Accelerometer-based sedentary time and physical activity from childhood through young adulthood with progressive cardiac changes: a 13-year longitudinal study

AIMS

Longitudinal evidence on the relationship of sedentary time (ST), light-intensity physical activity (LPA), and moderate-to-vigorous-intensity physical activity (MVPA) with changes in cardiac structure and function in the paediatric population is scarce. This evidence is clinically important due to the impact ST can have on the long-term prognosis of healthy young population in the lifetime continuum. This prospective observational study examined the relationships of cumulative ST, LPA, and MVPA from childhood with longitudinal changes in cardiac structure and function.

METHODS AND RESULTS

This is a secondary analysis from the Avon Longitudinal Study of Parents and Children, UK birth cohort of 1682 children aged 11 years. Participants who had at least one follow-up timepoints accelerometer-measured ST, LPA, and MVPA over a period of 13 years and repeated echocardiography-measured cardiac structure and function at ages 17- and 24-year clinic visit were included. Left ventricular mass indexed for height2.7 (LVMI2.7) and left ventricular (LV) diastolic function from mitral E/A ratio (LVDF) were computed. Among 1682 children (mean [SD] age, 11.75 [0.24] years; 1054 [62.7%] females), the cumulative one-min/day increase in ST from ages 11 to 24 years was associated with progressively increased LVMI2.7 {effect estimate 0.002 g/m2.7 [confidence interval (CI) 0.001-0.003], P < 0.001}, irrespective of sex, obesity, and hypertensive status. Cumulative one-min/day increase in LPA was associated with a decreased LVMI2.7 (-0.005 g/m2.7 [-0.006 to -0.003], P < 0.0001) but an increased LVDF. Cumulative one-minute/day increase in MVPA was associated with progressively increased LVMI2.7 (0.003 g/m2.7 [0.001-0.006], P = 0.015).

CONCLUSION

ST contributed +40% to the 7-year increase in cardiac mass, MVPA increased cardiac mass by +5%, but LPA reduced cardiac mass by -49%. Increased ST may have long-term pathologic effects on cardiac structure and function during growth from childhood through young adulthood; however, engaging in LPA may enhance cardiac health in the young population.

The move towards living systematic reviews and living guidelines in healthcare: consideration of the possibilities and challenges for living qualitative evidence syntheses

Over the past decade qualitative evidence synthesis (QES), a range of methods for synthesising qualitative research evidence, has become a valued form of evidence for guideline producers who wish to understand more about patient preference and acceptability of treatments. The surge in interest in living systematic reviews and the appearance of living guidelines as a response to the COVID-19 pandemic potentially weaken the value and usability of QES.There are currently no published methods for producing living QES, and if QES are to remain of worth to guideline producers then methods for the rapid, frequent updating of them will need to be developed. We discuss some of the similarities and differences between qualitative and quantitative evidence syntheses and highlight areas where development is needed if reviewers are to progress with living approaches to QES.

Case studies to explore the optimal use of randomized and nonrandomized studies in evidence syntheses that use GRADE

OBJECTIVES

Randomized controlled trials (RCTs) are the preferred source of evidence for the relative effect of healthcare interventions summarized in knowledge syntheses. Nonrandomized studies of interventions (NRSI) may provide replacement, sequential, or complementary evidence to RCTs. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach can provide different options for properly using RCTs and NRSI integrated in health syntheses. In this article, we discuss different implications on the certainty of evidence when authors consider the use of NRSI and RCTs in systematic reviews using GRADE. Although this is a GRADE-related article, it is not an official GRADE guidance or concept article.

STUDY DESIGN AND SETTING

We present case studies used during GRADE working group meetings for discussion of the effects of using NRSI and RCTs on GRADE domains and on the certainty of evidence. Several concepts were discussed through iterative feedback with experts in GRADE methods and Cochrane authors. We compared suggested solutions for possible scenarios that can be met in evidence syntheses informing decisions and future guidance.

RESULTS

Different scenarios for the use of RCTs and NRSI in evidence syntheses are presented, focusing on how different GRADE ratings between RCTs and NRSI affect the overall assessment of the evidence and possible health recommendations.

CONCLUSIONS

Considering differences and similarities grounded in the GRADE approach between NRSI and RCTs may help complement one another and maximize the value of knowledge syntheses and health recommendations.

An integrative review of the implementation of public health guidelines

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The evidence on public health guidelines implementation is scarce.

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Most implementation of public health guidelines centres on individuals’ behaviour.

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Most evaluations of public health guidelines focus on barriers to implementation.

Health guidelines are important tools to ensure that health practices are evidence-based. However, research on how these guidelines are implemented is scarce. This integrative review aimed to: identify the literature on evaluation of public health guidelines implementation to explore (a) the topics which public health guidelines being implemented and evaluated in their implementation process are targeting; (b) how public health guidelines are being translated into action and the potential barriers and facilitators to their implementation; and (c) which methods are being used to evaluate their implementation. A total of 2001 articles published since 2000 and related to both clinical and public health guidelines implementation was identified through searching four databases (PubMed, CINAHL, Web of Science, Scopus). After screening titles and abstracts, only 10 papers related to public health guidelines implementation, and after accessing full-text, 8 were included in the narrative synthesis. Data were extracted on: topic and context, implementation process, barriers and facilitators, and evaluation methods used, and were then synthesised in a narrative form using a thematic synthesis approach. Most of these studies focussed on individual behaviours and targeted specific settings. The evaluation of implementation processes included qualitative, quantitative and mixed-methods. The few articles retrieved suggest that evidence is still limited and highly context specific, and further research on translating public health guidelines into practice is needed.