Consensus on Exercise Reporting Template (CERT): Explanation and Elaboration Statement

Comparative effectiveness of exercise interventions for preventing falls in older adults: A secondary analysis of a systematic review with network meta-analysis

BACKGROUND

Systematic reviews have established that exercise reduces falls in older adults, however the most effective types of exercise are not known. This secondary analysis determined the comparative effectiveness of fall prevention exercise approaches.

METHOD

All fall prevention exercise interventions for older adults were identified from an existing search from inception until April 2017. Interventions were coded using a framework of 25 exercise types. Two reviewers independently screened studies, extracted data, and appraised risk of bias. Pairwise meta-analysis and network meta-analysis (NMA) were conducted. P-scores were used to rank exercise combinations.

RESULTS

One hundred and sixty-nine studies were included. NMA was conducted on 73 studies (30,697 participants) for the outcome of number of fallers. The exercise combination ranked with the greatest likelihood of being most effective relative to no exercise was: anticipatory control, dynamic stability, functional stability limits, reactive control and flexibility (p-score = 0.95). This exercise combination also significantly reduced number of fallers compared to 16 other combinations. No exercise combination had a significantly greater effect on reducing number of fallers more than this combination.

CONCLUSION

This analysis identified components of effective fall prevention exercise. The results can inform evidence-informed exercise recommendations and be used to design effective programs.

The relationship between prescribed pre-operative knee-extensor exercise dosage and effect on knee-extensor strength prior to and following total knee arthroplasty: a systematic review and meta-regression analysis of randomized controlled trials

OBJECTIVE

The aim of this systematic review was to evaluate the relationship between prescribed knee-extensor strength exercise dosage in pre-operative exercise intervention and the effect on knee-extensor muscle strength prior to and following TKA. Additional meta-analyses report the effect of pre-habilitation on outcomes prior to and following TKA.

DESIGN

A systematic literature search was performed including RCT's evaluating the effect of pre-operative exercise prior to and following TKA. Meta-regression analysis was performed to evaluate the dose-response relationship between prescribed exercise dose and the pooled effect, measured as standardized mean difference (SMD). The prescribed exercise dose was quantified using a formula accounting for as many exercise descriptors as possible. Risk of bias in the included trials was assessed using the Cochrane Risk of Bias Tool.

RESULTS

Twelve trials with 616 patients were included. Meta-regression analysis showed no relationship between prescribed pre-operative knee-extensor exercise dosage and change in knee-extensor strength neither prior to (slope 0.0005 [95%CI -0.007 to 0.008]) or 3 months following TKA (slope 0.0014 [95%CI -0.006 to 0.009]). Prior to TKA, a moderate effect favoring pre-operative exercise for increase in knee-extensor strength was found (SMD 0.50 [95%CI 0.12 to 0.88]), but not at 3 months following TKA (SMD -0.01 [95%CI -0.45 to 0.43]). Risk of bias was generally assessed as unclear.

CONCLUSION

Meta-regression analysis of existing trials suggests no relationship between the prescribed pre-operative knee-extensor exercise dosage and the change in knee-extensor strength observed prior to and following TKA. Pre-operative exercise including knee-extensor muscle strength exercise increased knee-extensor strength moderately prior to but not 3 months following TKA.

PROTOCOL REGISTRATION

PROSPERO ID (CRD42018076308) (http://www.crd.york.ac.uk/PROSPERO/).

A systematic review exploring the evidence reported to underpin exercise dose in clinical trials of rheumatoid arthritis

We aimed to evaluate the evidence reported to underpin exercise dose in randomised controlled trials (RCTs) using strengthening exercise in RA. We searched six different databases between 1 January 2000 and 3 April 2019. We included RCTs, where a main component of the intervention and/or control used strengthening exercise. Evidence sources cited to underpin dose were judged for their quality, consistency and applicability. Thirty-two RCTs were reviewed. Four (12.5%) piloted the intervention without using dose-escalation designs to determine optimal dose-response. Twenty (62.5%) reported no evidence underpinning dose. Where reported, quality, consistency and applicability of the underpinning evidence was a cause for methodological concern. The majority of RCTs did not report the evidence underpinning dose. When reported, the evidence was often not applicable to the clinical population. Frequently, the dose used differed to the dose reported/recommended by the underpinning evidence. Our findings illustrate exercise dose may not be optimised for use with clinical populations prior to evaluation by RCT.

The management of lower back pain using pilates method: assessment of content exercise reporting in RCTs

PURPOSE

To evaluate the quality of the reporting of exercise interventions with Pilates method for the treatment of lower back pain (LBP) in adults.

MATERIALS AND METHODS

Two independent evaluators selected randomized controlled trials (RCTs) of moderate and high methodological quality included in a Cochrane Systematic Review (SR) and from an additional updated search in the following databases: CENTRAL, MEDLINE, EMBASE, CINAHL, PEDro and SPORTDiscus. Three assessment tools (Consensus on Therapeutic Exercise Training (CONTENT) scale, Template for Intervention Description and Replication (TIDieR) checklist and Consensus on Exercise Reporting Template (CERT) checklist) were utilized by three pairs of two independent researchers trained. The scales' concordance was measured using the Kappa coefficient.

RESULTS

Ten RCTs were included. The CONTENT scale score was 5.3 (± 1.33) out of 9 points; the TIDieR checklist was 8.5 (± 1.71) out of 12 points and the CERT checklist was 9.5 (± 3.62) out of 19 points. The CONTENT and CERT had moderate concordance, while there was fair concordance between the other tools.

CONCLUSIONS

The overall reporting quality for the Pilates exercises in ten moderate-to-high quality RTCs for the management of LBP was low according to CONTENT scale and CERT checklist and high according to TIDieR checklist.Implications for RehabilitationReporting of Pilates exercise program in moderate-to-high quality RCTs for the management of lower back pain remains incomplete.Pilates exercise program should be personalized and contextualized to individual participants.There may be a need to consider adding to or combining the information available from various trials.

The effect of an online exercise programme on bone health in paediatric cancer survivors (iBoneFIT): study protocol of a multi-centre randomized controlled trial

BACKGROUND

New approaches on paediatric cancer treatment aim to maintain long-term health. As a result of radiotherapy, chemotherapy or surgery, paediatric cancer survivors tend to suffer from any chronic health condition. Endocrine dysfunction represents one of the most common issues and affects bone health. Exercise is key for bone mass accrual during growth, specifically plyometric jump training. The iBoneFIT study will investigate the effect of a 9-month online exercise programme on bone health in paediatric cancer survivors. This study will also examine the effect of the intervention on body composition, physical fitness, physical activity, calcium intake, vitamin D, blood samples quality of life and mental health.

METHODS

A minimum of 116 participants aged 6 to 18 years will be randomized into an intervention (n = 58) or control group (n = 58). The intervention group will receive an online exercise programme and diet counselling on calcium and vitamin D. In addition, five behaviour change techniques and a gamification design will be implemented in order to increase the interest of this non-game programme. The control group will only receive diet counselling. Participants will be assessed on 3 occasions: 1) at baseline; 2) after the 9 months of the intervention; 3) 4 months following the intervention. The primary outcome will be determined by dual energy X-ray absorptiometry (DXA) and the hip structural analysis, trabecular bone score and 3D-DXA softwares. Secondary outcomes will include anthropometry, body composition, physical fitness, physical activity, calcium and vitamin D intake, blood samples, quality of life and mental health.

DISCUSSION

Whether a simple, feasible and short in duration exercise programme can improve bone health has not been examined in paediatric cancer survivors. This article describes the design, rationale and methods of a study intended to test the effect of a rigorous online exercise programme on bone health in paediatric cancer survivors. If successful, the iBoneFIT study will contribute to decrease chronic health conditions in this population and will have a positive impact in the society.

TRIAL REGISTRATION

Prospectively registered in isrctn.com: isrctn61195625 . Registered 2 April 2020.

Do exercises for patellofemoral pain reflect common injury mechanisms? A systematic review

OBJECTIVES

Current best evidence has reported that therapeutic exercise programs that are designed to treat patellofemoral pain (PFP) should include both hip and knee specific exercises. The purpose of this review was to (1) examine the quality/comprehensiveness of exercise reporting in this field; (2) quantify the extent to which individual exercises comprised task-specific elements (single limb stance; eccentric control of the hip; rotational z-axis control) most likely to address key pathomechanics associated with PFP.

DESIGN

Systematic review: a systematic survey of RCTs.

METHODS

PubMed, CINAHL, Medline, Physiotherapy Evidence Database (PEDro) and SPORT Discus databases were searched for randomized controlled trials that addressed PFP utilizing a proximal control hip focused rehabilitation paradigm. The therapeutic exercise programs were evaluated, and each individual exercise was extracted for analysis. Quality assessments included the PEDro Scale and the Consensus on Exercise Reporting Template (CERT) was utilized to score the reporting of the interventions.

RESULTS

19 studies were included in the final analysis. 178 total exercises were extracted from the proximal hip and knee rehabilitation programs. The exercises were analyzed for the inclusion of elements that align with reported underlying biomechanical mechanisms.

CONCLUSIONS

The vast majority of the exercises were sagittal plane, concentric, non-weight bearing exercises, whereas multiplanar exercises, single limb weightbearing, and exercises where loading was directed around the longitudinal z-axis, were considerably under-represented. Current exercises for PFP utilize simplistic frameworks that lack progression into more task specific exercise, and are not reflective of the complex injury etiology.

Patients' experiences of abdominal exercises after stoma surgery: a qualitative study

PURPOSE

Abdominal exercises are being advocated after stoma surgery and investigated in clinical research. Little is known about the patients' perspective of doing abdominal exercises in the first three months after getting a stoma. The aim of this study was to explore patients' experiences with and attitudes toward abdominal exercises after stoma surgery.

MATERIALS AND METHODS

Patients with a new ileostomy or colostomy were invited to participate in an interview after having performed a set of abdominal exercises one time as part of a preceding study. Semi-structured interviews were conducted at inpatient wards and outpatient clinics at two hospitals. Audio recordings were transcribed to text verbatim and analyzed with inductive content analysis.

RESULTS

Analysis of 14 interviews resulted in four categories: "The attitude toward abdominal exercises is positive"; "Treatment and illness form barriers to abdominal exercises"; "Wish for help with abdominal exercises after stoma surgery"; and "Abdominal exercises are experienced as being easy".

CONCLUSIONS

Participants with a new stoma wished for guidance in abdominal exercises. Health professionals should be aware of potential barriers to participation in abdominal exercise in patients with a stoma. Abdominal exercises were easy to perform with a stoma in a supervised setting.Implications for rehabilitationParticipants were positive toward abdominal exercises, and the stoma was rarely in the way.Help and guidance with abdominal exercises is important after stoma surgery.Health professionals should consider possible barriers and concerns to exercise.

Searching for the Responder, Unpacking the Physical Rehabilitation Needs of Critically Ill Adults: A REVIEW

Survivors of critical illness can experience persistent deficits in physical function and poor health-related quality of life and utilize significant health care resources. Short-term improvements in these outcomes have been reported following physical rehabilitation. Safety and feasibility of delivering physical rehabilitation are established; however, low physical activity levels are observed throughout the recovery of patients. We provide examples on how physical activity may be increased through interdisciplinary models of service delivery. Recently, however, there has been an emergence of large randomized controlled trials reporting no effect on long-term patient outcomes. In this review, we use a proposed theoretical construct to unpack the findings of 12 randomized controlled trials that delivered physical rehabilitation during the acute hospital stay. We describe the search for the responder according to modifiers of treatment effect for physical function, health-related quality of life, and health care utilization outcomes. In addition, we propose tailoring and timing physical rehabilitation interventions to patient subgroups that may respond differently based on their impairments and perpetuating factors that hinder recovery. We examine in detail the timing, components, and dosage of the trial intervention arms. We also describe facilitators and barriers to physical rehabilitation implementation and factors that are influential in recovery from critical illness. Through this theoretical construct, we anticipate that physical rehabilitation programs can be better tailored to the needs of survivors to deliver appropriate interventions to patients who derive greatest benefit optimally timed in their recovery trajectory.

One-year aerobic interval training in outpatients with schizophrenia: A randomized controlled trial

Although aerobic interval training (AIT) is recognized to attenuate the risk of cardiovascular disease (CVD) and premature mortality, it appears that it rarely arrives at patients' doorsteps. Thus, this study investigated 1-year effects and feasibility of AIT delivered with adherence support in collaborative care of outpatients with schizophrenia. Forty-eight outpatients (28 men, 35 [31-38] (mean [95% confidence intervals]) years; 20 women, 36 [30-41] years) with schizophrenia spectrum disorders (ICD-10) were randomized to either a collaborative care group provided with municipal transportation service and training supervision (walking/running 4 × 4 minutes at ~90% of peak heart rate; HR_peak ) 2 d wk^-1 at the clinic (TG) or a control group (CG) given 2 introductory AIT sessions and advised to continue training. Directly assessed peak oxygen uptake ( V ˙ O 2 peak ) increased in the TG after 3 months (2.3 [0.6-4.4] mL kg^-1  min^-1 , Cohen's d = 0.33[-4.63 to 4.30], P = 0.04), 6 months (2.7 [0.5-4.8] mL kg^-1  min^-1 , Cohen's d = 0.42[-4.73 to 4.11], P = 0.02) and 1 year (4.6 [2.3-6.8] mL kg^-1  min^-1 , Cohen's d = 0.70[-4.31 to 4.10], P < 0.001) compared to the CG. One-year cardiac effects revealed higher HR_peak (7 [2-11] b min^-1 , Cohen's d = 0.34[-8.48 to 8.65], P = 0.01), while peak stroke volume tended to be higher (0.9 [-0.2 to 2.0] mL b^-1 , Cohen's d = 0.35[-1.62 to 2.01], P = 0.11) in the TG compared to the CG. Conventional risk factors (body weight, waist circumference, blood pressure, and lipids/glucose) remained unaltered in both groups. One-year AIT adherence rates were 15/25 (TG; different from CG: P < 0.001) and 0/23 (CG). AIT was successfully included in long-term collaborative care of outpatients with schizophrenia and yielded improved V ˙ O 2 peak , advocating this model for aerobic capacity improvement and CVD risk reduction in future treatment.

Psychological responses to HIIT and MICT over a 2-week progressive randomized trial among individuals at risk of type 2 diabetes

The purpose of this secondary analysis study was to examine the affective and social cognitive responses to low-volume high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) over a progressive two-week supervised intervention for individuals at risk of type 2 diabetes. Ninety-nine adults that were low-active and overweight were randomized into one of two exercise conditions and had affective and social cognitive measures assessed before, during, and after intervention. Increases over time in post-exercise enjoyment, attitudes towards exercise, and intentions to exercise were noted for both HIIT and MICT conditions (ps <.05). The patterns of change in acute affective responses over the two-week intervention were consistent for both conditions, with participants in MICT reporting more positive in-task affect and affective attitudes throughout (ps <.001). Positive correlational relationships between affective and social cognitive responses were revealed throughout the intervention (ps <.05), highlighting the relationship between reflexive responses and reflective cognitions. Research is warranted to determine whether findings are a consequence of familiarization with exercise, whether such findings are translatable to real-world environments and non-progressive exercise protocols, and whether these reflexive responses and reflective cognitions are predictive of future exercise behaviour for individuals at risk of type 2 diabetes.

Reporting of Resistance Training Dose, Adherence, and Tolerance in Exercise Oncology

PURPOSE

While general guidelines (such as CONSORT or Consensus on Exercise Reporting Template) exist to enhance the reporting of exercise interventions in the field of exercise science, there is inadequate detail facilitating the standardized reporting of resistance training adherence in the oncology setting. The purpose of this study was to apply a novel method to report resistance training dose, adherence, and tolerance in patients with cancer.

METHODS

A total of 47 prostate cancer patients (70.1 ± 8.9 yr, body mass index, 28.6 ± 4.0) with bone metastatic disease completed an exercise program for 12 wk. We assessed traditional metrics of adherence (attendance and loss to follow-up), in addition to novel proposed metrics (exercise-relative dose intensity, dose modification, and exercise interruption). Total training volume in kilograms (repetitions × sets × training load (weight)) was calculated for each patient.

RESULTS

Attendance assessed from traditional metrics was 79.5% ± 17.0% and four patients (9%) were lost to follow-up. The prescribed and actual cumulative total dose of resistance training was 139,886 ± 69,150 kg and 112,835 ± 83,499 kg, respectively, with a mean exercise-relative dose intensity of 77.4% ± 16.6% (range: 19.4% -99.4%). Resistance training was missed (1-2 consecutive sessions) or interrupted (missed ≥3 consecutive sessions) in 41 (87%) and 24 (51%) participants, respectively. Training dose was modified (reduction in sets, repetitions, or weight) in 40 (85%) of patients. Importantly, using attendance as a traditional metric of adherence, these sessions would have all counted as adherence to the protocol.

CONCLUSIONS

Traditional reporting metrics of resistance training in exercise oncology may overestimate exercise adherence. Our proposed metrics to capture resistance training dose, adherence, and tolerance may have important applications for future studies and clinical practice.

Progressive active mobilization with dose control and training load in critically ill patients (PROMOB): Protocol for a randomized controlled trial

The dose of progressive active mobilization is still uncertain. The purpose of this study is to identify if the addition of a protocol of progressive active mobilization with dose and training load control to usual care is effective in reducing the length of stay in intensive care unit (ICU) and the improvement of the functioning, incidence of ICU-acquired weakness (ICUAW), mechanical ventilation duration and mortality rate in patients hospitalized in ICU. It is Double-blind randomised clinical trial. The setting for this trial will be medical and surgical ICU of a university hospital. The study participants will be 118 patients aged> 18 years admitted to ICU for less than 72 hours. Participants will be randomized to either an experimental or control group. The experimental group will undertake addition of a protocol of progressive active mobilization with dose and training load control to usual care, while the control group will undertake only usual care. The primary outcome will be length of ICU stay. The secondary outcomes will be Cross-sectional area and muscle thickness of the rectus femoris and biceps brachii, Change in muscle strength from the baseline, Functional Status, incidence of ICUAW, Days with mechanical ventilation and Mortality. All statistical analyses will be conducted following intention-to-treat principles. It has a detailed description of the dose of exercise, was designed with the strictest methodological criteria. These characteristics allow to investigate with greater certainty the results progressive active mobilization in critical patients, allowing replication and future combinations in meta-analyzes.

Effects of 12-week aerobic exercise on patient-reported outcomes in women with systemic lupus erythematosus

PURPOSE

To evaluate the effects of aerobic exercise on patient-reported outcomes (PROs) in women with systemic lupus erythematosus (SLE), and whether changes in cardiorespiratory fitness (CRF) mediate the changes in PROs.

METHODS

A total of 58 women with SLE were assigned to either an exercise group (EG; n = 26) or a control group (CG; n = 32) in this non-randomized clinical trial. The EG comprised 12 weeks of aerobic exercise (2 sessions/week) between 40%-75% of the individual's heart rate reserve. At baseline, and at week 12, CRF (Bruce test) and PROs were assessed including psychological stress (Perceived Stress Scale), sleep quality (Pittsburg Sleep Quality Index), fatigue (Multidimensional Fatigue Inventory), depressive symptoms (Beck Depression Inventory), and quality of life (36-item Short-Form Health Survey).

RESULTS

In comparison to the CG, the EG showed a significant reduction in general fatigue (mean difference (MD) -2.86 units; 95%CI -5.70 to -0.01; p = 0.049), physical fatigue (MD -4.33 units; 95%CI -7.02 to -1.65; p = 0.002) and a non-significant reduction of reduced motivation (MD - 1.29 units; 95%CI -2.60 to 0.03; p = 0.055). There were no significant between-group differences in the changes in psychological stress, sleep quality, depressive symptoms, quality of life, or other fatigue dimensions (all p > 0.05). Changes in CRF mediated the effects of the exercise intervention on general fatigue by 53.8%.

CONCLUSION

The results suggest that 12 weeks of progressive aerobic exercise might improve relevant dimensions of fatigue in women with SLE, despite the absence of effects on other PROs. Improvements in CRF seem to mediate the effect of exercise on general fatigue.Implications for rehabilitationAerobic exercise could be safely introduced in rehabilitation programs for inactive patients with SLE with mild disease activity.Including physical activity recommendations as part of rehabilitation could improve relevant aspects of fatigue in women with SLE.When rehabilitation aims at reducing fatigue, cardiorespiratory fitness improvements derived from physical activity might enhance benefits.

Variability and limitations in home-based exercise program descriptions in oncology: a scoping review

BACKGROUND

The literature reflects considerable heterogeneity in what constitutes home-based exercise interventions. The variability for where and what "home-based" exercise can represent challenges interpretation of findings and appropriate advocacy, referral, or development of these models of care. Therefore, the objective of this review was to provide a comprehensive summary of how home-based exercise is defined and reported in the literature and summarize the range of supportive elements utilized in home-based exercise trials.

METHODS

We followed methodology for scoping reviews. Relevant research databases were searched from inception to March 2019. Two reviewers independently screened articles to determine eligibility and extracted terminology used to describe home-based exercise and intervention details for intervention delivery.

RESULTS

Of the 9432 records identified, 229 articles met inclusion criteria. Across the literature, exercise interventions were described as home-based if they were completed at-home, outdoors in the neighbourhood, and in community facilities; or in self-selected environments; or if they were unsupervised. Supportive elements for home-based models ranged with respect to the amount of supervision and resources utilized, including the provision of print materials, exercise equipment, telephone support, home visits, and technology.

CONCLUSIONS

This review provides a comprehensive summary of strategies previously utilized to deliver home-based exercise interventions in oncology, along with the various definitions of the home-based environment for exercise reported by researchers. Specific recommendations to improve the prescription and reporting of home-based exercise interventions are provided in order to facilitate the delivery, evaluation, and translation of findings into clinical practice.

Exercise as Medicine for Mental and Substance Use Disorders: A Meta-review of the Benefits for Neuropsychiatric and Cognitive Outcomes

BACKGROUND

Exercise may improve neuropsychiatric and cognitive symptoms in people with mental disorders, but the totality of the evidence is unclear. We conducted a meta-review of exercise in (1) serious mental illness (schizophrenia spectrum, bipolar disorder and major depression (MDD)); (2) anxiety and stress disorders; (3) alcohol and substance use disorders; (4) eating disorders (anorexia nervosa bulimia nervosa, binge eating disorders, and (5) other mental disorders (including ADHD, pre/post-natal depression).

METHODS

Systematic searches of major databases from inception until 1/10/2018 were undertaken to identify meta-analyses of randomised controlled trials (RCTs) of exercise in people with clinically diagnosed mental disorders. In the absence of available meta-analyses for a mental disorder, we identified systematic reviews of exercise interventions in people with elevated mental health symptoms that included non-RCTs. Meta-analysis quality was assessed with the AMSTAR/+.

RESULTS

Overall, we identified 27 systematic reviews (including 16 meta-analyses representing 152 RCTs). Among those with MDD, we found consistent evidence (meta-analyses = 8) that exercise reduced depression in children, adults and older adults. Evidence also indicates that exercise was more effective than control conditions in reducing anxiety symptoms (meta-analyses = 3), and as an adjunctive treatment for reducing positive and negative symptoms of schizophrenia (meta-analyses = 2). Regarding neurocognitive effects, exercise improved global cognition in schizophrenia (meta-analyses = 1), children with ADHD (meta-analyses = 1), but not in MDD (meta-analyses = 1). Among those with elevated symptoms, positive mental health benefits were observed for exercise in people with pre/post-natal depression, anorexia nervosa/bulimia nervosa, binge eating disorder, post-traumatic stress disorder and alcohol use disorders/substance use disorders. Adverse events were sparsely reported.

CONCLUSION

Our panoramic meta-overview suggests that exercise can be an effective adjunctive treatment for improving symptoms across a broad range of mental disorders.

The Effect of Pelvic Floor Muscle Interventions on Pelvic Floor Dysfunction After Gynecological Cancer Treatment: A Systematic Review

OBJECTIVE

The aim of this systematic review was to identify, evaluate, and synthesize the evidence from studies that have investigated the effect of nonsurgical, nonpharmacological, pelvic floor muscle interventions on any type of pelvic floor dysfunction or health-related quality of life in patients after any type of treatment for gynecological cancer.

METHODS

Six electronic databases (Cochrane Library 2018, CINAHL 1982-2018, MEDLINE 1950-2018, EMBASE 1980-2018, PsycINFO 1806-2018, and EMCARE 1995-2018) were systematically searched in June 2018. Reference lists of identified articles were hand searched. Randomized controlled trials (RCTs), cohort studies, and case series were included if they investigated the effects of conservative treatments, including pelvic floor muscle training or dilator training, on bladder, bowel, or sexual function in patients who had received treatment for gynecological cancer. Risk of bias was assessed using the Physiotherapy Evidence Database scale for RCTs and the Newcastle-Ottawa scale for cohort studies.

RESULTS

Five RCTs and 2 retrospective cohort studies were included (n = 886). The results provided moderate-level evidence that pelvic floor muscle training with counseling and yoga or core exercises were beneficial for sexual function (standardized mean difference = -0.96, 95% CI = -1.22 to -0.70, I2 = 0%) and health-related quality of life (standardized mean difference = 0.63, 95% CI = 0.38 to 0.88, I2 = 0%) in survivors of cervical cancer and very low-level evidence that dilator therapy reduced vaginal complications in survivors of cervical and uterine cancer (odds ratio = 0.37, 95% CI = 0.17 to 0.80, I2 = 54%). There were insufficient data for meta-analysis of bladder or bowel function.

CONCLUSION

Conservative pelvic floor muscle interventions may be beneficial for improving sexual function and health-related quality of life in survivors of gynecological cancer. Given the levels of evidence reported in this review, further high-quality studies are needed, especially to investigate effects on bladder and bowel function.

IMPACT

This review provides moderate-level evidence for the role of pelvic floor rehabilitation to improve health outcomes in the gynecological cancer survivorship journey. Clinicians and health service providers should consider how to provide cancer survivors the opportunity to participate in supervised pelvic floor rehabilitation programs.

The conservative treatment of longstanding adductor-related groin pain syndrome: a critical and systematic review

Longstanding (chronic) adductor-related groin pain syndrome is a widely common problem for athletes in many sports activities which often drastically reduces player activity and performance. The first choice in therapeutic treatment is conservative therapy. The objective of this study is to provide a systematic review regarding conservative treatment for longstanding adductor-related groin pain syndrome present in literature today. Furthermore, this study aims to give a critical vision of the current state of the art of the considered topic. After screening 234 articles, 19 studies following the inclusion criteria were included and summarized in this current systematic review and seven different types of therapeutic interventions were described. Compression clothing therapy, manual therapy together with strengthening exercise and prolotherapy were the therapeutic interventions which showed both the greatest level of strength of evidence (Moderate) and grade of recommendation (D). The remaining four types of therapeutic interventions i.e.: corticoid injection, platelet rich plasma therapy, intra-tissue percutaneous electrolysis and pulse-dose radiofrequency, showed both lower levels of strength of evidence (Conflicting) and grade of recommendation (C). In conclusion the literature available on the conservative treatment for longstanding adductor-related groin pain syndrome is limited and characterized by a low level of evidence. Therefore, our recommendation is to refer only to the few studies with higher level of evidence and at the same time to encourage further research in this area. The intervention showing the greater level of strength of evidence, and the greater grade of recommendation are compression clothing therapy, manual therapy and strengthening exercise, and prolotherapy. Other therapeutic interventions such as intra-tissue percutaneous electrolysis and pulse-dose radiofrequency seem promising but require further studies to confirm their efficacy.

How to Improve the Functional Capacity of Frail and Pre-Frail Elderly People? Health, Nutritional Status and Exercise Intervention. The EXERNET-Elder 3.0 Project

Aging is associated with the impairment of health and functional capacity, and physical exercise seems to be an effective tool in frailty prevention and treatment. The purpose of this study was to present the methodology used in the EXERNET-Elder 3.0 project that aims to evaluate the immediate and residual effects and of a multicomponent exercise training program called Elder-fit on frailty, fitness, body composition and quality of life, and also to analyse a possible dietary intake interaction according to health and metabolic status. A total of 110 frail and pre-frail elders participated in this study and were divided into a control group (CG = 52) and an intervention group (IG = 58). The IG performed a supervised multicomponent exercise training program of 6 months and 3 days per week, which included strength, endurance, balance, coordination and flexibility exercises, while the CG continued with their usual daily activities. Both groups received four speeches about healthy habits along the project. Four evaluations were performed: at baseline, after 3 months of training, at the end of the training program (6 months) and 4 months after the program had ended to examine the effects of detraining. Evaluating the efficacy, safety and feasibility of this program will help to develop efficacious physical interventions against frailty. Further, protocols should be described accurately to allow exercise programs to be successfully replicated.

Effects of exercise on the physical fitness and functionality of people with amputations: Systematic review and meta-analysis

STUDY DESIGN

systematic review and meta-analysis.

BACKGROUND

Despite existing scientific evidence alluding to the positive effects of physical exercise on people with amputations, there is a lack of consistency between the results of past studies.

OBJECTIVE

To identify if people with amputations taking part in an exercise training programme can benefit from improvements in their health status as measured by changes in their physiological fitness and functionality levels.

METHODS

A systematic review and meta-analysis of randomized controlled trials (RCTs) were performed after searching within several databases up to October 2019.

RESULTS

Ten RCTs with satisfactory methodological quality were found. Five RCTs were pooled in the meta-analysis. Exercise programmes with a combination of activities were most commonly delivered. Exercise had positive effects on aerobic and muscular fitness parameters. Findings from the meta-analysis indicated that exercise improved distance walked but did not have a significant impact on functional mobility or self-reported functional capacity.

CONCLUSION

Combined exercise of muscular endurance and functional physical exercise appear to have greater positive effects on cardiorespiratory fitness, muscular fitness and functionality levels in adult prosthesis users with unilateral lower limb amputation. Future studies should include different profiles of patients with amputations that are poorly represented in the current scientific literature.

Smartphone Apps Targeting Physical Activity in People With Rheumatoid Arthritis: Systematic Quality Appraisal and Content Analysis

BACKGROUND

Rheumatoid arthritis (RA) is a disabling, inflammatory joint condition affecting 0.5%-1% of the global population. Physical activity (PA) and exercise are recommended for people with RA, but uptake and adherence tend to be low. Smartphone apps could assist people with RA to achieve PA recommendations. However, it is not known whether high quality, evidence-informed PA apps that include behavior change techniques (BCTs) previously identified as effective for PA adherence are available for people with RA.

OBJECTIVE

This study aims to systematically identify apps that include goals to facilitate PA for adults with RA and assess app quality and content for the inclusion of relevant BCTs against recommendations for cardiorespiratory, resistance, flexibility, and neuromotor PA and exercise.

METHODS

A systematic search of the Apple App Store and Google Play Store in the United Kingdom was conducted to identify English language apps that promote PA for adults with RA. Two researchers independently assessed app quality (mobile app rating scale [MARS]; range 0-5) and content (BCT Taxonomy version 1, World Health Organization, the American College of Sports Medicine, and the European League against Rheumatism recommendations for PA). The completeness of reporting of PA prescription was evaluated using a modified version of the Consensus on Exercise Reporting Template (CERT; range 0-14).

RESULTS

A total of 14,047 apps were identified. Following deduplication, 2737 apps were screened for eligibility; 6 apps were downloaded (2 on the Apple App Store and 4 on the Google Play Store), yielding 4 unique apps. App quality varied (MARS score 2.25-4.17). Only 1 app was congruent with all aspects of the PA recommendations. All apps completely or partially recommended flexibility and resistance exercises, 3 apps completely or partially advised some form of neuromotor exercise, but only 2 offered full or partial guidance on cardiorespiratory exercise. Completeness of exercise reporting was mixed (CERT scores 7-14 points) and 3-7 BCTs were identified. Two BCTs were common to all apps (information about health consequences and instruction on how to perform behavior). Higher quality apps included a greater number of BCTs and were more closely aligned to PA guidance. No published trials evaluating the effect of the included apps were identified.

CONCLUSIONS

This review identifies 4 PA apps of mixed quality and content for use by people with RA. Higher quality apps were more closely aligned to PA guidance and included a greater number of BCTs. One high-quality app (Rheumatoid Arthritis Information Support and Education) included 7 BCTs and was fully aligned with PA and exercise guidance. The effect of apps on PA adherence should be established before implementation.

Physical fitness in older women with osteoporosis and vertebral fracture after a resistance and balance exercise programme: 3-month post-intervention follow-up of a randomised controlled trial

Background

Exercise is recommended for individuals with vertebral fractures, but few studies have investigated the effect of exercise on outcomes of importance for this population. Post-intervention effects of exercise are even less studied. The objective of this study was to evaluate habitual walking speed and other health-related outcomes after cessation of a 3-month exercise intervention.

Methods

This follow-up study was conducted 3 months post-intervention of a randomised controlled trial. A total of 149 community-dwelling Norwegian women aged 65 years or older, diagnosed with osteoporosis and vertebral fracture were randomised into either exercise or control group. Primary outcome was habitual walking speed at 3 months. Secondary outcomes were other measures of physical fitness – including the Four Square Step Test (FSST), functional reach, grip strength and Senior Fitness Test – measures of health-related quality of life and fear of falling. Herein we report secondary data analysis of all outcomes at 6 months (3 months post-intervention). Data were analysed according to the intention-to-treat principle, linear mixed regression models were employed.

Results

For the primary outcome, habitual walking speed, there was no statistically significant difference between groups (0.03 m/s, 95%CI − 0.02 to 0.08, p = 0.271) at the 3-month post-intervention follow-up. For secondary outcomes of physical fitness, statistically significant differences in favour of the intervention group were found for balance using the FSST (− 0.68 s, 95%CI − 1.24 to − 0.11, p = 0.019), arm curl (1.3, 95%CI 0.25 to 2.29, p = 0.015), leg strength using the 30-s sit to stand (1.56, 95%CI 0.68 to 2.44, p = 0.001) and mobility using the 2.45-m up and go (− 0.38 s, 95%CI − 0.74 to − 0.02, p = 0.039). There was a statistically significant difference between the groups regarding fear of falling in favour of the intervention group (− 1.7, 95%CI − 2.97 to − 0.38, p = 0.011). No differences between groups were observed for health-related quality of life.

Conclusion

The results show the improved effects of a multicomponent exercise programme on outcomes like muscle strength, balance and mobility as well as fear of falling in a group of older women with osteoporosis and vertebral fracture 3 months post-intervention.

Trial registration

ClinicalTrials.gov Identifier: NCT02781974. Registered 25.05.16. Retrospectively registered.

Modifying bowling kinematics in cricket pace bowlers with exercise-based injury prevention: A cluster-randomised controlled trial

OBJECTIVES

Undesirable bowling kinematics can increase the risk of low back injury. This study investigated if an exercise-based injury prevention program (IPP) could modify bowling kinematics in community-level adolescent pace bowlers.

DESIGN

Cluster-randomised controlled trial.

METHODS

Pace bowlers from eight cricket organisations were cluster-randomised into an intervention or control group. At baseline and follow-up sessions biomechanical bowling data were collected. Between sessions, the intervention group completed an eight-week IPP while the control continued their normal cricket activity. Treatment effects (95% CI) were estimated with linear mixed models.

RESULTS

There were significant treatment effects favouring the intervention group for shoulder counter-rotation (-3.8°; -7.2° to -0.3°) and lateral trunk flexion relative to the pelvis (-2.2°; -4.0° to -0.5°). Shoulder counter-rotation also increased in the control group by 2.2° (Cohen's d=0.22). There were no effects of the intervention on: lateral trunk flexion at front foot contact (FFC) (1.2°; -2.5° to 4.8°), lateral trunk flexion at ball release (BR) (-0.5°; -3.0° to 2.0°), pelvis rotation at FFC (0.9°; -4.0° to 2.2°), pelvis rotation at BR (-1.1°; -5.7° to 3.6°), front hip angle at FFC (1.6°; -3.6° to 6.7°), front hip angle at BR (-1.6°; -5.0° to 1.9°), front knee angle at FFC (-1.1°; -4.5° to 2.3°), front knee angle at BR (1.7°; -5.6° to 9.1°), or ball velocity (1.1kmh^-1; -7.5kmh^-1 to 9.7kmh^-1).

CONCLUSIONS

The IPP maintained shoulder counter-rotation and lateral trunk flexion relative to the pelvis in the intervention group and this could attenuate injury risk. No treatment effects were observed for lower-limb kinematics.

Heavy shoulder strengthening exercise in people with hypermobility spectrum disorder (HSD) and long-lasting shoulder symptoms: a feasibility study

Background

People with hypermobility spectrum disorder (HSD) are in great risk of experiencing shoulder symptoms, but evidence for treatment is sparse. Therefore, the objective was to evaluate the feasibility of 16-week shoulder strengthening programme for improving shoulder strength and function in people with HSD and shoulder symptoms for more than 3 months to inform a future randomised controlled trial (RCT).

Methods

Twelve participants (11 females, 39.3 ± 13.9 years) with HSD and shoulder instability and/or pain for more than 3 months underwent a 16-week heavy shoulder strengthening exercise programme three times weekly using exercises targeting scapular and rotator cuff muscles. Primary outcomes were pre-defined research progression criteria including recruitment rate (acceptable, 6 participants/month), assessment duration (acceptable: < 120 min), participant retention (acceptable: > 80% complete intervention), training adherence (acceptable: > 75% adhere to > 36 training sessions) and adverse events (acceptable: minor events with no participants discontinuing the study), besides participant and physiotherapist feedback. Secondary treatment outcomes were assessed using the Western Ontario Shoulder Instability Index (WOSI, 0–2100 better to worse), self-reported pain, kinesiophobia and fatigue, isometric shoulder strength, besides clinical tests for instability, hypermobility, laxity, and proprioception.

Results

Recruitment rate was 5.6/month, assessment duration (mean ± SD) 105 ± 9 min, retention 100%, adherence 83%, and four participants experienced short-lasting soreness or pain. Participant feedback was positive, and physiotherapists found the intervention relevant and applicable to the population. The WOSI total score showed an improvement by 51% (mean ± SD, points: baseline 1037 ± 215; Follow up 509 ± 365; mean change (95% CI), − 528 (− 738, − 318)), and participants reported reduced pain, kinesiophobia and fatigue. Shoulder strength measurements improved by 28–31% (mean change (95% CI), Nm/kg: scaption 0.51 (0.23, 0.78); internal rotation 1.32 (0.70, 1.95) and external rotation 0.89 (0.37, 1.40)), and clinical tests indicated decreased shoulder laxity/instability.

Conclusions

The shoulder strengthening exercise programme was feasible and safe for people with HSD and long-lasting shoulder symptoms. A future RCT, with an improved recruitment strategy, will demonstrate whether the exercise programme is also effective in improving symptoms and muscle-tendon function in this population.

Trial registration

ClinicalTrials.gov: NCT03547570. Registered on May 3, 2018.

Effects of exercise cessation on adipose tissue physiological markers related to fat regain: A systematic review

Tissues usually super compensate during the period that follow physical exercise. Although this is widely accepted for muscle and glycogen, the compensatory effect is not usually applied to fat tissues. Notwithstanding, evidence for this has been present since the 1970s when it was first suggested that the increased lipogenic activity in response to training might be an adaptation that enables to restore an energy reserve that can be used in times of need. In this context, the present review aimed to summarize information about the effect of detraining on fat metabolism and the physiological responses associated with fat regain. A systematic search on PubMed and Scielo was performed using "training cessation," "detraining," "exercise detraining," and "exercise cessation" combined with "fat tissue," "adipose tissue," "adipose metabolism," and "fat metabolism," as descriptors. From 377 results, 25 were included in this review, 12 humans and 13 rodents, resulting in a sample of 6772 humans and 613 animals. The analysis provided evidence for fat super compensation, as well as differences in humans and rodents, among different protocols and possible mechanisms for fat gain after exercise cessation. In summary, exercise cessation appears to increase the ability of the adipose tissue to store energy. However, caution should be taken, especially regarding conclusions based on investigations on humans, considering the multiple factors that could affect fat metabolism.

What do we know about physical activity interventions in vocational education and training? A systematic review

BACKGROUND

Although the health benefits of physical activity (PA) are well known, young people's level of PA is often insufficient and tends to decline in adolescence. Numerous studies have investigated the effectiveness of PA-promoting interventions among young people, but none have reviewed the effectiveness of PA interventions in the vocational education and training (VET) setting. This systematic review aims to (1) synthesize and review the available literature on PA-promoting interventions in VET and (2) examine the effects of these interventions on PA-related outcomes such as PA level, physical fitness, physiological parameters, or psychological factors.

METHODS

Five electronic databases were searched for studies involving adolescents aged 15 to 20 years that took place in VET settings and evaluated the effects of interventions with a PA component on PA-related outcomes such as PA level, physical fitness, physiological parameters, or psychological factors. The screening process and the quality assessment were conducted by two independent reviewers; data extraction was conducted by one reviewer and verified by another.

RESULTS

The literature search identified 18,959 articles and 11,282 unique records. After the screening process, nine studies, all coming from European or Asian countries, met the pre-defined eligibility criteria and were included in qualitative analyses. All but two studies reported significant improvements for at least one PA-related outcome. The interventions substantially differed in their development approaches (top-down vs. bottom-up approaches), complexity (multi- vs. single-component), and addressed behavior (multi-behavioral vs. single-behavioral). The most conspicuous finding was that bottom-up approaches tend to improve outcomes at the psychological level and top-down approaches at the physical level. Regarding the interventions' complexity and addressed behavior, we did not reveal any conclusive results.

CONCLUSION

This systematic review highlights the varying effects of PA-promoting interventions in VET. Nevertheless, heterogeneous effects, overall weak study quality and availability of studies only from two continents limited our ability to draw clear conclusions about the potentially most effective intervention strategies. Therefore, future research should focus on high-quality studies with long-term follow-ups to make recommendations for practical use.

TRIAL REGISTRATION

PROSPERO CRD42018109845.

Effectiveness of progressive and resisted and non-progressive or non-resisted exercise in rotator cuff related shoulder pain: a systematic review and meta-analysis of randomized controlled trials

Objective:

Synthesize evidence regarding effectiveness of progressive and resisted or non-progressive and non-resisted exercise compared with placebo or no treatment, in rotator cuff related pain.

Data sources:

English articles, searched in Cochrane CENTRAL, MEDLINE, EMBASE and CINAHL databases up until May 19, 2020.

Methods:

Randomized controlled trials in people with rotator cuff related pain comparing either progressive and resisted exercise or non-progressive and non-resisted exercise, with placebo or no treatment were included. Data extracted independently by two authors. Risk of bias appraised with the Cochrane Collaboration tool.

Results:

Seven trials (468 participants) were included, four trials (271 participants) included progressive and resisted exercise and three trials (197 participants) included non-progressive or non-resisted exercise. There was uncertain clinical benefit for composite pain and function (15 point difference, 95% CI 9 to 21, 100-point scale) and pain outcomes at >6 weeks to 6 months with progressive and resisted exercise compared to placebo or no treatment (comparison 1). For non-progressive or non-resisted exercise there was no significant benefit for composite pain and function (4 point difference, 95% CI −2 to 9, 100-point scale) and pain outcomes at >6 weeks to 6 months compared to placebo or no treatment (comparison 2). Adverse events were seldom reported and mild.

Conclusions:

There is uncertain clinical benefit for all outcomes with progressive and resisted exercise and no significant benefit with non-progressive and non-resisted exercise, versus no treatment or placebo at >6 weeks to 6 months. Findings are low certainty and should be interpreted with caution.

Effects of a resistance and balance exercise programme on physical fitness, health-related quality of life and fear of falling in older women with osteoporosis and vertebral fracture: a randomized controlled trial

Exercise is recommended for people with osteoporosis, but the effect for people who have suffered vertebral fracture is uncertain. This study shows that a multicomponent exercise-program based on recommendations for people with osteoporosis improved muscle strength, balance, and fear of falling in older women with osteoporosis and vertebral fracture.

INTRODUCTION

Guidelines for exercise strongly recommend that older adults with osteoporosis or osteoporotic vertebral fracture should engage in a multicomponent exercise programme that includes resistance training in combination with balance training. Prior research is scarce and shows inconsistent findings. This study examines whether current exercise guidelines for osteoporosis, when applied to individuals with vertebral fractures, can improve health outcomes.

METHODS

This single blinded randomized controlled trial included 149 older women diagnosed with osteoporosis and vertebral fracture, 65+ years. The intervention group performed a 12-week multicomponent exercise programme, the control group received usual care. Primary outcome was habitual walking speed, secondary outcomes were physical fitness (Senior Fitness Test, Functional Reach and Four Square Step Test), health-related quality of life and fear of falling. Descriptive data was reported as mean (standard deviation) and count (percent). Data were analyzed following intention to treat principle and per protocol. Between-group differences were assessed using linear regression models (ANCOVA analysis).

RESULTS

No statistically significant difference between the groups were found on the primary outcome, walking speed (mean difference 0.04 m/s, 95% CI - 0.01-0.09, p = 0.132). Statistically significant between-group differences in favour of intervention were found on FSST (dynamic balance) (mean difference - 0.80 s, 95% CI - 1.57 to - 0.02, p = 0.044), arm curl (mean difference 1.55, 95% CI 0.49-2.61, p = 0.005) and 30-s STS (mean difference 1.85, 95% CI 1.04-2.67, p < 0.001), as well as fear of falling (mean difference - 1.45, 95% CI - 2.64 to - 0.26, p = 0.018). No statistically significant differences between the groups were found on health-related quality of life.

CONCLUSION

Twelve weeks of a supervised multicomponent resistance and balance exercise programme improves muscle strength and balance and reduces fear of falling, in women with osteoporosis and a history of vertebral fractures.

TRIAL REGISTRATION

ClincialTrials.gov Identifier: NCT02781974. Registered 25.05.16. Retrospectively registered.

Assessing the reporting quality of physical activity programs in randomized controlled trials for the management of juvenile idiopathic arthritis using three standardized assessment tools

BACKGROUND

The reporting quality of physical activity (PA) programs in randomized controlled trials (RCTs) for the management of juvenile idiopathic arthritis (JIA) remains unknown. This study aimed to assess and compare the reporting quality of PA programs in RCTs for the management of JIA using three difference standardized assessment tools, and to describe the elements that were similar and different between these tools.

METHODS

A systematic search was conducted for moderate-to high-quality RCTs of PA programs in JIA, published up until January 2019. Two reviewers independently included 10 RCTs and scored the reporting quality of PA programs using the following tools: Consensus on Exercise Reporting Template (CERT) checklist, Consensus on Therapeutic Exercise Training (CONTENT) scale, and Template for Intervention Description and Replication (TIDieR) checklist.

RESULTS

Results showed that reporting of PA programs in 10 moderate- to high-quality RCTs for JIA management remains incomplete. The average reporting quality (± standard deviation) for all RCTs combined was moderate for the three standardized assessment tools with 70.8 (±14.3)% for the TIDieR checklist, 53.2 (±20.2)% for the CERT checklist, and 70.0 (±18.9)% for the CONTENT scale. Despite some overlap, the three standardized assessment tools (TIDieR, CERT, CONTENT) included different elements resulting in different scores. All tools assess elements linked to PA programs (provider, location, timing, personalization and adherence), but the CERT checklist includes other essential elements (e.g., additional resources, motivational strategies, adverse events).

CONCLUSIONS

The lack of complete reporting of PA programs in RCTs for the management of JIA and the variation in scores and assessed elements among standardized assessment tools show the need to improve reporting. Using the most comprehensive standardized tool (i.e., the CERT) and providing accessible supplemental information on PA programs may improve the reporting quality of PA programs in RCTs and help reproduce PA programs in research and clinical practice.

Adherence and drop-out in randomized controlled trials of exercise interventions in people with multiple sclerosis: A systematic review and meta-analyses

BACKGROUND

The short-term benefits of exercise in people with multiple sclerosis (MS) are well established. To sustain benefits exercise needs to continue long-term. Despite important clinical implications, no systematic reviews have synthesized evidence on adherence and drop-out in MS exercise interventions.

OBJECTIVES

1) To summarize reported adherence and drop-out data from randomized controlled trials (RCTs) of exercise interventions, and 2) identify moderators related to adherence and drop-out.

METHODS

Nine databases were electronically searched in October 2018. Included studies were RCTs of exercise interventions in adults with MS published from January 1993 to October 2018. Abstracts and full texts were independently screened and selected for inclusion by two reviewers. Methodological quality was assessed using the TESTEX rating scale.

RESULTS

Ninety three articles reporting 81 studies were included. Forty one studies (51%) reported both adherence and drop-out data during the intervention period with three (4%) also reporting follow-up data. Of the 41 studies, < 25% pre-defined adherence or described how adherence was measured. Meta-analyses of 59 interventions (41 studies) showed a pooled adherence estimate of 0.87 (95% CI 0.83 to 0.90) and 0.73 (CI 0.68-0.78) when including drop-outs. Mean age, proportion of females and intervention duration were inversely associated with adherence.

CONCLUSION

Little consensus existed on definition of adherence or determination of drop-out in MS exercise studies, with reporting generally of poor quality, if done at all. Hence it is largely unknown what can moderate adherence and whether exercise continued following an exercise intervention. Researchers should ensure clear transparent measurement and reporting of adherence and drop-out data in future trials.

Consensus on the exercise and dosage variables of an exercise training programme for chronic non-specific neck pain: protocol for an international e-Delphi study

INTRODUCTION

Clinical guidelines and systematic reviews recommend exercise in the management of chronic non-specific neck pain. Although exercise training programmes that consist of both motor control exercise and exercises for the superficial cervical muscles (segmental exercises) are effective, the exercise variables including dosage vary considerably across trials or are poorly reported. This study aims to gain expert consensus on these exercise variables so that they can be described clearly using intervention reporting checklists to inform clinical practice and future clinical trials.

METHODS AND ANALYSIS

This protocol for an international Delphi study is informed by the Guidance on Conducting and REporting DElphi Studies recommendations and published to ensure quality, rigour and transparency. The study will consist of three rounds using anonymous online questionnaires. Expert exercise professionals (physiotherapists, strength and conditioning coaches and so on) and academics in neck pain management will be identified through literature searches, peer referral and social media calls for expression of interest. In round 1, participants will answer open-ended questions informed by intervention and exercise reporting checklists. Responses will be analysed thematically by two independent reviewers. In round 2, participants will rate their level of agreement with statements generated from round 1 and previous clinical trials using a 5-point Likert scale where 1=strongly disagree and 5=strongly agree. In round 3, participants will re-rate their agreement with statements that achieved consensus in round 2. Statements reaching consensus among participants must meet progressively increased a priori criteria at rounds 2 and 3, measured using descriptive statistics: median, IQR and percentage agreement. Inferential statistics will be used to evaluate measures of agreement between participants (Kendall's coefficient of concordance) and stability between rounds (Wilcoxon rank-sum test). Statements achieving consensus in round 3 will provide expert recommendations of the key exercise and dosage variables in the management of chronic non-specific neck pain.

ETHICS AND DISSEMINATION

Ethical approval was provided by the University of Birmingham Ethics Committee (Ref:ERN_19-1857). Results will be disseminated through peer-reviewed publications and conference presentations.

Pelvic floor muscle training for preventing and treating urinary and faecal incontinence in antenatal and postnatal women

BACKGROUND

About one-third of women have urinary incontinence (UI) and up to one-tenth have faecal incontinence (FI) after childbirth. Pelvic floor muscle training (PFMT) is commonly recommended during pregnancy and after birth for both preventing and treating incontinence. This is an update of a Cochrane Review previously published in 2017.

OBJECTIVES

To assess the effects of PFMT for preventing or treating urinary and faecal incontinence in pregnant or postnatal women, and summarise the principal findings of relevant economic evaluations.

SEARCH METHODS

We searched the Cochrane Incontinence Specialised Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE In-Process, MEDLINE Epub Ahead of Print, CINAHL, ClinicalTrials.gov, WHO ICTRP, and handsearched journals and conference proceedings (searched 7 August 2019), and the reference lists of retrieved studies.

SELECTION CRITERIA

We included randomised or quasi-randomised trials in which one arm included PFMT. Another arm was no PFMT, usual antenatal or postnatal care, another control condition, or an alternative PFMT intervention. Populations included women who, at randomisation, were continent (PFMT for prevention) or incontinent (PFMT for treatment), and a mixed population of women who were one or the other (PFMT for prevention or treatment).

DATA COLLECTION AND ANALYSIS

We independently assessed trials for inclusion and risk of bias. We extracted data and assessed the quality of evidence using GRADE.

MAIN RESULTS

We included 46 trials involving 10,832 women from 21 countries. Overall, trials were small to moderately-sized. The PFMT programmes and control conditions varied considerably and were often poorly described. Many trials were at moderate to high risk of bias. Two participants in a study of 43 pregnant women performing PFMT for prevention of incontinence withdrew due to pelvic floor pain. No other trials reported any adverse effects of PFMT. Prevention of UI: compared with usual care, continent pregnant women performing antenatal PFMT probably have a lower risk of reporting UI in late pregnancy (62% less; risk ratio (RR) 0.38, 95% confidence interval (CI) 0.20 to 0.72; 6 trials, 624 women; moderate-quality evidence). Antenatal PFMT slightly decreased the risk of UI in the mid-postnatal period (more than three to six months' postpartum) (29% less; RR 0.71, 95% CI 0.54 to 0.95; 5 trials, 673 women; high-quality evidence). There was insufficient information available for the late postnatal period (more than six to 12 months) to determine effects at this time point (RR 1.20, 95% CI 0.65 to 2.21; 1 trial, 44 women; low-quality evidence). Treatment of UI: compared with usual care, there is no evidence that antenatal PFMT in incontinent women decreases incontinence in late pregnancy (very low-quality evidence), or in the mid-(RR 0.94, 95% CI 0.70 to 1.24; 1 trial, 187 women; low-quality evidence), or late postnatal periods (very low-quality evidence). Similarly, in postnatal women with persistent UI, there is no evidence that PFMT results in a difference in UI at more than six to 12 months postpartum (RR 0.55, 95% CI 0.29 to 1.07; 3 trials; 696 women; low-quality evidence). Mixed prevention and treatment approach to UI: antenatal PFMT in women with or without UI probably decreases UI risk in late pregnancy (22% less; RR 0.78, 95% CI 0.64 to 0.94; 11 trials, 3307 women; moderate-quality evidence), and may reduce the risk slightly in the mid-postnatal period (RR 0.73, 95% CI 0.55 to 0.97; 5 trials, 1921 women; low-quality evidence). There was no evidence that antenatal PFMT reduces the risk of UI at late postpartum (RR 0.85, 95% CI 0.63 to 1.14; 2 trials, 244 women; moderate-quality evidence). For PFMT started after delivery, there was uncertainty about the effect on UI risk in the late postnatal period (RR 0.88, 95% CI 0.71 to 1.09; 3 trials, 826 women; moderate-quality evidence). Faecal incontinence: eight trials reported FI outcomes. In postnatal women with persistent FI, it was uncertain whether PFMT reduced incontinence in the late postnatal period compared to usual care (very low-quality evidence). In women with or without FI, there was no evidence that antenatal PFMT led to a difference in the prevalence of FI in late pregnancy (RR 0.64, 95% CI 0.36 to 1.14; 3 trials, 910 women; moderate-quality evidence). Similarly, for postnatal PFMT in a mixed population, there was no evidence that PFMT reduces the risk of FI in the late postnatal period (RR 0.73, 95% CI 0.13 to 4.21; 1 trial, 107 women, low-quality evidence). There was little evidence about effects on UI or FI beyond 12 months' postpartum. There were few incontinence-specific quality of life data and little consensus on how to measure it.

AUTHORS' CONCLUSIONS

This review provides evidence that early, structured PFMT in early pregnancy for continent women may prevent the onset of UI in late pregnancy and postpartum. Population approaches (recruiting antenatal women regardless of continence status) may have a smaller effect on UI, although the reasons for this are unclear. A population-based approach for delivering postnatal PFMT is not likely to reduce UI. Uncertainty surrounds the effects of PFMT as a treatment for UI in antenatal and postnatal women, which contrasts with the more established effectiveness in mid-life women. It is possible that the effects of PFMT might be greater with targeted rather than mixed prevention and treatment approaches, and in certain groups of women. Hypothetically, for instance, women with a high body mass index (BMI) are at risk of UI. Such uncertainties require further testing and data on duration of effect are also needed. The physiological and behavioural aspects of exercise programmes must be described for both PFMT and control groups, and how much PFMT women in both groups do, to increase understanding of what works and for whom. Few data exist on FI and it is important that this is included in any future trials. It is essential that future trials use valid measures of incontinence-specific quality of life for both urinary and faecal incontinence. In addition to further clinical studies, economic evaluations assessing the cost-effectiveness of different management strategies for FI and UI are needed.

Effects of Workplace-Based Physical Activity Interventions on Cardiorespiratory Fitness: A Systematic Review and Meta-Analysis of Controlled Trials

BACKGROUND

Cardiorespiratory fitness is a strong predictor of all-cause mortality. Physical activity of at least moderate intensity can improve cardiorespiratory fitness. Workplaces may provide a relatively controlled setting in which to improve cardiorespiratory fitness through physical activity. Limited work has been conducted to quantify the impact of delivering physical activity in the workplace on cardiorespiratory fitness.

OBJECTIVE

The objective of this systematic review was to quantify the effects of workplace physical activity interventions on peak oxygen consumption (VO_2peak) and explore study and participant characteristics as putative moderators.

METHODS

Seven databases were searched up to September 2018. Search terms included "workplace", "physical activity" and "intervention". Inclusion criteria were controlled trials where physical activity of at least moderate intensity was delivered in the workplace and compared to controls or non-active comparators; and cardiorespiratory fitness measured by actual or predicted VO_2peak. Risk of bias was assessed using the PEDro scale. A random-effects meta-analysis was conducted with between-study variation quantified and then explored for putative predictors with a meta-regression. Pooled estimate uncertainty was expressed as 90% confidence intervals (CIs) and assessed against our threshold value for clinical relevance of 1 mL·kg^-1·min^-1.

RESULTS

The final dataset consisted of 25 estimates of VO_2peak from 12 trials. The pooled mean differences between intervention and control arms was a beneficial improvement of 2.7 mL·kg^-1·min^-1 (90% CI 1.6-3.8). The 95% prediction interval ranged from a reduction in VO_2peak of - 1.1 to an improvement of 6.5 mL·kg^-1·min^-1. Between-study heterogeneity (τau) was ± 1.6 mL·kg^-1·min^-1. The meta-regression showed longer interventions (3.2 mL·kg^-1·min^-1; 90% CI 1.6-3.8) to have an additive effect and studies with a low risk of bias (- 2.5 mL·kg^-1·min^-1; 90% CI - 4.0 to - 1.0), and participants of greater baseline VO_2peak (- 1.6 mL·kg^-1·min^-1; 90% CI - 3.6 to 0.4), and age (- 1.4 mL·kg^-1·min^-1; 90% CI - 3.2 to 0.3) having a lesser effect. Participant sex (percentage female) had an additive effect on VO_2peak (0.4 mL·kg^-1·min^-1; 90% CI - 1.6 to 2.4).

CONCLUSIONS

Workplace-based physical activity interventions consisting of at least moderate-intensity activity improve cardiorespiratory fitness. At the present time, we surmise that no single group of employees (e.g. older employees or less fit individuals) can be definitively identified as standing to benefit more from workplace physical activity interventions than others. This demonstrates the potential utility of workplace physical activity interventions for improving cardiorespiratory fitness in a broad range of healthy employees. Protocol registration: PROSPERO (registration number: 42017057498).

There Is Limited and Inconsistent Reporting of Postoperative Rehabilitation for Femoroacetabular Impingement Syndrome: A Scoping Review of 169 Studies

OBJECTIVE

To evaluate the reporting of rehabilitation guidelines in studies of postoperative outcomes of patients with femoroacetabular impingement (FAI) syndrome and/or labral tear.

DESIGN

Scoping review.

LITERATURE SEARCH

A computer-assisted literature search was conducted of the MEDLINE, CINAHL, and Embase databases on June 17, 2018. Using key words related to FAI syndrome/labral tear and both open and arthroscopic surgical outcomes, we identified 169 studies that included 16 675 patients. Separate authors calculated and verified the prevalence of reported outcomes.

STUDY SELECTION CRITERIA

We included intervention and observational studies that were prospective or retrospective in design. Studies must have included patients with a primary diagnosis of FAI syndrome and/or labral tear.

DATA SYNTHESIS

We calculated the mean ± SD prevalence for continuous variables, where possible.

RESULTS

Hip arthroscopy was the primary surgical procedure (76% of studies). The mean ± SD age of participants was 34.8 ± 9.2 years and the mean ± SD follow-up time was 27 ± 15.3 months. Of the 169 included studies, 74 (44%) discussed phases of rehabilitation, 49 (29%) reported details on goals between phases, 1 in 3 described details on rehabilitation progression, and fewer than 1 in 10 reported sufficient detail to replicate the rehabilitation protocol. Weight-bearing and range-of-motion restrictions were poorly reported and variable in duration.

CONCLUSION

Surgical outcome studies do not provide sufficient detail or consistency for practicing clinicians to replicate a postoperative rehabilitation protocol for patients with FAI syndrome/labral tear. J Orthop Sports Phys Ther 2020;50(5):252-258. doi:10.2519/jospt.2020.9189.

Implementing a system-wide cancer prehabilitation programme: The journey of Greater Manchester's 'Prehab4cancer'

Patients undergoing major cancer interventions such as major surgical resection, chemotherapy, radiotherapy, and immunotherapy are prone to the adverse effects of their cancer, as well as to the side effects of the treatments designed to cure them. The Prehabilitation process supports cancer patients in preparing for the physiological challenges of their cancer treatments, whilst aiming to shorten recovery time, reduce peri-operative complications and improve compliance with non-surgical treatments. Prehabilitation will be most useful in older patients. Greater Manchester Integrated Care system is the first regional system in the UK to introduce delivery of system-wide, large scale physical activity supported multi-modal prehabilitation and recovery programme, Prehab4Cancer as a standard of care for cancer patients. It builds upon the successful implementation of Enhanced Recovery After Surgery + programme to improve surgical care in Greater Manchester. During this review we describe the journey to develop a system wide prehabilitation model for patients with cancer. Prehab4Cancer to date has focused on robust co-design, development, and implementation of an effective service model with attention paid to stakeholder engagement. This has led to receipt of high numbers of referrals from across Greater Manchester for the all the cancer groups involved. The successful implementation of the P4C pathway in GM presents a best practice model that might be adopted by other local and combined authority areas nationally.

The Effects of Workplace Nature-Based Interventions on the Mental Health and Well-Being of Employees: A Systematic Review

Mental health in the workplace is a societal challenge with serious economical and human costs. Most prevalent mental disorders in the workforce (e.g., depression), however, are preventable. There is widespread agreement about the favorable effects of nature exposure and consequently, nature-based interventions (NBI) in the workplace have been proposed as a cost-effective approach to promote good health among employees. The objective of the present study was to systematically review scientific evidence on the effectiveness of NBI to promote mental health and well-being among actual employees in actual workplace settings. The review was conducted and presented in accordance with the PRISMA guidelines. The literature search was performed on five databases (PubMed, Embase, CENTRAL, CINHAL, and PsycINFO), hand-searching of field-specific journals, and the reference lists of retrieved papers over the past 5 years up to November (13th, 2018). Studies were eligible for inclusion if they (i) were randomized or nonrandomized controlled trials; (ii) comprised samples of actual employees; (iii) implemented a workplace-based intervention with exposure to nature; (iv) included comparison conditions that displayed a clear contrast to NBIs; and (v) investigated the quantitative effects on mental health or well-being. No restrictions on type of employees or workplace, publication period, or language of the publication were set. Risk of bias was assessed using the Cochrane's RoB2 tool. Narrative synthesis was performed due to large heterogeneity in outcome variables. Of the 510 articles identified, 10 NBIs (nine papers) met the eligibility criteria. The outcomes were grouped in five categories: (i) mental health indices, (ii) cognitive ability, (iii) recovery and restoration, (iv) work and life satisfaction, and (v) psychophysiological indicators. Narrative synthesis indicates consistently positive effects on mental health indices and cognitive ability, while mixed results were found for the other outcome categories. Caution must be given when interpreting the current evidence in this emerging research field because of the diversity of NBIs and the overall high risk of bias in the individual studies. Although in this field often researchers have to balance scientific rigor and ecological validity, there is a need for large, well-designed and rigorously conducted trials grounded in contemporary theories.

Effect of Isometric Resistance Training on Blood Pressure Values in a Group of Normotensive Participants: A Systematic Review and Meta-analysis

CONTEXT

Cardiovascular diseases cause 17 million deaths annually worldwide, of which hypertension is responsible for 9.4 million and a 7% burden of disease. High blood pressure is responsible for 45% of deaths from heart disease and 51% of deaths from stroke.

OBJECTIVE

The aim of this systematic review and meta-analysis was to quantify the effect of isometric resistance training on systolic, diastolic, and mean arterial blood pressure (SBP, DBP, and MAP, respectively) values in normotensive adult participants.

DATA SOURCES

This study was registered with the PROSPERO database. Eligible studies were identified after performing a systematic search within the following databases: PubMed, Scielo, BioMed Central, Clinical Trials, EMBASE, Cochrane Central Register of Controlled Trials, and EBSCO.

STUDY SELECTION

Randomized controlled trials that categorized participants as normotensive according to the guidelines of the American Heart Association and the American College of Cardiology were included.

STUDY DESIGN

Systematic review with meta-analysis.

LEVEL OF EVIDENCE

Level 1.

DATA EXTRACTION

Data related to participant characteristics, exercise programs, level of evidence, risk of bias, Consensus on Exercise Reporting Template, and outcomes of interest were systematically reviewed independently by 2 authors.

RESULTS

A total of 6 randomized controlled trials were included. The following reductions in blood pressure (compared with the control group) were generated by isometric resistance training: SBP (mean difference [MD], -2.83 mm Hg; 95% CI, -3.95 to -1.72; P < 0.00001), DBP (MD, -2.73; 95% CI, -4.23 to -1.24; P = 0.0003), and MAP (MD, -3.07; 95% CI, -5.24 to -0.90; P = 0.005).

CONCLUSION

It appears that isometric resistance training reduces SBP, DBP, and MAP in normotensive young adults in a statistically significant and clinically relevant manner. This type of exercise could be considered effective in preventing arterial hypertension.

Moving exercise research in multiple sclerosis forward (the MoXFo initiative): Developing consensus statements for research

Exercise as a subset of physical activity is a cornerstone in the management of multiple sclerosis (MS) based on its pleotropic effects. There is an exponential increase in the quantity of research on exercise in MS, yet a number of barriers associated with study content and quality hamper rapid progress in the field. To address these barriers and accelerate discovery, a new international partnership of MS-related experts in exercise has emerged with the goal of advancing the research agenda. As a first step, the expert panel met in May 2018 and identified the most urgent areas for moving the field forward, and discussed the framework for such a process. This led to identification of five themes, namely "Definitions and terminology," "Study methodology," "Reporting and outcomes," "Adherence to exercise," and "Mechanisms of action." Based on the identified themes, five expert groups have been formed, that will further (a) outline the challenges per theme and (b) provide recommendations for moving forward. We aim to involve and collaborate with people with MS/MS organizations (e.g. Multiple Sclerosis International Federation (MSIF) and European Multiple Sclerosis Platform (EMSP)) in all of these five themes. The generation of this thematic framework with multi-expert perspectives can bolster the quality and scope of exercise studies in MS that may ultimately improve the daily lives of people with MS.

Physical Exercise following bariatric surgery in women with Morbid obesity: Study protocol clinical trial (SPIRIT compliant)

BACKGROUND

Severe and morbid obesity are increasing globally, particularly in women. As BMI increases, the likelihood of anovulation is higher. The primary aim of the EMOVAR clinical trial is to examine, over the short (16 weeks) and medium (12 months) term, the effects of a supervised physical exercise program (focused primarily on aerobic and resistance training) on ovarian function in women with severe/morbid obesity who have undergone bariatric surgery. Secondary objectives are to examine the effects of the intervention on chronic inflammation, insulin resistance, arterial stiffness, physical fitness, and health-related quality of life.

METHODS

This is a randomized controlled trial in which ∼40 female bariatric surgery patients, aged between 18 and 45 years old, will be included. Participants assigned to the experimental group will perform a total of 48 sessions of supervised concurrent (strength and aerobic) training (3 sessions/week, 60 min/session) spread over 16 weeks. Patients assigned to the control group will receive lifestyle recommendations. Outcomes will be assessed at baseline, week 16 (i.e., after the exercise intervention) and 12 months after surgery. The primary outcome is ovarian function using the Sex-Hormone Binding Globuline, measured in serum. Secondary outcomes are serum levels of anti-mullerian hormone, TSH, T4, FSH, LH, estradiol, prolactine, and free androgen index, as well as oocyte count, the diameters of both ovaries, endometrial thickness, and uterine arterial pulsatility index (obtained from a transvaginal ultrasound), the duration of menstrual bleeding and menstrual cycle duration (obtained by personal interview) and hirsutism (Ferriman Gallwey Scale). Other secondary outcomes include serum markers of chronic inflammation and insulin resistance (i.e., C-reactive protein, interleukin 6, tumor necrosis factor-alpha, leptin, glomerular sedimentation rate, glucose, insulin and the HOMA-IR), arterial stiffness, systolic, diastolic and mean blood pressure, body composition, and total weight loss. Physical fitness (including cardiorespiratory fitness, muscular strength, and flexibility), health-related quality of life (SF-36 v2) and sexual function (Female Sexual Function Index) will also be measured.

DISCUSSION

This study will provide, for the first time, relevant information on the effects of exercise training on ovarian function and underlying mechanisms in severe/morbid obese women following bariatric surgery.

TRIAL REGISTRATION NUMBER

ISRCTN registry (ISRCTN27697878).

Exercise training improves sleep quality: A randomized controlled trial

BACKGROUND

Exercise holds promise as a non-pharmacological intervention for the improvement of sleep quality. Therefore, this study investigates the effects of different training modalities on sleep quality parameters.

MATERIAL & METHODS

A total of 69 (52.7% women) middle-aged sedentary adults were randomized to (a) control group, (b) physical activity recommendation from the World Health Organization, (c) high-intensity interval training (HIIT) and (d) high-intensity interval training group adding whole-body electromyostimulation training (HIITEMS). Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) scale and accelerometers.

RESULTS

All intervention groups showed a lower PSQI global score (all P < .022). HIIT-EMS group improved all accelerometer parameters, with higher total sleep time and sleep efficiency, and lower wake after sleep onset (all P < .016). No differences were found between groups in any sleep quality parameter.

CONCLUSION

In conclusion, exercise training induced an improvement in subjective sleep quality in sedentary middleaged adults. Moreover, HIIT-EMS training showed an improvement in objective sleep quality parameters (total sleep time, sleep efficiency and wake after sleep onset) after 12 weeks of exercise intervention. The changes observed in the HIIT-EMS group were not statistically different to the other exercise modalities.

Neuromuscular exercise and pain neuroscience education compared with pain neuroscience education alone in patients with chronic pain after primary total knee arthroplasty: study protocol for the NEPNEP randomized controlled trial

BACKGROUND

Total knee arthroplasty (TKA) is considered an effective treatment for pain relief and improved physical performances in end-stage knee osteoarthritis. However, several studies have reported less favorable outcomes after TKA with chronic pain rates of approximately 20%. Exercise might be an effective treatment strategy for chronic pain following TKA, but no randomized controlled trials have evaluated its effect. Therefore, the purpose of this randomized controlled trial is to investigate whether a 12-week neuromuscular exercise (NEuroMuscular EXercise training program for patients with knee or hip osteoarthritis assigned for total joint replacement; NEMEX-TJR) program combined with pain neuroscience education (PNE) provides greater pain relief and improvement in physical performances than PNE alone at 12 months follow-up in a population of patients with chronic pain after primary TKA.

METHODS

For this randomized controlled superiority trial, 120 patients with moderate-to-severe chronic pain after TKA are recruited from Aalborg University Hospital, Denmark. Patients are randomly assigned in a 1:1 ratio to one of two interventions: (a) NEMEX-TJR twice weekly for 12 weeks combined with two sessions of PNE or (b) two sessions of PNE given over 6 weeks. Assessment is performed at baseline before intervention and at 3, 6, and 12 months after initiation of the intervention. Outcome assessors are blinded toward group allocation. The primary outcome is the change in the Knee Injury and Osteoarthritis Outcome Score₄ (KOOS₄), defined as the mean score for the KOOS subscales pain, symptoms, activities of daily living, and quality of life. Secondary outcomes include all KOOS subscale scores and scores for PainDETECT, the Fear-Avoidance Beliefs Questionnaire, Global Perceived Effect, the Pain Catastrophizing Scale, pain intensities, temporal summation, conditioned pain modulation, and pressure pain thresholds. Physical performances are measured with walking, stair climbing, and chair standing tests as well as tests of muscle strength and power.

DISCUSSION

The findings will be useful in establishing effective treatment strategies for chronic pain after TKA. The randomized controlled trial involves rigorous scientific methods and uses clinically applicable interventions. The study interventions are conducted in clinical settings, thereby enhancing the possibility of future implementation of the treatments in the health care systems.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT03886259. Registered 22 March 2019. Ethics committee registration: N-20180046.

Can high intensity interval training improve health outcomes among people with mental illness? A systematic review and preliminary meta-analysis of intervention studies across a range of mental illnesses

BACKGROUND

High intensity interval training (HIIT) may have beneficial effects among people with mental illnesses. The aim of this systematic review was to establish the benefits, safety and adherence of HIIT interventions across all categories of mental illness.

METHODS

Major databases were searched from inception to 18/2/2019 for intervention studies investigating HIIT among people with mental illnesses. Study quality was assessed via the PEDro scale, intervention characteristics were reported using the TIDier and CERT checklists and findings narratively summarised. A preliminary meta-analysis was undertaken where possible.

RESULTS

12 intervention studies, (including 7 RCTs), were included. Evidence suggested HIIT improved cardiorespiratory fitness (5/8 intervention studies,63%), anthropometric variables (3/4,75%), mental health outcomes (9/12, 75%), cardiovascular fitness (5/9,56%), physical fitness (1/1,100%) and motor skills (1/1,100%), compare to pre-training. The preliminary meta-analysis of pre-post changes found HIIT reduced depression severity (Standardised mean difference (SMD):-1.36 [95%CI-1.63;-1.089], p<0.0001) and possibly improved VO2max (SMD:0.18 [95%CI -0.02; 0.37], p = 0.08) in people with depression. HIIT increased High-Density-Lipoprotein (SMD:0.373 [95%CI 0.18; 0.57], p = 0.0002) and possibly reduced general psychopathology (SMD:-1.58 [95%CI -3.35; 0.18], p = 0.08) in people with schizophrenia-spectrum disorders. No acute injuries were reported, mean adherence to HIIT sessions ranged from 64-94%, and dropout ranged from 0--50%.

LIMITATIONS

Results were limited to a small number of low-to-moderate quality intervention studies.

CONCLUSION

These findings suggest HIIT may improve a range of physical and mental health outcomes among people with mental illnesses. Nonetheless, high-quality well-powered trials are needed to reaffirm these findings, and future research should address the seemingly high rate of dropout.

Prehabilitation programs for cancer patients: a systematic review of randomized controlled trials (protocol)

BACKGROUND

Around twenty million new cases and ten million of deaths were attributed to cancer in 2018. Physical exercise, as main component of prehabilitation programs, has been associated with clinical improvements in aerobic capacity, muscular strength, gait speed, and fewer postoperative complications. This systematic review aims to determine the benefits and harms of prehabilitation programs, mainly composed of physical exercise, compared with standard care for cancer patients.

METHODS/DESIGN

A librarian will systematically search for randomized controlled trials in the following databases: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (PubMed), and EMBASE. Two independent reviewers will independently screen the retrieved references, appraise the methodological quality of the included studies, and extract data. If possible, we will pool the data. We will evaluate the completeness of reporting of prehabilitation programs by using the CERT checklist, and the GRADE approach will be used to evaluate the quality of the evidence.

DISCUSSION

This systematic review will determine the benefits and harms of prehabilitation programs for cancer patients. We will provide a complete appraisal of the quality of the evidence, our confidence in the results, and completeness of reporting of the exercise interventions evaluated in the prehabilitation programs. Findings from this review will assist health care providers, patients, decision-makers, and international organizations to make informed decisions in this field.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42019125658.

Metabolic rate in sedentary adults, following different exercise training interventions: The FIT-AGEING randomized controlled trial

BACKGROUND & AIMS

This study compares the influence of different exercise training programs on basal metabolic rate (BMR) and fat oxidation, in basal conditions (BFox) and during exercise (MFO), in sedentary, middle-aged adults.

METHODS

The study subjects of this 12 week-long, randomised controlled trial, were 71 middle-aged adults (age 53.5 ± 4.9 years; 52% women). Subjects were randomly assigned to one of the following groups: (1) no exercise, (2) concurrent training based on international physical activity recommendations (PAR group), (3) high intensity interval training (HIIT group), and (4) high intensity interval training plus whole-body electromyostimulation (HIIT + EMS group). Subject BMR, BFox and MFO were determined by indirect calorimetry before and after the intervention.

RESULTS

The HIIT + EMS subjects showed significant increases in BFox following the intervention compared with the control group (all P = 0.043); no such differences were seen in the PAR and HIIT compared with the control group (all P ≥ 0.1). A significant increase in post-intervention MFO was noted for the HIIT and HIIT + EMS group compared to the non-exercise control group (P < 0.05); no such difference was seen in the PAR group compared to the control group (all P ≥ 0.05).

CONCLUSIONS

Twelve weeks of high intensity interval training plus whole-body electromyostimulation may increase the BFox and MFO of middle-aged sedentary adults. These findings have important clinical implications; a well-designed high-intensity interval training program plus whole-body electromyostimulation might be followed to help combat the appearance of chronic metabolic diseases characterized by metabolic inflexibility in middle-aged sedentary adults, though it will be necessary to determine how long the effects last.

Do features of randomized controlled trials of pelvic floor muscle training for postprostatectomy urinary incontinence differentiate successful from unsuccessful patient outcomes? A systematic review with a series of meta-analyses

AIMS

Efficacy of pelvic floor muscle training (PFMT) for postprostatectomy incontinence (PPI) differs between randomized clinical trials (RCT). This might be explained by variation in content/delivery of PFMT (eg, biofeedback, muscles targeted, and time of commencement of training). This review investigated whether outcome of meta-analysis differs based on presence or not of specific RCT features.

METHODS

PubMed, CINAHL, EMBASE, Physiotherapy Evidence Database (PEDro), and Cochrane were searched for RCTs that investigated efficacy of PFMT on PPI. PFMT details and outcomes were extracted. Methodological quality and comprehensiveness of PFMT reporting was assessed using the PEDro scale and Consensus on Reporting Template, respectively. Effect size and 95% confidence intervals were calculated for incontinence rate at 3 months. To identify features that influenced efficacy, separate meta-analyses were performed for studies with and without specific features.

RESULTS

Twenty-two trials were included, and 15 were used for meta-analysis of 3-month outcomes. Overall, meta-analysis showed reduced incontinence with PFMT (risk ratio [RR] = 0.85; I² = 55%; P = .005). Meta-analyses showed better outcomes for PFMT than control groups when the study included preoperative PFMT (RR = 0.76; I² = 30%; P = .006), biofeedback (RR = 0.73; I² = 58%; P = .006), instruction to contract around the urethra (RR = 0.9; I² = 43%; P = .009), a control group without PFMT instruction (RR = 0.85; I² = 69%; P = .05), inclusion of all men irrespective of continence status (RR = 0.84; I² = 30%; P = .003) and continence defined as no leakage (RR = 0.85; I² = 48%; P = .05).

CONCLUSIONS

Preoperative PFMT, biofeedback, urethral instructions, no PFMT instruction for controls, inclusion of all men, and continence defined as no leakage are features associated with successful patient outcomes. Future studies should consider these features in design of interventions and pooling data for meta-analysis.

Exercise training for adults hospitalized with an acute respiratory condition: a systematic scoping review

OBJECTIVE

In adults hospitalized with an acute or chronic respiratory condition, to determine what has been reported regarding exercise programmes in terms of content, tolerability, evaluation and adverse events.

DATA SOURCES

A systematic search was conducted of electronic databases (PubMed, EMBASE, CINAHL, PEDro, The Cochrane Library), trial registries and conference abstracts (Thoracic Society of Australia and New Zealand Annual Scientific Meeting, the European Respiratory Society Congress, the American Thoracic Society International Conference).

REVIEW METHODS

Studies were included if they (1) recruited adults hospitalized with an acute or chronic respiratory condition, (2) described an exercise programme that targeted peripheral muscles and (3) reported that ⩾80% of the sample had initiated training within 72 hours of hospitalization.

RESULTS

The last search was conducted on 2 June 2019. Of the 6282 records identified, 20 met the study criteria. These described 18 separate studies (2018 participants). Studies were conducted in adults hospitalized with an exacerbation of chronic obstructive pulmonary disease or with community-acquired pneumonia. The content of exercise programmes included aerobic and/or resistance training, neuromuscular electrical stimulation, whole-body vibration or movement out of bed. In eight studies (44%), the initial session was prescribed using objective measures of exercise capacity, peripheral muscle force and the ability to undertake activities of daily living. Across 7420 training sessions, seven adverse events were reported.

CONCLUSION

Methods used to prescribe and titrate exercise programmes in adults hospitalized with an acute or an exacerbation of a chronic respiratory condition were disparate. When reported, programmes were well tolerated and adverse events were infrequent.

Exercise-based injury prevention for community-level adolescent cricket pace bowlers: A cluster-randomised controlled trial

OBJECTIVES

To investigate if an exercise-based injury prevention program (IPP) can modify risk factors for injury in community-level adolescent cricket pace bowlers.

DESIGN

Cluster-randomised controlled trial.

METHODS

Eight cricket organisations (training two times per week and no previous involvement in a structured IPP) participated in this cluster-randomised trial. Participants were aged 14-17 years, injury free, and not currently performing a rehabilitation/exercise program. Cricket organisations (clusters) were block-randomised by computerised number generation into an intervention group (performed an eight-week IPP at training) or control group (continued their usual cricket activity). Participants were not blinded to group allocation. Strength, endurance, and neuromuscular control were assessed at baseline and follow-up. Treatment effects were estimated using linear mixed models.

RESULTS

Sixty-five male adolescent pace bowlers (intervention n=32 and control n=33) were randomised. There were significant treatment effects favouring the intervention group for shoulder strength (90°/s) 0.05 (95% CI 0.02-0.09) Nm/kg, hamstring strength (60°/s) 0.32 (95% CI 0.13-0.50) Nm/kg, hip adductor strength dominant 0.40 (95% CI 0.26-0.55) Nm/kg and non-dominant 0.33 (95% CI 0.20-0.47) Nm/kg, SEBT reach distance dominant 3.80 (95% CI 1.63-6.04) percent of leg length (%LL) and non-dominant 3.60 (95% CI 1.43-5.78) %LL, and back endurance 20.4 (95% CI 4.80-36.0) seconds. No differences were observed for shoulder strength (180°/s) (p=0.09), hamstring strength (180°/s) (p=0.07), lumbopelvic stability (p=0.90), and single leg squat knee valgus angle (dominant p=0.06, non-dominant p=0.15).

CONCLUSIONS

Exercise-based IPPs can modify risk factors for injury in community-level adolescent pace bowlers. Future research is needed to confirm if IPPs can also reduce injury risk in this population.