parameters. Sensitivity analyses removing influential cases and using a frequentist approach were carried out. RESULTS: Pooled data showed that IMT intervention is effective to improve pulmonary function (standardised mean difference=0.53, 95% credible interval 0.13 to 0.94, SE=0.19). However, IMT did not present statistically significant results on physical fitness and QoL. Metaregression analyses found that the type of cancer, the moment of application and the evaluation tool used had significant moderation effects on pulmonary function. CONCLUSION: IMT could be an important part in the management of side effects suffered by cancer survivors. Considering the current evidence, this intervention is highly recommended in patients diagnosed with oesophageal and lung cancers. IMT may provide superior benefits before the biological treatment and after the surgery. PROSPERO REGISTRATION NUMBER: 304909.

Optimal Number of Steps per Day to Prevent All-Cause Mortality in People With Prediabetes and Diabetes.

OBJECTIVE: We aimed to examine the dose-response associations between the number of steps per day and all-cause mortality among adults with prediabetes and diabetes. RESEARCH DESIGN AND METHODS: This prospective study used data from 1,194 U.S. adults with prediabetes and 493 with diabetes for whom accelerometer-derived steps per day could be retrieved. Mortality was ascertained through the National Death Index (February 25, 2019). Splines were used to assess the dose-response associations between steps per day and all-cause mortality. RESULTS: Over ∼9 years of follow-up, 200 adults with prediabetes and 138 with diabetes died. Nonlinear associations akin to an L shape were observed. We estimated an optimal dose of ∼10,000 steps per day to reduce the risk of all-cause mortality for both individuals with prediabetes and those with diabetes. CONCLUSIONS: Accumulating more steps per day up to ∼10,000 steps per day may lower the risk of all-cause mortality of adults with prediabetes and diabetes.

Optimal dose and type of exercise to improve cognitive function in older adults: A systematic review and bayesian model-based network meta-analysis of RCTs.

OBJECTIVE: To examine the dose-response relationship between overall and specific types of exercise with cognitive function in older adults. DESIGN: Systematic Review and Bayesian Model-Based Network Meta-Analysis. DATA SOURCES: Systematic search of MEDLINE, Web of Science, Scopus, PsycINFO and SPORTDiscus. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Randomized controlled trials of exercise interventions in participants aged 50 years or over, and that reported on at least one global cognition outcome. RESULTS: The search returned 1998 records, of which 44 studies (4793 participants; 102 different effect sizes) were included in this review with meta-analysis. There was a non-linear, dose-response association between overall exercise and cognition. We found no minimal threshold for the beneficial effect of exercise on cognition. The estimated minimal exercise dose associated with clinically relevant changes in cognition was 724 METs-min per week, and doses beyond 1200 METs-min per week provided less clear benefits. We also found that the dose-response association was exercise type dependent, and our results show that clinically important effects may occur at lower doses for many types of exercise. Our findings also highlighted the superior effects of resistance exercises over other modalities. CONCLUSIONS: If provided with the most potent modalities, older adults can get clinical meaningful benefits with lower doses than the WHO guidelines. Findings support the WHO recommendations to emphasise resistance training as a critical component of interventions for older adults.