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Physical activity and risk of atrial fibrillation in the general population: meta-analysis of 23 cohort studies involving about 2 million participants.
Kunutsor, SK, Seidu, S, Mäkikallio, TH, Dey, RS, Laukkanen, JA
European journal of epidemiology. 2021;(3):259-274
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Regular physical activity is well established to be associated with reduced risk of cardiovascular disease outcomes. Whether physical activity is associated with the future risk of atrial fibrillation (AF) remains a controversy. Using a systematic review and meta-analysis of published observational cohort studies in general populations with at least one-year of follow-up, we aimed to evaluate the association between regular physical activity and the risk of AF. Relevant studies were sought from inception until October 2020 in MEDLINE, Embase, Web of Science, and manual search of relevant articles. Extracted relative risks (RRs) with 95% confidence intervals (CIs) for the maximum versus the minimal amount of physical activity groups were pooled using random-effects meta-analysis. Quality of the evidence was assessed by GRADE. A total of 23 unique observational cohort studies comprising of 1,930,725 participants and 45,839 AF cases were eligible. The pooled multivariable-adjusted RR (95% CI) for AF comparing the most physically active versus the least physically active groups was 0.99 (0.93-1.05). This association was modified by sex: an increased risk was observed in men: 1.20 (1.02-1.42), with a decreased risk in women: 0.91 (0.84-0.99). The quality of the evidence ranged from low to moderate. Pooled observational cohort studies suggest that the absence of associations reported between regular physical activity and AF risk in previous general population studies and their aggregate analyses could be driven by a sex-specific difference in the associations - an increased risk in men and a decreased risk in women.Systematic review registration: PROSPERO 2020: CRD42020172814.
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Workplace pedometer interventions for increasing physical activity.
Freak-Poli, R, Cumpston, M, Albarqouni, L, Clemes, SA, Peeters, A
The Cochrane database of systematic reviews. 2020;(7):CD009209
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BACKGROUND The World Health Organization (WHO) recommends undertaking 150 minutes of moderate-intensity physical activity per week, but most people do not. Workplaces present opportunities to influence behaviour and encourage physical activity, as well as other aspects of a healthy lifestyle. A pedometer is an inexpensive device that encourages physical activity by providing feedback on daily steps, although pedometers are now being largely replaced by more sophisticated devices such as accelerometers and Smartphone apps. For this reason, this is the final update of this review. OBJECTIVES To assess the effectiveness of pedometer interventions in the workplace for increasing physical activity and improving long-term health outcomes. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Occupational Safety and Health (OSH) UPDATE, Web of Science, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform from the earliest record to December 2016. We also consulted the reference lists of included studies and contacted study authors to identify additional records. We updated this search in May 2019, but these results have not yet been incorporated. One more study, previously identified as an ongoing study, was placed in 'Studies awaiting classification'. SELECTION CRITERIA We included randomised controlled trials (RCTs) of workplace interventions with a pedometer component for employed adults, compared to no or minimal interventions, or to alternative physical activity interventions. We excluded athletes and interventions using accelerometers. The primary outcome was physical activity. Studies were excluded if physical activity was not measured. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. When studies presented more than one physical activity measure, we used a pre-specified list of preferred measures to select one measure and up to three time points for analysis. When possible, follow-up measures were taken after completion of the intervention to identify lasting effects once the intervention had ceased. Given the diversity of measures found, we used ratios of means (RoMs) as standardised effect measures for physical activity. MAIN RESULTS We included 14 studies, recruiting a total of 4762 participants. These studies were conducted in various high-income countries and in diverse workplaces (from offices to physical workplaces). Participants included both healthy populations and those at risk of chronic disease (e.g. through inactivity or overweight), with a mean age of 41 years. All studies used multi-component health promotion interventions. Eleven studies used minimal intervention controls, and four used alternative physical activity interventions. Intervention duration ranged from one week to two years, and follow-up after completion of the intervention ranged from three to ten months. Most studies and outcomes were rated at overall unclear or high risk of bias, and only one study was rated at low risk of bias. The most frequent concerns were absence of blinding and high rates of attrition. When pedometer interventions are compared to minimal interventions at follow-up points at least one month after completion of the intervention, pedometers may have no effect on physical activity (6 studies; very low-certainty evidence; no meta-analysis due to very high heterogeneity), but the effect is very uncertain. Pedometers may have effects on sedentary behaviour and on quality of life (mental health component), but these effects were very uncertain (1 study; very low-certainty evidence). Pedometer interventions may slightly reduce anthropometry (body mass index (BMI) -0.64, 95% confidence interval (CI) -1.45 to 0.18; 3 studies; low-certainty evidence). Pedometer interventions probably had little to no effect on blood pressure (systolic: -0.08 mmHg, 95% CI -3.26 to 3.11; 2 studies; moderate-certainty evidence) and may have reduced adverse effects (such as injuries; from 24 to 10 per 100 people in populations experiencing relatively frequent events; odds ratio (OR) 0.50, 95% CI 0.30 to 0.84; low-certainty evidence). No studies compared biochemical measures or disease risk scores at follow-up after completion of the intervention versus a minimal intervention. Comparison of pedometer interventions to alternative physical activity interventions at follow-up points at least one month after completion of the intervention revealed that pedometers may have an effect on physical activity, but the effect is very uncertain (1 study; very low-certainty evidence). Sedentary behaviour, anthropometry (BMI or waist circumference), blood pressure (systolic or diastolic), biochemistry (low-density lipoprotein (LDL) cholesterol, total cholesterol, or triglycerides), disease risk scores, quality of life (mental or physical health components), and adverse effects at follow-up after completion of the intervention were not compared to an alternative physical activity intervention. Some positive effects were observed immediately at completion of the intervention periods, but these effects were not consistent, and overall certainty of evidence was insufficient to assess the effectiveness of workplace pedometer interventions. AUTHORS' CONCLUSIONS Exercise interventions can have positive effects on employee physical activity and health, although current evidence is insufficient to suggest that a pedometer-based intervention would be more effective than other options. It is important to note that over the past decade, technological advancement in accelerometers as commercial products, often freely available in Smartphones, has in many ways rendered the use of pedometers outdated. Future studies aiming to test the impact of either pedometers or accelerometers would likely find any control arm highly contaminated. Decision-makers considering allocating resources to large-scale programmes of this kind should be cautious about the expected benefits of incorporating a pedometer and should note that these effects may not be sustained over the longer term. Future studies should be designed to identify the effective components of multi-component interventions, although pedometers may not be given the highest priority (especially considering the increased availability of accelerometers). Approaches to increase the sustainability of intervention effects and behaviours over a longer term should be considered, as should more consistent measures of physical activity and health outcomes.
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Safety and efficacy of Cerebrolysin in motor function recovery after stroke: a meta-analysis of the CARS trials.
Guekht, A, Vester, J, Heiss, WD, Gusev, E, Hoemberg, V, Rahlfs, VW, Bajenaru, O, Popescu, BO, Doppler, E, Winter, S, et al
Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology. 2017;(10):1761-1769
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This meta-analysis combines the results of two identical stroke studies (CARS-1 and CARS-2) assessing efficacy of Cerebrolysin on motor recovery during early rehabilitation. Cerebrolysin is a parenterally administered neuropeptide preparation approved for the treatment of stroke. Both studies had a prospective, randomized, double-blind, placebo-controlled design. Treatment with 30 ml Cerebrolysin once daily for 3 weeks was started 24-72 h after stroke onset. In addition, patients participated in a standardized rehabilitation program for 21 days that was initiated within 72 h after stroke onset. For both studies, the original analysis data were used for meta-analysis (individual patient data analysis). The combination of these two studies by meta-analytic procedures was pre-planned, and the methods were pre-defined under blinded conditions. The nonparametric Mann-Whitney (MW) effect size of the two studies on the ARAT score on day 90 indicated superiority of Cerebrolysin compared with placebo (MW 0.62, P < 0.0001, Wei-Lachin pooling procedure, day 90, last observation carried forward; N = 442). Also, analysis of early benefit at day 14 and day 21 by means of the National Institutes of Health Stroke Scale, which is regarded as most sensitive to early improvements, showed statistical significance (MW 0.59, P < 0.002). The corresponding number-needed-to-treat (NNT) for clinically relevant changes in early NIHSS was 7.1 (95% CI: 4 to 22). Cerebrolysin had a beneficial effect on motor function and neurological status in early rehabilitation patients after acute ischemic stroke. Safety aspects were comparable to placebo, showing a favourable benefit/risk ratio.
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Modifiable lifestyle factors that could reduce the incidence of colorectal cancer in New Zealand.
Richardson, A, Hayes, J, Frampton, C, Potter, J
The New Zealand medical journal. 2016;(1447):13-20
Abstract
AIM: To estimate population attributable fractions for modifiable lifestyle factors and colorectal cancer in New Zealand. METHOD Relative risks for lifestyle risk factors for colorectal cancer, and population data on the prevalence of exposure in New Zealand, were used to estimate the population attributable fraction (PAF) for each risk factor. RESULTS Six modifiable lifestyle risk factors were identified. The PAFs for these risk factors were 9% for obesity, 7% for alcohol, 4% for physical inactivity, 3% for smoking, 5% for consumption of red meat and 3% for processed meat. PAFs differed by ethnic group and sex. In women, the highest PAFs were 19% for obesity in Pacific women, 14% for obesity in Māori women, 7% for physical inactivity in Asian women, and 8% for obesity in European/other women. In men, the highest PAFs were 17% for obesity in Pacific men, 14% for high alcohol consumption in Māori men, 5% for physical inactivity in Asian men and 9% for high alcohol consumption in European/other men. CONCLUSION If obesity, alcohol consumption, smoking and consumption of red and processed meats could be reduced, and physical activity could be increased among New Zealanders, it would reduce the risk of colorectal cancer considerably.
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A systematic review and meta-analysis of social cognitive theory-based physical activity and/or nutrition behavior change interventions for cancer survivors.
Stacey, FG, James, EL, Chapman, K, Courneya, KS, Lubans, DR
Journal of cancer survivorship : research and practice. 2015;(2):305-38
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PURPOSE Little is known about how to improve and create sustainable lifestyle behaviors of cancer survivors. Interventions based on social cognitive theory (SCT) have shown promise. This review examined the effect of SCT-based physical activity and nutrition interventions that target cancer survivors and identified factors associated with their efficacy. METHODS A systematic search of seven databases identified randomized controlled trials that (i) targeted adult cancer survivors (any point from diagnosis); (ii) reported a primary outcome of physical activity, diet, or weight management; and (iii) included an SCT-based intervention targeting physical activity or diet. Qualitative synthesis and meta-analysis were conducted. Theoretical constructs and intervention characteristics were examined to identify factors associated with intervention efficacy. RESULTS Eighteen studies (reported in 33 publications) met review inclusion criteria. Meta-analysis (n = 12) revealed a significant intervention effect for physical activity (standardized mean difference (SMD) = 0.33; P < 0.01). Most studies (six out of eight) that targeted dietary change reported significant improvements in at least one aspect of diet quality. No SCT constructs were associated with intervention effects. There were no consistent trends relating to intervention delivery method or whether the intervention targeted single or multiple behaviors. CONCLUSIONS SCT-based interventions demonstrate promise in improving physical activity and diet behavior in cancer survivors, using a range of intervention delivery modes. Further work is required to understand how and why these interventions offer promise for improving behavior. IMPLICATIONS FOR CANCER SURVIVORS SCT-based interventions targeting diet or physical activity are safe and result in meaningful changes to diet and physical activity behavior that can result in health improvements.
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[Accelerometer description as a method to assess physical activity in different periods of life; systematic review].
Aguilar Cordero, MJ, Sánchez López, AM, Guisado Barrilao, R, Rodríguez Blanque, R, Noack Segovia, J, Pozo Cano, MD
Nutricion hospitalaria. 2014;(6):1250-61
Abstract
INTRODUCTION The accelerometer is shown as one of the most accurate techniques in recording and saving the amount and level of physical activity, by each person in a given period of time. AIMS This review aims to describe and analyze the main items that use this method to assess physical activity. METHODS The review articles were identified through the following specialized Internet browser: SCOPUS, PUBMED, GOOGLE SCHOLAR, those were selected for inclusion with a total of 56 items. The validity of the articles was given by the degree of evidence demonstrated by describing the recommendations and the applicability to our context. This review has considered studies evaluating physical activity through accelerometers. RESULTS The results show that this method can be used in ages 3 to 90 years. It can also be used in subjects with overweight/obesity, articulation injuries, Down syndrome (just children), autism and people with psychological problems. Studies in pregnant women show satisfactory results. CONCLUSION The literature reviewed provides the accelerometer as a reliable and effective method to assess physical activity.
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Physical activity: from epidemiological evidence to individualized patient management.
Charansonney, OL, Vanhees, L, Cohen-Solal, A
International journal of cardiology. 2014;(3):350-7
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BACKGROUND Physical activity (PA), physical fitness (PF), and even a few sedentary behaviors (SB) are strongly and independently linked to improved survival rate. However, key questions remain: what are the physiological interrelationships between SB, PA, and PF? How should we differently emphasize promoting PA, increasing PF with exercise, and decreasing SB among other prevention measures? What are the interrelationships of both PA and SB levels with drug treatment efficacy? METHODS To address these questions we developed an integrated patient-centric model combining physiology with epidemiological evidence to characterize the individual risk attached to PA level, PF, and SB. Epidemiological data were collected by extensive literature review. RESULTS Nine meta-analyses, 198 cohort studies (3.8 million people), and 13 controlled trials were reviewed. 1. A high level of SB induces chronic stress and increases the risk of both chronic disease and mortality. 2. Vigorous PA increases PF and physiological reserve, thereby improving survival rate. This effect is not mediated by improved traditional risk factors. The risk for most individuals is a mix of high SB, low to mild PA, and low to mild PF. This model can improve the individualized prescription of PA modalities. Furthermore, the benefit of treatments such as statins or beta-blockers can be cancelled out if a decrease in PA or an increase in SB is induced by drug related side effects. CONCLUSIONS To improve patient management both types of therapeutic interventions and dose should be carefully chosen for each individual in order to maintain/increase PA level while decreasing SB.
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Physical activity programs for promoting bone mineralization and growth in preterm infants.
Schulzke, SM, Kaempfen, S, Trachsel, D, Patole, SK
The Cochrane database of systematic reviews. 2014;(4):CD005387
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BACKGROUND Lack of physical stimulation may contribute to metabolic bone disease of preterm infants, resulting in poor bone mineralization and growth. Physical activity programs combined with adequate nutrition might help to promote bone mineralization and growth. OBJECTIVES The primary objective was to assess whether physical activity programs in preterm infants improve bone mineralization and growth and reduce the risk of fracture.The secondary objectives included other potential benefits in terms of length of hospital stay, skeletal deformities and neurodevelopmental outcomes, and adverse events.Subgroup analysis:• Given that the smallest infants are most vulnerable for developing osteopenia (Bishop 1999), a subgroup analysis was planned for infants with birth weight < 1000 g.• Calcium and phosphorus intake may affect an infant's ability to increase bone mineral content (Kuschel 2004). Therefore, an additional subgroup analysis was planned for infants receiving different amounts of calcium and phosphorus, along with full enteral feeds as follows. ∘ Below 100 mg/60 mg calcium/phosphorus or equal to/above 100 mg/60 mg calcium/phosphorus per 100 mL milk. ∘ Supplementation of calcium without phosphorus. ∘ Supplementation of phosphorus without calcium. SEARCH METHODS The standard search strategy of the Cochrane Neonatal Review Group (CNRG) was used. The search included the Cochrane Central Register of Controlled Trials (CENTRAL) (2012, Issue 9), MEDLINE, EMBASE, CINAHL (1966 to March 2013), and cross-references, as well as handsearching of abstracts of the Society for Pediatric Research and the International Journal of Sports Medicine. SELECTION CRITERIA Randomized and quasi-randomized controlled trials comparing physical activity programs (extension and flexion, range-of-motion exercises) versus no organized physical activity programs in preterm infants. DATA COLLECTION AND ANALYSIS Data collection, study selection, and data analysis were performed according to the methods of the CNRG. MAIN RESULTS Eleven trials enrolling 324 preterm infants (gestational age 26 to 34 weeks) were included in this review. All were small (N = 16 to 50) single-center studies that evaluated daily physical activity for three and one-half to eight weeks during initial hospitalization. Methodological quality and reporting of included trials were variable.Four trials demonstrated moderate short-term benefits of physical activity for bone mineralization at completion of the physical activity program. The only trial assessing long-term effects on bone mineralization showed no effect of physical activity administered during initial hospitalization on bone mineralization at 12 months corrected age. Meta-analysis from four trials demonstrated a positive effect of physical activity on daily weight gain (weighted mean difference (WMD) 2.21 g/kg/d, 95% confidence interval (CI) 1.23 to 3.19). Data from four trials showed a positive effect on linear growth (WMD 0.12 cm/wk, 95% CI 0.01 to 0.24) but not on head growth (WMD -0.03 cm/wk, 95% CI -0.14 to 0.08) during the study period. Only one trial reported on fractures (this outcome did not occur in intervention and control groups) and complications of preterm birth (no significant differences between intervention and control groups). None of the trials assessed other outcomes relevant to this review. AUTHORS' CONCLUSIONS Some evidence suggests that physical activity programs might promote short-term weight gain and bone mineralization in preterm infants. Data are inadequate to allow assessment of harm or long-term effects. Current evidence does not support the routine use of physical activity programs in preterm infants. Further trials incorporating infants with a high baseline risk of osteopenia are required. These trials should address adverse events, long-term outcomes, and the effects of nutritional intake (calories, protein, calcium, phosphorus).
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No interactions between previously associated 2-hour glucose gene variants and physical activity or BMI on 2-hour glucose levels.
Scott, RA, Chu, AY, Grarup, N, Manning, AK, Hivert, MF, Shungin, D, Tönjes, A, Yesupriya, A, Barnes, D, Bouatia-Naji, N, et al
Diabetes. 2012;(5):1291-6
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Gene-lifestyle interactions have been suggested to contribute to the development of type 2 diabetes. Glucose levels 2 h after a standard 75-g glucose challenge are used to diagnose diabetes and are associated with both genetic and lifestyle factors. However, whether these factors interact to determine 2-h glucose levels is unknown. We meta-analyzed single nucleotide polymorphism (SNP) × BMI and SNP × physical activity (PA) interaction regression models for five SNPs previously associated with 2-h glucose levels from up to 22 studies comprising 54,884 individuals without diabetes. PA levels were dichotomized, with individuals below the first quintile classified as inactive (20%) and the remainder as active (80%). BMI was considered a continuous trait. Inactive individuals had higher 2-h glucose levels than active individuals (β = 0.22 mmol/L [95% CI 0.13-0.31], P = 1.63 × 10(-6)). All SNPs were associated with 2-h glucose (β = 0.06-0.12 mmol/allele, P ≤ 1.53 × 10(-7)), but no significant interactions were found with PA (P > 0.18) or BMI (P ≥ 0.04). In this large study of gene-lifestyle interaction, we observed no interactions between genetic and lifestyle factors, both of which were associated with 2-h glucose. It is perhaps unlikely that top loci from genome-wide association studies will exhibit strong subgroup-specific effects, and may not, therefore, make the best candidates for the study of interactions.
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Objectively measured physical activity and fat mass in children: a bias-adjusted meta-analysis of prospective studies.
Wilks, DC, Sharp, SJ, Ekelund, U, Thompson, SG, Mander, AP, Turner, RM, Jebb, SA, Lindroos, AK
PloS one. 2011;(2):e17205
Abstract
BACKGROUND Studies investigating the prevention of weight gain differ considerably in design and quality, which impedes pooling them in conventional meta-analyses, the basis for evidence-based policy making. This study is aimed at quantifying the prospective association between measured physical activity and fat mass in children, using a meta-analysis method that allows inclusion of heterogeneous studies by adjusting for differences through eliciting and incorporating expert opinion. METHODS Studies on prevention of weight gain using objectively measured exposure and outcome were eligible; they were adopted from a recently published systematic review. Differences in study quality and design were considered as internal and external biases and captured in checklists. Study results were converted to correlation coefficients and biases were considered either additive or proportional on this scale. The extent and uncertainty of biases in each study were elicited in a formal process by six quantitatively-trained assessors and five subject-matter specialists. Biases for each study were combined across assessors using median pooling. Results were combined across studies by random-effects meta-analysis. RESULTS The combined correlation of the unadjusted results from the six studies was -0.04 (95%CI: -0.22, 0.14) with considerable heterogeneity (I² = 78%), which makes it difficult to interpret the result. After bias-adjustment the pooled correlation was -0.01 (95%CI: -0.18, 0.16) with apparent study compatibility (I² = 0%). CONCLUSION By using this method the prospective association between physical activity and fat mass could be quantitatively synthesized; the result suggests no association. Objectively measured physical activity may not be the key determinant of unhealthy weight gain in children.