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Burley CV, Casey AN, Jones MD, Wright KE, Parmenter BJ. Nonpharmacological approaches for pain and symptoms of depression in people with osteoarthritis: systematic review and meta-analyses. Sci Rep 2023; 13:15449. [PMID: 37723233 PMCID: PMC10507102 DOI: 10.1038/s41598-023-41709-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 08/30/2023] [Indexed: 09/20/2023] Open
Abstract
People with osteoarthritis often experience pain and depression. These meta-analyses examined and compared nonpharmacological randomized controlled trials (RCTs) for pain and symptoms of depression in people living with osteoarthritis. RCTs published up until April 2022 were sourced by searching electronic databases EMBASE, PUBMED & MEDLINE, Web of Science, CINAHL and PEDro. Random-effects meta-analyses were performed to calculate pooled effect sizes (ES) and 95% confidence intervals (CI) for pain and depression. Subgroup analyses examined intervention subtypes. For pain, 29 interventions (n = 4382; 65 ± 6.9 years; 70% female), revealed a significant effect on reducing pain (ES = 0.43, 95% CI [0.25, 0.61], p < 0.001). Effect sizes were significant (p < 0.001) for movement meditation (ES = 0.52; 95% CI [0.35, 0.69]), multimodal approaches (ES = 0.37; 95% CI [0.22, 0.51]), and psychological therapy (ES = 0.21; 95% CI [0.11, 0.31]), and significant (p = 0.046) for resistance exercise (ES = 0.43, 95% CI [- 0.07, 0.94]. Aerobic exercise alone did not improve pain. For depression, 28 interventions (n = 3377; 63 ± 7.0 years; 69% female), revealed a significant effect on reducing depressive symptoms (ES = 0.29, 95% CI [0.08, 0.49], p < 0.001). Effect sizes were significant for movement meditation (ES = 0.30; 95% CI [0.06, 0.55], p = 0.008) and multimodal interventions (ES = 0.12; 95% CI [0.07, 0.18], p < 0.001). Resistance/aerobic exercise or therapy alone did not improve depressive symptoms. Mind-body approaches were more effective than aerobic/resistance exercise or therapy alone for reducing pain and depression in people with osteoarthritis.Systematic review registration: PROSPERO CRD42022338051.
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Affiliation(s)
- Claire V Burley
- UNSW Medicine & Health Lifestyle Clinic, School of Health Sciences, University of New South Wales, Sydney, Australia.
- Centre for Healthy Brain Ageing, School of Clinical Medicine, University of New South Wales, Sydney, Australia.
| | - Anne-Nicole Casey
- Centre for Healthy Brain Ageing, School of Clinical Medicine, University of New South Wales, Sydney, Australia
| | - Matthew D Jones
- Department of Exercise Physiology, School of Health Sciences, University of New South Wales, Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Kemi E Wright
- Department of Exercise Physiology, School of Health Sciences, University of New South Wales, Sydney, Australia
| | - Belinda J Parmenter
- UNSW Medicine & Health Lifestyle Clinic, School of Health Sciences, University of New South Wales, Sydney, Australia
- Department of Exercise Physiology, School of Health Sciences, University of New South Wales, Sydney, Australia
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Golledge J, Yip L, Venn A, Leicht AS, Jenkins JS, Fiatarone Singh MA, Reid CM, Ademi Z, Parmenter BJ, Moxon JV, Burton NW. Effect of Brief Counseling by Allied Health Professionals on Step Count of People With Peripheral Artery Disease: A Randomized Clinical Trial. JAMA Cardiol 2023; 8:394-399. [PMID: 36753250 PMCID: PMC9909571 DOI: 10.1001/jamacardio.2022.5437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 11/16/2022] [Indexed: 02/09/2023]
Abstract
Importance It is unclear how to effectively promote walking in people with peripheral artery disease (PAD). Objective To test whether brief counseling delivered by allied health professionals increases step count in participants with PAD. Design, Setting, and Participants In this randomized clinical trial, participants with symptomatic PAD were recruited from sites in Australia and randomly allocated 1:1 to the counseling intervention or an attention control. Data were collected from January 2015 to July 2021, and data were analyzed from March to November 2022. Interventions Two 1-hour face-to-face and two 15-minute telephone counseling sessions designed to increase walking. Main Outcomes and Measures The primary outcome was the between-group difference in change in daily step count estimated by accelerometer recordings over 7 days at baseline and 4 months, using imputation for missing values. Other outcomes at 4, 12, and 24 months included step count, 6-minute walk distance, and disease-specific and generic measures of health-related quality of life. Risk of major adverse limb events was assessed over 24 months. Results Of 200 included participants, 144 (72.0%) were male, and the mean (SD) age was 69.2 (9.3) years. The planned sample of 200 participants was allocated to the counseling intervention group (n = 102) or attention control group (n = 98). Overall, 198 (99.0%), 175 (87.5%), 160 (80.0%) and 143 (71.5%) had step count assessed at entry and 4, 12, and 24 months, respectively. There was no significant between-group difference in the primary outcome of change in daily step count over 4 months (mean steps, 415; 95% CI, -62 to 893; P = .07). Participants in the counseling group had significantly greater improvement in the secondary outcome of disease-specific Intermittent Claudication Questionnaire score at 4 months (3.2 points; 95% CI, 0.1-6.4; P = .04) and 12 months (4.3 points; 95% CI, 0.5-8.1; P = .03) but not at 24 months (1.2 points; 95% CI, -3.1 to 5.6; P = .57). Findings were similar for mean PAD Quality of Life Questionnaire component assessing symptoms and limitations in physical functioning (4 months: 1.5 points; 95% CI, 0.3-2.8; P = .02; 12 months: 1.8 points; 95% CI, 0.3-3.3; P = .02; 24 months: 1.3 points; 95% CI. -0.5 to 3.1; P = .16). There was no significant effect of the intervention on change in mean 6-minute walking distance (4 months: 9.3 m; 95% CI, -3.7 to 22.3; P = .16; 12 months: 13.8 m; 95% CI, -4.2 to 31.7; P = .13; 24 months: 1.2 m; 95% CI, -20.0 to 22.5; P = .91). The counseling intervention did not affect the rate of major adverse limb events over 24 months (12 [6.0%] in the intervention group vs 11 [5.5%] in the control group; P > .99). Conclusions and Relevance This randomized clinical trial found no significant effect of brief counseling on step count in people with PAD. Alternate interventions are needed to enable walking. Trial Registration Australian New Zealand Clinical Trials Registry Identifier: ACTRN12614000592640.
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Affiliation(s)
- Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Australia
- The Department of Vascular and Endovascular Surgery, Townsville University Hospital, Townsville, Australia
- The Australian Institute of Tropical Health and Medicine, Townsville, Australia
| | - Lisan Yip
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Australia
| | - Alkira Venn
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Australia
| | - Anthony S. Leicht
- The Australian Institute of Tropical Health and Medicine, Townsville, Australia
- Sport and Exercise Science, James Cook University, Townsville, Australia
| | - Jason S. Jenkins
- Department of Vascular Surgery, Royal Brisbane and Women’s Hospital, Brisbane, Australia
| | - Maria A. Fiatarone Singh
- Exercise and Sport Science, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts
| | - Christopher M. Reid
- School of Population Health, Curtin University, Perth, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Zanfina Ademi
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
| | - Belinda J. Parmenter
- Department of Exercise Physiology, School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney Australia
| | - Joseph V. Moxon
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Australia
- The Australian Institute of Tropical Health and Medicine, Townsville, Australia
| | - Nicola W. Burton
- School of Applied Psychology, Griffith University, Brisbane, Australia
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Centre for Mental Health, Griffith University, Brisbane, Australia
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Parmenter BJ, McLeod K, Jones M, Burley C, Feng X. Abstract P313: Characteristics and Patterns of a Middle-Class Australian Cohort With Cardiometabolic Multimorbidity: A Cross-Sectional Study. Circulation 2023. [DOI: 10.1161/circ.147.suppl_1.p313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/15/2023]
Abstract
Introduction:
Prevalence rates of cardiometabolic disease are rising, placing a significant burden on healthcare sectors, with cardiovascular disease (CVD) and type 2 diabetes contributing the most burden and being overweight the most contributing risk factor. With an ageing population, unfavourable risk factor trends and the challenges associated with CVD, we aimed to analyse a group of middle-class Australian adults for patterns in body composition, fitness and function.
Methods:
Data collected from adults attending a health clinic in eastern Sydney were analysed. Data were self-reported to or measured by an allied health clinician during initial consultations. Conditions reported included those contributing to the Australian disease burden in adults 45 years and over in 2018. Cardiometabolic multimorbidity was defined as the presence of two or more conditions simultaneously. Simple linear and stepwise regressions were used to assess potential relationships.
Results:
Data from 533 people (mean age 66.6±12.1 yrs; 67% female) were analysed. In total, 418 had a biological cardiometabolic risk factor or diagnosed CVD, of which 85.2% satisfied the criteria for cardiometabolic multimorbidity (73% female; 62% male), with most reporting 2-3 conditions. The most reported was coronary heart disease (64.4%), followed by hypertension (34.6%), type 2 diabetes (12.9%), cerebrovascular (5.1%), chronic kidney (1%) and peripheral artery (1%) disease. There was no relationship between the number of conditions and key outcomes, except for balance (r=0.12; p=0.03). There was a significant relationship between age and greater systolic blood pressure (SBP) (r=0.26; p<0.001), a larger waist (r=0.11; p=0.03) and poorer 6-minute walk (r=-0.38; p<0.001), muscle strength (r=-0.34; p<0.001) and balance (r=-0.30; p<0.001). A high SBP was significantly related to a higher body mass index and waist and lower body strength, with waist and lower body strength being the strongest predictors of higher SBP (p=0.005). A higher waist and lower body strength were significantly related to a poorer 6-minute walk, together with age, accounting for 41% of the variance in performance (p<0.001).
Conclusion:
Three in 4 Australian adults in this cohort had cardiometabolic multimorbidity, with a greater prevalence in females. Cardiometabolic multimorbidity was unrelated to key body composition parameters or fitness test performance. However, those that were older had a higher waist measurement and poorer lower body strength and performance in the 6-minute walk. Those with higher SBP also had a higher waist and lower body strength. With these fitness measures strongly related to cardiovascular mortality, more older adults need to participate in evidence-based healthy lifestyle education programs to help improve overall body composition, fitness and function, thereby reducing CVD.
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Wewege MA, Hansford HJ, Shah B, Gilanyi YL, Douglas SRG, Parmenter BJ, McAuley JH, Jones MD. Baseline imbalance and heterogeneity are present in meta-analyses of randomized clinical trials examining the effects of exercise and medicines for blood pressure management. Hypertens Res 2022; 45:1643-1652. [PMID: 35882996 PMCID: PMC9474297 DOI: 10.1038/s41440-022-00984-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 05/08/2022] [Accepted: 06/23/2022] [Indexed: 11/27/2022]
Abstract
Randomized clinical trials attempt to reduce bias and create similar groups at baseline to infer causal effects. In meta-analyses, baseline imbalance may threaten the validity of the treatment effects. This meta-epidemiological study examined baseline imbalance in comparisons of exercise and antihypertensive medicines. Baseline data for systolic blood pressure, diastolic blood pressure, and age were extracted from a network meta-analysis of 391 randomized trials comparing exercise types and antihypertensive medicines. Fixed-effect meta-analyses were used to determine the presence of baseline imbalance and/or inconsistency. Meta-regression analyses were conducted on sample size, the risk of bias for allocation concealment, and whether data for all randomized participants were presented at baseline. In one exercise comparison, the resistance group was 0.3 years younger than the control group (95% confidence interval 0.6 to 0.1). Substantial inconsistency was observed in other exercise comparisons. Less data were available for medicines, but there were no occurrences of baseline imbalance and only a few instances of inconsistency. Several moderator analyses identified significant associations. We identified baseline imbalance as well as substantial inconsistency in exercise comparisons. Researchers should consider conducting meta-analyses of key prognostic variables at baseline to ensure balance across trials. ![]()
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Affiliation(s)
- Michael A Wewege
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia. .,Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia.
| | - Harrison J Hansford
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia.,Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia
| | - Brishna Shah
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia.,Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia
| | - Yannick L Gilanyi
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia.,Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia
| | - Susan R G Douglas
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Belinda J Parmenter
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - James H McAuley
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia.,Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia
| | - Matthew D Jones
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia.,Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia
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McLeod KA, Jones MD, Thom JM, Parmenter BJ. Correction: Resistance Training and High-intensity Interval Training Improve Cardiometabolic Health in High Risk Older Adults: A Systematic Review and Meta-anaylsis. Int J Sports Med 2021. [PMID: 34808673 DOI: 10.1055/a-1681-5803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Kelly A McLeod
- Department of Exercise Physiology, School of Health Sciences, Faculty of Medicine & Health, UNSW Sydney, NSW, Australia
| | - Matthew D Jones
- Department of Exercise Physiology, School of Health Sciences, Faculty of Medicine & Health, UNSW Sydney, NSW, Australia
| | - Jeanette M Thom
- Department of Exercise Physiology, School of Health Sciences, Faculty of Medicine & Health, UNSW Sydney, NSW, Australia
| | - Belinda J Parmenter
- Department of Exercise Physiology, School of Health Sciences, Faculty of Medicine & Health, UNSW Sydney, NSW, Australia
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Hansford HJ, Parmenter BJ, McLeod KA, Wewege MA, Smart NA, Schutte AE, Jones MD. The effectiveness and safety of isometric resistance training for adults with high blood pressure: a systematic review and meta-analysis. Hypertens Res 2021; 44:1373-1384. [PMID: 34385688 DOI: 10.1038/s41440-021-00720-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 07/03/2021] [Accepted: 07/11/2021] [Indexed: 02/07/2023]
Abstract
High blood pressure (BP) is a global health challenge. Isometric resistance training (IRT) has demonstrated antihypertensive effects, but safety data are not available, thereby limiting its recommendation for clinical use. We conducted a systematic review of randomized controlled trials comparing IRT to controls in adults with elevated BP (systolic ≥130 mmHg/diastolic ≥85 mmHg). This review provides an update to office BP estimations and is the first to investigate 24-h ambulatory BP, central BP, and safety. Data were analyzed using a random-effects meta-analysis. We assessed the risk of bias with the Cochrane risk of bias tool and the quality of evidence with GRADE. Twenty-four trials were included (n = 1143; age = 56 ± 9 years, 56% female). IRT resulted in clinically meaningful reductions in office systolic (-6.97 mmHg, 95% CI -8.77 to -5.18, p < 0.0001) and office diastolic BP (-3.86 mmHg, 95% CI -5.31 to -2.41, p < 0.0001). Novel findings included reductions in central systolic (-7.48 mmHg, 95% CI -14.89 to -0.07, p = 0.035), central diastolic (-3.75 mmHg, 95% CI -6.38 to -1.12, p = 0.005), and 24-h diastolic (-2.39 mmHg, 95% CI -4.28 to -0.40, p = 0.02) but not 24-h systolic BP (-2.77 mmHg, 95% CI -6.80 to 1.25, p = 0.18). These results are very low/low certainty with high heterogeneity. There was no significant increase in the risk of IRT, risk ratio (1.12, 95% CI 0.47 to 2.68, p = 0.8), or the risk difference (1.02, 95% CI 1.00 to 1.03, p = 0.13). This means that there is one adverse event per 38,444 bouts of IRT. IRT appears safe and may cause clinically relevant reductions in BP (office, central BP, and 24-h diastolic). High-quality trials are required to improve confidence in these findings. PROSPERO (CRD42020201888); OSF ( https://doi.org/10.17605/OSF.IO/H58BZ ).
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Affiliation(s)
- Harrison J Hansford
- Department of Exercise Physiology, School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia. .,Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia.
| | - Belinda J Parmenter
- Department of Exercise Physiology, School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Kelly A McLeod
- Department of Exercise Physiology, School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Michael A Wewege
- Department of Exercise Physiology, School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia.,Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia
| | - Neil A Smart
- School of Science and Technology, University of New England, Armidale, NSW, Australia
| | - Aletta E Schutte
- School of Population Health, University of New South Wales, Sydney, NSW, Australia.,The George Institute for Global Health, Sydney, NSW, Australia
| | - Matthew D Jones
- Department of Exercise Physiology, School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia.,Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia
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McLeod KA, Jones MD, Thom JM, Parmenter BJ. Resistance training and HIIT improve cardiometabolic health in high risk older adults. Int J Sports Med 2021; 43:206-218. [PMID: 34320660 DOI: 10.1055/a-1560-6183] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Progressive resistance training (PRT) and high-intensity interval training (HIIT) improve cardiometabolic health in older adults. Whether combination PRT+HIIT (COMB) provides similar or additional benefit is less clear. This systematic review with meta-analysis of controlled trials examined effects of PRT, HIIT and COMB compared to non-exercise control in older adults with high cardiometabolic risk. Databases were searched until January 2021, with study quality assessed using the PEDro scale. Risk factor data was extracted and analysed using RevMan V.5.3. We analysed 422 participants from nine studies (7 PRT, n=149, 1 HIIT, n=10, 1 COMB, n=60; control n=203; mean age 68.1±1.4 years). Compared to control, exercise improved body mass index (mean difference (MD) -0.33 [-0.47, -0.20], p≤0.0001), body fat % (standardised mean difference (SMD) -0.71 [-1.34, -0.08], p=0.03), aerobic capacity (SMD 0.41 [0.05, 0.78], p=0.03), low-density lipoprotein (SMD -0.27 [-0.52, -0.01], p=0.04), and blood glucose (SMD -0.31 [-0.58, -0.05], p=0.02). Therefore, PRT, HIIT and COMB can improve cardiometabolic health in older adults with cardiometabolic risk. Further research is warranted, particularly in HIIT and COMB, to identify the optimal exercise prescription, if any, for improving older adults cardiometabolic health.
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Affiliation(s)
- Kelly Ann McLeod
- Exercise Physiology, University of New South Wales, Sydney, Australia
| | - Matthew D Jones
- Exercise Physiology, University of New South Wales, Sydney, Australia
| | - Jeanette M Thom
- Exercise Physiology, University of New South Wales, Sydney, Australia
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McLeod KA, Thom JM, Jones MD, Parmenter BJ. Resistance Training And High-intensity Interval Training Improve Cardiometabolic Health In Older Adults: A Meta-analysis. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000671620.92359.9a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Broderick C, Engel AC, Hardy L, Kwai N, Van Doorn N, Ward RE, Parmenter BJ. An Intervention For Fundamental Motor Skills And Physical Activity In Pre-schoolers: A Cluster-randomized Controlled Trial. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000675640.19376.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Parmenter BJ, Gardner LA, Champion KE, Chapman C, Thornton L, McBride N, Sunderland M, Newton NC. Limitations In Knowledge And Practice Of Healthy Lifestyle Guidelines In A Sample Of Australian Adults. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000678580.40034.0d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Golledge J, Leicht AS, Yip L, Rowbotham SE, Pinchbeck J, Jenkins JS, Clapperton R, Dally-Watkins M, Fiatarone Singh MA, Mavros Y, Noble Y, Haghighi MM, Hollings M, Parmenter BJ, Burton NW. Relationship Between Disease Specific Quality of Life Measures, Physical Performance, and Activity in People with Intermittent Claudication Caused by Peripheral Artery Disease. Eur J Vasc Endovasc Surg 2020; 59:957-964. [PMID: 32336621 DOI: 10.1016/j.ejvs.2020.02.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 01/13/2020] [Accepted: 02/07/2020] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The aims of this study were firstly to assess the correlation between disease specific measures of quality of life (QOL) and physical performance and activity, and secondly to identify demographic, clinical, functional, and physical activity measures independently associated with QOL in people with intermittent claudication. METHODS This was a cross sectional observational study of 198 people with intermittent claudication caused by peripheral artery disease who were recruited prospectively. QOL was assessed with the intermittent claudication questionnaire (ICQ) and the eight-theme peripheral artery disease quality of life questionnaire. Physical performance was assessed with the six minute walk test (6MWT) and short physical performance battery (SPPB), and an accelerometer was used to measure seven day step count. The associations between QOL scores and 6MWT distance, SPPB scores and seven day step count were examined using Spearman Rho's (ρ) correlation and multivariable linear regression. RESULTS ICQ scores were significantly correlated with 6MWT distance (ρ = 0.472, p < .001), all four SPPB scores (balance ρ = 0.207, p = .003; gait speed ρ = 0.303, p < .001; chair stand ρ = 0.167, p = .018; total ρ = 0.265, p < .001), and seven day step count (ρ = 0.254, p < .001). PADQOL social relationships and interactions (ρ = 0.343, p < .001) and symptoms and limitations in physical functioning (ρ = 0.355, p < .001) themes were correlated with 6MWT distance. The 6MWT distance was independently positively associated with ICQ and both PADQOL theme scores (ICQ: B 0.069, p < .001; PADQOL social relationships and interactions: B 0.077, p < .001; PADQOL symptoms and limitations in physical functioning: B 0.069, p < .001). CONCLUSION Longer 6MWT distance independently predicted better physical and social aspects of QOL in people with intermittent claudication supporting its value as an outcome measure.
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Affiliation(s)
- Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Australian Institute of Tropical Medicine, Townsville, Queensland, Australia; The Department of Vascular and Endovascular Surgery, The Townsville Hospital, Townsville, Queensland, Australia.
| | - Anthony S Leicht
- Sport and Exercise Science, James Cook University, Townsville, Queensland, Australia
| | - Lisan Yip
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Australian Institute of Tropical Medicine, Townsville, Queensland, Australia
| | - Sophie E Rowbotham
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Australian Institute of Tropical Medicine, Townsville, Queensland, Australia; The University of Queensland, UQ Centre for Clinical Research, Herston, QLD, 4029, Australia; Department of Vascular Surgery, The Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Jenna Pinchbeck
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Australian Institute of Tropical Medicine, Townsville, Queensland, Australia
| | - Jason S Jenkins
- Department of Vascular Surgery, The Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Roslyn Clapperton
- The University of Queensland, UQ Centre for Clinical Research, Herston, QLD, 4029, Australia; Department of Vascular Surgery, The Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Matthew Dally-Watkins
- The University of Queensland, UQ Centre for Clinical Research, Herston, QLD, 4029, Australia; Department of Vascular Surgery, The Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Maria A Fiatarone Singh
- Physical Activity, Lifestyle, Ageing and Wellbeing Faculty Research Group, The University of Sydney School of Health Sciences, Faculty of Medicine and Health, Lidcombe, New South Wales, Australia; Hinda and Arthur Marcus Institute for Ageing Research, Boston, MA, USA
| | - Yorgi Mavros
- Physical Activity, Lifestyle, Ageing and Wellbeing Faculty Research Group, The University of Sydney School of Health Sciences, Faculty of Medicine and Health, Lidcombe, New South Wales, Australia
| | - Yian Noble
- Physical Activity, Lifestyle, Ageing and Wellbeing Faculty Research Group, The University of Sydney School of Health Sciences, Faculty of Medicine and Health, Lidcombe, New South Wales, Australia
| | - Marjan M Haghighi
- Physical Activity, Lifestyle, Ageing and Wellbeing Faculty Research Group, The University of Sydney School of Health Sciences, Faculty of Medicine and Health, Lidcombe, New South Wales, Australia
| | - Matthew Hollings
- Physical Activity, Lifestyle, Ageing and Wellbeing Faculty Research Group, The University of Sydney School of Health Sciences, Faculty of Medicine and Health, Lidcombe, New South Wales, Australia
| | - Belinda J Parmenter
- Department of Exercise Physiology, School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Nicola W Burton
- School of Applied Psychology, Griffith University, Brisbane, Queensland, Australia
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Farah BQ, Christofaro DGD, Correia MA, Oliveira CB, Parmenter BJ, Ritti-Dias RM. Effects of isometric handgrip training on cardiac autonomic profile: A systematic review and meta-analysis study. Clin Physiol Funct Imaging 2020; 40:141-147. [PMID: 31971353 DOI: 10.1111/cpf.12619] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 01/17/2020] [Indexed: 01/23/2023]
Abstract
Meta-analyses have shown that isometric handgrip training reduces blood pressure in normotensive and hypertensive subjects. However, the effects on cardiac autonomic modulation are still controversial. Thus, the aim of this systematic review and meta-analysis was to analyse the effects of isometric handgrip training on cardiac autonomic modulation in normotensive and hypertensive subjects. For this, Medline, Cinhal, Embase, Spordiscus and PEdro were searched for relevant studies published until December 2018. Randomized controlled trials investigating the effect of isometric handgrip training on heart rate variability parameters were considered eligible. Parameters were obtained in time (standard deviation of all the RR intervals-SDNN, root mean square of successive differences between the normal adjacent RR intervals-RMSSD and the percentage of adjacent intervals with more than 50 ms-PNN50) and frequency domain (low frequency-LF, high frequency-HF and sympathovagal balance-LF/HF). Mean difference (MD) and 95% confidence interval (95% CI) were calculated using an inverse variance method with a random effects model. Seven trials were included in the systematic review and meta-analysis, totalling 86 participants. No significant effect was observed in heart rate variability parameters after isometric handgrip training (4 trials to SDNN: MD = -1.44 ms and 95% CI = -8.02, 5.14 ms; RMSSD: MD = -1.48 ms and 95% CI = -9.41, 6.45 ms; PNN50: MD = 0.85% and 95% CI = -1.10, 2.81%; 7 trials to LF: -0.17 n.u. and 95% CI = -6.32, 5.98 n.u.; HF: MD = 0.17 n.u. and 95% CI = -5.97, 6.30 n.u.; and LF/HF: MD = 0.13 and 95% CI = -0.34, 0.59). In conclusion, current literature indicates that isometric handgrip training does not improve heart rate variability.
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Affiliation(s)
- Breno Q Farah
- Department of Physical Education, Universidade Federal Rural de Pernambuco, Recife, Brazil
| | - Diego G D Christofaro
- Department of Physical Education, Universidade Estadual Paulista (UNESP), Presidente Prudente, Brazil
| | | | - Crystian B Oliveira
- Department of Physical Education, Universidade Estadual Paulista (UNESP), Presidente Prudente, Brazil
| | - Belinda J Parmenter
- Department of Exercise Physiology, Faculty of Medicine, UNSW Sydney, Sydney, NSW, Australia
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Parmenter BJ, Mavros Y, Ritti Dias R, King S, Fiatarone Singh M. Resistance training as a treatment for older persons with peripheral artery disease: a systematic review and meta-analysis. Br J Sports Med 2019; 54:452-461. [PMID: 30979698 DOI: 10.1136/bjsports-2018-100205] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2019] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Resistance training (RT) improves walking ability in persons with peripheral artery disease. We conducted a meta-analysis of randomised controlled trials (RCTs) investigating the effect of RT on peripheral artery disease (as measured by walking ability). DESIGN We included RCTs that investigated the effect of RT on treadmill and/or 6 min walk (6-MWT) distances. RT intensity was assessed according to the American College of Sports Medicine guidelines by 1 repetition maximum or rating of perceived exertion. Standardised mean (SMD) and mean differences (MD) were calculated using a random-effects inverse variance model. Heterogeneity and bias were assessed using RevMan V.5.3. Meta-regression and meta-analysis of variance were performed as moderator analyses. DATA SOURCES Databases (Medline, Embase, Web of Science, Cinahl and Google Scholar) were searched until July 2018. RESULTS Fifteen trials isolated RT; 7 trials compared RT with aerobic exercise. We analysed 826 patients (n=363 completing RT), with a mean age of 67.1±3.8 years. Training ranged from low-high intensity, 2-7 times per week for 17±7 weeks, with a mix of upper, lower or whole body training. Overall RT significantly improved constant load treadmill claudication onset (COD) (SMD 0.66 [0.40, 0.93], p<0.00001) and total walking distance (WD) (SMD 0.51 [0.23, 0.79], p=0.0003), progressive treadmill COD (SMD 0.56 [0.00, 1.13], p=0.05) and total WD (SMD 0.45 [0.08, 0.83], p=0.02), and 6-MWT COD (MD 82.23 m [40.91, 123.54], p<0.0001). Intensity played a role in improvement, with high-intensity training yielding the greatest improvement (p=0.02). CONCLUSIONS RT clinically improved treadmill and flat ground walking ability in persons with peripheral artery disease. Higher intensity training was associated with better outcomes. Our study makes a case for clinicians to include high-intensity lower body RT in the treatment of peripheral artery disease. TRIAL REGISTRATION NUMBER CRD42017081184.
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Affiliation(s)
- Belinda J Parmenter
- Department of Exercise Physiology, School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Yorgi Mavros
- Physical Activity, Lifestyle, Ageing and Wellbeing Faculty Research Group, Faculty of Health Sciences, Sydney Medical School, University of Sydney, Lidcombe, New South Wales, Australia
| | - Raphael Ritti Dias
- Programa de Pós-Graduação em Ciências da Reabilitação, Universidade Nove de Julho, Sao Paulo, Brazil
| | - Stephanie King
- Sport, Health and Exercise Sciences, University of Hull, Hull, United Kingdom
| | - Maria Fiatarone Singh
- Physical Activity, Lifestyle, Ageing and Wellbeing Faculty Research Group, Faculty of Health Sciences, Sydney Medical School, University of Sydney, Lidcombe, New South Wales, Australia.,Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School and Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, United States
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Wewege MA, Booth J, Parmenter BJ. Aerobic vs. resistance exercise for chronic non-specific low back pain: A systematic review and meta-analysis. J Back Musculoskelet Rehabil 2019; 31:889-899. [PMID: 29889056 DOI: 10.3233/bmr-170920] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND/OBJECTIVE This meta-analysis compared progressive aerobic training (PAT) to progressive resistance training (PRT) for pain, disability and quality of life (QoL) in people with chronic non-specific low back pain (CNSLBP). METHODS Five electronic databases were systematically searched up to 1 March 2016. Randomised controlled trials included land-based PAT, PRT or combined PRT and PAT, versus usual care for CNSLBP. Exercise interventions were supervised a minimum of once per week and performed ⩾ 2 days/week for ⩾ 6 weeks. Outcome measurements were pain intensity, disability, and QoL. Standardised mean difference (SMD) and mean difference (MD) were calculated using Review Manager 5.3. RESULTS Six studies were included, comprising 333 participants (94 PRT, 93 PAT, 146 usual care; 66% female; age = 44 ± 6 years; duration of pain = 7 ± 6 years). Exercise significantly reduced pain intensity (SMD =-0.42 [-0.80, -0.03]; p< 0.03) although neither mode proved superior. PRT significantly improved the Short Form Health Survey-Mental Component Score (SF-MCS) (MD = 5.74 [2.02, 9.47]; p= 0.002). CONCLUSIONS PAT and PRT decreased pain intensity in individuals with CNSLBP although neither mode was superior. Resistance exercise improved psychological wellbeing. High-quality RCTs comparing PAT, PRT, and PAT + PRT, are required.
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Wewege MA, Thom JM, Rye KA, Parmenter BJ. Aerobic, resistance or combined training: A systematic review and meta-analysis of exercise to reduce cardiovascular risk in adults with metabolic syndrome. Atherosclerosis 2018; 274:162-171. [PMID: 29783064 DOI: 10.1016/j.atherosclerosis.2018.05.002] [Citation(s) in RCA: 102] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 03/19/2018] [Accepted: 05/01/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND AIMS Exercise is beneficial to individuals with metabolic syndrome (MetS). An understudied group, who represent the majority of the MetS population, are individuals who have not developed diabetes. This review examined aerobic, resistance and combined (aerobic + resistance) exercise for cardiovascular risk factors in MetS without diabetes. METHODS Eight electronic databases were searched up to September 2017 for randomised controlled trials >4 weeks in duration that compared an exercise intervention to the non-exercise control in MetS without diabetes. MetS criteria, cardiorespiratory fitness and cardiovascular risk factors were meta-analysed in a random effects model. RESULTS Eleven studies with 16 interventions were included (12 aerobic, 4 resistance). Aerobic exercise significantly improved waist circumference -3.4 cm (p < 0.01), fasting glucose -0.15 mmol/L (p = 0.03), high-density cholesterol 0.05 mmol/L (p = 0.02), triglycerides -0.29 mmol/L (p < 0.01), diastolic blood pressure -1.6 mmHg (p = 0.01), and cardiorespiratory fitness 4.2 ml/kg/min (p < 0.01), among other outcomes. No significant effects were determined following resistance exercise possibly due to limited data. Sub-analyses suggested that aerobic exercise progressed to vigorous intensity, and conducted 3 days/week for ≥12 weeks offered larger and more widespread improvements. CONCLUSIONS Aerobic exercise following current guidelines offers widespread benefits to individuals with MetS without diabetes. More studies on resistance/combined exercise programs in MetS are required to improve the quality of evidence.
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Affiliation(s)
- Michael A Wewege
- School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.
| | - Jeanette M Thom
- School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Kerry-Anne Rye
- School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Belinda J Parmenter
- School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
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Engel AC, Broderick CR, van Doorn N, Hardy LL, Parmenter BJ. Exploring the Relationship Between Fundamental Motor Skill Interventions and Physical Activity Levels in Children: A Systematic Review and Meta-analysis. Sports Med 2018; 48:1845-1857. [DOI: 10.1007/s40279-018-0923-3] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Champion KE, Newton NC, Spring B, Wafford QE, Parmenter BJ, Teesson M. A systematic review of school-based eHealth interventions targeting alcohol use, smoking, physical inactivity, diet, sedentary behaviour and sleep among adolescents: a review protocol. Syst Rev 2017; 6:246. [PMID: 29208040 PMCID: PMC5717802 DOI: 10.1186/s13643-017-0645-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 11/24/2017] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Six key behavioural risk factors (risky alcohol use, smoking, poor diet, physical inactivity, sedentary behaviour and unhealthy sleep patterns) have been identified as strong determinants of chronic disease, such as cardiovascular disease, diabetes and cancers. School-based interventions targeting these multiple health risk behaviours among adolescents have the potential to halt the trajectory towards later disease, whilst online and mobile technology interventions offer advantages in terms of student engagement, reach and scalability. Despite this, the efficacy of eHealth school-based interventions targeting these six health risk behaviours among adolescents has not been evaluated. The proposed systematic review aims to address this by determining the nature and efficacy of existing eHealth school-based interventions targeting multiple health risk behaviours among adolescents. METHODS A systematic search of the MEDLINE, Embase, PsycINFO and Cochrane Library databases will be conducted to identify eligible published papers. Eligible studies will be randomised controlled trials, including cluster randomised controlled trials, of interventions targeting two or more of the following lifestyle risk behaviours: alcohol use, smoking, poor diet, physical inactivity, sedentary behaviour and sleep. Eligible studies will be those evaluating interventions delivered in a secondary school setting among participants 11-18 years of age, via an eHealth platform (Internet, computers of mobile technology). Two reviewers will independently screen studies for eligibility, extract data and assess the risk of bias. Study outcomes will be summarised in a narrative synthesis, and meta-analyses will be conducted where it is appropriate to combine studies. DISCUSSION It is anticipated that the results from this review will serve to inform the development of future eHealth multiple health behaviour interventions for adolescents by identifying common characteristics of effective programs and highlighting knowledge gaps in the evidence base. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42017072163.
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Affiliation(s)
- Katrina E Champion
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA. .,NHMRC Centre of Research Excellence in Mental Health and Substance Use, NDARC, UNSW Sydney, Sydney, NSW, Australia.
| | - Nicola C Newton
- NHMRC Centre of Research Excellence in Mental Health and Substance Use, NDARC, UNSW Sydney, Sydney, NSW, Australia
| | - Bonnie Spring
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA
| | - Q Eileen Wafford
- Galter Health Sciences Library, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Maree Teesson
- NHMRC Centre of Research Excellence in Mental Health and Substance Use, NDARC, UNSW Sydney, Sydney, NSW, Australia
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18
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Chow JJ, Thom JM, Wewege MA, Ward RE, Parmenter BJ. Accuracy of step count measured by physical activity monitors: The effect of gait speed and anatomical placement site. Gait Posture 2017; 57:199-203. [PMID: 28666177 DOI: 10.1016/j.gaitpost.2017.06.012] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 05/04/2017] [Accepted: 06/19/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Consumer-based physical activity monitors (PAMs) are becoming increasingly popular, with multiple global organisations recommending physical activity levels that equate to 10,000 steps per day for optimal health. We therefore aimed to compare the step count of five PAMs to a visual step count to identify the most accurate monitors at varying gait speeds, along with the optimal anatomical placement site. METHODS Participants completed 3min on a treadmill for five speeds (5.0km/h, 6.5km/h, 8.0km/h, 10km/h, 12km/h). An Actigraph wGT3XBT-BT was placed on the waist and wrist, a FitBit One on the waist, and a Fitbit Flex, Fitbit Charge HR and Jawbone UP24 on both wrists. A video of participant's lower limbs was recorded for visual count. Analyses of variance (ANOVAs) were conducted to examine the effects of gait speed and device placement site on step count accuracy. RESULTS Thirty-one participants (mean age 24.3±5.2yrs) took part. Step count error ranged from 41.3±13.8% for the wrist-worn Actigraph to only 0.04±4.3% and -0.3±4.0% for the waist-worn Fitbit One and Actigraph, respectively. Across all gait speeds, waist-worn devices achieved better accuracy than those on the wrist (p<0.001). The Jawbone was the most accurate wrist-worn consumer-based device at slower speeds (p=0.026), with the Fitbit Flex, and Fitbit Charge HR increasing in accuracy to match the Jawbone at higher speeds. CONCLUSION The accuracy and reliability of consumer-based PAMs and the Actigraph is affected by anatomical placement site and walking speed. The Fitbit One and Actigraph on the waist were the strongest performers across all speeds.
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Affiliation(s)
- Jessica J Chow
- Department of Exercise Physiology, School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.
| | - Jeanette M Thom
- Department of Exercise Physiology, School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.
| | - Michael A Wewege
- Department of Exercise Physiology, School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.
| | - Rachel E Ward
- Department of Exercise Physiology, School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.
| | - Belinda J Parmenter
- Department of Exercise Physiology, School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.
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Giuliano C, Parmenter BJ, Baker MK, Mitchell BL, Williams AD, Lyndon K, Mair T, Maiorana A, Smart NA, Levinger I. Cardiac Rehabilitation for Patients With Coronary Artery Disease: A Practical Guide to Enhance Patient Outcomes Through Continuity of Care. Clin Med Insights Cardiol 2017. [PMID: 28638244 PMCID: PMC5470863 DOI: 10.1177/1179546817710028] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Coronary artery disease (CAD) is a leading cause of disease burden worldwide. Referral to cardiac rehabilitation (CR) is a class I recommendation for all patients with CAD based on findings that participation can reduce cardiovascular and all-cause mortality, as well as improve functional capacity and quality of life. However, programme uptake remains low, systematic progression through the traditional CR phases is often lacking, and communication between health care providers is frequently suboptimal, resulting in fragmented care. Only 30% to 50% of eligible patients are typically referred to outpatient CR and fewer still complete the programme. In contemporary models of CR, patients are no longer treated by a single practitioner, but rather by an array of health professionals, across multiples specialities and health care settings. The risk of fragmented care in CR may be great, and a concerted approach is required to achieve continuity and optimise patient outcomes. ‘Continuity of care’ has been described as the delivery of services in a coherent, logical, and timely fashion and which entails 3 specific domains: informational, management, and relational continuity. This is examined in the context of CR.
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Affiliation(s)
- Catherine Giuliano
- Institute of Sport, Exercise and Active Living (ISEAL), Victoria University, Melbourne, VIC, Australia
| | - Belinda J Parmenter
- Department of Exercise Physiology, School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Michael K Baker
- Australian Catholic University School of Exercise Science, Strathfield, NSW Australia
| | - Braden L Mitchell
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Sansom Institute for Health Research, University of South Australia, Adelaide, SA, Australia
| | - Andrew D Williams
- School of Health Sciences, University of Tasmania, Launceston, TAS, Australia
| | - Katie Lyndon
- Exercise & Sports Science Australia, Albion, QLD, Australia
| | - Tarryn Mair
- Division of Medicine, Exercise Physiology Department, ACT Health, Canberra, ACT, Australia
| | - Andrew Maiorana
- School of Physiotherapy and Exercise, Science, Curtin University, Perth, WA, Australia.,Allied Health Department and Advanced Heart Failure and Cardiac Transplant Service, Fiona Stanley Hospital, Perth, WA, Australia
| | - Neil A Smart
- School of Science and Technology, University of New England, Armidale, NSW, Australia
| | - Itamar Levinger
- Institute of Sport, Exercise and Active Living (ISEAL), Victoria University, Melbourne, VIC, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), Victoria University and Western Health, St. Albans, VIC, Australia
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20
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Van Capelle A, Broderick CR, van Doorn N, E Ward R, Parmenter BJ. Interventions to improve fundamental motor skills in pre-school aged children: A systematic review and meta-analysis. J Sci Med Sport 2017; 20:658-666. [PMID: 28169146 DOI: 10.1016/j.jsams.2016.11.008] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 10/27/2016] [Accepted: 11/01/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Mastery in -fundamental motor skills (FMS) is associated with increased physical activity (PA) in school-aged children; however, there is limited research on pre-schoolers (3-5 years). We aimed to evaluate interventions for improving FMS as well as PA. DESIGN/METHODS A search of electronic databases was conducted for controlled trials using PA interventions with FMS as outcomes in healthy pre-schoolers. Standardised mean difference (SMD), 95% confidence intervals and publication bias were calculated for each outcome using Revman 5.3. RESULTS Twenty trials met inclusion criteria. In total, 4255 pre-schoolers were analysed with 854 completing a FMS intervention. Studies were categorised into three groups (i) Teacher-Led (TL)(n=13); (ii) Child-Centred (CC)(n=6) and (iii) Parent-Led (PL)(n=1). Mean age was 4.3±0.4 years, with equal gender distribution. Interventions ran for 21±17 weeks, 3±1 times per week for 35±17 minutes. TL interventions significantly improved overall FMS (SMD=0.14[0.06, 0.21]; p=0.0003), object control (SMD=0.47[0.15, 0.80]; p= 0.004), and locomotor skills (SMD=0.44[0.16, 0.73]; p=0.002), whereas CC interventions were not significant. There was a small, non-significant reduction in sedentary time (SMD=-0.35[-0.80, 0.10]; p= 0.12), and a large non-significant increase in PA (SMD=0.79[-0.83, 2.41]; p=0.34). CONCLUSION PA interventions improve FMS in pre-schoolers; however, due to limited research, more study is needed on CC interventions. Targeting FMS development in pre-schoolers may promote higher PA levels and reduce sedentary time, however more study is needed.
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Affiliation(s)
- Abbey Van Capelle
- Department of Exercise Physiology, School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Carolyn R Broderick
- Department of Exercise Physiology, School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, Australia; Children's Hospital Institute of Sports Medicine, The Children's Hospital at Westmead, Sydney, Australia
| | - Nancy van Doorn
- Department of Exercise Physiology, School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, Australia; Children's Hospital Institute of Sports Medicine, The Children's Hospital at Westmead, Sydney, Australia
| | - Rachel E Ward
- Department of Exercise Physiology, School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Belinda J Parmenter
- Department of Exercise Physiology, School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, Australia.
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Burton NW, Ademi Z, Best S, Fiatarone Singh MA, Jenkins JS, Lawson KD, Leicht AS, Mavros Y, Noble Y, Norman P, Norman R, Parmenter BJ, Pinchbeck J, Reid CM, Rowbotham SE, Yip L, Golledge J. Efficacy of brief behavioral counselling by allied health professionals to promote physical activity in people with peripheral arterial disease (BIPP): study protocol for a multi-center randomized controlled trial. BMC Public Health 2016; 16:1148. [PMID: 27829449 PMCID: PMC5103607 DOI: 10.1186/s12889-016-3801-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 11/01/2016] [Indexed: 01/24/2023] Open
Abstract
Background Physical activity is recommended for people with peripheral arterial disease (PAD), and can improve walking capacity and quality of life; and reduce pain, requirement for surgery and cardiovascular events. This trial will assess the efficacy of a brief behavioral counselling intervention delivered by allied health professionals to improve physical activity in people with PAD. Methods This is a multi-center randomised controlled trial in four cities across Australia. Participants (N = 200) will be recruited from specialist vascular clinics, general practitioners and research databases and randomised to either the control or intervention group. Both groups will receive usual medical care, a written PAD management information sheet including advice to walk, and four individualised contacts from a protocol-trained allied health professional over 3 months (weeks 1, 2, 6, 12). The control group will receive four 15-min telephone calls with general discussion about PAD symptoms and health and wellbeing. The intervention group will receive behavioral counselling via two 1-h face-to-face sessions and two 15-min telephone calls. The counselling is based on the 5A framework and will promote interval walking for 3 × 40 min/week. Assessments will be conducted at baseline, and 4, 12 and 24 months by staff blinded to participant allocation. Objectively assessed outcomes include physical activity (primary), sedentary behavior, lower limb body function, walking capacity, cardiorespiratory fitness, event-based claudication index, vascular interventions, clinical events, cardiovascular function, circulating markers, and anthropometric measures. Self-reported outcomes include physical activity and sedentary behavior, walking ability, pain severity, and health-related quality of life. Data will be analysed using an intention-to-treat approach. An economic evaluation will assess whether embedding the intervention into routine care would likely be value for money. A cost-effectiveness analysis will estimate change in cost per change in activity indicators due to the intervention, and a cost-utility analysis will assess change in cost per quality-adjusted life year. A full uncertainty analysis will be undertaken, including a value of information analysis, to evaluate the economic case for further research. Discussion This trial will evaluate the efficacy and cost-effectiveness of a brief behavioral counselling intervention for a common cardiovascular disease with significant burden. Trial registration ACTRN 12614000592640 Australian New Zealand Clinical Trials Registry. Registration Date 4 June 2014. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3801-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nicola W Burton
- The University of Queensland School of Human Movement & Nutrition Sciences, St Lucia, Brisbane, QLD, 4072, Australia
| | - Zanfina Ademi
- University of Basel Institute of Pharmaceutical Medicine, Basel, Switzerland.,University of Monash Department of Epidemiology and Preventive Medicine, Melbourne, 3004, VIC, Australia
| | - Stuart Best
- Queensland Research Centre for Peripheral Vascular Disease; College of Medicine and Dentistry, James Cook University, Townsville, QLD, 4811, Australia
| | - Maria A Fiatarone Singh
- Exercise, Health and Performance Faculty Research Group, Faculty of Health Sciences, University of Sydney, Sydney, NSW, 2141, Australia
| | - Jason S Jenkins
- Vascular Surgery The Royal Brisbane and Women's Hospital, Herston, QLD, 4059, Australia
| | - Kenny D Lawson
- Centre for Health Research, School of Medicine, Western Sydney University, Sydney, NSW, 2753, Australia.,Centre for Research Excellence in Chronic Disease Prevention, Australian Institute for Public Health and Tropical Health and Medicine, James Cook University, Townsville, QLD, 4811, Australia
| | - Anthony S Leicht
- Sport and Exercise Science, College of Healthcare Sciences, James Cook University, Townsville, QLD, 4811, Australia
| | - Yorgi Mavros
- Exercise, Health and Performance Research Group, Faculty of Health Sciences, University of Sydney, Sydney, NSW, 2141, Australia
| | - Yian Noble
- Exercise, Health and Performance Research Group, Faculty of Health Sciences, University of Sydney, Sydney, NSW, 2141, Australia
| | - Paul Norman
- Surgery Fremantle Hospital, The University of Western Australia, Crawley, WA, 6009, Australia
| | - Richard Norman
- School of Public Health, Curtin University, Perth, WA, 6845, Australia
| | - Belinda J Parmenter
- Department of Exercise Physiology, Faculty of Medicine, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Jenna Pinchbeck
- Queensland Research Centre for Peripheral Vascular Disease; College of Medicine and Dentistry, James Cook University, Townsville, QLD, 4811, Australia
| | - Christopher M Reid
- School of Public Health, Curtin University, Perth, WA, 6845, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Sophie E Rowbotham
- The University of Queensland School of Medicine, Herston, QLD, 4006, Australia.,The Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia
| | - Lisan Yip
- Queensland Research Centre for Peripheral Vascular Disease; College of Medicine and Dentistry, James Cook University, Townsville, QLD, 4811, Australia
| | - Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease; College of Medicine and Dentistry, James Cook University, Townsville, QLD, 4811, Australia. .,Department of Vascular and Endovascular Surgery, The Townsville Hospital, Townsville, QLD, 4811, Australia.
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Chow JJ, Ward RE, Thom JM, Parmenter BJ. Validating The Latest Commercial Physical Activity Monitors. Med Sci Sports Exerc 2016. [DOI: 10.1249/01.mss.0000485994.58432.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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May AEP, Parmenter BJ. Physical Activity Monitors as Interventions for Reducing Blood Pressure in Hypertensives. Med Sci Sports Exerc 2016. [DOI: 10.1249/01.mss.0000485224.87989.d7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Parmenter BJ, Dieberg G, Smart NA. Authors’ Reply to Li et al.: “Alternative Statistical Analysis Shows Exercise Training-Induced Improvements in Peak VO2 are Clinically Significant”. Sports Med 2015; 45:767-8. [DOI: 10.1007/s40279-015-0316-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Parmenter BJ, Dieberg G, Phipps G, Smart NA. Exercise training for health-related quality of life in peripheral artery disease: A systematic review and meta-analysis. Vasc Med 2014; 20:30-40. [DOI: 10.1177/1358863x14559092] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
We sought to quantify whether health-related quality of life (HRQoL) is improved through exercise training in people with peripheral artery disease (PAD) and to clarify which prescriptions were optimal for improving HRQoL when compared to usual care. We conducted a systematic search (PubMed, CINAHL, Cochrane Central Register of Controlled Trials; 1966 – 31 August 2014). We only included randomized controlled trials (RCTs) of exercise training versus usual medical care in persons with PAD that included the Walking Impairment Questionnaire (WIQ) and Short-Form Health Survey component summary scores as outcomes. Of 15 RCTs, 1257 participants were studied: 543 participated in supervised exercise, with only 61 undertaking resistance training and 316 unsupervised exercise. When compared to controls, participants who completed any form of exercise training significantly improved their WIQ speed [mean difference (MD) 9.60 (95% CI 6.98 to 12.23, p<0.00001)]; WIQ distance [MD 7.41 (95% CI 4.49 to 10.33, p<0.00001)] and WIQ stair-climbing [MD 5.07 (95% CI 3.16 to 6.99, p<0.00001)]. Walking also significantly improved the Short-Form Physical Component Summary (SF-PCS) score when compared to controls [MD 1.24 (95% CI 0.48 to 2.01, p=0.001)], but not the Mental Component Summary (SF-MCS) score [MD –0.55 (95% CI –1.27 to 0.18, p=0.14)]. Exercise training improves the SF-PCS dimension, as well as perceived walking distance, speed and stair-climbing as measured by the WIQ, but not the SF-MCS score. Future studies should aim to blind assessors of such subjective measures, and study alternative modes and prescriptions of exercise alternative to walking.
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Affiliation(s)
- Belinda J Parmenter
- Department of Exercise Physiology, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Gudrun Dieberg
- School of Science & Technology, University of New England, Armidale, NSW, Australia
| | - Glenn Phipps
- School of Science & Technology, University of New England, Armidale, NSW, Australia
| | - Neil A Smart
- School of Science & Technology, University of New England, Armidale, NSW, Australia
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Parmenter BJ, Dieberg G, Smart NA. Exercise Training for Management of Peripheral Arterial Disease: A Systematic Review and Meta-Analysis. Sports Med 2014; 45:231-44. [DOI: 10.1007/s40279-014-0261-z] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Parmenter BJ, Raymond J, Dinnen P, Lusby RJ, Fiatarone Singh MA. Response to Raphael Mendes Ritti Dias. J Am Geriatr Soc 2014; 62:996-7. [PMID: 24828940 DOI: 10.1111/jgs.12803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Belinda J Parmenter
- Exercise, Health and Performance Faculty Research Group, Faculty of Health Sciences, Exercise Physiology Unit, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
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Parmenter BJ, Raymond J, Fiatarone Singh MA. The effect of exercise on fitness and performance-based tests of function in intermittent claudication: a systematic review. Sports Med 2014; 43:513-24. [PMID: 23539309 DOI: 10.1007/s40279-013-0038-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND OBJECTIVE Exercise is a widely accepted treatment known to improve walking ability in persons with peripheral arterial disease (PAD); however, it has not been confirmed as to whether exercise improves fitness and performance-based function and, consequently, performance of activities of daily living (ADL). This systematic review aims to identify whether any mode of structured exercise improves physical fitness or performance-based tests of function and whether improvement in walking ability is related to an improvement in these outcomes. DATA SOURCES AND STUDY SELECTION Eligible studies included randomized controlled trials (RCTs) using an exercise intervention for the treatment of intermittent claudication with fitness (including the 6-min walk (6MW), aerobic capacity, shuttle and muscle strength) tests and performance-based tests of function as the outcomes. STUDY APPRAISAL AND METHODS: Assessment of study quality was performed using a modified version of the Physiotherapy Evidence Database Scale (PEDro). Relative effect sizes, mean differences (MDs) and 95 % confidence intervals were calculated and adjusted via Hedges' bias-corrected for small sample sizes. Regression analyses were performed to establish relationships between walking ability and fitness outcomes. RESULTS Twenty-four RCTs met the inclusion criteria: 19 aerobic training interventions and 5 progressive resistance training (PRT). In total 924 participants (71 % male) were studied; with few participants over 75 years of age and the mean ankle brachial index was mean ± standard deviation (SD) 0.66 ± 0.06. The most common outcome measured was aerobic capacity (52 % of trials), which improved by 8.3 % ± 8.7 % on average. Although there were no significant relationships, up to 16 % of the variance in walking distances can be explained by changes in walking economy. Muscle strength was measured in only five trials, improving by 42 % ± 74 % on average. There was a strong significant relationship between change in plantar flexor muscle strength and change in initial claudication time (r = 0.99; p = 0.001) and absolute claudication time (r = 0.75; p = 0.05) measured on a treadmill across trials measuring this muscle group. The 6MW distance was measured in only 14 % of trials. Walking and PRT significantly improved 6MW initial claudication distance (MD range 52-129 m) and total walking distance (MD range 36-108 m) in studies that measured this outcome. Only one trial assessed performance-based tests of function, and they did not improve significantly. CONCLUSION Although data are limited, there is a strong significant relationship between plantar flexor muscle strength and treadmill walking ability. More research is needed to assess improvements in walking economy at specific timepoints and whether this translates to improvements in claudication outcomes and measurements pertaining to muscle strength. Future trials should focus on interventions that improve lower limb muscle strength and assess muscle strength, power and endurance across a variety of lower extremity muscle groups in order to understand these relationships further. The 6MW, muscle strength and performance-based tests of function such as chair stand, balance scale, stair climb and gait speed are understudied in PAD. Future trials should examine the effects of exercise on performance-based tests of function, which may predict actual ADL performance and incident disability.
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Affiliation(s)
- Belinda J Parmenter
- Exercise, Health and Performance Faculty Research Group, Faculty of Health Sciences, University of Sydney, Sydney, NSW, Australia.
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Parmenter BJ, Raymond J, Dinnen P, Lusby RJ, Fiatarone Singh MA. High-Intensity Progressive Resistance Training Improves Flat-Ground Walking in Older Adults with Symptomatic Peripheral Arterial Disease. J Am Geriatr Soc 2013; 61:1964-70. [DOI: 10.1111/jgs.12500] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Belinda J. Parmenter
- Exercise, Health and Performance Faculty Research Group; Faculty of Health Sciences; University of Sydney; Lidcombe New South Wales Australia
- Exercise Physiology Unit; Faculty of Medicine; University of New South Wales; Kensington New South Wales Australia
| | - Jacqueline Raymond
- Exercise, Health and Performance Faculty Research Group; Faculty of Health Sciences; University of Sydney; Lidcombe New South Wales Australia
| | - Paul Dinnen
- Gold Coast Vascular Centre; Ashmore Queensland Australia
| | - Robert J. Lusby
- Sydney Medical School; University of Sydney; Sydney New South Wales Australia
| | - Maria A. Fiatarone Singh
- Exercise, Health and Performance Faculty Research Group; Faculty of Health Sciences; University of Sydney; Lidcombe New South Wales Australia
- Sydney Medical School; University of Sydney; Sydney New South Wales Australia
- Hebrew SeniorLife; and Jean Mayer USDA Human Nutrition Research Center on Aging; Tufts University; Boston Massachusetts
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Parmenter BJ, Raymond J, Dinnen P, Singh MAF. A systematic review of randomized controlled trials: Walking versus alternative exercise prescription as treatment for intermittent claudication. Atherosclerosis 2011; 218:1-12. [DOI: 10.1016/j.atherosclerosis.2011.04.024] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Revised: 04/09/2011] [Accepted: 04/26/2011] [Indexed: 10/18/2022]
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Parmenter BJ, Raymond J, Fiatarone Singh MA. The effect of exercise on haemodynamics in intermittent claudication: a systematic review of randomized controlled trials. Sports Med 2010; 40:433-47. [PMID: 20433214 DOI: 10.2165/11531330-000000000-00000] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Changes in lower limb haemodynamics such as arterial pressure and/or flow have often been, and continue to be, cited as possible mechanisms for the improvement in walking performance that occurs with exercise training in individuals with peripheral arterial disease (PAD), but data are conflicting in this regard. There are a small number of literature reviews examining the effects of exercise on PAD, however, there has been insufficient analysis synthesizing possible mechanisms of effect, overall benefits and limitations of these trials. Our objective was therefore to systematically review the evidence for the effect of exercise on lower limb haemodynamic measures of resting and post-exercise ankle brachial index (ABI), resting toe pressure, and resting and reactive hyperaemic calf blood flow in PAD. A systematic search of studies published between 1934 and March 2010 was conducted using MEDLINE, EMBASE, AMED, SportDiscus, CINAHL, PEDro, Premedline, Google Scholar and Web of Knowledge databases. Eligible studies included randomized controlled trials using an exercise intervention for the treatment of intermittent claudication with haemodynamic measures of disease severity as outcomes. Relative effect sizes (ESs) and 95% confidence intervals were calculated for outcomes. Correlation and regression analyses were performed to establish relationships between symptoms and haemodynamic outcomes. Thirty-three trials including 1237 subjects with mild to moderate claudication met the eligibility criteria. Exercise did not significantly change lower extremity haemodynamics in most trials; nor were clinical improvements related to changes in resting ABI (mean ES 0.09 +/- 0.26; r = 0.02; p = 0.94), post-exercise ABI (mean ES 0.18 +/- 0.3; r = -0.33; p = 0.52) or reactive hyperaemic calf blood flow (mean ES 0.38 +/- 0.67; r = 0.35; p = 0.26). A relationship may exist between a change in symptoms and changes in resting toe pressure (mean ES 0.22 +/- 0.22; r = 0.75; p = 0.25) and resting calf blood flow (mean ES 0.09 +/- 0.16; r = 0.59; p = 0.22). Changes in resting and post-exercise ABI and reactive hyperaemic calf blood flow do not appear to explain the clinical benefits of exercise in PAD. More study is required in the areas of resting toe pressure and resting calf blood flow.
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Affiliation(s)
- Belinda J Parmenter
- Exercise, Health and Performance Faculty Research Group, Faculty of Health Sciences, University of Sydney, Sydney, New South Wales, Australia.
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