Effectiveness of home-based exercise delivered by digital health in older adults: a systematic review and meta-analysis.

BACKGROUND: regular physical exercise is essential to maintain or improve functional capacity in older adults. Multimorbidity, functional limitation, social barriers and currently, coronavirus disease of 2019, among others, have increased the need for home-based exercise (HBE) programmes and digital health interventions (DHI). Our objective was to evaluate the effectiveness of HBE programs delivered by DHI on physical function, health-related quality of life (HRQoL) improvement and falls reduction in older adults. DESIGN: systematic review and meta-analysis. PARTICIPANTS: community-dwelling older adults over 65 years. INTERVENTION: exercises at home through DHI. OUTCOMES MEASURES: physical function, HRQoL and falls. RESULTS: twenty-six studies have met the inclusion criteria, including 5,133 participants (range age 69.5 ± 4.0-83.0 ± 6.7). The HBE programmes delivered with DHI improve muscular strength (five times sit-to-stand test, -0.56 s, 95% confidence interval, CI -1.00 to -0.11; P = 0.01), functional capacity (Barthel index, 5.01 points, 95% CI 0.24-9.79; P = 0.04) and HRQoL (SMD 0.18; 95% CI 0.05-0.30; P = 0.004); and reduce events of falls (odds ratio, OR 0.77, 95% CI 0.64-0.93; P = 0.008). In addition, in the subgroup analysis, older adults with diseases improve mobility (SMD -0.23; 95% CI -0.45 to -0.01; P = 0.04), and balance (SMD 0.28; 95% CI 0.09-0.48; P = 0.004). CONCLUSION: the HBE programmes carried out by DHI improve physical function in terms of lower extremity strength and functional capacity. It also significantly reduces the number of falls and improves the HRQoL. In addition, in analysis of only older adults with diseases, it also improves the balance and mobility.

Effects on Sleep Quality of Physical Exercise Programs in Older Adults: A Systematic Review and Meta-Analysis.

BACKGROUND: Given the beneficial effects of exercise in different populations and the close relationship between healthy ageing and sleep quality, our objective was to determine if physical exercise delivered through a structured program improves sleep quality in older adults. METHODS: Embase, PubMed/MEDLINE, Web of Science, and Cochrane Register of Clinical Trials (CENTRAL) were searched to 15 January 2023. Studies that applied physical exercise programs in older adults were reviewed. Two independent reviewers analysed the studies, extracted the data, and assessed the quality of evidence. RESULTS: Of the 2599 reports returned by the initial search, 13 articles reporting on 2612 patients were included in the data synthesis. The articles used interventions based on yoga (n = 5), multicomponent exercise (n = 3), walking (n = 2), cycling (n = 1), pilates (n = 1), elastic bands (n = 1), and healthy beat acupunch (n = 1). In the intervention group, we found significant improvement in Pittsburgh sleep quality index of -2.49 points (95% CI -3.84 to -1.14) in comparison to the control group (p = 0.0003) and sleep efficiency measured with objective instruments (MD 1.18%, 95% CI 0.86 to 1.50%, p < 0.0001). CONCLUSION: Our results found that physical exercise programs in older adults improve sleep quality and efficiency measured with objective instruments.

Professional competences to promote healthy ageing across the lifespan: a scoping review.

As societies age, the development of resources and strategies that foster healthy ageing from the beginning of life become increasingly important. Social and healthcare professionals are key agents in this process; therefore, their training needs to be in agreement with societal needs. We performed a scoping review on professional competences for social and health workers to adequately promote healthy ageing throughout life, using the framework described by Arksey and O'Malley and the Joanna Briggs Institute Guidelines. A stakeholder consultation was held in each of the participating countries, in which 79 experts took part. Results show that current literature has been excessively focused on the older age and that more attention on how to work with younger population groups is needed. Likewise, not all disciplines have equally reflected on their role before this challenge and interprofessional approaches, despite showing promise, have not been sufficiently described. Based on our results, health and social professionals working to promote healthy ageing across the lifespan will need sound competences regarding person-centred communication, professional communication, technology applications, physiological and pathophysiological aspects of ageing, social and environmental aspects, cultural diversity, programs and policies, ethics, general and basic skills, context and self-management-related skills, health promotion and disease prevention skills, educational and research skills, leadership skills, technological skills and clinical reasoning. Further research should contribute to establishing which competences are more relevant to each discipline and at what level they should be taught, as well as how they can be best implemented to effectively transform health and social care systems.

Completeness of reporting acupuncture interventions for chronic obstructive pulmonary disease: Review of adherence to the STRICTA statement.

Background: The quality of reporting of acupuncture interventions is critical to ensure the applicability and reproducibility of acupuncture clinical trials. In the past, different publications have evaluated the quality of reporting of acupuncture interventions for different clinical situations, such as knee osteoarthritis, neurological diseases or cancer. However, this has not been done for acupuncture trials for chronic obstructive pulmonary disease (COPD). Objective: To assess the quality of reporting of acupuncture interventions in trials for COPD. Methods: A total of 11 English and Chinese databases were screened up until May 2019 for randomised or quasi-randomised control trials of acupuncture for COPD. The STRICTA checklist was used to determine the quality of the reporting of acupuncture interventions. Results: A total of 28 trials were included in our review. Out of the 16 STRICTA checklist subitems analysed, only 3 were considered appropriately reported in more than 70% of the trials, while 7 were correctly reported in less than 40%. Conclusion: The adherence to STRICTA guidelines of acupuncture trials for COPD is suboptimal, and future efforts need to be addressed to improve the quality of reporting.

Acupuncture techniques for COPD: a systematic review.

BACKGROUND: This is the second part of a large spectrum systematic review which aims to identify and assess the evidence for the efficacy of non-pharmacological acupuncture techniques in the treatment of chronic obstructive pulmonary disease (COPD). The results of all techniques except for filiform needle are described in this publication. METHODS: Eleven different databases were screened for randomised controlled trials up to June 2019. Authors in pairs extracted the data and assessed the risk of bias independently. RevMan 5.3 software was used for the meta-analysis. RESULTS: Thirty-three trials met the inclusion criteria, which involved the follow techniques: AcuTENS (7 trials), moxibustion (11 trials), acupressure (7 trials), ear acupuncture (6 trials), acupressure and ear acupuncture combined (1 trial) and cupping (1 trial). Due to the great heterogeneity, only 7 meta-analysis could be performed (AcuTENS vs sham on quality of life and exercise capacity, acupressure vs no acupressure on quality of life and anxiety and ear acupuncture vs sham on FEV1 and FEV1/FVC) with only acupressure showing statistical differences for quality of life (SMD: -0.63 95%CI: - 0.88, - 0.39 I2 = 0%) and anxiety (HAM-A scale MD:-4.83 95%CI: - 5.71, - 3.94 I2 = 0%). CONCLUSIONS: Overall, strong evidence in favour of any technique was not found. Acupressure could be beneficial for dyspnoea, quality of life and anxiety, but this is based on low quality trials. Further large well-designed randomised control trials are needed to elucidate the possible role of acupuncture techniques in the treatment of COPD. TRIAL REGISTRATION: PROSPERO (identifier: CRD42014015074).

Filiform needle acupuncture for copd: A systematic review and meta-analysis.

BACKGROUND: This is the first part of a larger spectrum systematic review which aims to identify and evaluates the effectiveness of all different non-pharmacological acupuncture techniques used for COPD. In this first publication, we describe the results of filiform needle acupuncture METHODS: Randomised controlled trials up to May 2019 were searched in 11 databases. Data extraction and risk of bias assessment was conducted in pairs independently. RevMan 5.3 was used for the meta-analysis. RESULTS: 28 trials using filiform needle alone or in combination of other techniques were included. Compared with no acupuncture, no difference was seen for dyspnoea, but statistical benefits were found on quality of life (Std. MD: -0.62, 95%CI: -0.90, -0.34), exercise capacity (stable subgroup) (6MWT MD: 33.05 m, 95%CI: 19.11, 46.99) and lung function (FEV1% MD: 1.58, 95%CI: 0.51, 2.66). Compared with sham, statistical benefits were found on dyspnoea (Std. MD: -1.07, 95%CI: -1.58, -0.56), quality of life (Std. MD: -0.81, 95%CI: -1.12, -0.49), exercise capacity (6MWT MD: 76.68 m, 95% CI: 39.93, 113.43) and lung function (FEV1% MD: 5.40, 95%CI: 2.90, 7.91; FEV1/FVC MD: 6.64, 95%CI: 3.44, 9.83). CONCLUSIONS: Results show that filiform needle acupuncture might be beneficial for COPD, but due to the low quality of the studies this should be confirmed by future well-designed trials. PROTOCOL REGISTRATION: PROSPERO (identifier: CRD42014015074).