How should long-term free-living physical activity be targeted after stroke? A systematic review and narrative synthesis.

BACKGROUND: Increasing physical activity (PA) levels (regular movement such as walking and activities of daily living) and reducing time spent sedentary improves cardiovascular health and reduces morbidity and mortality. Fewer than 30% of independently mobile stroke survivors undertake recommended levels of PA. Sedentary behaviour is also high in this population. We aimed to systematically review the study characteristics and the promise of interventions targeting free-living PA and/or sedentary behaviour in adult stroke survivors. METHODS: Seven electronic databases were searched to identify randomised controlled trials (≥3-months follow-up) targeting PA and/or sedentary behaviour in adults with first or recurrent stroke or transient ischaemic attack. The quality assessment framework for RCTs was used to assess risk of bias within and across studies. Interventions were rated as "very", "quite" or "non-promising" based on within- or between-group outcome differences. Intervention descriptions were captured using the TIDieR (Template for Intervention Description and Replication) Checklist. Behaviour change techniques (BCTs) within interventions were coded using the BCT Taxonomy v1, and compared between studies by calculating a promise ratio. RESULTS: Nine studies fulfilled the review criteria (N = 717 randomised stroke patients) with a high or unclear risk of bias. None of the studies targeted sedentary behaviour. Six studies were very/quite promising (reported increases in PA post-intervention). Studies were heterogeneous in their reporting of participant age, time since stroke, stroke type, and stroke location. Sub-optimal intervention descriptions, treatment fidelity and a lack of standardisation of outcome measures were identified. Face to face and telephone-based self-management programmes were identified as having promise to engage stroke survivors in PA behaviour change. Optimal intensity of contact, interventionist type and time after stroke to deliver interventions was unclear. Nine promising BCTs (ratios ≥2) were identified: information about health consequences; information about social and environmental consequences; goal setting-behaviour; problem-solving; action planning; feedback on behaviour; biofeedback; social support unspecified; and credible source. CONCLUSIONS: Future research would benefit from establishing stroke survivor preferences for mode of delivery, setting and intensity, including measurement of physical activity. Interventions need to justify and utilise a theory/model of behaviour change and explore the optimal combination of promising BCTs within interventions.

Exercise as a treatment for sarcopenia: an umbrella review of systematic review evidence.

BACKGROUND: Sarcopenia is a progressive and generalised skeletal muscle disorder, and a powerful predictor of adverse health outcomes. Exercise is a widely recommended treatment but consensus about the best approach is lacking. OBJECTIVE: To synthesise current systematic review evidence on the effectiveness of exercise in the treatment of sarcopenia to inform clinical practice. DATA SOURCES: Five electronic databases were searched (15 November 2018): Cochrane Database of Systematic Reviews; MEDLINE without revisions; EMBASE; Scopus; and Web of Science. STUDY SELECTION OR ELIGIBILITY CRITERIA: Systematic reviews and meta-analyses of randomised controlled trials evaluating exercise to treat sarcopenia in adults including sarcopenic outcomes. STUDY APPRAISAL AND SYNTHESIS METHODS: Review data were extracted and quality assessed (using the AMSTAR 2) by two independent assessors. Due to a lack of eligible reviews, a narrative synthesis of the evidence was performed. RESULTS: Two reviews were identified which included seven studies with 619 participants. Study exercise interventions included: resistance; mixed and whole body vibration training programmes. Review findings demonstrate limited low quality evidence of positive effects of mixed and resistance training in treating sarcopenia. LIMITATIONS: Limited eligible reviews restricted synthesis and interpretation of findings. CONCLUSION AND IMPLICATIONS OF KEY FINDINGS: There is a lack of high quality research with which to inform the treatment of sarcopenia with exercise. Further research using more precision when selecting sarcopenic populations and outcomes is required in this field. This will enable the identification of effective ways of treating sarcopenia with exercise before evidence-based clinical guidelines can be established.