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

Effects of chronic exercise on different central features of depression in adults with depression: A systematic review and meta-analysis of random controlled trials

BACKGROUND

Exercise is considered an effective treatment for improving central symptoms of depression. However, the antidepressant effects of exercise on specific central features in adults with depression and the optimal exercise prescription remain unclear. The present review aimed to explore the impact of exercise on emotion regulation (ER) and executive function (EF) among adults living with depression as well as the moderating effects of exercise prescription characteristics.

METHODS

Two Chinese databases and two English databases were systematically searched from January 1, 2000 to October 30, 2023 to identify relevant randomized controlled trials (RCTs). Based on the results of heterogeneity analyses, the random effects model was used for the meta-analysis of rumination (260 participants in 5 studies), inhibition (578 participants in 7 studies) and updating (832 participants in 9 studies), whereas the fixed effects model was used for the meta-analysis for shifting (802 participants in 8 studies).

RESULTS

Exercise improved rumination (standardized mean difference [SMD] = -0.59, p = 0.02); however, these benefits were observed only for moderate-intensity aerobic exercise in one or two 31-60 min sessions per week for 5-8 weeks. The results indicated significant post-exercise improvement in shifting (SMD = -0.22, p = 0.002) but not inhibition (SMD = -0.21, p = 0.18) or updating (SMD = 0.15, p = 0.14). Moreover, substantial improvements in shifting were observed only from high-intensity aerobic exercise in three or four 31-60 min sessions per week for more than 8 weeks.

CONCLUSIONS

Exercise improved ER (i.e., rumination) and EF (i.e., shifting) in adults with depression. It is important to consider symptoms when prescribing exercise to adults with depression. However, given the limited number of included RCTs, these findings are preliminary and tentative.

Relationship Between Number of Different Lower-Limb Resistance Exercises Prescribed in a Program and Exercise Outcomes in People With Knee Osteoarthritis: A Systematic Review With Meta-Regression

OBJECTIVE

We determine whether there is a relationship between the number of different lower-limb resistance exercises prescribed in a program and outcomes for people with knee osteoarthritis.

METHODS

We used a systematic review with meta-regression. We searched the Cochrane Central Register of Controlled Trials, MEDLINE, and Embase up to January 4, 2024. We included randomized controlled trials that evaluated land-based resistance exercise for knee osteoarthritis compared with nonexercise interventions. We conducted meta-regressions between number of different exercises prescribed and standardized mean differences (SMDs) for pain and function. Covariates (intervention duration, frequency per week, use of resistance exercise machine[s], and comparator type) were applied to attempt to reduce between-study heterogeneity.

RESULTS

Forty-four trials (3,364 participants) were included. The number of resistance exercises ranged from 1 to 12 (mean ± SD 5.0 ± 3.0). Meta-regression showed no relationship between the number of prescribed exercises and change in pain (slope coefficient: -0.04 SMD units [95% confidence interval {95% CI} -0.14 to 0.05]) or self-reported function (SMD -0.04 [95% CI -0.12 to 0.05]). There was substantial heterogeneity and evidence of publication bias. However, even after removing 31 trials that had overall unclear/high risk of bias, there was no change in relationships.

CONCLUSION

There was no relationship between the number of different lower-limb resistance exercises prescribed in a program and change in knee pain or self-reported function. However, given that we were unable to account for all differences in program intensity, progression, and adherence, as well as the heterogeneity and overall low quality of included studies, our results should be interpreted with caution.

Feasibility of ballistic vs conventional resistance training in healthy postmenopausal women: A three-arm parallel randomised controlled trial

OBJECTIVES

Power training has gained attention as a method for enhancing functional performance and mitigating fall risk in older adults, yet its long-term feasibility and safety, particularly in ballistic resistance training, remain underexplored in postmenopausal women. We evaluated the feasibility of 8-month ballistic resistance training compared with conventional resistance training in postmenopausal women.

STUDY DESIGN

The Resistance Exercise Programme on Risk of Osteoporosis and Osteoarthritis in Females (REPROOF) study was a three-arm parallel group randomised controlled trial at a university lab in the UK. Healthy postmenopausal women (n = 109) were randomised to 30 weeks (2 sessions/week) of lower-body ballistic resistance training, conventional resistance training, or a non-exercising control group.

MAIN OUTCOME MEASURES

The primary outcomes, collected by questionnaire, were process feasibility, acceptability, perceived exercise efficacy, and adverse events.

RESULTS

Eighty-two participants completed the trial (75.2 % retention). Both ballistic resistance training and conventional resistance training were well accepted, with most participants rating the intervention positively. No differences in the perceived improvements in physical function and psychological well-being were found between the resistance training groups. Similarly, there was no significant difference in the rate of muscle-related adverse events between the resistance training groups (ballistic, 2.7 per 100 person-weeks; conventional, 2.3 cases per 100 person-weeks), but the rate was significantly lower in the control group (0.9 cases per 100 person-weeks). No serious adverse events occurred during or within 24 h of exercise sessions.

CONCLUSIONS

The absence of serious adverse events and the observed positive outcomes confirm the safety, satisfaction, and perceived effectiveness of ballistic resistance training, suggesting its potential for broader application in healthy postmenopausal women.

CLINICALTRIALS

gov registry ID NCT05889598.

Exercise interventions to improve physical frailty and physical frailty components in older adults with hypertension: A systematic review

Physical frailty and hypertension are both highly prevalent among older adults. Furthermore, physical frailty may impact the risk-benefit ratio of pharmacological hypertension treatment. Thus, it may be prudent to focus on physical activity and exercise interventions to achieve better patient outcomes that addresses both conditions. This systematic review aimed to investigate the effects of exercise interventions on physical frailty components and hypertension-related outcomes in older adults with hypertension. PubMed/Medline, Embase, Cochrane Library, Cinahl and PEDro were searched for exercise trials in older adults with hypertension, measuring physical frailty or physical frailty components. Preferred Reporting Items for Systematic Review and Meta-Analysis protocol (PRISMA-P) and Physiotherapy Evidence Database (PEDro) scale were used for internal validity. The searches retrieved 4965 titles without duplicates. Ninety-four potential full texts were evaluated, and 30 original studies were included in the review. Mean methodological quality of the included studies was 5.7 out of 10. Only one study measured frailty (using a cumulative deficit model) in older adults with hypertension. Different types of exercise training demonstrated improvements in components of physical frailty. This systematic review shows that there is no evidence whether exercise ameliorates the effects of physical frailty and hypertension and there is a need for more data to be generated.

Current State of Baseball Interval Throwing Programs: A Systematic Review of Content, Structure, and Variability of Published Throwing Programs

CONTEXT

There is need for an up-to-date comprehensive review of baseball interval throwing programs in the literature.

OBJECTIVE

To (1) understand the origin and basis of interval throwing programs; (2) evaluate the content of programs in the peer-reviewed literature including target audience, initiation criteria, throwing specifics, arm care, and performance evaluation metrics; (3) classify these variables as well defined, ambiguous, or missing; and (4) analyze variability in key aspects including starting criteria, length, progression, and completion criteria.

DATA SOURCES

Medline, Embase, Cochrane Reviews, Web of Science, and ScopusStudy Selection:The full text of studies, in English, had to be available. Included studies had to contain a complete interval throwing program designed for baseball players.

STUDY DESIGN

Systematic review.

LEVEL OF EVIDENCE

Level 4.

DATA EXTRACTION

Initial screening was conducted based on article title and abstract. Full text of the remaining articles was evaluated for fulfillment of inclusion criteria.

RESULTS

Nine studies initially met inclusion criteria. The programs' comprehensiveness was poor, with a mean Interval Throwing Program Checklist score of 20 (range 14-23) on a scale of 0 to 30. There were a variety of components, including progressive long toss, weighted ball, and throwing mechanics exercises. The programs identified had significant heterogeneity in duration, intensity, progression, and focus. Overall, there was a significant lack of attempts at validation or formal study of efficacy for published throwing programs.

CONCLUSION

Current published interval throwing programs are mostly variations of an original program published many years ago and were based on principles of progressive loading with pain as sign of injury that should be monitored carefully. However, these programs have minimal clinical validation and objective measures to quantify their effectiveness. This work identifies several limitations in the current literature and can serve as a foundation for future development of evidence-based interval throwing programs.

Effectiveness of reducing tendon compression in the rehabilitation of insertional Achilles tendinopathy: a randomised clinical trial

OBJECTIVE

To assess the effectiveness of low tendon compression rehabilitation (LTCR) versus high tendon compression rehabilitation (HTCR) for treating patients with insertional Achilles tendinopathy.

METHODS

In an investigator-blinded, stratified randomised trial, 42 sport-active patients (30 males and 12 females; age 45.8±8.2 years) with chronic (> 3 months) insertional Achilles tendinopathy were allocated in a 1:1 ratio to receive LTCR or HTCR. Both rehabilitation protocols consisted of a progressive 4-stage tendon-loading programme, including isometric, isotonic, energy-storage and release and sport-specific exercises. The LTCR programme was designed to control Achilles tendon compression by limiting ankle dorsiflexion during exercise, eliminating calf stretching and incorporating heel lifts. The primary outcome was the Victorian Institute of Sports Assessment-Achilles (VISA-A) score at 12 and 24 weeks, which measures tendon pain and function and was analysed on an intention-to-treat basis using a linear mixed model. Significance was accepted when p<0.05.

RESULTS

20 patients were randomised to the LTCR group and 22 to the HTCR group. Improvement in VISA-A score was significantly greater for LTCR compared with HTCR after 12 weeks (LTCR=24.4; HTCR=12.2; mean between-group difference=12.9 (95% CI: 6.2 to 19.6); p<0.001) and after 24 weeks (LTCR=29.0; HTCR=19.3; mean between-group difference=10.4 (95% CI: 3.7 to 17.1); p<0.001). These differences exceeded the minimal clinically important difference of 10.

CONCLUSIONS

In sport-active patients with insertional Achilles tendinopathy, LTCR was more effective than HTCR in improving tendon pain and function at 12 and 24 weeks. Consequently, LTCR should be considered in the treatment of insertional Achilles tendinopathy.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov (ID: NCT05456620).

Development of the rehabilitation interventions for people with an acute patellar dislocation in the Physiotherapy Rehabilitation Post Patellar Dislocation (PRePPeD) pilot randomized controlled trial

Aims

To develop the rehabilitation interventions for people with an acute patellar dislocation in the Physiotherapy Rehabilitation Post Patellar Dislocation (PRePPeD) pilot randomized controlled trial (RCT), and to describe how these interventions are delivered.

Methods

We developed the interventions drawing on a range of established intervention development approaches and frameworks. We selected intervention components after reviewing the existing evidence, clinical guidelines, UK NHS practice, and relevant scientific theory. We then created early versions of the interventions, and discussed these with clinical experts and patient and public partners. We finalized the interventions considering their feedback, findings from our preliminary study, and what would be acceptable and deliverable in the UK NHS.

Results

Upon randomization, all participants receive a workbook containing advice and initial exercises to implement before their first physiotherapy session. Self-managed rehabilitation then involves a single one-to-one session with a physiotherapist who provides advice, introduces a structured home exercise programme, and uses strategies to support exercise adherence. Participants then continue their recovery independently. Supervised rehabilitation involves four to six one-to-one physiotherapy sessions over a maximum of six months. Physiotherapists also provide advice, prescribe home exercise, and use exercise adherence strategies. Routine follow-up sessions enable physiotherapists to reassess participants and tailor the advice and exercises accordingly.

Conclusion

The interventions were developed and are currently being assessed in the PRePPeD pilot RCT. This will determine whether a full-scale RCT comparing these interventions is feasible. Results are anticipated in Summer 2025.

Feasibility and acceptability of an adapted peer-based walking intervention for adults with moderate-to-severe traumatic brain injury

PURPOSE

To examine the feasibility and acceptability of a 6-week peer-based walking intervention for adults with moderate-to-severe TBI with telehealth supports.

MATERIALS AND METHODS

Pre-post feasibility trial with 18 community-dwelling adults (10 men; 8 women) with moderate-to-severe TBI aged 21-61 years (M = 40.6, SD = 11.3). Feasibility outcomes included participation, attrition, safety across 12 90-minute sessions, and telehealth platform quality. Acceptability outcomes included program satisfaction. Exploratory outcomes included daily step count with activity trackers and pre-post intervention questionnaires (mood, leisure satisfaction, exercise self-efficacy, quality of life) through video conferencing.

RESULTS

15/18 (83%) participants completed ≥ 9 sessions (75%). Three participants were lost to attrition. No major adverse events reported. Minor events included fatigue and muscle soreness. Participants reported high satisfaction (M = 9.2/10, SD = 0.9). Average weekly steps per day rose from 10,011 to 11,177 steps (12%). Three participants' step count data were not included due to tremors or forgetting to wear the device (≥ 9 days). One major and several minor connectivity problems occurred. Wilcoxon Signed Ranks tests identified a significant change in negative affect (p < 0.002).

CONCLUSIONS

Findings support the feasibility and acceptability of a 6-week peer-based walking intervention with telehealth supports for our sample.

Perioperative lifestyle and nutritional interventions' details reporting in bariatric surgery trials according to the Template for Intervention Description and Replication (TIDieR) checklist: a cross-sectional study

BACKGROUND

Metabolic and bariatric surgery (MBS) is considered the most effective treatment for people with severe obesity, and certain interventions could enhance its long-term results. The complete reporting of interventions' details is necessary for their replication in clinical settings.

OBJECTIVES

To investigate the completeness of reporting of lifestyle and nutritional interventions applied in immediate perioperative period (30-days preoperatively and postoperatively) in patients undergoing MBS using the 12-item Template for Intervention Description and Replication (TIDieR) checklist, and to explore factors associated with compliant reporting.

SETTING

A cross-sectional study.

METHODS

We searched MEDLINE, Embase, and CENTRAL up to April 14 2024. The screening, extraction, and assessments were performed independently by 2 authors.

RESULTS

Information from the manuscript, protocol, and supplementary materials in 72 trials comprising 76 interventions satisfied a mean of the 70.4% (standard deviation 16.5) of TIDieR items. Altogether, 6.6% of the interventions fulfilled all items. The lowest scoring items were adherence to intervention (item 12, reported in 51.3% of the interventions), modes of delivery (item 6, 42.1%), intervention provider (item 5, 38.3%), and fidelity assessment and maintenance planning (item 11, 23.7%). A total of 6.9% of the trials contained relevant information in the protocol or supplementary materials and 93.1% required contacting authors for clarifications. We identified the number of authors, availability of a study protocol, availability of supplementary materials, reporting of the compliance with the Consolidated Standards of Reporting Trials (CONSORT) guidelines, and reporting of a plan for dealing with missing outcome data as predictors of better reporting, while the Asian country of the corresponding author implied less compliant reporting.

CONCLUSIONS

The completeness of reporting of lifestyle and nutritional interventions applied in immediate perioperative period in patients undergoing MBS is suboptimal and, consequently, impedes their replication in clinical practice. A wider adoption of the TIDieR checklist by authors, reviewers, and journal editors should enhance the transparency, clarity, and transferability of research.

An Updated Systematic Review and Meta-Analysis of Unimodal Prehabilitation with Exercise Intervention to Enhance Postoperative Outcomes in Cancer Surgery

BACKGROUND

The objective of this systematic review and meta-analysis was to update the body of evidence on the efficacy of prehabilitation with exercise interventions, in reducing postoperative complications and length of hospital stay after cancer surgery.

METHODS

A comprehensive literature search was conducted on MEDLINE, Embase, The Cochrane Library, CINAHL, AMED, and PsycINFO to identify randomized controlled trials investigating the impact of prehabilitation with exercise interventions for patients undergoing cancer surgery. Primary and secondary outcomes assessed were postoperative complications and length of hospital stay, respectively. Risk of bias was evaluated using the Cochrane risk of bias tool, and Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) methodology was used to determine the strength of evidence. Relative risk and mean difference were calculated using random-effects meta-analysis.

RESULTS

In this updated review, 32 trials (n = 2304 participants) were identified, with 5 trials focused on patients undergoing surgery for genitourinary cancer (n = 422 participants), 9 for lower gastrointestinal cancer (n = 639 participants), 6 for upper gastrointestinal cancer (n = 526), and 11 for lung cancer (n = 717 participants). The majority of included trials exhibited some risk of bias. Evidence of low-to-moderate quality indicated that prehabilitation with preoperative exercise significantly reduced postoperative complication rates by approximately 50% and decreased the length of hospital stay by 2.5 days in patients undergoing lung resection. Preoperative exercise did not demonstrate effectiveness in reducing postoperative complications or length of hospital stay for other cancer populations.

CONCLUSIONS

Evidence supports the efficacy of prehabilitation with exercise in reducing postoperative complications and length of hospital stay in patients undergoing lung cancer surgery. Further research is warranted to establish the efficacy of unimodal prehabilitation with exercise in genitourinary, lower gastrointestinal, and upper gastrointestinal cancer populations having cancer surgery.

Internet-Based Psycho-Physical Exercise Intervention Program in Mild-to-Moderate Depression: The Study Protocol of the SONRIE Randomized Controlled Trial

The COVID-19 pandemic has intensified depression due to isolation and reduced physical activity, highlighting the need for accessible remote treatments. The SONRIE study evaluates the effectiveness of a 12-week online intervention combining physical exercise and internet-based cognitive-behavioral therapy on depressive symptoms in adults with mild-to-moderate depression. This randomized controlled trial involved 80 adults aged 25-65 years diagnosed with depression according to the ICD-10 criteria. Participants were randomized to an experimental group receiving the combined online intervention or to a control group receiving standard care. The primary outcome was the change in depression severity, assessed by the Beck Depression Inventory, with outcomes measured at baseline, immediately post-intervention, and after an 8-week follow-up phase. Statistical analyses include analysis of covariance to compare group changes over time, with effect sizes quantifying the intervention's impact. The SONRIE study demonstrates a promising online approach for treating depression, with potential implications for clinical practice and public health strategies.

Home-based high-intensity functional strength training (HIFST) for community-dwelling older adults with preclinical mobility limitations after a slip, trip, or fall: a pilot randomized controlled trial

PURPOSE

To determine the feasibility and preliminary effects of a home-based 12-week high-intensity functional strength training (HIFST) intervention for community-dwelling older adults (≥55 years) experiencing preclinical mobility limitations after a slip, trip, or fall.

MATERIALS AND METHODS

Participants were randomized (1:1) to HIFST (interval-based strengthening using everyday movements) or a lower extremity stretching group. Both interventions were delivered virtually by a physiotherapist. Feasibility was assessed based on predetermined criteria for adherence, recruitment, retention, and safety. Preliminary effects on physical and cognitive functioning outcomes were assessed before and after the intervention. Exploratory analyses were also conducted to assess enjoyment throughout the intervention.

RESULTS

Twenty-four participants (mean age 67.5 years, 21 females) were randomized (12 in each group). All feasibility criteria were met; 86.1% of HIFST sessions were completed, 82.8% of eligible participants were enrolled, 91.7% of participants completed follow-up assessments, and no serious adverse events occurred. Exploratory analyses suggested benefits for HIFST on a self-reported mobility status, the Oral-Trails Making Test-B, and higher self-reported exercise enjoyment levels at several time points.

CONCLUSIONS

Home-based HIFST delivered virtually by a physiotherapist is feasible and results suggest beneficial effects which warrant further exploration in a larger fully powered trial.

Adherence to exercise intervention for community-dwelling older adults with sarcopenia: a systematic review and meta-analysis

BACKGROUND

Exercise is a highly recommended nonpharmacological intervention for older adults with sarcopenia. Poor exercise adherence is a main factor affecting treatment efficacy. However, evidence for overall adherence to exercise and intervention characteristics affecting adherence in this population remains unknown.

OBJECTIVE

To determine whether community-dwelling older adults with sarcopenia adhere to exercise programmes, what intervention components are used to improve adherence and how adherence relates to intervention characteristics and efficacy.

METHODS

Seven electronic databases and relevant systematic reviews were searched to identify randomised controlled trials (RCTs). The capability, opportunity, motivation and behaviour model with behaviour change techniques (BCTs) were used to categorise adherence intervention components. Random-effects meta-analysis and meta-regression analyses were employed.

RESULTS

Seventeen RCTs with 2975 participants were included in this review. The pooled estimate of adherence rates for exercise interventions amongst older adults with sarcopenia was 85% (95% CI: 0.79-0.89, range: 71%-100%). Nine BCTs were identified from the included studies. Exercise with programme durations (<24 weeks) (P = 0.01) might be associated with higher adherence rates compared with programme durations (≥24 weeks). However, exercise adherence was not associated with intervention efficacy.

CONCLUSION

Adherence to exercise interventions in community-dwelling older adults with sarcopenia is relatively high and may be affected by programme duration. Most studies incorporated only a small number of BCTs into their exercise interventions. Such an approach may be insufficient to enhance adherence in this population effectively. Future studies with theory-informed interventions to improve adherence in the field of exercise for older people with sarcopenia are needed.

Development and delivery of the rehabilitation interventions for older adults with an ankle fracture in the AFTER (Ankle Fracture Treatment Enhancing Rehabilitation) trial

OBJECTIVES

Describe the development and delivery of the interventions in the Ankle Fracture Treatment Enhancing Rehabilitation (AFTER) trial, a randomised controlled trial comparing the effectiveness of supervised versus self-directed rehabilitation for adults aged ≥50 years with an ankle fracture.

DESIGN

Intervention development.

SETTING

UK National Health Service (NHS) hospitals.

METHOD

We developed the interventions in stages. First, we reviewed two UK clinical guidelines and the existing research evidence. We then conducted a clinical practice survey (n = 59 physiotherapists) to inform a stakeholder meeting which identified key intervention components. Subsequently, we designed the interventions, tested them in a pilot trial (n = 61 participants), then refined them for the definitive AFTER trial.

RESULTS/FINDINGS

The definitive AFTER trial interventions start after randomisation, which occurs when the participant's cast/boot is removed and weightbearing and ankle movement restrictions are lifted. Participants allocated to self-directed rehabilitation receive a high-quality advice workbook, a progressively challenging self-directed exercise programme that they follow to self-manage their recovery, and strategies to encourage exercise adherence. Supervised rehabilitation participants receive a high-quality workbook, then 4 to 6 one-to-one face-to-face/remote sessions with a physiotherapist. The physiotherapist provides specific advice, home exercises, and uses strategies to facilitate adherence to prescribed exercises. The supervised rehabilitation intervention is tailored to individual participants during review sessions.

CONCLUSIONS

The definitive AFTER trial will provide high-quality evidence to guide rehabilitation provision for older adults with an ankle fracture. Results are anticipated in 2025.

TRIAL REGISTRATION NUMBER

ISRCTN registry (identifier: ISRCTN11830323). CONTRIBUTION OF THE PAPER.

Application of Exercise Snacks across Youth, Adult and Clinical Populations: A Scoping Review

BACKGROUND

Interest in 'exercise snacks' has increased, yet a comprehensive and holistic review of this novel concept is lacking. We aimed to map global research on 'exercise snacks', across youth, adult and clinical populations through a scoping review.

METHODS

A systematic search was conducted in six databases. Grey literature searches were also conducted. Studies whereby participants were prescribed a structured bout of intense exercise dispersed across the day, or the exercise was explicitly defined as a form of 'snacks', in any setting were included. We used the Consensus on Exercise Reporting Template (CERT) to assess the completeness of exercise descriptions. Data were recorded into spreadsheets, then descriptively analyzed and summarized in graphic form.

RESULTS

The 45 publications meeting our inclusion criteria represented 33 original studies. These 33 studies enrolled a total of 1118 participants, with a median sample size of 24. Studies were categorized as either acute (n = 12) or chronic (n = 21) trials with both trial types performed across a wide range of participant ages (range 8.7 to 78 years) but mostly conducted on healthy adults and older adults. The majority of studies (20/33) defined the concept as 'exercise snacks', with study context being predominantly the laboratory or home. A wide variety of exercise modes (e.g., cycling, stair climbing, body weight exercises) and comparator conditions (e.g., moderate intensity continuous exercise, prolonged sitting, non-exercise controls) were used. 'Exercise snack' intensity was prescribed more frequently than it was reported, and, of the available data, mean intensity was estimated at 76.9% of maximal heart rate and 5.2 Arbitrary Units (AU) on the Ratings of Perceived Exertion (RPE) CR10 scale. Study outcome measures were predominantly cardiovascular, metabolic, muscular, and psychological, with studies mostly adhering to the CERT, though there was underreporting of detail for the exercise provider, motivation strategies, adverse events and intervention fidelity.

CONCLUSION

The 'exercise snack' concept is being increasingly used to cover an array of exercise models. The most common protocols to date utilize body weight exercises or stair climbing. We recommend 'exercise snacks' terminology is consistently used to describe protocols whereby short, purposeful structured exercise is dispersed throughout the day. Future studies should provide detailed descriptions of their 'exercise snacks' model, through exercise and adverse event reporting checklists.

Effectiveness of a sport-specific exercise programme for overhead athletes with unilateral subacromial shoulder pain: a study protocol of a randomised controlled trial

Subacromial shoulder pain is one of the most common musculoskeletal conditions affecting overhead athletes, particularly those engaged in high-intensity training modalities such as CrossFit. The prevalence of shoulder injuries in this population continues to rise due to increased participation, repetitive overhead movements, and biomechanical stress on the rotator cuff and scapular stabilisers. While various rehabilitation approaches exist, no consensus exists on the most effective exercise intervention for improving shoulder function and pain outcomes in athletes with subacromial shoulder pain. Current rehabilitation protocols for overhead athletes lack specificity, failing to address the sport-specific demands and movement patterns that may contribute to persistent pain and dysfunction. This study compares the effectiveness of a sport-specific exercise programme versus a scapular stability programme in improving clinical and functional outcomes in CrossFit athletes with subacromial shoulder pain. This study follows a randomised controlled trial (RCT) design, adhering to Consolidated Standards of Reporting Trials and Standard Protocol Items: Recommendations for Interventional Trials guidelines for intervention-based trials. Outcome assessments will include validated patient-reported outcome measures, objective strength and mobility tests, and biomechanical performance metrics. Participants will be recruited from sports clinics and CrossFit training centres across Madrid, ensuring a representative sample of athletes experiencing shoulder pain.

Effects of a strength physical exercise program in chronic lymphocytic leukemia patients on quality of life, mental health, and frailty: a randomized controlled trial study protocol

Background

Chronic lymphocytic leukemia (CLL) is a type of cancer that affects the blood and bone marrow, and it is the most prevalent form of leukemia in adults. Many patients experience symptoms that can significantly impact their quality of life, particularly in terms of physical ability, emotional health, and fatigue. Therapeutic exercise has shown to be an effective intervention for alleviating both physical and psychological symptoms in these patients. Specifically, strength training may help address some common treatment side effects.

Objective

This study aims to evaluate the effects of a therapeutic exercise program, focused on frailty in patients with CLL, along with secondary objectives including impacts on functional capacity, quality of life, psychological status, sleep quality, body composition, anthropometric variables, lipid profile and on proteins related to the immune system and inflammation.

Methods

An open label, randomized controlled trial will be carried out with 36 participants, divided into an intervention group (supervised resistance training twice a week and home exercises) and a control group (home exercise only). The primary outcome measure is fraility, assessed using Short Physical Performance Battery (SPPB). Secondary outcomes include assessments using HADS, FACT-F, EORTC QLQ-C30, EORT QLQ-CLL17.

Results and conclusions

This study will explore how physical exercise can improve quality of life and various health metrics in patients with CLL. By creating customized exercise protocols, the research seeks to boost patient well-being, improve treatment outcomes, and lessen debilitating side effects, ultimately promoting the integration of physical activity into routine care.

Clinical Trial Registration

ClinicalTrials.gov, identifier (NCT06654206).

Quality Analysis of YouTube-Based Exercise Programs for Typically Developing Children: Content Analysis

Background: Physical activities in childhood are important. However, a lack of exercise among children and adolescents is becoming a global reality. Moreover, following the coronavirus disease 2019 pandemic, the increase in time spent at home has led to qualitative changes, such as at-home exercises and the use of YouTube content. This study aimed to conduct qualitative assessments of YouTube-based exercise education programs, such as video content and exercise education programs. Methods: A Python-based (version 3.11.6) video data crawl of YouTube using the keywords "children + exercise", "kid + exercise", "child + physical activity", and "kid + physical activity" was conducted on 27 November 2023. Duplicate, non-English, outdated (over 5 years old), short (<60 s) or long (>30 min) videos, and irrelevant content were excluded. Basic video characteristics, video popularity metrics, and qualitative analyses (m-DISCERN, GQS, i-CONTENT, CONTENT, CERT) were collected and assessed. Results: Of the 2936 retrieved videos, 126 were selected. Approximately 10% of the videos were uploaded by health professionals, and most videos covered aerobic and muscle-strengthening exercises. A qualitative analysis of the video content showed moderate to high quality, while only a few videos satisfied the criteria of an effective exercise program, especially in terms of "Type and timing of outcome assessment", "Qualified supervisor", "Patient eligibility", "Adherence to the exercise program", and "Dosage parameters (frequency, intensity, time)". In the correlation analysis of video content and exercise program quality, only a few items showed a statistically significant correlation. Conclusions: YouTube exercise-related educational content targeting children may be inadequate and is not correlated with video popularity. Although an overall weak to moderate correlation was observed between the quality evaluation of exercise education and video content, the use of video quality assessment tools to evaluate exercise program quality was insufficient.

Development and implementation of a physiotherapy exercise intervention with tailored support for exercise adherence for people with vertebral fragility fractures (OPTIN trial)

OBJECTIVES

The OsteoPorosis Tailored exercise adherence INtervention (OPTIN) trial is a two-arm, multi-centre randomised controlled trial. It compares the effectiveness of physiotherapy exercise rehabilitation with integrated support for exercise adherence, to physiotherapy exercise rehabilitation alone, for people with vertebral fragility fracture (VFF) and back pain. This paper describes the development of the physiotherapist-led adherence enhanced intervention.

METHODS

We used an intervention mapping approach and followed Medical Research Council guidelines for developing complex interventions. We co-created the intervention involving expert clinicians, service managers, researchers, and adults with long-term musculoskeletal conditions, including osteoporosis. We identified a theoretical framework, reviewed the evidence, used a feasibility study, and considered clinical practice and deliverability within UK National Health Service (NHS) outpatient physiotherapy secondary care. Through a collaborative workshop, we refined the intervention, involved patients again and re-tested the intervention. Finally, we manualised the intervention, produced patient and physiotherapist materials and trained physiotherapists for delivery.

RESULTS

The OPTIN intervention uses a motivational interviewing approach and captures information about patient goals, barriers, and facilitators to exercise. Physiotherapists assess exercise capability, opportunities and motivation and utilise at least three behaviour change approaches, selecting from an intervention toolkit of nine approaches to support exercise behaviour. Ninety minutes of additional physiotherapy are provided to deliver the intervention, integrated within the assessment and six follow-up visits.

CONCLUSIONS

A theory-informed intervention to support exercise adherence was developed and delivered by physiotherapists trained in the intervention to older adults with VFF and back pain in the intervention arm (n = 63) of the OPTIN trial.

TRIAL REGISTRATION NUMBER

ISRCTN 14465704. CONTRIBUTION OF PAPER.

Therapeutic Exercise Prescription for Overhead Athletes with Shoulder Impingement Syndrome: A Systematic Review and CERT Analysis

Background: Shoulder impingement syndrome (SIS) is a prevalent condition among overhead athletes, often managed through therapeutic exercise interventions. However, the quality of reporting in exercise protocols significantly impacts their reproducibility and clinical implementation. The Consensus for Exercise Reporting Template (CERT) provides a standardized framework to assess the quality of exercise reporting in clinical research. Objectives: This systematic review aimed to evaluate the quality of exercise protocols used to treat SIS in overhead athletes by applying the CERT checklist. Additionally, the risk of bias was assessed to determine the methodological rigor of included studies. Methods: A systematic review was conducted following PRISMA guidelines. Six electronic databases (MEDLINE, CINAHL, Sport Discuss, Web of Science, and Cochrane) were searched for eligible studies. Inclusion criteria encompassed randomized controlled trials (RCTs), cohort studies, and case series that investigated exercise therapy for SIS in overhead athletes. Studies had to be published in English and provide details on exercise interventions. Exclusion criteria included non-human studies, acute injuries, and postoperative management. The primary outcome was the quality of intervention reporting, assessed using the CERT checklist. The secondary outcome was the risk of bias, evaluated using the modified Downs and Black checklist. Results: Five studies met the inclusion criteria, comprising four RCTs and one case series. CERT scores ranged from 6 to 13 (median = 8, IQR = 1), indicating suboptimal reporting quality. Commonly reported CERT items included equipment usage and exercise tailoring. However, key aspects such as adherence, motivation, and intervention fidelity were consistently underreported. None of the included studies provided comprehensive details on exercise interventions as per CERT guidelines, limiting their reproducibility and clinical application. Conclusions: The quality of reporting on exercise-based interventions for SIS in overhead athletes remains insufficient. Critical gaps in adherence monitoring, patient motivation, and intervention fidelity were identified. Future research should prioritize standardized and detailed reporting of exercise interventions to enhance reproducibility and facilitate evidence-based clinical practice.

Effects of Telerehabilitation-Based Core and Scapular Stabilization Training in Young Adults With Chronic Neck Pain: A Randomized Controlled Trial

Although chronic neck pain (CNP) is associated with impairments in balance, the effects of muscle stabilization training are unknown. In this study, we compared the effects of core stabilization (CS) and scapular stabilization (SS) training via telerehabilitation on balance, functionality, pain, and depression in young adults with CNP. In this two-armed, randomized controlled study, we assigned 41 participants with CNP to either a CS (n = 21) or SS (n = 20) group. Both groups underwent stabilization training via telerehabilitation for eight weeks. We evaluated postural stability (PS), limits of stability (LOS), functionality (Neck Disability Index), pain (Visual Analog Scale), and depression (Beck Depression Inventory). Time × Group interactions were significant on VAS, NDI, PS overall, LOS overall, LOS forward, LOS backward, and LOS right (p < .05). Both groups showed significant improvements over time. However, the SS group demonstrated significantly greater improvements than the CS group in VAS (p < .001) and NDI (p = .001). On the other hand, the CS group showed significantly greater improvements in PS overall, as well as in various measures of LOS, including overall, forward, backward, and right (p < .05). While both groups showed significant improvements, there were notable differences between them. These findings suggest that SS training is more effective in pain management and functional improvement, while CS training has a stronger impact on balance and stability in young adults with CNP.

Painful considerations in exercise-management for rotator cuff related shoulder pain: a scoping review on pain-related prescription parameters

BACKGROUND

Resistance exercise is recommended as the first line of treatment for rotator cuff related shoulder pain (RCRSP), but with conflicting evidence supporting the superiority of specific prescription parameters. Particularly, the role of pain-related prescription parameters remains poorly understood, despite their wide clinical application and potential impact on treatment outcomes. This review aims to investigate how pain-related prescription parameters, such as pain allowance and intensity limits, are reported, described, and applied in clinical trials assessing resistance exercise interventions for RCRSP.

METHODS

Guided by PRISMA-ScR, this scoping review followed a comprehensive and systematic search in MEDLINE (Ovid), MEDLINE (EMBASE), Central (Cochrane), PEDro and CINAHL (EBSCO). Two authors independently performed title and abstract screening, and full text screening on eligible records. Randomized clinical trials (RCTs) published in English between 2018 and 2023, applying resistance exercise for RCRSP were included. Both quantitative and qualitative approaches to data analysis were conducted.

RESULTS

The literature search identified 7500 records, of which 4588 titles and abstracts were screened after duplicate removal. Altogether, 304 full texts were screened leaving a total of 86 records in the final analysis. Fifty-eight (67%) studies did not mention the use of any pain-related prescription parameters, resulting in data extraction from the 28 remaining studies. Applied parameters were widely heterogenic, but three categories of pain allowance styles were identified and categorized into "yes", "no" or "ambiguous". These categories were commonly guided by specific Numerical Rating Scale (NRS)/Visual Analog Scale (VAS) limits or individual pain tolerance, used for pain monitoring and exercise progression. Citations and/or justifications for the chosen pain-related prescription parameters were reported by 10 (36%) studies, in which 5 main themes for justifications, and 3 key papers for the citations were identified.

CONCLUSION

This review reveals substantial reporting deficiencies regarding pain-related prescription parameters in RCTs addressing RCRSP with resistance exercise. The identified parameters varied widely, reflecting a lack of consensus and evidence-based guidance in the literature and in a clinical setting. To advance our understanding on the role of pain-related prescription parameters, more consistent reporting of these parameters in future research is warranted.

TRIAL REGISTRATION

Published on the Open Science Framework 28.02.24: osf.io/a52kn.

Maternal brain plasticity, physiology and exercise science: A scoping narrative review

INTRODUCTION

The perinatal period is characterized by extreme shifts in hormones, neurochemistry, and life experiences that drive significant changes in the brain, known as maternal plasticity. Due to rising maternal health conditions, such as postpartum depression, there is a critical need to investigate factors, such as engagement in physical activity and exercise, that may mitigate susceptibility to maladaptive maternal plasticity. This scoping review aims to analyze exercise interventions and maternal brain outcomes during reproduction.

METHODS

A systematic search was completed in Medline, Embase, CINAHL, PsycINFO, SportDiscuss. The key concepts of the search were (i) brain plasticity, (ii) maternal reproductive period including pre-conception, pregnancy, and postpartum, and (iii) exercise interventions. Due to the limited amount of evidence available on this topic, the review findings were discussed using a combined scoping and narrative review approach.

RESULTS

The search produced 2,167 unique articles after removing 2588 duplicates. Covidence software was used for the screening procedure. Following title and abstract screening, 2160 articles were deemed irrelevant and removed. Seven articles moved forward to full-text screening. One article was excluded during full-text screening for wrong outcomes, leaving six papers for extraction. Extraction revealed that four out of six studies were conducted in the rodent alone, one was conducted in humans alone and one was conducted in both a human and a rodent model.

DISCUSSION

The methodological inconsistencies in the limited number of studies within this field highlight the need for standardization, which motivated the development of the Consensus on Exercise Reporting Template for animal research. Moreover, the present review highlights future directions and knowledge gaps, emphasizing the critical need for high-quality research to address the many unanswered questions regarding the impact of exercise on the maternal brain.

Graded activity for chronic low back pain

OBJECTIVES

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the benefits and harms of graded activity compared to placebo, sham, or no treatment for pain and function in adults with chronic non-specific low back pain.

High Intensity Interval Training and Arterial Hypertension: Quality of Reporting

The benefits of exercise have been well described for the treatment of hypertension. Poor reporting quality impairs quality appraisal and replicability. High intensity interval training (HIIT) has been shown to be an effective alternative to traditional aerobic exercise in patients with hypertension. We evaluated the completeness of reporting of randomized controlled trials (RCTs) with HIIT for hypertension and to compare both exercise modes in reporting quality. RCTs of HIIT with a minimum duration of 6 weeks in adults with at least high normal blood pressure (≥130 mmHg/≥85 mmHg) were evaluated using the Consensus on Exercise Reporting Template (CERT). Nine RCTs conducting HIIT in hypertensive patients (N=718; 51.8 years) were evaluated. A mean of 62.6% of items were sufficiently described, compared with 49.2% in moderate intensity training interventions. Exercise dose was adequately reported in 8 out of 9 studies. Only one study reported information on adverse events. In a small sample of RCTs with HIIT in patients with hypertension we found a better reporting quality than in moderate intensity training interventions. However, reporting completeness is not optimal for a good replicability in clinical practice. The lack of reporting of adverse events in interventions using high intensities is particularly unfavourable.

The Effects of Inspiratory Muscle Training in Critically ill Adults: A Systematic Review and Meta-Analysis

PURPOSE

The onset of diaphragmatic weakness begins within hours of commencing invasive mechanical ventilation (IMV), which may contribute to the physical disability that can persist at five years after intensive care unit (ICU) discharge. Inspiratory muscle training (IMT) has the potential to alleviate the negative effects of IMV.

METHODS

We conducted a systematic review and meta-analysis with an approach consistent with Cochrane methods. We registered our review a priori (PROSPERO: CRD 42023451809) and published our protocol. Randomized controlled trials (RCTs) which enrolled adults (≥18 years) admitted to ICU who required IMV for ≥24 h were eligible if they delivered an IMT intervention using an external device that provided airway resistance (eg, threshold device, tapered flow resistive device) compared to usual care. Our primary outcome was physical function. Secondary outcomes included respiratory muscle strength, mortality, length of stay, IMV weaning time, reintubation rate, dyspnea and endurance. We searched Medline, Embase, Emcare, AMED, CINAHL, CENTRAL and clinicaltrials.gov from inception and used the Covidence platform for study selection and data extraction. We reported results as standardized mean difference (SMD) if outcome measures were similar. We used the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) to assess the certainty of evidence.

RESULTS

We screened 12 945 studies and 18 met the inclusion criteria. Three studies reported the effects of IMT on physical function. IMT may have no effect on physical function (SMD = -0.05, 95% confidence interval: -0.46 to 0.36) however results are very uncertain.

CONCLUSION

Our results suggest physical function is not impacted by IMT; however, our results are based on a limited number of studies with small samples sizes. High quality, appropriately powered RCTs are needed to improve the precision of the effect estimate.

The effects of gluteal stretching vs. Lightback® on hip rotation range of motion and posterior chain flexibility in healthy subjects: a cross-over clinical trial

Introduction

Hip range of motion (ROM) across various planes is necessary in sport-related activities. Static stretching was commonly used to improve hip ROM. The Lightback system, a novel compression device, has been developed to enhance hip mobility by applying controlled axial forces on the femur. This study aimed to evaluate the effectiveness of the Lightback system in improving hip ROM and posterior chain flexibility compared to conventional static stretching.

Methods

A randomized cross-over trial was carried out in 31 physically active participants (62 lower limbs; n = 31 Lightback group (LBG) and n = 31 stretching group (SG)). Hip rotation at two positions of hip flexion (active and passive external (ER) and internal rotation (IR) at 0-90° hip flexion), total rotation ROM (TRROM), and the flexibility of the posterior chain (active knee extension test (AKE) and active straight leg raise (ASLR)) were measured before and after the stretching session.

Results

LBG demonstrated significantly greater improvements in hip ER and IR compared to the SG. Specifically, the LBG showed significant increases in active ER at 0° (p = 0.002) and 90° (p < 0.001) of hip flexion, as well as IR at 0° (p = 0.007) and 90° (p < 0.001). TRROM in neutral and at 90° of hip flexion also improved significantly in the LBG (p < 0.001). In passive ROM, the LBG exhibited significant increases in ER at 0° (p < 0.001), IR at 90° (p = 0.001), and TRROM at both positions (p < 0.001), compared to the SG. Regarding posterior chain flexibility, both groups improved in AKE and ASLR (p < 0.001), but the LBG showed a significantly larger effect in ASLR (p < 0.001), with no significant difference between groups in AKE.

Conclusion

This study demonstrated that both the Lightback system and static gluteal stretching improved passive hip ROM. However, the Lightback system showed greater improvements in active ROM, particularly in external and internal rotation at various degrees of hip flexion, as well as in posterior chain flexibility. Notably, the Lightback system significantly enhanced large improvement in the ASLR test.

Aquatic exercise interventions in the treatment of musculoskeletal upper extremity disorders: A scoping review

OBJECTIVE

To identify literature on aquatic exercise therapy used to manage upper extremity musculoskeletal disorders and identify key concepts, intervention components, and gaps in the evidence base.

DATA SOURCES

The comprehensive search included MEDLINE (Ovid), CINAHL (EBSCOHost), Embase (Ovid), CENTRAL (Cochrane Central Register of Controlled Trials) databases and grey literature sources.

REVIEW METHODS

JBI Scoping review methodology guided this review through protocol development, searching, screening, data extraction and analysis. Study Selection included: Participants - Adults with upper extremity musculoskeletal disorders; Concept - Aquatic based exercise therapy; Context - any setting in any very highly developed nation.

RESULTS

The search identified 5045 sources with 68 studies included in the final synthesis. Findings outlined shoulder problems were the most reported upper extremity condition treated (n = 78) especially following rotator cuff repair (n = 17), followed by the hand and wrist (n = 9), and elbow (n = 6). Range of movement (n = 36) and resistance exercises (n = 17) were the most common interventions reported for aquatic therapy, however compliance with reporting guidance across included studies was poor. Sixteen health domains were identified with range of movement (n = 21) and pain (n = 20) the most common, and 62 outcome measures were reported related to the identified domains. Qualitative aspects of aquatic interventions were evaluated in two papers.

CONCLUSION

There is a need for more primary experimental and qualitative studies related to the upper extremity and aquatic therapy. Improved reporting quality of aquatic therapy exercise intervention is required as is the need to establish specific core outcome sets and domains in this area.

Effects of Exercise-Based ACL Injury Prevention Interventions on Knee Motion in Athletes: A Systematic Review and Bayesian Network Meta-Analysis

OBJECTIVE: To compare the effectiveness of injury prevention programs (IPPs) for improving high-risk knee motion patterns in the context of reducing the risk of noncontact anterior cruciate ligament injury. DESIGN: Systematic review with Bayesian network meta-analysis. DATA SOURCES: PubMed, Embase, Web of Science, Cochrane Library, and the Cumulative Index to Nursing and Allied Health Literature were searched until September 10, 2023. ELIGIBILITY CRITERIA: We included randomized controlled trials involving athletes without prior anterior cruciate ligament injury. The trials had to provide data on peak knee flexion and valgus angles, obtained from 2-leg drop vertical jump, single-leg drop vertical jump, or side-step cutting test. RESULTS: The network meta-analysis synthesized data from 22 randomized controlled trials involving 878 participants, evaluating 12 different IPPs. Results of meta-analyses indicated that, in jumping tests, the external focus instructions (mean difference [MD] = 26; credible interval [CrI] = 7.5, 44; surface under the cumulative ranking curve [SUCRA] = 0.94) and internal focus of attention (MD = 19; CrI = 0.19, 37; SUCRA = 0.81) was effective for increasing peak knee flexion, and core stability training ranked first for reducing knee valgus (MD = -4.40; CrI = -7.7, -1.1; SUCRA = 0.96). None of the IPPs revealed statistically significant effects for the cutting test. CONCLUSION: The external focus instructions and internal focus of attention increased knee flexion, while core stability exercise reduced knee valgus in jumping tests. Intervention effects were inconsistent for cutting tests. J Orthop Sports Phys Ther 2025;55(2):1-14. Epub 20 December 2024. doi:10.2519/jospt.2024.12720.

Exercise and mind-body exercise for feeding and eating disorders: a systematic review with meta-analysis and meta-regressions

PURPOSE

To develop a systematic review with meta-analysis to summarize the effectiveness of exercise, regular physical activity, and mind-body exercise on harmful exercise habits, psychological factors, and quality of life in people clinically diagnosed with feeding and eating disorders.

MATERIAL AND METHODS

Randomized clinical trials and pilot randomized clinical trials were considered.

RESULTS

Twelve studies were included. No studies evaluated athletes. No studies examined regular physical activity as the targeted intervention. Quality of life could not be meta-analyzed. Overall, meta-analyses showed that exercise or mind-body exercise was not more effective than controls in reducing depression symptoms, harmful exercise habits, eating behaviors, or emotional regulation skills. However, important methodological and clinical issues were detected in the included studies. This affected the certainty of evidence of the meta-analyzed outcomes which ranged from low to very low. No studies reported in sufficient detail their interventions to be replicated.

CONCLUSIONS

Overall, exercise and mind-body exercise may be ineffective in improving meta-analyzed outcomes. However, the certainty of evidence ranged from low to very low and the body of knowledge in this field needs to be increased to reach robust conclusions.

The efficacy of high load-volume exercise versus low load-volume exercise for rotator cuff tendinopathy: A pilot and feasibility trial

BACKGROUND

The most effective exercise variables for rotator cuff tendinopathy are unknown.

OBJECTIVE

Determine feasibility of a fully powered trial comparing high load-volume versus low load-volume exercise for adults with rotator cuff tendinopathy.

DESIGN

Two arm, multi-centre pilot and feasibility randomised controlled trial.

METHODS

Participants aged over 18 were recruited via social media and randomised into 12 weeks of either high load-volume exercise (i.e. with dumbbell resistance) or low load-volume exercise (i.e. without added resistance). Feasibility outcomes were rates of recruitment, retention, questionnaire completion, adverse events and adherence to prescribed exercise.

RESULTS

Fifteen participants were randomised to high load-volume and 16 to low load-volume (18/31 were female). Retention rate was 84% at 6 weeks, and 81% at 12 and 26 weeks. Five participants withdrew and one participant was lost to follow up. Questionnaire completion rate was 78%. Adherence to the prescribed exercise sets was 77%. Recruitment, conversion and retention rates were above the pre-defined success criterion. There were no serious adverse events.

CONCLUSION

A fully powered multi-centre randomised trial is feasible with minor amendments addressing exercise adherence and questionnaire response rate. Future trials should utilise outcomes that consider participants baseline physical activity levels and adequately measure pain disparate from performance.

Promotion of physical activity-related health competence using digital workplace-based health promotion: a pilot study for office workers

Introduction

Engaging in health-enhancing physical activity (HEPA) can reduce the risk of developing chronic diseases, which is particularly important for office workers with sedentary lifestyles. Therefore, time- and location-independent interventions for increasing HEPA are necessary.

Methods

To achieve long-term changes in HEPA, interventions can be based on physical activity-related health competence (PAHCO). 48 office workers (83% female, 50 ± 8 years) completed an intervention consisting of bi-weekly exercise videos for 5 weeks, supplemented by PAHCO and anatomical education. The participants' HEPA levels were measured using the Physical Activity, Exercise, and Sport Questionnaire (Bewegungs- und Sportaktivität Fragebogen; BSA-F)and a physical activity diary, with follow-up measurements at 3 months.

Results

There was a significant increase in PAHCO (p = 0.002), especially in control competence (p < 0.001), after the intervention and at follow-up. The other sub-competences also increased, but not significantly. HEPA decreased after the intervention and at follow-up, but the decrease was not statistically significant.

Discussion

PAHCO increases after the end of the intervention, especially through the sub-competence of control competence. The other two sub-competences also improved, but not significantly. Participating in the study had no impact on HEPA as an outcome of the PAHCO model. Our study provides preliminary evidence that PAHCO can be enhanced through digital, time- and location-independent interventions. Future research should utilize a randomized controlled design to be able to causally attribute the effects of PA interventions in office workers to the intervention and objective measurements for HEPA should be employed.

Intensive care unit acquired weakness and physical rehabilitation in the ICU

Approximately half of critically ill adults experience intensive care unit acquired weakness (ICUAW). Patients who develop ICUAW may have negative outcomes, including longer duration of mechanical ventilation, greater length of stay, and worse mobility, physical functioning, quality of life, and mortality. Early physical rehabilitation interventions have potential for improving ICUAW; however, randomized trials show inconsistent findings on the efficacy of these interventions. This review summarizes the latest evidence on the definition, diagnosis, epidemiology, pathophysiology, risks factors, implications, and management of ICUAW. It specifically highlights research gaps and challenges, with considerations for future research for physical rehabilitation interventions.

Graded activity for acute and subacute low back pain

OBJECTIVES

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the benefits and harms of graded activity compared to placebo, sham, or no treatment, on pain and function in adults with acute and subacute non-specific low back pain.

Exercise interventions to improve bone mineral density in athletes participating in low-impact sports: a scoping review

BACKGROUND

Athletes participating in low-impact sports such as cycling and swimming are at increased risk for low bone mineral density, which may lead to long-term health issues. Exercise is known to increase bone mineral density, but there is little knowledge of the effects of this in athletes participating in low-impact sports. This review aims to identify potential exercise interventions that could improve bone health in these athletes.

METHODS

There appears to be little research on this topic, and we addressed the research question using a scoping review to get a broad overview of the research literature. The scoping review was conducted following the methodological framework of Arksey and O´Malley. A literature search was conducted May 2024 in SPORTDiscus, Web of Science, Scopus, MEDLINE, EMBASE, Cinahl, Cochrane, and Google Scholar. The Consensus on Exercise Reporting Template was used to evaluate the reporting of the exercise intervention(s).

RESULTS

A total of 2528 studies were screened and assessed for eligibility. Five studies met the inclusion criteria reporting results of exercise interventions on bone mineral density in cyclists and swimmers. Different designs were applied, and study populations varied. Five populations were explored; one cohort of adolescent swimmers (both sexes), one cohort of female Olympic artistic swimmers, one cohort of elite road cyclists (both sexes), one cohort of male competitive amateur cyclists, and one cohort of trained to well-trained cyclists (both sexes).

CONCLUSION

This scoping review found that resistance training, plyometric exercises, whole-body vibration, and a combined jumping exercise with collagen supplementation show promising results in improving bone mineral density in athletes participating in cycling and swimming. However, there is limited evidence due to few identified studies, with varying study designs and inconsistent exercise reporting, highlighting the need of further research to better understand how different training approaches can improve bone health in these athletes.

Comparative effectiveness of various exercise interventions on central sensitisation indices: A systematic review and network meta-analysis

BACKGROUND

Central sensitisation (CS) increases musculoskeletal pain. Quantitative sensory testing (QST) or self-report questionnaires might indicate CS. Indices of CS might be suppressed by exercise, although the optimal exercise regimen remains unclear.

OBJECTIVES

We conducted a systematic review and network meta-analysis (NMA) to investigate effectiveness of different exercise regimens on these CS indices in adults.

METHODS

We searched 6 electronic databases from inception to November 2023. Meta-analysis of randomised controlled trials (RCTs) investigated effects of exercise on all CS indices. Two independent reviewers assessed risk of bias. NMA of RCTs compared CS indices between exercise types. Sensitivity analysis using only high-quality studies was performed to verify the robustness of our results. Certainty was assessed using the GRADE approach.

RESULTS

Of the 249 eligible studies identified, 164 were RCTs, of which 89 provided data suitable for NMA. Meta-analysis revealed large improvement of post-intervention CS indices compared to baseline (SMD -0.81, 95 % CI -0.93 to -0.70). All reported categories of exercise, except stretching exercise alone, were more effective than non-exercise controls. Combined exercises that include stretching together with strengthening exercises (SMD -1.67, 95 % Credible Interval (CrI) -2.41 to -0.97), or strengthening, stretching and aerobic components (SMD -1.61, 95 % CrI -2.74 to -0.56) were most effective at reducing CS indices compared to non-exercise controls. Sensitivity analysis confirmed the robustness of our findings, particularly for combined stretching and strengthening exercise.

CONCLUSIONS

Our meta-analysis suggested that various exercise interventions are effective in improving CS. Multi-component exercise tends to be the most effective, but some exercise combinations might be better than others. Combined exercise featuring strengthening and stretching components, with or without aerobic exercise, shows the greatest likelihood among other combinations of being the optimal exercise type. These findings might have utility informing future trials and personalising treatment strategies for people with CS features.

Real-world evaluation of physiotherapist-led exercise prehabilitation and rehabilitation during autologous stem cell transplantation in myeloma: a single-centre experience

BACKGROUND

There is emerging evidence for the role of exercise in optimising function, quality of life (QoL) and reducing hospital length-of-stay if commenced prior to undergoing autologous stem cell transplantation (ASCT). A local pilot study of a prehabilitation and rehabilitation intervention during ASCT for myeloma patients indicated promising results and was adapted to translate into local clinical care. The aim of this report is to describe an overview of a newly implemented physiotherapist-led exercise prehabilitation and rehabilitation service delivered as part of the myeloma ASCT pathway, and present real-world findings related to changes in function and QoL.

METHODS

A service evaluation was conducted at a single-centre tertiary referral hospital for haematopoetic stem cell transplantation in the United Kingdom. A hybrid service using face-to-face clinical assessments and weekly remotely supervised group exercise, via an online video conferencing platform, in the phase between stem cell harvest and admission (prehabilitation), and from discharge to 100 days post-ASCT (rehabilitation). Functional (6 min walk and timed sit-to-stand tests) and patient-reported outcome measures (European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-C30) and EuroQol EQ5D-5L were assessed at preharvest, preadmission and in the post-ASCT evaluation (day 100) clinic.

RESULTS

Patients (n=46) with a diagnosis of multiple myeloma referred for ASCT following induction chemotherapy were assessed. Baseline assessments showed high prevalence of impaired function and lower limb strength. Improvements were evident following prehabilitation prior to admission, which were maintained post-ASCT. Changes in 6 min walk test and timed sit-to-stand were significant and beyond thresholds of clinical importance. Improvements were also seen in the domains of QoL.

CONCLUSIONS

Implementation of physiotherapist-led assessments in the myeloma clinic and group exercise delivery under remote supervision are acceptable to patients undergoing ASCT and indicate benefit in improving function and QoL.

Acute physiological and perceptual responses to three blood flow restricted interval exercise protocols: a randomised controlled trial

Blood flow restriction (BFR) may enhance the acute training stimulus of exercise. This study examined acute physiological and perceptual responses to three lower-limb BFR + interval exercise protocols. Twenty-four club/university male athletes (age 25 ± 3.5, V̇O2max 47.0 ± 5.5 mL∙kg∙min- 1) completed four experimental conditions in a randomised crossover manner: (i) high-intensity control (HI) - 100% maximal aerobic power (Wmax); (ii) high-intensity recovery occlusion (HIRO) - 100% Wmax, 80% limb occlusion pressure (LOP) during rest; (iii) moderate-intensity low occlusion (MILO) - 70% Wmax, 50% LOP during exercise; and (iv) moderate-intensity high occlusion (MIHO) - 70% Wmax, 80% LOP during exercise. All interval exercise protocols were three sets of five × 30 s cycling, 30 s unloaded active recovery with 3 min seated rest between sets. During recovery, HIRO condition indicated lower tissue saturation index, higher deoxyhaemoglobin, oxyhaemoglobin and total haemoglobin levels than other conditions (all p < 0.05). HIRO exhibited significantly higher heart rate (HR) from set 2 and blood lactate (bLa) at 5 min post-exercise than other conditions (all p < 0.05). Higher vastus lateralis muscle activity was exhibited on the last exercise repetition of HIRO than HI (p < 0.05). MIHO elicited significantly higher deoxygenation, lower muscle activation but similar HR and bLa than HI during exercise; and higher perceived pain and exertion than other conditions (all p < 0.05). Applying BFR during rest between high-intensity interval exercise sets increases physiological stresses without affecting exercise intensity or perceptual responses; applying BFR during moderate-intensity exercise may increase both physiological and perceptual responses beyond those of high-intensity exercise. Study registration: Clinicaltrials.gov (NCT05835544).

Effects of home-based exercise on the health of patients with fibromyalgia syndrome: a systematic review of randomized clinical trials

PURPOSE

Analyze the effects of interventions with home-based physical exercise on the health of patients with fibromyalgia and the characteristics of the protocols used.

METHODS

This systematic review was registered at PROSPERO and followed the PRISMA recommendations. Searches were performed in six electronic databases. Eligibility criteria for the selection of studies were compiled using the acronym PICOS. Data were extracted and checked in a Microsoft Excel® spreadsheet and the risk of bias was assessed using the Rob 2 tool.

RESULTS

The search resulted in seven studies included for analysis. Among them, the most common modality was aerobic exercise. The analyzed outcomes were: pain, quality of life, depression, anxiety, disease severity, physical function, pain catastrophizing, self-efficacy, psychological well-being, sleep quality and somatosensory and temporal discrimination. The effects of home-based exercise are limited, and improvements in pain and quality of life was found. For the other outcomes, the results were inconclusive. Most studies presented some concerns about the risk of bias.

CONCLUSION

It is necessary to expand the evidence on home-based exercises for fibromyalgia, as this is the first systematic review on the subject. Subsequent research should focus on methodological rigor and protocol detail, allowing findings to be replicated.

A systematic review and meta-analysis investigating the impact of exercise interventions on heart rate variability in hemodialysis patients

Patients with chronic kidney disease have a high incidence of cardiovascular diseases, and autonomic dysfunction has a determinant role in the relevant declines. Physical exercise influences heart rate variability and cardiac autonomic modulation. Thus, our objective was to systematically review, with a meta-analysis, the correlation between physical exercise interventions and alterations in cardiac autonomic modulation in hemodialysis patients. A customized research strategy was used across four databases. The search yielded 392 studies, with eight randomized clinical trials included (396 participants), indicating that the investigated indices favor the intervention group by increasing autonomic activity. The exercise training probably increases the standard deviation of all NN intervals (20.71 ms CI 95% [9.55, 31.87], p < 0.001, I²=95%) compared to the control group and showing an moderate certainty, was the most commonly used index (seven studies). Mean RR (35.57 ms CI 95% [14.56, 56.57], p = 0.91, I²=0%), the root mean square sum of squares of differences between NN intervals (10.55 ms CI 95% [6.75, 14.34], p = 0.37, I²=4%), and LF/HF (0.28 ms (n.u) [0.11, 0.44], p = 0.18, I²=39%) were also in favor of the training group. However, based on the GRADE analysis we are uncertain whether Mean RR can increase after an exercise intervention, as well RMSSD and LF/HF may increase slightly, we obtained low certainty of this evidence. The exact magnitude of the impact of physical training on the alteration of cardiac autonomic modulation in this patient population has yet to be conclusively defined.

Rate of Perceived Exertion Based on Repetitions in Reserve Versus Percentage of One-Repetition Maximum for Resistance Training Prescription in Cardiac Rehabilitation: A Pilot Study

The aims of this study were to assess the efficacy of the rate of perceived exertion (RPE) scale based on the number of repetitions in reserve (RIR) before exhaustion for the prescription of resistance training in cardiac rehabilitation and to compare it to the percentage of estimated one-repetition maximum (1RM) prescription method. Sixteen male patients (age 60 ± 8) with history of coronary artery disease were randomly assigned to two resistance training rehabilitation protocols lasting nine weeks and consisting of three sessions per week, with the same exercise selection, number of sets and repetitions, and rest periods, but different load prescription method (RPE vs. %1RM). Patients' strength was evaluated pre- and post-intervention. Patients in the RPE group showed significant increases in strength across all the exercises of the protocol (leg press 24.25 ± 17.07 kg; chest press 7.25 ± 3.41 kg; seated row 13.88 ± 7.57 kg; leg extension 14.24 ± 4.53 kg; shoulder press 5.75 ± 4.06 kg; lat pulldown 7.50 ± 4.66 kg). Post-intervention between-group analysis showed no differences in strength gains (leg press p = 0.955; chest press p = 0.965; seated row p = 0.763; leg extension p = 0.565; shoulder press p = 0.868; lat pulldown p = 0.780) and trivial effect sizes (ES) for one prescription method over the other (leg press ES = -0.03; chest press ES = 0.00; seated row ES = 0.10; leg extension ES = -0.29; shoulder press ES = 0.18; lat pulldown ES = 0.05). RPE based on RIR seems to be an effective prescription method for resistance training in cardiac rehabilitation, showing similar efficacy to the standardized practice of percentage of 1RM.

Heavy slow resistance training, radial extracorporeal shock wave therapy or advice for patients with tennis elbow in the Norwegian secondary care: a randomised controlled feasibility trial

OBJECTIVES

To evaluate the feasibility of recruitment, appointment adherence, intervention compliance, acceptance and comprehensibility, in addition to retention rate and data completeness. An ancillary aim was to describe within-group changes in the secondary outcome measures (patient-reported and performance-based).

DESIGN

A single-centre, three-armed, randomised controlled feasibility trial with a parallel design, with follow-up after 3 and 6 months.

SETTING

Participants were recruited from the outpatient clinic at Oslo University Hospital.

PARTICIPANTS

Patients with lateral epicondylalgia, commonly known as tennis elbow.

INTERVENTIONS

Participants were randomised in a 1:1:1 ratio to heavy slow resistance training, radial extracorporeal shock wave therapy or information and advice.

MAIN OUTCOME MEASURES

Feasibility was assessed according to a priori criteria for success.

RESULTS

In total, 89 patients were screened for eligibility, and 69 (78%) patients were eligible for randomisation. 60 (92%) participants were randomised which gave a recruitment rate of 3.4 per month (against an a priori success cut-off of 3.75). The participants rated all the interventions as acceptable and comprehensive. Only 6 of 19 (32%) did comply with heavy slow resistance training. Retention rate and completeness of data were successful at 3 months. At 6 months, the retention rate was below the criteria for success. Patient-reported and performance-based outcomes improved in all groups.

CONCLUSION

The current study shows that the process of recruitment and the retention rate at follow-up can be feasible with minor amendments. Participants had low compliance with heavy slow resistance training mainly due to pain aggravation, which suggests that this intervention was not suitable for patients with tennis elbow. Shock wave therapy and information and advice should be investigated further in a full-scale randomised controlled trial including sham shock wave therapy.

TRIAL REGISTRATION NUMBER

NCT04803825.

Exercise for osteoarthritis of the knee

BACKGROUND

Knee osteoarthritis (OA) is a major public health issue causing chronic pain, impaired physical function, and reduced quality of life. As there is no cure, self-management of symptoms via exercise is recommended by all current international clinical guidelines. This review updates one published in 2015.

OBJECTIVES

We aimed to assess the effects of land-based exercise for people with knee osteoarthritis (OA) by comparing: 1) exercise versus attention control or placebo; 2) exercise versus no treatment, usual care, or limited education; 3) exercise added to another co-intervention versus the co-intervention alone.

SEARCH METHODS

We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and two trial registries (ClinicalTrials.gov and World Health Organisation International Clinical Trials Registry Platform), together with reference lists, from the date of the last search (1st May 2013) until 4 January 2024, unrestricted by language.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) that evaluated exercise for knee OA versus a comparator listed above. Our outcomes of interest were pain severity, physical function, quality of life, participant-reported treatment success, adverse events, and study withdrawals.

DATA COLLECTION AND ANALYSIS

We used the standard methodological procedures expected by Cochrane for systematic reviews of interventions.

MAIN RESULTS

We included 139 trials (12,468 participants): 30 (3065 participants) compared exercise to attention control or placebo; 60 (4834 participants) compared exercise with usual care, no intervention or limited education; and 49 (4569 participants) evaluated exercise added to another intervention (e.g. weight loss diet, physical therapy, detailed education) versus that intervention alone. Interventions varied substantially in duration, ranging from 2 to 104 weeks. Most of the trials were at unclear or high risk of bias, in particular, performance bias (94% of trials), detection bias (94%), selective reporting bias (68%), selection bias (57%), and attrition bias (48%). Exercise versus attention control/placebo Compared with attention control/placebo, low-certainty evidence indicates exercise may result in a slight improvement in pain immediately post-intervention (mean 8.70 points better (on a scale of 0 to 100), 95% confidence interval (CI) 5.70 to 11.70; 28 studies, 2873 participants). Moderate-certainty evidence indicates exercise likely results in an improvement in physical function (mean 11.27 points better (on a scale of 0 to 100), 95% CI 7.64 to 15.09; 24 studies, 2536 participants), but little to no improvement in quality of life (mean 6.06 points better (on a scale of 0 to 100), 95% CI -0.13 to 12.26; 6 studies, 454 participants). There was moderate-certainty evidence that exercise likely increases participant-reported treatment success (risk ratio (RR) 1.46, 95% CI 1.11 to 1.92; 2 studies 364 participants), and likely does not increase study withdrawals (RR 1.08, 95% CI 0.92 to 1.26; 29 studies, 2907 participants). There was low-certainty evidence that exercise may not increase adverse events (RR 2.02, 95% CI 0.62 to 6.58; 11 studies, 1684 participants). Exercise versus no treatment/usual care/limited education Compared with no treatment/usual care/limited education, low-certainty evidence indicates exercise may result in an improvement in pain immediately post-intervention (mean 13.14 points better (on a scale of 0 to 100), 95% CI 10.36 to 15.91; 56 studies, 4184 participants). Moderate-certainty evidence indicates exercise likely results in an improvement in physical function (mean 12.53 points better (on a scale of 0 to 100), 95% CI 9.74 to 15.31; 54 studies, 4352 participants) and a slight improvement in quality of life (mean 5.37 points better (on a scale of to 100), 95% CI 3.19 to 7.54; 28 studies, 2328 participants). There was low-certainty evidence that exercise may result in no difference in participant-reported treatment success (RR 1.33, 95% CI 0.71 to 2.49; 3 studies, 405 participants). There was moderate-certainty evidence that exercise likely results in no difference in study withdrawals (RR 1.03, 95% CI 0.88 to 1.20; 53 studies, 4408 participants). There was low-certainty evidence that exercise may increase adverse events (RR 3.17, 95% CI 1.17 to 8.57; 18 studies, 1557 participants). Exercise added to another co-intervention versus the co-intervention alone Moderate-certainty evidence indicates that exercise when added to a co-intervention likely results in improvements in pain immediately post-intervention compared to the co-intervention alone (mean 10.43 points better (on a scale of 0 to 100), 95% CI 8.06 to 12.79; 47 studies, 4441 participants). It also likely results in a slight improvement in physical function (mean 9.66 points better, 95% CI 7.48 to 11.97 (on a 0 to 100 scale); 44 studies, 4381 participants) and quality of life (mean 4.22 points better (on a 0 to 100 scale), 95% CI 1.36 to 7.07; 12 studies, 1660 participants) immediately post-intervention. There was moderate-certainty evidence that exercise likely increases participant-reported treatment success (RR 1.63, 95% CI 1.18 to 2.24; 6 studies, 1139 participants), slightly reduces study withdrawals (RR 0.82, 95% CI 0.70 to 0.97; 41 studies, 3502 participants), and slightly increases adverse events (RR 1.72, 95% CI 1.07 to 2.76; 19 studies, 2187 participants). Subgroup analysis and meta-regression We did not find any differences in effects between different types of exercise, and we found no relationship between changes in pain or physical function and the total number of exercise sessions prescribed or the ratio (between exercise group and comparator) of real-time consultations with a healthcare provider. Clinical significance of the findings To determine whether the results found would make a clinically meaningful difference to someone with knee OA, we compared our results to established 'minimal important difference' (MID) scores for pain (12 points on a 0 to 100 scale), physical function (13 points), and quality of life (15 points). We found that the confidence intervals of mean differences either did not reach these thresholds or included both a clinically important and clinically unimportant improvement.

AUTHORS' CONCLUSIONS

We found low- to moderate-certainty evidence that exercise probably results in an improvement in pain, physical function, and quality of life in the short-term. However, based on the thresholds for minimal important differences that we used, these benefits were of uncertain clinical importance. Participants in most trials were not blinded and were therefore aware of their treatment, and this may have contributed to reported improvements.

Efficacy of exercise interventions on prevention of sport-related concussion and related outcomes: a systematic review and meta-analysis

OBJECTIVE

To review the efficacy of exercise interventions on sport-related concussion (SRC) incidence, as well as on linear and rotational head accelerations, and isometric neck strength and to assess reporting completeness of exercise interventions using the Consensus on Exercise Reporting Template (CERT).

DESIGN

Systematic review and meta-analysis, according to the Prisma in Exercise, Rehabilitation, Sport medicine and SporTs science guidelines.

DATA SOURCES

Six databases (MEDLINE, Embase, CINAHL, Scopus, Web of Science CC and SPORTDiscus) were searched up to 26 June 2023.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Randomised controlled trials (RCTs), cluster RCTs or quasi-experimental studies, evaluating exercise interventions on SRC incidence, linear and rotational head accelerations, and/or isometric neck strength in male and/or female athletes of any age, and/or in a healthy general population.

RESULTS

A total of 26 articles were included. A large effect size was observed for resistance training (RT) on isometric neck strength (standardised mean difference (SMD) 0.85; 95% CI 0.57 to 1.13; high-quality evidence). Non-significant effect sizes were observed for neuromuscular warm-up programmes on SRC incidence (risk ratio 0.69; 95% CI 0.39 to 1.23; low-quality evidence), or for RT on linear head acceleration (SMD -0.43; 95% CI -1.26 to 0.40; very low-quality evidence) or rotational head acceleration (SMD 0.08; 95% CI -0.61 to 0.77; low-quality evidence). No studies assessed the impact of RT on SRC incidence. CERT scores ranged from 4 to 16 (out of 19) with median score of 11.5 (IQR 9-13).

CONCLUSION

RT increases isometric neck strength, but the effect on SRC incidence is unknown. More adequately powered and rigorous trials are needed to evaluate the effect of exercise interventions on SRC incidence, and on linear and rotational head accelerations. Future studies should follow CERT guidelines, as the included interventions were generally not reported in sufficient detail for accurate replication.

PROSPERO REGISTRATION NUMBER

CRD42023435033.

Exercise and depression symptoms in chronic kidney disease patients: an updated systematic review and meta-analysis

OBJECTIVES

To investigate whether exercise intervention is associated with reducing depressive symptoms in chronic kidney disease (CKD) patients.

METHODS

Medline (PubMed), Web of Science, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) from inception to February 28, 2024. Randomized controlled trials comparing exercise intervention with usual care or stretching sessions for depression symptoms. Independent data extraction was conducted, and the quality of studies was assessed. A meta-analysis was carried out by using random effects models to calculate standardized mean difference (SMD) with a 95% confidence interval (95% CI) between groups.

RESULTS

23 trials with 1561 CKD patients were identified. Exercise interventions are associated with a significant reduction in depression symptoms among CKD patients, with a moderate average SMD of -0.726 (95% CI: -1.056, -0.396; t=-4.57; p < 0.001). Significant heterogeneity was observed (tau2 = 0.408 [95%CI: 0.227, 1.179], I2 = 79.9% [95% CI: 70.5%, 86.3%]). The funnel plot shows potential publication bias. Subgroup analyses showed that the beneficial effects of exercise on depression remained constant across all subgroups. The evidence is deemed as 'very low' certainty.

CONCLUSIONS

Our systematic review and meta-analysis showed that exercise intervention was associated with significantly alleviating depression symptoms (certainty of evidence: very low). While the very low certainty of the evidence highlights a need for further research.

PROSPERO REGISTRATION NUMBER

CRD42021248450.

Varus Thrust Assessment Identified Responders to Quadriceps Exercise in Individuals at Risk of or with Knee Osteoarthritis

PURPOSE

Identification of responders/nonresponders to unsupervised therapeutic exercise represents a critical challenge toward establishment of tailored self-management at home. Focusing on visualized varus thrust during gait as a possible effect moderator, this study determined whether and how varus thrust influences the therapeutic effects of home-based quadriceps exercise in individuals at increased risk of, or with, established knee osteoarthritis.

METHODS

This study is a secondary subgroup analysis of a randomized controlled trial ( n = 50). Varus thrust at baseline was assessed via recorded gait movie. Analysis of covariance and subsequent mediation analysis were used to determine whether and how varus thrust influences the therapeutic effect of home-based quadriceps exercise after adjustment for covariates. To address the possible distinct impact of varus thrust on unsupervised and supervised exercise, the results were cross-checked with previous supervised exercise cohort using a meta-analysis.

RESULTS

Individuals without varus thrust displayed greater and clinically meaningful pain relief after exercise after adjustment for covariates. The greater pain relief in individuals without varus thrust was attributed, at least partly, to an improvement in knee flexion range of motion. Notably, the meta-analysis revealed that unsupervised and supervised exercise programs induce consistent and clinically meaningful pain reduction in individuals without varus thrust.

CONCLUSIONS

Varus thrust is a robust effect moderator of the pain-reducing effect of quadriceps exercise. Furthermore, greater pain reduction may be a function of improvement of knee flexion range of motion. These studies provide evidence that varus thrust assessment represents valuable approach to identify responders/nonresponders to quadriceps exercise even for unsupervised protocol at their home environment.

Lifestyle empowerment for Alzheimer's prevention prescribed by physicians: Methods and adaptations to COVID-19

The health care system is insufficiently capitalizing on the benefits of physical exercise in America's aging population. Few tools exist to help clinicians incorporate physical activity into their clinical care, and barriers limit older adults from initiating and maintaining exercise programs. The Lifestyle Empowerment for Alzheimer's Prevention (LEAP! Rx) Program has been designed to support providers and participants in lifestyle change. LEAP! Rx uses two forms of participant enrollment: physician referrals through electronic health records and self-referrals to test the efficacy of delivering a community-based exercise and healthy lifestyle program to older adults. After referral into the program, participants are randomized to receive the LEAP! Rx Program or are placed in a standard-of-care group to receive the program later. The LEAP! Rx program consists of a personalized and structured exercise program, lifestyle education, and mobile health monitoring. This includes a 12-week Empowerment phase with coaching and supervised exercise training, followed by a 40-week Lifestyle phase with intermittent supervised exercise and coaching. Lifestyle education includes monthly, evidence-based classes on optimal aging. The evaluation of LEAP! Rx focuses on 1) the assessment of implementation and scalability of the LEAP!Rx Program for clinicians and patients 2) the effect of the LEAP! Rx Program on cardiorespiratory fitness, 3) the impact of the LEAP! Rx Program on secondary intervention outcome measures of chronic disease risk factors, including insulin resistance, body composition, and lipids. If successful, this study's findings could advance future healthcare practices, providing a new and practical approach to aging and chronic disease prevention.

A scoping review of studies exploring physical activity and cognition among persons with cancer

PURPOSE

This scoping review aimed to identify and synthesize published studies on physical activity (PA) and cognition among persons with cancer and elucidate knowledge gaps.

METHODS

Articles were identified through electronic and manual searches (02/21 and 03/22) using the following inclusion criteria: (1) empirical, peer-reviewed publication in English, (2) sample comprised persons with cancer, and (3) reported at least one statistical association between PA and cognition. Multiple reviewers independently performed study selection and data extraction, and results were mapped in tabular and narrative form.

RESULTS

Ninety-seven articles were eligible; these were largely published from 2017 to 2022 (54.6%), conducted in high-income countries (96.9%), and presented (quasi-)experimental studies (73.2%). Samples predominantly comprised women with breast cancer (48.5%), and recruitment often occurred post-treatment (63.9%). PA interventions included: aerobic (32.3%), resistance (4.8%), combined aerobic/resistance (38.7%), mind-body (19.4%), or other PA (4.8%). Most (66%) articles reported inconclusive findings; 32% were positive (in support of PA promoting cognition or vice versa), and 2.1% were negative. Diverse samples and studies with long-term follow-up were scarce.

CONCLUSIONS

The state of knowledge is insufficient and more rigorous, large-scale studies are required to provide definitive conclusions about the cognitive benefits of PA among persons with cancer.

IMPLICATIONS FOR CANCER SURVIVORS

Cancer-related cognitive impairment (CRCI) thwarts quality of life. This review summarizes what is known about the association between PA and cognition among persons with cancer and concludes that the evidence is currently equivocal. Hence, it remains uncertain if PA interventions can reduce CRCI, and large-scale PA intervention trials explicitly designed to promote cognition are greatly needed.