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Time of the day of exercise impact on cardiovascular disease risk factors in adults: a systematic review and meta-analysis.
Sevilla-Lorente, R, Carneiro-Barrera, A, Molina-Garcia, P, Ruiz, JR, Amaro-Gahete, FJ
Journal of science and medicine in sport. 2023;26(3):169-179
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In humans, shifted sleep patterns seem to interfere with several metabolic pathways. Shift work, short sleep duration, exposure to artificial light, inadequate eating time window, and lack of physical activity, are some characteristics of the modern lifestyle that contributes to the occurrence and worsening of cardiovascular disease (CVD). The aim of this study was to analyse the time of the day of exercise-induced effects on CVD risk factors in adults. This study was a systematic review and meta-analysis of twenty-two studies. Results showed that exercise produces an acute reduction of systolic blood pressure independently of the time of the day at which it is performed. Similarly, exercise produces an acute increase in blood glucose independently of the time of the day. Authors concluded that further research is needed to establish whether there is a diurnal variation of exercise on cardiovascular health and how it is related to health status, sex, or the type of exercise.
Abstract
OBJECTIVES To compare the effect of a single bout of morning vs. evening exercise on cardiovascular risk factors in adults. DESIGN Systematic review and meta-analysis. METHODS A systematic search of studies was conducted using PubMed and Web of Science from inception to June 2022. Selected studies accomplished the following criteria: crossover design, acute effect of exercise, blood pressure, blood glucose, and/or blood lipids as the study's endpoint, a washout period of at least 24 h, and adults. Meta-analysis was performed by analyzing: 1) separated effect of morning and evening exercise (pre vs. post); and 2) comparison between morning and evening exercise. RESULTS A total of 11 studies were included for systolic and diastolic blood pressure and 10 studies for blood glucose. Meta-analysis revealed no significant difference between morning vs. evening exercise for systolic blood pressure (g ∆ = 0.02), diastolic blood pressure (g ∆ = 0.01), or blood glucose (g ∆ = 0.15). Analysis of moderator variables (age, BMI, sex, health status, intensity and duration of exercise, and hour within the morning or evening) showed no significant morning vs. evening effect. CONCLUSIONS Overall, we found no influence of the time of the day on the acute effect of exercise on blood pressure neither on blood glucose.
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The effectiveness of digital interventions for increasing physical activity in individuals of low socioeconomic status: a systematic review and meta-analysis.
Western, MJ, Armstrong, MEG, Islam, I, Morgan, K, Jones, UF, Kelson, MJ
The international journal of behavioral nutrition and physical activity. 2021;18(1):148
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Low physical activity levels are responsible for many non-communicable diseases and a huge cost to health services. Low socioeconomic status is associated with lower physical activity levels and therefore it is important to increase activity amongst this group of people. The use of digital technologies to increase exercise has become popular in recent years, however it is unknown whether they have differing effectiveness depending on the socioeconomic status of the user. This systematic review and meta-analysis of 19 studies aimed to determine whether digital technologies which target physical activity levels are beneficial for those from low socioeconomic status. The results showed that digital interventions targeting activity have differing effectiveness depending on the socioeconomic status, with those from high socioeconomic status benefitting from these interventions, and those from a low socioeconomic status did not. It was concluded that future technologies need to be tailored to target individuals from low socioeconomic status to improve effectiveness. This study could be used by healthcare professionals to understand that digital technologies designed to increase physical activity may not be sufficient for individuals from a low socioeconomic status and extra support and guidance may be needed.
Abstract
BACKGROUND Digital technologies such as wearables, websites and mobile applications are increasingly used in interventions targeting physical activity (PA). Increasing access to such technologies makes an attractive prospect for helping individuals of low socioeconomic status (SES) in becoming more active and healthier. However, little is known about their effectiveness in such populations. The aim of this systematic review was to explore whether digital interventions were effective in promoting PA in low SES populations, whether interventions are of equal benefit to higher SES individuals and whether the number or type of behaviour change techniques (BCTs) used in digital PA interventions was associated with intervention effects. METHODS A systematic search strategy was used to identify eligible studies from MEDLINE, Embase, PsycINFO, Web of Science, Scopus and The Cochrane Library, published between January 1990 and March 2020. Randomised controlled trials, using digital technology as the primary intervention tool, and a control group that did not receive any digital technology-based intervention were included, provided they had a measure of PA as an outcome. Lastly, studies that did not have any measure of SES were excluded from the review. Risk of Bias was assessed using the Cochrane Risk of Bias tool version 2. RESULTS Of the 14,589 records initially identified, 19 studies were included in the final meta-analysis. Using random-effects models, in low SES there was a standardised mean difference (SMD (95%CI)) in PA between intervention and control groups of 0.06 (- 0.08,0.20). In high SES the SMD was 0.34 (0.22,0.45). Heterogeneity was modest in both low (I2 = 0.18) and high (I2 = 0) SES groups. The studies used a range of digital technologies and BCTs in their interventions, but the main findings were consistent across all of the sub-group analyses (digital interventions with a PA only focus, country, chronic disease, and duration of intervention) and there was no association with the number or type of BCTs. DISCUSSION Digital interventions targeting PA do not show equivalent efficacy for people of low and high SES. For people of low SES, there is no evidence that digital PA interventions are effective, irrespective of the behaviour change techniques used. In contrast, the same interventions in high SES participants do indicate effectiveness. To reduce inequalities and improve effectiveness, future development of digital interventions aimed at improving PA must make more effort to meet the needs of low SES people within the target population.
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Long-term clinical outcomes in survivors of severe acute respiratory syndrome and Middle East respiratory syndrome coronavirus outbreaks after hospitalisation or ICU admission: A systematic review and meta-analysis.
Ahmed, H, Patel, K, Greenwood, DC, Halpin, S, Lewthwaite, P, Salawu, A, Eyre, L, Breen, A, O'Connor, R, Jones, A, et al
Journal of rehabilitation medicine. 2020;52(5):jrm00063
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Alongside acute challenges, the severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) outbreaks resulted in significant long-term clinical problems for survivors, with implications for rehabilitation services and healthcare utilization. The aim of this study was to determine the long-term clinical complications for survivors of SARS and MERS after hospitalization and intensive care unit admission. This study is a systemic review and meta-analysis which included a total of 28 studies in the systematic review and 23 in the meta-analysis. Results indicate that health-related quality of life, measured using SF-36, was considerably reduced in survivors at 6 months post-infection, and showed only slight improvement beyond 6 months. Health-related quality of life of survivors remained below that of the normal population and of those with chronic conditions. Authors conclude that clinicians should monitor the survivors of COVID-19 for the range of physical and mental health impairments in order to manage these patients appropriately.
Abstract
OBJECTIVE To determine long-term clinical outcomes in survivors of severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) coronavirus infections after hospitalization or intensive care unit admission. DATA SOURCES Ovid MEDLINE, EMBASE, CINAHL Plus, and PsycINFO were searched. STUDY SELECTION Original studies reporting clinical outcomes of adult SARS and MERS survivors 3 months after admission or 2 months after discharge were included. DATA EXTRACTION Studies were graded using the Oxford Centre for Evidence-Based Medicine 2009 Level of Evidence Tool. Meta-analysis was used to derive pooled estimates for prevalence/severity of outcomes up to 6 months after hospital discharge, and beyond 6 months after discharge. DATA SYNTHESIS Of 1,169 identified studies, 28 were included in the analysis. Pooled analysis revealed that common complications up to 6 months after discharge were: impaired diffusing capacity for carbon monoxide (prevalence 27%, 95% confidence interval (CI) 15–45%); and reduced exercise capacity (mean 6-min walking distance 461 m, CI 450–473 m). The prevalences of post-traumatic stress disorder (39%, 95% CI 31–47%), depression (33%, 95% CI 20–50%) and anxiety (30%, 95% CI 10–61) beyond 6 months after discharge were considerable. Low scores on Short-Form 36 were identified beyond 6 months after discharge. CONCLUSION Lung function abnormalities, psychological impairment and reduced exercise capacity were common in SARS and MERS survivors. Clinicians should anticipate and investigate similar long-term outcomes in COVID-19 survivors.
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Impact of implementation intentions on physical activity practice in adults: A systematic review and meta-analysis of randomized clinical trials.
Silva, MAVD, São-João, TM, Brizon, VC, Franco, DH, Mialhe, FL
PloS one. 2018;13(11):e0206294
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Many behavioural interventions have been implemented in order to increase physical activity levels among adults. Despite these efforts, there is often a large gap between setting goals and attaining goals. The aim of this systematic review and meta-analysis was to evaluate the effectiveness of using theory-based strategies on goal attainment in promoting physical activity among adults (specifically implementation intentions or if-then planning). Particular interest was given to the impact of reinforcements during the intervention and follow-up period for coping with obstacles. A total of 13 randomised controlled trials were included. Implementation intentions consisted of two strategies. Firstly, action planning which was designed to increase awareness of possible future situations where behaviours could be achieved. Secondly, coping planning which focused on barriers that might impede the goal behaviour, and ways to overcome these possible barriers. According to the current literature, application of the theory-based goal setting promoted physical activity behaviours, and this was heightened among those who received reinforcement of plans to increase physical activity during the follow-up period.
Abstract
OBJECTIVE The aim of this study was to verify the efficacy of using theory-based strategies on implementation intentions in promoting physical activity (PA) among adults. METHODS This review was conducted in accordance with the PRISMA recommendations. The search was carried out in seven electronic databases (LILACS, PubMed, SciELO, Cochrane, Web of Science) and two searches of the "grey literature" were performed (Openthesis and OpenGrey). Randomized clinical trials (RCT), published up to September 2016, were considered eligible for this study. Two reviewers independently and systematically evaluated the eligibility criteria, and performed data extraction. A meta-analysis was performed for the purpose of comparing the effect between the intervention and control groups. The effect sizes were grouped in two subgroups with the purpose of more accurately verifying the effect caused by reinforcing the implementation intentions strategy, and using the inverse variance statistical method with random effects models to estimate the main effect of the implementation intention strategy on the PA behavior. Heterogeneity among the studies was evaluated by using I-square statistics, and the Jadad scale to evaluate the quality of included papers. RESULTS The search resulted in 12,147 records, of which 13 RCTs were considered eligible for this review. Sample age ranged from 18 to 76 years, and participants had conditions such as medullary lesion, coronary disease, obesity, diabetes mellitus, sedentarism or occupational stress. When the summary of the effect was analyzed in the meta-analysis, the result found in the subgroup with reinforcement of the implementation intentions strategy was 0.25 (IC 95% = 0.05-0.45) in favor of the intervention group. This demonstrated that application of the implementation intentions strategy was capable of increasing PA practice in the participants of these studies, in comparison with others that did not use this reinforcement. CONCLUSION The findings of this review indicated that application of the theory of implementation intentions promoted PA behavior among the adults who received reinforcement of this strategy. The systematic review protocol was registered in the PROSPERO database under the number CRD42018090482.
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Clinical review: treatment of pediatric obesity: a systematic review and meta-analysis of randomized trials.
McGovern, L, Johnson, JN, Paulo, R, Hettinger, A, Singhal, V, Kamath, C, Erwin, PJ, Montori, VM
The Journal of clinical endocrinology and metabolism. 2008;93(12):4600-5
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Childhood obesity represents a significant problem to society. It is associated with increased incidence of adult obesity and cardiovascular risk factors. This report was commissioned by the Endocrine Society to help them formulate a clinical practice guidance for paediatric obesity. The review completed a meta-analysis and systematic review of randomised controlled trials up until February 2006. It focused on exploring the efficacy of weight loss interventions (diet, lifestyle and pharmacological agents) for overweight children and adolescents (aged 2-18 years). The authors concluded that there was evidence of short-term efficacy of pharmacological interventions (sibutramine and orlistat in adolescents) on body mass index (BMI). The review also reported a moderate effect of physical activity on adiposity but not BMI, and a small to moderate effect of combined lifestyle interventions on BMI. The impact of parental influence on treatment for childhood obesity remain unclear, although the authors suggest it may be of benefit among children aged 8 years and over. Additionally, the long-term efficacy of obesity treatments on the health of children and adolescents remains unclear.
Abstract
CONTEXT The efficacy of treatments for pediatric obesity remains unclear. OBJECTIVE We performed a systematic review of randomized trials to estimate the efficacy of nonsurgical interventions for pediatric obesity. DATA SOURCES Librarian-designed search strategies of nine electronic databases from inception until February 2006, review of reference lists from published reviews, and content expert advice provided potentially eligible studies. STUDY SELECTION Eligible studies were randomized trials of overweight children and adolescents assessing the effect of nonsurgical interventions on obesity outcomes. DATA EXTRACTION Independently and in duplicate, reviewers assessed the quality of each trial and collected data on interventions and outcomes. DATA SYNTHESIS Of 76 eligible trials, 61 had complete data for meta-analysis. Short-term medications were effective, including sibutramine [random-effects pooled estimate of body mass index (BMI) loss of 2.4 kg/m(2) with a 95% confidence interval (CI) of 1.8-3.1; proportion of between-study inconsistency not due to chance (I(2)) = 30%] and orlistat (BMI loss = 0.7 kg/m(2); CI = 0.3-1.2; I(2) = 0%). Trials that measured the effect of physical activity on adiposity (i.e. percent body fat and fat-free mass) found a moderate treatment effect (effect size = -0.52; CI = -0.73 to -0.30; I(2) = 0%), whereas trials measuring the effect on BMI found no significant effect (effect size = -0.02; CI = -0.21 to 0.18; I(2) = 0%), but reporting bias may explain this finding. Combined lifestyle interventions (24 trials) led to small changes in BMI. CONCLUSIONS Limited evidence supports the short-term efficacy of medications and lifestyle interventions. The long-term efficacy and safety of pediatric obesity treatments remain unclear.