Effects of a short-term Interval Aerobic Training Programme with active Recovery bouts (IATP-R) on cognitive and mental health, functional performance and quality of life: A randomised controlled trial in sedentary seniors

Failure of Intrinsic Antitachycardia Pacing to Terminate Ventricular Tachycardia and Potential Proarrhythmic Effects

Intrinsic antitachycardia pacing (iATP) is a novel, automated antitachycardia pacing (ATP) algorithm that provides individualized therapy to terminate ventricular tachycardia (VT). If the first ATP attempt is unsuccessful, the algorithm analyzes the tachycardia cycle length and the postpacing interval and adjusts the subsequent sequence to successfully terminate VT. This algorithm was effective in a single clinical study without a comparator arm. However, iATP failure has not been well-documented in the literature. This publication represents the first case series with episode analysis of iATP failure, including a demonstration of its proarrhythmic effect.

An umbrella review of randomized control trials on the effects of physical exercise on cognition

Extensive research links regular physical exercise to an overall enhancement of cognitive function across the lifespan. Here we assess the causal evidence supporting this relationship in the healthy population, using an umbrella review of meta-analyses limited to randomized controlled trials (RCTs). Despite most of the 24 reviewed meta-analyses reporting a positive overall effect, our assessment reveals evidence of low statistical power in the primary RCTs, selective inclusion of studies, publication bias and large variation in combinations of pre-processing and analytic decisions. In addition, our meta-analysis of all the primary RCTs included in the revised meta-analyses shows small exercise-related benefits (d = 0.22, 95% confidence interval 0.16 to 0.28) that became substantially smaller after accounting for key moderators (that is, active control and baseline differences; d = 0.13, 95% confidence interval 0.07 to 0.20), and negligible after correcting for publication bias (d = 0.05, 95% confidence interval -0.09 to 0.14). These findings suggest caution in claims and recommendations linking regular physical exercise to cognitive benefits in the healthy human population until more reliable causal evidence accumulates.

Exercise program for the management of anxiety and depression in adults and elderly subjects: Is it applicable to patients with post-covid-19 condition? A systematic review and meta-analysis

The Coronavirus Disease 2019 (Covid-19) pandemic had dramatic effect on mental health, causing long-term psychiatricmorbidity. At present, there are no randomized trials reporting the effect of physical exercise on individuals with post- Covid-19 condition are available. The aim of this review was to summarize the evidence regarding the evidence on exercise as a treatment for anxiety and depression symptoms secondary to chronic diseases, which may be generalized to individuals suffering from the post- Covid-19 condition. Trials were included if they reported the effects of physical exercise programs on anxiety or depression symptoms in adults, either healthy or affected by chronic diseases. Outcomes were changes of anxiety or depression severity after an exercise-based intervention. Of the 2161 RCTs identified, eight out of 15 studies were included. Exercise was associated with greater improvements of depressive (SMD = -0.169; 95 % CI -0.302 at -0.003; p = 0.013) and anxiety symptoms (SMD = -0.263, 95 % CI -0.418 at -0.109; p = 0.001), compared with control interventions. Supervised exercise programs were effective against symptoms of anxiety or depression among individuals with chronich illnesses. Pending specific clinical trials, exercise may be considered for adoption among patients with the post Covid-19 condition.

Effect of High-Intensity Interval Training on Functional Movement in Older Adults: A Systematic Review and Meta-analysis

BACKGROUND

Preserving physiological functional capacity (PFC), the ability to perform the activities of daily life, and the ease with which they can be performed, in older adults, defined for this study as ≥ 50 years of age, is an important consideration for maintaining health and independence through the ageing process. Physical activity, and exercise training in particular, has been positively associated with improvement in PFC. In addition to improving aerobic and anaerobic capacity, promoting and preserving functional movement as a component of PFC is an important goal of physical activity, especially for older adults. High-intensity interval training (HIIT), an exercise protocol where repeated bouts of increased intensity are interspersed with active or passive recovery periods, has often been studied as an alternative to traditional moderate-intensity continuous training (MICT) exercise, where a continuous intensity is maintained throughout the exercise session. A large body of research has determined that both types of exercise programme are effective in improving measures of aerobic and anaerobic fitness in older adults. However, the effect of the two exercise modalities on functional movement has most often been a secondary outcome, with a range of observational techniques applied for measurement.

OBJECTIVES

The primary objective of this research is to systematically review and meta-analyse published studies of HIIT interventions that measured functional movement in older adults to conclude if HIIT is effective for improving functional movement. A secondary objective is to determine if there are significant differences between HIIT and MICT effect on functional movement.

METHODS

A search strategy of terms locating studies of HIIT interventions, functional movement outcome measures, and older adult population samples was executed on seven digital databases. Randomized and pair-matched trials of > 2 weeks were considered for inclusion. Studies of participants with neurological impairment or studies using combined exercise modality were rejected. Standardized mean difference for functional movement outcome measures was calculated. A meta-analysis of the included studies and subgroups was performed along with study quality (risk of bias and publication bias) evaluation.

RESULTS

A total of 18 studies were included in random effects model pooled analysis. Subgroup analysis of HIIT versus MICT on functional movement showed a trivial effect in favour of HIIT (ES 0.13, 95% CI [-0.06, 0.33] p = 0.18) and did not achieve statistical significance. However, HIIT showed a medium, statistically significant favourable effect on functional movement versus non-intervention control (ES = 0.60 95% CI [0.24, 0.95] p = 0.001). Further subgroups analysis using singular and multiple functional movement outcome measures showed similar results.

CONCLUSION

This meta-analysis indicates that HIIT interventions in older adults may be effective at promoting improvements in functional movement, though it is unclear whether HIIT is superior to MICT.

Effect of Aerobic, Resistance, and Combined Exercise Training on Depressive Symptoms, Quality of Life, and Muscle Strength in Healthy Older Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

BACKGROUND

Aerobic training, resistance training, or combined training are interventions that can be modified to suit the needs of aged people.

OBJECTIVE

This meta-analysis aimed to investigate the impact of exercise training on depression symptoms, quality of life, and muscle strength in healthy people aged 60 or more.

DATA SOURCES

Searches were conducted in PubMed, Web of Science, Medline, Google Scholar, and Scopus databases from inception to February 2022.

RESULTS

Eighteen studies, totaling 1354 participants, were included in the meta-analysis. Overall, exercise training significantly declined depressive symptoms (standard mean difference (SMD): -.52, 95% confidence interval (CI): -.76 to -.28; p < .001). Moreover, there was a significant reduction in bodily pain (p < .05) and body mass (p < .01), and a significant increase in mental health (p < .001), physical functioning (p < .01), and general health (p < .001) subscales of quality of life as well as upper- (p < .001) and lower-limb strength (p < .001). Subgroup analysis revealed that depression decreased significantly when aerobic training (p = .000) and resistance training (p = .003) were applied, and for studies including both genders (p = .000) or men subjects (p = .002). Moreover, subgroup analysis demonstrated that depression reduced following both medium- (p = .006) and long-term (p = .002) interventions.

CONCLUSION

These findings demonstrate that exercise interventions may produce improvements in depressive symptoms, some components of quality of life, muscle strength, and body mass. Additional research is required to define the optimal dose of exercise training interventions.

Physical Activity and Cognition in Sedentary Older Adults: A Systematic Review and Meta-Analysis

Background:

Epidemiologic evidence suggests that physical activity benefits cognition, but results from randomized trials in sedentary individuals are limited and inconsistent.

Objective:

To evaluate the effects of physical activity on cognition among sedentary older adults.

Objective:

A systematic literature search for eligible studies published up to January 1, 2021, was performed on six international (PubMed, Cochrane Library, Web of Science, Sinomed, FMRS, and OVID) and three Chinese databases (Wanfang, China National Knowledge Infrastructure, and VIP). We estimated the effect of physical activity on the cognition of sedentary elderly by standardized mean differences (SMD) and 95% confidence intervals (CI) using a random-effects model. We evaluated publication bias using funnel plots and heterogeneity using I² statistics. Subgroup analyses were conducted by baseline cognition, intervention duration, activity type, and country.

Results:

Seven randomized controlled trials (RCTs) comprising 321 (experimental group, 164; control group, 157) sedentary older adults were included in the meta-analysis. Physical activity significantly improved cognition in sedentary elderly adults compared with controls (SMD: 0.50, 95% CI:0.09–0.92). Subgroup analyses showed significant effects of baseline cognition impairment (SMD: 9.80, 95% CI: 5.81–13.80), intervention duration > 12 weeks (SMD: 2.85, 95% CI: 0.73–4.96), aerobic exercise (SMD: 0.74, CI: 0.19–1.29), and countries other than the United States (SMD: 10.50, 95% CI: 7.08–13.92).

Conclusion:

Physical activity might have a general positive effect on the cognition of sedentary older adults. Intervention > 12 weeks and aerobic exercise can effectively delay their cognitive decline; however, more rigorous RCTs are needed to support our findings.

Home physical exercise improves functional mobility and quality of life in the elderly: A CONSORT-prospective, randomised controlled clinical trial

AIMS

To test the hypothesis of a semi-supervised home physical exercise programme that is likely to improve the functional mobility and quality of life (QOL) of elderly in the community.

METHODS

This trial included elderly adults (88% female) aged 60 years or older and who were sedentary and without cognitive decline. The participants were randomly assigned to an intervention group (IG, home physical exercise and sleep hygiene) and a control group (CG, sleep hygiene). The International Questionnaire on Physical Activity, mental state mini-exam, World Health Organization Quality of Life Instrument-Older Adults Module (WHOQOL-OLD) and the Timed Up and Go (TUG) tests were conducted before and after the 12-week intervention period.

RESULTS

The study was concluded with 125 elderly participants. Anthropometric data were indicative of pre-obesity, with a mean body mass index of 27.3 ± 4, a low-income socio-economic profile (78% ≤ 2 SM) and low schooling rates (76% ≤ 3 years of study). Most of the elderly (87%) were considered physically active with IPAQ > 150 min/week. The group of elderly people who performed the home physical exercise programme showed a significant improvement in functional mobility according to the time of execution of the TUG test before (9.1 ± 2) and after (7.1 ± 1) with an average reduction of 2 ± 1 s (P < .01). The difference in the QOL of the elderly who participated in the exercise protocol was also observed, verified through the WHOQOL-OLD global score, which presented an initial score of 85 ± 10, changing to 90.4 ± 9 after the intervention.

CONCLUSION

Semi-supervised physical home exercise is safe and effective in improving the functional mobility and QOL of sedentary elderly people in the community.

Impact of high-intensity interval training on cardiorespiratory fitness, body composition, physical fitness, and metabolic parameters in older adults: A meta-analysis of randomized controlled trials

High-intensity interval training (HIIT) can effectively increase peak oxygen consumption, body composition, physical fitness, and health-related characteristics of adults; however, its impact in the older population remains highly debated. This review and meta-analysis aimed to evaluate the effects of high-intensity interval training on cardiorespiratory fitness, body composition, physical fitness, and health-related outcomes in older adults. Four electronic databases (PubMed, Scopus, Medline, and Web of Science) were searched (until July 2020) for randomized trials comparing the effect of HIIT on physical fitness, metabolic parameters, and cardiorespiratory fitness in older adults. The Cochrane risk of bias assessment tool was used to evaluate the methodological quality of the included studies; Stata 14.0 software was used for statistical analysis. HIIT significantly improved the maximum rate of oxygen consumption (VO_2peak) as compared to a moderate-intensity continuous training (MICT) protocol (HIIT vs. MICT: weighted mean difference = 1.74, 95% confidence interval: 0.80-2.69, p < 0.001). Additional subgroup analyses determined that training periods >12 weeks, training frequencies of 2 sessions/week, session lengths of 40 min, 6 sets and repetitions, training times per repetition of >60 s, and rest times of <90 s were more effective for VO_2peak. This systematic review and meta-analysis showed that HIIT induces favorable adaptions in cardiorespiratory fitness, physical fitness, muscle power, cardiac contractile function, mitochondrial citrate synthase activity, and reduced blood triglyceride and glucose levels in older individuals, which may help to maintain aerobic fitness and slow down the process of sarcopenia.

Inspiratory Muscle Strength and Cardiorespiratory Fitness Association With Health-Related Quality of Life in Healthy Older Adults

The main purpose of this study was to explore similarities and differences in the association between two capabilities affecting the cardiorespiratory system (overall and multifactorial cardiorespiratory fitness and inspiratory muscle strength) and the health-related quality of life (HRQoL), in a group of active healthy seniors. Sixty-five individuals (age, 73.01 ± 5.27 years; 53 women) who participated regularly in a multicomponent training program completed the EuroQol 5D-5L questionnaire, the 6-min walking test (6MWT), and the maximum inspiratory pressure test (MIP). Non-parametric correlations (Spearman's rho) were conducted to analyze the association between HRQoL indices (EQindex and EQvas), MIP, and 6MWT, considering both, the whole sample and men and women separately. Furthermore, partial correlation was made by controlling age and sex. We found a moderate association between HRQoL and cardiorespiratory fitness (EQvas: r = 0.324, p = 0.009; EQindex: r = 0.312, p = 0.011). Considering sex, relationship EQvas-6MWT decrease to small (r = 0.275; p = 0.028) whereas EQindex-6MWT remained moderated (r = 0.425; p = 0.000). When we considered women and men separately, the association between HRQoL and 6MWT appeared only in women, while the observed strong trend (p = 0.051) toward a large and positive association between EQindex and MIP, mediated by the covariate age, appeared only in men. Conversely to the cardiorespiratory fitness, MIP is not a limiting factor of HRQoL in healthy active elderly. Moreover, MIP and HRQoL should be included in the assessment of exercise interventions because they provide different information about the cardiorespiratory system deterioration. Similarly, EQvas and EQindex confirm to be complementary in the assessment of HRQoL. Furthermore, like aging process is different for men and women, the association between MIP and cardiorespiratory fitness with HRQoL may behave differently, so keeping on research these associations could help to improve training programs for this population.

Patterns of informal family care during acute hospitalization of older adults from different ethno-cultural groups in Israel

Introduction

Informal caregiving during hospitalization of older adults is significantly related to hospital processes and patient outcomes. Studies in home settings demonstrate that ethno-cultural background is related to various aspects of informal caregiving; however, this association in the hospital setting is insufficiently researched.

Objectives

Our study explore potential differences between ethno-cultural groups in the amount and kind of informal support they provide for older adults during hospitalization.

Methods

This research is a secondary data analysis of two cohort studies conducted in Israeli hospitals. Hospitalized older adults are divided into three groups: Israeli-born and veteran immigrant Jews, Arabs, and Jewish immigrants from the Former Soviet Union (FSU). Duration of caregiver visit, presence in hospital during night hours, type of support (using the Informal Caregiving for Hospitalized Older Adults scale) are assessed during hospitalization. Results are controlled by background parameters including functional Modified Barthel Index (MBI) and cognitive Short Portable Mental Status Questionnaire (SPMSQ) status, chronic morbidity (Charlson), and demographic characteristics.

Results

Informal caregivers of “FSU immigrants” stay fewer hours during the day in both cohorts, and provide less supervision of medical care in Study 2, than caregivers in the two other groups. Findings from Study 1 also suggest that informal caregivers of “Arab” older adults are more likely to stay during the night than caregivers in the two other groups.

Conclusions

Ethno-cultural groups differ in their patterns of caregiving of older adults during hospitalization. Health care professionals should be aware of these patterns and the cultural norms that are related to caregiving practices for better cooperation between informal and formal caregivers of older adults.

Aerobic, resistance, and mind-body exercise are equivalent to mitigate symptoms of depression in older adults: A systematic review and network meta-analysis of randomised controlled trials

Background: Exercise has been identified as an allied health strategy that can support the management of depression in older adults, yet the relative effectiveness for different exercise modalities is unknown. To meet this gap in knowledge, we present a systematic review and network meta-analysis of randomised controlled trials (RCTs) to examine the head-to-head effectiveness of aerobic, resistance, and mind-body exercise to mitigate depressive symptoms in adults aged ≥ 65 years.

Methods: A PRISMA-NMA compliant review was undertaken on RCTs from inception to September 12 ^th, 2019. PubMed, Web of Science, CINAHL, Health Source: Nursing/Academic Edition, PsycARTICLES, PsycINFO, and SPORTDiscus were systematically searched for eligible RCTs enrolling adults with a mean age ≥ 65 years, comparing one or more exercise intervention arms, and which used valid measures of depressive symptomology. Comparative effectiveness was evaluated using network meta-analysis to combine direct and indirect evidence, controlling for inherent variation in trial control groups.

Results: The systematic review included 82 RCTs, with 69 meeting eligibility for the network meta-analysis ( n = 5,379 participants). Pooled analysis found each exercise type to be effective compared with controls (Hedges’ g = -0.27 to -0.51). Relative head-to-head comparisons were statistically comparable between exercise types: resistance versus aerobic (Hedges’ g = -0.06, PrI = -0.91, 0.79), mind-body versus aerobic (Hedges’ g = -0.12, PrI = -0.95, 0.72), mind-body versus resistance (Hedges’ g = -0.06, PrI = -0.90, 0.79). High levels of compliance were demonstrated for each exercise treatment.

Conclusions: Aerobic, resistance, and mind-body exercise demonstrate equivalence to mitigate symptoms of depression in older adults aged ≥ 65 years, with comparably encouraging levels of compliance to exercise treatment. These findings coalesce with previous findings in clinically depressed older adults to encourage personal preference when prescribing exercise for depressive symptoms in older adults.

Registration: PROSPERO CRD42018115866 (23/11/2018).

Aerobic, resistance, and mind-body exercise are equivalent to mitigate symptoms of depression in older adults: A systematic review and network meta-analysis of randomised controlled trials

Background: Exercise has been identified as an allied health strategy that can support the management of depression in older adults, yet the relative effectiveness for different exercise modalities is unknown. To meet this gap in knowledge, we present a systematic review and network meta-analysis of randomised controlled trials (RCTs) to examine the head-to-head effectiveness of aerobic, resistance, and mind-body exercise to mitigate depressive symptoms in adults aged ≥ 65 years. Methods: A PRISMA-NMA compliant review was undertaken on RCTs from inception to September 12 th, 2019. PubMed, Web of Science, CINAHL, Health Source: Nursing/Academic Edition, PsycARTICLES, PsycINFO, and SPORTDiscus were systematically searched for eligible RCTs enrolling adults with a mean age ≥ 65 years, comparing one or more exercise intervention arms, and which used valid measures of depressive symptomology. Comparative effectiveness was evaluated using network meta-analysis to combine direct and indirect evidence, controlling for inherent variation in trial control groups. Results: The systematic review included 82 RCTs, with 69 meeting eligibility for the network meta-analysis ( n = 5,379 participants). Pooled analysis found each exercise type to be effective compared with controls (Hedges' g = -0.27 to -0.51). Relative head-to-head comparisons were statistically comparable between exercise types: resistance versus aerobic (Hedges' g = -0.06, PrI = -0.91, 0.79), mind-body versus aerobic (Hedges' g = -0.12, PrI = -0.95, 0.72), mind-body versus resistance (Hedges' g = -0.06, PrI = -0.90, 0.79). High levels of compliance were demonstrated for each exercise treatment. Conclusions: Aerobic, resistance, and mind-body exercise demonstrate equivalence to mitigate symptoms of depression in older adults aged ≥ 65 years, with comparably encouraging levels of compliance to exercise treatment. These findings coalesce with previous findings in clinically depressed older adults to encourage personal preference when prescribing exercise for depressive symptoms in older adults. Registration: PROSPERO CRD42018115866 (23/11/2018).

Effect of high-intensity interval training and continuous endurance training on peak oxygen uptake among seniors aged 65 or older: A meta-analysis of randomized controlled trials

BACKGROUND

Ageing is intrinsically associated with a progressive decline in cardiorespiratory fitness (CRF) as measured by peak oxygen uptake (VO_2peak ). Improving CRF through physical activity contribute to better and healthy ageing. High-intensity interval training (HIIT) is a potent method of improving CRF among seniors, yet comparisons between this type of training and traditional endurance training (ET) are equivocal especially among older adults.

PURPOSE

To analyse the effects of HIIT and ET on the VO_2peak of seniors aged 65 years or older when compared with controls and also when the two types of training were compared with one another.

METHODS

A comprehensive, systematic database search for manuscripts was performed in Embase, Medline, PubMed Central, ScienceDirect, Scopus and Web of Science using key words. Two reviewers independently assessed interventional studies for potential inclusion. Fifteen randomized controlled trials (RCTs) were included totalling 480 seniors aged 65 years or over. Across the trials, no high risk of bias was measured.

RESULTS

In pooled analysis of the RCTs, the VO_2peak was significantly higher after ET sessions compared with controls (mean difference-MD = 1.35; 95% confidence interval-CI: 0.73-1.96). Furthermore, VO_2peak was found significantly higher not only when compared HIIT with controls (MD = 4.61; 95% CI: 3.21-6.01), but also when compared HIIT with ET (MD = 3.76; 95% CI: 2.96-4.56).

CONCLUSION

High-intensity interval training and ET both elicit large improvements in the VO_2peak of older adults aged 65 or over. When compared with ET, the gain in VO_2peak was greater following HIIT. Nevertheless, further RCTs are therefore needed to confirm our results in senior's population.

Impact of an ambulatory physical activity program on balance and motor abilities of retirees: a prospective study

BACKGROUND

Given the public health problem generated by posture and gait disorders, a preventive approach is essential.

OBJECTIVE

We investigated the impact of an ambulatory physical activity program (APAP) on the motor skills of retirees.

METHOD

Retirees ≥60 years were recruited in this prospective study. The APAP was supported by a French regional health insurance plan. Between inclusion (T0) and 12 weeks (T1), subjects participated in an APAP (1 h/wk) that included strengthening muscular exercises, balance work, joint flexibility exercises, one-leg-balance test (OLB), stimulation of the foot arch and rise-from-the-floor (RFF). Timed-up-and-go test (TUG) duration, gait speed (GS), OLB duration and RFF success were compared between T1 and T0.

RESULTS

Two hundred subjects (86% women) were enrolled; mean age was 73.8 years (45.5% ≥75 years). TUG durations (s) were lower at T1 than at T0 (8.98 and 9.64; P < .0001). The GS (m/s) and OLB durations (s) were higher at T1 than at T0 (1.26 vs 1.12 for GS, 16.16 vs 13.02 for OLB; P < .0001). The rate of participants who successfully completed RFF was higher at T1 (94%) than at T0 (76%) (P < .0001). After the APAP, TUG duration was reduced in 64.5% of cases, the GS improved in 73% of cases, OLB duration increased in 50% of cases and RFF became possible in 18.5% of cases (all P < .0001).

CONCLUSION

Physical activity programs are effective for improving motor performance, even in older adults. Retirees must be encouraged to do regular physical activity to prevent or slow the functional decline associated with ageing, and to improve their overall quality of life.

Effect of 9 weeks continuous vs. interval aerobic training on plasma BDNF levels, aerobic fitness, cognitive capacity and quality of life among seniors with mild to moderate Alzheimer's disease: a randomized controlled trial

Background

Evidence suggests that aerobic-type training confers physical benefits and appears to contribute positively to brain health. This study aims to compare the effect of 9-weeks continuous (CAT) to interval aerobic training (IAT) on brain derived neurotrophic factor (BDNF) plasma level, aerobic fitness, cognitive performance, and quality of life among senior with Alzheimer's disease (AD).

Methods

52 participants were randomly allocated into three groups (CAT n = 14; IAT n = 17; and Controls n = 21). CAT and IAT consisted of 18 sessions of 30-min cycling, twice a week, over 9 weeks. During the same period, controls were engaged in interactive information sessions. Plasma BDNF level; aerobic fitness parameters (Metabolic equivalent task - METs; Maximal Tolerated Power - MTP); functional capacities (6-Minute Walk Test - 6MWT); cognitive performance (Mini Mental State Examination; Rey auditory verbal learning test; and digit span test) and quality of life (Quality Of Life of Alzheimer's Disease scale - QoL-AD) were measured in all participants at baseline and 9 weeks later. A third plasma BDNF level was quantified following a 4 weeks detraining.

Results

No significant change was measured in terms of plasma BDNF level and cognitive performance after interventions, in all groups compared to baseline. After 9 weeks, CAT and IAT significantly improved aerobic fitness parameters compared to controls (METs: + 0.6 and + 1.0 vs. + 0.4; MTP: + 16 watts and + 20 watts vs. + 10 watts; and functional capacities (6MWT: + 22 m and + 31 m vs. -40 m). Compared to controls, QoL-AD after CAT was improved (+ 2 points; p = 0.02).

Conclusions

Neither aerobic exercise modalities significantly modified plasma BDNF levels and cognitive performances. CAT and IAT enhanced aerobic fitness and functional capacities in AD patients and CAT their QoL.

Trial registration

ClinicalTrials.gov website (NCT02968875); registration date: 7 September 2016. "Retrospectively registered".