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Gabrys L, Schaller A, Peters S, Barzel A, Berrisch-Rahmel S, Dreinhöfer KE, Eckert K, Göhner W, Geidl W, Krupp S, Lange M, Nebel R, Pfeifer K, Reusch A, Schmidt-Ohlemann M, Sewerin P, Steindorf K, Ströhle A, Sudeck G, Wäsche H, Wolf S, Wollesen B, Thiel C. [DNVF Memorandum: Objectives and Methods of Physical Activity-Related Health Services Research]. DAS GESUNDHEITSWESEN 2024. [PMID: 39047784 DOI: 10.1055/a-2340-1669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
The DNVF Memorandum: Objectives and Methods of Physical Activity-Related Health Services Research summarizes, for the first time, the highly interdisciplinary and interprofessional field of physical activity-based health care in the German healthcare system. In addition to providing a conceptual framework and definition of key measures and concepts in physical activity-related health care research, existing research gaps and needs are identified, and methods for advancing this relatively young field of research are described. A particular focus of this study is the relevant outcome parameters and their standardized assessment using established and valid measurement tools. The memorandum aims to establish a general understanding of the complex subject of promoting physical activity and sports therapy in the context of healthcare, to give an impulse to new research initiatives, and to integrate the currently available strong evidence on the effectiveness of physical activity and exercise into healthcare.
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Affiliation(s)
- Lars Gabrys
- ESAB Fachhochschule für Sport und Management Potsdam, Gesundheitssport und Prävention, Potsdam, Germany
| | - Andrea Schaller
- Universität der Bundeswehr München, Institut für Sportwissenschaft, Arbeitsbereich Gesundheit, Betriebliche Gesundheitsförderung und Prävention, München, Germany
| | - Stefan Peters
- Deutscher Verband für Gesundheitssport und Sporttherapie e. V., Deutscher Verband für Gesundheitssport und Sporttherapie e. V., Hürth-Efferen, Germany
- Universität der Bundeswehr, Institut für Sportwissenschaft, Arbeitsbereich Gesundheit, Betriebliche Gesundheitsförderung und Prävention, München, Germany
| | - Anne Barzel
- Universitätsklinikum Ulm, Institut für Allgemeinmedizin, Ulm, Germany
| | - Susanne Berrisch-Rahmel
- Projektgruppe PG 05 Prävention der Deutschen Gesellschaft für Kardiologie, Herz- und Kreislaufforschung e.V., Sprecherin der AG Sport und Prävention des Bundesverband niedergelassener Kardiologen e.V., Düsseldorf, Germany
| | - Karsten E Dreinhöfer
- Medical Park AG, Orthopädie und Unfallchirurgie, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Katharina Eckert
- IST-Hochschule für Management GmbH, Gesundheitsmanagement & Public Health, Düsseldorf, Germany
| | - Wiebke Göhner
- Katholische Hochschule Freiburg, Bereich Gesundheitspsychologie, Freiburg, Germany
| | - Wolfgang Geidl
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Institut für Sportwissenschaft und Sport, Lehrstuhl Bewegung und Gesundheit, Erlangen, Germany
| | - Sonja Krupp
- Forschungsgruppe Geriatrie Lübeck, Krankenhaus Rotes Kreuz Lübeck - Geriatriezentrum, Lübeck, Germany
| | - Martin Lange
- IST-Hochschule für Management GmbH, Fachbereich Fitness & Gesundheit, Düsseldorf, Germany
| | - Roland Nebel
- Deutsche Gesellschaft zur Prävention und Rehabilitation von Herz-Kreislauferkrankungen e.V. (DGPR), Klinik Roderbirken der Deutschen Rentenversicherung Rheinland, Leichlingen, Germany
| | - Klaus Pfeifer
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Institut für Sportwissenschaft und Sport, Lehrstuhl Bewegung und Gesundheit, Erlangen, Germany
| | - Andrea Reusch
- Zentrum Patientenschulung und Gesundheitsförderung, (ZePG e.V.), Würzburg, Germany
| | | | - Philipp Sewerin
- Ruhr-Universität Bochum, Rheumazentrum Ruhrgebiet, Bochum, Germany
| | - Karen Steindorf
- Nationales Centrum für Tumorerkrankungen (NCT) Heidelberg, DKFZ, Abteilung für Bewegung, Präventionsforschung und Krebs, Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Germany
| | - Andreas Ströhle
- Charite Universitatsmedizin Berlin, Klinik für Psychiatrie und Psychotherapie Campus Charité Mitte, Berlin, Germany
| | - Gorden Sudeck
- Eberhard Karls Universität Tübingen, Arbeitsbereich Bildungs- und Gesundheitsforschung im Sport, Institut für Sportwissenschaft, Tübingen, Germany
- Eberhard Karls Universität Tübingen, Interfakultäres Forschungsinstitut für Sport und körperliche Aktivität, Tübingen, Germany
| | - Hagen Wäsche
- Universität Koblenz-Landau Fachbereich 3 Mathematik/Naturwissenschaften, Institut für Sportwissenschaft, Koblenz, Germany
| | - Sebastian Wolf
- Eberhard Karls Universität Tübingen, Arbeitsbereich Bildungs- und Gesundheitsforschung im Sport, Institut für Sportwissenschaft, Tübingen, Germany
| | - Bettina Wollesen
- Universität Hamburg, Arbeitsbereich Bewegungs- und Trainingswissenschaft, Fakultät für Psychologie und Bewegungswissenschaft, Hamburg, Germany
| | - Christian Thiel
- Hochschule für Gesundheit Bochum, Studienbereich Physiotherapie, Department für Angewandte Gesundheitswissenschaften, Bochum, Germany
- Ruhr-Universität Bochum, und Forschungsbereich Trainingswissenschaft, Fakultät für Sportwissenschaft, Bochum, Germany
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van Ierssel JJ, Galea O, Holte K, Luszawski C, Jenkins E, O'Neil J, Emery CA, Mannix R, Schneider K, Yeates KO, Zemek R. How completely are randomized controlled trials of non-pharmacological interventions following concussion reported? A systematic review. JOURNAL OF SPORT AND HEALTH SCIENCE 2024; 13:537-547. [PMID: 37619783 PMCID: PMC11184319 DOI: 10.1016/j.jshs.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/20/2023] [Accepted: 07/12/2023] [Indexed: 08/26/2023]
Abstract
PURPOSE The study aimed to examine the reporting completeness of randomized controlled trials (RCTs) of non-pharmacological interventions following concussion. METHODS We searched MEDLINE, Embase, PsycInfo, CINAHL, and Web of Science up to May 2022. Two reviewers independently screened studies and assessed reporting completeness using the Template for Intervention Description and Replication (TIDieR), Consensus on Exercise Reporting Template (CERT), and international Consensus on Therapeutic Exercise aNd Training (i-CONTENT) checklists. Additional information was sought my study authors where reporting was incomplete. Risk of bias (ROB) was assessed with the Cochrane ROB-2 Tool. RCTs examining non-pharmacological interventions following concussion. RESULTS We included 89 RCTs (n = 53 high ROB) examining 11 different interventions for concussion: sub-symptom threshold aerobic exercise, cervicovestibular therapy, physical/cognitive rest, vision therapy, education, psychotherapy, hyperbaric oxygen therapy, transcranial magnetic stimulation, blue light therapy, osteopathic manipulation, and head/neck cooling. Median scores were: TIDieR 9/12 (75%; interquartile range (IQR) = 5; range: 5-12), CERT 17/19 (89%; IQR = 2; range: 10-19), and i-CONTENT 6/7 (86%; IQR = 1; range: 5-7). Percentage of studies completely reporting all items was TIDieR 35% (31/89), CERT 24% (5/21), and i-CONTENT 10% (2/21). Studies were more completely reported after publication of TIDieR (t87 = 2.08; p = 0.04) and CERT (t19 = 2.72; p = 0.01). Reporting completeness was not strongly associated with journal impact factor (TIDieR: rs = 0.27; p = 0.01; CERT: rs = -0.44; p = 0.06; i-CONTENT: rs = -0.17; p = 0.48) or ROB (TIDieR: rs = 0.11; p = 0.31; CERT: rs = 0.04; p = 0.86; i-CONTENT: rs = 0.12; p = 0.60). CONCLUSION RCTs of non-pharmacological interventions following concussion demonstrate moderate to good reporting completeness, but are often missing key components, particularly modifications, motivational strategies, and qualified supervisor. Reporting completeness improved after TIDieR and CERT publication, but publication in highly cited journals and low ROB do not guarantee reporting completeness.
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Affiliation(s)
| | - Olivia Galea
- The Centre for Health, Activity and Rehabilitation Research, University of Otago, Dunedin 9016, New Zealand
| | - Kirsten Holte
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada; Alberta Children's Hospital Research Institute; University of Calgary, Calgary, AB T2N 1N4, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Caroline Luszawski
- Alberta Children's Hospital Research Institute; University of Calgary, Calgary, AB T2N 1N4, Canada; Department of Psychology, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Elizabeth Jenkins
- Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada
| | - Jennifer O'Neil
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON K1H 8M5, Canada; Bruyère Research Institute, Ottawa, ON K1N 5C8, Canada
| | - Carolyn A Emery
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada; Alberta Children's Hospital Research Institute; University of Calgary, Calgary, AB T2N 1N4, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Rebekah Mannix
- Departments of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Kathryn Schneider
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada; Alberta Children's Hospital Research Institute; University of Calgary, Calgary, AB T2N 1N4, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Keith Owen Yeates
- Department of Psychology, University of Calgary, Calgary, AB T2N 1N4, Canada; Alberta Children's Hospital Research Institute; University of Calgary, Calgary, AB T2N 1N4, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Roger Zemek
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada; Departments of Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada
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Sousa Filho LF, Farlie MK, Haines T, Borrelli B, Carroll C, Mathews C, Ribeiro DC, Fritz JM, Underwood M, Foster NE, Lamb SE, Sanchez ZM, Malliaras P. Developing an international consensus Reporting guideline for intervention Fidelity in Non-Drug, non-surgical trials: The ReFiND protocol. Contemp Clin Trials 2024; 142:107575. [PMID: 38750951 DOI: 10.1016/j.cct.2024.107575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 04/23/2024] [Accepted: 05/11/2024] [Indexed: 05/21/2024]
Abstract
BACKGROUND Inadequate reporting of fidelity to interventions in trials limits the transparency and interpretation of trial findings. Despite this, most trials of non-drug, non-surgical interventions lack comprehensive reporting of fidelity. If fidelity is poorly reported, it is unclear which intervention components were tested or implemented within the trial, which also hinders research reproducibility. This protocol describes the development process of a reporting guideline for fidelity of non-drug, non-surgical interventions (ReFiND) in the context of trials. METHODS The ReFiND guideline will be developed in six stages. Stage one: a guideline development group has been formed to oversee the guideline methodology. Stage two: a scoping review will be conducted to identify and summarize existing guidance documents on the fidelity of non-drug, non-surgical interventions. Stage three: a Delphi study will be conducted to reach consensus on reporting items. Stage four: a consensus meeting will be held to consolidate the reporting items and discuss the wording and structure of the guideline. Stage five: a guidance statement, an elaboration and explanation document, and a reporting checklist will be developed. Stage six: different strategies will be used to disseminate and implement the ReFiND guideline. DISCUSSION The ReFiND guideline will provide a set of items developed through international consensus to improve the reporting of intervention fidelity in trials of non-drug, non-surgical interventions. This reporting guideline will enhance transparency and reproducibility in future non-drug, non-surgical intervention research.
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Affiliation(s)
| | - Melanie K Farlie
- School of Primary and Allied Health Care, Monash University, Melbourne, Australia.
| | - Terry Haines
- School of Primary and Allied Health Care, Monash University, Melbourne, Australia.
| | - Belinda Borrelli
- Center for Behavioral Science Research, Department of Health Policy and Health Services Research, Boston University, Henry M. Goldman School of Dental Medicine, Boston, MA, USA.
| | | | - Catherine Mathews
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa; School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
| | - Daniel C Ribeiro
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand.
| | - Julie M Fritz
- Department of Physical Therapy & Athletic Training, University of Utah, Salt Lake City, UT, USA.
| | - Martin Underwood
- Warwick Clinical Trials Unit, University of Warwick, Warwick, UK.; University Hospitals of Coventry and Warwickshire, Coventry, UK.
| | - Nadine E Foster
- STARS Education and Research Alliance, Surgical Treatment and Rehabilitation Service (STARS), The University of Queensland and Metro North Health, Brisbane, Australia; School of Medicine, Keele University, Keele, UK.
| | - Sarah E Lamb
- University of Exeter, St Luke's Campus, Exeter, UK.
| | - Zila M Sanchez
- Department of Preventive Medicine, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.
| | - Peter Malliaras
- School of Primary and Allied Health Care, Monash University, Melbourne, Australia.
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Thomsen SN, Lucia A, Spence RR, Benatti FB, Joyner MJ, Berg RMG, Ried-Larsen M, Simonsen C. First, do no harm: a call to action to improve the evaluation of harms in clinical exercise research. Br J Sports Med 2024; 58:636-638. [PMID: 38637136 DOI: 10.1136/bjsports-2023-107579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2024] [Indexed: 04/20/2024]
Affiliation(s)
- Simon Nørskov Thomsen
- Centre for Physical Activity Research, Rigshospitalet, Copenhagen, Region Hovedstaden, Denmark
| | - Alejandro Lucia
- Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain
| | - Rosalind R Spence
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Improving Health Outcomes for People (ihop) Research Group, Brisbane, Queensland, Australia
| | - Fabiana Braga Benatti
- Faculdade de Ciências Aplicadas, Universidade Estadual de Campinas, Limeira, SP, Brazil
| | - Michael J Joyner
- Department of Anesthesiology & Perioperative Medicine, Mayo Clinic, Rochester, New York, USA
| | - Ronan Martin Griffin Berg
- Centre for Physical Activity Research, Rigshospitalet, Copenhagen, Region Hovedstaden, Denmark
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Region Hovedstaden, Denmark
| | - Mathias Ried-Larsen
- Centre for Physical Activity Research, Rigshospitalet, Copenhagen, Region Hovedstaden, Denmark
- Institute of Sports and Clinical Biomechanics, University of Southern Denmark, Odense, Syddanmark, Denmark
| | - Casper Simonsen
- Centre for Physical Activity Research, Rigshospitalet, Copenhagen, Region Hovedstaden, Denmark
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Mariano IM, Amaral AL, Ribeiro PAB, Puga GM. Exercise training improves blood pressure reactivity to stress: a systematic review and meta-analysis. Sci Rep 2023; 13:10962. [PMID: 37414810 PMCID: PMC10326007 DOI: 10.1038/s41598-023-38041-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 07/01/2023] [Indexed: 07/08/2023] Open
Abstract
Blood pressure (BP) reactivity to stress is associated with cardiovascular events and the incidence of hypertension, therefore, tolerance to stressors is important for better management of cardiovascular risks. Exercise training is among the strategies that have been investigated as blunting the peak response to stressors, however, its efficacy is poorly explored. The aim was to explore the effects of exercise training (at least four weeks) on BP responses to stressor tasks in adults. A systematic review was performed in five electronic databases (MEDLINE, LILACS, EMBASE, SPORTDiscus, and PsycInfo). Twenty-three studies and one conference abstract was included in the qualitative analysis, totaling 1121 individuals, and k = 17 and 695 individuals in the meta-analysis. Favorable results (random-effects) for exercise training were found, with attenuated peak responses in systolic (standardized mean difference (SMD) = -0.34 [-0.56; -0.11], representing average reductions of 2.5 ± 3.6 mmHg) and null effects on diastolic BP (SMD = -0.20 [-0.54; 0.14], representing average reductions of 2.0 ± 3.5 mmHg). The analysis removing outliers' studies improved the effects for diastolic (SMD = -0.21 [-0.38; -0.05]) but not systolic BP (SMD = -0.33 [-0.53; -0.13]). In conclusion, exercise training seems to lower stress-related BP reactivity, therefore has the potential to improve patients' ability to better respond to stressful situations.
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Affiliation(s)
- Igor M Mariano
- Laboratory of Cardiorespiratory and Metabolic Physiology, Physical Education Department, Federal University of Uberlândia, Rua Benjamin Constant, 1286. Bairro: Aparecida, Uberlândia, MG, 38400-678, Brazil
| | - Ana Luiza Amaral
- Laboratory of Cardiorespiratory and Metabolic Physiology, Physical Education Department, Federal University of Uberlândia, Rua Benjamin Constant, 1286. Bairro: Aparecida, Uberlândia, MG, 38400-678, Brazil
| | - Paula A B Ribeiro
- Research Center of University of Montreal Hospital Centre, Montreal, QC, H2X 0A9, Canada
- Centre de Médecine Comportemental de Montréal, CIUSSS-NIM, Montreal, QC, H4J 1C5, Canada
| | - Guilherme Morais Puga
- Laboratory of Cardiorespiratory and Metabolic Physiology, Physical Education Department, Federal University of Uberlândia, Rua Benjamin Constant, 1286. Bairro: Aparecida, Uberlândia, MG, 38400-678, Brazil.
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Petrigna L, Zanghì M, Maugeri G, D'Agata V, Musumeci G. Methodological consideration for a physical activity intervention in breast cancer population: An umbrella review. Heliyon 2023; 9:e17470. [PMID: 37455988 PMCID: PMC10338308 DOI: 10.1016/j.heliyon.2023.e17470] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 06/16/2023] [Accepted: 06/19/2023] [Indexed: 07/18/2023] Open
Abstract
Objective Breast cancer patients and survivors are increasing in the last years such as their mean age. A feasible and useful complementary intervention to improve physical and psychological health, and decrease some disease symptoms seems to be physical activity. Consequently, this umbrella review wanted to analyze the protocols of different physical activity interventions and to eventually propose a standard operating procedure for possible exercise training in breast cancer patients.Design, Data sources, Eligibility criteria. The electronic databases PubMed, Scopus, and Web of Science were searched till 25 March 2022 to detect all systematic review and meta-analysis of randomized controlled trials on this topic. The studies were analyzed narratively and evaluated with a scale to assess their quality. Results The studies presented heterogeneity in their population included in terms of disease stage and treatments, intervention protocols and outcomes evaluated. This made difficult to synthesize the findings. Conclusion It was not possible to propose a standard operating procedure but some indications were proposed to provide feedback for future studies. Ideally, an intervention should be composed of combined training (aerobic and resistance training) with a component of a mindfulness intervention, with an intensity from moderate to high, and 3 times a week. The intervention should be supervised in the first period and then it could be home-based. Exercise training should be personalized to the patients treated.
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Affiliation(s)
- Luca Petrigna
- Department of Biomedical and Biotechnological Sciences, Section of Anatomy, Histology and Movement Science, School of Medicine, University of Catania, Via S. Sofia n°97, 95123, Catania, Italy
| | - Marta Zanghì
- Department of Biomedical and Biotechnological Sciences, Section of Anatomy, Histology and Movement Science, School of Medicine, University of Catania, Via S. Sofia n°97, 95123, Catania, Italy
| | - Grazia Maugeri
- Department of Biomedical and Biotechnological Sciences, Section of Anatomy, Histology and Movement Science, School of Medicine, University of Catania, Via S. Sofia n°97, 95123, Catania, Italy
| | - Velia D'Agata
- Department of Biomedical and Biotechnological Sciences, Section of Anatomy, Histology and Movement Science, School of Medicine, University of Catania, Via S. Sofia n°97, 95123, Catania, Italy
| | - Giuseppe Musumeci
- Department of Biomedical and Biotechnological Sciences, Section of Anatomy, Histology and Movement Science, School of Medicine, University of Catania, Via S. Sofia n°97, 95123, Catania, Italy
- Research Center on Motor Activities (CRAM), University of Catania, Via S. Sofia n°97, 95123, Catania, Italy
- Department of Biology, College of Science and Technology, Sbarro Health Research Organization, Temple University, Philadelphia, PA, 19122, USA
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Thomsen SN, Lahart IM, Thomsen LM, Fridh MK, Larsen A, Mau-Sørensen M, Bolam KA, Fairman CM, Christensen JF, Simonsen C. Harms of exercise training in patients with cancer undergoing systemic treatment: a systematic review and meta-analysis of published and unpublished controlled trials. EClinicalMedicine 2023; 59:101937. [PMID: 37096190 PMCID: PMC10121410 DOI: 10.1016/j.eclinm.2023.101937] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/13/2023] [Accepted: 03/14/2023] [Indexed: 04/26/2023] Open
Abstract
Background Exercise is recommended for people with cancer. The aim of this study was to evaluate the harms of exercise in patients with cancer undergoing systemic treatment. Methods This systematic review and meta-analysis included published and unpublished controlled trials comparing exercise interventions versus controls in adults with cancer scheduled to undergo systemic treatment. The primary outcomes were adverse events, health-care utilization, and treatment tolerability and response. Eleven electronic databases and trial registries were systematically searched with no date or language restrictions. The latest searches were performed on April 26, 2022. The risk of bias was judged using RoB2 and ROBINS-I, and the certainty of evidence for primary outcomes was assessed using GRADE. Data were statistically synthesised using pre-specified random-effect meta-analyses. The protocol for this study was registered in the PROESPERO database (ID: CRD42021266882). Findings 129 controlled trials including 12,044 participants were eligible. Primary meta-analyses revealed evidence of a higher risk of some harms, including serious adverse events (risk ratio [95% CI]: 1.87 [1.47-2.39], I2 = 0%, n = 1722, k = 10), thromboses (risk ratio [95% CI]: 1.67 [1.11-2.51], I2 = 0%, n = 934, k = 6), and fractures (risk ratio [95% CI]: 3.07 [3.03-3.11], I2 = 0%, n = 203, k = 2) in intervention versus control. In contrast, we found evidence of a lower risk of fever (risk ratio [95% CI]: 0.69 [0.55-0.87], I2 = 0% n = 1109, k = 7) and a higher relative dose intensity of systemic treatment (difference in means [95% CI]: 1.50% [0.14-2.85], I2 = 0% n = 1110, k = 13) in intervention versus control. For all outcomes, we downgraded the certainty of evidence due to imprecision, risk of bias, and indirectness, resulting in very low certainty of evidence. Interpretation The harms of exercise in patients with cancer undergoing systemic treatment are uncertain, and there is currently insufficient data on harms to make evidence-based risk-benefits assessments of the application of structured exercise in this population. Funding There was no funding for this study.
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Affiliation(s)
- Simon N. Thomsen
- Centre for Physical Activity Research, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen OE, Denmark
| | - Ian M. Lahart
- Faculty of Health, Education, and Wellbeing, School of Sport, University of Wolverhampton, Walsall Campus, Walsall, WS1 3BD, UK
| | - Laura M. Thomsen
- Centre for Physical Activity Research, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen OE, Denmark
| | - Martin K. Fridh
- Department of Pediatrics and Adolescent Medicine, The Juliane Marie Center, University Hospital of Copenhagen – Rigshospitalet, Juliane Maries Vej 9, 2100, Copenhagen OE, Denmark
| | - Anders Larsen
- University Hospitals Centre for Health Research, Copenhagen University Hospital - Rigshospitalet, Ryesgade 27, 2200, Copenhagen N, Denmark
| | - Morten Mau-Sørensen
- Department of Oncology, Centre for Cancer and Organ Diseases, University Hospital of Copenhagen - Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen OE, Denmark
| | - Kate A. Bolam
- Department of Physical Activity and Health, The Swedish School of Sport and Health Sciences, Lidingovagen, 5626, Stockholm, Sweden
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Alle 23, 141 35, Stockholm, Sweden
| | - Ciaran M. Fairman
- Department of Exercise Science, University of South Carolina, Columbia, SC, USA
| | - Jesper F. Christensen
- Centre for Physical Activity Research, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen OE, Denmark
- Department of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark
- Digestive Disease Center, Bispebjerg Hospital, Nielsine Nielsens Vej 11, 2400, Copenhagen, Denmark
| | - Casper Simonsen
- Centre for Physical Activity Research, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen OE, Denmark
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8
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Spence RR, Sandler CX, Jones TL, McDonald N, Dunn RM, Hayes SC. Practical suggestions for harms reporting in exercise oncology: the Exercise Harms Reporting Method (ExHaRM). BMJ Open 2022; 12:e067998. [PMID: 36600391 PMCID: PMC9743394 DOI: 10.1136/bmjopen-2022-067998] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The volume of high-quality evidence supporting exercise as beneficial to cancer survivors has grown exponentially; however, the potential harms of exercise remain understudied. Consequently, the trade-off between desirable and undesirable outcomes of engaging in exercise remains unclear to clinicians and people with cancer. Practical guidance on collecting and reporting harms in exercise oncology is lacking. We present a harms reporting protocol developed and refined through exercise oncology trials since 2015.Development of the Exercise Harms Reporting Method (ExHaRM) was informed by national and international guidelines for harms reporting in clinical trials involving therapeutic goods or medical devices, with adaptations to enhance applicability to exercise. The protocol has been adjusted via an iterative process of implementation and adjustment through use in multiple exercise oncology trials involving varied cancer diagnoses (types: breast, brain, gynaecological; stages at diagnosis I-IV; primary/recurrent), and heterogeneous exercise intervention characteristics (face to face/telehealth delivery; supervised/unsupervised exercise). It has also involved the development of terms (such as, adverse outcomes, which capture all undesirable physical, psychological, social and economic outcomes) that facilitate the harms assessment process in exercise.ExHaRM involves: step 1: Monitor occurrence of adverse outcomes through systematic and non-systematic surveillance; step 2: Assess and record adverse outcomes, including severity, causality, impact on intervention and type; step 3: Review of causality by harms panel (and revise as necessary); and step 4: Analyse and report frequencies, rates and clinically meaningful details of all-cause and exercise-related adverse outcomes.ExHaRM provides guidance to improve the quality of harms assessment and reporting immediately, while concurrently providing a framework for future refinement. Future directions include, but are not limited to, standardising exercise-specific nomenclature and methods of assessing causality.
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Affiliation(s)
- Rosalind R Spence
- Menzies Institute of Health Queensland, Griffith University, Brisbane, Queensland, Australia
- Improving Health Outcomes for People (ihop) research group, Brisbane, Queensland, Australia
| | - Carolina X Sandler
- Improving Health Outcomes for People (ihop) research group, Brisbane, Queensland, Australia
- Sport and Exercise Science, School of Health Science, Western Sydney University, Sydney, New South Wales, Australia
| | - Tamara L Jones
- Improving Health Outcomes for People (ihop) research group, Brisbane, Queensland, Australia
- Melbourne School of Psychological Sciences, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Nicole McDonald
- Menzies Institute of Health Queensland, Griffith University, Brisbane, Queensland, Australia
- Improving Health Outcomes for People (ihop) research group, Brisbane, Queensland, Australia
| | - Riley M Dunn
- Improving Health Outcomes for People (ihop) research group, Brisbane, Queensland, Australia
| | - Sandra C Hayes
- Menzies Institute of Health Queensland, Griffith University, Brisbane, Queensland, Australia
- Improving Health Outcomes for People (ihop) research group, Brisbane, Queensland, Australia
- School of Health Sciences and Social Work, Griffith University, Brisbane, Queensland, Australia
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What is the believability of evidence that is read or heard by physical therapists? Braz J Phys Ther 2022; 26:100428. [PMID: 35849892 DOI: 10.1016/j.bjpt.2022.100428] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 05/23/2022] [Accepted: 06/23/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Physical therapists obtain information from a variety of sources. The sources may influence their believability and use in clinical practice. OBJECTIVES In this hypothesis-based study, we queried physical therapists (PTs) on the believability of evidence across six musculoskeletal treatment domains and analyzed variables that predicted the strength of beliefs. METHODS This international survey included six different language portals and used a snowball dispensation strategy. PTs who were credentialed, licensed, or who practiced in the field, were queried on the believability of six treatment domains (i.e., exercise, manual therapy, psychologically-informed practice, sports/occupational performance, thermal/electrical agents, and pain science/patient education) and potential predictors of believability (i.e., social media use, years of practice, time and access to literature, specialization, confidence in reviewing literature and attributions of the researcher). RESULTS In total, 1098 PTs from 36 countries completed the survey. PTs had strong beliefs in what they read or hear about exercise, sports/occupational performance, pain science/patient education, and psychologically-informed interventions. There was only moderate believability regarding manual therapy treatment and weak believability associated with thermal/electrical agents. Multiple linear regression analyses revealed that the most robust predictor to outcome relationships included time and access to literature and believability of pain science/patient education, years of clinical practice and believability of psychologically informed practice, and believability of thermal/electrical agents. CONCLUSION An important takeaway from this study is that believability was influenced by several factors (primarily by years of practice, attributions of the researcher, and time and access to literature) and appeared to vary across treatment domains.
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Fakhraei R, Peck SS, Abdel-Qadir H, Thavendiranathan P, Sabiston CM, Rivera-Theurel F, Oh P, Orchanian-Cheff A, Lee L, Adams SC. Research Quality and Impact of Cardiac Rehabilitation in Cancer Survivors. JACC CardioOncol 2022; 4:195-206. [PMID: 35818551 PMCID: PMC9270627 DOI: 10.1016/j.jaccao.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/17/2022] [Accepted: 03/23/2022] [Indexed: 11/03/2022] Open
Abstract
Background Cardiac rehabilitation (CR) is endorsed to improve cardiovascular outcomes in cancer survivors. The quality of CR-based research in oncology has not been assessed. Objectives The aim of this study was to evaluate the quality of reporting and evidence from CR-based intervention studies in oncology and to explore associations between intervention participation and outcomes. Methods Systematic searches of 5 databases were conducted (January 2020) and updated (September 2021). Randomized and nonrandomized studies evaluating CR-based interventions in adult cancer survivors during and after treatment were eligible. Independent reviewers extracted data using 2 reporting guidelines (Template for Intervention Description and Replication and Consolidated Standards for Reporting Trials Harms extension), risk of bias (ROB) assessment tools (Cochrane ROB 2.0 and Cochrane Risk of Bias in Non-Randomized Studies of Interventions), and a combined inventory (Tool for the Assessment of Study Quality and reporting in Exercise). A meta-analysis was used to explore pre-intervention/post-intervention differences for commonly assessed outcomes. Results Ten studies involving data from 685 survivors were included. The mean quality scores for intervention reporting (Template for Intervention Description and Replication) and harms (Consolidated Standards for Reporting Trials Harms extension) were 62% and 17%, respectively. There was moderate-to-high ROB across nonrandomized (Cochrane Risk of Bias in Non-Randomized Studies of Interventions score: 25%) and randomized (ROB 2.0 score: 50%) studies. The mean standardized cardiorespiratory fitness was higher (0.42; 95% CI: 0.27-0.57), fatigue was lower (−0.45; 95% CI: −0.55 to −0.34), and percent body fat (0.07; 95% CI: −0.23 to 0.38) was not different in survivors completing CR compared with those not completing CR. Conclusions CR-based studies in oncology have low-to-moderate reporting quality and moderate-to-high ROB limiting interpretation, reproducibility, and translation of this evidence into practice.
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Hansford HJ, Wewege MA, Cashin AG, Hagstrom AD, Clifford BK, McAuley JH, Jones MD. If exercise is medicine, why don't we know the dose? An overview of systematic reviews assessing reporting quality of exercise interventions in health and disease. Br J Sports Med 2022; 56:692-700. [PMID: 35168956 DOI: 10.1136/bjsports-2021-104977] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2022] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To determine how well exercise interventions are reported in trials in health and disease. DESIGN Overview of systematic reviews. DATA SOURCES PubMed, EMBASE, CINAHL, SPORTDiscus and PsycINFO from inception until June 2021. ELIGIBILITY CRITERIA Reviews of any health condition were included if they primarily assessed quality of exercise intervention reporting using the Consensus on Exercise Reporting Template (CERT) or the Template for Intervention Description and Replication (TIDieR). We assessed review quality using a modified version of A MeaSurement Tool to Assess systematic Reviews. RESULTS We identified 7804 studies and included 28 systematic reviews. The median (IQR) percentage of CERT and TIDieR items appropriately reported was 24% (19%) and 49% (33%), respectively. TIDieR items 1, Brief name (median=100%, IQR 4) and 2, Why (median=98%, IQR 6), as well as CERT item 4, Supervision and delivery (median=68%, IQR 89), were the best reported. For replication of exercise interventions, TIDieR item 8, When and how much, was moderately well reported (median=62%, IQR 68) although CERT item 8, Description of each exercise to enable replication (median=23%, IQR 44) and item 13, Detailed description of the exercise intervention (median=24%, IQR 66) were poorly reported. Quality of systematic reviews ranged from moderate to critically low quality. CONCLUSION Exercise interventions are poorly reported across a range of health conditions. If exercise is medicine, then how it is prescribed and delivered is unclear, potentially limiting its translation from research to practice. PROSPERO REGISTRATION NUMBER CRD42021261285; Open Science Framework: osf.io/my3ec/.
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Affiliation(s)
- Harrison J Hansford
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia.,Centre for Pain IMPACT, Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - Michael A Wewege
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia.,Centre for Pain IMPACT, Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - Aidan G Cashin
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia.,Centre for Pain IMPACT, Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - Amanda D Hagstrom
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Briana K Clifford
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia.,School of Nursing Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
| | - James H McAuley
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia.,Centre for Pain IMPACT, Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - Matthew D Jones
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia .,Centre for Pain IMPACT, Neuroscience Research Australia, Randwick, New South Wales, Australia
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