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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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Effectiveness of wearable activity trackers to increase physical activity and improve health: a systematic review of systematic reviews and meta-analyses.
Ferguson, T, Olds, T, Curtis, R, Blake, H, Crozier, AJ, Dankiw, K, Dumuid, D, Kasai, D, O'Connor, E, Virgara, R, et al
The Lancet. Digital health. 2022;4(8):e615-e626
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A sedentary or physically inactive lifestyle significantly contributes to non-communicable diseases such as coronary heart disease, type 2 diabetes and stroke. Wearable activity trackers are low-cost solutions that encourage users to engage in physical activity. This umbrella review of systematic reviews and meta-analyses investigated the benefits of wearable activity trackers in improving physical activity levels and their beneficial effects on physiological and psychosocial outcomes. This umbrella review included thirty-nine systematic reviews, of which twenty-five systematic reviews included meta-analyses of the benefits of wearable trackers on physical activity levels. Results of this umbrella review suggest that wearable trackers increased physical activity levels, especially daily steps count and energy expenditure. The physiological outcomes included improvements in BMI, blood pressure, cholesterol, glycosylated haemoglobin, waist circumference, and body weight. There was also a slight improvement in the quality of life of the participants who used wearable activity trackers. Further robust studies are required to evaluate the effects of wearable trackers on the psychosocial outcomes in people with mental illness. However, healthcare professionals can use the results of this study to understand the impact of wearable trackers on physiological and psychosocial effects in a non-clinical population.
Abstract
Wearable activity trackers offer an appealing, low-cost tool to address physical inactivity. This systematic review of systematic reviews and meta-analyses (umbrella review) aimed to examine the effectiveness of activity trackers for improving physical activity and related physiological and psychosocial outcomes in clinical and non-clinical populations. Seven databases (Embase, MEDLINE, Ovid Emcare, Scopus, SPORTDiscus, the Cochrane Library, and Web of Science) were searched from database inception to April 8, 2021. Systematic reviews of primary studies using activity trackers as interventions and reporting physical activity, physiological, or psychosocial outcomes were eligible for inclusion. In total, 39 systematic reviews and meta-analyses were identified, reporting results from 163 992 participants spanning all age groups, from both healthy and clinical populations. Taken together, the meta-analyses suggested activity trackers improved physical activity (standardised mean difference [SMD] 0·3-0·6), body composition (SMD 0·7-2·0), and fitness (SMD 0·3), equating to approximately 1800 extra steps per day, 40 min per day more walking, and reductions of approximately 1 kg in bodyweight. Effects for other physiological (blood pressure, cholesterol, and glycosylated haemoglobin) and psychosocial (quality of life and pain) outcomes were typically small and often non-significant. Activity trackers appear to be effective at increasing physical activity in a variety of age groups and clinical and non-clinical populations. The benefit is clinically important and is sustained over time. Based on the studies evaluated, there is sufficient evidence to recommend the use of activity trackers.
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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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Nutrition, Physical Activity, and New Technology Programs on Obesity Prevention in Primary Education: A Systematic Review.
Navidad, L, Padial-Ruz, R, González, MC
International journal of environmental research and public health. 2021;18(19)
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Obesity in children is increasing and low rates of activity and poor eating habits appear to be at the heart of the problem. New digital technologies and interventions to encourage physical activity are becoming popular and have been assessed in previous reviews, but none of these have focused on children. This systematic review aimed to determine the effectiveness of new digital technologies being used to encourage physical activity in primary school aged children. The results showed that using new digital technologies to improve eating habits and levels of physical activity were of benefit to primary school aged children, however this had limited effect on body mass index. It was concluded that the use of digital technologies in school aged children may be of benefit to health through the prevention of obesity. This study could be used by healthcare professionals to understand that obesity in children is increasing and the use of digital technology to improve physical activity and eating habits may be an effective strategy to combat this.
Abstract
Early acquisition of healthy lifestyle habits is crucial for good adult health. For this reason, the primary stage of education is a critical period to implement educational policies in this regard. The aim of this review is to compile the published evidence regarding school interventions at the primary stage aimed at preventing obesity, and which integrate as part of their action plan two features: an improvement in knowledge or nutrition habits and the promotion of physical activity (PA), and the use of new information and communications technologies (ICT) to do this. The method used for this review is the searching of different databases for publications that include these criteria. The results show beneficial effects of such interventions in improved eating habits and increased PA. The effect on BMI is limited, and the use of ICT can be of help at a motivational level for the maintenance and fulfilment of the health objectives. However, studies of this type in elementary school are very limited, so it would be necessary to continue researching on this line. In conclusion, this review demonstrates the suitability of carrying out mixed interventions (improved nutrition and PA) together with the use of new technologies to improve health and prevent obesity at an early age.
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The potential long-term impact of the COVID-19 outbreak on patients with non-communicable diseases in Europe: consequences for healthy ageing.
Palmer, K, Monaco, A, Kivipelto, M, Onder, G, Maggi, S, Michel, JP, Prieto, R, Sykara, G, Donde, S
Aging clinical and experimental research. 2020;32(7):1189-1194
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Individuals with non-communicable diseases (NCD's), i.e. diseases that are not transmitted from person to person, such as diabetes and heart disease, are at a much higher risk of death from Covid-19. But for individuals who contract Covid-19 and survive, there could be considerable implications on the progression of their pre-existing condition. This review study aimed to discuss how the Covid-19 pandemic might impact management and outcomes in individuals with NCD's. The paper outlined that higher Covid-19 death rates in individuals with NCD's, will cause a decline of these diseases within populations. Although there is little peer reviewed research to support this, circumstantial reports are already suggesting lower hospital admissions for stroke and heart attacks. However it should be noted that it is obvious that this paper was written at the start of the pandemic. The paper went on to discuss that the pandemic and subsequent government actions to control the infection will affect individuals with NCD's through reductions in physical activity, social interaction, and vitamin D intake. Changes to medical management, the subsequent possibility of decreased adherence to medications and the halting of much needed research on NCD's in favour of Covid-19 research, will further exacerbate the impact on individuals with pre-existing conditions. Finally, areas upon which the healthcare system and government should be focusing in order to help individuals with NCD's were discussed. Amongst these was the acknowledgement that the public and private healthcare systems have collaborated with success and this should continue and that on-going support through technology such as Telehealth services and patient advocacy associations is a necessity. Clinicians could use this paper to understand how Covid-19 could accelerate disease progression in individuals with NCD’s and that close monitoring is essential. For individuals with NCD’s who do not have Covid-19, close monitoring would still be required to ensure that government strategies to contain the virus do not exacerbate their condition.
Abstract
The early stages of the COVID-19 pandemic have focused on containing SARS-CoV-2 infection and identifying treatment strategies. While controlling this communicable disease is of utmost importance, the long-term effect on individuals with non-communicable diseases (NCD) is significant. Although certain NCDs appear to increase the severity of COVID-19 and mortality risk, SARS-CoV-2 infection in survivors with NCDs may also affect the progression of their pre-existing clinical conditions. Infection containment measures will have substantial short- and long-term consequences; social distancing and quarantine restrictions will reduce physical activity and increase other unhealthy lifestyles, thus increasing NCD risk factors and worsening clinical symptoms. Vitamin D levels might decrease and there might be a rise in mental health disorders. Many countries have made changes to routine management of NCD patients, e.g., cancelling non-urgent outpatient visits, which will have important implications for NCD management, diagnosis of new-onset NCDs, medication adherence, and NCD progression. We may have opportunities to learn from this unprecedented crisis on how to leverage healthcare technologies and improve procedures to optimize healthcare service provision. This article discusses how the COVID-19 outbreak and related infection control measures could hit the most frail individuals, worsening the condition of NCD patients, while further jeopardizing the sustainability of the healthcare systems. We suggest ways to define an integrated strategy that could involve both public institutional entities and the private sector to safeguard frail individuals and mitigate the impact of the outbreak.
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Coronavirus disease 2019 (COVID-19) and obesity. Impact of obesity and its main comorbidities in the evolution of the disease.
Cornejo-Pareja, IM, Gómez-Pérez, AM, Fernández-García, JC, Barahona San Millan, R, Aguilera Luque, A, de Hollanda, A, Jiménez, A, Jimenez-Murcia, S, Munguia, L, Ortega, E, et al
European eating disorders review : the journal of the Eating Disorders Association. 2020;28(6):799-815
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The Covid-19 pandemic has caused thousands of deaths worldwide. Being obese is associated with worse outcomes following infection with Covid-19. This review aimed to summarise the data available on the relationship between Covid-19 and obesity, and explored some of the possible reasons for this relationship. The researchers found that obesity is an independent and strong risk factor for severe infection, Intensive Care Unit (ICU) admission and death. The impact of obesity might be of particular relevance in males and in younger individuals. Long‐term complications of Covid‐19 could also be more frequent and severe in obese subjects. There are many potential mechanisms that could explain this relationship. These include the effects of obesity and related diseases such as diabetes, high blood pressure and heart disease on the immune system, lung function, vitamin D deficiency and male hormones. The researchers also discussed the possibility of fat cells acting as a possible reservoir for Covid-19 infection. Research into Covid-19 is still at a very early stage and more studies are needed.
Abstract
The COVID-19 pandemic is posing a great challenge worldwide. Its rapid progression has caused thousands of deaths worldwide. Although multiple aspects remain to be clarified, some risk factors associated with a worse prognosis have been identified. These include obesity and some of its main complications, such as diabetes and high blood pressure. Furthermore, although the possible long-term complications and psychological effects that may appear in survivors of COVID-19 are not well known yet, there is a concern that those complications may be greater in obese patients. In this manuscript, we review some of the data published so far and the main points that remain to be elucidated are emphasized.
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The association between sedentary behaviour and risk of anxiety: a systematic review.
Teychenne, M, Costigan, SA, Parker, K
BMC public health. 2015;15:513
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Sedentary behaviour (SB) (e.g. sitting, computer use), has been linked to poor physical outcomes in adults. Research also suggests that SB may be linked to mental health conditions such as depression and self-esteem, but less is known about the link between SB and anxiety. The aim of this systematic review was to investigate the link between SB and anxiety. The review, based on nine studies, concluded that there was moderate evidence to suggest that SB was linked to increased risk of anxiety although there is limited insight into the underlying mechanisms that may explain the link between SB and anxiety. Possible biological mechanisms include central nervous system arousal, sleep disturbances and poor metabolic health. Other possible explanations include social withdrawal; the theory that prolonged SB like television viewing may lead to social solitude and increased anxiety as a result. Equally, the authors suggested that it may be that people with increased anxiety spend more time socially withdrawn leading to an increase in SB. The authors concluded that further robust research was required to better understand the relationship between SB and anxiety.
Abstract
BACKGROUND Previous research has linked sedentary behaviour (SB) to adverse physical health outcomes in adults and youth. Although evidence for the relationship between SB and mental health outcomes (e.g., depression) is emerging, little is known regarding risk of anxiety. METHODS A systematic search for original research investigating the association between SB and risk of anxiety was performed using numerous electronic databases. A total of nine observational studies (seven cross-sectional and two longitudinal) were identified. Methodological quality of studies was assessed and a best-evidence synthesis was conducted. RESULTS One cross-sectional study demonstrated a strong methodological quality, five cross-sectional studies demonstrated a moderate methodological quality and three studies (two cross-sectional one longitudinal) received a weak methodological quality rating. Overall, there was moderate evidence for a positive relationship between total SB and anxiety risk as well as for a positive relationship between sitting time and anxiety risk. There was inconsistent evidence for the relationship between screen time, television viewing time, computer use, and anxiety risk. CONCLUSION Limited evidence is available on the association between SB and risk of anxiety. However, our findings suggest a positive association (i.e. anxiety risk increases as SB time increases) may exist (particularly between sitting time and risk of anxiety). Further high-quality longitudinal/interventional research is needed to confirm findings and determine the direction of these relationships.
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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.