Is meta-analysis of RCTs assessing the efficacy of interventions a reliable source of evidence for therapeutic decisions?

Perspectives on Concurrent Strength and Endurance Training in Healthy Adult Females: A Systematic Review

BACKGROUND

Both strength and endurance training are included in global exercise recommendations and are the main components of training programs for competitive sports. While an abundance of research has been published regarding concurrent strength and endurance training, only a small portion of this research has been conducted in females or has addressed their unique physiological circumstances (e.g., hormonal profiles related to menstrual cycle phase, menstrual dysfunction, and hormonal contraceptive use), which may influence training responses and adaptations.

OBJECTIVE

The aim was to complete a systematic review of the scientific literature regarding training adaptations following concurrent strength and endurance training in apparently healthy adult females.

METHODS

A systematic electronic search for articles was performed in July 2021 and again in December 2022 using PubMed and Medline. This review followed, where applicable, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The quality of the included studies was assessed using a modified Downs and Black checklist. Inclusion criteria were (1) fully published peer-reviewed publications; (2) study published in English; (3) participants were healthy normal weight or overweight females of reproductive age (mean age between > 18 and < 50) or presented as a group (n > 5) in studies including both females and males and where female results were reported separately; (4) participants were randomly assigned to intervention groups, when warranted, and the study included measures of maximal strength and endurance performance; and (5) the duration of the intervention was ≥ 8 weeks to ensure a meaningful training duration.

RESULTS

Fourteen studies met the inclusion criteria (seven combined strength training with running, four with cycling, and three with rowing or cross-country skiing). These studies indicated that concurrent strength and endurance training generally increases parameters associated with strength and endurance performance in female participants, while several other health benefits such as, e.g., improved body composition and blood lipid profile were reported in individual studies. The presence of an "interference effect" in females could not be assessed from the included studies as this was not the focus of any included research and single-mode training groups were not always included alongside concurrent training groups. Importantly, the influence of concurrent training on fast-force production was limited, while the unique circumstances affecting females were not considered/reported in most studies. Overall study quality was low to moderate.

CONCLUSION

Concurrent strength and endurance training appears to be beneficial in increasing strength and endurance capacity in females; however, multiple research paradigms must be explored to better understand the influence of concurrent training modalities in females. Future research should explore the influence of concurrent strength and endurance training on fast-force production, the possible presence of an "interference effect" in athletic populations, and the influence of unique circumstances, such as hormone profile, on training responses and adaptations.

Systematic review and meta-analysis of early aortic valve replacement versus conservative therapy in patients with asymptomatic aortic valve stenosis with preserved left ventricle systolic function

BACKGROUND

A quarter of patients with severe aortic stenosis (AS) were asymptomatic, and only a third of them survived at the end of 4 years. Only a select subset of these patients was recommended for aortic valve replacement (AVR) by the current American College of Cardiology/American Heart Association guidelines. We intended to study the effect of early AVR (eAVR) in this subset of asymptomatic patients with preserved left ventricle function.

METHODS AND RESULTS

We searched PubMed and Embase for randomised and observational studies comparing the effect of eAVR versus conservative therapy in patients with severe, asymptomatic AS and normal left ventricular function. The primary outcome was all-cause mortality. The secondary outcomes were composite major adverse cardiac events (MACE) (study defined), myocardial infarction (MI), stroke, cardiac death, sudden death, the development of symptoms, heart failure hospitalisations and major bleeding. We used GRADEPro to assess the certainty of the evidence. In the randomised controlled trial (RCT) only analysis, we found no significant difference in all-cause mortality between the early aortic intervention group versus the conservative arm (CA) (incidence rate ratio, IRR (CI): 0.5 (0.2 to 1.1), I2=31%, p=0.09). However, in the overall cohort, we found mortality benefit for eAVR over CA (IRR (CI): 0.4 (0.3 to 0.7), I2=84%, p<0.01). There were significantly lower MACE, cardiac death, sudden death, development of symptoms and heart failure hospitalisations in the eAVR group. We noticed no difference in MI, stroke and major bleeding.

CONCLUSION

We conclude that there is no reduction in all-cause mortality in the eAVR arm in patients with asymptomatic AS with preserved ejection fraction. However, eAVR reduces heart failure related hospitalisations and death or heart failure hospitalisations.

PROSPERO REGISTRATION NUMBER

CRD42022306132.

Effectiveness of virtual reality interventions on physiological and psychological outcomes of adults with cardiovascular disease: A systematic review and meta-analysis

PURPOSE

The aim of this study was to provide evidence of the effectiveness of virtual reality interventions on the physiological and psychological outcomes of adults with cardiovascular disease.

DESIGN

A systematic review and meta-analysis.

METHODS

Database searches were carried out in CINAHL, Cochrane Central, Web of Science, PubMed, Scopus, Science Direct, and Ovid without restriction of year up to December 2021. The study was carried out in accordance with PRISMA 2020 and Cochrane 2021 recommendations. The intervention effects were pooled using the random effects model. The Risk of Bias 2 tool was' used to assess the risk of bias. Heterogeneity and publication bias were also assessed.

FINDINGS

In total, 14 trials were included. The included studies found a significantly higher effect on anxiety (Hedge's g = -0.85, 95% CI: -1.55 to -0.14, p = 0.01) and a medium effect on physical functional capacity (Hedge's g = 0.54, 95% CI: 0.01 to 1.08, p = 0.05), stress (Hedge's g = -0.36, 95% CI: -0.60 to -0.11, p = 0.01), and depression (Hedge's g = -0.39, 95% CI: -0.68 to -0.11, p = 0.01) compared to the control group. The Cochrane GRADE approach showed low level evidence for the effect of virtual reality on anxiety and moderate level evidence for stress, depression, and physical functional capacity.

CONCLUSIONS

The effect size and grade evaluation results showed that virtual reality may be an effective intervention to reduce anxiety, stress, and depression and to increase physical functional capacity in patients with cardiovascular disease. However, more study is necessary in order to establish evidence.

REGISTRATION

Registered in the PROSPERO database: PROSPERO international prospective register of systematic reviews Registration number: CRD42022296578.

Dispositions and Causality Assessment in Pharmacovigilance: Proposing the Dx3 Approach for Assessing Causality with Small Data Sets

A new approach is proposed for assessing causality in pharmacovigilance. The Dx3 approach is designed to qualitatively evaluate three types of dispositions when assessing whether a particular medicine has or could have caused a certain adverse event. These are: the drug disposition; the pre-disposition of the patient taking the drug (vulnerability) and; the disposition of the patient–drug interaction (mutuality). Each of these three types of dispositions will represent valuable causally relevant evidence for assessing a potential signal of harm. A checklist is provided to guide the assessment of causality for both single individual case safety reports (ICSRs) and case series. Different types of causal information are ranked according to how well suited they are for establishing a disposition. Two case examples are used to demonstrate how the approach can be used in practice for assessment purposes. One aim of the approach is to offer a qualitative way to assess causality and to make the reasoning of different assessors more transparent. A second aim is to encourage the collection of more qualitatively rich patient narratives in the ICSRs. Crucially, we believe this approach can support the inclusion of the single ICSR as a valid and valuable form of evidence.