Effects of the Addition ofT'ai Chito a Dietary Weight Loss Program on Lipoprotein Atherogenicity in Obese Older Women

Evidence-Based Strategies to Enhance Weight Management Programs for Adult Military Beneficiaries: A Narrative Review

INTRODUCTION

Overweight and obesity trends are on the rise among both civilian and military beneficiaries. The purpose of this narrative review was to evaluate nutrition, behavioral, lifestyle, pharmacotherapy, and alternative approaches to weight management (WM) among adults with a focus toward identifying gaps and evidence-based strategies that could support or enhance current and future WM programming among military adult beneficiaries.

MATERIALS AND METHODS

A trained research team identified publications (January 2013-January 2020) for abstract review using key search terms and inclusion criteria. Two independent researchers conducted both the abstract review and full-paper bias scoring using selected Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. All eligible studies were assessed for bias and categorized based on key themes. The study was registered in PROSPERO, the international prospective register of systematic reviews.

RESULTS

The research team identified 741 articles, with 278 meeting final inclusion criteria. The mean bias score was 7.5 ± 3.9 (score of 0-13; higher indicating fewer bias factors), with 64% scoring ≥9. Factors contributing to low bias included intervention compliance, dropout rate, and inability to blind participants. The most common published weight-loss interventions included a combination of therapies (59%), diet/supplement (17%), other approaches (12%), behavior change (7%), and exercise (6%). Themes identified to improve WM outcomes included leveraging technology, increasing intervention interactions, community support, emphasis on early weight loss, pharmacotherapy risk-benefit, enhanced behavioral component, resistance exercise, mindfulness, and benefits of quality-of-life measures.

CONCLUSIONS

Reviewers identified several validated tools and techniques to augment and update existing WM programming to improve health and weight outcomes. The review affirmed use of individualized dietary patterns and not a "one-size-fits-all approach" as well as incorporating more comprehensive and team-approached treatments to make the best use of tools and strategies to enhance outcomes.

Exercise training, dietary intervention, or combined interventions and their effects on lipid profiles in adults with overweight and obesity: A systematic review and meta-analysis of randomized clinical trials

AIMS

We performed a systematic review and meta-analysis to compare the effects of Ex (exercise training) vs. DI (dietary intervention) vs. combined Ex and DI on total cholesterol (TC), low-density lipoprotein cholesterol (LDL), triglycerides (TG), and high-density lipoprotein cholesterol (HDL) in adults with overweight and obesity.

DATA SYNTHESIS

PubMed, Web of Science, and Scopus were searched to identify original articles published until March 2022, using keywords for the categories "exercise training," "dietary intervention," "overweight and obesity," and "randomized." Studies that included lipid profiles as outcomes and performed in adults with body mass indexes (BMIs) ≥ 25 kg/m2 were included. A total of 80 studies involving 4804 adult participants were included in the meta-analysis. Ex was not as effective as DI for reducing TC and TG and was less effective for reducing LDL. In addition, Ex increased HDL to a greater extent than DI. Combined interventions decreased TC, TG, and LDL but did not increase HDL more than Ex alone. Combined interventions failed to reduce TC or LDL but decreased TG and increased HDL more than DI alone.

CONCLUSIONS

Our results suggest that the combination of Ex and DI can be more effective than either Ex or DI alone in improving lipid profiles in adults with overweight and obesity.

Nutrition and exercise interventions to improve body composition for persons with overweight or obesity near retirement age: A systematic review and network meta-analysis of randomised controlled trials

The retirement phase is an opportunity to integrate healthy (nutrition/exercise) habits into daily life. We conducted this systematic review to assess which nutrition and exercise interventions most effectively improve body composition (fat/muscle mass), body mass index (BMI) and waist circumference (WC) in persons with obesity/overweight near retirement age (ages 55-70). We conducted a systematic review and network-meta-analysis (NMA) of randomised controlled trials, searching four databases from their inception up to 12 July 2022. The NMA was based on a random effects model, pooled mean differences, standardised mean differences, their 95% confidence intervals, and correlations with multi-arm studies. Subgroup and sensitivity analyses were also conducted. 92 studies were included, 66 of which with 4957 participants could be used for the NMA. Identified interventions were clustered into 12 groups: no intervention, energy restriction (i.e. 500-1000 kcal), energy restriction plus high protein (HP) intake (1.1-1.7 g/kg/body weight), intermittent fasting, mixed exercise (aerobic and resistance), resistance training (RT), aerobic training (AT), HP plus RT, energy restriction plus HP plus exercise, energy restriction plus RT, energy restriction plus AT, and energy restriction plus mixed exercise (ME). Intervention durations ranged from 8 weeks to 6 months. Body fat was reduced with energy restriction plus any exercise or plus HP intake. Energy restriction alone was less effective and tended to decrease muscle mass. Muscle mass was only significantly increased with ME. All other interventions including exercise effectively preserved muscle mass. A BMI and/or WC decrease was achieved with all interventions except AT/RT alone or RT plus HP. Overall, the most effective strategy for nearly all outcomes was combining energy restriction with RT or ME and HP. Healthcare professionals involved in the management of persons with obesity need to be aware that an energy-restricted diet alone may contribute to sarcopenic obesity in persons near retirement age. This network meta-analysis is registered at https://www.crd.york.ac.uk/prospero/as CRD42021276465.

Efficacy of traditional Chinese exercises in improving anthropometric and biochemical indicators in overweight and obese subjects: A systematic review and meta-analysis

BACKGROUND

The efficacy of traditional Chinese exercise (TCE)-based intervention in the improvement of anthropometric and biochemical indicators in overweight and obese patients is controversial. In this regard, the aim of this review was to summarize the evidence of TCE interventions to evaluate their effectiveness on the anthropometric and biochemical indicators of overweight and obese patients.

METHOD

Five databases were systematically searched for relevant articles published from inception to October 2022. Randomized controlled trials examining TCE intervention in overweight and obese patients The treatment effects were estimated using a random-effect meta-analysis model with standardized mean differences (Hedges' g). The categorical and continuous variables were used to conduct moderator analyses. This review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (identifier CRD42022377632).

RESULT

Nine studies involving a total of 1297 participants were included in the final analysis. In the anthropometric indicators outcomes, the meta-analytic findings revealed large and significant improvements in body mass index (g = 1.44, 95% confidence interval [CI] = 1.27-1.61, P = .000, I2 = 99%), weight (g = 1.47, 95% CI = 1.25-1.68, P = .000, I2 = 95%), fat percentage (g = 1.22, 95% CI = 0.52-1.93, P = .000, I2 = 93%), and small and significant improvements in waist circumference (g = 0.38, 95% CI = 0.21-0.54, P = .000, I2 = 99%). In the biochemical indicators outcomes, the findings revealed large and significant improvements in low density lipoprotein (g = 2.08, 95% CI = 1.80-2.37, P = .000, I2 = 98%), moderate and significant improvements in triglyceride (g = 0.69, 95% CI = 0.56-0.81, P = .000, I2 = 96%), small and significant improvements in total cholesterol (g = 0.37, 95% CI = 0.19-0.54, P = .000, I2 = 77%), and high-density lipoprotein (g = -0.71, 95% CI = -0.86 to 0.57, P = .000, I2 = 99%). The moderator shows that the effects of TCE on anthropometric and biochemical indicators were moderated by frequency of exercise, exercise duration, and type of control group.

CONCLUSION

TCE intervention is a beneficial non-pharmacological approach to improving anthropometric and biochemical indicators in overweight and obese subjects, especially in body mass index, weight, fat percentage, triglyceride, and low-density lipoprotein. The clinical relevance of our findings is pending more extensive trials and more rigorous study designs to strengthen the evidence.

Efficacy of traditional Chinese exercise for obesity: A systematic review and meta-analysis

BACKGROUND

Obesity is considered one of the biggest public health problems, especially in the background of the coronavirus disease 2019 (COVID-19) lockdown. It is urgent to find interventions to control and improve it. We performed this systematic review and meta-analysis to summarize the effect of traditional Chinese exercise on obesity.

METHODS

We searched PubMed, Embase, Cochrane Library, the China National Knowledge Infrastructure (CNKI), the Chinese Scientific Journal Database (VIP), the Chinese Biomedical Literature Database (CBM), and WanFang database for updated articles published from the inception of each database to June 2022. Randomized controlled trials (RCTs) on traditional Chinese exercise in weight reduction were included, and related data were extracted. The random-effects model was used to adjust for the heterogeneity of the included studies, and funnel plots were used to examine publication bias.

RESULTS

A total of 701 participants were included in the 10 studies. Compared with the control group, the outcome of body weight [mean difference (MD) = -6.10; 95% CI = -8.79, -3.42], body mass index (MD = -2.03; 95% CI = -2.66, -1.41), body fat mass (MD = -3.12; 95% CI = -4.49, -1.75), waist circumference (MD = -3.46; 95% CI = -4.67, -2.24), hip circumference (MD = -2.94; 95% CI = -4.75, -1.30), and waist-to-hip ratio (MD = -0.04; 95% CI = -0.06, -0.03) in the intervention group had significant differences. Egger's test and funnel plots showed that the potential publication bias of the included studies was slight (p = 0.249).

CONCLUSION

Traditional Chinese exercise is an effective treatment for obesity; people under the COVID-19 lockdown could do these exercises to control weight. However, a precise and comprehensive conclusion calls for RCTs on a larger scale with more rigorous designs considering the inferior methodological quality and limited retrieved articles.

SYSTEMATIC REVIEW REGISTRATION

www.crd.york.ac.uk/PROSPERO/, identifier CRD42021270015.

Physical Activity Assessment and Promotion in Clinical Settings in the United States: A Scoping Review

OBJECTIVE

The purpose of this scoping review was to systematically examine interventions that focused on physical activity assessment and promotion in clinical settings in the United States.

DATA SOURCES

A literature search was performed in 6 major databases to extract published peer-reviewed studies from 2008 to 2019.

INCLUSION AND EXCLUSION CRITERIA

Interventions with practicing health professionals in the United States who performed physical activity assessment and promotion with adult patients 18 years of age and older. Studies were excluded if they were published in non-English, observational or case study designs, or gray literature.

DATA EXTRACTION

Studies were screened and coded based on the population, intervention, comparison, outcomes and study setting for scoping reviews (PRISMA-ScR) framework. Of 654 studies that were identified and screened for eligibility, 78 met eligibility criteria and were independently coded by two coders.

DATA SYNTHESIS

Data were synthesized using qualitative and descriptive methods.

RESULTS

Forty-three of the included studies were randomized controlled trials with a majority being delivered by physicians and nurses in primary care settings. Fifty-six studies reported statistically significant findings in outcome measures such as anthropometrics and chronic disease risk factors, with 17 demonstrating improvements in physical activity levels as a result of the interventions.

CONCLUSION

The assessment and promotion of physical activity in clinical settings appears to be effective but warrants continued research.

Effects of Tai Chi or Conventional Exercise on Central Obesity in Middle-Aged and Older Adults : A Three-Group Randomized Controlled Trial

BACKGROUND

Central obesity is a major manifestation of metabolic syndrome, which is a common health problem in middle-aged and older adults.

OBJECTIVE

To examine the therapeutic efficacy of tai chi for management of central obesity.

DESIGN

Randomized, controlled, assessor-blinded trial. (ClinicalTrials.gov: NCT03107741).

SETTING

A single research site in Hong Kong between 27 February 2016 and 28 February 2019.

PARTICIPANTS

Adults aged 50 years or older with central obesity.

INTERVENTION

543 participants were randomly assigned in a 1:1:1 ratio to a control group with no exercise intervention (n = 181), conventional exercise consisting of aerobic exercise and strength training (EX group) (n = 181), and a tai chi group (TC group) (n = 181). Interventions lasted 12 weeks.

MEASUREMENTS

Outcomes were assessed at baseline, week 12, and week 38. The primary outcome was waist circumference (WC). Secondary outcomes were body weight; body mass index; high-density lipoprotein cholesterol (HDL-C), triglyceride, and fasting plasma glucose levels; blood pressure; and incidence of remission of central obesity.

RESULTS

The adjusted mean difference in WC from baseline to week 12 in the control group was 0.8 cm (95% CI, -4.1 to 5.7 cm). Both intervention groups showed reductions in WC relative to control (adjusted mean differences: TC group vs. control, -1.8 cm [CI, -2.3 to -1.4 cm]; P < 0.001; EX group vs. control: -1.3 cm [CI, -1.8 to -0.9 cm]; P < 0.001); both intervention groups also showed reductions in body weight (P < 0.05) and attenuation of the decrease in HDL-C level relative to the control group. The favorable changes in WC and body weight were maintained in both the TC and EX groups, whereas the beneficial effect on HDL-C was only maintained in the TC group at week 38.

LIMITATIONS

High attrition and no dietary intervention.

CONCLUSION

Tai chi is an effective approach to reduce WC in adults with central obesity aged 50 years or older.

PRIMARY FUNDING SOURCE

Health and Medical Research Fund.

Effects of Tai Chi on health outcomes among community-dwelling adults with or at risk of metabolic syndrome: A systematic review

OBJECTIVES

This systematic review evaluated the effects of Tai Chi on health outcomes among community-dwelling adults with or at risk of metabolic syndrome (MetS).

METHODS

Randomized controlled trials (RCTs) were searched in 10 databases. Data were statistically pooled for meta-analysis.

RESULTS

Twenty RCTs were included. One study involved adults with MetS, and the other 19 studies involved adults with at least one risk factor for MetS. Tai Chi was found to reduce waist circumference and increase high-density lipoprotein cholesterol in obese adults. Tai Chi also reduces waist circumference, body mass index, blood glucose level, insulin resistance, and increases the quality of life (QoL) in adults with elevated blood glucose/type 2 diabetes (T2DM). Among participants with hypertension, Tai Chi improves blood pressure, lipid profiles, anxiety, depression, and physical QoL.

CONCLUSIONS

Tai Chi may be effective for enhancing the physiological and psychosocial wellbeing of community-dwelling adults at risk of MetS. Further RCTs are needed to examine its effects in adults with MetS and identify optimal regimes.

Meta-Analysis of Randomized Controlled Trials of the Effects of Tai Chi on Blood Pressure

Objectives

The purpose of this study was to investigate the influences of Tai Chi on blood pressure (BP) using the meta-analysis.

Methods

This paper used 6 e-resource databases, and randomized controlled trials on the role of Tai Chi on blood pressure were retrieved. Besides, the meta-analysis was conducted according to the guidelines of the Moose-recommendations and applied with Review Manager 5.3, and the risk of bias assessment was performed with the Cochrane Collaboration's tool. The inclusion, data extraction, and risk of bias assessment were independently finished by two researchers.

Results

There are 24 trials meeting the criteria of inclusion and the results were reviewed. The meta-analysis indicates that, compared with no exercise, Tai Chi had the influence of lowering systolic blood pressure (mean difference = −6.07, 95%CI (−8.75, −3.39), P < 0.00001) and diastolic blood pressure (mean difference MD = −3.83, 95%CI (−4.97, −2.69), P < 0.00001). No significant discrepancies in all outcomes between Tai Chi and other aerobic exercises were discovered.

Conclusion

Tai Chi can significantly reduce systolic and diastolic pressure than inactivity. However, Tai Chi does not show advantages in reducing blood pressure compared to other aerobic exercises. The trial is registered with CRD42020175306.

Effectiveness of martial arts exercise on anthropometric and body composition parameters of overweight and obese subjects: a systematic review and meta-analysis

BACKGROUND

Obesity is considered a top public health concern, and its prevalence is growing every day. Thus, interventions to address this problem should be encouraged and further studied. In this regard, the aim of this review was to summarize the evidence of martial arts interventions to evaluate their effectiveness on the anthropometric and body composition parameters of overweight and obese subjects.

METHODS

A systematic literature search was conducted on January 26, 2020 using the PubMed, Medline, Lilacs, Cochrane, and Scielo databases. Reference lists of eligible articles and relevant reviews have also been examined. All randomized clinical trials on martial arts that evaluated the anthropometric and body composition parameters of overweight and obese subjects were included, and a narrative synthesis of eligible studies was conducted in accordance with PRISMA guidelines. The Downs & Black checklist was used to assess the quality of the studies. This review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (identifier CRD42018086116).

RESULTS

A total of 82 articles were identified from the initial search strategy. A further 2 articles were identified from the review of relevant bibliographies. Six studies encompassing 258 participants who were overweight or obese were included. Four studies reported Tai Chi practice, one study reported Kung Fu exercise, and another study reported martial arts exercise. The examined meta-analyses did not reveal significant benefits from martial arts practice over control groups after the experiment period for body mass index (- 1.34 kg/m2; 95% CI: - 2.72, 0.05), waist circumference (1.41 cm; 95% CI: - 0.72, 3.54) and percentage of body fat (- 0.75%; 95% CI: - 5.58, 4.08).

CONCLUSION

The scarcity, heterogeneity, short intervention time, small sample size, and significant methodological limitations of the available studies do not allow to conclude whether martial arts are effective in the anthropometric and body composition parameters of overweight and obese individuals. This study highlights the need for more research to assess the benefits of martial arts for overweight and obese individuals.

Factors Influencing Dietary Intake Frequencies and Nutritional Risk among Community-Residing Older Adults

Older adult (OA) dietary practices may be placing them at nutritional risk. This cross-sectional study examined the dietary intake frequencies (DIF) and nutritional risk (NR) using the Dietary Screening Tool (DST) of OA attending community-based nutrition education and physical activity programs. Most were white females aged 60-80 years. The majority (80.1%) were classified as "at NR" or "at possible NR." Participants had "low" lean protein, dairy, and processed meat DIF and "moderate" whole fruit and juice, total and whole grains, vegetables and added fats, sugars, and sweets DIF. State influenced whole fruit and juice (p ≤ .001) and vegetable (p = .021) DIF, age influenced processed meat DIF (p = .001), and gender influenced NR (p = .006), vegetable (p = .022), and processed meat (p = .033) DIF. Results indicate that OA participating in lifestyle interventions are at NR. When developing future nutrition education programs, educators should consider sociodemographic factors to promote dairy and protein-rich foods to OA at NR.

Efficacy of Tai Chi and qigong for the prevention of stroke and stroke risk factors: A systematic review with meta-analysis

BACKGROUND

This review aims to summarize the evidence of Tai Chi and qigong interventions for the primary prevention of stroke, including the effects on populations with major stroke risk factors.

METHODS

A systematic literature search was conducted on January 16, 2017 using the PubMed, Scopus, Cochrane Library, and CINAHL databases. Randomized controlled trials examining the efficacy of Tai Chi or qigong for stroke prevention and stroke risk factors were included. Risk of bias was assessed using the Cochrane Risk of Bias tool.

RESULTS

Twenty-one trials with n = 1604 patients with hypertension, hyperlipidaemia, diabetes, overweight or obesity, or metabolic syndrome were included. No trials were found that examined the effects of Tai Chi/qigong on stroke incidence. Meta-analyses revealed significant, but not robust, benefits of Tai Chi/qigong over no interventions for hypertension (systolic blood pressure: -15.55 mm Hg (95% CI: -21.16; -9.95); diastolic blood pressure: -10.66 mm Hg (95% CI: -14.90, -6.43); the homeostatic model assessment (HOMA) index (-2.86%; 95% CI: -5.35, -0.38) and fasting blood glucose (-9.6 mg/dL; 95% CI: -17.28, -1.91), and for the body mass index compared with exercise controls (-1.65 kg/m; 95% CI: -3.11, -0.20). Risk of bias was unclear or high for the majority of trials and domains, and heterogeneity between trials was high. Only 6 trials adequately reported safety. No recommendation for the use of Tai Chi/qigong for the prevention of stroke can be given.

CONCLUSION

Although Tai Chi and qigong show some potential more robust studies are required to provide conclusive evidence on the efficacy and safety of Tai Chi and qigong for reducing major stroke risk factors.

Effect of Tai Chi exercise on blood lipid profiles: a meta-analysis of randomized controlled trials

OBJECTIVE

Studies have demonstrated that Tai Chi exercise improves blood lipid level with inconsistent results. A meta-analysis was conducted to quantify the effects of Tai Chi on blood lipid profiles in humans.

METHODS

We screened the databases of PubMed, EMBASE, Cochrane Library (Central), Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang data, and Clinicaltrials.gov for randomized controlled trials with Physiotherapy Evidence Database (PEDro) score more than 3 points up to June 2015. Six studies involving 445 subjects were included. Most trials applied 12-week Tai Chi intervention courses.

RESULTS

In comparison with the control group, blood triglyceride (TG) level difference between follow-up and baseline was statistically significantly lower in the Tai Chi practicing group (weighted mean difference (WMD) -16.81 mg/dl; 95% confidence intervals (CI) -31.27 to -2.35 mg/dl; P=0.02). A trend to improving total cholesterol (TC) reduction was found with Tai Chi (WMD -7.96 mg/dl; 95% CI -17.30 to 1.39 mg/dl; P=0.10). However, no difference was found in blood low-density lipoprotein cholesterol (LDL-C) or high-density lipoprotein cholesterol (HDL-C).

CONCLUSIONS

Tai Chi exercise lowered blood TG level with a trend to decrease blood TC level. Our data suggest that Tai Chi has the potential to implement meaningful blood lipid modification and serve as an adjunctive exercise modality. The relationship between Tai Chi exercise regimen and lipid profile change might have a scientific priority for future investigation.

Mind-Body Exercises for Nurses with Chronic Low Back Pain: An Evidence-Based Review

Background. Chronic low back pain (CLBP) among nurses is a growing health concern. The multimodal nature of mind-body exercises has potential to impact physiological and psychological processes associated with chronic pain, affording possible advantages over conventional unimodal therapies. This paper summarizes the prevalence of and risk factors for CLBP among nurses, reviews the effectiveness in treating pain and disability of mind-body exercises (yoga and tai chi) for CLBP among the general and nursing population, and describes implications. Methods. Articles, published during or prior to 2015, were systematically identified through the PubMed/MEDLINE, Web of Science, and ScienceDirect databases using the following search terms: nurses, mind-body, integrative, biopsychosocial, yoga, tai chi, back pain, and/or risk factors. Results. Prevalence estimates of CLBP among nurses ranged from 50% to 80%. Associated risk factors for CLBP included lifestyle and physical, psychological, psychosocial, and occupational factors. No published studies were identified that evaluated yoga or tai chi for nurses with CLBP. Studies in the general population suggested that these interventions are effective in reducing pain and disability and may improve factors/processes predictive of CLBP. Conclusion. This review suggests that evaluating the impact of multimodal interventions such as yoga and tai chi for nurses with CLBP warrants investigation.

The combined effects of tai chi, resistance training, and diet on physical function and body composition in obese older women

Obesity is a major health problem in the USA, especially in minority populations over the age of 60 years, and the aging process can cause adverse effects on physical function. Previous research has shown that Tai Chi, resistance training (RT), and diet result in overall health improvements. However, the combination of these specific interventions has yet to be translated to obese older women in an urban setting. The purpose of this study was to examine a combined intervention on the primary outcomes of physical function and body composition. Using a nonrandomized design, 26 obese women (65.2 ± 8.1 years) completed a 12-week intervention; participants were assigned to an intervention (EXD) group or a control (CON) group. The EXD group (n = 17) participated in Tai Chi, RT, and a dietary session. The CON group (n = 9) was asked to continue their normal lifestyle. Timed up and go (TUG) time was reduced by 0.64 ± 2.1 seconds (P = 0.04) in the EXD group while the CON group saw a borderline significant increase of 0.71 sec (P = 0.051). The combined intervention helped improve performance on TUG time, but there were no significant increases in other body composition or function measures.

Approach to reduction of blood atherogenicity

We have earlier found that blood sera of patients with coronary heart disease (CHD) increase lipid levels in cells cultured from subendothelial intima of human aorta. We have also revealed that the ability of blood sera to raise intracellular cholesterol; that is, their atherogenicity is caused by at least modified low density lipoprotein (LDL) circulating in the blood of patients and autoantibodies to modified LDL. In the present work we have demonstrated significant impact of nonlipid factor(s) to blood atherogenicity. We have developed an approach to removal of nonlipid atherogenicity factor(s) from blood serum based on the use of immobilized LDL. This approach was used for extracorporeal perfusion of patient's blood through the column with immobilized LDL. Pilot clinical study confirmed the efficacy of this approach for prevention of coronary atherosclerosis progression.